Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NCM 116 Lecture > Midterms_ CVA > Flashcards

Midterms_ CVA Flashcards

1
Q

an ischemic stroke or“brain attack, ” is a sudden loss of brain function resulting from Cerebral Vascular Accident (Ischemic Stroke) disruption of the blood supply to a part of the brain.

A

cerebrovascular accident (CVA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

FIVE CLASSES OF STROKE BY SEVERITY LEAST TO MOST SEVERE

A

TRANSIENT ISCHEMIC ATTACK (TIA) “ANGINA OF THE BRAIN

REVERSIBLE ISCHEMIC NEUROLOGICAL DEFICIT (RIND)

PARTIAL, NON PROGRESSING STROKE

PROGRESSING STROKE (STROKE IN EVOLUTION)

COMPLETED STROKE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

a warning sign of stroke
- localized ischemic event
- produces neurological deficits lasting only
minutes or hours.
- full functional recovery within 24-48 hours.

A

TRANSIENT ISCHEMIC ATTACK (TIA) “ANGINA OF THE BRAIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

similar to TIA
- finding lasts between 24 hours and three weeks
- usual functional recovery within three to four
weeks

A

REVERSIBLE ISCHEMIC NEUROLOGICAL DEFICIT (RIND)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

some neurological deficit, but stabilized

A

PARTIAL, NON PROGRESSING STROKE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

deterioration of neurological status often with grand mal seizure activity.
- has residual neurological deficits that last indefinitely.

A

PROGRESSING STROKE (STROKE IN EVOLUTION)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

results from a stroke in evolution.

A

COMPLETED STROKE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TWO TYPES OF STROKE BY“CAUSE”

A

Ischemic Stroke
Hemorrhagic Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

stroke commonly results from occlusion of the lumen of the cerebral vessels by a thromboembolism.
Systemic hemodynamic failure can also result in ischemic stroke as a consequence of a decreased volume of blood flowing through the cerebral vessels.

A

Ischemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 Ischemic Etiologies

A

Embolic
Thrombotic
Lacunar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cardiogenic emboli are a common source of recurrent stroke. They may account for up to 20% of acute strokes and have been reported to have the highest 1-month mortality.

A

Embolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Large-artery infarctions often involve thrombotic in situ occlusions on atherosclerotic lesions in the carotid, vertebrobasilar, and cerebral arteries, typically proximal to major branches; however, large-artery
Infarctions may also be cardioembolic.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Small vessel or lacunar strokes are associated with small focal areas of ischemia due to obstruction of single small vessels, typically in deep penetrating arteries, that generate a specific vascular pathology.

A

Lacunar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MANIFESTATIONS OF ISCHEMIC STROKE

A

Symptoms depend upon the location and the size of the affected area.
● Numbness or weakness of face, arm, or leg, especially on one side.
● Confusion or change in mental status
● Trouble speaking or understanding speech
● Difficulty in walking, dizziness, or loss of balance
or coordination
● Sudden severe headache
● Perceptual disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

typically results from the rupture of a cerebral vessel.
● abrupt onset
● occurs most often in hypertensive older adults

A

HEMORRHAGIC STROKE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HEMORRHAGIC STROKE

CLASSIFIED INTO TWO SUBTYPES:

A
  1. Intracerebral
  2. Subarachnoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

hematoma is formed within the brain parenchyma with or without blood extension into the ventricles.

A

● Intracerebral hemorrhage (ICH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

life-threatening and result from the accumulation of blood between the arachnoid and the pia mater.

traumatic in nature.

A

Subarachnoid hemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

presenting symptom is the thunderclap headache, which clients may describe as the “worst headache of my life”

A

Subarachnoid hemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hemo Stroke May be due to spontaneous rupture of small vessels primarily related to:

A

Hypertension
- subarachnoid hemorrhage due to ruptured
aneurysm
- or intracerebral hemorrhage related to amyloid
angiopathy, arteriovenous malformations
(AVMs), intracranial aneurysms,
- or medications such as anticoagulants or
thrombolytic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

most often caused by rupture of saccular intracranial aneurysms.
- more than 90 % are congenital aneurysms

A

SUBARACHNOID HEMORRHAGE (SAH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

cerebral arterial vessels are involved. often loss of consciousness for a short period of time called transient unconsciousness

A

Epidural Bleeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

vein are involved may not be evident until months after an initial trauma

A

Subdural Bleeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MANIFESTATIONS OF HEMORRHAGIC STROKE

