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NRSG 200: Med Surg 3 > [Exam 5] Chapter 67 - Mx of Patients with Cerebrovascular Disorders > Flashcards

[Exam 5] Chapter 67 - Mx of Patients with Cerebrovascular Disorders Flashcards

1
Q

Cerebrovascular Disorders: What is this?

A

This is an umbrella term. Is functional abnormality of the CNS that occurs when the blood supply is disrupted

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2
Q

Cerebrovascular Disorders: What is the primary disorder seen here?

A

A stroke. Third leading cause of death in the United States

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3
Q

Cerebrovascular Disorders: Stroke is the leading cause of what

A

serious long-term disability in the United States

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4
Q

Cerebrovascular Disorders: The bigger the stroke, the bigger that what?

A

The bigger the infarction and the longer the rehab process wil be. Will have harder time getting back to ADLs.

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5
Q

Cerebrovascular Disorders: What is a ischemic stroke?

A

There has been some type of occlusion that results in hyperperfusion of the brain.

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6
Q

Cerebrovascular Disorders: How common are ischemic strokes?

A

they are about 85% of all strokes.

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7
Q

Cerebrovascular Disorders: What are hemorrhagic strokes?

A

This includes bleeding to the brain or subarachnoid space.

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8
Q

Cerebrovascular Disorders: What is the subarachnoid space?

A

Area between the pia matter and arachnoid mater.

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9
Q

Cerebrovascular Disorders: How common are hemorrhagic strokes?

A

Around 15% common. Not as common as ischemic strokes

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10
Q

Cerebrovascular Disorders - Prevention: What is one of the best things that we can do for strokes?

A

Prevention of them

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11
Q

Cerebrovascular Disorders - Prevention: What are some nonmodifiable risk factors?

A

Age (Older than 55), Male, African American

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12
Q

Cerebrovascular Disorders - Prevention: What are some modifiable risk factors?

A 
Hypertension (Primary RF)
Cardiovascular Disease
Elevated Cholesterol or Hct
Obesity
Diabetes
Oral Contraceptive use
Smoking or Alcohol/Drug Use
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13
Q

Cerebrovascular Disorders - Prevention: Why are African Americans at larger risk?

A

They are at higher risk for hypertension, which is a big modifiable risk factor for strokes

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14
Q

Cerebrovascular Disorders - Prevention: What diet will be used?

A

DASH Diet. It sands for dietary appraoches to stop hypertension

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15
Q

Cerebrovascular Disorders - Prevention: What will be included in a DASH Diet?

A

High fruit, high veggie, low fat, low animal protein. Protein should come form plants

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16
Q

Cerebrovascular Disorders - Prevention: Protein from plants should come from where?

A

Nuts , seeds.

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17
Q

Cerebrovascular Disorders - Prevention: What do oral contraceptive use lead to?

A

Blood clots. If prone for blood clots, will be at higher risk for stroke with this

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18
Q

Stroke: Another term for this?

A

Brain attack.

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19
Q

Stroke: What is this sometimes called a brain attack?

A

You have a lack of blood flow to the brain tissue.

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20
Q

Stroke: What is a stroke?

A

Sudden loss of function resulting from a disruption of the blood supply to a part of the brain.

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21
Q

Stroke: What are the main causes of ischemic stroke?

A

Large Artery Thrombosis
Small Penetrating Artery Thrombosis
Cardiogenic Embolic
Crptogenic (No Known cause)

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22
Q

Stroke: Main presenting symptoms of ischemic stroke?

A

Numbness or weakness of the face, arm, leg, especially on one side of the body

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23
Q

Stroke: Functional recovery for ischemic stroke?

A

Usually plateaus at 6 months

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24
Q

Stroke: Causes of hemorrhagic stroke?

A

Intracerebral hemorrhage
Subarachnoid hemorrhage
Cerebral Aneurysm
Arteriovenous Malformation

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25
Q

Stroke: Main presenting symptoms of hemorrhagic stroke?

A

“Exploding Headache”

Decreased LOC

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26
Q

Stroke: Functional recovery for hemorrhagic stroke?

A

Slower, usually plateaus at about 18 months

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27
Q

Stroke: Simple definition of ischemic stroke?

