recovering form stroke the early stages Flashcards
what age group are most people who suffer from a stroke
65 years or older
Do most people become disabled after a stroke
No only 35%
65% live independently after a stroke.
how long does recover from a stroke take
years after stroke.
what are the clinical symptoms found in a stroke patient
ipsilateral body function loss- one side of face droops and same side the body cannot be moved.
expressive aphasia
homonymous hemianopia- visual field defect in the opposite eye.
what part of the brain does the ACA supply
medial and anterior surfaces.
what part of the brain does the MCA supply
lateral surface- motor and sensory cortex
what part of the brain does the PCA supply
medial and lateral posterior surface
Is weakness caused by a stroke on the contralateral or ipsilateral side
contralateral due to damage of the motor cortex.
what are the consequences of weakness and incoordination of oropharyngeal muscles
Dysarthria: slurred, indistinct speech
Incoordination of swallowing
which language areas are affected in stroke
broca’s and wernicke’s of the opposite side
what type of aphasia does damage to broca’s cause
expressive.
Difficulty finding words but comprehension is fine.
in which lobe is broca’s
lateral frontal lobe.
what type of aphasia does damage to wernicke’s cause
receptive apahsia Flow of speech is fluent Neologism- made up words Mistake closely related words Comprehension, reading and writing is impaired.
in which lobe in wernicke’s
posterior superior temporal lobe.
define neologism
made up words.
what happens to blood pressure immedialtey after a stroke
rises
what happens to blood pressure a few days after a stroke
It settles down
Antihypertensive treatment is not given after stroke unless.
Intracerebral haemorrhage with systolic BP >200,
Hypertensive encephalopathy/ nephropathy/ cardiomyopathy
Aortic dissection
Eclampsia/ pre-eclampsia
what must the oxygen saturation be below for an individual to be on gas
95%
how is capillary blood glucose checked
finger prick test
how is diabetes confirmed
checking fasting venous blood glucose
Aim to control blood glucose between 4-11mmol/
what does the acroymn SMART stand for which is used in stroke patient rehabilitiation
Specific, Measurable, Achievable, Relevant, Time-limited
how many days within admission should the SMART goals be set
5 days
what is the assessment for swallowing
patient is given teaspoon of water at a time and if they patient drools then they are said to be nil by mouth
If they consume 50 ml of water then there is no problem
what are the clinical signs of aspiration pneumonia
Acutely short of breath and confused Respiratory rate high Temperature high Heart rate high Blood pressure low
what are the preventative measures of DVT
LMWH
what is the treatment for DVT
Warfarin
what are the risk factors of DVT
immobility and sepsis
What are the risk factors of pressure sores
Immobility, malnutrition, diabetes, smoking, terminal illness, sensory impairment
pathogenesis of pressure sores
Sustained pressure, often over bony prominence- only takes a few minutes before causes tissue ischemia- eventually causing tissue necrosis.
what causes shoulder sub laxation post stroke
Neglect of affected limb in stroke
management of shoulder sub laxation
optimises positioning and shoulder support
define neuropathic pain
Pain down entire right side: arm and leg
Burning, tingling
Present since 2 or 3 days after stroke, but getting worse
Not much benefit from paracetamol and ibuprofen he is taking for his shoulder and knee.
define negative phenomana
Decreased sensation in one or more modalities
define positive phenomena:
Paraesthesia, burning, shooting pains
Dysaesthesia: altered perception (e.g. soft touch felt as prickly pain
what medication is used to treat post stroke pain
Pregabalin or Gabapentin: anti-epileptic agents
Amitriptyline: a type of antidepressant- causes drowsiness
why must bladder incontinence be managed
can’t tell staff when he need to go due to lack of communication.
Inability to access nurse call buzzer: hemi sensory neglect.
Immobility: can’t reach toilet in time
Constipation with overflow
Medication: on laxatives, diuretics
how is a patient tested for depression
History
Observation of behaviour: crying, withdrawal
Standardised assessments: some suitable for use in dysphasic patients
management of depression
Counselling: supported conversation approach
Drugs: (selective serotonin reuptake inhibitors) second line
what are the common health problems which arise post-MI
hypertension DVT Shoulder sub laxation speech difficulty movement difficulty- sub laxation of the shoulder aspiration pneumonia bed/ pressure sores.
