Stroke Flashcards by Ashlyn Landrum

ischemia

inadequate blood flow

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hemorrhage

bleeding

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causes of stroke?

disruption in blood supply to part of the brain

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can be classified as what?

ischemic or hemorrhagic

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non modifiable risk factors for stroke

-age
-gender : more common in men
-ethnicity : higher incidence in African Americans
-hereditary / family hx

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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

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T or F : more women die from strokes than men

true
women live longer

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what percentage of strokes are due to modifiable risk factors

90%

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two types of ischemic strokes

thrombotic
embolic

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transient ischemic attack is what?

normally a precursor to ischemic stroke

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what percent of strokes are ischemic?

80%

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two types of hemorrhagic strokes

intracerebral
subarachnoid

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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

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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

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what is a hemorrhagic stroke?

a burst blood vessel may allow blood to seep into and damage brain tissue until it clots off

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what type of stroke is the most common cause/60%?

thrombotic

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manifestations of ischemic stroke may progress in the first how many house ? as what increases?

72 hours
infarction and cerebral edema

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what can be a main cause for a thrombotic stroke ? why?

DM and HTN
cause plaque buildup

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what is the 2nd most common type of stroke?

embolic stroke

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where does an embolic stroke mostly originate from?

endocardial layer of heart - Afib, MI, valve replacement (anticoagulants)

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embolic stroke manifestations

-sudden onset + severe symptoms
-warming signs less common
-pt usually remains conscious
-headache

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prognosis of embolic stroke is related to

how long blood flow is lost, can recur if cause is not treated

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hemorrhagic stroke - intracerebral hemorrhage is cause by

bleeding within the brain caused by a rupture of a vessel

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hemorrhagic stroke - intracerebral hemorrhage

sudden/delayed onset?
progression
prognosis

-sudden onset of symptoms
-progression over min-hours because of ongoing bleeding
-prognosis = poor

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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