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CJA > stroke > Flashcards

stroke Flashcards

1
Q

what is the leading cause of disability?

A

stroke

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2
Q

what is an ischemic stroke?

A

blockage/obstruction of cerebral artery

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3
Q

is afib a stroke risk?

A

yes

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4
Q

what is a hemorrhagic stroke?

A

rupture/opening of cerebral artery with bleeding into other brain areas

prognosis isn’t good

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5
Q

main presenting symptoms of hemorrhagic stroke

A

decreased LOC

might tell you they have the worst headache of their life

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6
Q

etiology of stroke

A
  1. thrombotic stroke
  2. embolic stroke
  3. hemorrhagic stroke
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7
Q

time is brain, act F.A.S.T.

A

Face (is one side of smile drooping)
Arms (ask person to raise their arms, is one week)
Speech (is it slurred)
Time (call 911 at first sign of stroke

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8
Q

why is the mono-kellie hypothesis important in strokes?

A

they usually head to swelling which can lead to death

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9
Q

non-modifiable risk factors for stroke

A

-age (above 55), assigned male at birth, African American or black

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10
Q

modifiable risk factors for stroke

A

-hypertension is primary risk factor
-previous stroke
-cardiovascular disease
-afib.
-carotid stenosis
-atherosclerosis
-elevated hematocrit
-estrogen replacements
-DM
-obesity
-sleep apnea
-migraines
-hypercoaguable states (postpartum, post-surgery)
-periodontal disease
-smoking
-excessive alcohol consumption
-illicit drugs

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11
Q

Transient ischemic attack (TIA)

A

-temporary neurologic deficit resulting from impairment of cerebral blood flow
-symptoms last 1-2 hours
-brain imaging shows NO evidence/damage of ischemia
-“warning of impending stroke”
diagnostic work-up to investigate causes, risk factors, prevent future stroke
-have to get imaging to know
-get CT to see if bleeding, if no bleeding can use contrast

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12
Q

preventative treatment of strokes

A

-health promotion measures: healthy lifestyle, stop smoking healthy diet & weight
-anticoagultion therapy for afib.
-anti platelet therapy
-“statins”
-antihypertensive meds
-carotid artery stenosis treatments

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13
Q

carotid endarterectomy

A

-physically go in & clean our carotid artery
-can be seen via US at bedside
-as a nurse priority is assessment
-after they’re placed in ICU & have neuro assessments
-worry about clots flicking out
-need good BP

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14
Q

ischemic stroke clinical manifestations

A

-manifestations depend on the location and size of the affected brain area, generally sudden and new/worse from the person’s baseline

-monitor weakness of face, arm, legs, esp one sided
-speech changes, dysarthria, expressive aphasia, receptive aphasia
-balance problems, ataxia, dizziness
-sensory changes
-vision changes
-cognition changes

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15
Q

if someone has vision changes post stroke what do you do?

A

take them to scan the room

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16
Q

stroke diagnostics

A

-careful history: time last seen as well
-rapid and focused neurological and physical examination (GCS, NIH stroke scale)
-get CT within minutes (no contrast if unsure of bleed or awful kidneys)
-lumbar puncture (only is ICP is not expected to be elevated)
-EKG

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17
Q

how long do you have to save brain tissue?

A

4-6 hours

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18
Q

how long does it take to see ischemic stroke?

A

24 hours

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19
Q

when do you not give TPA

A

after 6 hours
if there’s a bleed

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20
Q

how long after a stroke will you see dead tissue on an mRI?

A

12-24 hours

21
Q

acute medical management of ischemic stroke

A

-thrombolytic therapy (tPA to dissolve clot)
endovascular therapy (direct removal of clot)
-hemodynamic monitoring & management
-intracranial pressure monitoring, & management
-intubation, mechanical ventilation & sedation

22
Q

tPA

A

-converts plasminogen into plasmin and causes lysis of clot
-given IV bolus followed by infusion over 1 hour
-goal is to ADMINISTER 4.5 HOURS OF SYMPTOM ONSET (60 minutes of ED arrival)

23
Q

nursing management when giving tPA

A

-see if it’s working via neuro checks every 15 minutes for 6 hours & every 15 minute vital signs
-headaches are a red flag

24
Q

if there’s a change in vital signs or headache while giving tPA what do you do?