A

Clot blocks blood flow

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28
Q

Stroke: Simple definition of hemorrhagic stroke?

A

Bleeding inside or around brain

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29
Q

Ischemic Stroke: Actual definition for this?

A

Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of rbain tissue

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30
Q

Ischemic Stroke: What are the difefrent type of thromboses?

A

Large Artery Thrombosis
Small Penetrating Artery Thrombosis
Cardiogenic Embolism
Cryptogenic

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31
Q

Ischemic Stroke: What is a large artery Thrombotic Stroke

A

That is usually caused by plaque buildup in the large blood vessels

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32
Q

Ischemic Stroke: What si a small penetrating artery thrombosis?

A

Usually one or more smaller vessels. This is the most common. Also called Lacunar strokes. Named this because it creates a cavity in the brain tissue after infarction occurs

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33
Q

Ischemic Stroke: What is a cardiogenic embolism?

A

This is referring to a blood clot that came because the patient had afib.

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34
Q

Ischemic Stroke: What is a big problem with AFib?

A

People can have blood clots that cause strokes

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35
Q

Ischemic Stroke: What is a cryptogenic stroke?

A

Usually we don’t know what causes these. We cannot identify waht causees the lack of blood flow

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36
Q

Ischemic Stroke: What are other reasons for this?

A

Elicit drug use, coagulotherapy where they tend to clot more.

Migraines can cause this.

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37
Q

Ischemic Stroke - Patho: What happens ot the body once there is ischemia?

A

This leads to an energy failure. This means lack of oxygen in tissue leading to aerobic to anaerobic metabolism.

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38
Q

Ischemic Stroke - Patho: What happens in the body due to anaerobic metabolism?

A

You start to see an increase of lactic acid buildup. This leads to acidosis and ion imbalance.

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39
Q

Ischemic Stroke - Patho: After acidosis and ion imbalance occur, what occurs next in the body?

A

Depolarization leading to increase in glutamate and an increased in intracellular calcium.

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40
Q

Ischemic Stroke - Patho: What happens since there is an increase in intracellular calcium?

A

Cell membranes and proteins break down. Formation of free radicals and protein production decreased

This leads to cell injury and death

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41
Q

Ischemic Stroke - Patho: Why does calcium get released?

A

Once the neurons in the back start to get damaged from lack of blood flow

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42
Q

Ischemic Stroke - Patho: What is the complete patho of this?

A

Ischemia ->Energy Failure (Anaerobic, Lactic Acid) -> Acidosis/Ion Imabalance -> Depolarization (Increased Glutamate) and Intracellular Calcium Increased -> Cell membrane and probein break down, free radicals, and protein decreased -> Cell injury and death

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43
Q

Manifestations of Ischemic Stroke: Symptoms depend on what?

A

Location and size of the affected area

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44
Q

Manifestations of Ischemic Stroke: What are some signs of this?

A

Numbness or weakness of the face, arm , or leg, espeically on one side

Facial droop

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45
Q

Manifestations of Ischemic Stroke: Neurological changes?

A

Confusion or change in mental status

May have sudden, severe headache

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46
Q

Manifestations of Ischemic Stroke: How will their speech be?

A

Trouble speaking or understanding speech

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47
Q

Manifestations of Ischemic Stroke: Major difficulty with what?

A

Walking, dizziness, or loss or balance or coordination

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48
Q

Manifestations of Ischemic Stroke: What kind of disturbance may they have?

A

Perceptual Disturbances. Things aren’t making as much sense, maybe can’t see things as clearly as they are used to.

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49
Q

Stroke Terms: What is Hemiplegia?

A

Paralysis of the face, arm or legs. On the same side.

Remember that upper motor neurons cross in brain. Affected brain side will be opposite on motor

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50
Q

Stroke Terms: What is Hemiparesis

A

Weakness of the face, arm or legs on the same side

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51
Q

Stroke Terms: What is Dysarthria?

A

Difficulty in forming words

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52
Q

Stroke Terms: What is Expressive Aphasia

A

They are unable to form words. May be able to speak but not making sense.

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53
Q

Stroke Terms: What is Receptive Aphasia

A

They are unable to comprehend what is being said to them.

