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
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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
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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)
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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
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5
Q

The benefits of CEA (Carotid Endarterectomy) are greatest in what 4 situations?

A
  • Men
  • Older pts
  • Recent cerebral ischemia
  • Ulcerated plaque
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6
Q

CEA (carotid endarterectomy) has a lower risk of what 2 things?

A
  • Peri-procedural stroke or death
  • Less risk of restenosis
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7
Q

Carotid Angioplasty (CAS) / Stenting has a lower risk of what 2 things?

A
  • Cranial Nerve Injury
  • MI
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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
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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)
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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
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11
Q

5 stroke mimcs

A
  • Encephalitis
  • HTN encephalopathy
  • Hypoglycemia
  • Migraine
  • Seizures
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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
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