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Med Surg > Ischemia Stroke > Flashcards

Ischemia Stroke Flashcards

1
Q

Ischemic Stroke

A

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

Isc = back/stop
hemic = blood
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2
Q

Thrombolytic Therapy

A

is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

Throm = blood cot
lytic = breakdown/dissolve
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3
Q

Early treatment with thrombolytic therapy for ischemic stroke results in ____ stroke symptoms and ___ loss of function

A

fewer, less

Treatment window is 3 hours after the onset of a stroke, and scientific statements expanded use for up to 4.5 hours

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4
Q

Symptoms of Ischemic Stroke

A
  • Numbness or weaknes of the face, arm, or leg, especially on one side of the body.
  • Confusion or change in mental status
  • Trouble speaking or understanding speech
  • Visual disturbances
  • Difficulty walking, dizziness, or loss of balance or coordination
  • Sudden severe headache
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5
Q

Causes of Ischemic Stroke

A

-Large artery thrombosis
-Small penetrating artery
-Cardiogenic embolic
-Cryptogenic (no known cause)
Other

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6
Q

Large artery thrombotic strokes

A

are caused by atherosclerotic (build up fats, cholesterol and other subsatnces) plaques in the large blood vessels of the brain. Thrombus formation and occlusion (blood clot formtion and bloackage) at the site of the atherosclerosis result in ischemia and infarction (tissue necrosis in an area deprived of blood supply) (@0%)

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7
Q

Small penetrating artery thrombotic strokes

A

affect one or more vessels and are a common type of ischemic stroke. Small artery thrombotic strokes are also called lacunar strokes because of the cavity that is created after the death of infarcted brain tissue. (25%)

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8
Q

Cardiogenic embolic strokes

A

are associated with cardiac dysrhythmias, usually atrial fibrillation (an irregular and often rapid heart rate when two upper chambers of the heart experience chaotic electrical signals). Embolic strokes can also be associated with valvular heart disease and thrombi in the left ventricle. Emboli originate from the heart and circulate to the cerebral vasculature, most commonly the left middle cerebral artery, resulting in a stroke. Embolic strokes may be prevented by the use of anticoagulation therapy in patients with atrial fibrillation. (20%)

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9
Q

Cryptogenic strokes

A

cryptogenic strokes, which have no known cause, and strokes from other causes, such as illicit drug use (cocaine), coagulopathies, migraine/vasospasm, and spontaneous dissection of the carotid or vertebral arteries. (30%)

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10
Q

The Ischemic Cascade

A

is series of cellular metabolic events. It begins when cerebral blood flow decreases to less than 25 mL per 100 g of blood per minute.
1st - At this point, neurons are no longer able to maintain aerobic respiration
2nd - The mitochondria must then switch to anaerobic respiration, which generates large amounts of lactic acid, causing a change in the pH.

3nd - This switch to the less efficient anaerobic respiration also renders the neuron incapable of producing sufficient quantities of adenosine triphosphate (ATP) to fuel the depolarization processes.

4th - The membrane pumps that maintain electrolyte balances begin to fail, and the cells cease to function

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11
Q

Penumbra Region,

A

an area of low cerebral blood flow that exists around the area of infraction (death of tissue because of lack of blood fow). The ischemic brain tissue can be salvaged with timely intervention.

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12
Q

The results of depolarization of the cell wall leads to increase intracellular calcium and glutamate and if continued_____

A

leads to the destruction of the cell membrane. Which enlarge the infarction into the penumbra extending the stroke,

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13
Q

The ischemic brain ages _____ each hour without treatmen

A

3.6 years

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14
Q

The penumbra area may be revitalized by administartion of ________.

A

tissue plasminogen activator (t-PA).

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15
Q

Neuroprotectants.

A

medications that protect the brain from secondary injury.

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16
Q

A storke on the left upper motor neuron region of the brain effects what side of the body?

A

Right side of the body because he upper motor neurons decussate (cross).

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17
Q

The most common motor dysfunction is_____?

A

hemiplegia Paralysis of one side of the body, or part of it caused by a lesion of the opposite side of the brain

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18
Q

Hemiparesis

A

weakness of one side of the body, or part of it, is another sign.

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19
Q

Aphasia

A

a = not
hasia = speak
inability to express oneself or to understand language

20
Q

Dysarthria

A

dys = difficult
arthria = articulation
difficulty in speaking cause caused by paralysis of the muscles responsible for producing speech.

21
Q

Dysphasia

A

dys = difficult
sphasia = spoken
impaired speech caused by paralysis of the muscles responsible for producing speech.

22
Q

Expressive Aphasia

A

inability to express oneself.

23
Q

Receptive Aphasia

A

inability to understand language

24
Q

Global Aphasia

A

mixed aphasia

25
Q

Hemianopsia

A

blindness in half of the visual field in one or both eyes may occur from stroke and may be temporary or permanent. The affected side of vision corresponds to the paralyzed side of the body.

