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Med Surg 2 > Stroke > Flashcards

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.
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2
Q

stroke also know as

A

Brain attack
Cerebrovascular accident (CVA)

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3
Q

stroke classifications

A

hemorrhagic stroke
ishemic stroke

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4
Q

hemorrhagic stroke

A

occur secondary to a ruptured artery or aneurysm.

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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.
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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

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7
Q

manifestations of a thrombotic stroke how long does it evolve

A

evolve over a period of several hours to days.

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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
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9
Q

extent of an ischemic stroke depends on

A

Rapidity of onset
Size of the lesions

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10
Q

what proceeds an thrombotic stroke

A

Thrombotic strokes are preceded by TIAs

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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).
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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.
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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
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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

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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

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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.
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17
Q

what can prevent the subsequent occurrence of stroke

A

Antithrombotic medication and/or surgical removal of atherosclerotic plaques in the carotid artery

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18
Q

what is the left cerebral hemisphere responsible for

A

for language, mathematics skills, and analytic thinking

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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
Q

nursing care with swallowing

A
  • 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
Q

types of liquid consistencies

A
  • thin (water, juice)
  • nectar-like (cream soups, nectars)
  • honey-like (honey, yogurt)
  • spoon-thick (pudding, cooked cereals)
27
Q

food levels for dysphagia

A

pureed, mechanically altered, advanced/mechanically soft, and regular.

28
Q

nursing care on eating

A
  • 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
Q

preventing complication

A
  • 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
Q

nursing care of extremities

A
  • 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
Q

transporting

A
  • 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
Q

ADLs care

A
  • 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
Q

respiratory system
risk for

A

Management of the respiratory system is a nursing priority.
- Risk for atelectasis
- Risk for aspiration pneumonia
- Risks for airway obstruction

34
Q

Most obvious effect of stroke include impairment of:

A

Most obvious effect of stroke include impairment of:

  • Mobility
  • Respiratory function
  • Swallowing and speech
  • Gag reflex
  • Self-care abilities
35
Q

home care/ambulatory care

A

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
Q

preventive drug therapy

A

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
Q

aspirin

A
  • 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
Q

Recombinant tissue plasminogen activator (tPA)

A
  • 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
Q

anticoagulants

A
  • heparin sodium
  • Enoxaparin/ lovenox
  • warfarin/ cumodin

Use of anticoagulants is controversial
and not recommended due to the high risk of intracerebral bleeding.

40
Q

Antiepileptics

A
  • 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
Q

Therapeutic Procedures for Hemorrhagic Stroke

A

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
Q

intra arterial TPA

A
  • 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
Q

Carotid artery angioplasty with stenting (CAS)

A

Inserting a catheter in the femoral artery and placing a protection device to catch clot debris

44
Q

Carotid endarterectomy removes atherosclerotic plaque.

A

This procedure is performed when the carotid artery is blocked or when the client is experiencing TIAs.

45
Q

Dysphagia

A
  • 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
Q

what do assess for for dysphasia

A
  • 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
Q

eating with dysphagia

A
  • 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.

Med Surg 2 (35 decks)

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