Stroke Flashcards
What are the different types of stroke?
Heamorrhagic (15%)
Ischaemic (85%) :
- thrombotic (57%)
- embolic (16%)
What can middle cerebral occlusion lead to?
Contralateral hemiplegia Contralateral hemisensory loss Hemianopia Aphasia Neglect and dressing dyspraxia
What assessment do the nurses need to carry out if they suspect a pt has had a stroke?
ABCDE
Assessment of consciousness
Pupil size and reaction to light
Motor and sensory function
How do you determine if a pt need thrombolysis?
An urgent CT is required to determine type of stroke
What thrombolysis is given for ischaemic stroke?
If there are no contraindications, alteplase is given
What is the window of opportunity to administer thrombolysis?
3-4.5 hours from onset of stroke
Which pts are eligible for thrombolysis?
Pts with no intracerebral haemorrhage or other contraindications
Present within 3 hrs of known onset
Pts under 80 yrs if presenting within 3-4.5 hrs onset
Individual basis if between 3-6 hrs
How successful is thrombolysis?
Significantly reduces death and disability at 90 days
Effectiveness is greatest when given early
What do hyper-acute stroke units consist of?
High quality stroke specialist nursing care Critical care for enhanced monitoring SALT Dietician Physio
What is the treatment for pts post thrombolysis?
High intensity nursing for 24 hrs
Bed rest 24 hrs
Eat and drink if swallow test passed
BP =
What should you do if a stroke pt deteriorates?
Contact the stroke team and rescan the pt
What respiratory assessment should be undertaken on stroke pts?
Regular monitor RR, pattern and effort of breathing
Why should you monitor stroke pts for signs of partial airway obstruction?
Transient obstruction is not uncommon during sleep
Why is it important to monitor for hypercapnia?
It can act as a potent cerebral vasodilator and will increase cerebral blood flow and ICP
What is the National Stroke Strategy (DH, 2007)
It is the framework for development of stroke services
16 quality markers including:
- recognising and acting upon suspected stroke
- long term care
How do you respiratory manage a stroke pt?
Change pts position
Encourage regular deep breathing
Encourage pt to cough
What are the two situations when a pt blood pressure would be pharmalogically lowered after the acute stage of a stroke?
Administration of thrombolysis
Hypertensive emergency
After a pt has had a intracerebral harmorrhage, when would their BP be reduced?
If SBP>180 mmHg
What is the usual BP for a pt post thrombolysis?
Must be
At what figure does the CPP need to be maintained at after a stroke?
> 70mmHg
What is important to remember about fluids and electrolytes for a stroke pt?
Aim for normovolaemia and correct electrolytes
0.9% NaCl is fluid of choice
Avoid dextrose solutions in first 48 hrs
At what temperature is a poor outcome likely in stroke pts?
> 37.5 degrees
What is the ideal blood glucose range for a stroke pt within the first 24-48 hrs?
4-11 mmols
What is important to remember about neurological deterioration in stroke pts?
It regularly occurs, can be subtle and insidious in onset
All pts are at risk
What are the causes of neurological deterioration in stroke pts?
Cerebral oedema
Hydrocephalus
Heamorrhagic transformation
Stroke extension/recurrence
What are the early signs of raised IVP following stroke?
Increasing drowsiness, agitation and restlessness
Increasing difficulty in achieving the same GCS results
Slight but gradual deterioration in limb function or GCS
What is important to remember about stroke pts and seizures?
5% will have epileptic seizures
Most commonly focal but can have secondary generalisation
Which stroke pts are eligible to recurve anti platelet drugs?
TIA and ischaemic strokes unless there are clear contraindications
The benefits outweigh the risks
What anti platelet drugs are given to stroke pts?
Aspirin 300 mg daily for 2 weeks the clopidogrel 75 mg
What are the functional impairments a pt suffered following a stroke?
Motor/sensory Communication Swallowing Continence Cognition Behaviour
What is the percentage of pts who are affected by dysphagia?
64-90%
Swallowing should therefore be screened within 4 hours
What happened if a stroke pt fails the swallow screening?
Refer to SALT
Keep pt NBM
NG feeding commenced within 24 hrs
What is the nurse responsible for for a stroke pts suffering from dysphagia?
Pts ongoing assessment
Weight monitoring
Providing assistance at mealtimes
Management of alternative methods of feeding
What communication difficulties can a stroke pt suffer with?
Dysarthria - impaired motor speech production
Receptive or expressive aphasia - impaired language skills resulting in difficulty in understanding or expressing language
What are some specific strategies to help a stroke pt with speech?
Allow plenty of time to formulate a response Closed questions Other means of communication Picture boards Encouragement and feedback
What does correct positioning and early mobilisation of a stroke pt prevent?
Skin breakdown Muscle spasticity Chest infections Shoulder pain DVTs
What is used to reduce the risk of DVTs in stroke pts?
IPC
What is important to remember about incontinence with stroke pts?
40-60% suffer urinary incontinence
30% suffer faecal incontinence
It is often related to functional disability
What are the priorities for a stroke pt following the hyperacute phase of a stroke?
Individualised secondary stroke prevention management plan
Implement an individualised rehab plan
Prepare pt and family for discharge from acute services
What is important to remember about stroke recurrence risk?
26% within 5 yrs
39% within 10 yrs
Risk is highest in first month following stroke
Secondary prevention should be commenced asap
What are the modifiable risk factors of a stroke?
Hypertension Smoking High cholesterol Obesity Diet Diabetes Alcohol
What are the non-modifiable risk factors of a stroke?
Age
Race
Family history
Why are anti hypertensive drugs given to stroke pts?
Reduce the risk of future stroke
Reduce risk of long term disability and cognitive decline
What anti hypertensive drugs are given to stroke pts?
Initial therapy = calcium channel blockers or athiazide
ACE inhibitors added if needed
When are stroke pts treated for their cholesterol?
When their cholesterol is >3.5 mmols
Treatment commenced after hyper acute stage
When are anticoagulants given to a stroke pt?
Only used for caardiobolic ischaemic stroke pts who are at high risk of further stroke
Commenced 14 days post stroke
What is important to remember about anticoagulants for stroke pts?
The risk of haemorrhage outweighs the benefits
When can stroke pts have a carotid endarterectomy?
Candidates have carotid imaging within 1 week and surgery within 2 weeks of stroke
Which stroke pts qualify as candidates for carotid endarterectomy?
Pts who are stable without severe neurological deficits following acute ischaemic stroke or TIA involving carotid artery territory
What are cognition impairments following a stroke?
Memory Executive functions Language Attention Perception
What are the nurses role in managing psychosocial aspects of a stroke?
Early involvement of family and friends in planning care pathways
Help to develop skills or strategies that can be accessed to deal with difficult situations
Prepare the pt for changes they face
Listen and provide solutions
