Stroke

Question 1

Stroke

Answer 1

Third most common cause of death in Canada. Ischemia to part of the brain or hemorrhage into the brain.

Question 2

non-modifiable stroke risk fx

Answer 2

age, sex, ethnicity and race, heredity/family hx, personal circumstances, arteriovenous malformation

Question 3

Modifiable stroke risk fx

Answer 3

hypertension, diabetes, heart disease, increased cholesterol, heavy alcohol consumption, physical inactivity, smoking, substance use, obesity

Question 4

Ischemic Stroke

Answer 4

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

Question 5

Transient Ischemic attack

Answer 5

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.

Question 6

Thrombotic Stroke

Answer 6

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.

Question 7

Embolic Stroke

Answer 7

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.

Question 8

Hemorrhagic Stroke

Answer 8

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.

Question 9

Motor function and stroke

Answer 9

impairment of mobility, respiratory function, swallowing and speech, gag reflex, self care abilities,

Question 10

Communication and stroke

Answer 10

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

Question 11

Affect and Stroke

Answer 11

Patients have difficulty controlling their emotions - can be exaggerated or unpredictable.

Question 12

Intellectual function and stroke

Answer 12

left brain stroke is more likely to result in memory problems related to language

Question 13

Spatial-Perceptual alterations and stroke

Answer 13

right brain stroke is more likely to cause problems in spatial-perceptual orientation

Question 14

Apraxia

Answer 14

inability to perform PURPOSEFUL movements in the absence of motor problems

Question 15

Agnosia

Answer 15

inability to recognize familiar objects

Question 16

Global aphasia

Answer 16

total inability to communicate.

Question 17

Expressive aphasia

Answer 17

you know what you want to say, but you have trouble saying or writing your thoughts

Question 18

Receptive aphasia

Answer 18

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.

Question 19

Ataxia

Answer 19

loss of movement of the muscles

Question 20

Dysphagia

Answer 20

swallowing difficulties

Question 21

Dysarthria

Answer 21

difficulty articulating words

Question 22

CT scan for acute stroke

Answer 22

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

Question 23

Interventions for Stroke Priority

Answer 23

(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)

Question 24

tPA administration

Answer 24

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

Question 25

tPA contraindications

Answer 25

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.

Question 26

Nursing Management integumentary system

Answer 26

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

Question 27

Nursing Management gastrointestinal system

Answer 27

constipation is the most common bowel condition after stroke. patients may be placed on stool softeners or fibre prophylactically. physical activity promotes bowel function.

Question 28

Nursing Management urinary system

Answer 28

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)

Question 29

Rehabilitation of stroke

Answer 29

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.

Question 30

Medications to prevent stroke

Answer 30

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.

Question 31

signs of increased intracranial pressure

Answer 31

changes/deterioration in vitals
sudden increase in BP
vomiting
new onset of headache
**intracranial hemorrhage can happen during tPA infusion