Strokes Flashcards
Ischemic strokes are caused by what?
interruption in blood flow caused by a blood clot or narrowing of the arteries
Ischemic Strokes are divided into what 3 categories?
Large-artery thrombotic stroke
Embolic Stroke
Small penetrating artery thrombotic stroke
What are Hemorrhagic Strokes?
A ruptured artery resulting is bleeding in or around the brain
Causes of Hemorrhagic Strokes
- aneurysm bursts
- uncontrolled HTN
- old age
What happens with Ischemic Cascade?
The brain cells switch to anaerobic metabolism, generating large amounts of lactic acid/glautamate causing a change in pH
What are Large-artery Thrombotic Strokes caused by?
Atherosclerotic plaques in the large blood vessels of the brain
Thrombus formation/occlusion can occur at the site of the atherosclerosis and result in what?
Ischemia and Infarction
What is the most common type of ischemic stroke?
Small Penetrating Artery Thrombotic Stroke
Small penetrating artery thrombotic strokes are typically caused by what?
- longstanding HTN
- hyperlipidemia
- diabetes
Cardiac Embolic strokes are associated w/ what?
- Arrhythmias like A-fib
- valvular heart disease
- left ventricular thrombus
What are Cryptogenic Strokes?
Strokes w/ no identifiable cause
Strokes from Other Causes
drugs (cocaine)
coagulopathies
migraine
spontaneous dissection
Risk Factors for Stroke (STROKES HAPPEN)
S-smoking T-thinners R-rhythms O-oral contraceptives K-kin/family E-excessive weight S-senior citizens H-HTN A-atherosclerosis P-physical inactivity P-previous TIA E-elevated glucose (diabetes) N-aNeurysm
What is a TIA?
“Mini Stroke”
a brief episode of neurologic dysfunction
TIA are results from what?
Focal cerebral ischemia, but NOT associated w/ permanent cerebral infarction
What are the 2 subtypes of Hemorrhagic Strokes?
Intracerebral and subarachnoid
How long does a nurse have to administer TPA to help break up the clot and resolve the stroke?
3 hours from the time the S/S start
S/S of Strokes (FAST)
F-face-drooping/asymmetric A-arms-numb or weak S-speech-slurred T-time to act -aphasia -dysarthria -apraxia -agraphia -alexia -agnosia -dysphagia -hemianopia
Aphasia
unable to speak or comprehend speech
-receptive and expressive
Receptive Aphasia
unable to comprehend speech
Werincke’s Area
Expressive Aphasia
comprehends speech but can’t respond back w/ speech
Broca’s Area
Intracerebral Hemorrhage are commonly results of what?
Trauma
Dysarthria
unable to speak clearly due to weak muscles
Apraxia
can’t perform voluntary movements
Agraphia
loss ability to write
Alexia
loss ability to read-cannot understand or see words
Subarachnoid Hemorrhage is commonly associated w/ what?
intracranial aneurysms
trauma
arteriovenous malformations
Agnosia
doesn’t understand sensations or recognize known objects/people
Dysphagia
issues swallowing
Hemianopia
limited vision
Primary ICH from spontaneous rupture of small arteries is commonly caused by what?
Uncontrolled HTN
How are Strokes diagnose?
CT scan
MRI
TPA (Altepase) is used only for what type of stroke?
Ischemic Strokes
How does TPA work?
dissolves the clot by activating the protein that causes fibrinolysis
Criteria for Receiving TPA (Altepase)
- CT scan negative for bleeding
- Labs w/ normal limits
- BP controlled < 185/110
- Hasn’t recently received Heparin or other anticoagulants
Nursing Interventions for TPA (Altepase)
- monitor for bleeding
- Neuro checks around the clock
- BP meds if needed for HTN
- vital signs/labs
- bedrest
- avoid sticks and IM injections
- ICU to be monitored
Patients w/ ruptured AVM will typically present w/ what?
sudden severe headache and sudden LOC
What is the most common motor dysfunction resulting from stroke?
Hemiparesis-weakness on one side of body
What is the most common visual impairment after stroke?
Hemianopia-visual field loss
Dysphagia can lead to what types of problems?
aspiration pneumonia
dehydration
poor nutrition
Optimal Medical Therapy for prevention of more strokes includes prescribing what Meds?
- anti-platelet
- a statin
- antihypertensive
- anticoagulant
Carotid Endarterectomy (CEA)
removal of atherosclerotic plaque or thrombus from the ICA to prevent recurrent stroke
What is an alternative to a CEA when surgery poses a high risk?
Carotid Angioplasty and stenting
When are CEA’s or Carotid Angioplasty’s recommended?
When the patient is hemodynamically stable and w/in 2 weeks following event
