Stroke Flashcards by Brina Quintanilla Reyes

What does stroke mean?
And this can depend on? (2)

Loss of function
The location and extend of brain tissue

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Stroke can lose a patient function to perform (3) ?

Physical
Cognitive
Emotional movement

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What two other terms can mean stroke?

Brain attack
Cerebrovascular accident (CVA)

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Patients may experience these long term symptoms after having a stroke? (5)
Define them

Hemiparesis ( half paralysis )
Inability to walk
Aphasia ( communication disorder )
Dependence for ADL
Depression

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Stroke is the ___most common cause of death in the USA?

5th

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About ___ have a stroke each year
__to___% with permanent disability
____change for survivor and family

800k
15%-30%
Lifelong

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There are two types of stroke what are they?

Ischemia
Hemorrhage

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What is ischemia stroke?

Inadequate blood supply to part of brain

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What is hemorrhage stroke?

Bleeding into the brain that results in death of brain cells

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What are the 4 nonmodifiable risk factors?
Examples for each

Age
- doubles at 55

Gender
- men

Ethnicity
- African Americans

Heredity/family history

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What is the biggest risk factor for stroke?

Hypertension!!!

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What’s an anagram to help me remember the 12 risk factors for stroke?

Hyper
Heart
Dies
Secretly
So
Oliver
Sleeps
More
Lazy
Posture
Dreams
About Fiona

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What’s the 12 risk factors for stroke?

Hypertension
Heart disease
Diabetes
Serum cholesterol
Smoking
Obesity
Sleep apnea
Metabolic syndrome
Lack of physical exercise
Poor diet
Drug and alcohol use
Atrial fibrillation

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What is a mini stroke called?

Transient ischemic attack (TIA)

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Can a history of TIA increase the risk of a stroke?
True or false

True

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What is TIA? Definition & caused by(3) but without what?

Transient episode of neurologic dysfunction
caused by focal brain, Spinal cord, retinal ischemia
But without acute infraction of brain

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How long doesTIA symptoms will usually last?

Less than an hour

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Tia is considered to be a what?

Medical emergency since it can lead to a stroke

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True or false
TIA is ischemia without infarction
But
A stroke is infarction ( cell death )

True

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Ischemic strokes results from inadequate blood flow to the brain from partial or complete occlusion of an artery
In which classify this stroke as two things?

Thrombotic or embolic

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Hemorrhagic stroke results from bleeding into the brain tissue itself
In which we classify this by which 2 spaces bleeding occurs?

Intracerebral
Subarachnoid

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What is a ischemia thrombotic stroke ?
How does this usually occur?

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

Occurs from injury to a blood vessel wall & forms a blood clot

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Thrombotic ischemic stroke is the most common stroke ___% cases
Often assuociated with (2)
Often preceded by ___

60%
Hypertension & diabetics mellitus
TIA ( mini stroke )

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The extend of a stroke depends on (3) things for thrombotic ischemic stroke
Which are?

Rapidity of onset
Size of damage to the area
Presence of collateral circulation

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What is embolic stroke for ischemic? What is an embolus ?

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 flow of blood

Ischemic embolic stroke results in? (2)

Infarction & edema of area supplies by involved vessels

Embolic ischemic stroke is the __ most common cause of stroke Has a __ onset with severe clinical manifestations

2nd Sudden

How do you prognoses embolic ischemic stroke? And is recurrence common?

Related to amount of brain tissue deprived of blood supply Yes, very much

What is intracerebral hemorrhage?

Bleeding within the brain caused by a rupture of a vessel

Hemorrhagic stroke will have what type of onset of symptoms?

Sudden

Intracerebral hemorrhage has a poor prognosis within what day frames ? And it increases mortality rate from __ to ___

30 day 40-80%

Intracerebral hemorrhage what is the most common cause?

Hypertension

Other causes for hemorrhagic stroke are? (6)

Vascular malformation Coagulation disorders Anticoagulant drugs Trauma Brain tumors Ruptured aneurysm

What are manifestations of hemorrhagic stroke? (6)

Neurologic deficits Headaches Nausea Vomiting Decreased LOC Hypertension

What is subarachnoid hemorrhage? Often caused by ?

