Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 353 > STROKE > Flashcards

STROKE Flashcards

1
Q

CVA can either be

A

hemorrhagic or ischemic (blockage of blood flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ischemic can either be

A

thrombolic (result of vascular sclerosis –> narrowing of the artery) or embolic (thrombus, fat, cellular clumps)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

patient profile for stroke

A

non-modifiable
age, gender (equal in both sexes), ethnicity (afr-american bc of higher occurances of HTN and DM)
modifiable
- lifestyle issues, such as smoking, alcohol, lack of physical activity
- hypertension, hyperlipidemia, obesity, diabetes, periodontal disease, atrial fibrillation, oral contraceptives
- drug use (cocaine, amphetamines, OTC cough and cold drugs)
- cold/cough drugs raise blood pressure
- illicit drugs can lead to sudden vasoconstriction, blood cannot flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TIA

A

žForm of thrombotic stroke
žUsually the least serious
žOcclusion of a very small artery, or arteriole
žAffects only a small portion of brain tissue
žUsually no permanent neurological compromise
žUsually lasts < 5 minutes, always < 24 hr
ž*Considered a forewarning of thrombotic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

approach to care after TIA

A

Same as for stroke prevention:
Lifestyle
- focus on modifiable areas intensively
Medications
- aspirin and other antiplatelets; anticoagulants if atrial fib. chronically
Surgical/catheter interventions
- endarterectomy, stenting, and other approaches as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Endarterectomy (surgical response to TIA)

A 
Removal of atherosclerotic plaque
Reopens carotid blood vessel
Indications:  TIA or mild CVA
—70% - 99% carotid blockage   
Significant risks
Chance to damage blood vessels, go thru wall and cause bleeding, etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Carotid stenting

A

Mesh tubes that are inserted into the blood vessel, blood will go through but clots get trapped in meshwork
Less invasive than endarterectomy
Used for those with high surgical risk
Same indications and results for both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

POST OP nursing care for stroke

A

monitor VS/neuro status (grips, MOE, swallowing, tongue, thrusts, smile, chew, shoulder shrug) –> cranial nerve impairment???
facial pulses –> adequate circulation
o2 pulse and pulse ox –> airway compromise?
assess incision for edema/hematoma/tracheal deviation –> airway compromise? neck edema –> tracheal deviation –> airway obstruction ??
elevate HOB; position off operative side –> promote drainage and wound visibility
NOTIFY MD IF PARAMETERS ARE NOT MET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

WARNING!! signs for TIA/stroke

A
  • trouble with walking
  • trouble with speaking and understanding
  • paralysis or numbness of the face, arm or leg
  • trouble with seeing in one or both eyes
  • headache
  • ** FAST! FACE, ARM, SPEECH, TIME***
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CVA acute phase

A

Change in level of consciousness or responsiveness
žPresence or absence of voluntary or involuntary movements
žChange in quality/rates of pulse and respiration
žChange in ability to speak
žPresence of bleeding
žVital signs/O2 sat
žVisual changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CVA Post acute phase

A 
žMental status changes
judgment and general behavior
žLoss of motor control
žSwallowing ability !!!
Do not feed until careful swallowing evaluation has been done
žSelf care compromises
žSensation/perception 
žChanges in nutritional and hydration status
žSkin (like impairment and mobility)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

signs and symptoms of stroke

A
  • relatively independent of cause
    depend on…
  • size of the lesion
  • amount of pre-existing collateral blood flow
  • location of the lesion (lobe of the brain, right or left)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

damage to occipital region

A

visual stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

hemiplegia

A

half of the body parlysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

hemiparesis

A

half weak… half area is weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

dysarthria

A

difficulty announciating or forming language due to neurologic event… problems with speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

aphasia

A

difficulty expressing myself, maybe can’t tell you that I need to use the bathroom

receptive. .. can’t receive the incoming information that they are receiving
global. .. elements of both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hemianopsia

A

lose half your vision… half of your visual fields

maybe one eye

19
Q

left hemisphere affected

A
  • paralysis/weakness on right side
  • right visual field deficit
  • aphasia (expressive, receptive, or global)
  • altered intellectual ability
  • slow, cautious behavior
    • left behind
    • a lot of language centers are in the left side of the brain
20
Q

right hemisphere affected

A
  • paralysis/weakness on left side
  • left visual field deficit
  • spatial-perceptual deficits
  • increased distractibility
  • impulsive behavior
  • poor judgement
  • lack of awareness of deficits
  • ** always right’
  • ** people we really worry about their safety because they are impulsive and forget that they have issues lol
21
Q

CT scan

A
  • if we see signs first thing we do is this person will get
22
Q

CT scan

A
  • if we see signs first thing we do is this person will get
    a CT scan
  • with or without intravenous contrast
  • detailed tissue and bone imaging
  • can detect hemorrhages, tumors, fractures, abscesses, hydrocephalous, edema, ventricular or vascular anomalies
  • if they come in ER we want this within 30 mins
  • tell us about any tissue injury inside the brain
  • # 1 CHOICE!
23
Q

cerebral angiogram

A
  • picture of the blood vessels in the cerebrum
  • nice tree of blood vessels but if there is an area that isnt lit up then this indicates a blockage
  • used to assess vasculature in brain
  • contrast dye injected into artery
  • series of images obtained
  • must obtain written consent
  • NPO prior to test
24
Q

diagnostics

** NEUROLOGICALLY RELATED

A

lumbar puncture (dealing with CSF, is there blood)
CT scan (edema, lesions, structure)
PET scan (blood flow and metabolic activity in regions of the brain)
MRI (shows size/location of lesion… more detailed than CT… not really necessary for someone with stroke)
angiography (ID narrowing, blocked, and or ruptured blood vessels) … checking blood flow
EEG (access localized damage… seizure activity)

