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Unit 2 > Perfusion: Stroke > Flashcards

Perfusion: Stroke Flashcards

1
Q

Types of strokes

A

Ischemic stoke: thrombotic stroke or embolic stroke; hemorrhagic stroke: intracerebral hemorrhage, subarachnoid hemorrhage, or arteriovenous malformation

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2
Q

Ischemic stoke

A

Caused by a thrombus (clot) or embolus (dislodged clot)

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3
Q

Thrombotic stroke

A

Associated with atherosclerosis in intracranial or extracranial arteries; have a gradual occlusion (commonly at the bifurcation of the common carotid artery and the vertebral arteries); slow onset (minutes to hours)

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4
Q

Embolitic stroke

A

Caused by a thrombus or thrombi that breaks off from one area of the body and travels to the cerebral arteries via the carotid artery or the vertebrobasilar system; usual source of the embolus is the heart; may be plaque that breaks off from the carotid sinus or interior carotid artery; middle cerebral artery is most commonly involved; sudden development

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5
Q

Hemorrhagic stroke

A

Intracerebral hemorrhage; subarachnoid hemorrhage

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6
Q

Intracerebral hemorrhage

A

Bleeding into the tissue resulting from hypertension; damage to the brain occurs from bleeding, causing edema, distortion, and displacement, which are direct irritants to the brain; occur most often with sudden dramatic increases in blood pressure

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7
Q

Subarachnoid hemorrhage

A

More common; results from bleeding into the subarachnoid space; usually caused by a ruptured aneurism or arteriovenous malformation

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8
Q

Aneurism

A

Abnormal ballooning or blister along a normal artery; causes bleeding into the subarachnoid space, ventricles, and/or intracerebral tissues

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9
Q

Vasospasm

A

Sudden and periodic constriction of a cerebral artery; results from a cerebral hemorrhage due to an aneurism rupture; blood flow to the distal areas of the brain is diminished leading to cerebral ischemia and infarction and further neurological damage

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10
Q

Arteriovenous malformation

A

Occurs during embryonic development; tangled or spaghetti-like mass of malformed, thin walled, dilated vessels; vessels may rupture causing bleeding into the subarachnoid space or into the intracerebral tissue

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11
Q

Evolution of thrombotic stroke

A

Intermittent or stepwise improvement between episodes of warning; completed stoke

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12
Q

Onset of thrombotic stroke

A

Daytime; gradual (minute to hours)

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13
Q

LOC affected by thrombotic stroke

A

Preserved

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14
Q

Contributing associated factors to thrombotic stoke

A

Hypertension; atherosclerosis

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15
Q

Prodromal symptoms of thrombotic stoke

A

Transient ischemic attack

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16
Q

Neurological deficits of thrombotic stroke

A

Deficits during the first few weeks; slight headache; speech deficits; visual problems; confusion

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17
Q

Cerebrospinal fluid in thrombotic stoke

A

Normal; possible presence of protein

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18
Q

Seizures with thrombotic stoke

A

None

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19
Q

Duration of thrombotic stroke

A

Improvements over weeks to months; permanent deficits possible

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20
Q

Evolution of embolic stroke

A

Abrupt development of completed stroke; steady progression

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21
Q

Onset of embolic stroke

A

Daytime; sudden

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22
Q

LOC with embolic stroke

A

Preserved

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23
Q

Contributing associated factors with embolic stroke

A

Cardiac disease

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24
Q

Prodromal symptoms with embolic stroke

A

None

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25
Q

Neurological deficits with embolic stroke

A

Maximum deficit at onset; paralysis; expressive aphasia

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26
Q

Cerebrospinal fluid with embolic stroke

A

Normal

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27
Q

Seizure with embolic stroke

A

None

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28
Q

Duration of embolic stroke

A

Rapid improvements

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29
Q

Evolution of Hemorrhagic stroke

A

Usually abrupt onset

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30
Q

Onset of hemorrhagic stroke

A

Daytime; sudden, may be gradual if caused by HTN

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31
Q

LOC in hemorrhagic stroke

A

Deepening stupor or coma

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32
Q

Contributing associated factors with hemorrhagic stroke

A

Hypertension; vessel disorders

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33
Q

Prodromal symptoms with hemorrhagic stroke

A

None

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34
Q

Neurological deficits with hemorrhagic stroke

A

Focal deficits; severe, frequent

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35
Q

Cerebrospinal fluid in hemorrhagic stroke

A

Bloody

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36
Q

Seizures in hemorrhagic stroke

A

Usually

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37
Q

Duration of hemorrhagic stroke

A

Variable; permanent neurological deficits possible

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38
Q

Modifiable risk factors of stroke

A

Smoking, substance abuse, obesity, sedentary lifestyle, oral contraceptive use, heavy alcohol use, use of phenylpropanolamine found in antihistamine drugs