Intracranial bleeding into the CSF Rupture of a cerebral aneurysm

Overall clinical manifestations if a stroke all depend on what?

Location of the stroke

Neural tissue destruction is basis for?

Neurologic dysfunction

Is the time of onset of symptoms And length of period of ischemia important?

SUPER!

What is right brain damage symptoms? (8)

Paralyzed left side ( hemiplegia ) Left side neglect Spatial perceptual deficits Tends to deny problems Rapid performance/short attention Impulsive ( not safe ) Impaired judgment Impaired time concepts

What are left brain damage symptoms? (6)

Paralyzed right side ( hemiplegia ) Impaired speech Impaired Right/left understanding Slow performance/cautious Aware of deficits/depression Impaired comprehension of math/language

Stroke clinical manifestions ( remember this applies to every type of stroke ) Motor functions addition (7)

Impaired Mobility Respiratory function swallowing Speech Gag reflex Self care abilities Akinesia ( loss of skill voluntary movement)

When a stroke is happening you are going to want to follow what acronym ? What does it stand for?

Fast Face dropping Arm weakness Speech difficulties Time to call

Before I continue with my flashcards What are the big clinical manifestations of stroke? (5)

Motor functions Communication Affect Intellectual function Spatial-perceptual alterations

What is the term for stroke patients who gets their communication affected? What are the 3 groups of ?

Aphasia Receptive Expressive Global

What is receptive What is expressive ( example what to do ) What is global

Loss of comprehension Loss of production of language - ask yes or no questions Total inability to communicate

What does the broca area do? Where ? Does what? Difficult what? What does the wenicke area do? Where ? Does what? Difficult what,

Frontal lobe - understand speech ( short sentences ) ( difficult forming words) Temporal lobe - forms words ( long, meaningless words ) ( difficult understanding )

Many patients may experience aphasia but they will also have dysarthria ; which is? This can impaired there ability to? (3)

Problem with muscular control of speech Pronounce Articulate Phonation

Does dysarthria effect the meaning of communication or language comprehension? Why?

No Because it only effects the mechanisms or muscular control of speech

What does affect mean for clinical manifestions of stroke?

Patients who have a stroke may have a hard time controlling their emotions

Patient with affect clinical manifestations usually will have exaggerated or unpredictable emotions which can be magnified by (3) Don’t over think it, think of like what would change you if you had a stroke

Depression Changes in body image Loss of function

What is clinical manifestions of intellectual function for stroke patients? This is determined by what?

Both memory and judgment may be impaired because of the stroke Which side of the brain had the stroke

What is spatial perceptual alteration of clinical manifestation? (4) What are the 4 things patients will undergo & define them

Incorrect perception of self and illness Unilateral neglect of affect side ( homonymous hemianopsia ) - blindness Agnosia - inability to interpret sensations and hence recognize things Apraxia - without coordination

Who is more common to get spatial perceptual alternations? Right or left sided stroke patients?

Right

What are the diagnostic studies for a stroke? (4)

MRI Noncontrast CT scan CTA/MRA cerebral angiography

MRI and CT scan will help show what? (4)

Size & location Ischemic or hemorrhagic

What are Interprofessional care for stroke patients to help promote health? Think of modifiable risk factors (7)

Healthy diet Weight control Regular exercise No smoking Limit alcohol BP management Routine health assessment

What are preventive drug therapy ti help avoid a thrombus or embolus stroke? And example & how many mg/day ?

Antiplatelet drugs Aspirin (81 mg/day)

We can have surgical interventions for patients with TIAs due to carotid disease May include? (3)

Carotid endarterectomy Transluminal angioplasty Stenting

Post operative care is very important because we want to assess (2) And what 3 complications?

Neurovacular Blood pressure Stent occlusion Retropertional hemorrhage Bleeding

What is the 3 goals for ischemic stroke in acute care?