25
Q

acute medical care goals

A
  • prevent/minimize the risk of rebleeding
  • remove blood clot
  • re-vascularize affected brain tissue
  • assess any initial injury
  • prevent/treat complications
26
Q

complications that might occur

A
  • seizures
  • bleeding
  • bradycardia (response to brain damage)
  • respiratory compromise (resp centers of the brain may be damaged)
27
Q

management

A
  • sedate to decrease the metabolic demands of the brain
  • reduce intracranial edema/pressure
    (osmotic diuretics, maintain CO2 range 30-35, position to avoid hypoxia, elevate HOB)
  • intubation to preserve airway
  • surgical intervention if (hematoma exceeds 3 cm and glasgow coma scale score decreases)
  • t-PA administration (thrombolytic drug to break down the blood clot)
  • clot retrieval
28
Q

tissue plasminogen activator (T-PA)

A
  • dissolves the blood clot
  • only works on blood clot not fat embolism or made of anything else
  • window of opportunity is 3-6 hours, ideally less than three hours
  • idea is to break down the clot so that blood flow is restored
  • run the risk of cerebral edema
  • don’t want to give someone TPA if they are bleeding/having hemorrhagic stroke
  • might use stroke scale to determine the severity
  • exclusions… recent trauma, surgery, cancer, CVA, GI/GU bleed, INA > 1.7, BP > 185/110
  • admit to ICU/CCU (freq monitoring of VS and neuro status (Q15 to start), continuous cardiac monitoring, serial labs, serial CT scans, and seizure precautions
29
Q

monitor interventions after T-PA

A

Monitor all invasive lines for signs of bleeding
IV, catheter, endotracheal tube, NG tube
Monitor all output for signs of bleeding
Delay any invasive treatment for 24 hours
Injections/lab draws/IV restarts
Monitor of signs of intracranial bleeding
Complaints of headache, change in LOC, loss of function, etc.
Monitor vital signs
Monitor labs
Monitor medications for interactions that can cause bleeding/prevent clotting (LIKE ASPIRIN BC THEN THIS WILL LEAD TO CONTINUED BLEEDING)
DONT WANT TO DO ANYTHING THAT WOULD INCREASE BLEEDING!!!**

30
Q

ischemic CVA clot retrieval

A

Micro catheter guided beyond thrombus
žProximal loops deployed through thrombus
žBalloon inflated to prevent blood flow while thrombus retracted into catheter with aspiration
- basically vacuum the clot out of the blood stream

31
Q

nursing interventions after clot retrieval

A 
t-PA interventions PLUS
Keep flat 4 – 6 hours
Prevent dislodging of clot at femoral access site
Monitor pulse distal to access site
Pulse
Movement
Temperature
*** make sure blood vessel itself has not been damaged d/t this removal***
32
Q

prevention!!

A

Diet, exercise, and attention to periodontal disease
Carotid endarterectomy
Anticoagulant therapy
Antiplatelet therapy (aspirin, clopidogrel/Plavix, and others)
“Statins”
Getting cholesterol down
Antihypertensive medications
Long term damage of HTN and prevent hemorrhagic stroke

33
Q

prevent/treatment clipping of aneurysm

A

Blood won’t get sidetracked into the aneurysm, prevent rupture
Aneurysm can be the source of a hemorrhagic stroke
apply clip at the base of the aneurysm so that way blood cannot build up in that area and then rupture
don’t know who has aneurysm

34
Q

coiling of an aneurysm

A

Platinum and soft metals
Fills the aneurysm, leave it there, prevents blood from entering
then blood will go where it belongs instead! then it won’t rupture i guess lol

35
Q

neuro checks

A

use a glascow coma scale
get points in regards to eyes, verbal, motor
higher the better, 3 minimum, 15 maximum

36
Q

major considerations for recovery

A 
Aspiration
Aphasia
Expressive, receptive, or global
Coping
Dysphagia
Speech therapy (also with aphasia)
Watch for pneumonia (person repeatedly aspirating and getting stuff in their lungs)
Mobility
Physical therapy
Enhancing self-care
Occupational therapy
Sensory or cognitive impairment
Bowel and bladder control – and retraining
Skin care (if there are mobility issues there is likely to be skin issues)
37
Q

improving mobility

A
  • encourage pt to exercise unaffected side (with repeated use and effort people may regain function)
  • establish regular exercise routine
  • muscle strengthening exercises recommended byb PT
  • assist pt OOB as soon as possible; assess balance; move slowly
  • make sure you have proper safety in place
  • ambulation training
38
Q

functional independence measure (FIM)

A
  • instrument which provides information about current mobility, social and cognitive function
  • usually prior to entering a rehab unit
  • effort to let you know where a person is in terms of functionality and independence (may determine where a person may go, insurance coverage)
39
Q

aspiration wall suction unit

A

low suction when suctioning away, don’t want it to be in the red

40
Q

suction canister

A

short tubing attaches to wall unit, long tubing is attached to suction catheter

41
Q

suction catheter

A

mouth, nose, airway, down to lungs (sterile)

when trouble swallowing or choking

42
Q

yankauer suction

A
  • tonsil-tip suction
  • rigid, plastic, larger opening tool
  • can go back down the throat, does not go down the airway (rigid) used more for secretions in the mouth or to clear the mouth out
43
Q

BE FAST!

A 
BALANCE
EYES 
FACE
ARMS 
SPEECH 
TIME 
- fast approach to detect many strokes 
- it can miss posterior circulatory issues - involving the vertebrobasilar arterial system 
- strokes arising from this area have a mortality of > 85%
- be FAST w assessment

NURS 353 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions