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nurse 251 > Stroke > Flashcards

Stroke Flashcards

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1
Q

what is a stroke?

A
  • occurs when there is ischemia (inadequate blood flow) to part of the brain or hemorrhage into the brain that results in the death of brain cells
  • “brain attack”
  • time sensitive medical emergency
  • longer =more damage
  • 50,000 ppl in Canada have a stroke annually
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2
Q

what happens to the part of the brain that is affected by the stroke?

A
  • functions such as movement, sensations, or emotions that were controlled by the affected area the brain are lost or impaired
  • most ppl have mental or physical impairments after a stroke
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3
Q

what two major arteries supply the brain with blood?

A
  • internal carotid arteries (2) -anterior circulation

- posterior vertebral arteries -posterior circulation

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4
Q

what is the worst type of stroke? (location)

A

basilar artery stokes are the worst because the circle of willis is cut off right at the beginning- so no blood flow is going to the brain whatsoever

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5
Q

what is connected at the circle of willis?

A

-the anterior and posterior cerebral circulation is connected at the circle of willis by the anterior and posterior communicating arteries

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6
Q

diagram of the blood flow to brain

A

look at notes bitsh if u wanna pass and move on with ur life
do it u piece of shit

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7
Q

why does the brain need a continuous supply of blood?

A

because it needs oxygen and glucose that neurons need to function
-brain has no where to store these things

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8
Q

if blood flow Is totally interrupted (cardiac arrest), how long does it take for neurological metabolism to be altered? metabolism? cellular death?

A

neurological metabolism:30 seconds

  • metabolism stops in 2 min
  • cellular death occurs in 5
  • brain death can occur very quickly

-because the connection between arteries at the circle of willis, an area of brain can potentially receive blood supply from another blood vessel if its original blood supply is cut off (due to thrombus)

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9
Q

what is atherosclerosis?

A
  • thickening and hardening of arteries
  • major cause of ischemic stoke
  • can lead to thrombus formation and contribute to emobli
  • cerebral infraction occurs when a cerebral artery becomes blocked and blood supply to the brain beyond the blockage is occluded
  • Wherever a clot is, the area distal to is does not have blood supply
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10
Q

where do MCA strokes come from?

A

the carotid artery

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11
Q

what are some NON modifiable risk factors for stroke?

A
  • Age
  • gender (more men than women)
  • ethnicity
  • family history
  • Prior TIA increases risk of stroke by 50%
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12
Q

what are some modifiable risk factors for risk of stroke?

A
  • Hypertension (single most important modifiable risk)
  • Atrial fibrillation (left ventricle quivers and shakes causing stasis which can lead to clot)
  • alcohol- thins blood, weakens vessels
  • Physical inactivity- results in higher levels of inflammation, contributing to atherosclerotic development
  • oral contraceptives (being greater than age 35 + smoking really increases risk)
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13
Q

what is an ischemic stroke?

A

-results from inadequate blood flow to the brain from partial or complete occlusion of an artery
-accounts for approx 80% of strokes
-

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14
Q

what are the two divisions of an ischemic stroke?

A

Thrombotic or embolic

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15
Q

what is a transient ischemic attack?

A
  • A TIA is a transient episode of ischemia without acute infraction of the brain
  • symptoms last less than 1 hour
  • are a warning sign of cerebrovascular disease
  • ppl tend to downplay things when the resolve on thier own
  • TIA is usually a precursor for ischemic stroke
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16
Q

symptoms of a TIA?

A
  • temporary loss of vision in one eye
  • transient hemiparesis (paralysis of brain)
  • inability to speak
  • numbness or loss of sensation and vertigo
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17
Q

objective indications of TIA?

A
  • CT or MRI
  • ultrasounds on internal carotid
  • bruit on auscultation if its on the carotid
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18
Q

what is a thrombotic stroke

A
  • subtype of ischemic stroke
  • occurs from injury to blood vessel wall and formation of a blood clot
  • the lumen of the blood vessel becomes narrowed, and if it becomes occluded, infraction occurs
  • symptoms may progress in the first 72 hrs as infraction and cerebral edema increase
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19
Q

what is the main difference between TIA and stroke?

A
  • TIA occurs without infraction

- Stroke: infraction and cell death occurs

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20
Q

what is an embolic stroke?

