Stroke (Final Exam)

Question 1

What are non-modifiable risk factors for stroke? (3)

Answer 1

1) age: doubles each decade after 55
2) gender: more common in men
3) ethnicity: higher incidence in African Americans

Question 2

What are 9 modifiable risk factors for stroke?

Answer 2

1) HYPERTENSION
2) heart disease
3) serum cholesterol
4) smoking
5) obesity/no exercise
6) sleep apnea
7) metabolic syndrome
8) poor diet
9) drug/alcohol abuse

Question 3

What 2 arteries supply blood to the brain?

Answer 3

1) internal carotid artery

2) vertebral arteries

Question 4

what is the Circle of Willis?

Answer 4

the internal carotid artery and vertebral arteries branch out and connect together forming the Circle of Willis

Question 5

Regulation of cerebral blood flow: cell death occurs in _______ if blood flow is stopped and is not supplied with oxygen

Answer 5

5 mins

Question 6

Increased CO2 = Increased ___

Decreased O2 = Increased ___

Answer 6

Increased CO2 = Increased CBF

Decreased O2 = Increased CBF

Question 7

What factors effect CBF? (3)

Answer 7

• systemic BP
• cardiac output
• blood viscosity

Question 8

What is a transient ischemic attack (TIA)?

Answer 8

transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia but without an acute infarction of the brain, attacks last 5 mins

Question 9

A history of TIA leads to an?

Answer 9

increased risk for stroke

Question 10

Symptoms of TIA (6) usually last ______

Answer 10

Symptoms typically last less than 1 hour: tinnitus, vertigo, blurred vision, ataxia, dysphagia, bilateral numbness/weakness

Question 11

Prevention of stroke for TIA?

Answer 11

oral low-dose aspirin therapy (inhibits platelet aggregation to prevent a stroke after a TIA)

Question 12

Describe the functions of the right side of the brain (6)

Answer 12

1) creativity, music, art
2) maintains attention span/emotions
3) ability to solve everyday problems
4) reasoning (understanding jokes)
5) makes judgement calls
6) memory recalls

Question 13

Describe the functions of the left side of the brain? (3)

Answer 13

(Left = Logical)

1) thinking
2) speaking
3) writing

Question 14

Clinical manifestations of a stroke on the right side of the brain (s/s manifested on the LEFT side) (7)

Answer 14

1) left sided weakness (hemiplegia)
2) confused on date, time, place
3) left side neglect
4) short attention span
5) spatial-perceptual orientation (parietal lobe)
6) agnosia (visual recognition)
7) apraxia

Question 15

Clinical manifestations on the left side of brain (s/s manifested on the RIGHT side of the body) (5)

Answer 15

1) aphasia (trouble forming words)
2) agraphia (issues with writing)
3) experiences depression, anger, frustration
4) slow performance
5) impaired comprehension related to language and math

Question 16

What are two types of strokes?

Answer 16

1) ischemic

2) hemorrhagic

Question 17

ischemic strokes result from?

Answer 17

inadequate blood flow to the brain and occlusion of an artery

Question 18

2 types of ischemic strokes?

Answer 18

• thrombotic

- embolic

Question 19

Describe thrombotic ischemic stroke (3)

Answer 19

• most common cause of stroke
• process of clot formation (thrombosis) = narrowing of the lumen, blocking the passage of blood through the artery
• associated with hypertension, diabetes, precedes TIA

Question 20

Describe embolic ischemic stroke (4)

Answer 20

• embolus: blood clot or other debris circulating in the blood either from a HEART VALVE OR ATRIAL FIBRILLATION
• lodges a narrow artery in the brain and blocks the cerebral artery
• results in INFARCTION and EDEMA of the area supplied by the vessel
• manifestations are less common, patient remains conscious

Question 21

2 types of hemorrhagic stroke?

Answer 21

1) intracerebral

2) subarachnoid

Question 22

Describe hemorrhagic strokes

Answer 22

burst blood vessel may allow blood to seep into it and damage brain tissues until clotting shuts off the leak

Question 23

Causes of hemorrhagic stroke (3)

Answer 23

1) brain aneurysm
2) uncontrolled hypertension
3) old age (vessels are not resilient)

Question 24

Describe intracerebral hemorrhagic stroke (5), clinical manifestations (5)

Answer 24

1) bleeding within the brain caused by a RUPTURE of a vessel
2) most common cause: HYPERTENSION
3) occurs during activity
4) sudden onset of progression over minutes to hours
5) clinical manifestations: headache, nausea/vomiting, decreased LOC, hypertension

Question 25

Describe subarachnoid hemorrhagic stroke (2)

Answer 25

1) intracranial bleeding into the CBF

2) commonly caused by rupture of a cerebral aneurysm, trauma, or drug abuse

Question 26

Diagnostic studies performed for patients with stroke

Answer 26

MRI or noncontrast CT scan (indicates the size and location of the lesion, differentiates between ischemic and hemorrhagic stroke)

Question 27

Goal of care for ischemic stroke?

Answer 27

prevent further brain damage, reduce disability

Question 28

What is the most important to assess for in a patient’s history who suffered from an ischemic stroke?

Answer 28

time of onset

Question 29

Treatment for ischemic stroke?

Answer 29

recombinant tissue plasminogen activator (tPA) must be given via IV within 3-4.5 hours of the onset of the s/s of ischemic stroke

Question 30

Purpose of tPA

Answer 30

reestablishes blood flow through the blocked artery to prevent cell death

Question 31

Goal of care for hemorrhagic stroke

Answer 31

manage ABC and intracranial pressure

Question 32

Surgical interventions for hemorrhagic stroke? (3)

Answer 32

1) resection
2) clipping/coiling of aneurysm
3) evacuation of hematomas

Question 33

What medications are contraindicated for hemorrhagic stroke?

Answer 33

anticoagulants and antiplatelet inhibitors

Question 34

What is the goal of stroke prevention?

Answer 34

Management of modifiable risk factors to prevent stroke (eg: healthy diet, weight control, regular exercise, CONTROL HYPERTENSION, limit alcohol, routine health assessments)

Question 35

Surgical therapy for patients with TIAs from carotid disease include? (3)

Answer 35

1) carotid endarterectomy
2) transluminal angioplasty
3) stenting

Question 36

Describe acute nursing management for a patient with a stroke? (7)

Answer 36

• respiratory: avoid atelectasis, airway obstruction, aspiration pneumonia
• cardiovascular: cardiac assessment, infusions, fluid balance, PREVENT VTE
• integ: turn pt q2h
• GU: constipation (stool softeners, fiber intake)
• GI: poor bladder control, incontinence (AVOID INDWELLING CATHETERS)
• assess swallowing ability in the first 24 hours
• HOMONYMOUS HEMIANOPSIA: blindness in the same half of each visual field, check for persistent disregard of objects in part of the visual field