Stroke Flashcards
Neurologic deficits Ischemic or hemorrhagic Neurologic deficits vary; 3rd leading cause of death in North America Survivors have some degree of impairment Highest incidence in people more than 65
Stroke or Brain Attack
Brain is 2% of body wt but requires 20% of Cardiac output and requires 20% of body’s oxygen consumption
- Cerebral blood flow is self regulated (Autoregulation)
- Maintains a constant blood flow despite changes in systemic blood pressure.
- Autoregulation is lost when
- systemic BP less than 50 mmHg or above 160 mmHg
- Cerebral Blood flow increases with increase CO2 concentration, increased hydrogen ion concentration and decreased oxygen conc.
Perfusion required/ stroke
Blood flow and oxygenation decreased
- to cerebral neurons
- cellular metabolism ceases
- cells swell
- Dead/dying cells surrounded by Penumbra
- neurologic deficits used to identify location
- contralateral deficits
Pathophysiology and Etiology stroke
- Ischemic but still viable cerebral tissue
- This region will die if reperfusion is not established during the early hours.
- The penumbra is where pharmacologic interventions are most likely to be effective.
sm. time frame given for TPA (3 to 4.5 hrs)
Penumbra; the partially shaded outer region of the shadow cast by an opaque object.
Ischemic strokes; blood clots, stenosis
- transient ischemic attack (TIA)
- mini stroke
- Thrombotic stroke
- occlusion of large vessel by thrombus; plaque build up over years.
- Embolic stroke
- blood clot or matter through cerebral vessels
A fib; emoblic stroke clots in atrium and embolizes
Pathophysiology and Etiology; Stroke
Hemorrhagic stroke *Intracranial hemorrhage; worst headache of my life. pass out *Ruptured cerebral blood vessel *form that is most fatal -Types: Intracerebral Subarachnoid #1 cause HTN
Pathophysiology and Etiology; Stroke
Hypertension Heart disease Diabetes mellitus Sleep apnea Blood Cholesterol levels Smoking Sickle Cell disease Substance abuse Living in stroke belt; southeastern US. greasy foods; soul foods
Risk Factors of Stroke
Fam hx Obesity Sedentary lifestyle Recent infections Hx of TIA's Oral contraceptives Pregnancy Childbirth Menopause Migraines with aura Autoimmune disorders Clotting disorders Previous stroke
Other Risk Factors for Stroke
Cerebral artery involved; varies
Area of brain affected; varies
Focal; one-sided
Stroke clinical manifestations
Weakness of face, arm, leg Numbness of one side Loss of vision Speech difficulties Sudden severe headace Difficulty balancing
FAST; face, arm drop, speech, time
**Quicker TPA better they will do. 3-4.5 hr window
Clinical Manifestations of Stroke
Call 911 immediately
Sensory Perceptual deficits:
- Hemianopsia; 1/2 visual field
- Agnosia; can’t recognize objects
- Apraxia; clumsiness. romberg test
- Neglect syndrome; right sided CVA; don’t recognize left side of body is theirs.
- Pain
Complications of stroke
Cognitive and behavioral changes;
- changes in consciousness
- emotional lability
- loss of self-control
- decreased tolerance for stress
- intellectual changes
Complications of stroke cont.
Communication disorders:
- Result of stroke affecting dominant hemisphere. Left side/language
- Aphasia;
- expressive; can’t express
- receptive; hearing
- mixed or global
- dysarthria; movement
Complications of stroke
Motor deficits: *mild weakness to severe limitation *weakness, paralysis, spasticity *Specific deficits; -hemiplegia, -hemiparesis -flaccidity -spasticity Elimination disorders; -partial loss of sensations that trigger elimination; Contractures from old strokes Flaccidity from new strokes
Complications of stroke
Motor deficits on right side Right visual field deficits Language deficits; aphasia, agraphia or alexia Slow and cautious behavior style Anxiety before new skills attempt Frustration, anger, depression, worrisome Sense of guilt or worthlessness Difficulties with memory Chewing or swallowing problems
Left sided CVA
Motor deficits on left side Left visual field deficit Spatial perceptual deficits -unilateral spatial Neglect USN; don't approach a cripple from their crippled side Impulsiveness Easily distracted Denial or unawareness of deficits Poor judgement, overestimation of abilities Euphoria, constant smiling ***impulsive safety risk
Right sided CVA
Three treatment stages: *prevention *acute care *rehabilitation Goals of stroke care *rapid recognition and reaction to warning *rapid emergency medical services dispatch *rapid EMS transport and prenotification *Rapid diagnosis and treatment
Collaboration; Stroke care
Check blood sugars
too high or too low could indicate stroke symptoms
TPA wouldn’t work
Elevated bp; perfusion, don’t bring Bp too low
Stroke scale -NIH stroke scale CT scan Cerebral arteriography; down the line Transcranial Doppler ultrasound MRI PLAC blood test (phospholipase A2); increase risk for reoccurance of stroke Lumbar puncture (relieve pressure in ischemic stroke)
Diagnostic tests for Stroke
Prevention: Antiplatelet agents Low-dose aspirin *Acute stroke -ischemic stroke-anticoagulant therapy -thrombotic stroke-fibrinolytic therapy TPA; activator clot buster in central lines; 30% will help; 6% chance make it worse; hemorrhage
Pharmacologic therapies for Stroke
Carotid endarterectomy
Extracranial intracranial bypass
Carotid angioplasty with stenting
Surgery for Stroke victims
Physical Therapy
Occupational therapy (masters level)
Speech therapy
Rehabilitation for stroke victims
Stoke prevention: Control HTN!!
