Stroke Flashcards
Risk factors for stroke
HTN, Cardiovascular disease, A fib, DM, hyperlipidemia
Smoking, heavy ETOH use, obesity, oral contraceptive use
Brief episode of neurological dysfunction caused by temporary disturbance of blood supply to an area of the brain
Transient ischemic attack (TIA)
Will have stroke-like symptoms but then resolves as the ischemia resolves
These patients are at HIGH risk for ischemic stroke (highest risk in the first 3 months after TIA)
Accounts for 75% of all strokes
ischemic strokes
Two types of ischemic strokes
embolic: clot originating from somewhere else in the body (abrupt onset bc clot suddenly obstructs blood flow)
thrombotic: clot within the vessel caused by plaque build up over time (slower onset because clot grows over time)
Pathophysiology of hemorrhagic strokes
caused by a ruptured aneurysm or vascular malformation (no capillary beds, just arteries to veins which makes the vessels weak and easy to rupture)
Uncontrolled bleeding in the skull
Primary neuronal injury vs penumbra
primary neuronal injury: center of the stroke
penumbra: area around the stroke where there is hypoperfusion and edema (can give mannitol to reduce swelling; important to protect this area so the stroke doesn’t get larger than it already is)
What is the FIRST thing you do when someone arrives at the hospital with stroke-like symptoms
get vital signs and a CT scan to see what kind of stroke they are having (hemorrhagic strokes will show up white on CT)
What is the timeframe for someone to be eligible for thrombolytic therapy (tPA)
ischemic stroke within 3 hours of the onset of symptoms
Common causes of embolic strokes
atherosclerosis, A fib, mechanical prosthetic valve, endocarditis (think clots)
Medical management of strokes
early identification, optimize oxygenation (maintain airway), manage BP (make sure it doesn’t get to low bc you need to perfuse the brain), minimize reoccurrence with anticoagulants
Primary cause of hemorrhagic strokes
HTN
Deficits following a stroke
depends on the type and location of the stroke
hemiparesis/hemiparalysis
Aphasia (problems with speech and comprehension; usually with left sided)
Dysphagia (problems swallowing & risk for aspiration)
Apraxia (can’t carry out a skilled act such as dressing oneself)
Agnosia (can’t recognize familiar objects)
Types of aphasia
Expressive aphasia (Broca’s): damage to the left frontal lobe; causes problems with making words and getting them out
Receptive aphasia (Wernicke’s): damage to the left temporal lobe; causes problems with language comprehension
These both occur more frequently with left sided strokes
Nursing management of strokes
treat ineffective tissue perfusion: monitor ICP, BP, neuro checks, elevate HOB to reduce cerebral edema, O2
risk for aspiration: don’t give them anything until speech therapist sees them
impaired physical mobility: encourage bed exercises
