Stroke Flashcards
1
Q
why does stroke occur
A
- Stroke occurs when there is ischemia or hemorrhage into the brain that results in death of brain cells.
- Normal blood flow to brain is interrupted.
2
Q
stroke also know as
A
Brain attack
Cerebrovascular accident (CVA)
3
Q
stroke classifications
A
hemorrhagic stroke
ishemic stroke
4
Q
hemorrhagic stroke
A
occur secondary to a ruptured artery or aneurysm.
5
Q
prognosis of hemorrhagic stroke
A
- The prognosis is poor due to the amount of ischemia and increased ICP caused by the expanding collection of blood.
- If it is caught early and evacuation of the clot can be done with cessation of the active bleed, the prognosis of a hemorrhagic stroke improves significantly.
6
Q
thrombotic stroke
A
is an ischemic stroke that occurs secondary to the development of a blood clot that shuts off the artery and causes ischemia
7
Q
manifestations of a thrombotic stroke how long does it evolve
A
evolve over a period of several hours to days.
8
Q
what is an embolic stroke
A
- Embolic is an ischemic stroke caused by an embolus traveling from another part of the body to a cerebral artery.
- Blood to the brain distal to the occlusion is immediately shut off causing neurologic deficits or a loss of consciousness to instantly occur
9
Q
extent of an ischemic stroke depends on
A
Rapidity of onset
Size of the lesions
10
Q
what proceeds an thrombotic stroke
A
Thrombotic strokes are preceded by TIAs
11
Q
what stroke can be reversed
A
- Ischemic strokes (thrombotic or embolic) can be reversed with fibrinolytic therapy using alteplase(tPA)
-Give within 3 to 4.5 hr of the initial symptoms (unless contraindicated by factors such as presence of active bleeding).
12
Q
health promotion and disease prevention for strokes
A
- Hypertension, diabetes mellitus, smoking, and other related disorders can increase a client’s risk for a stroke.
- Early treatment of hypertension, maintenance of blood glucose within expected range, and refraining from smoking will decrease these risk factors.
- Maintaining a healthy weight and getting regular exercise can also decrease the risk of a stroke.
13
Q
risk factors
A
- Cerebral aneurysm
● Arteriovenous malformation (AV)
● Diabetes mellitus
● Obesity
● Hypertension
● Atherosclerosis
● Hyperlipidemia
● Hypercoagulability
● Atrial fibrillation
● Use of oral contraceptives
● Smoking
● Cocaine use
14
Q
tpa vs platlet agrregites
A
agrregates prevents platlets from agregating and tpa unravels clot and can promote bleeding and can turn into little clots
15
Q
modifiable risk factors
A
Hypertension
Heart disease
Serum cholesterol
Smoking
Excess alcohol consumption
Obesity
Sleep apnea
Lack of physical exercise
Poor diet
Drug abuse
16
Q
stroke expected findings
A
- Some clients report transient manifestations, such as visual disturbances, dizziness, slurred speech, and a weak extremity.
- These manifestations can indicate a transient ischemic attack (TIA), which can be a warning of an impending stroke.
17
Q
what can prevent the subsequent occurrence of stroke
A
Antithrombotic medication and/or surgical removal of atherosclerotic plaques in the carotid artery
18
Q
what is the left cerebral hemisphere responsible for
A
for language, mathematics skills, and analytic thinking
19
Q
findings from left side
A
- Expressive and receptive aphasia (inability to speak and understand language)
- Agnosia (unable to recognize familiar objects)
- Alexia (reading difficulty)
- Agraphia (writing difficulty)
- Right extremity hemiplegia (paralysis) or hemiparesis (weakness)
- Slow, cautious behavior
- Depression, anger, and quick to become frustrated
- Visual changes, such as hemianopsia (loss of visual field in one or both eyes) use eyepatch
20
Q
right cerebral hemoshphere responsible for
A
visual and spatial awareness and proprioception.
21
Q
right cerebral hemisphere findings
A
- Altered perception of deficits (overestimation of abilities)
- Unilateral neglect syndrome (ignore left side of the body: cannot see, feel, or move affected side, so client unaware of its existence).
- Loss of depth perception
- Poor impulse control and judgment
- Left hemiplegia or hemiparesis
- Visual changes, such as hemianopsia
22
Q
vital signs
A
- Monitor vital signs every l to 2 hr.
- Notify the provider immediately if blood pressure exceeds a systolic greater than 180 mm Hg or a diastolic greater than 110 mm Hg. (can restroke do to not enough blood leaving heart
This can indicate the client is experiencing an ischemic stroke. - Monitor the client’s temperature.
A fever can cause an increase in intracranial pressure. - Provide oxygen therapy to maintain oxygen saturation level greater than 92%, or if the client’s level of consciousness is decreased.
23
Q
nursing care
A
- Place the client on a cardiac monitor to detect arrhythmias.
- Monitor for changes in level of consciousness (increased ICP sign).
- Elevate the head of the bed approximately 30° to reduce ICP and to promote venous drainage.
- Avoid extreme flexion or extension of the neck, and maintain the client’s head in the midline neutral position.
- Institute seizure precautions.
24
Q
nursing care with communication
A
- Assist with the client’s communication skills if speech is impaired.
- Assess the ability to understand speech by asking the client to follow simple commands.
- Observe for consistently affirmative answers when the client actually does not comprehend what is being said.
- Assess accuracy of yes/no responses in relation to closed-ended questions.
- Supply the client with a picture board of commonly requested items/needs.
- For expressive and receptive aphasia speak slowly and clearly, use one-step commands.
25
nursing care with swallowing
- Assist with safe feeding.
- Assess swallowing and gag reflexes before feeding.
