Module 9 Info To Know Flashcards
- reduced blood flow
Ischemic
-bleeding or release of broken blood vessel inside or outside the body.
Hemorrhagic
- formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system.
Thrombotic
-a sudden blockage of an artery.
Embolic
What is the definition of transient ischemia attack (TIA)?
A brief stroke-like attack that often resolves within minutes to hours. It requires immediate medical attention and may be a warning sign of future stroke.
What is the pathophysiology of an ischemic stroke?
Occurs when blood clots block or narrow an artery leading to the brain.
Caused by the occlusion (blockage) of a cerebral or carotid artery by either a thrombus or an embolus.
A stroke that is caused by a thrombus (clot) is referred to as a thrombotic stroke, whereas a stroke caused by an embolus (dislodged clot) is referred to as an embolic stroke.
Thrombotic strokes account for more than half of all strokes and are commonly associated with the development of atherosclerosis in either intracranial or extracranial arteries (usually the carotid arteries). Atherosclerosis is the process by which fatty plaques develop on the inner wall of the affected arterial vessel.
If PERFUSION to any part of the brain is interrupted for more than a few minutes, cerebral tissue dies (infarction). Brain metabolism and blood flow after a stroke can be affected around the infarction and in the contralateral (opposite side) hemisphere. Effects of a stroke on the nonaffected side may be the result of brain edema or global changes in PERFUSION in the brain.
As a result of brain edema, patients may develop increased intracranial pressure and secondary brain damage.
List at least three risk factors for stroke
High blood pressure, diabetes, smoking, a-fib, high cholesterol, heart disease, obesity, overweight, sedentary lifestyle, old age, gender, race, and family hx.
Common Modifiable Risk Factors for Developing a Stroke
- Smoking
- Substance use (particularly cocaine) • Obesity
- Sedentary lifestyle
- Oral contraceptive use
- Heavy alcohol use
- Use of phenylpropanolamine (PPA), found in antihistamine drugs
- American Indian and Alaskan Native groups have the highest prevalence of stroke when compared to other populations.
Black men and women have more strokes than white men and women, especially hemorrhagic strokes caused by hypertension.
Hispanic or Latino men have more strokes than non-Hispanic men.
All of these groups tend to be at a higher risk for hypertension than the Euro-American population.
Socioeconomic factors, such as lifestyle (e.g., diet), health care disparities, and genetic or familial factors, may also play a role in stroke risk among these minority groups
List at least six possible signs of a stroke (include at least two lesser common symptoms)
Transient Ischemic Attack Symptoms resolve typically within 24 hours. Visual Deficits
• Blurred vision
• Diplopia (double vision)
• Blindness in one eye
• Tunnel vision Mobility (Motor) Deficits
• Weakness (facial droop, arm or leg drift, hand grasp)
• Ataxia (gait disturbance) Sensory Perception Deficits
• Numbness (face, hand, arm, or leg)
• Vertigo Speech Deficits
• Aphasia
• Dysarthria (slurred speech)
What is the gold standard imaging to be done in an acute stroke?
For definitive evaluation of a suspected stroke,
CT perfusion scan is used to assess ischemia of brain tissue (or areas of decreased PERFUSION to or in brain tissue).
Cerebral aneurysms or AVM may also be identified.
Magnetic resonance angiography (MRA) and multimodal techniques such as perfusion-weighted imaging enhance the sensitivity of the MRI to detect early changes in the brain, including confirming blood flow.
Ultrasonography (carotid duplex scanning) may also be performed.
List at least 3 contraindications for thrombolytic therapy
Prior intracranial hemorrhage, ischemic stroke with in 3 months, aneurism, arteriovenous malformation, malignant intracranial tumor, head trauma with in 3 months.
List at least 4 signs and symptoms of increased intracranial pressure (ICP)?
