Stroke/ Cerebral Vascular Accident (CVA) Flashcards
What is stroke?
● An abrupt interruption of the blood flow to the brain causes altered neurological metabolism (function).
● After 2 minutes metabolism has stopped
● After 5 minutes cell death has started to occur
● THIS IS A MEDICAL EMERGENCY
What are the types of stroke?
Ischemic: Caused by a blood clot blocking blood flow to the brain.
Hemorrhagic: From bleeding into the brain tissue itself
Ischemic Stroke
Thrombotic- Most common cause (Older Adults)
○Similar to myocardial infarction
○A clot develops in the vessel wall due to plaque buildup and damage to the vessel wall.
○Narrowing of the artery causes disruption of blood flow to that area of the brain.
○Partial or complete blockage
○Mostly associated with HTN and DM
oThe size of the infarction is determined by:
▪The location
▪Speed of onset
▪Presence of collateral circulation
●In the 1st 72 hours of the infarct can cause CEREBRAL EDEMA!
Embolic – Second most common type- (any age group)
o Occurs when an embolus (free floating clot, plaque, or other object) lodges in and occludes an artery.
o Occurs rapidly
o Most occur from the endocardium
▪ Blood clot from the heart caused by:
●Atrial fibrillation
●heart valve dysfunction
●patent foramen ovale
●atrial septal defects
●infective endocarditis
● rheumatic heart disease (young to middle-age)
Hemorrhagic Stroke
Bleeding occurs in the brain tissue itself
Intracerebral/Intraparenchymal hemorrhage: bleeding caused by a ruptured vessel
- Most occur in the Circle of Willis
- 40-80% mortality rate
- 1/2 will die in the 1st 48 hours
what causes it?
- hypertension: most common cause
- coagulation disorder
- anticoagulant or thrombolytic drugs
- trauma
- brain tumors
- ruptured aneurysms
- vascular malformations
Sudden onset of s/s
- neuro deficits: altered LOC
- severe headache
- N/V
- hypertension
Subarachnoid: bleeding into the space between the arachnoid and Pia mater membranes where CSF is stored.
“Known as the Silent Killer”
what causes it?
- most often from cerebral aneurysm (Circle of Willis)
- trauma
- cocaine use or other illicit drugs
- anticoagulant use
S/S
- WORST HEADACHE EVER!
- focal neurological deficits: one-sided weakness
- cranial nerve deficits: vision problems (one or both eyes)
- N/V
- stiff neck
- possible loss of LOC
Diet for Ischemic Stroke
○ Diet: Low-fat, low-cholesterol diet to reduce atherosclerosis risk.
○ Fluid Intake: Maintain hydration; dehydration can worsen ischemic stroke outcomes.
Diet for Hemorrhage Stroke
○ Diet: Focus on reducing blood pressure with a low-sodium diet and adequate hydration.
○ Fluid Intake: Carefully monitored to avoid increasing intracranial pressure (ICP).
what is Transient Ischemic Attack (TIA)
Temporary blockage in the brain
● usually lasting 1 hour or less
*A brief stroke-like attack that, despite resolving within minutes to hours, still requires immediate medical attention to distinguish from an actual stroke.
S/S of Transient Ischemic Attack (TIA)
Vision loss (often in one eye).
Transient hemiparesis (weakness on one side of the body).
Numbness or loss of sensation.
Sudden inability to speak (aphasia).
Medication for Transient Ischemic Attack
- Antiplatelets:
-Aspirin: Reduces blood clot formation.
-Clopidogrel (Plavix): Another antiplatelet drug, sometimes used in combination with aspirin for better prevention. - Anticoagulants (if the TIA is related to atrial fibrillation or other clotting disorders):
-Warfarin (Coumadin): Used to prevent clot formation.
-Direct oral anticoagulants (DOACs): Such as dabigatran (Pradaxa) or apixaban (Eliquis). - Statins:
-Atorvastatin (Lipitor) or Simvastatin (Zocor): To lower cholesterol and prevent plaque buildup in arteries. - Antihypertensives:
- ACE inhibitors (e.g., lisinopril) or beta-blockers (e.g., metoprolol) to control blood pressure. - Diuretics (e.g., hydrochlorothiazide) may also be prescribed to help lower blood pressure.
How to prevent Transient Ischemic Attack (TIA)?
Focus on managing risk factors like high blood pressure, heart disease, and high cholesterol through lifestyle changes and, if necessary, medication, and avoid smoking and excessive alcohol consumption
Education for Transient Ischemic Attack (TIA)?
BE FAST: can help you remember the most common signs of TIA and stroke:
B: alance off/dizziness.
E: yes: experiencing sudden blurred vision, double vision or sudden, persistent vision trouble.
F: ace drooping.
A: rm weakness.
S: peech difficulty.
T: ime to call 911.
Regular Monitoring:
- Regular check-ups to monitor blood pressure, cholesterol, and other stroke risk factors.
- Follow-up appointments to track recovery and modify treatment if necessary.
What to do if you suspect a TIA?
Call 911 immediately .
Do not wait to see if the symptoms pass.
Do not drive yourself to the hospital, but call 911 for emergency medical services.
Time is critical
Nursing Interventions for Ischemic Strokes
➔ Most Important History: Time of symptom onset is critical for treatment decisions.
➔ Airway, Breathing, Circulation (ABCs): Initial stabilization.
➔ Monitor neurological status: Check for changes in consciousness, pupil response, or motor function.
