Exam 2 Flashcards
Ischemic stroke patho
Disruption in blood supply that lasts more than 24 hours
Two types- thrombotic and embolitic
Thrombotic stroke-ischemic stroke
Due to atherosclerosis
S/s occur SLOWLY and develop over time; often have TIA before stroke
-slight headache
-speech deficits
-visual disturbances
-confusion
why may thrombotic s/s occur slowly over time?
My have collateral circulation
Embolitic stroke-ischemic
Embolus usually from the heart (A-fib)
Clot breaks off and travels to smaller vessels
SUDDEN onset
-facial droop
-slurred speech
-paralysis
-expressive aphasia
More likely to die as clot travels producing more s/s
Hemorrhagic stroke Patho
Occurs during activity due to BP and increased pressure on the vessels
Causes: aneurysm, AV malformation
S/s occur quickly:
-headache
-lethargy
-stupor
-coma
-seizures
What is the most common cause of hemorrhagic strokes?
AV malformation
AV malformation
Arteries shunt directly into veins instead of capillaries
What are the two causes of hemorrhagic strokes?
Aneurysm ruptures and AV malformation
TIA patho
Transient decrease in blood flow to the brain “halfway to CVA”. Transient focal deficits lasts no longer than 24 hrs
Evaluated with carotid ultrasound and EKG
-drooping, slurred speech, vision changes
Ischemic vs hemorrhagic vs TIA
Ischemic=lack/low blood flow to brain, s/s slowly and develop over time or sudden depending on type (thrombotic vs embolitic)
Hemorrhagic= structural or pathological causes
S/s quickly
TIA= warning sign, s/s no longer than 24 hrs
Ischemic stoke assessment findings
Hemorrhagic stroke assessment findings
S/s occur quickly
Doesn’t look like FAST
-collapse, high BP, increased ICP, decreased LOC, s/s bleeding:enlarged neck, deviated trachea, respiratory distress, dysphagia
TIA assessment findings
Ischemic stroke management
restore the blood flow-> t-PA
Monitor LOC
Monitor RR and depth
Maintain airway
Hemorrhagic stroke management
Too much blood- stop the bleeding!
-control HTN
-complete bed rest HOB elevated, quiet dark room, no stimuli, no caffeine, no hot/cold fluids
-sedate PRN
-NO restraints
-monitor for severe headache, N/V, dec LOC
TIA management
Safety concerns w management post CVA
Physical limitations for post CVA management and safety concerns
Psychosocial concerns post CVA and management safety concerns
Early recognition of s/s stroke
First thing- what time did s/s start? (4 hr time frame)
-sudden weakness/numbness (face, arm, leg unilateral)
-sudden confusion
-sudden trouble walking
-dizziness or loss of balance/coordination
-sudden severe headaches with no known cause
F.A.S.T assessment
Facial drooping - “smile”
Arm weakness/drift-close eyes and extend both arms palms up for 10 sec… drift?
Speech difficulty/slurred-“you cant teach an old dog new tricks”
Time to call 911- 4 hr window for t-PA
Actions to take when recognizing a stroke
Call 911 immediately and have EMS call stroke code to clear CT machine; note the time s/s started
Eligibility criteria for t-PA adminstration (Tissue plasminogen activator)
Contraindications: other thinners, pregnant, any bleeding, bleeding disorder, recent surgery (neuro/brain.. but all), AV malformation, uncontrolled BP, within 3-4 hour window form onset of s/s, assessed with NIHSS
t-PA
Stroke rehabilitation focuses
Dysphagia, dysphasia, hemianopsia, unilateral neglect prevention
Dysphagia assessment
Dysphagia rehabilitation strategies used
Complications of dysphagia
Dysphasia
Hemianopsia
Unilateral neglect
What testing identifies the disease?
Preop management for carotid disease
Post-op management for carotid disease
Medications for carotid disease
Surgical interventions for carotid disease
Pt education for
HF nursing interventions
HF teaching strategies
Diet considerations and fluid restrictions for HF pts
Left sided HF
Right sided HF
How right sided HF affects QOL, ADL, IADL
How left sided HG affects QOL, ADL, IADL
Weight-HF
Discharge (dry) weight HF-why is it important?
HF weights-when
HF weights-How
HF exacerbations
HF exacerbations causes
What is required for HF exacerbations management?
