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Neuro 142 > Stroke > Flashcards

Stroke Flashcards

1
Q

• Slurred speech
• Asymmetrical smile
• R/L sided weakness hemiplegia
• It passes with 6-12 hrs
• Important to ID what part of brain was showing ischemia
• Must follow up to find out the cause for TIA
• Reversible ischemic neurological deficit – new concept AKA RIND
o Pt appears to have stroked and are fine with in 24 hrs.
o Might be caused by vasospasm, which reversed itself with in 24 hrs.

A

S/S of TIA

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2
Q

o Blood clot or narrowing of vessels and decrease blood flood, obscuring blood flow causing death of tissue.

A

Thrombic Stroke

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3
Q

• Blood clot can occur due to hardening of plaque/fat deposits
• Plaque is nicked
• Platelets attack clot
• Platelets create blood clot on the vessel wall
• It can happen in internal/external carotid artery
• The plaque will narrow arterial wall and restrict blood flow going to brain
o Occurs because of a BLOCKED (not ruptured) blood vessel

A

Thrombic stroke

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4
Q
  • Occurs when blood clots are thrown and travel to brain region causing occlusion, depriving brain of O2
  • Similar to fat emboli
  • A-Fib – when atrium of the heart/upper chamber fibrillates, which causes blood to clot inside atrium making it possible for clot to get out
  • Any kind of valve disease usually L side of Heart, will cause brain damage
  • Damage to R side of heart will cause damage to lungs
A

Embolitic Embol

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5
Q

is caused by lack of blood flow in smaller arteries that supply deep brain structures. A common cause is chronic high blood pressure, leading veins to narrow, making it easier for blood clots to block blood flow.

A

Lacunar stroke

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6
Q

• An intracranial bleed between Pia mater and arachnoid space
o Occurs because of ruptured blood vessels
• Occurs suddenly
• Contributing factor to hemorrhagic stroke and CVA is hypertension

A

Hemorrhagic Strokes

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7
Q

Where does the bleed occur?
o Did it occur in cerebral spinal fluid?
• One of the ways to diagnose bleed in the circle of Willis is a spinal tap
• Look for presence of blood in CSF
• If blood is present pt has a bleed in subarachnoid space
• Pt with subarachnoid bleed will suffer from severe headache

A

Assessment of Hemorrhagic stroke

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8
Q

• Tightening of neck/nuchal rigidity
o Seen in subarchnoid bleed because blood is irritating in CSF which goes up and down spinal cord and in meningitis: -
▪ Ask pt to put chin on chest
▪ If it really hurts they must immediate get a lumbar puncture
• Tinnitus - ringing in the ear - potential for hemorrhagic stroke

A

Assessment of Hemorrhagic stroke

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9
Q
  • TIA
  • Reversible
  • Progressive
  • Completed
  • Progressive strokes are observed for 24 hrs.
  • Completed strokes: is what the pt appears with - deficit may be permanent
  • We would like to get pt within 24 hrs so it can be treated immediately
A

4 Major Classes

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10
Q
  • Intense or severe h/a – S/S of bleed
  • Facial weakness, asymmetry
  • Loss of coordination with weakness
  • Visual loss
  • Vertigo
  • Dysphagia (g for gag reflex, difficulty swallowing)
  • Photophobia + nuchal rigidity, they go together irritation or blood in CSF
  • N/V
  • Hearing loss
A

S/S of CVA

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11
Q

• Found in frontal lobe and cerebellum
• Hemiparesis – weakness
• Hemiplegia – paralysis
• Ataxia – unsteady gait (drunk like) seen in MS
• Muscle flaccidity:
o When pt arrives at ER muscles are flaccid – like a dolls arm
▪ Later on pt becomes spastic- Can’t get arms to open up
▪ Pt will get a splint
▪ ROM exercise

A

Motor Deficit

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12
Q

• In parietal lobe
• Hemianopsia – blindness in ½ visual field
o Must teach pt to scan environment
• Agnosia – inability to use objects – Pt unable to recognize
• Apraxia – inability to carry out activity – forget how to use a fork, that a fork is used to eat with
• Neglect – unilateral neglect - part of body doesn’t belong to them

A

Sensory Deficit

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13
Q

• If on dominant side it is going to be Broca’s aphasia
o Inability to form words or speak
o Dysarthria- an inability to articulate words
• If on non-dominant side it is Wernicke’s aphasia
o Inability to understand words said to them
o Talk in mumbling rambling sentences
o Loss of ability to write
• Global- both types of aphasia

A

Verbal Deficit

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14
Q
  • Found in frontal lobe
  • Short / long term memory impairment
  • Decrease attention span
  • To test give 4 simple instructions
  • Pt will only be able to carry out one instruction
  • Keep instruction simple and singular
  • Impaired judgment - concerned about risk for injury -r sided stroke
  • Inability to learn, focus, concentrate - concerned about pt teaching
A

