Stroke Flashcards
Ischemic stroke -3
- disruption of blood supply to part of the brain
- obstruction of cerebral blood flow
- causes ischemia to brain tissue
What is the penumbra region?
Ischemic brain tissue that can still be salvaged
Stroke Symptoms
-HA
-mental changes
-aphasia
-Respiratory problems
-decrease cough and swallow reflex
-Agnosia
-Incontinence
-seizures
-Hemiparesis or hemiplegia
-emotional lability
-visual changes
-Horners syndrome
-vomiting
-perceptual defects
-HTN
-Apraxia
-
Hemiparesis
Weakness on one side of the body
Hemipalegia
Paralysis on one side of the body
Where does motor loss happen in a CVA pt?
On opposite sides body of brain injury
Agnosia
difficulty interpreting sensory stimuli
Ataxia
Impaired balance or coordination
Dysarthria
Difficulty forming words
Dysphagia
Difficulty swallowing
Expressive aphasia
Unable to form words that are understandable
Receptive aphasia
Inability to understand language
Transient Ischemic Attack —> what is it? How long does it last? What is it a warning of? Does it show up on scans?
- temporary neurological deficit resulting from a temporary impairment of blood flow
- temporary neurological symptoms lasting 1-2 hours
- warning sign of impending stroke
- no evidence of ischemia on brain images
What is the biggest question to ask when someone comes in with signs of stroke?
When was the last time they were seen normal?
Why do we want the BP to be slightly elevated in a stroke patient?
To maintain adequate perfusion (want it to be around 140/90)
Initial ex tool for CVA
Non-contrast CT (determines if stroke is ischemic or hemorrhagic, determines where the blockage is)
Other dx tests for stroke
- MRI angiogram
- Transesophageal echocardiogram
- carotid ultrasound
Anticoags used for stroke
Warfarin, apixiban, rivaroxaban
What is the target INR for warfarin
2-3
What to check for when pt is on anticoags
BLEEDING (nose bleeds, blood in urine)
ex of statin
Simvastatin
WHen should statins be given?
At night
When should t-PA be given?
Within 3 (up to 4.5 hours)
what to monitor for when giving t-PA
Bleeding
Delay for what when pt is on t-PA
24 hour delay in placement of NG tubes, catheters and intra-arterial pressure catheters
What is the goal for t-PA?
Effective revascularization
In regard to t-PA why can’t it be given after 4.5 hours?
The risks of bleeding outweigh the benefits of therapy…at this point the distal clot probably wont recover
T-PA contraindications (3)
- onset greater than 3 (4.5) hours
- pt with INR > 1.7
- pt with recent intracranial pathogen in the last three months
ischemic stroke nursing interventions (8)
- ROM exercises
- frequent repositioning
- assist with ambulatory
- promote self care
- monitor for dysphagia
- establish bowel/bladder control
- assist with improving communication
- promote effective coping strategies
Stroke prevention (5)-healthy lifestyle
- low fat diet
- exercise
- no smoking
- maintain healthy weight
- moderate alcohol consumption
High risk groups for stroke (3)
Men
Age > 55
African American
Stroke prevention —> manage chronic health conditions (3)
- HTN
- Afib
- Carotid stenosis
Potential stroke complications - 6
- increased ICP
- decreased cerebral blood flow
- PNA
- UTI
- seizures
- pressure ulcers
Can t-PA be used for a hemorrhagic stroke?
NO
Causes of hemorrhagic stroke (9)
- HTN (most common)
- DM
- atherosclerosis
- brain tumor
- illicit drug use
- anticoags therapy
- cerebral aneurysm
- head trauma
- Arteriovenous malformation
Clinical manifestations of hemorrhagic stroke (7)
- severe headache (most commonly reported symptom)
- N/V
- sudden change in LOC
- seizures
- loss of consciousness
- pain/rigidity of back of neck
Dx of hemorrhagic stroke (4)
- CT or MRI
- CT angiogram
- Lumbar puncture (if ct is negative)
- tox screen
Medical management of hemorrhagic stroke (8)
- prevent risk of additional bleeding
- reverse anticoag if bleeding was caused by warfarin (vitamin K)
- allow brain to rest and recover
- intermittent pneumatic compression stockings
- anticonvulsants if seizures present
- control BP to avoid HTN
- surgical management
Hemorrhagic stroke nursing interventions (10)
- monitor neuro status, patient at risk for rebleeding
- provide a quiet, non-stimulating environment
- minimize patients anxiety
- seizure precautions
- monitor for HA
- assess s/s vasospasm
- assess drowsiness, stupor, changes in behavior (hydrocephalus)
- monitor for hyponatremia
- promote self care
- promote coping
Potential complications of hemorrhagic stroke
- additional bleeding
- cerebral hypoxia
- vasospams
- increased ICP
- hydrocephalus
- seizure
How to prevent cerebral hypoxia (3)
- administer supplemental O2
- maintain adequate hydration
- keep BP slightly elevated
Prevention of increased ICP (4)
- mannitol may be given
- fluid balance monitored
- elevate HOB to 30 degrees
- avoid hypo/hyperglycemia
