Stroke Flashcards
Describe the pathophysiology of strokes, generally, and ischemic vs. hemorrhagic (which is more common?)
-generally, blocked blood supply to brain –> brain damage
2 main types:
-Ischemic (most common): stoppage of blood flow
-Hemorrhagic
(less common): rupture of cerebral vessel –> blood leaks into brain tissue
Name some modifiable risk factors for stroke.
-#1: hypertension
-cardiac disease
-A fib
-MI
-cardiomyopathy
-congenital defects (ex: foramen ovale)
-valve defect
-diabetes
-smoking
-alcohol
-sleep apnea
-metabolic syndrome, obesity, physical inactivity
Name some nonmodifiable risk factors for stroke.
-age >55
-race: Black Americans are 2x more likely than whites to have a stroke, and have the highest mortality rate
-family history/genetics
-history of TIA
Strokes are more common in _____(men/women), but _____(men/women) are more likely to die from a stroke.
Strokes are more common in men, but women are more likely to die from a stroke.
Describe a TIA. What would you tell a patient experiencing a TIA?
Transient Ischemic Attack: ‘mini-stroke’ s/s last for minutes to an hour.
Seek medical help ASAP! TIA can progress to a full stroke.
Compare thrombotic stroke vs embolic stroke (type, which is most common?)
-both ischemic strokes
Thrombotic most common:
-blood vessels narrow, embolus forms in major brain artery
-progressive manifestation
Embolic:
-embolus (often from endocardium) travels into major brain artery
-Severe and Sudden manifestation
Compare intracerebral vs subarachnoid stroke
-both hemorrhagic
Intracerebral
-hypertension –> vessel rupture –> bleeding in brain
-sudden onset, often during activity
-high mortality rate (40-80% over 30 days)
Subarachnoid
-Willis aneurysm rupture –> bleeding into CSF between brain and arachnoid membrane
-‘silent killer’ unnoticeable until aneurysm ruptures
The BE-FAST acronym stands for:
Balance loss
Eyesight changes
Facial drooping
Arm weakness
Speech changes
Time to call 911
Signs/symptoms of stroke are dependent on:
the location of the stroke
S/S of a stroke (compare L and R hemispheres)
BOTH:
Motor deficits:
-hypo –> hyperreflexia
-loss of motor muscle control
-respiratory function impaired
-swallow/speech/gag ability impaired
**L sided strokes will cause R sided deficits and vice versa
-incontinence
L SIDED STROKE:
-aware of deficit
-aphasias: receptive (can’t comprehend), expressive (can’t express), or global (both)
-slow, cautious, anxious, fearful
-impaired language and math comprehension
R SIDED STROKE:
-denies/minimizes deficits
-spatial-perceptual issues, trouble perceiving time
-impaired judgement, impulsivity
Emergent management of a stroke (type unknown):
1) ABCs (O2, get vitals, EKG)
2) NIH stroke scale w/in 20 min
3) CT ASAP to rule out hemorrhage
Rx: ischemic stroke
(+ guidelines for blood pressure management)
-ABCs, O2 PRN
-NIH-SS
-tPA within 3 hours
-long term: anticoagulants (warfarin, DOACs), anti-platelets (aspirin, clopidogrel), statins
BP management (WHEN to give IV labetelol, nicardipine):
-w/o tPA: SBP > 220 or DBP > 120
-w/ tPA: SBP > 185 or DBP > 110
Contraindications for tPA:
-Hx of coagulation disorders
-GI bleed, stroke, or head trauma w/in past 3mo
-surgery in past 14 days
-internal bleed in past 22 days
Rx: hemorrhagic stroke
-manage hypertension w/ PO or IV labetelol, nicardipine (goal SBP < 160)
-Nimodipine (Ca channel blocker that vasodilates, treats vasospasm–cerebro-protective)
-seizure prophylaxis PRN
Surgery:
-remove if > 3cm
-clip/coil aneurysms
-AVM resection
-CSF drainage (ventriculostomy)
Describe intracranial regulation and the Monro-Kelli Doctrine as it applies to management of intracranial pressure
The Monro-Kelli Doctrine claims that the total volume of the intracranial space (brain volume + CSF vol+ intracranial blood vol) is always __________.
constant
What is the normal range for Cerebral Perfusion Pressure (CCP)?
What is the critical ischemia threshold?
normal CCP: 60-80 mmHg
critical ischemia threshold: 30-40 mmHG
How is Cerebral Perfusion Pressure (CCP) calculated?
MAP - ICP = CCP
(Mean Arterial Pressure - Intracranial Pressure = Cerebral Perfusion Pressure)
What is the normal range for Intracranial Pressure (ICP)?
normal ICP: 5-15
According to the Monro-Kellie doctrine, an ICP over ___ mmHg will compromise CCP.
20 mmHg
Nursing management to control ICP post-stroke (positioning, meds, temp control…)
-HOB > 30
-Board-like body: align head and neck, no hip flexion
-manage pain and sedation
-prevent constipation
-antipyretics/TTM to maintain temp of 96.8-98.6)
-IV mannitol and 3-5% hypertonic saline
-barbiturates–induce coma if ordered
Monitor closely for S/S of __________ with tPA administration.
bleeding
After a stroke, patients will be NPO until:
a swallow study confirms they can safely swallow
A full neuro assessment and NIH-SS assessment should be done when?
-beginning of shift
-end of shift
-with any change in pt condition
