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Med Surg 2 > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke/ brain attack/CVA RF

A

HTN
Cigarette smoking
Estrogen/progesterone
DM
Carotid artery disease
HX of TIA

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2
Q

Stroke modifiable RF

A

Stress
Smoking
Wt
Sleep apnea
Diet

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3
Q

Stroke non modifiable RF

A

Age
Race
Gender
Family hx

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4
Q

Stroke primary, seconday prevention and health goals

A

Primary:
Smoking cessation, wt loss

Secondary:
BP, knowing lab values

Health goals:
Lower Na intake
Normal wt
Normal BP
Limit smoking
⬆️ exercise

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5
Q

TIA

A

Temporary focal cerebral ischemia

Caused by transient decrease in blood supply to brain
S/s same as stroke: resolve spontaneously
Last less than 24 hrs

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6
Q

TIA
Diagnostic workup
Management

A

Workup within 24-48 hrs

Management:
-prevent stroke
-Antplatelets or anti coags.
(Antiplt: ASA, clopidogrel)
(Anticoags: warfarin(inr), (vitk & FFP for antidote)
-control BP

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7
Q

Types of ischemic strokes

A

Thrombotic:
Clot forming and plaque causes narrowing:

Associated with:
CAD, DM, TIA

Embolic:
Embolis of clot reachs a small artery and blocks it
Associated with:
A-fib

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8
Q

Hemorrhagic stroke

A

Intracerebral bleeding:
Ruptured vessel

Most common cause:
HTN

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9
Q

Aneurysms/hemorrhagic stroke:
Name
Where mostly occur
Causes
S/s
Risk of

A

SAH: subarachnoid hemmorrhage (bleed in arachnoid space)
Most are in circle of willis

Causes: trauma or cocaine use

S/s:
Severe HA(thunder clap)
Vomiting
Lethargy
Seizure, coma

Risk of vasospasms up to 2-3 wks post bleed (may mimic stroke like s/s give meds for vasospasms)
ca channel blockers

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10
Q

Sx specific to hemorrhagic stroke

A

Prevent rupture:

Aneurysm clipping

Coil inserted into the aneurysm
(Immediate protection to pulsations to cause rupture)

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11
Q

Tx if cant do sx for hemorrhagic stroke

A

Angiography to ID bleed site
Neuro assessment Q1
Monitor increased ICP, VS, MAP(CPP)

tx:
Ca channel blockers: vascular antispasms

Keep BP up so CPP is up but not too high bc can cause rupture

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12
Q

Stroke patho

A

Brain deprived of O2

primary neuronal injury : Irreversible ischemia to cells in the center of stroke area

Penumbra: zone where there is reversible ischemia

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13
Q

When you have a stroke what bad happens
Biochemical cascade
Edema

A

Biochemical cascade:
Neurotoxins released
Influx of Ca & Na
Causes cytotoxic edema

Edema increases damage

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14
Q

BEFAST

A

Balance
Eyes
Face
Arm
Speech
Tongue not midline (also Time)

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15
Q

Call 9-11 if have 1 or more

A

Sudden:
-Numbness or weakness of face, arm, or leg
-Confusion, trouble speaking or understanding
-Trouble seeing
-Trouble walking, dizziness, loss of balance
-Severe HA with no known cause

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16
Q

Stroke CM
Visual and sensory

A

Visual field deficits:
Homonymous hemianopsia: loss of vision of the same halves on both eyes
Diplopia: double vision

Sensory deficits:
Paresthesia

17
Q

Vision changes in stroke

A

Hemianopia: blindness over half field of vision

Binasal-blindness: inner half of eyes

Bitemporal-blindness: outer half of eyes

Homonymous blindness: same half of visual field each eye

18
Q

Unilateral visual neglect

A

Pt starts to neglect one half of their body or dont realize there is another half of things.

Example: may only eat half the plate of food.

