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NUR 211 Exam 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Stroke is also called

A

brain attack / cerebrovasular accidents

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2
Q

What is a stroke?

A

Disruption in the cerebral blood flow secondary to ischemia, hemorrhage, brain attack or embolism.

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3
Q

Name 3 types of strokes

A

Thrombotic stroke ( ischemic)
Embolic Stroke ( ischemic)
Hemorrhage stroke ( bleeding directly into the brain.)

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4
Q

What type of stroke can be reversed?

A

Ischemic strokes

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5
Q

Ischemic strokes incldes what types of stroke?

A

Thrombotic and embolic

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6
Q

Ischemic strokes can be reversed by?

A

fibrinolytic therapy using alteplase, also known as (TPA) tissue plasminogeb activator . if given within 3-4.5hrs of initial manifestations.

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7
Q

What is a hemorrhagic stroke?

A

Bleeding directly into the brain. Can be suddden onset of symptoms.

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8
Q

Hemorhagic stroke is secondary to what?

A

Ruptured artery or aneurysm

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9
Q

Seizures are common in which types of stroke?

A

Hemorrhagic stroke

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10
Q

Describe a Thrombotic stroke (Ischemic)

A

-Secondary to the development of a blood clot on an atherosclerotic plaque in the ( originates in) cerebral artery.
- Evolve over a period of several hours to days.
-Symptoms get progressively worse as the infarctin and edema increase.

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11
Q

Describe a Embolic Stroke ( Ischemic)

A
  • Caused by embolus traveling from another part of the body to a cerebral artery.
  • Can Cause LOC ( Loss of consciousness)
  • sudden, severe symptoms, headache
    -Warning signs are less common.
    -Client remains conscious and may have a headache.
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12
Q

Strokes are common in which ethics groups?

A

-Mexican Americans
-Latin Americans
-African Americans
-Japanses and Chinses
- Gender ( men survival for than women)
- age > 55

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13
Q

Risk Factors for a stroke

A
  • Cerebral Aneurysm
    -Arteriovenous Malformation (AV)
    -Atherosclersis
    -Hypertension
    -Anticoagulation therapy
    -Diabetes
    -Stress
    -Obesity
    -Oral Contraceptives
    -hypercoagulability
  • hypercholesterolemia
    -A.Fib
    -Smoking, cigarettes
    -Cocaine us ( illicit drug use)
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14
Q

Right side of the brain is responsible for?

A

visual, spatial awarness, and proprioception

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15
Q

Left side of the brain is responsible for?

A

(MAL) Language, Math skills and analytic thinking

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16
Q

Right-side Brain Damage

A

-Impaired judgment
-impaired time concept
-Impulsive, safety problem ( Overestimation of abilities)
-Left-side neglect
-Paralyed left-side: Hemiplegia
-Rapid performance, short attention span
-Spatial-pereptual defictis
-Tends to deny or minimize problems
-Visual changes (Hemianopsia)
-Loss of depth perception

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17
Q

Left-side brain damage

A

-Aware of deficits: depression, anxiety, anger, quick to become frustrated.
-Imparied comprehension related to language and math.
-Imparied right/left discrimination
-Imparied speech/language aphasias
-Paralyzed right side: Hemiplegia
-slow performace, cautions.
-Angosia ( unabble to recognize familiar objects)
-Agraphia ( difficulty writing)
-Alexia ( difficulty reading)
-Hemianopsia ( visual changes)
-Loss of visual field in one or both eyes.

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18
Q

Contralateral side:

A

Opposite side if the body

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19
Q

If the right side of the brain is damaged, which side is affected?

A

The left side is affected

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20
Q

If the left side of the brain is damaged, which side is affected?

A

the right side is affected

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21
Q

Which motors skills are in the frontal lobe?

A

Smell, Speech, concentraption, planning, problem solving, motor control

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22
Q

Which motor skills are in the parietal lobe?

A

touch and pressure, taste, body awarness

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23
Q

which motor skills are in the temporal lobe?

A

Hearing, facial recognition

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24
Q

Which motor skills are in the occipital lobe?

A

vision

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25
Q

Which motor skills are in the cerebellum lobe?

A

Coordination

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26
Q

Frontal lobe contain?

A

Broca’s area

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27
Q

Tempopraietal lobe is apart of what area?

A

Wernick’s area

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28
Q

The brainstem is responsible for?

A

breathing, consciousness, blood pressure, HR and sleep.

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29
Q

where is the hippocampus found?

A

inner folds of the temporal lobe

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30
Q

What is the Hippocampus resoponsible for?

A

learning and memory

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31
Q

Anterior cerebral artery includes?

