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Health Challenges > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke

A

A stroke occurs when ischemia or hemorrhage into the brain results in death of brain cells.

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2
Q

Stroke; facts

A

-Functions are lost or impaired (such as movement, sensation, or emotions that were controlled by the affected area of the brain)
-Severity of the loss of function varies according to the location and extent of the brain involved
-Third most common cause of death in Canada and the United States
-Leading cause of serious, long term disability
-Physical, cognitive, and emotional impact

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3
Q

Stroke; risk factors

A

-Most effective way to decrease the burden of a stroke is prevention
-Risk factors can be divided into non-modifiable risks and modifiable risks

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4
Q

Stroke risk factors; non-modifiable

A

-Age
-Gender
-Ethnicity and Race
-Heredity/Family history
-Low birth weight

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5
Q

Stroke; modifiable risk factors

A

-Hypertension
-Diabetes Mellitus
-Heart disease
-Heavy alcohol consumption
-Oral contraceptive use
-Physical inactivity
-Smoking
-Obesity

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6
Q

Types of stroke

A

Strokes are classified on the basis of underlying pathophysiological findings.
-Ischemic
-Hemorragic

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7
Q

Major types of stroke

A

-Thrombolytic stroke
-Embolic Stroke
-Hemorrhagic stroke

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8
Q

Thrombolytic stroke

A

The process of clot formation (thrombosis) results in a narrowing of the lumen, which blocks the passage of blood through the artery.

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9
Q

Embolic Stroke

A

An embolus is a blood clot or other debris circulating in the blood. When it reaches an artery in the brain that is too narrow to pass through, it lodges there and blocks the flow of blood.

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10
Q

Hemorrhagic Stroke

A

A burst blood vessel may allow blood to seep into and damage brain tissues until clotting shuts off the leak.

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11
Q

Ischemic Stroke

A

-Ischemic strokes result from inadequate blood flow to the brain from partial or complete occlusion of an artery.
-87% of all strokes are ischemic strokes.
-A TIA is usually a precursor to an ischemic stroke.

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12
Q

Ischemic strokes can be

A

-Thrombolytic
-Embolic

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13
Q

Transient Ischemic Attack (TIA)

A

-Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction of the brain
-Symptoms last less than one hour.

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14
Q

Thrombotic Stroke

A

-Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot.
-Result of thrombosis or narrowing of the blood vessel.
-Most common cause of stroke.
-Lacunar strokes are typically asymptomatic.

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15
Q

Embolic stroke

A

-Occurs when a embolus lodges in and occluded a cerebral artery
-Results in infarction and edema of the area supplied by the involved vessel
-Second most common cause of stroke

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16
Q

Embolic stroke symptoms

A

-Client with Embolic stroke commonly has a rapid occourance of severe clinical symptoms.
-Onset of Embolic stroke is usually sudden and may or may not be related to activity.
-Client usually remains conscious, although may have headache.

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17
Q

Hemorrhagic stroke

A

-Account for approximately 15% of all strokes.
-Result from bleeding into the brain tissue itself or into the subarachnoid space ventricles.

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18
Q

Intracerebral hemorrhage

A

-Bleeding within the brain caused by rupture of a vessel
-Hypertension is the most important cause
-Hemorrhage commonly occurs during periods of activity
-Often a sudden onset of symptoms, with progression over minutes to hours because of ongoing bleeding

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19
Q

Intracerebral hemorrhage; manifestations

A

-Neurological deficits
-Headache
-Nausea and/or Vomiting
-Decreased levels of consciousness
-Hypertension

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20
Q

Subarachnoid hemorrhage

A

-Intracranial bleeding into the cerebral-spinal fluid-filled space between the arachnoid and pia matter
-Commonly caused by rupture of a cerebral aneurysm

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21
Q

Subarachnoid hemorrhage; aneurysm

A

-An aneurysm may be saccular or berry.
-Majority of aneurysms are in the circle of Willis.
-“Worst headache of one’s life”

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22
Q

Subarachnoid hemorrhage; tx

A

-most frequent surgical procedure to prevent rebleeding is clipping of the aneurysm.
-Coiling is another procedure.

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23
Q

Hemorrhagic stroke; CM

A

-Affects many body functions
-Motor activity
-Elimination
-Intellectual function
-Spatial-perceptual alterations
-Personality
-Affect
-Sensation
-Communications

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24
Q

Manifestations of Right-Brain Stroke

A

-Paralyzed left side: hemiplegia
-Left-side neglect
-Spatial-perceptual deficits
-Tends to deny or minimize problems
-Rapid performance, short attention span
-Impulse; safety problems
-Impaired judgement
-Impaired time concepts

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25
Q

Manifestations of Left-brain stroke

A

-Paralyzed right side; hemiplegia
-Impaired speech-language (aphasias)
-Impaired right-left discrimination
-Slow performance, cautious
-Aware of deficits: depression, anxiety
-Impaired comprehension related to language, math

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26
Q

Hemorrhagic stroke; motor function

A

-Most obvious effect of stroke
-Include impairment of
•mobility
•respiratory function
•swallowing and speech
•gag reflex
•self-care abilities

27
Q

Characteristic motor deficits

A

-Loss of skilled voluntary movement
-Impairment of integration of movements
-Alterations in muscle tone
-Alterations in reflexes

28
Q

Hemorrhagic stroke; communication (aphasia)

A

-Client may experience aphasia when a stroke damages the dominant hemisphere of the brain.
-Aphasia is the total loss of comprehension and use of language.

