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Year One > Older Adults Stroke > Flashcards

Older Adults Stroke Flashcards

1
Q

What is the watershed effect?

A

Areas of the brain which are furthest away from the damage are more effected as there is less blood supply

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2
Q

What is a cerebrovasuclar accident?

A

Any sudden episode where the blood systems of the brain are damaged or stop working

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3
Q

The general public have a poor awareness of stroke

A

Stroke association (2011):
42% did not know what a stroke is
Low awareness of risk factors -39% blood pressure, 9% diet
FAST campaign

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4
Q

Fast campaign

A

Facial weakness
Arm weakness
Slurred speech
Time to call

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5
Q

What is ischemia/infarction?

A

Loss of blood flow around the brain (clot)

Also accounts for loss of important things contained in the blood eg diabetic stroke

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6
Q

What is a Haemorrhage?

A

Leakage of blood from the vessels (bleed).

Burst pipe analogy, Central heating high water pressure

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7
Q

Epidemiology WHO (2011)

A

Second most common cause of death after CVD

Most common cause of severe neurological disability

130,000 people per year
60,000 die

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8
Q

What are the 8 common causes and mechanisms of ischemia / infarction?

A
  1. Atherosclerosis
  2. Thrombus
  3. Embolism
  4. Hypoglycaemia
  5. Tachycardia
  6. Hypotension
  7. Blood vessel compression
  8. Atriovenous malformation
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9
Q
  1. Atherosclerosis
A

Plaques building up within the vessel wall, like a dam

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10
Q

Thrombus

A

Blood clot within the brain

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11
Q

Embolism

A

Blood clot travels into the brain, common following heart surgery, angina

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12
Q

Hypoglycaemia

A

Low blood glucose

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13
Q

Tachycardia

A

Fast resting heart beat

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14
Q

Hypotension

A

Low blood pressure, Blood coagulates,

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15
Q

Blood vessel compression

A

Vessels are squeezed common in young stroke - car accident, weight lifting

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16
Q

Arteriovenous malformations

A

Problems in construction of blood vessels

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17
Q

What is the treatment for ischemia / infarction

A

If within 41/2 hours can be treated with thrombolysis to break down the clot and allow blood flow to resume

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18
Q

9 common causes of haemorrhage..

A
  1. Hypertension damage to blood vessels (50%)
  2. Cerebral amyloid angiopathy - build up of plaques in walls of arteries (10%)
  3. Excessive cerebral blood flow
  4. Aneurysm rupture (vessels can expand and restrict also may have a ballon due to this if the wall is weakened, can rupture completed)
  5. Arteriovenous malformations eg weak walls
  6. Tumour
  7. Infection
  8. Trauma
  9. Obstruction to veins leaving the brain
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19
Q

Risk factors include ( anything that damages or interferes with blood supply)

A

Hypertension
Hypercholesterolemia - fatty deposits reduce elasticity making ruptures more likely, embolism less likely to pass through…
Obesity - more vessels heart working harder
Smoking -hardening vessels
Alcohol - neurotoxin
Sodium intake
Genetics

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20
Q

How long do symptoms last for in a transient ischeamic attack?

A

24hrs

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21
Q

What are the main components of the cerebrovascular system?

A

Middle cerebral artery
Anterior cerebral artery
Posterior cerebral artery

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22
Q

What is the middle cerebral artery?

A

The largest brain artery, feeds the outer sides of the brain and the sensory motor cortex and language centres

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23
Q

What is the anterior cerebral artery?

A

The second most largest artery. It feeds the inner sides of the brain and the frontal lobes responsible for higher level functioning

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24
Q

What is the posterior cerebral artery?

A

The third largest cerebral artery. Feeds the rear parts of the brain. Responsible for vision and brain stem functioning e.g balance

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25
Q

What is vascular dementia?

A

Continued strokes that result in a stepwise progression in neurological functioning.
Political issue, no clear cut distinction

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26
Q

What are the 5 year survival rates for vascular dementia compared with age-matched controls?