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54
Q

Stroke Terms: What is Hemianopsia

A

Patients are unaware of persons or object on the side of visual loss. Tend to neglect one side of the syndrome. May wash only right side of face or brush only right side of hair and forget about left.

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55
Q

Transient Ischemic Attack (TIA): What is this?

A

Temporary neurological deficit resulting from a temporary impairment of blood flow. Temporary motor loss.

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56
Q

Transient Ischemic Attack (TIA): How long does this last?

A

Less than an hour

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57
Q

Transient Ischemic Attack (TIA): Why is this significant?

A

Can be a warning of an impending stroke. 15% of strokes precipitated by this.

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58
Q

Transient Ischemic Attack (TIA): What is required after this?

A

Diagnostic workup required to treat and prevent irreversible deficits.

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59
Q

Transient Ischemic Attack (TIA): Workup for TIA or CVA will include what?

A

CT Scan initially. Should be done within 25 minutes of patients presenting to hospital.

EKG - Because we know AFib is a big cause of this, shows potential dysrhythmia.

Caratoid Ultrasound - Some determine some blockages.

CT Angiograph - Shows better look at vessels

MRI - Better look at tissues

Echocardiogram - Echocardio gram can get a better look at the valves, to see if clots forming here.

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60
Q

Preventive Treatment and Secondary Prevention: What is the most important thing to do?

A

Health Maintenance. This includes a healthy diet (DASH DIET), exercise, and the prevention and treatment of peridontal disease (can lead to valve problems, leading to blood clots, leading to stroke)

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61
Q

Preventive Treatment and Secondary Prevention: If patient has history of AFib, what will they be given

A

Anticoagulants. Couamdin/Warfarin used to be used and then monitor their INR to make sure they are having anticoagulant effect.

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62
Q

Preventive Treatment and Secondary Prevention: INR therapeutic range for Couamdin is what?

A

2-3 , very important to understand that

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63
Q

Preventive Treatment and Secondary Prevention: What newer anticoagulants may be used now?

A

Perderexa and Zoltero for patients in AFib.

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64
Q

Preventive Treatment and Secondary Prevention: What other type of medications may be used?

A

Antiplatelet Therapy
Statins
Antihypertensive

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65
Q

Preventive Treatment and Secondary Prevention: What kind of antiplatelets would be used?

A

Aspirin, Dipyridamole plus aspirin (Aggrenox) , Clopidogrel (Plaxis)

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66
Q

Preventive Treatment and Secondary Prevention: Aspirin can be used as what?

A

Antitcoagulant and antiplatelet

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67
Q

Preventive Treatment and Secondary Prevention: What is a first baselien treatment for antiplatelet?

A

Aspirin. IF at risk for stroke, clopidogren (plavix) used

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68
Q

Preventive Treatment and Secondary Prevention: Why are statins imporrant?

A

Help with cholesterol and plaque buildup

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69
Q

Preventive Treatment and Secondary Prevention: Why would antihypertensive medicatiosn be used?

A

Because if we know that they have high hypertension, we want to give them to help them control their blood pressure

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70
Q

Medical Mx of Acute Phase of Stroke: If a patient presents with this, what do you want ot do immediately?

A

Prompt diagnosis and treatment.

Diagnosis through CT to see if ischemic or hemorrhagic

Assessment of stroke using NIHSS Assessment tool

Thrombolytic Therapy

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71
Q

Medical Mx of Acute Phase of Stroke: What is the NIHSS assessment tool?

A

Basically, it goes through and scores patients on different areas. Looks at LOC (alert, unresponsive), gauze, facial drooping, check strength of extremities, see what their sensory is, are they able to articulate their words?

Goes through test to get their scores.

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72
Q

Medical Mx of Acute Phase of Stroke: Score ffor NIHSS assessment tool?

A

IT goes from 0-41. The higher the score, the more severe the stroke.

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73
Q

Medical Mx of Acute Phase of Stroke: NIHSS stands for what?

A

National Institute of Health Stroke Scale. Can be certified in this.

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74
Q

Medical Mx of Acute Phase of Stroke: Once they have been diagnosed and are having a iscshemic stroke, what is given first?

A

Thrombolytic Therapy.

