CVA-Stroke Flashcards
T or F, by 65 years of age, 25% of Men and 20% of women have a stroke?
False, 85
T or F. Morbidity associated with stroke is high, with at least 88.2% of stroke survivors having some form of impairment?
TRUE
T or F. Stroke deaths have increased in minority populations?
TRUE
Non-traditional stroke symptoms include:
Headache, face and limb pain, nausea, hiccups, chest pain, SOB, palpitations
True or False. Non-traditional symptoms is higher in men than women?
False, the prevalence of non-traditional symptoms is higher in women.
What is a Brain Attack?
An abrupt loss of consiousness with resulting paralysis that may be temporary or permanent. It is also defined as an abrupt onset of persistent s/s because of a decreased blood supply to the brain.
What is the most common cause of stroke?
Thrombus
What are the 2 primary types of Brain Attacks?
Ischemic, Hemorrhagic
What 2 factors can cause an Ischemic stroke?
Thrombus, Emboli
What 2 factors can cause a Hemorrhagic stroke?
Rupture of an aneurysm, malformations
T or F. Ischemic strokes can become hemorrhagic?
TRUE
What is the difference between thrombotic and embolic?
Thrombotic refers to a clot in the brain, whereas embolic refers to a clot that comes frome somewhere else in the body.
Identify 5 risk factors associated with Stroke/ CVA?
Age (64-74), Gender (males), African American race, Sickle Cell Anemia, Polycythemia, Atherosclerosis, Cardiac Valvular Dz/ Heart Dz, Anticoagulation therapy, A. Fib., Excessive alcohol, Cocaine use, smoking, sedentary lifestyle
Why is A. Fib a common cause for embolic stroke?
A. Fib patients are at risk for emboli, that’s why they’re put on antiplatelet/ anticoagulants because fibrilation from the atria can send micro-emboli to the carotid circulation.
T or F. The risk for stroke increases 1% each year after the age of 65?
TRUE
T or F. Hypertension is the major risk factor associated with Stroke?
TRUE
Why is substance abuse, such as cocaine use, a risk factor for stroke?
It causes changes in vital signs: increased BP, HR, RR, as well as increased metabolic rate, vasospams, and increased platelet formation.
Stroke is an acute brain injury that leads to chronic defits. Name the 4 categories in which they can be classified based on the time s/s appear.
TIA, Reversible Ischemic Neurological Deficit (RIND), Stoke in Evolution, Completed Stroke
What symptoms would you expect to see in a PT suffering from a TIA?
Numbness, weakness, transient visual and motor deficits, brief global aphasia, ataxia, dizziness, vertigo
T or F. The neuro deficits associated with a TIA last more than 24 hours?
False. TIA deficits are gone in less than 24 hrs.
What is the MAJOR difference between TIA and RIND?
The RIND manifestations last longer than TIA; 24- 48 hrs of deficits.
What is the MAJOR difference between a Stroke in Evolution vs. a Completed Stroke?
In evolution, injuries cause more and more damage each day, meaning that new deficts occur each day. In completed, there are no more NEW appearing deficits.
T or F. Stroke in Evolution and Complete Stroke only applies to Hemorragic Strokes?
False, only Ischemic Strokes.
T or F. Strokes are classified by Time and Type?
TRUE
T or F. 70-80% of all CVAs are Ischemic?
TRUE
Ischemic Stroke
Occurs when oxygen-rished blood flow to the brain is restricted by a clot or other blockage
Causes of Ischemic Stroke include:
Atherosclerosis, carotid changes, vascular dz (thrombotic); Heart Dz, edema, HTN (embolic); Tissue damage- IICP.
Hemorragic Stroke
Intracerebral bleed that can occur in the frontal, occiptal, or temporal region.
What risk factors are most often associated with Hemorrhagic Stroke?
Older patients, Subarachnoid hemorrage caused by head injury or trauma, Blood Dyscrasias, Intracranial Aneurysms, Congenital AV malformations, Sepsis, Arteriosclerosis, HTN
What is Blood Dyscrasias?
Risk for clotting abnormalities
T or F. Recovery for Ischemic stroke is much lower than Hemorragic stroke?
False. Recovery time is less than Ischemic
Identify 4 common effects that Hemorragic Stroke can cause?
