Stroke Flashcards
Pathophysiology of Stroke
An interruption of perfusion to any part of the brain that results in infarction (cell death)
Acute Ischemic Stroke
Definition: Caused by the occlusion of a cerebral or carotid artery by either a thrombus or embolus
Thrombotic Stroke: A stroke that is caused by a thrombus. Commonly associated with atherosclerosis in either intracranial or extracranial arteries.
Embolic Stroke: Caused by a thrombus or group of thrombi that break off from one area of the body and travel to the cerebral arteries via the carotid artery or vertebrobasilar system
Hemorrhagic Stroke
Definition: Vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the subarachnoid space
Intracerebral Hemorrhage: Bleeding into the brain tissue that results from severe or sustained hypertension.
Subarachnoid Hemorrhage: Results from bleeding into the subarachnoid space caused by a ruptured aneurysm or arteriovenous malformation
Signs/Symptoms of Stroke
- Sudden confusion or trouble speaking or understanding others
- Sudden numbness or weakness of the face, arm or leg
- Sudden trouble seeing in one or both eyes
- Sudden dizziness, trouble walking, or loss of balance or coordination
- Sudden severe headache with no known cause
Risk Factors/Causes of Stroke
- Smoking
- Obesity
- Hypertension
- Diabetes
- Elevated Cholesterol
Health Assessment for a patient with a stroke
Accurate history is important in the diagnosis of a stroke, the PRIORITY is to ensure that the patient is transported to a stroke center
Important parts of history include:
1. When did the symptoms start?
2. What was the patient doing when the stroke began?
3. How did the symptoms progress?
4. Did the symptoms worsen after the initial onset, or did they begin to improve?
5. What is the patient’s medical history?
6. What are the patient’s current medications, including prescribed drugs, over the counter drugs, herbal and nutritional supplements and recreational drug use?
7. What is the patient’s social history, including education, employment, travel, leisure activities, and personal habits?
Physical Assessment for a patient with a stroke?
- Complete neurologic assessment
- LOC (use GCS)
- Assess patient’s ability to effectively cough (impaired breathing may occur)
- Patient’s with an embolic stroke may have a heart murmur, dysrhythmias and/or hypertension
Psychosocial Assessment for a patient with a stroke
- Assess patient’s reaction to the illness, especially changes in body image, self-concept and ability to perform ADLs
- Identify any problems with coping or personality changes
- Ask about financial status and occupation
- Assess emotional lability
Laboratory Assessment for a patient with a stroke
No definitive laboratory test confirms its diagnosis
1.Elevated hematocrit and hemoglobin: the body attempts to compensate for lack of oxygen to the brain
- Elevated WBC: indicate the presence of an infection or a response to physiologic stress of inflammation
- Blood Glucose and hemoglobin A1C: Whether client has diabetes and whether it is controlled
- aPTT, PT and INR: establish baseline information before fibrinolytic or anticoagulation therapy may be started
Imagining Assessment for a patient with a stroke
- CTP
- CTA
- MRA
- Ultrasonography
Interventions for Cerebral Perfusion
- Fibrinolytic Therapy
> Early use is important
> “Clot busting drug”- improves blood flow to tissue/brain
> Success is dependent of time- interval of time between onset of symptoms and available treatment
> Alteplase (Activase, tPA)
> 3-4.5 hours
> BP parameters- must be below 185/110 mm Hg - Endovascular Interventions
> Intra-arterial thrombolysis: delivers fibrinolytic agent directly into thrombus within 6 hours (used for patients outside time window or with clot in middle cerebral artery)
> Mechanical embolectomy: surgical blood clot removal
> Carotid angioplasty and stenting: used to prevent or manage acute ischemic stroke - Ongoing drug therapy:
> Antiplatelets: Aspirin, Clopidogrel
> Anticoagulants: used in clients with cardiopulmonary issue (Afib)
> Calcium Channel Blockers: treat or prevent cerebral vasospasm after subarachnoid hemorrhage (Nimodipine)
> Drugs for symptom management (stool softeners, analgesics, anti-anxiety drugs)
Interventions to promote mobility and ADL activity
- Assessment of functional ability
> Bed mobility skills
> Ambulation with or without assistance
> ADLs (feeding, bathing, dressing) - HIGH RISK FOR ASPIRATION D/T IMPAIRED SWALLOWING BECAUSE OF MUSCLE WEAKNESS
> Maintain NPO until swallowing ability is assessed!
> Monitor weight and albumin levels to detect any decrease from baseline - Rehabilitation ASAP
> Prevent complications: pneumonia, atelectasis, pressure injuries and DVT - Flaccid or Spastic Paralysis
> Support affected arm (on pillow when sitting to prevent shoulder subluxation)
> Avoid pulling
Interventions to promote effective communication
- Present one idea or thought at a time
- Uses one-step directions
- Speak slowly (NOT LOUDLY) and use cues/gestures as needed/appropriate
- Avoid yes/no questions with expressive aphasia
- Alternate forms of communication (communication boards, pictures, flash cards, computer, handheld mobile device)
- Do not rush patient to speak
- Collaborate with SLP
Interventions to manage changes in sensory perception
Right Hemisphere Interventions
1. Use frequent verbal and tactile cues and break down tasks into steps
2. Approach from the unaffected side; unaffected side should face door of the room
3. Teach to touch and use both side of body
4. Dress unaffected side first
5. With homonymous hemianopsia- teach to turn head from side to side to expand visual field
6. Place objects within field of vision
Left Hemisphere Interventions:
1. Assist with ADLs but encourage patient to do as much as they can
2. Establish a routine/schedule that is structured, repetitious and consistent
3. If apraxia is present- PT can help
Types of Aphasia
- Expressive
- Receptive
- Mixed
- Global
