Stroke Flashcards
Stroke
Third most common cause of death in Canada. Ischemia to part of the brain or hemorrhage into the brain.
non-modifiable stroke risk fx
age, sex, ethnicity and race, heredity/family hx, personal circumstances, arteriovenous malformation
Modifiable stroke risk fx
hypertension, diabetes, heart disease, increased cholesterol, heavy alcohol consumption, physical inactivity, smoking, substance use, obesity
Ischemic Stroke
inadequate blood flow to the brain from partial or complete occlusion of an artery. A transient ischemic attack (TIA) is usually a precursor to ischemic stroke.
Can be classified as (a) Thrombotic or (b) Embolic
Transient Ischemic attack
transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia, without acute infarction of the brain. Symptoms last <1 hour. Most TIAs resolve, however patients are encouraged to go to ER as you do not know if it will persist and become a true stroke.
Thrombotic Stroke
occurs when there is an injury (narrowing of an artery by plaque) on a blood vessel wall. This can then cause a clot to form which blocks the flow of blood.
This is the most common cause of ischemic strokes (hypertension and diabetes accelerate atherosclerosis)
Usually have consciousness.
Embolic Stroke
Occurs when an embolus (blood clot or other debris circulating in the blood) lodges in an artery (that is too narrow) and blocks the flow of blood.
Usually have consciousness.
Hemorrhagic Stroke
results from bleeding into the brain tissue itself. Often a sudden onset of symptoms with patients experiencing “the worst headache of their life”
Hypertension is the most common cause.
Motor function and stroke
impairment of mobility, respiratory function, swallowing and speech, gag reflex, self care abilities,
Communication and stroke
aphasia (difficulty related to the comprehension or use of language).
Can also experience dysarthria (disturbance in the muscular control of speech) - effects pronunciation, articulation, phonation
Affect and Stroke
Patients have difficulty controlling their emotions - can be exaggerated or unpredictable.
Intellectual function and stroke
left brain stroke is more likely to result in memory problems related to language
Spatial-Perceptual alterations and stroke
right brain stroke is more likely to cause problems in spatial-perceptual orientation
Apraxia
inability to perform PURPOSEFUL movements in the absence of motor problems
Agnosia
inability to recognize familiar objects
Global aphasia
total inability to communicate.
Expressive aphasia
you know what you want to say, but you have trouble saying or writing your thoughts
Receptive aphasia
when someone is able to speak well and use long sentences, but what they say may not make sense. They may not know that what they’re saying is wrong, so may get frustrated when people don’t understand them.
Ataxia
loss of movement of the muscles
Dysphagia
swallowing difficulties
Dysarthria
difficulty articulating words
CT scan for acute stroke
can indicate the size and location of the lesion and differentiate between ischemic and hemorrhagic stroke. For optimal results, the CT scan should be obtained within 25 minutes and read within 45 minutes of arrival at the emergency department. If the stroke is ischemic and is less than 3 hours old, the CT will appear normal
Interventions for Stroke Priority
(1) ensure patent airway (2) call stroke code (3) remove dentures (4) perform pulse oximetry and maintain adequate oxygenation (5) obtain IV access (6) maintain BP according to guidelines (7) insert foley catheter (8) obtain CT scan (9) keep pt NPO until swallow reflux is evaluated (dysphagia is ruled out)
tPA administration
used to re-establish blood flow through a blocked artery to prevent cell death in patients with acute onset on ischemic stroke
IV admin within 4 hrs of clinical onset
tPA contraindications
it increases the risk of intracranial hemorrhage - patients must obtain a CT or MRI to rule out hemorrhagic stroke before getting tPA
screening also is done prior to administration to look for a recent hx of gastrointestinal bleeding, stroke, head trauma or major surgery within 14 days.
Nursing Management integumentary system
integumentary system is susceptible to breakdown related to loss of sensation, decreased circulation, immobility (compounded by pt age, poor nutrition, dehydration, edema and incontinence)
nurse should provide position changes, special mattresses, or wheelchair cushions
Nursing Management gastrointestinal system
constipation is the most common bowel condition after stroke. patients may be placed on stool softeners or fibre prophylactically. physical activity promotes bowel function.
Nursing Management urinary system
in the acute stage, poor bladder control results in incontinence. Efforts should be made to promote normal bladder function.
Avoid use of indwelling catheters (if needed initially, remove as soon as patient is medically and neurologically stable)
Rehabilitation of stroke
SLP may be involved for communication. OT and dietician (to help with normal feeding - test swallowing, chewing, gage reflex should occur before oral feeding) also involved.
Health management focuses on maintaining BP, blood glucose, limiting alcohol and smoking, promote diet and exercise.
Medications to prevent stroke
anti-platelets (aspirin or plavix) are the most common medication used to prevent further stroke in patients who have had a TIA.
Statins (lower cholesterol)
oral anticoagulants also used for this with Afib and past TIA.
signs of increased intracranial pressure
changes/deterioration in vitals
sudden increase in BP
vomiting
new onset of headache
**intracranial hemorrhage can happen during tPA infusion
