Stroke

Question 1

Cranial Nerve II

Optic

Answer 1

Visual Acuity (Sensory)
Ask pt to read Snellen's chart about 20 ft away. Close one eye at a time.

Question 2

Cranial Nerve III

Oculomotor

Answer 2

Pupillary Constriction (Motor)
Assess ocular movements and pupil reaction. PERRLA

Question 3

Cranial Nerve IV

Trochlear

Answer 3

Vertical Eye Movement (Motor)

Ask pt to move eyeballs up and down

Question 4

Cranial Nerve V

Trigeminal

Answer 4

Face Sensation (Sensory)
Light touch, wipe forehead, cheeks, and chin with cotton (eyes closed)
Mastication Muscles (Motor)
Palpate temporal and masseter muscles as pt clences teeth

Question 5

Cranial Nerve VI

Abducens

Answer 5

Horizontal eye movement (motor)

ask pt to move eyeballs laterally

Question 6

Cranial Nerve VII

Facial

Answer 6

Taste (sensory)
Facial Expression (Motor)
Ask pt to do facial expressions like smile, frown, raise eyebrows

Question 7

Cranial Nerve IX

Glossopharyngeal

Answer 7

Taste (Sensory)
Gag Reflex (Motor)
Depress tongue, pt says “ahhhh” uvula and soft palate should rise to midline

Question 8

Cranial Nerve X

Vagus

Answer 8

Pharynx and Larynx (Motor)

Ask pt to swallow, assess speech for hoarseness

Question 9

Cranial Nerve XII

Hypoglossal

Answer 9

Movement of tongue (Motor)

Inspect the tongue

Question 10

Frontal Lobe Function

Answer 10

• behavior/emotions
• planning/problem solving
• thinking/concentration
• expressive speech (Broca’s Area - if damaged they can understand but not speak)
• body movement

Question 11

Parietal Lobe Function

Answer 11

• Senses (touch, pain, temp)
• Interprets signals (vision, hearing, motor)
• Interprets languages & words

Question 12

Temporal Lobe Function

Answer 12

• Hearing
• Memory
• Understand language (Wernicke’s Area - damaged cannot understand speech and does not make sense)

Question 13

Occipital Lobe Function

Answer 13

• Interprets vision (color, light, movement)

Question 14

Left Side Functions

Answer 14

• Logical side
• Dominant side
• Speaking/language
• Reading
• Writing
• Math
• Analysis
• Planning

Question 15

Right Side Functions

Answer 15

• Creative side
• Creativity
• Imagination
• Music Awareness
• Showing emotions
• Art awareness

Question 16

Ischemic Stroke

Answer 16

• Usually due to a blocked artery (often by a blood clot)
• Brain cells do not receive enough oxygen/glucose and can soon die
  Causes: Embolism (clot forms in body and travels to brain) or Thrombosis (clot forms in the artery in neck or brain)

Question 17

Hemorrhagic Stroke

Answer 17

• Due to bleeding blood vessel in and around the brain
• Blood vessel ruptures, blood leaks into brain tissue or around the brain (decreased blood to brain cells, and increased swelling in brain)
  Causes: Rupture of brain aneurysm, uncontrolled HTN, or age of blood vessels.

Question 18

Transient Ischemic Attack (TIA)

Answer 18

• Early warning sign of impending stroke
• Caused by brief interruption of the blood supply of the brain
• Blood supply restored quickly, no tissue dies, brain function returns quickly
  Microemboli

Question 19

Sympathetic Nervous System

Answer 19

Eyes: dilates pupils
Salivary glands: inhibits saliva production
Lung: dilates bronchi
Heart: HR, muscle contraction increase
Adrenal gland: stimulates epi and norepi
Liver: stimulates glucose release
Kidney: inhibits urine secretion
Digestive: inhibits peristalsis & pancreatic secretion
Bladder: inhibits urination

Question 20

Parasympathetic Nervous System

Answer 20

Eyes: constricts pupils
Salivary glands: stimulates saliva production
Lung: constricts bronchi
Heart: HR, and muscle contraction decrease
Kidney: stimulates urine secretion
Digestive tract: stimulates peristalsis & promotes pancreatic secretion
Bladder: stimulates urination
Genitalia: promotes erection
ACETLYCHOLINE

Question 21

Prepocedure Lumbar

Answer 21

Vital signs
notify HCP for increased ICP
Place pt in side lying position 
have pt void
educate pt on procedure
may feel temporary sharp pain radiating down the leg

Question 22

Postprecedure Lumbar

Answer 22

Monitor for headache and drainage

Teach pt to report numbness, tingling, and movement of extremities

Question 23

FAST

Answer 23

Facial droop
Arm weakness
Speech
Time

Question 24

Intracerebral Hemorrhage Manifestations

Answer 24

Severe headache with nausea and vomit
Decreased LOC
Hypertension

Question 25

Right Side Damage

Answer 25

Paralyzed LEFT side
Left sided neglect
Spatial-perceptual deficits
Tends to deny or minimize problem
Short attention span
Impulsive, safety issues
Impaired judgment
Impaired time concepts

Question 26

Left Side Damage

Answer 26

Paralyzed RIGHT side
Impaired speech/language 
Impaired R/L discrimination
Slow performance
Aware of deficits = depression, anxiety
Impaired comprehension to language and math

Question 27

Preventative Therapy

Answer 27

Primary: management of modifiable risk factors
Antiplatelet drugs - Aspirin, Clopidogrel, Dipyridamole
Carotid endarterectomy
Transluminal angioplasty
Stenting
MERC

Question 28

Drug Therapy for Hemorrhagic Stroke

Answer 28

NO TPA!
Anticoags and platelet inhibitors are contraindicated
Main therapy is mgmt of hypertension meds

Question 29

Normal ICP range

Answer 29

5 - 15 mmHg

Sustained pressure greater than 20 is considered abnormal

Question 30

Factors affecting Cerebral Blood Flow

Answer 30

High CO2 causes high CBF and high ICP
Low CO2 causes low CBF and low ICP
O2 less than 50 causes high CBF and high ICP
High hydrogren causes ICP

Question 31

Cushing’s Triad

Answer 31

Widended pulse pressure (high BP)
Bradycardia
Irregular respirations

Question 32

Decorticate position

Answer 32

internal rotation and adduction of the arms

Question 33

Decerebrate position

Answer 33

arms stiffly extended and hyperpronated

Question 34

Drug Therapy for ICP

Answer 34

Mannitol
HYpertonic Saline (5% NS)
Corticosteroids