Cognitive deficit

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15
Q 
- pt is right handed
• R Sided paralysis
• Aphasia – loss of ability to produce and or comprehend language
• Agraphia – loss of ability to write
• Alexia – loss of ability to read - word blindness
• Slow Caution: it takes longer to care for pt (key with left brain injury)
▪ Pt take their time
• Memory deficit
• Frustrated
• Confuse R&L
• Problems naming objects
• Sensory loss
A

Left Brain Is Dominant

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16
Q
  • We worry about this pt
  • Incorporate in nursing care pt’s lack of judgment - the impulsive nature
  • Pts don’t really understand but very impulsive in their judgment
  • Left sided paralysis
  • No spatial perception
  • Quick and impulsive
  • Memory deficit
  • Short attention span
  • Loss of vision on L side
  • Difficult recognizing faces
  • Be careful with these pt - automatically put bed alarm on
  • These pt’s move very quickly
  • These pt’s get discharged faster, they learn faster but still lack judgment
A

Right side brain

17
Q

o Predictor for cardio vascular disease

A

C-reactive protein

18
Q

Monitors how 02, glucose and dopamine is used in brain

o Reaction to drugs in brain

A

PET Scan

19
Q

3-dimentional imaging technique

o Measures brain metabolism

A

SPECT

20
Q
  • ABC Airway à Priority pt
  • Respiration assessment q 2-4 h
  • Keeps 02 Sat at 94%
  • HOB 30˚
  • Suction PRN
  • Turn q 2 hrs
A

Nursing intervention

21
Q 
• Blood pressure control:
o Ominous sign
o Monitor q 2-4 hrs
o If giving TPA, keep pressure below 185 /140
• Hyperthermia
o Sign of poor outcome
o Hypothermia is neuroprotective
• Hyperglycemia - decreases success of surgical procedure
o Keep sugar within very tight control
o Keep between 80–110
• Control Arrhythmia
o More common in R Hemisphere
o 4% will develop arrhythmia
o 3% will have MI
• Anticoagulation:
o Immobilization
o DVT
A

Nursing management

22
Q

• Every Pt should get a swallow test by speech therapist
o Make sure pt swallows properly and doesn’t aspirate /choke
o Injury to right middle lobe will most likely result in aspiration pneumonia
o Can be observed under breast bone
• Perform swallow study:
o Have pt swallow methylene blue
o If methylene blue is coughed up or suctioned from lungs pt, isn’t ready to swallow
• Teach pt chin tuck:
o Tuck chin when swallowing
o Closes off airway and opens esophagus
• Strict intake/output
o How much of tray was eaten?
o How much did pt drink?
• Monitor consistency of food – thin liquid/thick liquid

A

Risk for aspiration R/T dysphagia

23
Q
  • Assess speech patterns
  • Speak slowly/clearly
  • Use hand gestures
  • Minimize loud noises
  • Break tasks down
  • Demonstrate
  • Patience
  • Do not yell – pt isn’t hard of hearing
  • Demonstrate or show pictures of what you want
  • Do not rush pt since pt is slow and caution
A

Impaired verbal communication R/t aphasia syndrome

24
Q

• 70% of all Pt with stroke will complain of shoulder pain
o Be careful when turning and positioning
o Never reach for them by their shoulder
o Get them form under back
• Most pts are in splints
• Put on pt multi podus boots to prevent plantar flexion
• ROM
• Keep splints on at all times to keep pt in correct anatomical position

A

Self care deficit: feeding; bathing; dressing,

25
Q 
o Severe H/A
o Nuchal rigidity
o Loss of vision
o Double vision
o Tinnitus
A

Hemorrhagic stroke

26
Q

– bleed occurs w/in circle of willis due to AV malformation or aneurism
▪ There is blood where CSF should be
▪ Lumbar puncture – The initial diagnostic test to determine if pt has bleed
• If CSF is bloody, the pt is bleeding in the space

A

Subarachnoid bleed

27
Q

o Not everything can get into brain, such as:
• Antibiotics and chemotherapy agents
o ETOH, sedatives, hypnotics, CAN get into brain

A

Blood – brain barrier

28
Q

reflex, also known as the ice caloric or cold caloric reflex, a physician will instill at least 20 ml of ice water into the patient’s ear. In patients with an intact brain stem, the eyes will move laterally toward the affected ear. In patients with severe brain stem injury, the gaze will remain at midline.

A

oculovestibular

29
Q

Flash light in pt’s eye. Light should be seen in exact place in both eyes

A

Hirschberg

Neuro 142 (13 decks)

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