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NURS2522 > STROKE > Flashcards

STROKE Flashcards

1
Q

What are the 2 types of strokes?

A

Ischemic (80%)
- loss of blood flow to an area of the brain due to a thrombus or embolus

Hemorrhagic (15%)
- bleeding into the brain or surface of the brain due to rupture of a blood vessel supply to the brain

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2
Q

modifiable risk factors

A
  • hypertension
  • metabolic syndrome
  • smoking and alcohol consumption
  • physical inactivity
  • poor diet
  • sleep apnea
  • heart disease
  • oral contraceptive use
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3
Q

non-modifiable factors

A
  • age
  • gender
  • ethnicity and race
  • heredity + family Hx
  • low birth weight
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4
Q

Subarachnoid vs intracerebral hemorrhage

A

subarachnoid

  • subarachnoid space (between pia matter and subarachnoid membrane) fills with blood
  • blood pools and pushes on the brain

intracerebral
- bleeding due to rupture of a vessel supply the brain matter

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5
Q

What is act “FAST”

A

F - facial drooping
A - arms (cannot lift both up)
S - speech slurred
T - time to call 911

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6
Q

What is a CT used for

A
  • First diagnostic test
  • differentiates between ischemic (dark) and hemorrhagic (white)
  • confirm that it is a stroke and not a tumor
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7
Q

What is given within 60 mins following assessment and diagnosis of ischemic stroke with a CT scan

A

Give thrombolytic injection

- ex. tPA

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8
Q

Initial Interventions following diagnosis of stroke

A

A - AIRWAY

  • keep patent
  • use head tilt, chin lift

B - BREATHING

  • monitor SpO2, RR, rhythm and depth
  • intubation if pt cannot maintain adequate O2 levels
  • ambu bag

C - CIRCULATION

  • establish IV access in case of emergency
  • consider fluid and electrolytes related to BP
  • monitor BP
D - DISABILITY (NEURO)
- CT scan STAT 
position head midline 
- HOB at 30 degrees to facilitate venous drainage 
- Seizure precautions
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9
Q

What is CPP?

A 
CPP = cerebral perfusion pressure 
CPP = mean arterial P - intracranial P

CPP is also affected by autoregulation

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10
Q

How does autoregulation impact your choice of interventions?

A

Lots of auto-regulation will occur as a result of an ischemic stroke. One being increased BP to maintain circulation; thus hypertension is normal after a stroke.

We do NOT treat the high BP UNLESS it is really high ( > 220/130), as it risks extending the stroke

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11
Q

Acute care interventions (what to do after recognition of a stroke)

A

1) ensure patent airway
2) call stroke team
3) remove dentures
4) perform pulse oximetry
5) monitor and maintain adequate oxygenation
6) obtain IV access w/ normal saline
7) maintain BP
8) remove clothing
9) Insert Foley catheter
10) obtain CT scan STAT
11) perform baseline lab tests
12) position head midline
13) HOB > 30 degrees
14) seizure precautions
15) keep pt NPO until swallowing reflex is evaluated

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12
Q

When would you give tPA?

A

tPA - tissue plasminogen activator

inclusion criteria

  • ischemic stroke that has a disabling neurological deficit
  • > 18 yrs of age
  • time of last stroke < 4.5 hrs

exclusion criteria
- evidence of hemorrhagic stroke or hemorrhage in the brain

Relative exclusion

  • look at lab values
  • does pt have a blood clotting issue? If so, tPA will be ineffective
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13
Q

What can you give as treatment if tPA is not an option?

A

anti-platelet drugs

  • CHEWABLE Aspirin (ASA) - immediate effect
  • Plavix (clopidogrel)
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14
Q

what is EVT?

A

Endovascular thrombectomy

- removing blood clots with a thin wire and balloon

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15
Q

Clipping and wrapping aneurysms

A

a small metal clip is used to stop blood flow into the aneurysm

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16
Q

GDC coil

A

A platinum coil is induced through the femoral artery and is pushed into the aneurysm to prevent bleeding

17
Q

Other diagnostic studies

A
  • electrocardiogram
  • chest x ray
  • cardiac markers (troponin)
  • echocardiogram
  • blood glucose
  • CTA
  • MRI
  • angiography
  • transcranial doppler ultrasonography
18
Q

When would you do a lumbar puncture?