➔ Administer oxygen: Ensure adequate oxygenation to the brain.
➔ Elevate head of bed: To reduce intracranial pressure and promote venous drainage.
➔ Ensure safety: Protect patients from falls or aspiration due to weakness or altered sensorium.
➔ Encourage passive range of motion (ROM): If paralysis occurs.
Nursing Interventions for Hemorrhagic Strokes
➔ Monitor for signs of increased ICP: Watch for changes in LOC, altered respiratory pattern, and pupils.
➔ Maintain strict bed rest: To reduce stress on the cerebral vessels and limit bleeding.
➔ Control hypertension: Administer antihypertensive medications to prevent further bleeding.
➔ Seizure precautions: As brain irritation from hemorrhage can lead to seizures.
Education of Pt & Family
➔ Recognize Signs and Symptoms: Teach FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911).
◆ WILL MOST LIKELY BE ON EXAM!!!!!
➔ Medication Adherence: Ensure the patient understands the importance of taking prescribed medications consistently.
➔ Diet and Exercise: Encourage a healthy lifestyle to prevent stroke recurrence (e.g., low-fat, high-fiber diet, regular exercise).
➔ Rehabilitation: Educate the patient and family on the importance of rehabilitation (physical, speech, and occupational therapy).
What should be included in patient and family education after a stroke?
Risk factors: Educate on controlling blood pressure, cholesterol, diabetes, quitting smoking, and reducing alcohol intake.
Medication adherence: Emphasize the importance of taking prescribed medications like anticoagulants, antihypertensives, and statins.
Signs of a recurrent stroke: Teach the FAST acronym (Face drooping, Arm weakness, Speech difficulty, Time to call 911).
Physical therapy and rehabilitation: Discuss the need for ongoing therapy to improve mobility, speech, and function.
Lifestyle changes: Encourage a healthy diet, regular exercise, and weight management to prevent further strokes.
How can you distinguish between left and right side strokes?
Left-sided stroke (typically affecting the right side of the body):
Speech: May have aphasia (difficulty speaking or understanding language).
Right-sided paralysis or weakness.
Memory: May have difficulty with short-term memory.
Emotion: May appear more cautious or anxious.
Right-sided stroke (typically affecting the left side of the body):
Spatial and visual perception: May have trouble judging distance or recognizing objects.
Left-sided paralysis or weakness.
Emotional lability: May experience mood swings or be impulsive.
Unilateral neglect: May not recognize the left side of their body.
What are some therapeutic communication strategies when working with stroke patients?
Be patient: Allow extra time for the patient to process information and respond.
Use simple, clear language: Speak slowly and clearly, using simple words and short sentences.
Non-verbal communication: Use gestures, visual aids, and written instructions if speech is impaired.
Encourage participation: Include family members and encourage patients to make decisions when possible.
Avoid frustration: Remain calm and positive, even if communication is difficult. Use reassurance.
Active listening: Show that you are fully engaged and listening, acknowledging their feelings and experiences.
What are common medications used to manage stroke or reduce the risk of recurrence?
Ischemic Stroke:
● Antihypertensive Medications: Used if BP exceeds 220/120 mmHg (e.g., Labetalol, Nicardipine).
● Fibrinolytics (tPA): Administered within 3-4.5 hours of symptom onset to dissolve blood clots.
● Anticoagulants: For patients with atrial fibrillation (e.g., Warfarin, Xarelto, Eliquis).
● Statins: Cholesterol-lowering medications (e.g., Atorvastatin, Simvastatin).
● Aspirin: Used for secondary stroke prevention (e.g., after a TIA).
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Hemorrhagic Stroke:
● Antihypertensives: Medications to control blood pressure and prevent re-bleeding (e.g., Labetalol).
● Seizure Prophylaxis: Anticonvulsants may be required
● Anticoagulants (e.g., Warfarin, Heparin) and antiplatelets (e.g., aspirin) are contraindicated due to the increased risk of bleeding.
What is the NIH Stroke Scale (NIHSS), and how is it used?
The NIH Stroke Scale (NIHSS) is a tool used to assess the severity of a stroke. It evaluates the neurological status of a patient by scoring various areas of function, including:
Level of consciousness (alertness and responsiveness).
Motor function (movement, paralysis, coordination).
Sensory function (touch, pressure, vision).
Speech and language (ability to speak and understand).
Cranial nerve function (vision, facial movement).
Ataxia (balance and coordination).
Scoring: The NIHSS score helps determine the severity of the stroke, guiding treatment and prognosis.
Mild stroke: Score 0-5.
Moderate stroke: Score 6-15.
Severe stroke: Score 16-42.
What are the signs that a stroke patient should be taught to recognize and act on?
FAST acronym:
F: Face drooping – Ask the person to smile. Does one side of the face droop?
A: Arm weakness – Ask the person to raise both arms. Does one arm drift downward?
S: Speech difficulty – Ask the person to repeat a simple sentence. Is their speech slurred or hard to understand?
T: Time to call 911 – If any of these symptoms are present, call for medical help immediately.
Why is it important to identify a stroke within the first few hours?
Early intervention is crucial for limiting brain damage and improving recovery outcomes.
Thrombolytics (rtPA) can be administered within the first 3-4.5 hours to dissolve the clot and restore blood flow.
The faster the intervention, the better the chances for a full or partial recovery, as brain cells begin to die quickly without proper blood supply.
