Stroke Flashcards
What are the two types of strokes? Define each and which one is the most common?
Ischaemic - most common and is caused by a blood clot -> block of blood flow to the brain. Results in swelling and oedema
Haemorrhagic - break in vessel in or around the brain causing bleeding -> lack of O2 and nutrients
Ischaemic strokes can be further classified into 2 sub categories. List and explain the aetiology
Embolic: where a clot forms somewhere in the body (usually heart) and travels up to the brain -> clot small blood vessels
Thrombotic: build up of cholesterol plaques that narrows or blocks the artery -> blocks blood flow to the brain. Typically causing deposits in the brain
What is meant by the phrase ‘time is brain’?
The greater the time w/o blood flow, the greater the damage to brain tissue
Ideally, treat within 3 hrs of symptoms to minimise disability
Describe the pathophysiology of an ischaemic stroke
lack of perfusion of blood flow through an artery –>
ischaemia and odema in surround tissue –>
death of brain cells and tissue –>
more damage and oedema that resolves only with perfusion
Describe the pathophysiology, symptoms, and mortality of a haemorrhagic stroke
- bleeding in the brain causing lack of O2
- may result from uncontrolled hypertension, aneurysms, vascular malformations
- symptoms: intense, painful headache; nausea, vomiting
- MR higher than for ischaemic stroke
What are 3 classes (list suffixes) of drugs that can be used to reduce the risk of stroke? What are their indications, MOA and provide an exmaple
- OLOL: hypetension and angina. Blocks beta-receptor to reduce HR, BP, heart contractility. ATENOLOL
- IPINE: hypertension. Blocks calcium channels in periphery, reduce blood vessel resisatnce. AMLODIPINE
- STATIN: hypercholesterolaemia. Limits cholersterol synthesis . ATORVASTATIN
A history of a transient ischaemic attack (TIA) is significant because….
- a sign of an impending stroke
- greatest risk of stroke in 1st week following a TIA
- some people may experience multiple TIAs before a significant stroke event
What are some non-modifiable risk factors for an iscahemic stroke?
- increased age (>65)
- sex: men more likely
- race: African Americans > Caucasians
- family history
- atrial fibrillation (fast irregular heart beat)
What are some modifiable risk factors of ischaemic strokes?
- hypertension: increases risk
- diabetes: increases risk
- abdominal - obesity
- exercise: reduces risk
- smoking: increases risk
What are the differences in risk factors between embolic and thrombotic strokes?
Embolic: dysrhythmias, enlarged heart, bacterial endocarditis, heart failure, aortic valve disease
Thrombotic: Atherosclerosis, blood clotting disorders, increased plates, vasculitis
What are the signs and symptoms of an acute ischaemic stroke?
- weakness/numbness: face, arms, legs often on one side
- confusion, frustration
- difficulty in speaking or understanding
- difficulty in walking/falling
- severe headaches
- visual disturbances: loss, blurred vision
What clinical features are seen in right-brain stroke?
- left-side weakness/paralysis
- impaired perception, memory and judgement
- left side neglect
- short attention span
- impulsive
What clinical features can be seen of left-brain stroke?
- right-side weakness/paralysis
- impaired language and math skills
- impaired left-right distinction
- cautious
- aware of deficits; depression, anxiety
Stroke can occur from the blockage of cerebral artery (CA) List the 4 locations is can occur in and some of the associated symptoms
Middle CA: facial symmetry, unilateral arm/hand weakness, diff. speaking
Anterior CA: sensory loss, lower body weakness, incontinence, abnormal behaviour
Posterior CA: visual disturbances and complete loss of vision
Vertebral-Basilar artery:
- cerrebellum: dizzinesss, N/Vs, slurred speech, headache
- brain stem: cross with isachemia signs. Quadriplegia, double vision,
decreased consciousness
What drug would be administered to a patient having an ischaemic stroke? What is it’s MOA and the route of administration?
Alteplase: thrombolytic drug
MOA: converts plasminogen > plasmin -> lysis of fibrin (clot) -> venous flow
Given: w/i 4.5 hrs of onset
DOSE: IV bolus dose (0.1mg/kg) –> infusion (0.8mg/kg) over 60 minutes
There is a checklist for alteplase before administration. Why would it be important to completed this checklist?
Alteplase eventually leads to perfusion of blood. Hence, can’t be used in haemorrhagic stroke as that would cause more blood flow so need to rule that out
What nursing actions should be completed in first 48hrs post-stroke?
- intracranial pressure
- vital signs
- BP management
- DVT, nutrition
- immobility
- constipation
- infections
Define intracranial pressure (icp). Why would stroke increase icp? What are the signs of increased icp?
- ICP: pressure exerted inside cranium by the brain, CSF and blood
- Ischaemic stroke results in swelling an oedema
- haemorrhagic stroke: bleeding in the brain and tissue
- signs: headache, confusion, lowering consciousness, vital signs, aphasia (language)
Why is it important to monitor BP in stroke patients?
- BP = blood pressure in arteries. Elevated BP is common in acute ischaemic stroke
- High BP (>185/110) increases risk of haemorrhagic stroke
- Low BP risks further brain damage
Describe the indication for glyceryl trinitrate patches and also it’s ‘off label’ use.
- indication: angina
- off label: reduces peripheral BP w/o affecting central blood flow to the brain
