Stroke Flashcards
What does stroke mean?
And this can depend on? (2)
Loss of function
The location and extend of brain tissue
Stroke can lose a patient function to perform (3) ?
Physical
Cognitive
Emotional movement
What two other terms can mean stroke?
Brain attack
Cerebrovascular accident (CVA)
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
Stroke is the ___most common cause of death in the USA?
5th
About ___ have a stroke each year
__to___% with permanent disability
____change for survivor and family
800k
15%-30%
Lifelong
There are two types of stroke what are they?
Ischemia
Hemorrhage
What is ischemia stroke?
Inadequate blood supply to part of brain
What is hemorrhage stroke?
Bleeding into the brain that results in death of brain cells
What are the 4 nonmodifiable risk factors?
Examples for each
Age
- doubles at 55
Gender
- men
Ethnicity
- African Americans
Heredity/family history
What is the biggest risk factor for stroke?
Hypertension!!!
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
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
What is a mini stroke called?
Transient ischemic attack (TIA)
Can a history of TIA increase the risk of a stroke?
True or false
True
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
How long doesTIA symptoms will usually last?
Less than an hour
Tia is considered to be a what?
Medical emergency since it can lead to a stroke
True or false
TIA is ischemia without infarction
But
A stroke is infarction ( cell death )
True
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
Hemorrhagic stroke results from bleeding into the brain tissue itself
In which we classify this by which 2 spaces bleeding occurs?
Intracerebral
Subarachnoid
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
Thrombotic ischemic stroke is the most common stroke ___% cases
Often assuociated with (2)
Often preceded by ___
60%
Hypertension & diabetics mellitus
TIA ( mini stroke )
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
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%