A

frontal lobe, parietal lobe, most of the temporal lobe

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32
Q

Middle cerebral artery inculde:

A

small part of temporal lobe

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33
Q

Posterior cerebral artery include?

A

occipital and small part of temporal lobe

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34
Q

Expressive aphasia

A

unable to communicate verbally (Damage to the Broca’s areas of the frontal lobe)

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35
Q

Receptive aphasia

A

unable to understand the spoken and written word. ( damage to the Wernicke’s area, temporoparietal lobes)

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36
Q

Global (mixed) Aphasia

A

Dysfunction occurs in expression and reception

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37
Q

Agnosia

A

unable to recognize familiar objects

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38
Q

Alexia

A

reading difficulty

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39
Q

Agraphia

A

writing difficulty

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40
Q

Hemiplegia

A

one side paralysis

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41
Q

paresis

A

weakness

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42
Q

Hemiparesis

A

one-side weakness

43
Q

Hemianopsia

A

loss of half the visual field in one eye or both

44
Q

Homonymous Hemianopsia

A

Loss if vision in the same half of the visual fiels of each eye

45
Q

proprioception

A

The body’s ability to sense its location, movement and actions

46
Q

ataxia

A

imparied balance ir coordination

47
Q

dysphagia

A

difficulty swallowing

48
Q

Dysarthria

A

difficulty or unclear articulation ( garbled speech)

49
Q

Nuchal rigidity

A

neck stiffness, inability to move the neck muscles

50
Q

Apraxia

A

inability to execute skilled movement or gesturs despite having the ability and desire to perform them.

51
Q

B.E F.A.S.T. means? (s/s of a stroke)

A

B. balance issues
E. eyesight changes
F. facial drooping
A. arm waekness
S. speech difficulties
T. Time to call 911

52
Q

Ways to diagnose a stroke?

A

CT
MRI
Magnetic Resonance Angiography
Lumbar puncture
Glasgow coma scale

53
Q

What is the time frame for a stroke assessment and results?

A

Door-CT: within 25 mins of arrival to ED
Door- CT results: within 45 mins of arrival to ED

54
Q

What is a CT scan for?

A

Determination of the type of stroke. Ischemic vs hemorrhagic

55
Q

MRI is used for?

A

Identify edema, ischemia, and necrosis

56
Q

Magnetic Resonance Angiography is used for what?

A

To identify the presence of a cerebral hemorrhage, abnormal vessel structures, vessel ruptures and regional perfusion of blood flow in the carotid arteries and brain.

57
Q

Reason for a lumbar puncture?

A

To assess for the presence of blood in the cerebrospinal fluid. A postive finding is consistent with a cerebral hemorrhage or ruptured aneurysm.

58
Q

Reason to use the Glasgow Coma scale?

A

used when the client as a decrease in LOC or orientation.

59
Q

Antidote for Thrombolytics

A

Amicar ( aminocaproic)

60
Q

When are thrombolytics given?

A

Within 4.5hrs. of initial manifestation for clients who experiencing embolic stroke evidence by CT scan results.

61
Q

Thrombolytics are given for which type of stroke?

A

Embolic ( Ischemic)

62
Q

Name two thrombolytic medications?

A

Alteplase
Rereplase

63
Q

How are thromboltic medications given?

A

IV push bolus, Followed by weight-based infusion over 1-hr.

63
Q

Thromboltics should reconstituted with?

A

sterile water

63
Q

What size needle is used when given a thrombolytic?

A

18g

64
Q

Name two contraindications for using a thrombolytic med?

A

uncontrolled hypertension
Hemorrhagic stroke

65
Q

nursing interventions for thrombolytic meds

A

-start 2 IV line prior to initiation
- Assess for bleeding q15 mins
-Assess VS
- Assess LOC
-Monitor labs ( type &cross) ( have bleed ready @ all times.)
- bedrest during therapy
- Avoid IM/ SQ injections
- Apply prolonged pressure after a arterial or venous punctures.
- Assess for s/s of PE or MI ( clots can dislodge & travel)

66
Q

Labs to monitor when using thrombolytic meds/

A

(H.P.P)
Hgb/HCT
PLT
PT/PTT

67
Q

S/s of bleeding

A

Nose bleeds
bleeding gums
Bruising/petechiae
Black-tary stools

68
Q

important client teaching for thrombolytic meds?

A

-purpose of the drug
- report unusual bruising or bleeding, rash or SHOB
- avoid shaving or vigorous tooth brushing
- notifiy HCP of pregnacy or breastfeeding

69
Q

Top 4 Side effects for thrombolytic

A

GI bleeding, GU bleeding, Allergic Rxn, intercranial bleeding

70
Q

Name 3 anticoagulants

A

Warfarin, Heparin, Enoxaparin

71
Q

anticoagulants are given for what type of stroke?

