Stroke Module Flashcards
Major risk factors of stroke (modifiable)
Hypertension (most important; control the HTN to prevent stroke) Metabolic syndromes (diabetes) Heart disease (atherosclerosis)(CAD) Heavy ETOH consumption Poor diet Drug abuse Sleep apnea Obesity Physical inactivity Smoking
What is the most significant modifiable risk factor for stroke?
Hypertension
Ischemic stroke
Ischemic strokes result from Inadequate blood flow to the brain from partial or complete occlusion of an artery 80% of all strokes are ischemic strokes Ischemic strokes can be A. Thrombotic (arthrosclerosis) B. Embolic (traveling blood clot)
Hemorrhagic stroke
Account for approximately 15% of all strokes
Result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles
Intracerebral hemorrhage
Bleeding within the brain caused by rupture of a vessel
HYPERTENSION is the most important cause
Hemorrhage commonly occurs during periods of physical activity (sex, exercise)
Non modifiable risk factors for stroke
Age,
Gender,
Race,
Genetics/family history
What is a TIA?
Transient Ischemic Attack (TIA) is a temporary focal loss of neurologic function caused by ischemia.
Most TIAs resolve within 3 hours; beyond 3 hours is a stroke
TIAs may be due to microemboli that temporarily block the blood flow
TIAs are a warning sign of progressive cerebrovascular disease
Thrombotic stroke (Ischemic)
Thrombotic stroke
Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot
Result of thrombosis or narrowing of the blood vessel
Most common cause of stroke
Two-thirds are associated with hypertension and diabetes mellitus
Often preceded by a TIA
Embolic stoke (Ischemic)
Embolic stroke
Occurs when an embolus lodges in and occludes a cerebral artery
Results in infarction and edema of the area supplied by the involved vessel
Second most common cause of stroke
Majority of emboli originate in the inside layer of the heart, with plaque breaking off from the endocardium and entering the circulation
Patient with an embolic stroke commonly has a rapid occurrence of severe clinical symptoms
MANIFESTATIONS: Intercerabral hemorrhage d/t hemorrhagic stroke
Often a sudden onset of symptoms, with progression over minutes to hours because of ongoing bleeding MANIFESTATIONS Neurologic deficits Headache Nausea and/or vomiting Decreased levels of consciousness Hypertension
Subarachnoid hemorrhage
Intracranial bleeding into cerebrospinal fluid–filled space between the arachnoid and pia mater
Commonly caused by rupture of a cerebral aneurysm
An aneurysm may be saccular or berry
Majority of aneurysms are in the circle
of Willis
“Worst headache of one’s life”
Most frequent surgical procedure to prevent rebleeding is clipping of the aneurysm
Coiling is another procedure
Stroke Features: Thrombotic
ONSET: Gradual, in minutes to hours
LOC: Preserved
Neuro: Deficits Headache, speech, visual, confusion
Duration: Improvements over weeks to months
Stroke Features: Embolic
ONSET: Sudden
LOC: Preserved
Neuro Deficits: Paralysis, aphasia
Duration: Rapid but may be persistent if embolism is not absorbed
Stroke Features: Hemorrhagic
ONSET: Usually sudden
LOC: Stuporous, coma
Neuro Deficits: Focal deficits
Duration: Variable, permanent deficits possible
Clinical manifestations of stroke: Cognitive changes
Cognitive changes
- increased ICP, confusion
- right sided = vision/spatial, personality changes
- left sided = aphasia, decreased analytical skills
Clinical manifestations of stroke: Motor changes
Motor changes - hemiplegia, hemiparesis - hypotonia, flaccidity - incontinence - seizures, unequal pupils, facial drooping
Clinical manifestations of stroke: Sensory changes
Sensory changes
- apraxia (lack of purposeful movement)
- neglect syndrome (RCVA, client unaware of L paralysis)
- dysphagia, poor mastication
Lab & Diagnostic studies for stoke
Elevated WBC Elevated Hgb, Hct PT/INR (baseline) CSF CT
More Lab & Diagnostic studies for stroke
MRI Angiography Brain scan Doppler studies Cardiac monitoring
Nursing Care: Goals during the acute phase
Goals for collaborative care during the acute phase are
Preserving life (ABC)
Preventing further brain damage from occuring - what kind of stoke? Give TPA if under 3 hours
Reducing disability-getting the patient in terms of rehab once stabilized.
Nursing Care of the Client With TIA and CVA
Initiate aspiration precautions are key
NPO, until swallow evaluations are done
Initiate fall precautions d/t unilateral weakness
Sequential compression devices (depending on cause of stroke) (Not if stroke was DVT)
Vital signs Q 1-2 hours
Neuro checks Q 1-2 hours (GCS)
Thrombolytic meds
- Recombinant tissue plasminogen activator (rt-PA), for those who meet criteria, within FIRST 3 HOURS)
Nursing Care of the Client With TIA and CVA (cont.)
Lipid lowering agents (preventative measures)
Intracranial pressure monitoring (ICP)
- special transducer calibration
- monitors cerebral perfusion pressure, waveforms
-Monitor for signs & symptoms of infection (i.e. ICP device insertion site)
-Elevate HOB no greater than 30 degrees
-Avoid clustering nursing interventions
-Decreased sensory stimuli i.e. noise and lighting
-Bedrest
-IV fluids as ordered
-Approximately 5% to 7% of patients who experience a stroke will have seizures, usually within 24 hours
Phenytoin is given if seizures occur
Nursing Care: Respiratory system
Respiratory system
Management of the respiratory system is a nursing priority
Risk for atelectasis d/t weakness
get the on the IS
Risk for aspiration pneumonia - post proper signs
Risks for airway obstruction - they may pocket food, so make sure to check the inside of their cheeks.
May require endotracheal intubation and mechanical ventilation
Nursing Care: Neurologic system
Neurologic system Monitor closely to detect changes suggesting extension of the stroke ↑ ICP Vasospasm Recovery from stroke symptoms
Nursing Care: Cardiovascular
Cardiovascular system - Key assessment area after a pt suffers from a stoke.
Goals aimed at maintaining homeostasis
Many patients with stroke have decreased cardiac reserves from the secondary diagnoses of cardiac disease
NURSING INTERVENTIONS:
Monitoring vital signs frequently
Monitoring cardiac rhythms (a-fib?)
Calculating intake and output, noting imbalances
Regulating IV infusions
Adjusting fluid intake to the individual needs of the patient
Monitoring lung sounds for crackles and rhonchi (pulmonary congestion)
Monitoring heart sounds for murmurs or for S3 or S4 heart sounds
After stroke, patient is at risk for deep vein thrombosis
Related to immobility, loss of venous tone, and ↓ muscle pumping in leg
Most effective prevention is keeping the patient moving