Atrial fibrillation patho
Physical assessment findings for Atrial fibrillation
Stable findings for A fib
Unstable findings for A fib
Abnormal EKG presentation for A fib
What is the EKG missing for an A fib pt?
Cardioversion
Stable cardioversion
Unstable cardioversion
Cardioversion aftercare
A fib treatments
Cardioversion and ablation
After care by nurse for ablation pt
Ablation
Oral medications for management for ablation pt
DVT
Deep vein thrombosis patho
DVT physical assessment findings
DVT labs
D-Dimer
Nursing care for DVT
Medications for management of DVT
Peripheral vascular disease- arterial physical assessment findings
Peripheral vascular disease- venous physical assessment findings
Nursing care of arterial disease
Nursing care of venous disease
Differences between arterial and venous peripheral vascular disease
Medications used for management of arterial PVD
Medications used for management of venous PVD
Intermittent claudication-PVD
S/s intermittent claudicaiton
Tx for intermittent claudication
Surgical revascularization indications
Surgical revascularization
Surgical revascularization client education pre-op
Surgical revascularization client education post-op
Surgical revascularization nursing interventions pre-op
Surgical revascularization nursing interventions post-op
Antihypertensive
ACE, ARB, Beta blockers
Diuretics
Aldosterone antagonists, loop diuretics
Anticoagulants (old and new)
Platelet aggregation inhibitors, NSAIDS, low molecular weight heparin, activated factor Xa inhibitor, and Vitamin K inhibitors
ACE examples
Captopril, enalapril
-pril
ARB examples
Telmisartan
-sartan
Beta blocker example
Metoprolol
-olol
Aldosterone antagonists example
Spirolactone
Loop diuretic example
Furosemide
Platelet aggregation inhibitors example
Clopidogrel
NSAID example
Aspirin
Low molecular weight heparin example
Enoxaparin
Activated factor Xa inhibitor example
Fondaparinux/ rivaroxaban
Vitamin K inhibitor example
Warfarin
Antiarrythmics
Calcium channel blockers, cardiac glycosides
Calcium channel blocker example
Diltiazem, verapamil
-dipine, -amil, -azem
Cardiac glycoside example
Digoxin
Statins
Pt education for ACE inhibitors
Pt education for ARBs
Pt education for Beta blockers
Safety issues with ACEs
Safety issues with ARBs
Safety issues with beta blockers
Safety issues for aldosterone antagonists
Pt eduction for aldosterone antagonists
Pt education for loop diuretics
Safety issues with loop diuretics
Pt education for platelet aggregation inhibitors
Pt education for NSAIDs
Pt education for LWMH
Pt education for activated factor Xa inhibitor
Safety issues for activated factor Xa inhibitor
Pt education for vitamin K inhibitors
Safety issues for platelet aggregation inhibitors
Safety issues for NSAIDs
Safety issues for LWMH
Safety issues for vitamin K inhibitors
Pt education for CCBs
Pt education for Cardiac glycosides
Pt education for Statins
Safety issues for CCBs
Safety issues for Cardiac glycosides
Safety issues for Statins
Key safety issues for CVA
Key safety issues for carotid disease
Key safety issues for PVD
Key safety issues for HF
Key safety issues for DVT
Key safety issues for atrial fibrillation
What needs to be taught to pts regarding CVAs?
What needs to be taught to pts regarding Carotid disease
What needs to be taught to pts regarding HF
What needs to be taught to pts regarding Atrial fibrillation
What needs to be taught to pts regarding DVT
What needs to be taught to pts regarding PVD
What needs to be taught to pts regarding Antihypertensives
What needs to be taught to pts regarding Diuretics
What needs to be taught to pts regarding Anticoagulants
What needs to be taught to pts regarding Antiarrythmics
What needs to be taught to pts regarding Statins
CVA diet
Carotid disease diet
HF diet
Atrial fibrillation diet/lifestyle modifications
DVT diet/lifestlye modifications
PVD diet/ lifestyle modifications
What to avoid diet wise with ACEs
What to avoid diet wise with ARBs
What to avoid diet wise with Diuretics
What to avoid diet wise with Anticoagulants
What to avoid diet wise with Antiarrythmics
What to avoid diet wise with Statins
