Stroke Flashcards
ischemia
inadequate blood flow
hemorrhage
bleeding
causes of stroke?
disruption in blood supply to part of the brain
can be classified as what?
ischemic or hemorrhagic
non modifiable risk factors for stroke
-age
-gender : more common in men
-ethnicity : higher incidence in African Americans
-hereditary / family hx
modifiable risk factors for stroke
-HTN!!!!!! (#1)
-history of TIA
-cardiovascular dz (afib, murmurs)
-diabetes
-smoking (vasoconstriction)
-alcohol/substance abuse
-BC pills, hormone replacement
-obesity
-sleep apnea
T or F : more women die from strokes than men
true
women live longer
what percentage of strokes are due to modifiable risk factors
90%
two types of ischemic strokes
thrombotic
embolic
transient ischemic attack is what?
normally a precursor to ischemic stroke
what percent of strokes are ischemic?
80%
two types of hemorrhagic strokes
intracerebral
subarachnoid
what is a thrombotic stroke?
injury to blood vessel wall leads to clot formation (thrombosis) which results in narrowing of the blood vessel, which blocks the passage of blood through the artery
what is embolic stroke?
embolus = 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, there is a blockage in the blood flow
what is a hemorrhagic stroke?
a burst blood vessel may allow blood to seep into and damage brain tissue until it clots off
what type of stroke is the most common cause/60%?
thrombotic
manifestations of ischemic stroke may progress in the first how many house ? as what increases?
72 hours
infarction and cerebral edema
what can be a main cause for a thrombotic stroke ? why?
DM and HTN
cause plaque buildup
what is the 2nd most common type of stroke?
embolic stroke
where does an embolic stroke mostly originate from?
endocardial layer of heart - Afib, MI, valve replacement (anticoagulants)
embolic stroke manifestations
-sudden onset + severe symptoms
-warming signs less common
-pt usually remains conscious
-headache
prognosis of embolic stroke is related to
how long blood flow is lost, can recur if cause is not treated
hemorrhagic stroke - intracerebral hemorrhage is cause by
bleeding within the brain caused by a rupture of a vessel
hemorrhagic stroke - intracerebral hemorrhage
sudden/delayed onset?
progression
prognosis
-sudden onset of symptoms
-progression over min-hours because of ongoing bleeding
-prognosis = poor
most common cause of intracerebral hemorrhage?
HTN
hemorrhage occurs when? (intracerebral hemorrhage)
activity
s/s of intracerebral hemorrhage
-neuro deficits
-headache
-n/v
-decreased LOC
-HTN
subarachnoid hemorrhage (SAH) bleeding where?
into CSF filled space between arachnoid and Pia mater
SAH often caused by?
rupture of a cerebral aneurysm, trauma, illicit drug use (cocaine)
hemorrhagic stroke - complication : cerebral vasospasm - administer?
ca+ channel blocker - nimodipine
true or false - subarachnoid hemorrhage is higher In women
true
what does nimodipine do ?
lower BP
why permissive HTN?
if you drop BP quickly, it can bottom the pt out abruptly
if stroke occurs on the right side of the brain, what side will symptoms be on?
left
hemiplegia
paralysis on left or right side of body (half)
hemiparesis
partial weakness on one side of the body
ataxia
lack of muscle control
motor deficits from stroke
hemiplegia
hemiparesis
ataxia
communication deficits for stroke
dysarthria
dysphagia
aphasia
dysarthria
difficulty speaking , muscles affected
dysphagia
difficulty swallowing/ gag reflex
aphasia - 3 types
receptive
expressive
global
expressive aphasia
can understand you, cant respond - cant respond to specific questions
receptive aphasia
cannot receive or process information
global aphasia
inability to speak / communicate
cognitive impairment from stroke
-memory loss
-decreased attention span
-poor reasoning
-altered judgement
psychological affects of stroke
-loss of self control
-depression
-emotional ability - cant express emotions properly (opposite)
-elimination (incontinent)
how do we help with incontinence after stroke?
bowel/bladder retraining
stroke complications - homonymous hemianopsia
blindness on one side
right or left sided
right sided brain stroke is most likely to cause what?
spatial-perception orientation
first scan done to confirm stroke
what can it identify ?
CT
hemorrhagic stroke
second scan done for more info on stroke after CT? what can it identify?
MRI
ischemic stroke
what med is held before CTA/MRA?
metformin (48hrs before and after)
if pt is receiving dye, what do you check for?
allergies to shellfish
can there be a delayed allergic reaction to dye?
yes - check for hot, itchy, red skin, rash
one of the most important preventions for stroke
manage modifiable risk factors
drugs used to prevent stroke
-antiplatelet drugs - TIA pts
-aspirin 81 mg (antiplatelet)
-oral anticoagulant for pt with Afib
-warfarin
-statins, antihypertensives
ischemic stroke management - thrombolytic therapy
-within 3 hrs of s/s
-noncontrast CT
-blood test for coagulation studies
-screening for hx of GI bleed, stroke, head trauma (3 months), surgery (14 days), internal bleeding (22days)
-TPA (tissue plasminogen activator)- break up clots
what do we do when pt gets TPA?
2 large IV lines, fall bundle, foley
watch VS - BP control
bed rest for 72hrs
side effect of TPA
-more bleeding (only for ischemic stroke)
ischemic stroke surgery
-carotid endarterectomy (remove plaque)
-carotid stenting (restore blood blow)
hemorrhagic stroke surgery
-aneurysm clipping, coiling
-resection of arteriovenous malformation
nursing interventions
-support resp system (atelectasis, asp. pneumonia, airway obstruction)
-frequent neuro exam (post TPA-at risk for hem stroke, after surgery)
-monitor cardiovascular system
-monitor for skin breakdown
-monitor for constipation
-promote normal bladder function
-assess and monitor nutritional status
-support
goals for pt and family
-improvement of mobility
-avoidance of shoulder pain
-achievement of self care
-attainment of bladder control
-improvement of thought process
-some form of communication
-skin integrity
-family functioning
-no complications