A

stop drip, anticipate cat scan, stay with patient

25
Q

eligibility criteria for tPA

A

-onset of symptoms under 4.5 hours before beginning treatment
-over 18
-no bleeds or surgery for last 3 months
-can’t do is with SBP over 185 or DBP over 110
-INR should be less than 1.7

26
Q

warnings of when to weigh risk/benefit with tPA

A

-serum glucose less than 50
-pregnacy
-over 80

27
Q

before tPA administration

A

-prior to initiate invasive procedures prior to administration
-bleeding precautions and ICU for 24 hours after
-BP must be under 185/110 prior ro treatment
need CT first to rule out bleed

28
Q

after tPA

A

-24 hour “no touch” period, no invasive procedures
-bedrest

29
Q

post stroke work-up/treatment

A

-NPO until speech sees them
-depending on size of stroke, may need to watch for secondary cerebral edema
-assess stroke factors
-statin therapy
-lifestyle modification
-PT/OT/SLP evaluations
-need rehab evaluations

30
Q

see any decline or change in neurologic function or LOC?

A

report to provider immediately

31
Q

therapy for someone who neglects side of body after stroke?

A

make them touch it

32
Q

most common stoke cause?

A

HTN

33
Q

hemorrhagic stroke

A

bleeding into brain tissue

34
Q

causes of hemorrhagic stroke

A

-rupture of small vessels primarily related to HTN
-trauma
-cerebral amyloid antipathy

35
Q

when does functional recovery plateau for hemorrhagic stroke?

A

18 months

36
Q

hemorrhagic stroke clinical manifestations

A

-sudden & severe headache, described as worst headache of their life (specifically for SAH)
-vomiting, nuchal rigidity, photophobia
-focal neurological deficits
-collapse, LOC if severe

37
Q

initial acute complications of hemorrhagic stroke

A

-cerebral ischemia (ineffective perfusion)
-re-bleeding
-increased ICP, drowsy or confused,
-hypothalamus/pituitary dysregulation
-cardiac arrhythmias

38
Q

in first 24 hours of hemorrhagic stroke what do you want SBP under?

A

less than 150

39
Q

when is brain herniation more dangerous?

A

24-72 hours after stroke, know via change and assessment

40
Q

CPP less than 50?

A

results in neurological damage

41
Q

what is the goal range for CPP?

A

greater than 60

42
Q

early clinical manifestations of increased ICP

A

-decreased LOC
-any change in condition, restlessness, confusion, increased respiratory effort, purposeless movements

43
Q

late clinical manifestations of increased ICP

A

-decreased or erratic HR/RR, widening pulse pressure
-worsening respiratory pattern, including cheyne-stokes breathing & respiratory arrest
-loss of brainstem reflexes: pupil, gag, corneal
-cushing’s triad

44
Q

if there’s a intrventricular catheter what should you do?

A

clamp it if doing anything with patient

45
Q

management for increased ICP

A

reduce cerebral edema via IV meds like: osmotic diuretics (manitol), hypertonic fluids, loop diuretics

46
Q

surgical management of increased ICP

A

-craniotomy
-craniectomy
-cranioplasty
-burr holes
-endovascular

47
Q

SAH other complications

A

-first 21 days: vasospasm causes cerebral ischemia, seizures, hyponatremia, hydrocephalus

-longterm: personality changes

48
Q

cerebral vasospasm

A

-for 21 days Q1hour neurochecks
-secondary injury that SAH are at risk for, peak is usually 7-10 days post bleed
-causes cerebral arteries to constrict and can lead to ischemic infarcts
-prevention is Nimodipine (calcium channel blocker), hydration

49
Q

treatment of cerebral vasospasm

A

-induced hypertension and aggressive hydration & endovascular treatment

CJA (31 decks)

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