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