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75
Q

Medical Mx of Acute Phase of Stroke: What is given in Thrombolytic therapy?

A

tPa.

76
Q

Medical Mx of Acute Phase of Stroke: How does tPA treatment work?

A

This is a powerful clot buster. BInds to fibrin and converts fibrogen to plasma which stimulates fibrolysis of the clot. Means its a clot buster and busts the clot buster.

77
Q

Medical Mx of Acute Phase of Stroke: How quickly does tPA need to be given?

A

Within 3 hours of onset of symptoms to be most effective

78
Q

Medical Mx of Acute Phase of Stroke: What needs to be done before giving tPa?

A

Confirm they’ve had ischemic stroke. Make sure they don’t have any risk factors for bleeding like coumadin and no heparin products within 48 hours.

No prior intracranial hemorrhages or aneurysms.

Puts a huge risk for bleeding.

79
Q

Medical Mx of Acute Phase of Stroke: What does tPA stand for?

A

Tissue Plasmagenosis Activator

80
Q

Medical Mx of Acute Phase of Stroke: How is tPA given?

A

Given through IV. Will be dosed by weight. 0.9 mg/kg. Will get bolus of whatever 10% the dosage is over minute. Rest will run over an hour.

81
Q

Medical Mx of Acute Phase of Stroke: Why must you be careful with administration of TPA?

A

Has a huge risk for bleeding

82
Q

Medical Mx of Acute Phase of Stroke: Other interventions other than tPA?

A

Maintain cerebral blood flow by elevated HOB. (25-30 degrees)

Maintain airway (>92%) and ventilation

83
Q

Medical Mx of Acute Phase of Stroke: What must you monitor for?

A

Monitor through hemodynamic monitoring and neurologic assessment.

84
Q

Medical Mx of Acute Phase of Stroke: What should their vital signs be at?

A

Keep blood pressure higher. Systolic not treated until higher than 220. Higher blood pressure forces perfusion to the brain adn want to restore blood flow to area of ischemia.

85
Q

Carotid Endarterectomy: What is this?

A

Surgical prevention of a stroke. Main procedure for TIA and Mild strokes. This is the surgical removal of atherosclerotic plaque or thrombus from the carotid artery

86
Q

Carotid Endarterectomy: You should think of this as what?

A

It goes into carotid and grab out all of the plaque, suck it out. May see a stent placed in here as well to keep artery open.

87
Q

Carotid Endarterectomy: What will these patients need?

A

Close monitoring. IF some of plaque broke off, it will go into the brain and can cause them to have an infarction in brain.

NEed frequent assessment, neuro assessmets

88
Q

Carotid Endarterectomy: Need to monitor for what?

A

Complications. Monitor the dressings and make sure the wound is not getting bigger

Hypertension and Hypotension. Real fine line of where you want their BP to be at.

89
Q

Carotid Endarterectomy: What complciations can they have?

A 
Incision Hematoma
Hypertension
Postop Hypotension
Hyperperfusion Syndrome
Intracerebral Hemorrhage
90
Q

Carotid Endarterectomy: Why would high BP be mad?

A

Can cause hyper-perfusion to brain causing neurological impairment.

91
Q

Carotid Endarterectomy: What is hyper perfusion syndrome?

A

Occurs when cerebral vessel auto regulation fails. Arteries may become permanently dilated increasing blood flow to brain leading to capillary bed damage, edema, and hemorrhage. Can cause headache.

92
Q

Nursing Process - Pt Recovering from Ischemic Stroke , Assessment: Acute phase from stroke can last how long

A

1-3 days.

93
Q

Nursing Process - Pt Recovering from Ischemic Stroke , Assessment: What assessments will occur during the acute phase?

A

Ongoing, frequent monitoring of all systems. Includes VS and Neurologic Assessment - LOC, Motor Symptoms, Speech, Eye Symptoms (PEERLA, Same Size, Reacting. Unequal is a problem)

Color of Skin and Extremities
Temperature of Skin

94
Q

Nursing Process - Pt Recovering from Ischemic Stroke , Assessment: During acute phase, monitor for potential complications that include what?

