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management of patients with cerebrovascular disorders Flashcards

1
Q

terminology

agnosia

A

loss of ability to recognize obhects through a particular sensory system; may be visual, auditory, or tactile

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2
Q

terminology

aphasia

A

inability to express oneself or to understand language

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3
Q

terminology

apraxia

A

inability to perform previously learned purposeful motor acts on a voluntary basis

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4
Q

terminology

dysarthria

A

defects of articulationdue to neurologic causes

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5
Q

terminology

dysphagia

A

difficulty swallowing

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6
Q

terminology

expressive aphasia

A

inability to express oneself; often associated with damage to the left frontal lobe area

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7
Q

terminology

hemianopsia

A

blindness of half of the field of vision in one or both eyes

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8
Q

terminology

hemiparesis

A

weakness of one side of the body, or part of it, due to an injury in the motor area of the brain

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9
Q

terminology

hemiplegia

A

paralysis of one side of the body, or part of it, due to an injury in the motor area of the brain

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10
Q

terminology

receptive aphasia

A

inability to understand what someone else is saying; often associated with damage to the temproal lobe area

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11
Q

describe ischemic stroke

A
  • approximately 87%
  • occurs over minutes to hours to days
  • caused by thrombosis/emoblism
  • clot deposits in large vessels or small vessels (small vessles r/t diabetes, called lacunar)
  • incidence and mortalities have declined
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12
Q

describe hemorrhagic stroke

A
  • approximately 13%
  • rapid
  • occurs over minutes to hours
  • bleeding
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13
Q

describe thrombolytic therapy for ischemic strokes

A
  • prevents or limits the extent of brain tissue
  • must be administered ASAP after onset
  • treatment window 3-4.5hrs
  • referred to as “brain attack”
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14
Q

name the 5 types of ischemic strokes

A
  • large artery thrombotic
  • small penetrating artery thrombotic
  • cardiogenic embolic
  • cryptogenic
  • others: coagulotherapies, cocaine use, migraines/vasospasms, spontaneous dissection
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15
Q

describe large artery thrombotic strokes

A

atherosclerotic plaques

occur in carotid

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16
Q

describe small penetrating artery thrombotic strokes

A

lacunar - r/t diabetes

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17
Q

describe cardiogenic embolic strokes

A

r/t arrhythmias (afib)

emobolic r/t valvular diseases leads to left middle cerebral artery

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18
Q

describe cryptogenic strokes

A

idiopathic/no known cause

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19
Q

what are some thrombotic causes of ischemic strokes

A
  • atherosclerosis
  • bifurcation of common carotid
  • most common in diabetics
  • lacunar infarct from small vessels d/t HTN and diabetes
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20
Q

what are some embolic causes of ischemic strokes

A
  • travels from outside of brain and occludes cerebral artery
  • plaque
  • clot from afib
  • mechanical valves
21
Q

what are some covid-19 considerations for strokes

A
  • covid causes abnormal clotting
  • high d-dimer
  • less than 50 years of age
  • occurs in large blood vessels (carotid/midcerebral)
  • severe neurological deficits
22
Q

describe the pathophysiology of ischemic strokes

A

disruption of cerebral blood flow due to obstruction of blood vessel

cascade of events:
Decreased blood flow → loss of aerobic respiration → switch to anaerobic → creates lactic acid → change in pH → neurons cannot produce sufficient ATP for depolarization → failure of membrane to maintain electrolyte balance → loss of cellular function

23
Q

what kind of BP do you want for an ischemic stroke?

A

higher BP to get more blood to the brain

24
Q

what kind of BP do you want for hemorrhagic stroke?

A

low BP bc blood to getting out everywhere

25
Q

what are some symptoms of a stroke

A

Motor loss – Upper motor neuron lesion; disturbance of voluntary control on one side of body; hemiplegia, hemiparesis; decrease in deep tendon reflexes, flaccid paralysis, spasticity

Communication Loss – aphasia, dysarthria, expressive aphasia, receptive aphasia, apraxia
Perceptual disturbances – hemianopsia, loss of visual-spatial relations

Sensory loss – loss of proprioception, difficulty in interpreting tactile, visual, auditory stimuli, agnosia

Cognitive Impairment and psychological effects – limited attention span, difficulties in comprehension, forgetfulness, lack of motivation. Psych: frustration, depression, emotional ability, hostility, resentment, lack of cooperation, and others.

