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NURS 353 > STROKE > Flashcards

STROKE Flashcards

1
Q

CVA can either be

A

hemorrhagic or ischemic (blockage of blood flow)

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2
Q

ischemic can either be

A

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

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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

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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

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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

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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
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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

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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

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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***
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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

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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)
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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)
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13
Q

damage to occipital region

A

visual stimuli

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14
Q

hemiplegia

A

half of the body parlysis

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15
Q

hemiparesis

A

half weak… half area is weak

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16
Q

dysarthria

A

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

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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

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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
acute medical care goals
- prevent/minimize the risk of rebleeding - remove blood clot - re-vascularize affected brain tissue - assess any initial injury - prevent/treat complications
26
complications that might occur
- seizures - bleeding - bradycardia (response to brain damage) - respiratory compromise (resp centers of the brain may be damaged)
27
management
- 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
tissue plasminogen activator (T-PA)
- 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
monitor interventions after T-PA
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
ischemic CVA clot retrieval
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
nursing interventions after clot retrieval
``` 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
prevention!!
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
prevent/treatment clipping of aneurysm
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
coiling of an aneurysm
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
neuro checks
use a glascow coma scale get points in regards to eyes, verbal, motor higher the better, 3 minimum, 15 maximum
36
major considerations for recovery
``` 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
improving mobility
- 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
functional independence measure (FIM)
- 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
aspiration wall suction unit
low suction when suctioning away, don't want it to be in the red
40
suction canister
short tubing attaches to wall unit, long tubing is attached to suction catheter
41
suction catheter
mouth, nose, airway, down to lungs (sterile) | when trouble swallowing or choking
42
yankauer suction
- 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
BE FAST!
``` 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)

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