A

Only done if we suspect a subarachnoid hemorrhage, but we cant see anything on the CT

  • Blood in CSF suggests subarachnoid hemorrhage
  • Also to rule out infections of the CSF
19
Q

Assessments for a stabilized patient

A

comprehensive assessment

  • HPI, meds, RF’s, FHx
  • comprehensive neurological assessment
20
Q

Planning

A

Set goals w/ pt

  • maximize communication abilities
  • avoid complications
  • maintain effective coping
21
Q

Implementation

A
  • health promotion
  • address and intervene regarding system issues identified
  • ambulatory and home care (rehab)
22
Q

Evaluation

A

Assess goals

  • maintain stable or improved LOC
  • attain maximum physical functioning
  • maximize self-care abilities
  • maintain stable body functions
  • maximize communication abilities
  • avoid complications of stroke
  • maintain effective coping
23
Q

What does the Canadian Neurological Stroke Scale assess?

A

A common scale used on stroke floors

assess

  • cognition
  • LOC
  • motor abilities
  • CN FN
  • sensation
  • proprioception
  • cerebellar FN
  • deep tendon reflexes
24
Q

According to the Canadian neurological scale, what findings should have you notify the MD

A
  • a decrease of > 1 point and/or
  • changes in pupil size or reaction to light
  • changes in vital signs
25
Q

what should you monitor in the respiratory system?

A
  • risk for atelectasis
  • risk for pneumonia (if gag reflex is affected and they have dysphagia)
  • risk for airway obstruction
  • If pt cannot maintain an airway. They may require endotracheal intubation
26
Q

ongoing monitoring of neurological system

A

Look for signs suggesting:

  • extension of stroke
  • increased ICP
  • vasospasm
  • recovery from stroke symptoms
27
Q

ongoing monitoring of CVS

A
  • VS
  • cardiac rhythms
  • intake/output
  • regulating IV infusions
28
Q

Motor FN impairments

A
  • motility
  • respiratory FN
  • swallowing and speech
  • gag reflex
  • ADLs
29
Q

Ongoing monitoring of MSK

A

goal - maintain optimal FN and prevent injury

  • prevent joint contractures
  • ROM exercises
  • positioning
30
Q

Communication deficits in stroke pts

occurs in the dominant hemisphere

A

Aphasia
- total loss of comprehension and use of language

dysphagia
- difficulty related to comprehension or use of language due to partial disruption

dysarthria

  • disturbance in muscular control of speech
  • mechanism of speech is impaired. Comprehension intact
  • ex. pronunciation, articulation, phonation
31
Q

What are the 4 types of dysphagia

A

Expressive dysphagia - difficulty expressing what you want to say

Receptive - when someone has difficulty understanding either written or spoken language

Anomic/amnesic - trouble naming objects when speaking and writing

Global - symptoms of expressive and receptive dysphagia

32
Q

Changes in Affect

A
  • may experience difficulties controlling emotions
  • emotional responses may be exaggerated or unpredictable
  • depression

NURSING INTERVENTIONS

  • explain to family that emotional outbursts may occur and is beyong the pts control
  • distract pt
  • maintain calm environment
  • avoid shaming pt
33
Q

Changes to intellectual FN

A

memory
judgment

left brain stroke more likely to result in language and memory problems

34
Q

spatial-perceptual alterations (4 types)

A

more common in RIGHT side strokes
ANOSOGNOSIA - lack of insight, impaired ability to understand and perceive his/her own illness

ERRONEOUS PERCEPTION OF SELF IN SPACE

AGNOSIA - unable to recognize and identify objects, persons, sounds

APRAXIA - unable to perform learned and familiar movements on command even though the command is understood and there is willingness to perform the movement

35
Q

what is homonymous hemianopsia

A

blindness in the same half of the visual field in both eyes

36
Q

Visual problems that may occur after a stroke

A
  • homonymous hemianopsia
  • diplopia
  • loss of corneal reflex
  • ptosis
37
Q

Changes to elimination

A

problems w/ urination and elimination occur initially and are temporary

  • urinary frequency
  • urgency or incontinence
  • constipation

Implement a bowel management program

If there is no contraindications to having fluids, we want the pt to intake 2500-3000 ml of fluid/day
Cooked veggies and fruit - cooked foods are easier to masticate and swallow

NURS2522 (5 decks)

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