39
Q

Nonmodifiable risk factors for stroke

A

Age, sex, family history, race, history of MI, history of migraine headaches, prior stroke, sickle cell disease, berry aneurysms

40
Q

Risk factors for stroke that can be modified with collaborative management

A

High BP, high cholesterol levels, TIAs, cardiovascular disease, diabetes, blood clotting disorders, sleep apnea

41
Q

Recommended diet for those at risk for stroke

A

High in fruits and vegetables and low in saturated and trans fats

42
Q

Lab assessment for stroke

A

Elevated HGB and HCT levels; elevated WBC; PT, PTT, INR to establish baseline; serum electrolytes including blood glucose, BUN, and creatinine; CBC with diff and platelet count

43
Q

Imaging assessment for stroke

A

CT without contrast; ischemic stroke CT may be negative for 24 hrs, after which it will show progressive changes of ischemia, infarction, and cerebral edema; MRI demonstrated ischemic injury earlier than CT; ultrasonography and echocardiography help determine cardiovascular risks

44
Q

Other diagnostic assessments for stroke

A

12-lead electrocardiogram and eval of cardiac enzymes; might see inverted T-wave, ST depression, and prolongation of the QT interval

45
Q

Priority problems for pts with stoke

A

Inadequate perfusion to the brain; impaired swallowing; impaired physical mobility; self-care deficit; aphasia or dysarthria; urinary and/or bowel incontinence; sensory changes; unilateral body neglect syndrome

46
Q

Improving cerebral perfusion interventions

A

Start 2 IV lines; non-dextrose isotonic saline; continuously monitor for increasing ICP; fibrinolytic therapy; endovascular interventions; ongoing supportive care; prevent and monitor for early signs of complications (hyperglycemia, UTI, pneumonia); prevent pt falls

47
Q

Fibrinolytic therapy

A

Standard of practice to improve blood flow to or through the brain; success depends on the time the pt was last seen normal (LSN) and available treatment

48
Q

IV fibrinolytic therapy: recombinant tissue plasminogen activator (rtPA)

A

Only drug approved for the tx of acute ischemic stroke; standard window of eligibility is 3-4.5 hrs from LSN; dosage is based on actual weight

49
Q

Interventions during or following IV admin of rtPA

A

Infuse 0.9 mg/kg over 60 minutes with 10% given as a bolus over the first minute; admit to cc or stroke unit; perform neuro assessments and VS every 10-15 during and every 30 following for 6 hrs; if BP >180/105 give anti hypertensive drugs as prescribed; do not place invasive tubes until pt is stable to prevent bleeding; discontinue the infusion in case of reaction; obtain follow up CT scan before starting anti-platelet or anticoagulants; no IM injections

50
Q

Endovascular interventions for stroke

A

Intra-arterial thrombolysis (drug therapy), and embolectomy (clot removal)

51
Q

Intra-arterial thrombolysis

A

delivers the fibrinolytic directly into the thrombus within 6 hrs of the stroke’s onset; beneficial for those who arrive in the ED after the window for rtPA

52
Q

Mechanical embolectomy

A

Removes the clot by suction or other method; admitted to CC; may be performed if pt arrives less than 8 hrs after the time LSN

53
Q

Changes in the brain r/t stoke

A

If blood supply is interrupted for more than a few minutes, cerebral tissue dies and disability occurs depending on the area of damage and the amount of brain tissue affected

54
Q

Right-side brain damage

A

Paralyzed left side; left side neglect; spatial/perceptual deficits; tends to deny or minimize problems; rapid performance, short attn span; impulsive safety probs; impaired judgement; impaired time concept

55
Q

Left-side brain damage

A

Paralyzed right side; impaired speech/language; impaired left/right discrimination; slow performance, cautious; depression/anxiety; aware of deficits; impaired comprehension r/t language and math

56
Q

Paroxysmal atrial fibrillation

A

Electrical signals and rapid HR begin suddenly and then stop on their own; symptoms can be mild or severe; last less than 24 hrs up to 1 wk

57
Q

Persistent atrial fibrillation

A

The abnormal heart rhythm continues for more than a week; may stop on its own or with treatment

58
Q

Permanent atrial fibrillation

A

Normal heart rhythm can’t be restored with treatment; paroxysmal and persistent may become more frequent and turn into permanent a-fib

59
Q

Cardioversion

A

Most direct treatment for a-fib; success can be enhanced with careful attn to details (electrode placement and skin prep); must be synced with the r-wave; start with 200 joules and increase as needed

60
Q

Atrial fibrillation characteristics on ECG

A

No p-waves before the QRS; irregular heart rate caused by irregular impulses that. The ventricles are receiving; baseline will have waves; think “Jazz hands”

61
Q

F.A.S.T.

