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Nursing Acutely Ill > Stroke > Flashcards

Stroke Flashcards

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1
Q

Estimated % of population that have a stroke per year

A

10%

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2
Q

What are 10 examples of modifiable risk factors associated with stroke?

A 
Smoking 
Activity level 
BP control 
Weight 
Hypertension 
T2DM 
Education 
Atrial fibrilation 
Alcohol intake 
Cholesterol
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3
Q

What are 7 examples of non-modifiable risk factors associated with stroke?

A 
Aneurysm 
Genetics 
Diabetes 
Blood disorders 
Race 
Low birth weight 
Increasing age
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4
Q

What are the 5 major causes of ischaemic stroke?

A 
Embolism 
Blood clots 
Thrombus 
Hypertension 
Diabetes
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5
Q

What are the 5 major causes of haemorrhagic stroke?

A 
Trauma 
Aneurysm 
Hypertension 
Arteriovenous malformation (AVM) 
Subarrachnoid haemorrhage
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6
Q

What does TIA stand for and mean?

A

Transient Ischaemic Attack. Causes a temporary interruption to the blood supply to an area of the brain.

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7
Q

What are the two major pairs of arteries that supply the brain?

A

Right and left carotid arteries

Right and left vertebral arteries

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8
Q

What does FAST stand for?

A

Face
Arms
Speech
Time

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9
Q

How quickly should a CT scan be performed on a pt with suspected stroke?

A

Immediately

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10
Q

In a pt going for thrombolysis what drug, what dose over how long?

A

A tissue plasminogen activator (tPA) such as Alteplase is given at a dose of 0.9mg/kg up to a max dose of 90mg. Administrated as 10% in a bolus over 1 minute to see the effect on the pt. Then the rest given via IV through a pump over 1 hour.

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11
Q

What % of pts will have a permanent disability following stroke?

A

40-50%

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12
Q

Define the term ischaemia

A

Inadequate blood supply to an organ or tissue

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13
Q

What % of strokes occur to the under 65 age group?

A

25%

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14
Q

Which type of stroke isn’t suitable for thrombolysis?

A

Haemorrhagic

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15
Q

What are 4 contraindications for thrombolysis being given?

A

Trauma <2weeks
Lumbar puncture <2weeks
Taking anticoagulants
NSAIDS

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16
Q

Define dysphasia/what occurs in dysphasia?

A

Inability to speak

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17
Q

Define dysphagia/ what occurs in dysphagia?

A

Inability to swallow

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18
Q

What % of stroke pts aren’t suitable for rehabilitation?

A

15%

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19
Q

What are the 4 diagnostic criteria for stroke?

A

Sudden onset
Focal/neurological defects
Vascular origin
Symptoms lasting >24 hours

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20
Q

What may thrombosis occur as a result of?

A

Large artery atherosclerosis.

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21
Q

What may cause an embolism to occur?

A

Atrial fibrillation
Prosthetic valves
Post MI

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22
Q

What is the more prevalent type of stroke ischaemic or haemorrhagic?

A

Ischaemic

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23
Q

Diagnostic criteria for a TIA

A

Sudden onset
Focal/ cerebral deficit
Vascular origin
Symptoms lasting <24 hours

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24
Q

What are the 5 stages in the mechanism of iscaehemic stroke?

A 
Occlusion of blood vessel 
Two zones of local injury 
Ischaemic core 
<10-20% blood flow, inadequate O2 and glucose supply 
Death of brain cells known as infarction
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25
Q

In ischaemic stroke what is the mechanism of brain injury to the ischaemic penumbra?

A

Time limited circulatory reserve
Lack of adequate perfusion
Results in larger area of infarction

26
Q

What are the names of the two areas of injury following an ischaemic stroke?

A

Ischaemic core

Ischaemic penumbra

27
Q

What is the mechanism of brain injury due to haemorrhagic stroke?

A

Blood vessel rupture
Bleed into surrounding brain tissue
Reduction in perfusion of oxygen and glucose to the brain cells
Increase in pressure to surrounding tissues
Cerebral oedema resulting in further cell death

28
Q

What is the ROSIER scoring system used for?

A

Recognition of stroke

29
Q

What are 11 important areas of assessment required for identifying stroke?