29
Q

Hemorrhagic stroke; communication (dysphasia)

A

-Dysphasia refers to difficulty related to the comprehension or use of language and is due to partial disruption or loss
-Four catagories:
•expressive
•Receptive
•Anomic/Amnesic
•Global

30
Q

Hemorrhagic stroke; communication (Dysarthia)

A

-Disturbance in the muscular control of speech
-Impairments may involve:
•Pronunciation
•Articulation
•Phonation

31
Q

Hemorrhagic stroke; Affect

A

-Clients who suffer a stroke may have difficulty controlling their emotions.
-Emotional responses may be exaggerated or unpredictable.

32
Q

Hemorrhagic stroke; intellectual functions

A

-Both memory and judgement may be impaired as a result of stroke.
-A left-brain stroke is more likely to result in memory problems related to language.

33
Q

Hemorrhagic stroke; Spatial-perceptual alterations

A

-Stroke on the right side of the brain is more likely to cause problems in spatial-perceptual orientation.
-However, this may occur with left-brain stroke.

34
Q

Spatial-perceptual alterations; four categories

A
  1. Deny illness and own body parts (anosognosia)
  2. Erroneous perception of self in space
  3. Inability to recognize an object by sight, touch or hearing (agnosia)
  4. Inability to carry out learned sequential movements on command (apraxia)
35
Q

Hemorrhagic stroke; Elimination

A

-Most problems with urinary and bowel elimination occur initially and are temporary.
-When a stroke affects one hemisphere of the brain the prognosis for normal bladder function is excellent

36
Q

Stroke; diagnostics

A

-When symptoms of a stroke occur, diagnostic studies are done to
•confirm that it is a stroke
•identify the likely cause of the stroke
-CT is the primary diagnostic test used after a stroke

37
Q

Stroke; other diagnostic studies

A

-CTA
-MRI, MRA
-Cerebral or carotid angiography
-Digital subtraction angiography
-Transcranial Doppler ultrasonography
-Lumbar Puncture

38
Q

Stroke; cardiac diagnostic studies

A

-Electrocardiogram
-Chest X-ray
-Cardiac markers
-Echocardiography

39
Q

Stroke; CC Prevention

A

-Priority for decreasing morbidity and mortality from stroke
-Goals of stroke prevention include;
•health promotion for the well individual.
•Education and management of modifiable risk factors to prevent a stroke.
-Clients know risk factors require close management.
•diabetes Mellitus
•hypertension
•smoking
•high serum lipids
• cardiac dysfunction

40
Q

Stroke; CC Prevention (cont.)

A

-Antiplatelet drugs are usually the chosen treatment to prevent further stroke in clients who have had a TIA.
-Aspirin is the most frequently used antiplatelet agent.
-Statins

41
Q

Surgical interventions for the client with TIAs from carotid disease include

A

-Carotid endarterectomy
-Transluminal angioplasty
-Stenting
-Extracranial-intracranial bypass

42
Q

Stroke; CC Acute Care (goals)

A

-Goals for collaborative care during the acute phase are
•Preserving life
•Preventing further brain damage
•Reducing disability
-Treatment differs according to type of stroke and as client changes

43
Q

Stroke; CC Acute Care (CABs)

A

-Begins with managing the CABs
•Circulation
•Airway
•Breathing

44
Q

Stroke; CC Acute Care (causes)

A

-Sudden vascular compromise causing disruption of blood flow to the brain
-Thrombosis
-Trauma
-Aneurysm
-Embolism
-Hemorrhage
-Arteriovenous malformation

45
Q

Stroke; CC Acute Care (Assessment findings)

A

-Altered level of consciousness
-Weakness, numbness, or paralysis
-Speech or visual disturbances
-Severe headache
-Increased or decreased HR
-Respiratory distress
-Unequal Pupils
-Hypertension
-Facial dropping on affected side
-Difficulty swallowing
-Seizures
-Bladder or bowel incontinence
-Nausea and vomiting
-Vertigo

46
Q

Stroke; CC Acute Care (initial interventions)

A

-Ensure patient airway
-Call stroke code or code team
-Remove dentures
-Preform pulse oximetry
-Maintain adequate oxygenation
-Obtain IV access with normal saline
-Maintain BP according to guidelines
-Remove clothing
-Insert Foley catheter
-Obatin CT scan immediately
-Preform baseline lab tests
-Position head midline
-Elevate head of bed 30° if no symptoms of shocks or injury occur
-Institute seizure precautions
-Anticipate thrombolytic therapy for ischemic stroke
-Keep client NPO until swallow reflex evaluated.