A

Face drooping; Arm weakness; Speech deficiency; Time to call 911

62
Q

Most obvious effects of stroke include:

A

Mobility, respiratory function, swallowing and speech, gag reflex, self-care abilities

63
Q

Characteristic motor deficits of stroke

A

Loss of skilled voluntary movement, impairment of integration of movement, alterations in muscle tone, alterations in reflexes, an initial period of flaccidity followed by spasticity of the muscles r/t interruptions in upper motor neuron influence

64
Q

Rate control medications

A

Beta-blockers, calcium channel blockers, cardiac glycosides

65
Q

Rhythm control medications

A

Flecainide, propafenerone, quinidine, sotalol, amiodarone, dronedarone

66
Q

Time interval: door to doctor

A

10 minutes

67
Q

Time interval: access to neurological expertise

A

15 minutes

68
Q

Time interval: door to CT scan

A

25 minutes

69
Q

Time interval: door to CT scan interpretation

A

45 minutes

70
Q

Time interval: door to treatment

A

60 minutes

71
Q

Time interval: admission to ICU

A

3 hrs

72
Q

Indications for craniotomy

A

Subdural hematoma, aneurysm clipping, AVM

73
Q

Peri-operative care: Craniotomy

A

Explain pre-op labs, tests, procedures, anesthesia, est length of procedure, how long in recovery, ICU, pts appearance after procedure, what to expect post-op regarding dressings, catheter, ETT, IVs, IS, pain management; nearest relative may need to sign consent; scalp prep; baseline neuro assess; address anxiety

74
Q

Post-op meds: craniotomy

A

Anticonvulsants; corticosteroids; histamine blockers; analgesics; antibiotics; calcium channel blocker

75
Q

Post-op complications: craniotomy

A

Increased ICP; hematomas; hypovolemic shock; hydrocephalus; atelectasis; hypoxia; pneumonia; neurogenic pulmonary edema; infection; meningitis; dehydration; hyponatremia; seizures; CSF leak; cerebral edema; do not cluster care; watch BS with corticosteroids

76
Q

Clinical manifestations: cerebral edema

A

Change in LOC; change in VS; cushions triad (widening PP, bradycardia, HTN); ocular signs; decrease in motor function; decerebrate posturing; decorticate posturing

77
Q

Glasgow Coma Scale

A

Score of 13-14: mild deficit; 9-12: moderate deficit;

78
Q

Ventriculostomy

A

CSF can be drained when ICP exceeds the upper pressure parameter set by the physician; intermittent drainage via 3-way stopcock to allow CSF to flow into the drainage bag for brief periods (30-120 s) until the pressure is below the upper pressure parameters

79
Q

ICP collaborative care

A

Supplemental O2; mannitol; hypertonic saline; corticosteroids; barbiturates; quiet environment; do not overstimulate; do not cluster care; increased need for glucose; keep pt normovolemic; early and aggressive nutritional support; TPN or feeding tube

80
Q

Broca’s aphasia

A

Expressive; ability to comprehend ; language is retained but the pt has trouble expressing words or naming objects; gestures, groans, swearing, or nonsense words may be used

81
Q

Wernicke’s aphasia

A

Receptive; inability to recognize or comprehend spoken words; as if foreign language I’d being spoken or if the pt had word deafness; often good at responding to nonverbal cues

82
Q

Global aphasia

A

Combination of spoken and comprehensive difficulty

83
Q

Homonymous hemianopsia

A

Blindness in the same side of both eyes; pt does not see entire visual field without turning head to scan environment

84
Q

Unilateral neglect

A

Unawareness of the paralyzed side of the body; place items on the affected side and approach from the affected side in order to bring awareness to the affected side

85
Q

Dysphasia

A

Impairment of speech and of comprehension of speech

86
Q

Dysphagia

A

Difficulty swallowing

87
Q

Coping tasks of stroke pts

A

Modify routine and lifestyle; obtain knowledge and skill; maintain normalcy; maintain positive health; adjust relationships; grieve losses; deal with role changes; handle physical discomfort; comply with tx regimen; confront inevitability; deal with social stigma; maintain feeling of control; maintain hope

88
Q

Physical therapy

A

Walking, ROM

89
Q

Occupational therapy

A

Taking care of oneself

90
Q

Speech language therapy

A

Communication skill, swallowing, cognition

91
Q

Recreational therapy

A

Cooking, gardening, etc

92
Q

Mobility training

A

Balance/sitting/standing; walking (level, stairs, parallel bars to walker progression; wheelchair skills; transfer skills; increase strength and endurance

93
Q

Pt/family teaching

A

Caregiver training; positioning; transfer training; bowel/bladder management; fall prevention

94
Q

Stroke prevention

A

Health promotion for the well individual; education and management of modifiable risk factors; anti platelet drugs to prevent further stroke in pts who have had TIA

Unit 2 (3 decks)

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