Stroke 3- SG Flashcards
1
Q
Prevent Complications (7 things)
- NPO until swallowing eval
- Sequential compression devices if stroke was <48hrs / Heparin
- Avoid foley catheters
- Docusate for all pts
- H2 blockers / PPI
- Acetaminophen + abx if needed
A
- NPO: Aspiration
- Seq / Heparin: DVT
- Foley: UTI
- Docusate: Constipation
- Decubitus Ulcers
- H2 blocker / PPI: UGI bleed
- Acet: Fever
2
Q
Post-Stroke Depression
- Suspect this if sxs persist ___ after stroke
- Occurs in ___% of stroke pts
- May affect _____
- Often resolves within ___
- Tx?
A
- 1 - 2 weeks
- 50%
- Rehab & Recovery
- 1 year
- SSRIs, unless pt on Warfarin:
- Escitalopram
- Citalopram
- Sertraline
3
Q
Secondary Stroke Prevention
Hypercholesteremia
- DO or DO NOT discontinue Statins on admission?
- Obtain LDL within ___ of stroke onset
- If LDL ___ or greater, use hi-dose statin to decrease stroke/MI/death
- If LDL
- Outpatient LDL goal is
A
- DO NOT, put all pts on Statins regardless of LDL
- 48 hrs
- 100
- 100
- 70 (but give statins to all pts)
4
Q
- What are the 2 Carotid Stenosis Procedures?
- Which one is done in only high risk pts?
A
- Carotid Endarterectomy (CEA)
- Carotid Angioplasty/Stenting (CAS) –> high risk pts
5
Q
The benefits of CEA (Carotid Endarterectomy) are greatest in what 4 situations?
A
- Men
- Older pts
- Recent cerebral ischemia
- Ulcerated plaque
6
Q
CEA (carotid endarterectomy) has a lower risk of what 2 things?
A
- Peri-procedural stroke or death
- Less risk of restenosis
7
Q
Carotid Angioplasty (CAS) / Stenting has a lower risk of what 2 things?
A
- Cranial Nerve Injury
- MI
8
Q
Secondary Stroke Prevention / Risk Factor Modification
- Alcohol should be:
- < __ oz for men
- < __ oz for women
- Which type of diet?
- Exercise type and how often?
- Sleep apnea tx?
A
- 2 men
- 1 women
- Mediterranean diet
- aerobic, over 20 mins, over 3 d/wk
- CPAP
9
Q
Secondary Stroke Prevention
Risk Factor Modification
- Prescribe what 2 drugs?
- Avoid which 4 drugs?
A
Prescribe:
- Antithrombotic (warfarin)
- Statin (regardless of cholesterol)
Avoid:
- Estrogen (OCP, HRT)
- Sympathomimetic agents (decongestants , diet pills)
- NSAIDS (asa + ibu = bad)
- PPIs (if pt on Plavix)
10
Q
Prognosis
- Dependent on what 2 things?
- Better for infarction or hemorrhage?
- ___ = worse outcome
- 25-35% of stroke pts will ____
- Recurrent strokes often have higher _____
- Must manage risk factors ____/
A
- Time of arrival to hospital / Extent of infarct/insult
- Infarction
- LOC
- have another stroke within their lifetime
- rate of death
- aggressively
11
Q
5 stroke mimcs
A
- Encephalitis
- HTN encephalopathy
- Hypoglycemia
- Migraine
- Seizures
12
Q
Another 5 stroke mimics
A
- Stroke reactivation
- TIA
- Toxic / Metabolic
- Tumor (do not give tPA)
-
Conversion disorder / psychogenic
- no true CNS features
- Signs/Sxs in non-vascular, non-neuro distribution