[Exam 4] Chapter 67: Management of Patients with Cerobrovascular Disorders (Page 2009-2013, 2017, 2025-2028) Flashcards
What is a Cerebrovascular Disorder?
Functional abnormality of the CNS that occurs when the blood supply is disrupted
What is the primary Cerebrovascular Disorder?
Stroke
Cerebrovascular Disorders: What two strokes will we look at?
Ischemic (80-85%) and Hemorrhagic (15-20%)
Cerebrovascular Disorder: Whats a nonmodifiable risk factor?
Age (older than 55) , male, or African Americans
Cerebrovascular Disorder: What are some modifiable risk factors?
Hypertension
CVD
Elevated Cholesterol or Hematocrit
Obesity
Diabetes
Oral Contraceptive Use
Smoking and Drug and Alcohol Abuse
Cerebrovascular Disorder: What happens when blood supply to brain is disrupted?
Brain tissues die, and leads to physical impairments due to neuronal death
Cerebrovascular Disorder: What is a stroke known as?
“Brain Attack”
Ischemic Stroke: What is this?
Obstruction of blood supply usually a thrombus or embolism that causes infarction of brain tissue
What is Hemiplegia?
Paralysis on one side of body
What is Hemiparesis?
Weakness on one side of body
What is Dysarthria?
Difficult or unclear speech that is linguistically normal
What is Aphasia?
(Inability to express speech, error in sentence structure or word choice) Expressive aphasia(The word meaning keeps changing, but knows what diet coke is), receptive aphasia. (hears diet coke, but thinks of something else)
What is Hemianopsia?
Blindness over half the field of vision
What is a Transient Ischemic Attack (TIA)?
Temporary neurologic deficit resulting from a temporary impairment of blood flow
Transient Ischemic Attack (TIA): This does not cause..
long term deficit
Transient Ischemic Attack (TIA): Warning sign of
an impending stroke
Transient Ischemic Attack (TIA): What needs to be done to prevent CVA?
Diagnostic Workup
Transient Ischemic Attack (TIA): Original symptoms look similar to
a stroke, but don’t last as long. MRI/CT shows no damage
Cerebrovascular Disorder: Health maintenance measures include
a healthy diet, exercise, and the prevention and treatment of periodontal disease
TIA: Preventive measures /Medical Management include?
Carotid Endarterectomy (Done to remove atheroscletotic plaques blocking cerebral blood flow)
Anticoagulant Therapy - 81 mg ASA
Antiplatelet Therapy : Aspirin, Dipyridamole plus Aspirin, Clopidogrel
“Statins” (decreases cholesterol)
Antihypertensive Meds
Ischemic Stroke: Signs of this?
Numbness or Weakness of Face (Facial Drooping), Arm, Or Leg
Confusion of Change in Mental Status
Trouble Speaking/Understanding Speech
Difficulty in walking, dizziness, loss of balance
Sudden, severe headache
Perceptual Disturbances
Ischemic Stroke: What will you do during the acute phase of the stroke? Ongoing frequent monitoring of all systems including
VS and neurologic assessment: LOC, motor symptoms, speech, eye symptoms
Ischemic Stroke: Acute Phase, monitor for what potential complications?
Musculoskeletal Problems, Swallowing Difficulties, Respiratory Problems, And S&S of increased ICP and Meningeal Irritation
Ischemic Stroke: After the stroke is complete, what will you assess?
Focus on patient function; self-care ability, coping, and education regarding needs to facilitate rehabilitation
Ischemic Stroke: Increased ICP can lead to what symptoms?
N/V
Increased BP
Decreased LOC
Decreased Pupil Constriction
Double Vision
Shallow Breathing
Seizures
Ischemic Stroke: Assessment, view if the patient is able to perform what?
ADLs, swallowing impairments or ability to communicate
Cerebrovascular Disorder: What are the Nursing Diagnosis? (13)
Impaired Physical Mobility
Acute Pain
Self-Care Deficit
Disturbed Sensory Perception
Impaired Swallowing
Urinary Incoontinence
Disturbed Thought Process
Impaired Verbal Communication
RF Impaired Skin integrity
Interrupted Family Processes
Depression
Ineffective tissue perfusion
Anxiety
Cerebrovascular Disorder: What are the goals for this? (13)
Improved Mobility
Avoidance of shoulder pain
Self-Care Achievement
Relief of sensory and percecptual deprivation
Prevention of apspiration
Continence
Improved thought process
Achievement of communication
Maintain skin
Restored family function
relief of depression
absence of complications
improved cerebral tissue perfusion
Hemorrhagic Stoke: What is this caused by?
Bleeding into the brain tissue, ventricles, or subarachnoid space
Hemorrhagic Stoke: This could be caused by what?
Spontaneous rupture of vessels RT hypertension , subarachnoid hemorrhage caused by ruptured aneurysm , anticoagulants, or aneurysm rupture
Hemorrhagic Stoke: What happens to brain metabolism here?
Disrupted due to blood exposure. Blood around the brain tissues causes increased pressure compressing arteries reducing blood flow in addition to the lack of blood flow from the bleed
Hemorrhagic Stoke: Body vasoconstricts due to
blood loss leading to even less blood flow to brain tissue and it becomes ischemic
Hemorrhagic Stoke: ICP increases caused by
blood in the subarachnoid space
Hemorrhagic Stoke: What causes injury to brain tissue?
Compression or secondary ischemia from reduced perfusion or vasoconstriction
Hemorrhagic Stoke: Signs of this?
Similar to ischemic
Early/Sudden Change in LOC
Severe Headache with projectile vomiting thats very forceful
Hemorrhagic Stoke: What should you monitor in the patient?
Monitor fluid balance and Hgb, Hct, BUN, and Cr
Hemorrhagic Stoke: Assessment for someone with this?
Neurologic Assessment, use neurologic flow chart
Monitor respiratory and oxygenation
Monitor ICP
Monitor for potential complications
Monitor fluid balance/lab
All changes reported immediately
Hemorrhagic Stoke: Where should a patient with intracerebral or subarachnoid hemorrhage be monitored?
ICU
Hemorrhagic Stoke: Diagnosis for someone with this?
Ineffective Tissue Perfusion (Cerebral)
Disturbed Sensory Perception
Anxiety
Hemorrhagic Stoke: Goals for this include
Improved cerebral tissue perfusion
Relief of sensory and perceptual deprivation
Relief of anxiety
absence of complications
Cerebrovascular Disorder: Complications with this?
Aspiration
Skin Breakdown
Falls
Musculoskeletal Comps: Contractures, Atrophy
ICP
Cerebrovascular Disorder: Prevention of this?
Healthy Diet: Low Fat, Low Cholesterol
Exercise
Prevention and Tx of Peridontal Disease
Cerebrovascular Disorder: Labs that will be used here?
CT, MRI
Cerebrovascular Disorder: What interventions will we perform?
Aspiration Precautions
OT,PT, ST
Turn Q4h
Up with Assistance
REport changes immeditaly
Cerebrovascular Disorder: Education for patient?
Prevention
Signs and symptoms of stroke and to recieve immediate care
Teaching new ways to perform ADLs with deficits
