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Med Surg II > Exam 2: Stroke (aka: CVA/"Brain attack") > Flashcards

Exam 2: Stroke (aka: CVA/"Brain attack") Flashcards

1
Q

What are the 2 types of Strokes ?

A
  • Ischemic

- Hemmorrhagic

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2
Q

Ischemic strokes are due to what ?

A

Thrombolic or Embolic

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3
Q

What is a Thrombus ?

A

Is a blood clot that FORMS in a vein

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4
Q

What is an Embolus ?

A

A clot that MOVES through the blood vessels, until it reaches a vessel that is too small to let it pass.

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5
Q

What is an Ishemic stroke ?

A

Inadequate blood flow due to a clot

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6
Q

What are manifestations of an Ischemic stroke ?

A
  • SUDDEN weakness or numbness on one side of the body
  • SUDDEN confussion (change n LOC), trouble speaking or understanding
  • SUDDEN vision changes in one or both eyes
  • SUDDEN trouble walking, dizziness, or loss of balance
  • SUDDEN severe headache
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7
Q

What is a Hemorrhagic stroke ?

A
  • Bleeding in the space either between the brain & the tissue covering the brain (Subarachnoid bleed)
    OR
  • A bleed in the brain tissue itself
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8
Q

Hemorrhagic strokes can be either _____________ or _______________ ?

A
  • Intracerebral

- Subarachnoid

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9
Q

How do pt’s with hemorrhagic strokes appear ?

A

Appear more seriously ill

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10
Q

True or False: Pt’s with hemorrhagic strokes, deteriorate more rapidly ?

A

True

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11
Q

How do Hemorrhagic strokes present ?-

A
  • More severe headaches
  • Display more marked disturbances in consciousness
  • Have more sever nausea & Vomiting
    (vomiting = projectile)
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12
Q

What type of Stroke occurs when an obstruction blocks blood flow to a part of the brain ?

A

Ischemic Stroke

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13
Q

What type of stroke occurs when a weekend vessel wall ruptures causing bleeding in the brain ?

A

Hemorrhagic Stroke

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14
Q

What are the warning signs of a stroke ?

A
  • Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion or trouble speaking, or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headache with no known cause
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15
Q

What is the Acronym used for the identification of a stroke ?

A

Act FAST

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16
Q

What does the acronym FAST stand for

A

F: Face, facial drooping
A: Arms, weakness, drift
S: Speech difficulties
T: Time, any of these things call 911

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17
Q

What are Non-modifiable risk factors for strokes ?

A
  • Gender
  • Age
  • Race
  • Heredity - sickle cell
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18
Q

What are potentially modifiable risk factors for strokes ?

A
  • Cardiac disease
  • Blood lipid abnormalities
  • Lifestyle: smoking/obesity
  • TIA
  • HTN
  • Diabetes
  • A-fib
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19
Q

Which sex is at an increased risk for having a stroke ?

A

Males

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20
Q

True or False: The chances of having a stroke increase with age ?

A

True

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21
Q

Which race is 2x more likely of having a stroke ?

A

African Americans

22
Q

Many of the modifiable risk factors for strokes can be controlled how ?

A
  • Diet
  • Exercise
  • Medications
23
Q

When trying to diagnose a stroke, what is the first thing we want to do ?

A

Want to try an establish a timeline !

  • Determine when the pt. was last seen well/acting normal
24
Q

What diagnostics are used to detect strokes ?

A
  • CT scan (bleed vs. ischemic)
  • MRI (size, location, etc)
  • 12 lead EKG
  • CXR
  • Pulse Oximetry
  • Labs: BMP with ionized calcium, CBC, INR, PTT
  • Find etiology
25
Q

What is the main thing were looking to do (treat) with ischemic strokes ?

A

Restore perfusion !

26
Q

What is tPA ?

A

Tissue Plasminogen Activator

AKA: Clot buster

27
Q

What is the immediate Tx for a stroke if the onset of symptoms is < 4.5hrs & there are no contraindications ?

