Stroke Flashcards
1
Q
Define stroke
A
- occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts
Caused by:
- Ischemia to part of the brain
OR
- Hemorrhage into the brain that results in death of brain cells
- Also known as brain attack OR CVA (cerebrovascular accident)
2
Q
What are the effects of having a stroke?
A
- Loss of function varies according to the location and extent of brain tissue involved.
- Physical, cognitive, and emotional impact on patient and family
- Different degrees of damage
- Impairment of some sort
- Cannot control some impulses
3
Q
Non-modifiable risk factors
A
- Age: stroke risk doubles each decade after 55
- Gender: more common in men but more women die
- Ethnicity/race: higher incidence in African Americans (HTN is very common in African American males, if there is a weak blood vessel in the brain, high pressure, it can rupture and cause bleeding in the brain)
- Heredity/family hx
4
Q
Modifiable risk factors
A
- Hypertension: exercise, diet, low sodium, weight loss, stress
- Heart disease
- Atrial Fibrillation: the blood does not get out well since it pools and starts to form blood clots and getting into circulation and can lodge in many places
- Serum cholesterol: diet
- Smoking
- Excess alcohol consumption
- Obesity
- Sleep apnea
- Metabolic syndrome
- Lack of physical exercise
- Poor diet
- Drug abuse
5
Q
Define a TIA (transient ischemic attack)
A
- associated with an increased risk of stroke
- TIA is a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of the brain.
- Episodes of hypoxia
- Not a complete stroke and not a complete blockage
- Infarction (cutting off) of the blood flow
6
Q
Define the types of stroke - ischemic
A
- Ischemic
- 80% of all strokes
- Inadequate blood flow to brain
- TIA can be precursor
- Thrombotic-vessel wall injury, narrowing of wall, blood clot
- Embolic-embolus lodges in cerebral artery, infarction, edema
- Cut off of blood flow due to plaque or blood ends up clotting
- Blood vessel is narrowing
- Plaque makes the blood sluggish
- Clot that has now clotted
- Ischemia = Narrowing
7
Q
Define the types of stroke - hemorrhagic
A
- Hemorrhagic
- Intracerebral
- Bleeding within brain caused by rupture of a vessel
- Sudden onset of symptoms
- Progression over minutes to hours because of ongoing bleeding
- Prognosis is poor with a 30-day mortality rate of 40-80%.
- Subarachnoid
- Bleeding into cerebrospinal fluid–filled space between the arachnoid and pia mater
- Commonly caused by rupture of a cerebral aneurysm, trauma, or drug abuse, arteriovenous malformation (AVM)
- Aneurysms silent killer -40% die during the first episode
- Brain bleed
- Just keep bleeding and can hardly get into it due to location, can cause more issues by doing surgery
- Aneurysm: weakened area of an artery that kind of balloons out and with pressure will rupture
- AVM: in utero as she was developing, an abnormal tangle of blood vessels connecting arteries and veins, which disrupts normal blood flow and oxygen circulation, children often die from this as they bleed out
- Hemorrhagic = bleeding, the pressure will cause a lot of pain making people say it is the worst headache they have ever felt, thunderclaps headache
8
Q
Diagnostics for strokes
A
- Diagnostic studies are done to:
- Confirm that it is a stroke
- Identify the likely cause of the stroke
- Non-contrast CT scan or MRI:
- Indicate the size and location of the lesion
- Differentiate between ischemic and hemorrhagic stroke
9
Q
Define FAST
A
- warning signs of stroke
Face drooping
Arm weakness
Speech difficulties
Time - Have pt. smile, stick their tongue out
- Have them say “the sky is blue”
- Do they have trouble seeing or walking, feeling dizzy
10
Q
Clinical manifestations of stroke - motor
A
- Related to the location of the stroke
- Neural tissue destruction is the basis for neurologic dysfunction
- Affects many body functions
- Related to the artery involved and the area/half of the brain it supplies
- Time of the onset of symptoms /length of period of ischemia is important
- Droopy face
- One sided weakness
- Vision issues
- Swallowing issues
- Paralyzed on both sides
- If I have a stroke on the L side, it will take effects on the R side of the body
- Most obvious effect of stroke: speech
- Include impairment of:
- Mobility
- Respiratory function
- Swallowing and speech
- Gag reflex
- Self-care abilities
- Symptoms are caused by the destruction of motor neurons in the pyramidal pathway (nerve fibers from the brain that pass through the spinal cord to the motor cells).
11
Q
Clinical manifestations of stroke - communication
A
- Dysphasia refers to impaired ability to communicate
- Used interchangeably with aphasia
- Receptive aphasia-loss of comprehension
- Expressive aphasia-inability to produce language
- Global-total inability to communicate
- Many patients experience dysarthria
- Disturbance in the muscular control of speech
- Impairments may involve:
- Pronunciation
- Articulation
- Phonation
- Dysphasia = speech issues
- Dysphagia = swallowing issues
- can understand but cannot get the words out
- can hear it but cannot understand it
12
Q
Clinical manifestations of stroke - affect
A
- Patients who suffer a stroke may have difficulty controlling their emotions
- Emotional responses may be exaggerated or unpredictable.
- May be magnified by depression, changes in body image, and loss of function
13
Q
Nursing interventions for stroke
A
- Begins with managing “ABC’s”
- Primary assessment is focused on:
- Neurologic assessment
- Cardiac status
- Respiratory status
- If the patient is stable, obtain a hx
14
Q
Stroke Assessment - NEURO
A
- Neurological Assessment
- Monitor closely to detect changes
- Pupillary responses
- Vital Signs
- ↑ ICP
- Recovery from stroke symptoms
- Level of consciousness/mental status
- Include NIH Stroke Scale
- Cognition
- Motor abilities
- Extremity movement and strength
15
Q
Nursing Diagnosis for Stroke
A
- Impaired Communication
- Risk for Aspiration
- Impaired Mobility
- Risk for Injury
- Difficulty Coping
19
Q
Surgical Therapy for Strokes
A
Surgical interventions for patient with TIAs from carotid disease include:
- Carotid endarterectomy
- Transluminal angioplasty
- Stenting
- Evaluation must be done to confirm that the signs and symptoms of a TIA are not related to other brain lesions, such as a developing subdural hematoma or an increasing tumor mass.
- Transluminal angioplasty is the insertion of a balloon to open a stenosed artery in the brain and improve blood flow. The balloon is threaded up to the carotid artery via a catheter inserted in the femoral artery.
20
Q
Surgical Therapy for HEMORRHAGIC Stroke
A
Surgical interventions used to treat hemorrhagic strokes include:
- Resection
- Clipping of an aneurysm
- Evacuation of hematomas
- Procedure is chosen based on cause of stroke
27
Q
Nursing Interventions - Self-Eating
A
- Using the unaffected upper extremity to eat
- Employing assistive devices such as rocker knives, plate guards, and non-slip pads for dishes
- Removing unnecessary items from tray or table, reducing spills
A. The curved fork fits over the hand. The rounded plate helps keep food on the plate. Special grips and swivel handles are helpful for some persons.
B. Knives with rounded blades are rocked back and forth to cut food. The person does not need a fork in one hand and a knife in the other.
C. Plate guards help keep food on the plate. D, Cup with special handle. - After the acute phase, a dietician can assist in determining the appropriate daily caloric intake based on the patient’s size, weight, and activity level.
- Interventions to promote self-feeding include using the unaffected upper extremity to eat; employing assistive devices such as rocker knives, plate guards, and non-slip pads for dishes; removing unnecessary items from tray or table, reducing spills; providing a non-distracting environment to reduce sensory overload with distraction.