A

Musculoskeletal Problems

Swallowing Difficulties

Respiratory Problems (Able to Breathe)

Signs of Increased ICP (Neurological Changes, Headache) and Meningeal Irritation

95
Q

Nursing Process - Pt Recovering from Ischemic Stroke , Assessment: After stroke is complete, focus on what patient function?

A

Self-Care Ability
Coping
Education regarding needs to facilitate rehabilitation

96
Q

Nursing Process - Pt Recovering from Ischemic Stroke , Assessment: Goal of patient after stroke is complete for what?

A

Getting them back to their ability level pre-stroke.

97
Q

Nursing Process - Pt Recovering from Ischemic Stroke , Assessment: Goal of rehabilitation?

A

To be able to perform self-care again. May not get back to pre-stroke levels but should be able to perform self-care.

98
Q

Ischemic Stroke - Nursing Diagnosis: This includes what?

A 
Impaired Physical Mobility
Acute Pain
Self-Care Deficits
Disturbed Sensory Perception
Impaired Swallowing
Urinary Incontinence
Disturbed Thought Process
Impaired Verbal Communication
RF Impaired Skin Integrity
Interrupted Family Proceses
Sexual Dysfunction
99
Q

Ischemic Stroke - Nursing Diagnosis: What to know for impaired physical mobility?

A

This is related to loss of balance and coordination. Stroke, Hemaphoresis. Inability to move one side of body

100
Q

Ischemic Stroke - Nursing Diagnosis: Impaired verbal communication why?

A

Huge after stroke for a lot of patients, continues to be a struggle for these patients.

101
Q

Ischemic Stroke - Nursing Diagnosis: Why do they have interrupted family processes?

A

Impacts spouse the most, because the patient is no longer able to do what they originally were able to .

102
Q

Ischemic Stroke Complications: What complications will occur?

A

Decreased cerebral blood flow
Inadequate oxygen delivery to brain
Pneumonia

103
Q

Ischemic Stroke Complciations: Decreased cerebral blood flow big why?

A

Because they are not getting enough oxygen to the brain.

104
Q

Ischemic Stroke Complciations: Why may pneumonia be a huge problem?

A

Patients are immobile, sitting around. Are not able to take as deep of breaths. Cannot deep breathe or cough.

105
Q

Ischemic Stroke - Planning: Major goals for this patient will be to improve what?

A

Improve mobility, improve thought process, improve sexual function

106
Q

Ischemic Stroke - Planning: How to improve mobility?

A

This can be done through physical therapy, OT.

107
Q

Ischemic Stroke - Planning: You want to prevent what from forming?

A

Joint deformity. Such as avoidance of shoulder pain. Relief of sensory and perceptual deprivation

108
Q

Ischemic Stroke - Planning: How to prevent joint deformity?

A

Positioning of hands and bodies. Want to make sure we change their position.

109
Q

Ischemic Stroke - Planning: Why do patients have shoulder pain?

A

Patients may be lifted by flaccid shoulder.

110
Q

Ischemic Stroke - Planning: Goals include achievements of what?

A

Achievement of Self-Care

Form a Communication. Never want to speak for patient. Have to come up with ways to communicate to patient.

111
Q

Ischemic Stroke - Planning: You want to prevent what from occurring?

A

Aspiration and incontinence/constipation. After stroke, patients may have problems with having sensation to void. Bladder can become atonic. May also have trouble with bowel control and will need high fiber/enough fluid.

112
Q

Ischemic Stroke - Planning: How to maintain skin integrity?

A

Turn the patient every 2hours

113
Q

Ischemic Stroke - Planning: How to restore family functioning?

A

Educating patient and family members on how they will be able to gain their functional ability back.

114
Q

Ischemic Stroke - Planning: How to help improve sexual function?

A

Education will come into play with partner.

115
Q

Ischemic Stroke - Planning: Absence of complications include?

A

Making sure to prevent pneumonia.

Doing interventions needed such as ST, no aspiration, monitoring them for absence of neurologic deficits.

116
Q

Ischemic Stroke - Planning: What are all the major goals that may be included?

A 
Improved Mobility
Avoidance of Shoulder Pain
Achievement of Self-CAre
Relief of Sensory-Perceuptual Deprivation
Prevention of ASpiration
Contience of Bowel/Bladder
Improved Though Process
Achieving form of Communication
Maintain Skin Integrity
Restored Family Functioning
Improved Sexual Function
Absence of Complciations
117
Q

Interventions: Focus on what?

