MS QUIZ #1 FINALS: TIA & CVA

Question 1

❖ It is known as a “mini stroke”, which is only temporary.

Answer 1

TRANSIENT ISCHEMIC ATTACK (TIA)

Question 2

→ Temporary loss of consciousness or dizziness.
→ Paresthesias.
→ Slurring of speech.
→ People with TIAs need to be initially admitted, observed, and examined in the hospital to determine the underlying cause of the condition such as high blood pressure, heart disease, diabetes mellitus, and blood disorders.

Answer 2

CLINICAL MANI OF TIA

Question 3

TIA MEDICAL MANAGEMENT

Answer 3

→ Antiplatelet Medications (e.g., aspirin, clopidogrel, dipyridamole)
▪ They work by preventing blood platelets from sticking together and forming clots.
▪ This helps to reduce the risk of blood clots blocking the arteries in the brain, which can cause a TIA or stroke.

Question 4

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

Answer 4

CEREBROVASCULAR ACCIDENT (CVA)

Question 5

❖ TYPES OF STROKE

▪ most common cause of stroke
▪ frequently the result of:
✔ atherosclerosis
✔ hypertension
✔ smoking
✔ diabetes
✔ may occur after sleep or shortly after awakening

Answer 5

→ Thrombotic

Question 6

❖ TYPES OF STROKE

▪ embolus commonly originates during atrial fibrillation or myocardial infarction or any heart surgery
▪ typically occurs during activity
▪ develops rapidly
▪ Emboli generally originates in the heart or large arteries following:
✔ Atrial Fibrillation

Answer 6

→ Emboli

Question 7

❖ TYPES OF STROKE
▪ third most common type of stroke
▪ typically caused by hypertension or rupture of aneurysm
✔ diminished blood supply to areas applied by ruptured artery and compression by accumulated blood

Answer 7

→ Hemorrhagic

Question 8

● This is the number one cause of CVA in females.
● The heart contracts at a rate of 400 to 600 beats per minute.
● As a result of the rapid contraction of the heart, the atrioventricular valves close immediately, preventing all of the blood from being sent into the ventricles. Therefore, blood may accumulate in the left atrium, becoming viscous and leading to the formation of thrombi. When the left atrium contracts, these thrombi can be ejected into the left ventricle, then into the ascending aorta, and eventually to the brain, resulting in a CVA.

Answer 8

✔ Atrial Fibrillation

Question 9

▪ It specializes in spatial perception (main problem).
✔ Spatial Perception = own interpretation
✔ If the lesion is on the right, there is no spatial perception. For example, if you give a glass of water, the patient does not know what to do with it.
✔ A patient with a lesion on the right should always be oriented.
● For example: Ms. Cruz, this is a toothbrush, which is used to clean your teeth. (use verbal and nonverbal communication)
▪ It is responsible for the modulation of voice.
✔ The patient cannot modulate their voice and is always loud.
▪ It is responsible for the recognition of faces.
✔ The patient is unable to recognize your face.
▪ A lesion in the right hemisphere makes the patient accident-prone because they cannot interpret what they see.

Answer 9

right hemi

Question 10

▪ A lesion on the left hemisphere, the primary issue lies in speech. The individual experiences dysarthria, affecting their ability to articulate words clearly. This impairment in speech leads to difficulties in communication.
✔ Types of Aphasia
● Expressive Aphasia (can understand but unable to express oneself)
● Receptive Aphasia (inability to understand spoken or written words)
● Global Aphasia (mixed)

▪ The left hemisphere is responsible for analytical functions. Despite the challenges with speech, the patient may display a keen ability to analyze situations or information presented to them.

Answer 10

→ Left Hemisphere.

Question 11

▪ ___ Area: Located in the frontal lobe of the brain, typically in the left hemisphere, Broca’s area is primarily involved in the production of speech. It is responsible for the generation of speech movements and the coordination of the muscles required for speech production. Damage to Broca’s area can result in expressive aphasia, where individuals have difficulty forming coherent speech but can often understand language.
▪ ___ Area: Situated in the posterior part of the superior temporal gyrus of the brain’s left hemisphere, Wernicke’s area is primarily associated with language comprehension. It plays a crucial role in understanding and processing spoken and written language. Damage to Wernicke’s area can lead to receptive aphasia, where individuals have difficulty understanding language but may produce fluent yet nonsensical speech.