- smoking cessation
- avoid drug use
- normal weight
- diet
- exercise
- cholesterol levels
- Treat cardiovascular disorders
Nursing Process:Assessment, Stroke prevention
Increase awareness of warning signs
- sudden weakness/numbness face, arm, leg
- confusion, difficulty speaking, understanding
- sudden trouble walking
- dizziness
- lack of coordination
- sudden difficulty with vision in one/both eyes
- sudden severe headache without cause
Assessment nursing process
Health hx -risk factors -previous stroke -drug use; cocaine, heroin -smoking Physical assessment -LOC, communication -Motor strength
Assessment nursing process; Stroke
Ineffective Tissue Perfusion: Cerebral Impaired Physical Mobility Self Care Deficity Impaired Verbal Communication Impaired Urinary Elimination Risk for Constipation Impaired Swallowing
Nursing Diagnosis; Stroke
Blood pressure within normal range
Participate in rehabilitation
No complication from immobility
Nutritional needs met.
Plan; Nursing Stroke
Monitor respiratory status and airway patency Suction as necessary Side-lying position Oxygen as ordered Assess mental status and LOC
Monitor
- strength and reflexes
- Cardiac status
- Temperature increase; increase ICP
- Intake and output
- Seizure activity
Implementation: Ineffective Tissue Perfusion: Cerebral; Stroke
Encourage ROM for nonaffected side
Passive ROM to affective side
Turn and reposition every 2 hours
Assess lower extremities for thromboembolism formation
-Physical therapy consult
Implementation: Impaired Physical Mobility; Stroke
Encourage use of unaffected limb for self-care
- Teach to dress affected side first
- Occupational therapy consult
- Stand strong walk weak
Implementation; Self-Care Deficit-Stroke
- Approach/treat client as adult
- Do not; assume client has hearing deficit
- Talk with raised voice
- Allow time for client to respond
- Face client and speak slowly
Implementation: Impaired Verbal Communication; Stroke
If unable to understand speech
- be honest and say so
- use short, simple statements, questions
- accept frustration and anger
- try alternative methods of communication.
Implementation: Impaired Verbal Communication; Stroke
-Assess for urinary frequency, urgency, incontinence, nocturia
-Encourage bladder training
-Teach kegel exercises
-Use positive reinforcement
-Discuss pre-stroke bowel habits
bladder training q. 2hrs on pan or commode.
Implementation: Impaired Urinary Elimination and Risk for Constipation; Stroke
Encourage Fluids up to 2000 ml/day
- high fiber diet
- increase physical activity as tolerated
- assist with using toilet facilities, same time
- administer prescribed stool softeners
Implementation: Impaired Urinary Elimination and Risk for Constipation: Stroke
Dysphagia can cause choking, drooling aspiration, regurgitation
- monitor swallow studies
- ensure safety when eating
- upright position with neck slightly flexed
- pureed or soft foods
- liquids consistency of honey
Implementation: Impaired Swallowing; stroke victims
Eating/swallowing techniques Assess for coughing with eating or drinking Have suction equipment at bedside Monitor lung sounds Minimize distractions
Implementation: Impaired Swallowing; stroke victims
Client participates in rehab
Client communicates needs
Client receives adequate family/communication support
Client experiences no complications
Evaluation; nursing stroke victims
The nurse assesses for which predisposing factor for embolic stroke in the history of the client admitted to the hospital after having a brain attack?
Atrial fibrillation
Which point of care testing should be performed early when someone is having signs and symptoms of stroke?
Blood sugar