A

Cardioemobolic stroke

72
Q

What type of stroke should not use anticoagulants?

A

Hemorrhagic stroke

73
Q

What is the antidote for heparin?

A

protamine sulfate

74
Q

What the antidote for warfarin?

A

Vitmain K

75
Q

actions of anticoagulants

A

-interferes or inactivates clotting factors
- prevent clots from forming
- prevent futher clot growth
- short-term therapy ( heparin / enoxaparin)
- long-term therapy ( warfarin)

76
Q

Side effects of anticoagulation?

A

HIT* ( heparin-induced thrombocyopenua)
Rash
Anemia
Fever
Alopecia
Ecchymosis
Osteoporosis

77
Q

Nursing intervention for anticoagulation?

A

-assess for bleeding
-assess VS
-Montior labs
-MAY CAUSE HYPERKALEMIA
-MAY INCREASE AST AND ALT (LEFTs)
- bedrest during therapy
-Avoid IM/SQ injections
-Apply prolonged pressure to arterial or venouse puntures sites,

78
Q

While on heparin. Which labs should be monitored?

A

aPtt

79
Q

While on PO warfarin. Which labs should be watched?

A

PT/INR

80
Q

What are contrindictions when taking anticoagulates?

A

-bleeding disorder (Thrombocytopenia)
-Ulcer disease
-Hemorrhagic stroke or active bleeders
- Uncontrolled HTN
-Pregnant/lactating

81
Q

Therapeutic level of aPTT?

A

1.5-2.5 times the normal valuse
Normal value is 30-45 seconds.

82
Q

Dietary teaching for client on anitcoagaluates?

A

leafy greens contains high levels of vitamin K, which makes the warfin less effective.

83
Q

client teaching for anticoaglautes

A

-explain purpose of medication/ need for close monitorning.
-Report unusual bruising, bleeding, rash or SHOB
- Do not take aspirin, NSAIDs whil on heparin
-Only use electric razor
-Take PO medication at same time each day ( in the evening)
- Avoid alcohol
-Notify HCP of pregancey or breastfeeding
-notifiy HCP med regimen before surgery
-Carry ID card

84
Q

Complications of stroke

A

-Dysphagia
-aspiration
-unilateral neglect
-Constipation
-Urinary incontinence

85
Q

Novel oral anticoagulants is an alterative medication to what type of drug therpy?

A

Warfarin

86
Q

NOACs (novel oral anticoagulants ) are given for what type of stroke? (Dabigatran, apixaban, Rivaroxaban)

A

Ischemic ( cardiembolic stroke)

87
Q

Antiplatelelts are given for what type of stoke?
( aspirin, dipyridmole, clopidogrel)

A

ischemic stroke

88
Q

What type of medication is used for seizures after a stroke?

A

antiepileptic ( phenyton and gabapentin)

89
Q

If the blood pressure is low after a stoke. What dose that mean?

A

If the Bp is low this could indicate that the stroke is actually getting worse and there is a decrease to cerebral perfusion.

90
Q

Nursing diagnose for a stroke?

A

The nursing diagnoses are based on the assessment finding of the client.

91
Q

young-old

A

65-75

92
Q

old

A

75-85

93
Q

old-old/oldest old

A

85-up

94
Q

Types of conflicts: intrapersonal

A

within a person

95
Q

types of conflicts: interpersonal

A

between and among clients, nurses, or other staff members.

96
Q

Types of conflict: organizational

A

When a employee confronts the policies and procedures of an organization.

97
Q

Charaterics of avoidance

A
  • unassertive
    -uncooperature
    -do not pursue their own needs, goals, or concerns
    -Postpone dealing with issues
98
Q

charaterics of Accommodation

A

-neglect their own needs, goals or concerns while trying to satisfy those of others.
- Obeys and serves others
-Feels resentment and disappointment because they “ get nothing in return”

99
Q

charaterics of competition

A

-pursue their own needs, goals at the expense of others.
-Stands up for rights
-Defends important principles

100
Q

Charaterics of compromise

A

-assertive
-cooperative
-Works creatively and openly to find solutions that satisfies most all-important objective and goals.

101
Q

how to resolve conflict

A

(Always aim for a win-win resolution)
-identify the source of the conflict
- Generate possible solutions
-Evaluate suggested solutions
-choose the best solutions
-implement the chosen solution
-Evaluate: is the conflict resolved

NUR 211 Exam 2 (1 decks)

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