A
  • subtype of ischemic stroke
  • occurs when an embolus lodges in and occludes a cerebral artery = infraction and edema of the area supplied by the blood vessel
  • majority of emboli are from plaque breaking off from the endocardium
  • (left atrium is the most common area it comes from)
  • rapid onset of symptoms
  • recurrence of embolic stroke is common unless underlying cause is aggressively treated (need to fix problem with heart of else it will just keep occurring)
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21
Q

what are some heart conditions that are associated with embolic stroke?

A
  • valvular heart disease
  • MI
  • Endocarditis
  • atrial fibrillation
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22
Q

what is a hemorrhagic stroke?

A
  • accounts for 15% of all strokes
  • A hemorrhagic stroke is either a brain aneurysm burst or a weakened blood vessel leak. (intracerebral or intraparenchymal)
  • Blood spills into or around the brain and creates swelling and pressure, damaging cells and tissue in the brain
  • There are two types of hemorrhagic stroke called intracerebal and subarachnoid
23
Q

what is an intracerebral hemorrhage?

A
  • subtype of hemorrhagic stroke
  • Rupture of blood vessel in brain that causes bleeding inside of brain
  • accounts for 10% of stroke
  • hypertension is most important cause
  • other causes include vascular malformation, coagulation disorders, trauma, ruptured aneurysms
24
Q

symptoms of intracerebral hemorrhage?

A

-sudden onset of symptoms: severe headache, nausea, vomiting, decreased LOC and hypertension

25
Q

what is a subarachnoid hemorrhage?

A
  • subtype of hemorrhagic stroke
  • occurs when there is intracranial bleeding into the CSF (filled space between the arachnoid and pia mater membrane on teh surface of the brain)
  • commonly caused by rupture of cerebral aneurysm
  • sudden onset of headache “WORST headache”
  • complications: rebleeding or cerebral vasospasm: narrowing of the large blood vessels at the base of the brain, which can result in cerebral infraction
26
Q

what are clinical manifestations of a stroke?

A
  • motor deficits are the most obvious effect
  • motor deficits include impairment of:
  • mobility: right or left side weakness, cant walk
  • Resp function: labored breathing, periods of apnea
  • swallowing and speech: pts are often left unable to speech, can cough on own tongue, dysphagia
  • gag reflex: no gag reflux
  • self care abilities: problems with ADL’s
27
Q

what is a possible outcome of arms are legs on the affected side?

A

may be weakened or paralyzed to different degrees depending on which part of and what extent of cerebral circulation was compromised

28
Q

what might change about the persons affect after having a stroke?

A
  • may have difficulty controlling thier emotions

- depression and feelings associated with changes in body image and loss of function can make this worse

29
Q

what might be different in intellectual function after having a stroke?

A
  • both memory and judgement may be imparied as result of stroke
  • a left-brain stroke is more likely to result in memory problems related to language
  • a right brained stroke tends to be impulsive and to move quickly- risk for falling out of bed
30
Q

what might be different in communication after having a stroke

A

-left hemisphere is dominant for language
-pt may experiance aphasia (total loss of comprehension and use of language or total inability to communicate)
Dysphasia refers to imparied ability to communicate
-many pts also experiance dysarthria, a disturbance in the muscular control of speech-impairment may involve pronunciation, articulation, and phonation
Brocha’s aphasia: hard for them to get out words
Wernickes aphasia: words come out but dont make sense

31
Q

What are the diagnostic tools for stroke?

A
  • Single most important neuroimaging tool for stroke pt is brain imaging- either MRI or CT scan
  • CT should be obtained within 25 min and read within 45 min of arrival at the emergency department
  • CT differentiate between ischemia and hemorrhagic stroke
32
Q

what is included in primary prevention for decreasing morbidity and mortality of stroke?

A
  • BP control
  • Blood glucose control
  • Diet and exercise
  • smoking cessation
  • limiting alcohol consumption
  • routine health assessment
33
Q

drug therapy for stroke?

A
  • antiplatelets are usually the chosen tx to prevent stroke in pts who have had a TIA
  • aspirin 81-325mg /day
  • other drugs include clopidogrel (Plavix) -stops platelets from sticking together
34
Q

surgical therapy for stroke?