47
Q

Stroke; CC Acute care (cont.)

A

-Hypertension is common immediately after stroke
•drugs to lower BP is markedly increased
-Fluid and electrolyte balance must be controlled carefully
•Adequate hydration promotes perfusion and decreases further brain injury

48
Q

Stroke; CC acute care (ongoing interventions)

A

-Monitor vital signs and neurological status
•Level if concioisness
•Motor and sensory function
•Pupil size and reactivity
•O2 Sat
•Cardiac Rythm

49
Q

Stroke; Recombinant tissue plasminogen activator (tPA)

A

•Used to reestablish blood flow through a blocked artery to prevent cell death in clients with acute onset of ischemic strokes symptoms.
•Must be administered within 3-4.5 hours of onset of clinical signs of ischemic stroke

50
Q

Stroke; CC Acute care (aspirin)

A

-Aspirin is used within 24-48 hours of stroke
-No antiplatlets or anticoagulants may be given tPA

51
Q

Stroke; CC acute care (surgical intervention)

A

-Endovascular treatment
-The retriever goes to the artery that is blocked, directly to the site of the problem, and pulls the clot out.

52
Q

Stroke; Rehabilitation

A

-After a stroke has stabilized for 12-72 hours, collaborative care shifts from preserving life to lessening disability and attaining optimal function.
-Client may be transferred to rehabilitation unit, outpatient therapy, or home care based on rehabilitation.

53
Q

Stroke; Nursing Assesment (stable client)

A

If the client is stable obtain:
•description of the current illness with attention to initial symptoms
•history of similar symptoms previously experienced
•current medications
•history of risk factors and other illnesses
•family history of stroke and cardiovascular disease

54
Q

Stroke; nursing Assesment (neuro exam)

A

-Level of consciousness (using Canadian neurological scale)
-Cognition
-Motor abilities
-Cranial nerve function
-Sensation
-Proprioception
-Cerebellar function
-Deep tendon reflexes

55
Q

Stroke; nursing diagnosis

A

-Decreased intracranial adaptive capacity
-Risk for aspiration
-Impaired physical mobility
-Impaired verbal communication
-Unilateral neglect
-Impaired urinary elimination
-Impaired swallowing
-Situational low self-esteem

56
Q

Stroke; nursing planning

A

Goals are that the client will;
•maintain stable or improved level of conciousness
•attain maximum physical functioning
•maximize self-care abilities and skills
•maintain stable body functions

Goals for client;
•maximize communication abilities
•Avoid complications of stroke
•Maintain effective personal and family coping

57
Q

Stroke; Health promotion

A

-To reduce the incidence of stroke, the nurse should focus teaching towards stroke prevention.
•particularly in persons with known risk factors
•education about hypertension control and adherence to medication

-Teaching clients and families about;
•early symptoms (Stroke, TIA)
•when to seek health care for symptoms

58
Q

Stroke; Respritory system

A

-Management for the respiratory system is a nursing priority
-Risk for atelectasis
-Risk for aspiration pneumonia
-Risks for airway obstruction
-May require endotracheal intubation and mechanical ventilation

59
Q

Stroke; neurological system

A

Monitor closely to detect changes suggesting:
-extension of the stroke
-increased ICP
-Vasospasm
-Recovery from stroke symptoms

60
Q

Stroke; cardiovascular system

A

-Goals aimed at maintaining homeostasis
-Many clients with stroke have decreased cardiac reserves from the secondary diagnosis of cardiac disease.
-Cardiac efficiency may be compromised
-Adjusting fluid intake to the individual needs of the client
-Monitoring lung sounds for crackles and rhonchi (pulmonary congestion)
-Monitoring heart sounds for murmurs or for S3 or S4 heart sounds

61
Q

Stroke; cardio vascular system nursing interventions

A

Nursing interventions:
-Monitoring vital signs
-monitoring cardiac rhythms
-Calculating intake and output, noting imbalances
-Regulating IV infusions

62
Q

Stroke; cardiovascular system (after stroke)

A

-After stroke client is a lot risk for DVT
•related to immobility, loss of venous tone, and decreased muscle pumping in leg
•most effective prevention is keeping client moving

63
Q

Stroke; musculo-skeletal system

A

-Goal is to maintain optimal function
-Accomplished by the prevention of joint contractures and muscular atrophy
-in the acute phase, ROM exercises and positioning are important
•paralyzed or weak side needs special attention when positioned

64
Q

Stroke; musculo-skeletal system cont.

A

-Trochanter roll at hip to prevent external rotation
-Hand splints to prevent hand contractures
-Arm suppourts with slings and lap boards to prevent shoulder displacement
-Avoidance pulling the client by the arm to avoid shoulder displacement
-Posterior leg splints, footboards, or high-topped tennis shoes to prevent foot drop
-Hand splints to reduce spasticity

Health Challenges (13 decks)

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