19
Q

Stroke CM
Motor deficits
Incontinence

A

Motor deficits: usually contralateral
-hemiparesis (unitlateral paresis)
-hemiplegia (unilateral paralysis)
-ataxia: bad balance
-Dysarthria: slurred speech
-Dysphagia

Incontinence:
Frequency, urgency, constipation

20
Q

Stroke CM
Verbal deficits

A

Expressive aphasia: trouble verbalizing

Receptive aphagia: trouble understanding communication

Global aphasia (mixed)

21
Q

Stroke CM communication issues w/
Left sided brain injuries

A

Wernicke’s (wacky)
-fluent aphasia
-word salad (made up words long sentences)
-difficulty understanding speech
-unaware of their mistakes

Broca’s (broken)
-non fluent aphasia
-short phrases, makes sense but takes effort to talk
-understands speech
-aware of their difficulties

Global aphasia:
-non fluent aphasia
-difficulty understanding and speaking

22
Q

Behavioral changes
Cognitive and emotional

A

Cognitive:
Poor reasoning, altered judgement, memory loss

Emotional:
Loss of self-control, emotional lability, depression

23
Q

Right brain damage

A

Left sided: hemiplegia
Left-sided neglect
Spatial-perceptual deficits
Tends to deny or minimmize problems
Short attention span
Impulsive
Impaired judgement, impaired time concepts

24
Q

Left-brain damage

A

Right side: hemiplegia
Impaired speech/language aphasia
Right/left discrimination impaired
Slow performance
Aware of deficits
Impaired comprehension related to language, math

25
Q

Horner’s syndrome

A

Stroke causes paralysis in sympathetic nerves in eyes

Ptosis
Sunken eyeball
Elevation of lower lid
Pupillary constriction
Lack of tearing

26
Q

Stroke diagnostics:

A

CT: stat (non contrast) (check if its hemmorragic or ischemic)

MRI (see ischemia happening in the brain)

Angiography (visual of cerebral blood vessels)

EEG

Doppler of carotid arteries

NIH stroke scale

BP (1st)

27
Q

How to ID stroke early

A

NIH stroke scale
GCS
history/symptoms

28
Q

Treatment reconmentdation
Door to needle

A

Door to MD: 10 min
Access to neuro: 15min
Door to CT complete: 25min
Door to CT read: 45min
Door to treatment: 60min
Admit to ICU/stroke: 3hrs

29
Q

Protect the ischemic penumbra

A

Maintain cerebral oxygen

Blood sugary management early: if above 200

Goal temp is: 96.8-98.6 degree

30
Q

BP recomendations
Ischemic strokes

A

Lower BP only if SBP >220 or DBP >120
But SBP >185 is a contraindication for thrombolytics
If receiving tPA BP maintained <185 for 24 hrs

***Labetalol is initial drug for BP

31
Q

BP recomendations
Hemorragic strokes

A

SBP <160

32
Q

When a client arrives in the ER with an ischemic stroke, what is the priority assesssment in relation to tx with rt-PA?

A. Current medications
B. Complete hx and physical
C. Time of onset of current stroke
D. Upcoming surgical procedures

A

C. Time of onset of current stroke

(Need to be given 3-4.5 hours of onset of symptoms)

33
Q

Recombinant tissue plasminogen activator
-restore cerebral flow using what?
Give in what time frame
CI

Prevent complications

A

Restore cerebral blood flow:
*evalate for rt-PA therapy
-within 3-4.5hr of onset of symptoms
CI:
GI bleed, hemorrhagic stroke, head trauma 3mo, sx past 14 days

Prevent complications:
Bleeding after rt-PA
-no other anticoags for 24hrs after rt-PA
-monitor BP <185
-stop if:
severe HA, N/V, decreased LOC

34
Q

Clot removal systems

A

Penumbra system: disolves clots

Merci clot remover: removes them

35
Q

Risk after stroke

A

Cerebral edema: signs
-cushings triad
-increased ICP

Stroke recurrence:
Prevent: go home on ASA 325g and anticoags

36
Q

when to start REHAB

A

As soon as hemodynamically stable:

Preferably by 2nd hospital day

37
Q

Nursing diagnoses

A

-Impaired verbal communication
-Risk for corneal abrasion
-Disturbed thoughts and vision
-Unilateral neglect
-Ineffective coping
-Ineffective cerebral tissue perfusion
-Hemorrhage
-Risk of aspiration, hyperthermia, impaired skin integrity, contracture development
-Impaired physical mobility
-self-care deficit

38
Q

Imbalanced nutrition: less thn body requirments

A

-Dysphagia diets
-Eval from speech therapy
-Aspiration precautions
-Position of pt
-Food to unafftected side
-Alternate bites w/ fluids
-May need thickened fluids
-Assistive devices

Med Surg 2 (5 decks)

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