A

The whole person. Pay attention to them and listen to them. Let them express what they have to say

118
Q

Interventions: These should be done to provide what?

A

Interventions to prevent complications and promote rehabilitation

Provide support and encouragement

119
Q

Improving Mobility and Preventing Joint Deformities: What should be done every 2 horus?

A

Turning the patient and ensuring they have correct alignment

120
Q

Improving Mobility and Preventing Joint Demorities: What devices can be used?

A

The use of splits

121
Q

Improving Mobility and Preventing Joint Demorities: How often should they exercise

A

This is very important. Passive or Active ROM 4-5 times a day to prevent joint deformity and helps retrain the brain and how they should be moving

122
Q

Improving Mobility and Preventing Joint Demorities: Positioning should focusing on what?

A

Hands and Fingers to prevent flexion contractures and preventing shoulder abduction .

123
Q

Improving Mobility and Preventing Joint Demorities: Make sure to not lift by what?

A

By the flaccid shoulder, can cause more damage. Find measures to prevent and treat shoulder problems

124
Q

Should Abduction: How to prevent shoulder abduction?

A

Patient is lying on their lift side. Elbow is bent so that hand is almost level with head.

Right arm on top of body with pillow placed between body and arm. Right hand is by the waist

125
Q

Hip Flexion: How to prevent this?

A

Prone Positioning.

Can place patient stomach down. Pillow under legs, sheet underneath abdomen, and pillow below head.

126
Q

Improving Mobility and Preventing Joint Deformities: You want the patient to do what?

A

Encourage patient to exercise unaffected side by establishing regular exercise routin

127
Q

Improving Mobility and Preventing Joint Deformities: What body parts should be exercised?

A

Quadriceps and gluetal exercises to prevent atrophy

128
Q

Improving Mobility and Preventing Joint Deformities: What should be done as soon as patient is able to move?

A

Assist patient out of bed as soona s possible. Assess the patient and help patient achieve balance, move slowly. May need ambulation training to help walk

129
Q

Interventions Continued: How to enhance self-care?

A

Set realistic goals with patient
Encourage personal hygiene
Ensure patient does not neglect the affected side
Use of assistive devices and modification of clothing

130
Q

Interventions Continued: What modified clothing can be done?

A

Work with PT/OT/ST/Social work. tools and clothing can be easier to buttom.

131
Q

Interventions Continued: In order to gain fuctional ability back, patient should do what first?

A

Work out the unaffected side.

132
Q

Interventions Continued: Patient needds what from us?

A

Support and encouragement and strategies to enhance communication. We should not complete sentences of patient. We should have a set list of things to do ahead of time so that way patients knows what to expect and does not struggle as much.

133
Q

Interventions Continued: What movements should patient perform if visual loss of left side?

A

Encourage the patient to turn head, look at the side with visual field loss. If no vision on left, encourage patient to turn head to the left

134
Q

Interventions Continued - Nutrition: Consult will be done with who here

A

Speech therapy or nutritional services

135
Q

Interventions Continued - Nutrition: What should be done when patient is eating?

A

Having patient sit upright, preferably out of bed to eat.

Chin tuck or swallowing methods

136
Q

Interventions Continued - Nutrition: What kind of foods may they consume?

A

Thickened liquids (Nectar, Honey Thick) or pureed diet

137
Q

Interventions Continued - Nutrition: Why may they chin tuck?

A

To help swallow and help prevent aspiration

138
Q

Interventions Continued - Bowel/Bladder Control: Assesment of what here?

A

Assessment of voiding and can also schedule voiding. This can help retrain the bladder

139
Q

Interventions Continued - Bowel/Bladder Control: Measures need to be taken to prevent constipation how

A

By giving them fiber, fluids, and having a toileting schedule

140
Q

Hemorrhagic Stroke: What is this?

A

This accounts for 15-20% of strokes. Primarily causes by intracranial or subarachnoid hemorrhage.

141
Q

Hemorrhagic Stroke: This can be caused by what?

