Neuro Stroke

Question 1

where do the carotid arteries circulate blood in the brain

Answer 1

anterior circulation

Question 2

where do the vertebral arteries circulate blood in the brain

Answer 2

posterior circulation

Question 3

how long does loss of blood supply result in cellular brain death

Answer 3

5 mins

Question 4

what are some factors that affect blood flow

Answer 4

Systemic B/P; CO; viscosity of blood

Question 5

why are older adults able to retain more brain function after loss of blood flow then younger adults

Answer 5

collateral circulation happens over time making new paths - so older adults have more routs for blood flow then younger adults

Question 6

what is a thrombotic stroke

Answer 6

grew in one area and stayed - blocked blood flow

Question 7

what is a embolic stroke

Answer 7

came from another area in the body and blocked blood flow

Question 8

whats the difference between Intracerebral and Subarachnoid Hemorrhage

Answer 8

Intracerebral is more inside the brain and hard to get to, Subarachnoid on the outer of the brain and easier to get to and drain

Question 9

what is the included in the initial evaluation for a stroke

Answer 9

Head CT Scan no contrast needed, PT/INR & PTT, 12 Lead ECG (to know if that caused it like afib), B/P, Neuro Evaluation, Last KNOWN Normal (LKN) – last time someone can say they weren’t acting normal

Question 10

what is a transient ischemic attack

Answer 10

brief episode where one of the vessels that supply blood to the brain gets blocked it lasts less then 1 hour and return to baseline within 24 hours

Question 11

what are some measures to prevent development of a thrombus or embolus in patients at risk for stroke

Answer 11

Antiplatelet drugs are used in patients who have had a TIArelated to atherosclerosis, Aspirin is most frequently used as an antiplatelet agent

Question 12

what is a surgical intervention used for transient ischemic attacks

Answer 12

Carotid endarterectomy or Transluminal angioplasty with Stenting

Question 13

what are the interventions for Carotid endarterectomy

Answer 13

Monitor for swelling at incision site and prevent actions that would increase ICP
Frequent Neuro Checks

Question 14

what are some normal findings after Carotid endarterectomy

Answer 14

Neck soreness; low grade temp; difficulty to swallow (dysphagia)

Question 15

what are some modifiable risk factors for stroke

Answer 15

hypertension, Heart disease, DM, Serum cholesterol, Smoking, Obesity, Sleep apnea, Metabolic syndrome, Lack of physical exercise, Poor diet, Drug and alcohol abuse, Estrogen replacement therapy & high dose estrogen containing Birth Control

Question 16

what are some non modifiable risk factors for stroke

Answer 16

Age (Stroke risk doubles each decade after 55), Gender (More common in men; more women die), (Ethnicity/race
Higher incidence in African Americans bc BP), Heredity/family history

Question 17

what are some diagnostic for CVA

Answer 17

CT w/o contrast (indicate size and location and shows difference between ischemic and hemorrhagic stroke), MRI, ECHO, MRA

Question 18

when is medication recommend to control BP

Answer 18

greater then 220/ greater then 120

Question 19

does HTN and DM put you more at risk for thrombotic or embolic stroke

Answer 19

thrombotic

Question 20

does a fib and cardiac valve abnormalities put you more at risk for thrombotic or embolic stroke

Answer 20

emobolic

Question 21

what does the Recombinant tissue plasminogen activator (tPA) med do

Answer 21

Used to reestablish blood flow through a blocked artery toprevent cell death– can be targeted, Must be administered within 3 to 4 ½ hours of onset ofclinical signs of ischemic stroke a head ct is done first to rule out hemorrhage

Question 22

After the patient has stabilized and to prevent further clotformation, patients with strokes caused by thrombi andemboli may be treated with what

Answer 22

plateletinhibitors and/or anticoagulants, aspirin is started in the first 24-48 hours, statins

Question 23

what are the inclusion criteria of intraarterial tPA

Answer 23

ober 18 yrs old, diagnosis of stroke with measurable deficit, time of onset less then 3 hours before tx will begin

Question 24

what is the exclusion criteria for intraarterial tPA

Answer 24

evidence of ICH on CT, hx of ICH or AVM, suspected SAH with normal CT, active internal bleeding, platelets less then 100,000, heaprin within 48 hours with an elevated PTT, current use of oral anticoagulant with PT over 15 secs,

Question 25

what is Intracerebral hemorrhageor intraparenchymal hemorrhage

Answer 25

sudden onset of bleeding into the brain tissue during activity, HTN most common cause

Question 26

what is Subarachnoid hemorrhage (SAH)or intraventricular hemorrhage

Answer 26

bleeding into subarachnoid/ventricle space- caused by rupture of a cerebral aneurysm (40% die in 1st episode),trauma, or drug abuse (cocaine)

Question 27

how are vasospasms tx

Answer 27

CCB

Question 28

what are some ss of intracerebral/subarachnoid

Answer 28

Neurologic deficits – neuro assessment changes, Headache, Nausea and/or vomiting, Decreased levels of consciousness, Hypertension

Question 29

what is the focus for hemorrhagic stroke

Answer 29

blood pressure

Question 30

what are the interventions for respiratory system after a stroke

Answer 30

watch out for atelectasis, aspiration pneumonia, airway obstruction, so keep NPO until dysphagia ruled out

Question 31

what are the interventions for the cardiac system after a stroke

Answer 31

Monitoring vital signs frequently, Monitoring cardiac rhythms, Calculating intake and output, noting imbalances, Watch for orthostatic hypotension before ambulating patient for 1sttime

Question 32

what are some ways to avoid increase ICP

Answer 32

Do NOT Cluster care
Hyperoxygenation before doing care
Avoid neck and hip flexion
HOB 30 degrees

Question 33

what are some ways to optimize musculoskeletal function

Answer 33

Passive range-of-motion exercise is begun on the first day of hospitalization., Trochanter roll at hip to prevent external rotation, Hand cones to prevent hand contractures, Arm supports with slings and lap boards to prevent shoulder displacement, Avoidance of pulling the patient by the arm to avoid shoulder displacement, Posterior leg splints, footboards, orhigh-topped tennis shoes to prevent foot drop, Hand splints to reduce spasticity

Question 34

what is aphasia/dysphasia

Answer 34

Receptive/Fluent– loss of comprehension, Speech is present but contains little meaningfulcommunication- ask yes or no question

Question 35

what is Expressive/Non-fluent

Answer 35

– loss of production of language (The client knows what they wish to communicate but are unable to do so) Minimal speech activity with slow speech

Question 36

what is dysarthria

Answer 36

does not affect the meaning of communication or the comprehension of language, but it does affect the mechanics of speech.

Question 37

what are some sensory perceptual alterations seen in left sided stroke

Answer 37

Slower in organization and performance of tasks
Impaired spatial discrimination
Have fearful, anxious response to stroke
Respond well to nonverbal cues

Question 38

what are some sensory perceptual alterations seen in right sided stroke

Answer 38

Difficulty in judging position, distance, and movement
Impulsive, impatient, and deny problems related to stroke
Respond best to directions given verbally