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z_MS1_Neuro Study > GF4: Neuro Strokes and CVAs > Flashcards

GF4: Neuro Strokes and CVAs Flashcards

1
Q

What are the two main types of strokes?

A

Transient Ischemic Attack (TIA)

Cerebral Vascular Accident (CVA)

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2
Q

Describe the components of a TIA.

A
  • Transient: short time frame
  • Ischemic: low O2
  • Attack: happens suddenly
  • TIAs come and go and often resolve themselves
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3
Q

Describe a CVA.

A

No O2 causing long-term damage

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4
Q

What are the two types of CVA? Describe each.

A

Ischemic CVA: clot = blocked O2 to tissues

Hemorrhagic CVA: Bleed = ↑ICP

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5
Q

What are the two types of ischemic stroke?

A

Trombotic: via fatty deposit and atherosclerosis

Embolic: dislodged clot that travels to smaller vessel in brain and blocks it

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6
Q

What are some causes of hemorrhagic stroke?

A
  • HTN
  • Aneurysms
  • Blood thinners (overuse)
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7
Q

What is the patho of a CVA?

A
  • CVA happens when the brain lacks oxygen resulting in long-term permanent damage.
  • Typically resulting from a blood clot, narrowed blood vessels (arteriosclerosis) or a ruptured blood vessel (aneurysm).
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8
Q

What are the risk factors for a stroke?

A
  • HTN : #1RF, take meds regularly (ex. 142/94)
  • Smoking: scars the blood vessels making them weak
  • Hyperlipidemia: high cholesterol creates narrowed blood vessels
  • Uncontrolled diabetes: thick sugar in blood increases pressure on vessels
  • Use of birth control pills or estrogen hormone therapies
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9
Q

What are the non-modifiable risk factors for stroke?

A
  • Age >55
  • Black
  • Male
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10
Q

If a stroke pt presents w/ a BP over 200 systolic, how do we lower it and why?

A
  • Admin meds as ordered
  • Keep systolic BP over 170 for the first 24-48 hrs
  • This is to bring the rate down slowly so the system doesn’t go into shock from a rapid change
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11
Q

A severe headache is a symptom of what type of CVA?

A

Hemorrhagic

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12
Q

Why would a stroke pt be prescribed antiplatelet meds such as Plavix, Persantine or aspirin?

A

To promote blood flow and prevent/reduce clotting

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13
Q

Which type of stroke is the most common?

A

80% of all strokes are thrombotic/ischemic

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14
Q

Describe a lacunar acute ischemic stroke.

A

Small vessel perforates

Typically caused by chronic HTN, DM, Hyperlipidemia

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15
Q

What are the first signs of a stroke?

A

FAST

  • Facial/smile drip
  • Arm drift – one sided weakness
  • Speech impairment
  • Time to call 911, CT scan immediately!
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16
Q

What is a Carotid Endarterectomy?

A

Carotid endarterectomy is a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery

17
Q

What dx test is done to confirm stroke?

A

CT scan

18
Q

What is the pharmacological tx for a thrombolytic ischemic stroke?

A

Thrombolytics

TPA must be started w/in 3hrs of onset of symptoms

19
Q

What is tPA?

A
  • Tissue plasminogen activator
  • Aka a “Clot buster”
  • It catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown
  • Ex. alteplASE, streptokinASE
20
Q

What is the tPA calculation and how is it administered?

A
  • Formula = 0.9 mg/kg, not to exceed 90mg total dose
  • 10% of dose give IV bolus over 1min
  • Rest infused over 1hr
21
Q

What are common blood thinners that may be used to prevent further clotting in an ischemic stroke pt?

A
  • Heparin
  • Fragmin (no INR, PT, PTT needed)
  • Lovenox (no INR, PT, PTT needed)
22
Q

What do antifibriolytics do?

A

Help blood to clot

23
Q

What is the antidote for tPA and what are its side fx?

A
  • Amicar
  • Chest tight/pain
24
Q

After stabilization, what is the initial plan of care for a pt with suspected embolic stroke?

A
  • Obtain CT of head stat
  • Perform neuro assessment
  • Admin tPA w/in 3hrs of symptom onset
25
Q

What are some contraindications for use of tPA?

A
  • Symptom onset > 4.5hrs
  • Any present or hx of intracranial hemorrhage
  • GI bleeds w/in 21 days
  • Persistent elvated BP
  • Use of any anticoagulant drugs
26
Q

What lab values are contraindicated for tPA use?

A
  • Platelets < 100,000
  • INR > 1.7
  • aPTT > 40
  • PT > 15
27
Q

True or False

PTs w/ hemorrhagic stroke are treated w/ tPA to resolve the issue.

A

False, it would exacerbate the bleeding

28
Q

What is our immediate care for hemorrhagic stroke pts?

A
  • Implement seizure precautions
  • Strict bed rest
  • Limit ANY activity that may increase ICP
29
Q

Why may stool softeners be prescribed for a stroke pt?

A

To prevent straining and bearing down during bowel movements which would increase ICP

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