A

Hypertension

142
Q

Hemorrhagic Stroke: WHat is a Intracerebral Hemorrhage?

A

This is most common in patients with hypertension or cerebral atherosclerossi. Causes vessels to become weakened. Eventually breaks and will see bleed into brain.

143
Q

Hemorrhagic Stroke: What is a Intracranial Aneurysm

A

Dilation of the walls of the cerebral arery. Develops as a weakness of the cerebral wall. Will usually be a out-pouching.

144
Q

Hemorrhagic Stroke: What is a Arteriovenous Malformation (AVM)

A

This is caused by abnormality in the erybronial development that leads to tangled arteries. Arteries and veins become tangled within each other.

145
Q

Hemorrhagic Stroke: What is Subarachnoid Hemorrhage?

A

You will see this as a result of AVM if it ruptures or a trauma. Hypertension can also cause this as well.

146
Q

Hemorrhagic Stroke: Problem with aneurysm?

A

They can be a ticking time bomb. Are just waiting. If it ruptures, they will hemorrhage.

147
Q

Hemorrhagic Stroke: Aneurysm can be caused by what?

A

Atherosclerosis or can be a congenital defect in the wall.

148
Q

Hemorrhagic Stroke: Where will you often see arteriovenous malformation?

A

In young people. Like if young people had a hemorrhagic stroke due to this forming when in embryonic stage

149
Q

Hemorrhagic Stroke - Intracranial Aneurysms and AV Malformation: Depending on where aneurysm is at, it determines what

A

Determines what symptoms they will have.

150
Q

Hemorrhagic Stroke: What are teh different types?

A

Intracerebral Hemorrhage
Intracranial Aneurysm
Arteriovenous Malforamtion
Subarachnoid Hemorrhage

151
Q

Hemorrhagic Stroke - Manifestations: Will be simialar to what?

A

Ischemic stroke

152
Q

Hemorrhagic Stroke - Manifestations: Biggest difference with this compared to ischemic?

A

Patient will report a sudden, severe headache.

153
Q

Hemorrhagic Stroke - Manifestations: What changes will this cause in patient?

A

Early and sudden changes in LOC. May also be vomiting.

154
Q

Hemorrhagic Stroke - Diagnostics for this?

A

CT Scan / MRI to confirm what is going on

155
Q

Hemorrhagic Stroke - Assessment: What will be be during during the assessment at first?

A

Complete and perform an ongoing neurological assessment using stroke scale

156
Q

Hemorrhagic Stroke - Assessment: With any type of neurological and brain injury, what is always monitored?

A

Respiratory Status and Oxgyenation. Want to monitor their airway.

Also monitor their ICP because they will continue to increase

157
Q

Hemorrhagic Stroke - Assessment: What type of unit will they be placed in?

A

The ICU. If ICP is increasing, they may have monitors.

158
Q

Hemorrhagic Stroke - Assessment: Monitor will include what?

A

Potential complicatiosn and fluid balance an lab data.

159
Q

Hemorrhagic Stroke - Assessment: What to do if a change occurs?

A

Report if immediately!!

160
Q

Hemorrhagic Stroke - Nursing Diagoses: What are the main ones?

A

Ineffective Tissue Perfusion (Cerebral)
Disturbed Sensory Perception
Anxiety

161
Q

Hemorrhagic Stroke - Problems and Potential Complications: What can occur?

A 
Vasospasms
Seizures
Hydrocephalus
Rebleeding
Hyponatremia
162
Q

Hemorrhagic Stroke - Problems and Potential Complications: What will occur with vasospams?

A

They will have an increased headache, decreased responsiveness. Vessels within brain are spasming causing lack of blood flow.

163
Q

Hemorrhagic Stroke - Problems and Potential Complications: When will these complication occur?

A

Within 1 - 3 day

164
Q

Hemorrhagic Stroke - Problems and Potential Complications: What can be done to prevent vasospasms?

A

Give a calcium channel blocker. ALso make sure that the patient has enough volume.

165
Q

Hemorrhagic Stroke - Problems and Potential Complications: What to if seizure occurs?

A

Make sure patient airway is present. To stop, may be ativan.

166
Q

Hemorrhagic Stroke - Problems and Potential Complications: What to do with Hydrocephalus?