A

-transluminal angioplasty is the insertion of a balloon to open a stenosed artery to improve blood flow

35
Q

number 1 priorities for acute care of stroke?

A
  • preserving life, preventing further brain damage
  • ABC’s, ensure airway
  • most important point if pts history is time of onset
36
Q

what is the standard of care for stroke?

A

-receive thrombolytic therapy within 4.5 hours from time of onset of symptoms

37
Q

is increased bp a good for bad thing when a stroke occurs?

A
  • its a good thing- mean good perfusion to brain, it is common immediately after a stroke and may be protective response to maintain cerebral perfusion
  • immediately following ischemic stroke, use of drugs to lower BP is recommended if BP is markedly increased (systolic over 220mmhg)
  • 20 hours after stroke, start getting better control on BP
38
Q

what drug therapy is used for ischemic stroke?

A
  • recombinant tissue plasminogen activator (tPA) breaks down clots- its administered through IV to re-establish blood flow through a blocked artery and prevent cell death
  • dissolves blood clot
39
Q

what is the only tx indicated for acute ischemic stroke?

A

tPA

40
Q

what strict time frame must the pt be at the hosptial from the time the stroke occurred to receive tPA?

A

less than 60 minutes

-tPA is VERY expensive

41
Q

what will happen is tPA is given to a hemorrhagic stroke?

A

it will kill the patient

42
Q

what are some contraindications of tPA?

A
  • GI bleeding
  • stroke or head trauma in past 3 months
  • major surgery within past 14 years
43
Q

what drugs are contraindicated in pts with hemorrhagic stroke? (will harm pt)

A

-anticoagulants and platelet inhibitors

44
Q

what is the main drug therapy for pts with hemorrhagic stroke?

A

-managment of hypertension (systolic less than 160)

45
Q

surgical interventions for hemorrhagic stroke?

A
  • surgical interventions include immediate evacuation of aneurysm induced hematomas
  • tx of an aneurysm involves clipping or coiling the aneurysm to prevent re-bleeding
  • Nimodipine is given to SAH pts to decrease the effects of vasospasm and minimize cerebral damage
46
Q

what happens after acute stroke pt has been stabilized for 12-24 hours?

A

collaborative care shifts from preservation of life -> lessening disability and attainting optimal function

47
Q

what is primary assessment focused on?

A

focused on cardiac and respiratory statis and neurological assessment

48
Q

what is secondary assessment focused on?

A
  • should include a comprehensive neurological exam:
  • LOC
  • Motor abilities
  • Cranial nerve function
  • sensation
  • proprioception
  • cerebellar function (finger to nose test)
  • deep tendon reflexes
49
Q

what respiratory needs should be evaluated or watched for?

A
  • risk for aspiration pneumonia my be high because of impaired consciousness or dysphagia
  • problems with chewing and swallowing, food pocketing and tongue falling back
  • all pts should be screened for thier ability to swallow and kept NPO until dysphagia has been ruled out
50
Q

neurological monitoring after stroke?

A
  • monitor closely to detect changes suggesting extension of stoke, increased ICP, vasospasm or recovery from stroke symptoms
  • Glasgow Coma Scale (GCS0 measures LOC, mental status, pupillary responses, and extremity movement and strength
  • a decreasing LOC may indicate ICP
51
Q

What to keep in mind about communication with a stroke pt?

A
  • an alert pt is usually anxious bc of lack of understanding about what has happened and because communication is difficult
  • speak slowly and calmly to pt
52
Q

what to keep in mind about coping (for pt after stroke)

A
  • a stroke is usually a sudden, extremely stressful event for the pt, family member, and significant others
  • a stroke is often a family disease, affecting family emotionally, socially, and financially as well as changing roles and responsibly within the family
  • a social service referral is often helpful
53
Q

what changes about a pts affected after stroke?

A
  • pts who have had stroke exhibit emotional responses that are not appropriate for the situation
  • pts may appear, apathetic, depressed, fearful, anxious, weepy, frustrated, and angry
  • some pts exhibit exaggerated mood swings, especially those with a stroke of left side of brain
  • pt has difficulty controlling emotions and may suddenly burst into tears or laughter.

nurse 251 (14 decks)

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