OA E1

Question 1

Cerebrvascular Accident/CVA/Stroke occurs when

Answer 1

there is eschemia to part of the brain or hemorrage into the brain that results in death of brain cells.

Question 2

Stroke risk factors

Answer 2

-HTN -heart diseas -diabetes mellitus -sleep apnea -blood cholesterol levels -smoking -substance abuse -living south eastern us

Question 3

types of stroke

Answer 3

ischemic or hemorrhagic

Question 4

ischemic

Answer 4

lack of blood flow to brain cells due to complete or partial occlusion of an artery.
most common type of stroke
can be thrombotic or embolic

Question 5

hemorrhagic

Answer 5

bleeding into brain tissue, subarachnoid space, or ventricles.
approx. 15% of all strokes
accumulation of blood causes pressure on brain tissue leading to ischemia and infarction.
-decreases cerebral blood flow -causes cerebral edema
-can induce cerebral vasospasm

Question 6

thrombotic stroke

Answer 6

most common cause of stroke
result of thrombosis or narrowing of the cerebral blood vessels.
injury to a cerebral blood vessel wall and formation of a blood clot

Question 7

embolic stroke

Answer 7

second most common cause of stroke.
occurs when an embolus travels from another vessel in the body and lodges in and occludes a cerebral artery.
infarction and edema of the area supplied by the involved vessel
onset of embolic stroke is usually sudden

Question 8

transient ischemic attack “TIA”

Answer 8

transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction of the brain.
symptoms usually last 1-2 hours (have cases where s/s lasted 24 hrs.)

Question 9

stroke warning signs

Answer 9

-numbness -weakness -difficulty with speech -dizziness -sudden intense headache -sudden nausea and vomiting -sudden inability to remember events -“heavy arm” -facial drooping

Question 10

F
A
S
T

Answer 10

F-face. look for an uneven smile
A-arm. check if one arm is weak
S-speech. listen for slurred speech
T-time. call 911 at the first sign

Question 11

collaborative care

Answer 11

first goal: re-perfuse the brain.
when symptoms first occur diagnostic studies are first done to confirm it is a stroke, and identify the likely cause of stroke (ischemic or hemorrhagic)
CT scan is primary diagnostic test and first priority after stabilizing patient

Question 12

hemorrhagic treatment options

Answer 12

evacuate bleeding: ventriculostomy, burr hole surgery, open craniotomy
blood pressure control: more focused on MAP and cerebral perfusion pressure

Question 13

ischemic treatment options

Answer 13

tPA administration: for IV use by the RN the tPA must be given within 4.5 hours of onset of symptoms.
most effective if given within 1 hr
for endovascular administration by interventional radiologist tPA must be given within 6 hrs.

Question 14

IV tPA

Answer 14

tissue plasminogen activator 
fibrinolytic agent ("clot buster"). brand name: activase, altepase
The first FDA approved acute ischemic stroke treatment in 1996: better outsomes associated with earlier intervention; indicated for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability

Question 15

tPAc

Answer 15

very strict criteria
dose is based on pts weight, must get exact weight
bolus dose is 10% of total dose and given over 2 mins followed by continuous infusion