A

● Similar to ischemic stroke
● Severe headache
● Early and sudden changes in LOC
● Vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
RISK FACTORS Modifiable
Hypertension ● Atrial fibrillation ● Hyperlipidemia (elevated cholesterl, triglyceride) ● Obesity ● Smoking ● Diabetes ● Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis, prosthetic heart valves) ● Periodontal disease ● illicit drug use (esp cocaine) Bleeding Disorder/ anticoagulant use
26
Nonmodifiable risk factors
● Advanced age (older than 55 years) ● Gender (Male) ● Race (African American)
27
Recognizing Stroke: BE FAST
Balance Eyes Face Arms Soeech Time
28
General signs and symptoms include
numbness or weakness of face, arm, or leg (especially on one side of the body); confusion or change in mental status; trouble speaking or understanding speech; visual disturbances;loss of balance, dizziness, difficulty walking; or sudden severe headache.
29
CLINICAL MANIFESTATIONS
1.Motor loss 2. Communication Loss 3. Perceptual disturbances and sensory loss 4. Impaired cognitive and psychological effects 5. Localizations
30
Diagnostic Findings
CT scan. PET scan Cerebral angiography. Lumbar puncture. CSF total protein level Transcranial Doppler ultrasonography. EEG Skull x-ray ECG Laboratory studies to rule out systemic causes: CBC, platelet and clotting studies, VDRL/RPR, erythrocyte sedimentation rate (ESR),chemistries (glucose, sodium).
31
is one of the most useful tests in evaluating patients with stroke. Increasingly, it is being performed earlier in the evaluation, not only to define the cause of the stroke but also to stratify patients for either medical management or carotid intervention if they have carotid stenoses. Patients with symptomatic critical stenoses on carotid duplex scanning may require anticoagulation before intervention is performed. is one of the most useful tests in evaluating patients with stroke. Increasingly, it is being performed earlier in the evaluation, not only to define the cause of the stroke but also to stratify patients for either medical management or carotid intervention if they have carotid stenoses. Patients with symptomatic critical stenoses on carotid duplex scanning may require anticoagulation before intervention is performed.
Carotid duplex scanning
32
Medical Management
1. Recombinant tissue plasminogen activator 2. Increased ICP. 3. Endotracheal Tube. 4. Hemodynamic monitoring 5. Neurologic assessment
33
would be prescribed unless contraindicated, and there should be monitoring for bleeding.
34
Management of increased ICP
includes osmotic diuretics, maintenance of PaCO2at 30-35mmHg,and positioning to avoid hypoxia through elevation of the head of the bed.
35
There is a possibility of intubation establish patent airway if necessary
Endotracheal Tube
36
should be implemented to avoid increasing blood pressure.
Hemodynamic monitoring.
37
to determine if the stroke is evolving and if other acute complications are developing
Neurologic assessment
38
Stroke: Emergency Treatment • ischemic stroke
emergency treatment focuses on medicine to restore blood flow. A clot-busting medication is highly effective at dissolving clots and minimizing long-term damage, but it must be given within three hours of the onset of symptoms.
39
Stroke: Emergency Treatment Hemorrhagic strokes
are more difficult to manage. Treatment usually involves attempting to control high blood pressure, bleeding, and brain swelling.
40
Treatment ICH
Pharmacologic • antihypertensive agents : alpha-blockers and beta- blockers • systemic steroids: dexamethasone (Decadron) • osmotic diuretics: mannitol • antifibrinolytic agents: aminocaproic acid (Amicar) • vasodilators • anticonvulsants • Recombinant factor VIlla (rFVlla) therapy • Reverse coagulopathies • Vitamin K. FFP, Platelets
41
treatment ICH
Neurosurgical ICU • Constant monitoring • Bedrest • Pain control • Reverse coagulopathies • Vitamin K, FFP, Platelets • ICP control • Mannitol, Induced Coma, Hyperventilation
42
Treatment of SAH
• Neurosurgical ICU • Constant monitoring • Bedrest • Pain control • Reverse coagulopathies • VT Prophylaxis • Blood Pressure Management • Management of Aneurysms/AVMs
43
Treatment Common to both types of stroke • care based on findings
nutritional support • physical • speech • behavioral • Occupational
44
Benchmarks for Potential Thrombolysis Candidate.
Time interval. Time Target Door to doctor 10 min Access to neurologic expertise 15 min Door to CT scan completion 25 min Door to CT scan interpretation 45 min Door to treatment 60 min Admission to monitored bed 3 h
45
General Management of Patients with Acute Stroke
Blood glucose Blood pressure Cardiac monitor Intravenous fluids Oral intake Oxygen Temperature
46
Management:Blood Glucose
Treat hypoglycemia with D50 Treat hyperglycemia with insulin if serum glucose >200 mg/dL
47
Management: BP
See recommendations for thrombolysis candidates and noncandidates
48
Management: Cardiac Monitor
Continuous monitoring for ischemic changes or atrial fibrillation
49
Management: IV Fluids
Avoid D5W and excessive fluid administration IV isotonic sodium chloride solution at 50 mL/h unless otherwise indicated
50
Management: Oral Intake
NPO initially; aspiration risk is great, avoid oral intake until swallowing assessed Supplement if indicated (Sa02 <90%, hypotensive etc)
51
Management: Oxygen
Supplement if indicated (Sa02 <90%, hypotensive etc)
52
Management: Temperature