Edema, Hydrocephalus, Re-bleeding, Infarction, Coma, Death
T or F. Signs and symptoms of Stoke are dependent on area affected and adequacy of collateral circulation?
TRUE
What 3 things should you always ASSESS if you suspect your patient has had a stroke?
LOC, Aphasia (receptive, expressive, mixed), Hemineglect syndrome
What are the most COMMON clinical manifestations of Stroke?
Decreased LOC or unconsciousness, stetorous breathing, unequal pupils (larger pupil noted on same side of stroke), paralysis on one side, aphasia, dysphagia, visual defects/ blank stare, inability to make decisions, loss of memory, gait instability, hallucinations, incontinence, paresis, tremors, pain
What are some long term effects associated with Stroke?
motor defects, language and speech changes, aphasia, dysphasia.
In regards to treatment, what is the greatest priority after you realize your patient had a stroke?
Salvage brain tissue within 3 hours.
What 2 medications can be used to help salvage brain tissue within 3 hrs.?
Throbolytics and Anticoagulants
When trying to help salvage brain tissue within 3 hrs, what is most important to remember about tPA administation?
Thrombolytics (TPA) can’t be given after 3hrs.
Besides thrombolytics and anticoagulants, what other medications are used to treat Stroke?
Antihypertentives, Vasodilators, Beta Blockers, Ca Channel Blockers, Systemic Diuretics, Steroids, Anticonvulsants, Stool Softners
T or F. Heparin might not be the Rx of choice to use in the ACUTE phase of Stroke Tx?
True, Aspirin should be given instead because it could lead to more bleeding problems.
What long term anticoagulant Rx would you expect a stroke patient to have?
Coumadin, Warfarin, Plavix.
T or F. The use of Steroids to treat stroke patients is controversial?
TRUE
Your stroke patient has a prescription for a stool softener and wants to know why they have to take it, what do you say?
Stool softeners decrease cerebral pressure by preventing straining.
What 3 general areas MUST you always assess after a patient has a stroke?
Consciousness and Cognition, Motor Function, Sensory Function
During your assessment of consiousness and cognition, what will you be looking for in your patient?
altered consciousness, memory, language, signs of IICP and cerebral edema
During your assessment of motor fuction, what will you be looking for in your patient?
Paralysis, paresis, gait stability, presence of voluntaty/ involuntary movements, reflexes, posturing in response to stimuli, seizures
During your assessment of sensory function, what will you be looking for in your patient?
Check cranial nerves, speficially hearing, vision, smell, taste, temperature regulation, Peripheral sensation, presence of paesthesias, and sexual dysfunction when stabalized.
What is posturing?
An effect of the cerebral cortex; involuntary movement into a certain position
Identify 5 COMMON nursing issues r/t Stroke?
Impaired verbal communication, Impaired physical mobility, Anxiety, Deficient knowlede regarding diagnosis/prognosis/tx, Risk for disturbed body image, Disturbed sensory Perception, Dist. thought processes, Risk for injury/ harm r/t unilateral neglect.
What is the #1 Nursing Issue/ Problem r/t Stroke?
Altered Cerebral Perfusion
What is the best tool to use when assessing for Consiousness and Cognition?
Glasgow Coma Scale
T or F. AV malformations are congenital and often unrecognizable until rupture?
TRUE
T or F. Cushing’s Reflex and Cushing’s Triad can help determine if Cerebral edema and IICP is increasing?
TRUE
What would you expect to see during the Cushing’s Reflex?
Rise in SYSTOLIC BP, wide pulse pressures, slowing of HR.
What would you expect to see during the Cushing’s Triad?
Bradycardia, bradypnea, HTN, signs of an impending herniation
What 3 things would indicate an impending herniation and/or that things are getting worse?
Pupils/ Occular movement, Respiratory pattern changes (>40), Posture– indicate IICP is getting worse.
You’re conducting an assessment on a patient suspected of being unconscious or having an altered mental status, what will you be looking for?
Responsivesness (LOC, alertness, eye openings, pupil reactions, size of pupils), Respiration pattern, Eye movements/ corneal reflexes, Facial symmetry, Swallowing reflexes, Spontaneous neck movement or nuchal rigidity, posturing/ noxious stimuli, motor reflexes
As a nurse, how would you help prevent strokes in patients that are at risk?
Encourage the avoidance of smoking, sedentary lifestyle, high fat diet, and excessive alcohol consumption. Also promote weight control and control of HTN with exercise and decreased Na intake.
Nursing interventions for Ineffective Cerebral Tissue Perfusion include:
Administer systemic thrombolytic therapy, Perform neuro assessment, Monitor ICP, Assess LOC, Elevate HOB 30-45, Instruct PT to avoid activities and procedures that may increase intracranial pressure (push-ups), Fully assess need for suctioning.
Your patient has just been admitted for IICP, what nursing interventions are most important at this time?
Maintain patent airway, Elevate HOB 30-45, Implement seizure precautions, Intructs PT to avid couging, REPORT presence of cerebralspinal fluid (CSF) from PT’s nose or ears to MD.
For PTs at risk for IICP, why is it important to leave the HOB elevated 30-45 degrees?
This allows for draining and decreases pressure.
T or F. For post-shock patients, it’s ok to leave the HOB elevated 30-45 degrees?
False, you should NEVER elevate the HOB. This only applies to patients at risk for IICP.
What are 3 Nursing Diagnosis r/t Cerebral Edema and IICP?
Ineffective tissue perfusion, Ineffective breathing patterns, Risk for infections r/t monitoring devices, LPs
What common complications are most often associated with IICP?
Herniation, DI, SIADH, Coagulopathies
In regards to seizures, what are 3 common Nursing Problems?
Risk for injury, Fear and Anxiety, Ineffective Coping, Altered Cerebral Perfusion (status epilepticus) r/t IICP
T or F. For patients experiencing a seizure, there is medication available to stop it?
False, There is no Rx to give during.
DI
not enough ADH, increased water loss (polyuria)
SIADH
too much ADH, overload of fluid (retention)
T or F. Anyone with any brain injury/ stroke can develop a seizure?
TRUE
You’re caring for a patient at risk for a seizure, what nursing INTERVENTIONS could you perform?
Keep patient safe (precautions), Obtain history (aura, frequency), Observe and document time of episode, loss of consciousness, incontinence, mental status post-ictal, Monitor anticonvulsant blood levels, Support to improve coping.
Your patient is having a seizure, what actions can you take right now?
Make sure Pt is safe, turn them on their side to ensure airway, remember not to push down on patient too hard if their body is contracting. Not much more to do other than document when it occured and the post-ictal phase.
Your patient has Impaired Physical Mobility and Self Care Deficit, what Nursing Interventions could you perform to improve this?
ROM exercises for the involved extremities, Reposition frequently, Prevent DVT, Focus therapy on PTs performance of ADLs.Its VERY important to involve the Pt as well as their caregiver/ family in plan of care
Unilateral Neglect
Syndrome most commonly seen with RIGHT cerebral stroke.
Your patient has Unilateral Neglect, what will you need to teach them?
Observe saftey measures, touch and use both sides of their bodies, use the scanning technique of turning the head from side to side to expand the visual field.
Disturbed Sensory Perception (Right Hemisphere Damage)
Causes difficulty in the performance of visual-perceptual or spatial-perceptual tasks.
Disturbed Sensory Perception (Left Hemisphere Damage)
Causes memory deficits and changes in the ability to carry out simple tasks.
T or F. In regards to Impaired Verbal Communication, language or speech problems are usually the result of damage to the non-dominant hemisphere?
False, Dominant hemisphere
Expressive Aphasia
Result of damage in Broca’s area of the Frontal lobe. Pt knows and is aware that what they’re doing or saying is wrong, usually irritable and upset.
Receptive (Wernicke’s or Sensory) Aphasia
Due to injury in the temporoparietal area. Pt is unaware of the wrong answer they give after they are asked a simple question.
Nursing interventions for Impaired Swallowing include:
Assess pts ability to swallow, position pt appropriately to facilitate the process of swallowing before feeding, aspiration precautions, provide the appropriate diet for the pt, including semisoft foods and fluids.
T or F. Altered LOC may cause incontinence or impaire innervation, or an inability to communicate?
TRUE
What is the best Nursing Intervention for Urinary and Bowel Incontinence?
Develop a bladder and bowel training program for the pt.