A 
ROSIER scoring 
Time of onset 
Full blood screen 
Blood glucose measurement 
Full vital signs 
PMHX (current, past and meds)
Full neurological assessment 
Physical examination
ECG 
CT scan 
National institutes Health stroke scale
30
Q

What does ROSIER stand for?

A

Recognition Of Stroke In the Emergency Room

31
Q

What are the 7 components of the ROSIER score?

A 
Loss of consciousness
Seizure activity 
Onset of asymmetrical arm weakness 
Onset of asymmetrical face weakness
Onset of asymmetrical leg weakness
Speech disturbance 
Visual field defect
32
Q

What is the range in score for ROSIER?

A

-2 to +5

33
Q

What ROSIER score indicates a stroke?

A

> 0

34
Q

What are the two treatment options for ischaemic stroke?

A

Thrombolysis or intra-arterial thrombectomy

35
Q

What is the exclusion criteria for thrombolysis?

A 
>3-4.5 hrs since stroke onset 
>80 years of age 
Have coagulation disorder 
On anticoagulants 
Have had haemorrhagic stroke
36
Q

What is the name of the route and drug given in thrombolysis?

A

IV infusion of alteplase

37
Q

What is the dosage of the drug alteplase?

A

0.9mg/kg of pt

38
Q

What is mechanical clot retrieval designed to do?

A

Recanulise obstructed arterial vessels in order to reperfuse the ischaemic penumbra.

39
Q

For how long does a patient following thrombolysis require 1-1 care?

A

6 hours

40
Q

What are the 6 signs of an adverse reaction to thrombolysis?

A 
Urticarial rash 
Periorbital swelling 
Oro lingual angioedema (tongue swelling) 
Tachypnoea 
Dyspnoea 
Tachycardia
41
Q

What should be avoided 24 hours prior to thrombolysis?

A

Arterial/intravenous blood samples
Intravenous line
Urinary catheters
NG tubes

42
Q

What is the frequency of obs following thrombolysis treatment?

A

Every 15 mins for 2 hours
Every 30 mins for 6 hours
Hourly for 16 hours

43
Q

Alternative treatment to thrombolysis?

A

Intra-arterial thromboectomy

44
Q

In terms of respiratory, what are warm, cyanosed hands an indication of?

A

Retention of CO2

45
Q

What is clubbing?

A

Painless, bolbus enlargement of the fingers with a soft nail bed and no nail angle

46
Q

What is a way to check for clubbing?

A

No diamond shape when fingernails pressed together

47
Q

What may be the cause of clubbing?

A

Lack of O2 rich blood to peripheries

48
Q

Use of bronchodilators may cause what due to receptors on skeletal muscle?

A

Finger tremors

49
Q

What are the signs in the hands of carbon dioxide retention?

A

Warm cyanosed hands.

Warm, sweaty flapping tremor hands

50
Q

At what O2% does cyanosis occur?

A

85%

51
Q

What causes central cyanosis?

A

Disease of heart such as ventricular failure.
Disease of lungs such as pulmonary fibrosis.
Lead to deoxygenated blood leaving left side of heart.

52
Q

What is a sign of central cyanosis?

A

Blue mucous membranes such as the lips and tongue

53
Q

What causes peripheral cyanosis?

A

Decrease in circulation and increased O2 requirements of tissues.

54
Q

During peripheral cyanosis blood leaving the left side of the heart has normal oxygenation. True or false?

A

True

55
Q

What is the normal angle of the ribs compared to the spine?

A

45 degrees

56
Q

What does auscultation of the lungs involve?

A

Pt takes deep breath through mouth. Each side f the chest is listened to with a stethoscope.

57
Q

What does a peak flow measure?

A

The max rate of airflow which can be achieved from sudden forced expiration of a full inspiration. AKA peak expiratory flow rate

58
Q

What is peak flow commonly used to measure condition wise?

A

Asthma

59
Q

What is peak expiratory flow rate?

A

Maximum speed of expiration.

60
Q

What would the normal features of the lungs on a chest xray be?

A

Vessels decreasing in size towards the periphery
Hair line fissures
Diaphragm, chest wall

Nursing Acutely Ill (11 decks)

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