- the speech-language pathologist (SLP) may request a swallowing study that can involve swallowing a barium substrate and radiography of the peristaltic activity of the esophagus.
26
types of liquid consistencies
- thin (water, juice)
- nectar-like (cream soups, nectars)
- honey-like (honey, yogurt)
- spoon-thick (pudding, cooked cereals)
27
food levels for dysphagia
pureed, mechanically altered, advanced/mechanically soft, and regular.
28
nursing care on eating
- Have the client eat in an upright position and swallow with the head and neck flexed slightly forward.
- Place food in the back of the mouth on the unaffected side.
- Have suction on standby.
- Maintain a distraction-free environment during meals.
- Collaborate with dietitian to ensure appropriate caloric intake, because weight loss is common following stroke.
29
preventing complication
- Prevent complications of immobility, such as atelectasis, pneumonia, pressure sores, and deep-vein thrombosis (DVT).
- Clients who have experienced strokes are ambulated as soon as possible to prevent complications.
- Maintain skin integrity.
- Reposition the client frequently and use padding.
30
nursing care of extremities
- Monitor bony prominences, paying particular attention to the affected extremities.
- If the client has one-sided neglect, teach to protect and care for the affected extremity to avoid injuring it in the wheel of the wheelchair or hitting/ smashing it against a doorway.
- Encourage passive range of motion every 2 hr to the affected extremities and active range of motion every 2 hr to the unaffected extremities
31
transporting
- Elevate affected extremities to promote venous return and reduce swelling.
- Maintain a safe environment to reduce the risk of falls.
- Assistive devices, such as transfer belts and sliding boards, should be used during transfers.
- Sit-to-stand lifts can also facilitate transfers and reduce strain on the care provider’s body
32
ADLs care
- Provide assistance with ADLs as needed.
- Instruct the client to dress the affected side first and sit in a supportive chair that aids in balance.
- Have occupational therapy assess the client for adaptive aids, such as a plate guard, utensils with built-up handles, a reaching tool to pick things up, and shirts and shoes that have hook and loop fasteners or tape instead of buttons and ties.
- Provide frequent rest periods from sitting in the wheelchair by returning the client to bed after therapies and meals.
- When sitting the client up in bed or in the wheelchair, leaning to the affected side typically occurs and should be countered with some manner of support.
- Support the client during periods of emotional lability and depression.
33
respiratory system
risk for
Management of the respiratory system is a nursing priority.
- Risk for atelectasis
- Risk for aspiration pneumonia
- Risks for airway obstruction
34
Most obvious effect of stroke include impairment of:
Most obvious effect of stroke include impairment of:
- Mobility
- Respiratory function
- Swallowing and speech
- Gag reflex
- Self-care abilities
35
home care/ambulatory care
Toileting interventions
- Implement a bowel management program for problems with
- Bowel control: q2hr
- Constipation: hydration, fiber, stool softner
- Incontinence
- High-fiber diet and adequate fluid intake
36
preventive drug therapy
used in patients at risk for stroke.
- Antiplatelet drugs are used in patients who have had a TIA related to atherosclerosis.
- Aspirin is the most frequently used antiplatelet agent.
37
aspirin
- Low-dose aspirin is given within 24 to 48 hr following a stroke to prevent further clot formation.
- Other antiplatelets, such as clopidogrel, are not recommended
38
Recombinant tissue plasminogen activator (tPA)
- drug used for ischemic stroke
- Used to reestablish blood flow through a blocked artery to prevent cell death.
- Must be administered within 3 to 4.5 hours of onset of clinical signs of ischemic stroke.
- Intra-arterial tPA can be given within 6 hours.
39
anticoagulants
- heparin sodium
- Enoxaparin/ lovenox
- warfarin/ cumodin
Use of anticoagulants is controversial
and not recommended due to the high risk of intracerebral bleeding.
40
Antiepileptics
- Phenytoin/ dylintin
- Gabapentin/ nurontin
- These medications are not commonly given following a stroke unless the client develops seizures.
- Gabapentin can be given for paresthetic pain in an affected extremity.
41
Therapeutic Procedures for Hemorrhagic Stroke
Surgical interventions used to treat hemorrhagic strokes include:
- Resection or Clipping of an aneurysm
- Evacuation of hematomas
- Procedure is chosen based on the cause of the stroke.
42
intra arterial TPA
- restores cerebral blood flow.
- Must be administered within 6 hr of onset of symptoms.
- It is contraindicated for treatment of a hemorrhagic stroke and for clients who have an increased risk of bleeding due to anticoagulant therapy or other bleeding anomaly.
- Possibility of hemorrhagic stroke is ruled out with an MRI prior to the initiation of thrombolytic therapy.
43
Carotid artery angioplasty with stenting (CAS)
Inserting a catheter in the femoral artery and placing a protection device to catch clot debris
44
Carotid endarterectomy removes atherosclerotic plaque.
This procedure is performed when the carotid artery is blocked or when the client is experiencing TIAs.
45
Dysphagia
- can result from damage to cranial nerves that innervate the face, tongue, soft palate, and throat.
- As a result, the client’s risk of aspiration is great.
- Not all clients who have a stroke have dysphagia, but all should be evaluated prior to reestablishing oral nutrition and hydration
46
what do assess for for dysphasia
- Assess gag reflex
- If the gag reflex is present, give the client a small sip of water to determine if choking occurs
- If the client exhibits difficulty managing food or fluids, a swallowing evaluation should be done by an SLP
- Keep the client completely NPO until evaluated by the SLP.
47
eating with dysphagia
- Begin with the prescribed liquid-consistency and observe closely for choking.
- Have suction equipment available, but feed with care because suctioning increases ICP.
- Initial feedings should be done by an RN,
- Some clients require an eating environment without distractions to prevent choking.