26
Q

what are some generalized findings of a stroke

A
  • HTN
  • headache
  • vomiting
  • seizures
  • change in mental status
  • fever
  • changes in EKG
27
Q

what are some early warning signs of a stroke

A
  • TIA
  • transient hemiparesis
  • loss of speech
  • hemisensory loss
  • severe occipital/nuchal HA
  • vertigo/syncope
  • transient paralysis
  • retinal hemorrhage
28
Q

describe what happens with left hemispheric stroke

A
  • paralysis or weakness of right side of body
  • right visual field deficit
  • aphasia (expressive, receptive, or global)
  • altered intellectual ability
  • slow, cautious behavior
29
Q

describe what happens with a right hemispheric stroke

A
  • paralysis or weakness on left side of body
  • left visual field deficit
  • spatial-perceptual deficits
  • increased distractibility
  • impulsive behavior and poor judgements, lack of awareness of deficits
30
Q

whats included in the assessment of a stroke

A
  • careful history
  • neuro exam
  • airway patency
  • CV status
  • neurologic deficits
31
Q

descrieb the careful history taken for stroke assessment

A
  • warning signs include TIA (loss oc circulation for a brief moment, resolves within 24hrs)
  • BP maintenance
  • sx of afib and management of afib
32
Q

describe the neuro exam for stroke assessment

A
  • cranial nerves, muscle strength, drift
  • facial droop, drooling, reflexes
33
Q

when talking about airway patency, whats a person having a stroke at risk for?

A

aspiration

34
Q

what are some neurological deficits found upon stroke assessment

A

drooping, paralysis, weakness

35
Q

what are some diagnostic tests for stroke assessment

A
  • CT wihtouf contrast (then with if not hemorrhagic)
  • MRI (changes not apparent until 8-12hrs after onset)
  • ECG (loof for afib)
  • transcranial doppler (see what blood flow is like)
  • carotid duplex (US -> look for blockage)
  • echo (clots in atria or vegetation or valves)
36
Q

whats the drug given for strokes and what are the guidelines for it

A

TPA

be sure to ask when the patient was last known to be normal, has to be given in a 3-4hr window

37
Q

whats included in the primary prevention of stroke

A
  • healthy diet - DASH (dietary approaches to stop hypertension)
  • engaging in physical activity
  • maintain ideal body weight
  • maintain safe cholesterol levels
  • smoking cessation
  • low dose estrogen birth control
  • reduce heavy alcohol intake
  • eliminate illicit drug use (cocaine = bad)
38
Q

whats included in secondary prevention of stroke

A
  • adequate BP control
  • check cholesterol
  • care of DM
  • treatment of CV disease, TIA, and afib
39
Q

what are some modifiable stroke risk factors

A
  • hyperlipidemia
  • cigarette smoking
  • heavy alcohol consumption
  • cocaine use
  • obesity
  • women of chilbearing years (pregnancy/birth control)
  • unhealthy diet
  • physical activity
40
Q

what are some non-modifiable stroke risk factors

A
  • genetics/family history
  • advancing age
  • women > men
  • sickle cell
  • race ethnicity (african americans, american natives)
  • carotid stenosis
41
Q

what are some major stroke risk factors

A
  • hypertension (leading cause)
  • CV disease
  • diabetes
  • prior strokes/TIA
  • high cholesterol
  • sickle cell disease
42
Q

whats included in the medical management of strokes

A

treatment of afib
- warfarin (INR 2-3)
- other anticoagulants (dabigatran, apixaban, edoxaban, rivaroxaban, aspirin, aspirin/clopidogrel)
- platlet inhibitors (aspirin, dipyridomole, clopidogrel)

statins

antihypertensives
- ACEs
- diuretics

thrombolytic therapy
- tPA

endovascular therapy

surgical prevention
- carotid endarterectomy (scrape out the carotid)

43
Q

describe nursing management of strokes

A
  • maintain a patent airway (elevate HOB, monitor for aspiration, swallow eval)
  • improving mobility/preventing joint deformity
  • preventing complications
  • preventing surgical complications
  • med administration
  • monitoring VS (monitor and maintain BP)
  • monitoring NIH stroke scale (score <5/42 is indicative of a minor stroke, want a low score)
  • enhancing self care
  • assisting with nutrition
  • maintain skin integrity (turn Q2)
  • assess with patient and family coping
  • maintain glucose control
44
Q

post giving tPA, whatre you gonna watch for

A

bleeding

45
Q

whats super important for stroke management

A

early recognition and intervention

46
Q

describe FAST

A

Face - ask the person to smile to look for facial droop
Arms - ask the person to raise both arms and look for drifiting
Speech - ask the person to repeat a simple phrase and assess for slurred or strange speech
Time - everything has to be taken care of speedy quick

47
Q

describe hemorrhagic stroke

A
  • rupture of ateriosclerotic and hypertensive vessels
  • often secondary to hypertension after age 50
  • reuptured aneurysms (2-6mm in diameter)
  • produces spasms of cerebral vessels and cerebral ischemia
  • extensive residual functional loss
  • slow recovery
  • 25-60% mortality

other causes include:
- cerebral arterial spasm
- hypercoagulable states - protein C&S deficiencies and disorders of clotting cascade

48
Q

describe rehab after a stroke

A

relearning can take place - need early rehab

interdisciplinary management:
- physical therapy
- occupational therapy
- speech therapy
- case management

adults (51 decks)

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