A

IV tPA

28
Q

What is intra-arterial tPA ?

A

They insert a thin catheter right up into the femoral artery and put it right against the area of the clot and actually inject tPA right into the clot

29
Q

When can Intra-arterial tPA be given when a stroke is suspected ?

A

When the onset of the symptoms is between 3-6 hours

30
Q

When can Mechanical clot removal be used with a suspected stroke?

A

Up to 8hrs post symptom onset

31
Q

What are we monitoring very closely with Hemorrhagic strokes ?

A

ABCs

32
Q

What other treatments used for Hemorrhagic strokes ?

A
  • Reverse anticoagulants (give clotting factors via fresh frozen plasma)
  • Correct bleeding
  • Strict BP control
    (want systolic kept below 160mmHg)
33
Q

Injury to the right side of the brain from a stroke damages what side of the body ? which includes what type of things ?

A

Left side of body

  • creativity
  • Music
  • Spatial Orientation
  • Artistic awareness
34
Q

Injury to the left side of the brain from a stroke damages what side of the body ? Which includes what types of things ?

A

Right side of the body

  • Spoken language
  • Reasoning
  • Number skills
  • Written language
35
Q

What area of the brain is responsible for speech ?

A

Broca’s area

36
Q

Which area of the brain is responsible for speech comprehension

A

Wernicke’s area

37
Q

What are the 2 types of Aphasia ?

A
  • Expressive

- Receptive

38
Q

What is Expressive Aphasia ?

A

The pt can’t say what they want to say

39
Q

When somebody has expressive aphasia, where in the brain, is the damage ?

A

Broca’s area (Motor)

40
Q

What is Receptive Aphasia ?

A

The inability to understand what is being said to them

41
Q

When somebody has receptive aphasia, where in the brain, is the damage ?

A

Wernicke’s area (sensory)

42
Q

What is Dysarthria ?

A

Muscle control of speech

  • The pt. may have slurring/unintelligible speech d/t dysarthria
43
Q

Spatial Perceptual problems related to a stroke, are more common with what ?

A

Right hemisphere strokes

44
Q

What are Manifestations of Spatial Perceptual problems associated with a stroke (most commonly R hemisphere) ?

A
  • Deny illness or body parts
  • Neglect all input from the affected side
  • Homonymous hemianopsia
    (loss of 1/2 of visual field, on the same side of both eyes)
  • Agnosia
  • Apraxia
45
Q

What is Agnosia ?

A

Inability to recognize objects by sight, touch, or hearing

46
Q

What is Apraxia ?

A

Inability to carryout learned, sequential movements

  • things they have done in the past
47
Q

What is the Management for Ischemic strokes ?

A
  • Anti-platelet therapy
    • Aspirin*
    • Clopidogrel (plavix)*
  • Anticoagulants for A-fib
    • Coumadin (warfarin)
    • Eliquis
  • Tx carotid artery stenosis/intracranial stenosis
  • “Statin” therapy for LDL >70
  • BP management
  • Dysphagia screening
  • DVT prophylaxis
  • PT/OT/Speech
48
Q

What is the management for Hemorrhagic strokes ?

A
  • ABC’s
  • Reverse anticoagulants
  • Correct bleeding disorders
  • Strict BP control
  • Monitor of NIHSS (stroke scale) & VS
  • Monitor for increased ICP
  • Monitor for cerebral vasospasms
  • Possible ventricular drain
  • Elevate HOB 30 degrees
  • Seizure prevention
  • Temperature management
49
Q

What things are used to reverse anticoagulants ?

A
  • Vitamin K
  • Fresh frozen plasma
    (has clotting factors right in it)
50
Q

What things are done for the prevention of strokes ? (collaborative management)

A
  • Manage modifiable risk factors
  • Platelet inhibitors
  • Anticoagulants for A-fib
  • Surgery
    • Carotid angioplasty or endartectomy
  • Acute care & Rehabilitation
    • depends and area & extent of stroke

Med Surg II (13 decks)

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