Test 3 Stroke Shi Flashcards
What are risk factors for stroke?
HTN
Diabetes
High cholesterol
Smoking
Obesity/ inactivity
AFIB
Heavy alcohol use
Unhealthy Diet
What are the types of strokes?
Ischemic
Hemorrhagic
What’s an ischemic stroke?
Blood vessel supplying blood gets obstructed
Reduced blood flow and oxygen
What can cause an ichemic stroke?
Thrombosis
Embolism
What’s a hemorrhagic stroke?
Bleeding within the brain (ventricles, brain tissue, subarachnoid space)
What can cause a hemorrhagic stroke?
Spontaneous rupture of small vessels ; can be related to hyptertension
Subarachnoid hemorrhage due to aneurysm
Intracerebral hemorrhage caused by amyloid angiopathy
Arterial venous malformations
Intraranial aneurysms
Anticoagulants can cause this too
What are some symptoms of an ischemic stroke?
Numbness/ weakness on face, or limbs especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty walking
Dizziness/ loss of balance or coordination
Sudden severe headache
What are signs of left hemispheric stroke?
Paralysis or weakness of right side of body
Right visual field deficit
Aphasia
Altered intellectual ability
Slow, cautious behavior
What are signs of right sided stroke?
Paralysis on lefrt side
Left visual field deficit
Spatial perceptual deficits
Increased distractibility
Impulsive behavior and poor judgement / lack of awareness
What are some signs of a hemorrhagic stroke?
Very similar to ischemic
Severe headache (hallmark sign)
Early and Sudden changes in LOC
Vomiting
Bleeding
Why do we use CT scans for strokes?
To see if they are ischemic or hemorrhagic
How do we manage acute ischemic stroke?
TPA
Elevate head of bed unless contraindicated
Maintain airway and ventilation
Continuous hemodynamic monitoring and neurologic assessment
Maintain blood pressure to keep perfusion good
How do we diagnoise a Hemorrhagic stroke?
CT scan
Cerebral angiography
Lumbar puncutre if CT is negative and ICP is not elevated
Oxygen
Assessment of the Patient Recovering from Ischemic Stroke
Mental status
Sensation/ perception
Motor control
Swallowing Ability
Nutrirional and hydration status
Skin integrity
Activity tolersnce
Bowel and bladder fx
What should we teach patients to do when recovering from ischemic stroke?
Improving mobility and preventing joint deformities
Prevent shoulder abduction
Position the hands and fingers
Change position every 2 hours
Establish ecercise program
Prepare for ambulation
Preventing shoulder pain
Enhance self care
Adjust to physical changes
Assist w nutrition
What should we do to assist patient with nutrition following stroke?
Consult wit speech therapy or nutritional services
Have patient sit upright, preferably out of bed
Chin tuck or swallowing method
Use of thickened liquids or pureed diet
Nursing interventions for patient with hemorrhagic stroke
Prevent ICP increase
Absolute bedrest with HOB 30 degrees
Avoid all activity
Stool softener and mild laxatives
Nonstimulating environment
VIsitors are restricted
Relieving anxiety
* Keep sensoriy stimulation to a minimum
* Reality orientation
Seizure precautions
How do we calculate CPP?
MAP - ICP
Normal range is 70- 100
What does a CPP of 50 or below mean lol?
Permanent neurological damage
Early manifestations of increased ICP
Changes in LOC
Restlessness, drowsiness, confusion, increased respiratory effort, aggrvated by movement or straining
What are late manifestations of increased ICP?
Respiratory and Vasomotor changes
Increased systolic BP
Cushing Triad
* Bradycardia
* HTN
* Bradypenia
Vomitting
Loss of brainstem reflexes: Pupil, gag, corneal, swallowing
Cerebral Edema peaks how long after intracranial surgery?
24 hours
What’s a normal and stable ICP reading?
Less than 15
How long after can we start thrombolytic therapy?
3 hours max
INR greater than 2 is contraindicated