A

Fitzpatrick et al (2005) 39% vs 75%

27
Q

What are the benefits of having a diagnosis of vascular dementia vs multiple strokes

A

May have better access to cpns, services

But may be age limited

28
Q

What are the general outcomes following stroke?

A 
McKevitt et al (2004) 
1/2 admitted
1/3 die
1/3 significant impairment
1/3 little or no impairment (TIA)
29
Q

What are some common factors an individual may rely on nursing staff for?

A 
33% lose consciousness 
10% talking/ swallowing
10% moving
Incontinence 
Bedsores
30
Q

For which type of stroke do outcomes tend to be better?

A

Ischemic / infarction rather than haemorrhage,

31
Q

Common psychological effects of stroke: (x9)

A
  1. Cognitive difficulties 75% (RCP, 2008)
  2. Sig distress 30-50% (kneebone & Lincoln, 2012)
  3. Depression 33% (Hackett et al. 2005)
    4 anx disorder 25% (burvill et al., 1995)
  4. Emotion regulation 25% (Calvert et al., 1998)
  5. Anger 25% (aybek et al., 2005)
  6. PTSD 20% (bruggimann et al., 2006)
  7. 2x increased risk for completed suicide (Teasdale & engberg, 2001)
  8. Relationship breakdown 30-50%
32
Q

What is emotionalism / emotional lability / emotional dysregulation?

A

25%, difficulty regulating emotions.

Exhibit short lived, sudden, disproportionate emotional reactions, sometimes no obvious trigger

33
Q

What type of stroke does emotionalism tend to result from?

A

More severe strokes, can be almost any brain region.

NTC premorbid personality, pathology or normal distress reactions

34
Q

What can be done to help with emotional dysregulation?

A

Poses distress to survivor and their system.
Can be an obstacle to rehabilitation.
Psychoeducation can reduce distress and prevent relationship breakdown.
Alleviates worry that they are “making things worse” by visiting
Small dose antidepressants can help as it is a psychomotor problem.

35
Q

Greatest natural recovery occurs during…

A

The first month

36
Q

Natural functional recovery includes:

A
  1. Reduced swelling/ oedema repair
  2. Cerebral reperfusion / return of blood supply
  3. Stabilise surviving cells - viable heal, dying die
  4. Blood is reabsorbed, toxicity removed
  5. Masking - create new connections to learn repost skills
37
Q

Common difficulties experienced on discharge include : (4)

A
  1. Previous routines / ADLs
  2. Adaptation finding, what works, what do they have problems with
  3. Sick role behaviour, learned helplessness
  4. Depression related to inactivity
38
Q

Stress appraisal model

A

Lazarus & folk man (1984)

39
Q

Describe Lazarus and folkman’s (1984) stress appraisal model.

A
  1. Primary stressor - the stroke, needs, impairments and behaviours as a result.
  2. Primary appraisal
  3. Secondary appraisal with resources (eg family, profs, skills…)
  4. Problem focused coping
    Emotion focused coping
  5. Secondary stressors - arise from coping, may feed back into primary appraisal (e.g physio pain - not going to recover)
  6. Outcome
40
Q

Health beliefs

A

Janz & Becker (1984)

41
Q

What does the health beliefs model consider?

A
  1. Demographics
  2. Perceived susceptibility
  3. Perceived severity
  4. Health motivation
  5. Perceived benefits
  6. Perceived barriers/costs
  7. Cues to action
  8. Preventative action
42
Q

Describe sensory motor impairment

A

Paralysis is usually one sided, contralateral to damage

43
Q

What are the outcomes of sensory-motor impairment?

A

1/3 no recovery
1/3 need aids
1/3 recover walking

44
Q

What is the general hierarchy of recover of sensory motor functioning

A
  1. Legs
  2. Arms
  3. Fingers
45
Q

What are dyspraxia and apraxia, and what area of impairment are they associated with?

