Stroke Flashcards
A stroke results in
Death of brain cells
How do you know a patient is having a stroke? What signs do you see?
“FAST”
- Face droops
- Arm weakness
- Speech difficulty
- Time is critical
What causes a stroke?
Disruption in the blood supply to part of the brain
What are strokes classified as?
- Ischemic: inadequate blood flow to brain
- Hemorrhagic: Bleeding into brain
What are the diagnostic tests for stroke?
- CT 1st
- MRI
Non modifiable risk factors for stroke
- Age
- Gender — more common in men
- Ethnicity — higher in African Americans
- Hereditary
Modifiable risk factors for stroke
- HTN!
- CV disease
- Diabetes
- Smoking, alcohol, drugs
- Birth control pills/hormone replacement
- Obesity
- Sleep apnea
Types of Stroke
- Transient Ischemic Attack (TIA)
- Ischemic
- Hemorrhagic
Transient ischemic attack (TIA)
Transient episode of neurologic dysfunction that serves as warning sign of further Cerebrovascular disease
Ischemic strokes are either
Thrombotic or Embolic
Define an ischemic stroke
Deprivation of oxygen to brain
Ischemic: Thrombotic Stroke
- Occurs from injury to blood vessel wall & formation of a blood clot
- Results from thrombosis or narrowing of blood vessel
- Most common
Thrombotic strokes are associated with
- DM and HTN
- Can be preceded by a TIA
Ischemic: Embolic Stroke
- Embolus dislodges & occludes a cerebral artery
- Results in infarction and edema of area supplied by involved vessel
What do patients take when they have Embolic stroke?
Blood thinners
Embolic stroke mostly originates from
The endocardial layer of the heart
Embolic stroke ______ onset
- Sudden onset with severe clinical manifestations
-Pts usually remain conscious - Commonly recur
Hemorrhagic stroke results from
Bleeding into
- brain tissue
- subarachnoid space or ventricles
Intracerebral Hemorrhage
- Bleeding in brain caused by rupture of vessel
- Sudden onset
- Progression over minutes to hours because of ongoing bleeding
Intracerebral hemorrhage prognosis
Poor with a 30 day mortality rate of 40-80%
Intracerebral hemorrhage most commonly caused by
HTN
Intracerebral hemorrhage manifestations
- Neurological deficits
- Headache
- N/V
- Decreased LOC
- HTN
Subarachnoid hemorrhage
Intracranial bleeding into cerebrospinal fluid-filled space between arachnoid and pia mater
Subarachnoid hemorrhage often caused by
Rupture of cerebral aneurysm, trauma, or illicit drug use
- Incidence increases with age; higher in women
- Silent killer
Cerebral vasospasm
Administration of calcium channel blocker (Nimodipine)
Stroke on right side of brain
- Paralyzed left side : hemiplegia
- Spatial perceptual deficits
- Rapid performance, short attention span
- Impulsive, safety problems
- Impaired judgement and time concepts
Stroke on left side of brain
- Paralyzed right side
- Impaired speech
- Slow performance, cautious
- Aware of deficits (anxiety and depression)
- Impaired comprehension of language and math
Clinical manifestations of stroke
- Motor deficits
- Communication deficits
- Cognitive impairment
- Psychological effects
- Elimination
Motor deficits
- Hemiplegia: complete/severe loss of strength
- Hemiparesis: mild loss of strength
- Ataxia: poor muscle control
Communication
- Dysarthria: can’t form words
- Dysphasia: affects ability to understand and use words
- Aphasia
Cognitive impairment
- Memory loss
- Decreased attention span
- Poor reasoning
- Altered judgement
Psychological effects
- Loss of self control
- Depression
- Emotional lability
Stroke on right side of brain is more likely to cause
- Problems in spatial perceptual orientation
- Agnosia: loss of ability to identify objects or people
- Apraxia: difficulty with skilled movements
What does a CT or MRI tell you?
Tells if the stroke is ischemic or hemorrhagic
Prevention
- Diet
- Weight control
- Exercise
- No smoking
- Limit alcohol
- BP management!! Bc HTN
Prevention drug therapy
- Antiplatelet drugs used in pts who have had TIA
- Aspirin (81mg/day)
- Anticoagulation for pt w a fib
- Warfarin
- Statins, antihypertensives
Thrombolytic therapy within
3 hours of s/s
Surgical management for ischemic stroke
- Carotid endarterectomy
- Carotid stenting
Surgical management for hemorrhagic stroke
- Aneurysm clipping, coiling
- Resection of arteriovenous malformation
Nursing interventions for stroke
- Support resp. system
- Frequent neuro exam
- Monitor CV and musculoskeletal system
- Monitor for skin breakdown and constipation
- Promote normal bladder function
- Nutritional status
- Be supportive w communication
- Initially arrange clients environment within perceptual field
- Clear and understandable explanations
Achieve self care
- Encourage to assist in personal hygiene as soon as able to sit up
- Start with affected side
- Dressing — better balance when seated
- Use larger clothing
- Place on affected side — dress first
Attain bladder control
- Bladder retraining program
- Offer urinal/bedpan on schedule
- Avoid use of catheters
- Upright posture and standing position for males
What medications can decrease a patients risk for stroke?
- Warfarin
- Antiplatelet
- Statin
- Antihypertensive
