Stroke Flashcards
Stroke that is due to brain bleed from a broken blood vessel. Excessive swelling
hemorrhagic stroke
causes of hemorrhagic stroke
brain aneurysm bursts, uncontrolled hypertension, old age (vessels not resilient)
Mini stroke. S/S lasts minutes to hours
Transient Ischemic Stroke (TIA)
S/S of TIA “Strokes Happen”
Smoking, Thinners, Rhythm (AFib), Oral contraceptives, Kin, Excessive weight, Senior Citizens. Hypertension, Atherosclerosis, Physical inactivity, Previous TIA, Elevated blood glucose (DM), aneurysm brain
Type of stroke that is a blockage of blood vessels, narrowing, and lack of blood flow to an area. “Brain Attack”
Ischemic stroke
why do ischemic strokes happen?
Embolism, thrombus clot forms within artery wall in neck or brain, seen in pt. with hyperlipidemia or atherosclerosis
what are the two types of ischemic stroke?
thrombotic and embolic
type of ischemic stroke that is acute occlusion by blood clots secondary to atherosclerosis which narrow the lumen of the artery (stenosis)
thrombotic
type of ischemic stroke where a clot breaks off, travel and blocks blood flow resulting in infarct/death of tissue distal to the embolism
embolic stroke
what heart condition is transient ischemic attacks similar to
angina
risk factors for embolic stroke
plaque, faulty heart valves (pooling of blood), and cardiogenic embolisms
weakness, sensory loos on one side of the body, unilateral visual deficits, loss of speech, facial droop
neurological signs of stroke
clinical manifestations of stroke
sudden weakness, numbness, difficulty talking, difficulty understanding, severe headaches with no known cause
which part of the brain would you have weakness of left extremities and face
motor area of the right cerebral hemisphere
which part of the brain would you have loss of coordination on right extremities
left parietal lobe
which part of the brain would you have unsteadiness and poor coordination
cerebellum
which part of the brain would you have receptive dysphasia
Wernicke’s area
which part of the brain would you have expressive dysphasia
Broca’s area
Three part of Glascow coma scale
Eye opening response (1-4), Best Verbal response (1-5), and Best Motor response (1-6)
GCS eye opening response list
Spontaneously (4), To speech (3), To pain (2), Unresponsive (1)
GCS verbal response list
Oriented to time, place and person (5), Confused (4), Inappropriate words (3), Incomprehensible sounds (2), No response (1)
GCS motor response list
Obeys commands (6), Moves to localized pain (5), Flexion withdraw from pain (4), Abnormal flexion (decorticate) 3, abnormal extension (decerebrate) 2, No response (1)
LOC: alert and oriented x 3, good verbal and written comprehension and expression, socially acceptable responsible behavior
fully conscious
LOC: disoriented to time, place, or person, short attention span, memory difficulties, difficulty following commands and change in agitation, restlessness, or irritability
confusion
LOC: speech, mental processes, motor activities are slower
lethargy
LOC: around with tactile stimuli, responds with one or two works, follows simple commands only when stimulated
obtundation
LOC:minimal spontaneous movement except with vigorous and constant stimuli are applied, moaning/groaning, responds purposefully when noxious stimuli are applied
stupor
LOC: total absence or awareness of self and environment
Coma
Ask the client to smell and identify the smell of cologne with each nostril separately and with the eyes closed.
Cranial nerve I (olfactory)
Provide adequate lighting and ask client to read from a reading material held at a distance of 36 cm. (14 in.).
Cranial nerve II (optic). Visual acuity/visual fields
Reaction to light:
Using a penlight and approaching from the side, shine a light on the pupil. Observe the response of the illuminated pupil. Shine the light on the pupil again, and observe the response of the other pupil.
Cranial nerve III (oculomotor). Eye and lid moment, pupil constriction , lens accommodation
Reaction to accommodation:
Ask client to look at a near object and then at a distant object. Alternate the gaze from the near to the far object. Next, move an object towards the client’s nose.
Cranial nerve III (oculomotor). Eye and lid moment, pupil constriction , lens accommodation
Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally.
Cranial nerve IV (trochlear). Eye movement
While client looks upward, lightly touch lateral sclera of eye to elicit blink reflex.
To test light sensation, have client close eyes, wipe a wisp of cotton over client’s forehead.
To test deep sensation, use alternating blunt and sharp ends of an object. Determine sensation to warm and cold object by asking client to identify warmth and coldness.
Cranial nerve V (trigeminal). Corneal reflex, mastication, facial sensation
Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight through the six cardinal fields of gaze.
Cranial nerve VI (abducens). Eye movement, eye muscles
Ask client to smile, raise the eyebrows, frown, and puff out cheeks, close eyes tightly. Ask client to identify various tastes placed on the tip and sides of tongue.
Cranial nerve VII (facial). Facial expression, salivation, tearing, taste, ear sensation.
Have the client occlude one ear. Out of the client’s sight, place a tickling watch 2 to 3 cm. ask what the client can hear and repeat with the other ear.
Ask the client to walk across the room and back and assess the client’s gait.
Cranial nerve VIII ,acoustic: hearing and equilibrium
Ask the client to say “ah” and have the patient yawn to observe upward movement of the soft palate.
Elicit gag response.
Note ability to swallow
Cranial nerve IX (Glossopharyngeal). Taste, swallowing, gag, sensation of tongue and pharynx
Ask the patient to swallow and speak (note hoarseness)
Cranial nerve X (vagus).
Ask client to shrug shoulders against resistance from your hands and turn head to side against resistance from your hand (repeat for other side).
XI. Accessory. Sternocleidomastoid and trapezius muscles
Ask client to protrude tongue at midline and then move it side to side.
XII. Hypoglossal, Movement of tongue
which medication has many set limits on whether you can use it due to bleeding
t-PA (streptokinase)
antiplatelet medications: inhibit platelet adhesion and aggression
Aspirin, Clopidogrel (Plavix). Monitor for bleeding, bruise, petechiae, coffee ground emesis, tarry stool, frank blood
anticoagulant therapy
warfarin (Coumadin) - monitor PT/INR.
osmotic diuretic
Mannitol
hyperosmolar treatment to reduce cerebral edema
hypertonic solution for cerebral edema