A

Sensory motor,

Difficulties planning motor sequences

46
Q

What are important predicates of damage in strokes affecting the sensory motor cortex

A

Size of damage and connectivity

47
Q

what percentage rely on unpaid family / carers for help with personal care and ADLs?

A

Wilkinson et al. (1997) 40-50%

48
Q

What are some common activities individuals are reliant on carers for following stroke?

A 
Warlow et al. (2011) 
Bathing (33%)
Walking outdoors
Stairs
Dressing
Feeding
Bladder
Walking indoors
Transfers
Toileting
Grooming (11%)
NTC individual difficulties and their impact e.g makeup in women and self esteem
49
Q

When does the focus move from spontaneous recovery to compensatory strategies?

A

6-12 months post stroke.

Coincides with reduction of support

50
Q

How can the brain develop adaptive strategies and skills? (4)

A
  1. Can recover functioning
  2. Existing neurons can create new connections
  3. Adjacent brain areas can take over some functioning
    - > evidence base evolving
51
Q

Some themes of depression in stroke: (10)

A
  1. Actual loss
  2. Perceived progression
  3. Proximity to premorbid self
  4. Level of disability
  5. Identity - role changes and adaptations
  6. Hope for future
  7. Current relationships, bidirectional influence
  8. Isolation, abandonment - attachment styles, anxious more difficult
  9. Access to resources
  10. Burden/guilt
52
Q

Common themes in anxiety

A
  1. Threat of loss
  2. Stigma
  3. Confidence in abilities -falls, ADLs, visual recognition, acalcula, continence, communication
  4. Another stroke
  5. Trauma of stroke/hospital
  6. Guilty, worry about others
53
Q

What are the quality of life factors that are important to consider (12)

A
  1. Finance
  2. Health
  3. Personal growth
  4. Achievements
  5. Work/career
  6. Friendship
  7. Security
  8. Energy
  9. Self-esteem
  10. Fun & recreation
  11. Home & family
  12. Relationships
54
Q

Obstacles to recovery

A

Stroke association (2011)
Not given info and support on emotional coping (80%)
Emotional needs not looked after as well as physical (66%)
Anxiety (67%)
Depression (59%)
Family breakdown (50%)
No one to talk to (34%)

55
Q

Family and carer difficulties

A 
Stroke association (2012)
Frustration, anger (burnout, arguments, neglect, abuse) 85%
Anxiety (79%)
Emotional impact is hardest 64%
Knowledge not respected or valued 60%
Depression 59%
56
Q

What percentage of stroke services have access to actinic am psychologist?

A

20%

57
Q

Factors in mood problems

A 
Acceptance of loss of functioning
Adapting to changes
Fear of falling
Uncertainty of future and present 
Emotional dysregulation 
Loss of roles and identities
Guilt and shame 
Existential challenges
58
Q

The carers act 2014 states

A

That we should provide carers with the tools and support that they need. This can be difficult in the NHS- not geared towards it eg note taking separately not manageable

59
Q

Predictors of distress in carers (6)

A

Low et al 1999

  1. Poor information provision
  2. Lack of appreciation of emotional needs
  3. Poor preparation for role
  4. Social isolation
  5. Reduced self care
  6. Financial strain
60
Q

What is associated with aphasia in carers?

A 
Ross & Morris (1998)
1, poorer adjustment
2. Greater role changes
3. Depression
4. Loneliness
5. Rel difficulties
61
Q

Name predictors of carers who adapt well

A

Greenwood et al (2009)

  1. One day at a time
  2. Routine
  3. Asking for help / information
  4. Being patient
  5. Satisfaction with healthcare services
62
Q

What percentage return to work after stroke

A

10%, but this is mostly voluntary.

Odd- 1/3 have no significant problems

63
Q

Personal predictors of return to work

A
  1. Disability severity
  2. Psychological problems
  3. Personality
  4. Gender
  5. Age
64
Q

Systemic predictors of return to work

A
  1. Social demographic
  2. Economic demographic
  3. Employers attitudes

Year One (4 decks)

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