Preserve life Precent further brain damage Reduce disability

What is the famous words Trish said about time? Why?

Time is tissue!! The longer you wait, the more damage can be done to your brain tissue and lose it 100%

You always want to get a baseline of neurologic assessment why?

Because patients will show signs of increasing neurologic deficit 25-48 hours worsen

What is very common vital sign after a stroke? Why is that?

Elevated blood pressure Because of a protective response to maintain cerebral perfusion

Since the blood pressure is elevated after a stroke due to that protective response to maintain cerebral perfusion You only want to give an antihypertensive medication when the BP is? (2)

Greater than 130 mean arterial pressure Greater than 220 systolic

The patient who just had a stroke, we want to make sure they have about how much fluid intake in order to what?

1500-2000ml To maintain cerebral blood flow / perfusion

Once the patient is done with the stroke we want the bed to be at least what degrees ? What is the only time we don’t do this?

30 If the patient has symptoms of poor tissue perfusion

What is the super strong medication we can give to patients with a stroke?

TPA ( recombinant tissue plasminogen activator )

Why is TPA given to stroke patients?

To reestablish blood flow through a blocked artery to prevent cell death Clot buster

What is the time frame you can only give TPA?

3 to 4.5 hours

After the patient is stabilized with the TPA what do we give to prevent further clot formation ? (3) Examples include ASA Ticlopidine Clopidogel Dipyridamole

Anti coagulant & anti platelet & statins

Before we give TPA, what do we do?

Screen them CT or MRI

If an TPA can not be given What may we do? Define it/steps?

Endovascular therapy Catheter goes inside and allows blood flow to the brain Clot goes into the stent and both are removed

What are the goals for acute hemorrhagic stroke ? Abcs and I?

Airway Breathing Circulation Intracrnial pressure

What is the treatment/surgical therapy for hemorrhagic stroke? (2)

Evacuation of hematomas (removal) Clipping or coiling of an aneurysm

Another few questions Can you give TPA on blood thinner? TPA for hemorrhagic stroke? What type of vitamin reverses blood thinning effects?

No cause it’ll cause more bleeding No more bleeding Vitamin K

After stroke patient has stabilized for 12 to 24 hours interprofessional care shifts from preserving life to ? (2)

Lessening disability & reaching optimal function

What are the core measures for stroke? Assess/monitor ? Pulse ox more than ? Who do you call? Maintain what VS? Disganotic testing example? HOB degree? What diet? What scale?

ABCS 95 STROKE TEAM BP LABS/IMAGING 30 NPO NIH STROKE SCALE

What is the NIH stroke scale? Ranges from 0-42 The higher the number the ? The NIH assess 15 items LOC, ability to answer questions/commands, gaze, vision, facial palsy, motor/drift, limb ataxia, sensory, language, dysarthria, inattention, motor function

Scale to measure the severity of the stroke The higher the number the more severe

What are the 6 diagnosis for stroke?

Decreases intracranial adaptive capacity Risk for aspiration Impaired communication Impaired mobility Risk for injury Difficulty coping

What will we plan for stroke patients? Don’t over think it

Improve LOC Maintain functions Avoid complications

When the patient has stabilized we are going to want to help them communication So we will give them a ?

Speech therapies

We want to keep our stroke patients NPO why? How do we give them a diet though? What type of foods?

Risk for aspiration When we have a gag reflex Easy to swallow, soft, warm

Which is right sided or left sided ? Difficulty in judging, position, distance, motion Impulsive/impatient Deny problems ( neglect ) Often slower in tasks Response best to direction verbally Impaired spatial discrimination Anxious response Denial of deficits Respond to nonverbal cues Depression Left hemiplegia Right hemiplegia

R R R L R L L R L L R L

ambulatory care for stroke We want to do what? (3)

Gain all functions No complications Family support

Georontolic considerations Stroke causes what? ___ strokes that require hospitalization occurs in adults greater than 65 Extra note Patient, care giver and family require ongoing assessment and adapation to changing needs

Death & disability 66%