Hemorrhagic stroke Flashcards by Yaz Bassi

What are the two types of hemorrhage stroke

intracerebral
subarachnoid

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What occurs in a subarachnoid hemorrhage

the bleeding occurs in the subarachnoid space, directly into the cerebrospinal fluid

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What occurs in a intracerebral hemorrhage

the bleeding occurs within the tissues of the brain

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What is the most common type of hemorrhage stroke

intracerebral

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What are the risk factors for a intracerebral hemorrhage stroke

HTN, older age, anticoagulants or antiplatelets drugs, trauma, bleeding disorders or illicit drug use

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What are subarachnoid hemorrhages caused by

rupture of a saccular (berry) aneurysm also can be due to trauma, bleeding disorder, and illicit drug use

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What are the major risk factors for subarachnoid hemorrhage

cig smoking, HTN, family HX

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Manifestations of a intracerebral hemorrhagic stroke

may occur with exertion or emotions
gradual onset
HA, vomiting, loss of conciousness
possible seizures

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Manifestations of a subarachnoid hemorrhagic stroke

comes on quickly
thunderclap HA
neck pain or stiffness
vomiting
brief loss of conciousness

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After a subarachnoid hemorrhage, clients often experience vasospasm in the brain. What medication is used to prevent this complication?
 Oral nimodipine
 Intravenous labetolol
 Oral ramipril
 Intravenous nitroglycerine

 Oral nimodipine

calcium channel blocker, and it acts to relax the smooth muscle in arteries… and specifically the arteries in the brain

IV admin can cause severe cardiovascular events including death

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When managing BP in a client with a hemorrhagic stroke, if the patient has a BP of 220 systolic what is the goal BP

140-160

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When managing BP in a client with a hemorrhagic stroke, if the patient has a BP of 150-220 systolic what is the goal BP

approx 140

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Why is it important to avoid lowering a patients BP below 140 if they have a hemorrhagic stroke

the brain needs a blood pressure great enough to perfuse their brain. This is called cerebral perfusion pressure

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What MAP does autoregulation work best with

50-150 mm Hg

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In autoregulation, if the cerebral BP becomes too high what will happen

The cerebral blood vessels will constrict to prevent too much blood from entering the brain

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In autoregulation, if cerebral BP becomes too low what will happen

cerebral blood vessels will dilate to encourage more blood flow

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Which factor has the strongest influence on causing arteries in the brain to DILATE, increasing blood flow to
the brain?
 Elevated blood glucose levels
 Elevated blood pH
 Elevated levels of oxygen in the blood
 Elevated levels of carbon dioxide in the blood

 Elevated levels of carbon dioxide in the blood

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What happens to arteries in the brain when CO2 is elevated

they dilate!

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What do arteries in the brain do if CO2 is reduced

constrict

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What is another antidote for Warfarin that is quicker than Vitamin K

4-factor prothrombin complex concentrate (PCC)

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A nurse is reviewing the doctor’s orders for a client with a hemorrhagic stroke. Which order for IV fluids
should the nurse QUESTION?

 Normal saline
 Hypertonic saline
 5% dextrose in water
 Intravenous mannitol

 5% dextrose in water

Hypotonic solutions should be avoided at all times in people with hemorrhagic strokes as they can make cerebral edema worse

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In patients who have been admitted for a hemorrhagic stroke, what intervention is helpful to prevent thromboembolism?

The use of pneumatic compression devices

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IF the pressure in the brain is increasing, what might be administered to help this

a hypertonic solution such as mannitol or osmotic diuretics

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what are two common causes of fever in stroke patients

UTI and aspiration pneumonia

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If a hemorrhagic stroke damages the pituitary gland and causes SIADH, what clinical manifestations should the nurse watch for?  Hypokalemia, dysrhythmias, and reduced glomerular filtration rate  Hypernatremia and low urine osmolality  Oliguria, confusion, and low serum osmolality  High urine output and high serum osmolality

 Oliguria, confusion, and low serum osmolality

What three components make up the inside of the skull

brain tissue blood CSF

If a client with a head injury develops an epidural hematoma, where is the blood accumulating?  Outside of the membrane (dura mater) surrounding the brain  Between the dura mater and the arachnoid membrane  Below the dura mater that surrounds the brain  Inside the brain tissue (parenchyma)

 Outside of the membrane (dura mater) surrounding the brain

Subdural hematomas can be either

chronic developing slowly or acute occuring suddenly

What is the first sign of increased ICP

subtle changes in LOC (anxiety, agitations or cognition changes)

what are common signs of increased ICP excluding LOC changes

HA, nausea and sudden vomiting that might not be preceded by nausea, changes in vision, drowsiness

What happens initially to pupils when ICP increases

first, the pupil on the affect side dilates, than if it keeps increasing the other side with dilate aswell. If not treated, as more pressure builds up the pupils will stop responding to light and become fixed and dilated.

What is the cushing triad

elevation of systolic BP (greater pulse pressure), bradycardia and irregular respirations.

What is decorticate positioning

arms flexed into the body

what is decerebate positioning

arms extended out by side

What is brainstem herniation

fatal condition which occurs when there is so much ICP, it begins trying to push some of the brain out of the skull to make more room.

What is passing out during the Valsalva manoeurve due to

Low BP and reduced oxygen to the brain

What happens in the stages of the valsalva manoeuvre

Phase 1: ↑ Pressure → ↑ BP Phase 2: ↓ Venous return → ↓ BP → ↑ HR Phase 3: Release → brief ↓ BP Phase 4: Blood rushes back → ↑ BP → reflex ↓ HR

What should be given to the patient to prevent straining during pooping

give a stool softner such as docusate sodium

In what position should a nurse position a client who is at risk for increased intracranial pressure?  Trendelenburg  Supine  Head of bed elevated 30  High Fowlers

 Head of bed elevated 30

because sneezing and coughing increase ICP what should the nurse admin

a antitussive to prevent coughing, codeine may be used.... or a antihistamine to prevent sneezing

A nurse is caring for a client with a ventriculostomy drain. At what level should the nurse place the zero line on the drain / transducer?  Level with the client’s heart  Level with the client’s ear  Level with the client’s nares  Level with the tip of the client’s chin

 Level with the client’s ear This is the same level as the ventricles inside the brain where CSF accumulates

What are some stratgies to short term reduce ICP

- induce hyperventilation which will drop CO2 levels and cause vasoconstriction =less ICP. - in patients with severe HTN only, you could give a anithypertensive - reduce fluid volume

What does IV mannitol do

osmotic diuretic, so it pulls free water out of the tissues of the brain into the blood circulation

What are ways that fluid volume in the brain could be reduced with medications

IV mannitol Hypertonic Saline IV furosemide

Fever and chills can increase ICP so what would the nurse what to administer

antipyretics such as acetaminophen. NOT Ibuprofen as this increases risk for bleeding

When are glucocorticoids such as dexamethasone not helpful in decrease ICP

if it is caused by bleeding! (hemorrhagic stroke)

In the ICU, what might be given to decrease ICP by reducing brain metabolism and reducing SNS stimulation

sedative or barbs such as propofol or pentobaribital

What is a decompressive craniectomy

Bone flap is removed and dura mater is opened to allow the brain to swell. Then... A second surgery is needed later on, to close the opening in the skull

Whats a coup head injury

The brain strikes the skull on the side of impact

A GCS score of 13-15 indicates

mild brain injury scoring

Whats a contracoup head injury

Brain sloshes over and smacks the other side of the skull opposite of the impact causing another injury.

A GCS scoring of 9-12 indicates

moderate brain injury

A GCS of 8 or less indicates

severe tramatic brain injury

If a nurse is caring for a client with a basilar skull fracture, what intervention should the nurse AVOID?  Insertion of a nasogastric tube  Administration of greater than 6 L/min supplemental oxygen  Insertion of a urinary catheter  Administration of analgesics

 Insertion of a nasogastric tube

clinical manifestation of a concussion

loss of conciousness, confusion, lack of awareness, amnesia, HA, dizziness, N/V

What are the most common manifestations of post-concussion syndrome

HA, Dizziness, fatigue, insomnia, loss of concentration and memory, noise sensitivity

What treatments are provided for post concussion syndrome

symptoms management such as analgesics or migraine medications for HA. Counselling Tmt for seizures as risk increases for first 5 years

 What is a normal ICP? .

5-15 mmHg

 What is an abnormally elevated ICP?

20 mmHg or more.

What is autoregulation

Automatic alteration in the diameter of the cerebral blood vessels.

how do you calculate cerebral perfusion pressure

CPP = MAP – ICP.

Is Cushing’s Triad an early or late sign of increased ICP?

late

 What are the characteristics of vomiting caused by increased ICP?

Not preceded by nausea.

What diagnostic test SHOULD NOT be performed when a client is thought to have increased ICP (due to the risk for brain herniation)? .

Lumbar puncture

What is a ventriculostomy?

Gold standard for monitoring for ICP. - A catheter is inserted into the lateralventricle and coupled to an external transducer. - used to monitor ICP

 What should the nurse record if it’s not possible to assess an area

not testable

 What type of brain injury is a concussion?

Diffuse injury.

o What do healthcare providers need to know about the fencing response?

Fencing response is an involuntary tensing of fist from a moderate brain injury.