The patient may have impaired COGNITION in addition to changes in LOC. LOC varies, depending on the extent of increased intracranial pressure (ICP) caused by the stroke and the location of the stroke. Assess for: • Denial of the illness • Spatial and proprioceptive (awareness of body position in space) dysfunction • Impairment of memory, judgment, or problem-solving and decision-making abilities • Decreased ability to concentrate and attend to tasks • Difficulty in remembering events (past or present) Dysfunction in one or more of these areas may be severe, depending on the hemisphere involved.
Symptoms of increased ICP include severe headache, deteriorating LOC, restlessness, and irritability. Dilated or pinpoint pupils that are slow to react or nonreactive to light are late signs of increased ICP. Treatment of increased ICP is the same as that described under Interventions in the Traumatic Brain Injury section.
Chart 45-4 Key Features Left and Right Hemisphere Strokes
a. Which are early signs, and which are late signs?
Early: change in alertness, headache, changes in vitals, deterioration in motor function, irritability, restlessness, decreased Glasgow’s coma scale, seizures, vomiting, decreased eye contact.
Late: bulging fontanel, posturing, further LOC, decreased spontaneous movement, Cushing’s triad, irregular respiration, increased BP, decreased pupil reaction to light, pupil dilation, posturing, papilledema (optic nerve swelling behind eye).
List at least 4 nursing interventions/considerations to reduce high ICP?
Promoting fluid and electrolyte balance and monitoring the effects of treatments and drug therapy.
Providing health teaching and emotional support for the patient and family are vital parts of the plan of care.
Take and record the patient’s vital signs every 1 to 2 hours or more often based on patient acuity.
The health care provider may prescribe IV fluids or drug therapy to prevent severe hypertension or hypotension.
Dysrhythmias and nonspecific ST-segment or T-wave changes may occur, possibly in response to stimulation of the autonomic nervous system or an increase in the level of circulating catecholamines (such as epinephrine) from the stress of trauma.
Document and report the presence of cardiac dysrhythmias, hypotension, and hypertension to the primary health care provider.
Obtain the target range for blood pressure and heart rate from the health care provider and monitor parameters.
. What are the key assessment findings in an epidural hematoma?
Epidural hematomas and intracranial hemorrhage are manifested by
-severe headache, a
-rapid decrease in LOC,
-progressive neurologic deficits,
and herniation syndromes (brain tissue shifting, often downward).
-Bleeding into the posterior fossa may lead to sudden cardiovascular and respiratory arrest.
Treatment of a hematoma requires surgical removal. An intracranial hemorrhage is treated with aggressive medical management (e.g., osmotic diuretics, ICP monitoring)
List at least eight signs and symptoms of a mild traumatic brain injury?
Mild Traumatic Brain Injury Physical Findings • Appears dazed or stunned • Loss of consciousness <30 minutes (unresponsive after injury) • Headache • Nausea • Vomiting • Balance or gait problems • Dizziness • Visual problems • Fatigue • Sensitivity to light • Sensitivity to noise Cognitive Findings • Feeling mentally foggy • Feeling slowed down • Difficulty concentrating • Difficulty remembering • Amnesia about the events around the time of injury Sleep Disturbances • Drowsiness • Sleeping less than usual • Sleeping more than usual • Trouble falling asleep Emotional Changes • Irritability • Sadness • Nervousness • More “emotional” • Depression
Includes a wide array of physical and cognitive problems that range from
•headache and dizziness to changes in behavior listed on Chart 45-7.
Symptoms usually resolve within 72 hours. Symptoms may persist and last days, weeks, or months. Persistent symptoms following MTBI are also referred to as
•post-concussion syndrome.
Characterized by a blow to the head, transient •confusion or feeling dazed or disoriented, and one or more of these conditions:
(1) loss of consciousness for up to 30 minutes, (2) loss of memory for events immediately before or after the accident, and
(3) focal neurologic deficit(s) that may or not be transient. Loss of consciousness does not have to occur for a person to be diagnosed with MTBI. No evidence of brain damage on a CT or MRI imaging scan.
The early detection of changes in the patient’s neurologic status enables the health care team to prevent or treat potentially life-threatening complications.
•Subtle changes in blood pressure, consciousness, and pupillary reaction to light can be very informative about neurologic deterioration.