26
Q

Visual–Spatial

A

perceiving the relationship of two or more objects in spatial area) are frequently seen in patients with right hemispheric damage.

27
Q

Anosia

A

s the loss of the ability to recognize objects through a particular sensory system; it may be visual, auditory, or tactile.

28
Q

Initial assessment focuses on

A
  • airway patency, which may be compromised by loss of gag or cough reflexes and altered respiratory pattern.
  • cardiovascular status including blood pressure, cardiac rhythm and rate, carotid bruit.
  • neurologic deficits..
  • reful history eliciting the last time the patient was seen well.
  • neurologic examination
29
Q

Transient ischemic attack

A

TIA is a neurologic deficit typically lasting 1 to 2 hours. A TIA is manifested by a sudden loss of motor, sensory, or visual function. Neurological deficits resolve within 24 hours.

30
Q

Symptoms for TIA

A

result from temporary ischemia (impairment of blood flow) to a specific region of the brain; however, when brain imaging is performed, there is no evidence of ischemia

31
Q

t-PA

A

Tissue plasmingoen activator

A thrombolytic agent used to treat ischemic stroke by binding to fibrin and converting plasminogen to plasmin, which stimulates fibrinolysis (dissolving) of the clot. Basically to dissolve clots and restore perfusion (blood flow) to the brain.

Given within 3 hours reduces the size of the strole and improvement in function outcome after 3 months. The goal is to be given within 60 minutes of patient arriving to the ED.

Patients may be prescribed an antiplatelet (antiblood clots) drug at discharge, such as clopidogrel (plavix).

32
Q

Intra-Arterial Delivery of t-PA

A

can allow for higher concentrations of the drug to be given directly to the clot, and the time window for treatment may be extended up to 6 hours.

33
Q

Example of a standard protocolwould be to obtain vital signs every __ minutes for the first 2 hours, every __ minutes for the next 6 hours, then ___ hour until 24 hours after treatment

A

15, 30, every

34
Q

What are interventions can reduce ICP from brain edema?

A
  • To reduce increased intracranial pressure by administering an osmotic diuretic (mannito).
  • Providing supplemental oxygen if oxygen saturation is below 95%
  • Elevation of the head of the bed to 30 degrees to assist the patient in handling oral secretions and decrease ICP
  • Possible hemicraniectomy for increased ICP from brain edema in a very large stroke
  • Intubation with an endotracheal tube to establish a patent airway, if necessary
  • Continuous hemodynamic monitoring
  • Frequent neurologic assessments to determine if the stroke is evolving and i complications seizures, bleeding from anticoagulation, or medication-induced bradycardia, which can result in hypotension and subsequent decreases in cardiac output and cerebral perfusion pressure
35
Q

Carcinoembryonic antigen

A

s the removal of an atherosclerotic plaque or thrombus from the carotid artery to prevent stroke in patients with occlusive disease of the extracranial cerebral arteries.

36
Q

Carotid artery stenting

A

is a less invasive procedure that is used for treatment of carotid stenosis. This procedure has less discomfort for the patient and a shorter recovery time than CEA.

37
Q

Lack of awareness or deficits (shortage) occur with a ____ hemishpere stroke

A

right

38
Q

Patients suffering from a left hemisphere stroke exhibit ___ and ____ ____.

A

slow, catious behavior

39
Q

Reversible Ischemic neurological disorder

A

(RIND) Symptoms last longer than 24 hours with a return to normal function.

40
Q

Embolic

A

A dislodged clot. Blood clots or debris become lodged in the cerebral circulation.
The usual source of the emboli is the heart. Atrial fibrillation is a major cause.
Often occurs during activity or when BP is elevated
Often seen in younger patients
Adrupt onset

41
Q

Thrombotic

A

Clot: atheroaclerosis. Plaque forms rough, irregular surfaces allowing platelets to adhere & clum, forming a clot that narrows the lumen size.
Ususally proceded by TIA &RINDs
Offten occur during sleep & first noticed upon waking
Neurologiclal deficits are not maximal at onset but increse in severity over minutes to hours.

42
Q

Normal cerebral blood flow is?

A

40-50ml/100g/min

43
Q

Oligemia

A

A deficiency of blood in the body or any organ or tissue. 30-40

44
Q

Mild Ischemia

A

is a reduction of oxygen-rich blood supply to the heart muscle. 20-30

45
Q

Penumbra

A

s the area surrounding an ischemic event such as thrombotic or embolic stroke. Immediately following the event, blood flow and therefore oxygen transport is reduced locally, leading to hypoxia of the cells near the location of the original insult. 10-20

46
Q

Epicenter of a stoke

A

0-10 irreversible brain damage.

Med Surg (5 decks)

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