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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
what are some symptoms of a stroke
**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
what are some generalized findings of a stroke
- HTN - headache - vomiting - seizures - change in mental status - fever - changes in EKG
27
what are some early warning signs of a stroke
- TIA - transient hemiparesis - loss of speech - hemisensory loss - severe occipital/nuchal HA - vertigo/syncope - transient paralysis - retinal hemorrhage
28
describe what happens with left hemispheric stroke
- paralysis or weakness of right side of body - right visual field deficit - aphasia (expressive, receptive, or global) - altered intellectual ability - slow, cautious behavior
29
describe what happens with a right hemispheric stroke
- 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
whats included in the assessment of a stroke
- careful history - neuro exam - airway patency - CV status - neurologic deficits
31
descrieb the careful history taken for stroke assessment
- warning signs include TIA (loss oc circulation for a brief moment, resolves within 24hrs) - BP maintenance - sx of afib and management of afib
32
describe the neuro exam for stroke assessment
- cranial nerves, muscle strength, drift - facial droop, drooling, reflexes
33
when talking about airway patency, whats a person having a stroke at risk for?
aspiration
34
what are some neurological deficits found upon stroke assessment
drooping, paralysis, weakness
35
what are some diagnostic tests for stroke assessment
- 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
whats the drug given for strokes and what are the guidelines for it
TPA be sure to ask when the patient was last known to be normal, has to be given in a 3-4hr window
37
whats included in the primary prevention of stroke
- 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
whats included in secondary prevention of stroke
- adequate BP control - check cholesterol - care of DM - treatment of CV disease, TIA, and afib
39
what are some modifiable stroke risk factors
- hyperlipidemia - cigarette smoking - heavy alcohol consumption - cocaine use - obesity - women of chilbearing years (pregnancy/birth control) - unhealthy diet - physical activity
40
what are some non-modifiable stroke risk factors
- genetics/family history - advancing age - women > men - sickle cell - race ethnicity (african americans, american natives) - carotid stenosis
41
what are some major stroke risk factors
- **hypertension (leading cause)** - CV disease - diabetes - prior strokes/TIA - high cholesterol - sickle cell disease
42
whats included in the medical management of strokes
**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
describe nursing management of strokes
- 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
post giving tPA, whatre you gonna watch for
bleeding
45
whats super important for stroke management
early recognition and intervention
46
describe FAST
**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
describe hemorrhagic stroke
- 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
describe rehab after a stroke
relearning can take place - need early rehab interdisciplinary management: - physical therapy - occupational therapy - speech therapy - case management

adults (51 decks)

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