Avoid hyperthermia, oral or rectal acetaminophen as needed
53
SURGICAL MANAGEMENT
1, Carotid endarterectomy. 2. Hemicraniectomy
54
This is the removal of atherosclerotic plaque or thrombus from the carotid artery to prevent stroke in patients with occlusive disease of the extracranial cerebral arteries.
Carotid endarterectomy
55
may be performed for increased ICP from brain edema in severe cases of stroke.
Hemicraniectomy
56
NURSING ASSESSMENT
ACUTE PHASE (1-3 DAYS) POST ACUTE PHASE
57
ACUTE PHASE (1-3 DAYS)
Weigh patient (used to determine medication dosages), and maintain a neurologic flowsheet to reflect the following nursing assessment parameters: ● Change in level of consciousness or responsiveness, ability to speak, and orientation ● Presence or absence of voluntary or involuntary movements of the extremities: muscletone, body posture, and head position ● Stiffness or flaccidity of the neck ● Eye opening, comparative size of pupils and pupillary reactions to light, and ocular position ● Color of face and extremities; temperature and moisture of skin ● Quality and rates of pulse and respiration; ABGs, body temperature, and arterial pressure ● Volume of fluids ingested or administered and volume of urine excreted per 24 hours ● Signs of bleeding ● Blood pressure maintained within normal limits
58
POST ACUTE PHASE
Assess the following functions: ● Mental status (memory, attention span, perception, orientation,affect, speech/language) Sensation and perception (usually the patient has decreased awareness of pain and temperature). ● Motor control (upper and lower extremity movement); swallowing ability, nutritional and hydration status, skin integrity, activity tolerance, and bowel and bladder function.• ● Continue focusing nursing assessment on impairment of function in patient’s daily activities.
59
NURSING DIAGNOSES
★ Impaired physical mobility related to hemiparesis, loss of balance and coordination, spasticity, and brain injury ★ Acute pain related to hemiplegia and disuse ★ Deficient selfcare (bathing, hygiene, toileting, dressing,grooming, and feeding) related to stroke sequelae ★ Disturbed sensory perception (kinesthetic, tactile, orvisual) related to altered sensory reception, transmission,and/or integration ★ Impaired swallowing ★ Impaired urinary elimination related to flaccid bladder, detrusor instability, confusion, or difficulty in communicating ★ Disturbed thought processes related to brain damage ★ Impaired verbal communication related to brain damage ★ Risk for impaired skin integrity related to hemiparesis or hemiplegia,decreased mobility ★ Interrupted family processes related to catastrophic illness and caregiving burdens ★ Sexual dysfunction related to neurologic deficits or fear of failure
60
NURSING INTERVENTIONS in patients with stroke
1, Positioning 2. Prevent flexion 3. Prevent adduction 4.prevent edema 5. Full range of motion 6. Prevent venous stasis 7. regain balance 8. Personal Hygiene 9. Manage Sensory Difficulties 10.Visit a speech therapist 11. Voiding Patterns 12. be consistent in patients activities 13. Assess skin
61
Demonstrates structural abnormalities, edema, hematomas, ischemia, and infarctions.
CT SCAN
62
May not immediately reveal all changes, e.g., ischemic infarcts are not evident on CT for 8–12 hr; however, intracerebral hemorrhage is immediately apparent; therefore,emergency CT is always done before administering ________
tissue plasminogen activator (t-PA).
63
patients with TIA commonly have a NORMAL CT scan (T/F)
TRUE
64
Provides data on cerebral metabolism and blood flow changes
PET scan
65
Shows areas of infarction, hemorrhage, AV malformations, and areas of ischemia.
MRI
66
Helps determine specific cause of stroke, e.g., hemorrhage or obstructed artery, pinpoint site of occlusion or rupture. Digital subtraction angiography evaluates patency of cerebral vessels, identifies their position in head and neck, and detects/evaluates lesions and vascular abnormalities.
Cerebral angiography.
67
Pressure is usually normal andCSFisclear in cerebral thrombosis, embolism, andTIA.
Lumbar puncture
68
suggest subarachnoid and intracerebral hemorrhage.
● Pressure elevation and grossly bloody fluid
69
level may be elevated in cases of thrombosis because of the inflammatory process.
CSF total protein level
70
Evaluate The Velocity of blood flow through major intracranial vessels;identifies AV disease, e.g., problems with the carotid system(blood flow/presence of atherosclerotic plaques).
Transcranial Doppler ultrasonography
71
Identifies problems based on reduced electrical activity in specific areas of infarction; and can differentiate seizure activity fromCVAdamage.
EEG
72
May show a shift of pineal gland to the opposite side from an expanding mass; calcifications of the internal carotid may be visible in cerebral thrombosis; partial calcification of walls of an aneurysm may be noted in subarachnoid hemorrhage.
Skull x-ray
73
To rule out cardiac original source of embolus (20% of strokes are the result of blood or vegetative emboli associated with valvular disease, dysrhythmias, or endocarditis).
ECG and echocardiography.
74
to rule out systemic causes: CBC, platelet and clotting studies, VDRL/RPR, erythrocyte sedimentation rate (ESR),chemistries (glucose, sodium).
Laboratory studies
75
Provide a high fiber diet and adequate fluid intake (2 to 3 L/day), unless contraindicated (T/F)
TRUE

NCM 116 Lecture (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions