Stroke

Question 1

Indications for a Carotid Endarterectomy?

Answer 1

-Done to those with severe asthcolorosis – signs of those who have a TIA
-Done to those with Ischemic Stroke

Question 2

Why do we do a Dysphagia asessment?

Answer 2

Dysphagia – swallow assessment

Do this so we can see how much motor function they still have and if they can safely swallow

Question 3

What is a Carotid Endarterectomy?

Answer 3

Sugery where atherosclerotic plaque is removed from the carotid artery to restore blood flow to the brain

Question 4

Clinical symptoms of a hemorrhagic stroke?

Answer 4

-Going to come on sudden
-Going to have a persistent SEVRE headache
-HIGHHHHHH blood pressure
-More severe symptoms and a much longer recovery time

Question 5

What are we looking at for blood glucose for management of an Ischmeic stroke?

Answer 5

Blood Glucose: We are looking at their A1C and if this is to high throughout an extended period of time

Question 6

What does FAST stand for? WHat makes up each component?

Answer 6

Face: Droop, ask them to smile or raise their eye brows,

Arm: Ask them to lift up their arms to see what their movement is like – affected side will not be able to equally lift arms

Speech: Do they have slurred speech – we can do a GCS here

Time: How long has it been or taken them to get to the hospital

Question 7

What is a TIA?

Answer 7

-It is a warning sign that a Ischemic stroke will occur (typically within 6 months)

A transient ischemic attack (TIA) is a stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms, which usually occur suddenly, are similar to those of stroke but do not last as long.

Question 8

What kind of stroke recives tPA for treatment? What is admonistered?

Answer 8

Will give Alteplase or streptokinase for ischemic strokes

Question 9

Management of hemorrhagic stroke?

Answer 9

-Urgent placement of external ventricular drain - used to elevate pressure and evacuate fluid

-urgen evacuation of hematoma - surgery where hey find and fix the source of the bleed

Question 10

What are some common stroke outcomes?

Answer 10

Mobility
Swallowing
Speech
Memory
Vision
Bladder/bowel dysfunction
Psychosocial concerns

Question 11

What kind of scans do we run to diagnose a stroke?

Answer 11

• CT Scan or MRI (gold standard is a CT scan)
  –Doing a CT immediately if we suspect stroke – first we do a non contrast CT then after we will do an MRI
  • Carotid Artery Imaging

Question 12

What do we include in our education for family mebers whos love one have just had a stroke?

Answer 12

-Talk to them about risk factors (smoker, diabetes, hypertension, high stress) – target their risk factors and tell them that its those risk factors that brought them there
-Monitor their ADLs- what are their limitations/modifications going to potentially look like post-stroke – DEPRESSION due to loss of body image
-Signs and symptoms of a stroke (FAST)

Question 13

Nursing care for a TIA?

Answer 13

-Do a symptoms analysis
-Do a CT to see if damage has been done
-Blood work (coagulation status, platelets, etc)

Question 14

Why do we sometimes do a lumbar puncture as a diagnostic tool with strokes?

Answer 14

Lumbar Puncture: This is done to see if there is blood in the CSF to indicate a hemotagic stroke that is crossing the BBB or infection (meningitis)

Question 15

What is endovascular treatment?

Answer 15

-Form of treatment for an Ischmeic stroke

This is surgery where they will go directly in and remove the clot

-This will be done if we are outside of the 4 ½ hour window

Question 16

Causes of an Ischemic Stroke?

Answer 16

-Previous stroke
-DVT (people that are more prone to DVT)
-Hypercoagulability
-A fib (quivering atrium and blood is pooling in the valves)
- Trauma
-Surgery
-Biggest cause is hypertension, DM, and atherosclerosis!!!

Question 17

Complication of a Carotid Endarterectomy?

Answer 17

Stroke or TIA.
Heart attack.
Pooling of blood into tissue around the incision site causing swelling.
Nerve problems with certain functions of the eyes, nose, tongue, or ears.
Bleeding into the brain (intracerebral hemorrhage)
Seizures (uncommon)

Question 18

What causes a TIA?

Answer 18

A transient ischemic attack (TIA) is caused by a temporary state of reduced blood flow in a portion of the brain. This is most frequently caused by tiny blood clots that temporarily occlude a portion of the brain.

Question 19

Why do we do a urinalysis as a diagnostic tool with strokes?

Answer 19

Urinalysis: This is done to look for ketones, Infections (UTI) this could be masking our other symptoms

Question 20

What is the main difference between a TIA and a stroke?

Answer 20

-it is a warning sign that a Ischemic stroke will happen/occur

-Main difference is within 20 min – a couple hours the symptoms are gone

Question 21

What are some common post stroke complications we need to monitor for and prevent?

Answer 21

Vasospasm
Vasospasm: This is the narrowing of the arteries caused by the narrowing/contraction of the blood vessels

Increased intracranial pressure
-Increased ICP: Due to the inflammatory process – Normal ICP is 5-15
-Normal Cerebral perfusion pressure is 60 – 80 we solve this MAP-ICP

Hemorrhagic transformation
-Transformation: Tissues themselves are changing due to the bleeding/ re direction of blood flow

Seizures

Shoulder pain assessment and treatment
-Shoulder pain: can come from soft tissue damage/trauma, spacitiy, can be referred pain but typically it is not

Question 22

Post-op care for a Carotid Endarterectomy?

Answer 22

-Watching for clotting – doing GSC every 20min
-Watching BP – could indicate bleeding out
-ICP changes
-Could see a change in airway – this is from development of a hemotoma
-Doing vitals
-Looking at dressing
-We can see Hypo+Hypertension
-Keeping in the recovery room for 2 – 4 hrs

Question 23

What labwork do we run to diagnose an Ischemic stroke?

Answer 23

Serum (blood) tests & urine

RBC- looking at hemoglobin - makes them more coagulable – hemocrat
Looking at a liver panel
Bloose glucose – do they have diabetes

Question 24

Whos are risk for devloping a hemorrhagic stroke?

Answer 24

-Smokers
-DM
-Age (due to the weakening of the vessles)

Question 25

Exclusion criteria for administeration of tPA?

Answer 25

-Any delays make the patient ineligible (over 4 ½ hours)
Not given to the pediatric population (risk outweigh the benefits)
Not given to those in a trauma (due to risk of internal bleeding)

Question 26

What do we do for nursing care after administration of tPA?

Answer 26

Nursing Care for after administration of tPA:
-Doing a fall risk – we keep patients in bed to avoid falls
-Vitals
-Risk of bleeding
-Risk of endoedema
-BP – we need to slowly bring down the systolic pressure below 180!
-Obtain abother CT scan – monitoring for reperfusion and monitoring for any repurfution injuries

Question 27

Treatment for hemorrhagic stroke?

Answer 27

1.) Microsurgical clipping (clip off the cerebral aneurysm)

2.) Endovascular coiling ( Cut off the blood flow to the cerbreal aneurysm by putting coils in it)

Question 28

Symptoms of a TIA?

Answer 28

-Tingly feelings on the affected side
-Eye droop
-Partial facial paralysis
-Vision distrubance
-Hard to lift arm and to touch things