Stroke Flashcards
• 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.
S/S of TIA
o Blood clot or narrowing of vessels and decrease blood flood, obscuring blood flow causing death of tissue.
Thrombic Stroke
• 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
Thrombic stroke
- 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
Embolitic Embol
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.
Lacunar stroke
• 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
Hemorrhagic Strokes
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
Assessment of Hemorrhagic stroke
• 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
Assessment of Hemorrhagic stroke
- 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
4 Major Classes
- 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
S/S of CVA
• 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
Motor Deficit
• 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
Sensory Deficit
• 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
Verbal Deficit
- 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
Cognitive deficit
- 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
Left Brain Is Dominant
- 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
Right side brain
o Predictor for cardio vascular disease
C-reactive protein
Monitors how 02, glucose and dopamine is used in brain
o Reaction to drugs in brain
PET Scan
3-dimentional imaging technique
o Measures brain metabolism
SPECT
- ABC Airway à Priority pt
- Respiration assessment q 2-4 h
- Keeps 02 Sat at 94%
- HOB 30˚
- Suction PRN
- Turn q 2 hrs
Nursing intervention
• 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
Nursing management
• 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
Risk for aspiration R/T dysphagia
- 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
Impaired verbal communication R/t aphasia syndrome
• 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
Self care deficit: feeding; bathing; dressing,