A

This is from CSF building up. CSF circulation impaired due to bleeding.

Will get a ventricularostomy drain to help drain CSF and help decrease ICP

167
Q

Hemorrhagic Stroke - Problems and Potential Complications: Acute Hydrocephalus characterized by what?

A

Sudden onset of stupor or coma.

168
Q

Hemorrhagic Stroke - Problems and Potential Complications: Rebleeding may occur why?

A

After bleeding is controlled, they can go in and see that the patient has rebleed. Aneurysm rebleeding occurs often within first 2 weeks. Just hasn’t healed yet

169
Q

Hemorrhagic Stroke - Problems and Potential Complications: Why may hyponatremia occur?

A

After a subarachnoid hemorrhage, half patients have this. Important to check labs.

Not sure why this happens.

170
Q

Hemorrhagic Stroke - Planning: Goals may incldue what?

A

Improving cerebral tissue perfusion

Relief of sensory and perceptual deprivation

Relief of anxiety

Absence of complications

171
Q

Hemorrhagic Stroke - Aneurysm Precautions: What type of movement will they have?

A

Need to be left alone. Absolute bed rest.

172
Q

Hemorrhagic Stroke - Aneurysm Precautions: Stimulation may cause what to happen”?

A

ICP to increase causing further damage.

173
Q

Hemorrhagic Stroke - Aneurysm Precautions: Elevating HOB does what?

A

Elevating to 30 degrees helps promote venous drainage or flat to increase cerebral perfusion

174
Q

Hemorrhagic Stroke - Aneurysm Precautions: What should be avoided?

A

All activity that may increase ICP or BP. Valsalva Maneuver causes them to vagal down. No acute flexion or rotation of bed.

Also make sure to exhale trough mouth when voiding or defecating

175
Q

Hemorrhagic Stroke - Aneurysm Precautions: WHo provides care?

A

Nurse provides all personal care and hygiene. Do not want to stress the patient

176
Q

Hemorrhagic Stroke - Aneurysm Precautions: What environement will they be in?

A

Nonstimulating, nonstressful. Dim lights. No tv, no reading, no radio.

177
Q

Hemorrhagic Stroke - Aneurysm Precautions: What should be restriction?

A

Constipation and visitors. Want calm environment

178
Q

Hemorrhagic Stroke - Interventions: What will this include?

A

Relief sensory deprivation and anxiety
Deep sensory stimulation to a minimum for aneurysm precautions

Patient and fam education

Support and reassurance (Pt and Fam)

Seizure precautions

strategies to regain and promote self-care during rehabilitation.

179
Q

Hemorrhagic Stroke - Interventions: Famiily education why?

A

If child had AVM. mom and dad won’t be about no visitors. But you have to tell them why this must happen.

180
Q

Hemorrhagic Stroke - Interventions: Seizure precaution how?

A

Oral airway at side. Bumpers and pads on the side of the bed.

181
Q

Hemorrhagic Stroke - Home Care and Education for Patient Recovering from Stroke: What is huge here?

A

Preventing the stroke and complications to begin with.

182
Q

Hemorrhagic Stroke - Home Care and Education for Patient Recovering from Stroke: If on Aspirin or Coumadin, what must be done?

A

Education. If on Coumadin, they must be on certain diet. Amount of green veggies they eat must be consistent everyday.

183
Q

Hemorrhagic Stroke - Home Care and Education for Patient Recovering from Stroke: What will this include?

A 
Preventing Signs of Complications
MEdication Regimen
Safety MEasures
Devices for ADLs
Nutrition
Elimination
Exercise and Activites
Socialization, Support Group, Ccommunity Resources
184
Q

Hemorrhagic Stroke - Home Care and Education for Patient Recovering from Stroke: What is included in nutrition?

A

Diet, swallowing techniques, tube feeding administration if they patient is able to swallow without aspirating.

185
Q

Hemorrhagic Stroke - Home Care and Education for Patient Recovering from Stroke: What to know for bowels and bladder?

A

If they cant’ do these, may need intermittent catherization.

Make sure that they are sterile when doing this to prevent UTIs/

NRSG 200: Med Surg 3 (46 decks)

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