Test 3: Stroke

Question 1

Ischemic Stroke: Patho, Types

Answer 1

Patho:

-thrombotic or embolitic
- lack of perfusion - decrease BF and Q
- Low O2

Thrombotic - stationary and slow onset

Embolic - sudden, appears like TIA

Question 2

Hemorrhagic Stroke: Patho, Cause, S/Sx, Complications

Answer 2

1 HTN (>140)

Patho:

Bleeding –> Increased Pressure –> Edema –> Ischemia

Cause:

#2 Trauma
#3 AV malformation
#4 Annyeurism

Dx:

CT will show midline shift

S/Sx:

• “Worst headache of life”
• HTN

Complications:
- Increased ICP/edema push on brain stem –> VS decrease

Question 3

Stroke Signs

Answer 3

“FAST”

Face drooping
Arm weakness
Speech difficulty
Time to call 911

Pupil change

Question 4

Right Brain Stoke

Answer 4

R = reckless, really creative
Affects LEFT side

• Behavioral Change
• Lack of impulse control
• Left-sided weakness/hemiparesis (new/sudden arm drift)
• Left-side neglect/one-side neglect
• Visual/spatial deficit
• Left homonymous hemianopsia

Question 5

Left Brain Stroke

Answer 5

L = language
Affects right side

• Issues w/ language (dysphasia & aphasia)
• Right-Sided weakness (hemiparesis, new, sudden, arm drift)
• Reading/writing problems

Question 6

Ischemic Stroke Interventions

Answer 6

1 ABC - give O2

#2 CT w/ in 2- minutes to assess TYPE of stroke. Ischemic will have normalish CT and require MRI
#3 Medications -

Fibrinolytic/Clot-blusting (-ase) medication w/ in 45-minutes (or 4.5 hours of symptom onset) - alteplase or streptokinase - NO longer beneficial after 3-4.5 hours and will require endovascular therapy

Anticoag b/c we removed all clotting factors and body will try to compensate with new ones - heparin, warfrin, antiplatlet, ASA/plavix

Betablocker - labetol to slowly decrease BP

Statin

• EKG
• Initial Neuro Assessment
  -Labs: troponin, pt, ptt, inr, ABG, CBC, chem 12
• Seizure precautions
• Frequent neuro assessment
• cluster care to minimize stimuli

Question 7

When are “clot busting” drugs like alteplase contraindicated?

Answer 7

• systolic > 180
• Increased INR
• Active bleeding

Question 8

What is the intervention for systolic BP >200?

Answer 8

• Keep systolic >170 mm Hg for 1st 24-48 hours
• Lower pressure slowly

Question 9

dysphaGia & intervention

Answer 9

difficulty swallowing

Intervention:

• Thicken foods
• Pureed
• Allow time to eat

Question 10

DysphaSia

Answer 10

Difficulty speech

“S” for speech

Question 11

aphaSia

Answer 11

W/o Speech

Broca and Wernicke

Question 12

aTAXIa

Answer 12

Difficulty walking

Question 13

Broca’s Aphasia: What it is, S/Sx

Answer 13

• Expressive aphasia
• B= big mouth
• Understands BUT not able to talk back

S/Sx:
- easily frustrated when trying to speak
- limited speech
- short phrases
- gibberish

Question 14

Wernicke’s Aphasia: What is it? S/Sx?

Answer 14

• Receptive aphasia
• Not able to understand or comprehend

May misunderstand verbal cues

Question 15

Hemorrhagic Stroke Interventions

Answer 15

1) ABC
2) CT w/ in 20 minutes to determine type of shift. Will show midline shift
3) PRIORITY is to stop bleeding - NO fibrinolytic drugs
4) Medication

• Labetol to slowly decrease BP
• Nimodapine to prevent edema induced vasospasm
• Stool softener

5) Seizure Precautions - HOB >30
6) Strict bedrest to prevent increased ICP.