Answer 11

Broca’s
Wernicke’s

Question 12

● Paralysis or weakness on the right side of the body.
● RIght visual field deficits.
● Aphasia (expressive, receptive, or global)
● Altered intellectual ability
● Slow, cautious behavior

Answer 12

Left Hemispheric Stroke

Question 13

● Paralysis or weakness on the left side of the body.
● Left visual field deficits.
● Spatial-perceptual deficits.
● Increased distractibility
● impulsive behavior and poor judgement, lack of awareness of deficits.

Answer 13

Right Hemispheric Stroke

Question 14

Impaired Swallowing (dysphagia)
NURSING MANAGEMENT

Answer 14

• assess for gag reflex
• high fowler’s position to prevent aspiration pneumonia
• 1tsp or half tsp maximum at a time
• semi-solid diet (scrambled eggs, cereals, mashed fruits or vegetables like carrots, potatoes, bananas, chicken, tuna) in order to stimulate the sensation in the mouth and to improve the ability to swallow.
• place the 1 tsp of food to the unaffected side of the face
• do not allow the patient to sip fluids with a straw because they will have a hard time controlling the fluid, and may lead to aspiration pneumonia.
• never give liquid diet to a patient with CVA
• perform a finger sweep before you put another tsp of food to remove any large food after every swallow. check the oral cavity (penlight and tongue depressor)
• Keep the patient in upright postion for 45 to 60 mins? ano daw

Question 15

▪ Nursing Considerations (Phenytoin)

Answer 15

…

Question 16

→ Interventions to prevent the patient from performing a valsalva maneuver.

Answer 16

▪ instruct the patient to breathe continuously when pooping avoid holding their breath
▪ put the side table within reach to prevent the patient from holding their breath
▪ don’t allow the patient to put themselves up in bed
▪ elevate the head 15 to 30 degrees
▪ Encourage the patient to eat foods high in fiber…
▪ Increase fluid intake
▪ Ambulation - increases peristalsis

Question 17

CVA NRX MANAGEMENT

Answer 17

❖ NURSING MANAGEMENT
→ Patients who have had a stroke can experience bedridden conditions, so it’s important to place a footboard to prevent foot drop.
▪ Neuropathic gait presents with foot drop, making it difficult to walk due to the inability to dorsiflex the feet.
→ Turn the patient every 2 hours to prevent bedsores.
▪ Common site for bedsore:
✔ Sacrum - carries weight of patient in lying position
→ Assess the gag reflex.
▪ hhhh of the airway is the priority of nursing care for a patient having an acute stroke.
▪ If the gag reflex is absent, it indicates that the nasopharynx is open; therefore, food may exit from the nose and enter the lungs.
→ Semi-solid Deit
→ Avoid straws
→ Finger Sweep
→ Train the urinary bladder to hold a normal amount of urine.
▪ Maintain fluid intake of 2000 mL/24hr
✔ 400 to 500 mL with each meal
✔ 200 mL between meals
✔ limit fluid intake after 6 pm
▪ Pelvic Floor Exercises or Kegel Exercises
✔ To strengthen the muscles surrounding the urethra and external urethral sphincter in order to reduce or prevent urine leakage.
→ Avoid caffeinated beverages because they have a diuretic effect and not to drink more than their daily fluid requirements.
→ If the patient has aphasia:
▪ Face the patient and establish eye contact. because some people can perform lip reading.
▪ Use short phrases and pause between phrases to allow the patient time to understand what’s being said.
▪ As the patient uses and handles an object, say what the object is.
▪ Speak slowly, clearly, and use nonverbal cues.
▪ Minimize loud noises when trying to communicate.
▪ Use appropriate aids to communicate (picture board, magic slate, pencil, and paper).
▪ Allow ample time for communication.

Question 18

❖ 10 CRUCIAL STEPS IN STROKE PREVENTION

Answer 18

→ Maintain healthy blood pressure. - hypertension is the no.1 cause of stroke.
→ EKG for Atrial Fibrillation. -
→ Stop smoking. - can cause vasoconstriction
→ Limit alcohol consumption to no more than 2 drinks per day.
→ Maintain a healthy cholesterol level.
→ Aim to get at least 30 (preferably 60) minutes of physical activity everyday. - exercise can thin the blood
→ Eat a diet low in saturated fat, and rich in fruits, vegetables, whole grains, and fibers.
→ If positive of DM, control it through proper nutrition, exercise, and medication.
→ If positive of blood problems, seek medical help.
→ Know the symptoms - SEEK CARE IMMEDIATELY!