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Nursing 2 Exam 3 > Unit 14 Stroke > Flashcards

Unit 14 Stroke Flashcards

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1
Q

What part of the brain is the highest level of function?

A

Cerebrum

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2
Q

What are the lobes of the brain, the associated areas within them and function?

A

Frontal lobe (Broca’s area) concentration, judgement, language

Temporal lobe (Wernick’s area) comprehension of speech

Occipital lobe

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3
Q

What does the cerebellum control?

A

balance

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4
Q

The brain stem is considered what level of function and contains what 3 things?

A

the 2nd

Mid-brain
pons
medulla

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5
Q

What is each hemisphere of the brain associated with?

A

Left: language-2 speech centers

Right: perceptual/spatial relationships

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6
Q

The Glasgow Coma Scale assess what 3 areas?

A

Eye opening
Motor response
Verbal Response

Total score is up to 15

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7
Q

What are ways to assess to for painful stimulation?

A

Central stimulation

  • Supraorbital pressure
  • Trapezius squeeze
  • Sternal rub

Peripheral stimulation
-Nail bed squeeze

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8
Q

What does decorticate mean?

A

low level brain function

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9
Q

What are assessments for motor response?

A 
Obeys
Localizes 
Withdraws 
Abnormal flexion (decorticate posturing)
Abnormal extension (decerebrate posturing)
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10
Q

What is NOT part of the GCS?

A

Strength

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11
Q

What is an early sign of stroke?

A

drift

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12
Q 
Define the following. 
Paresis
Plegia
Contralateral
Ipsilateral
A

Paresis- weakness
Plegia- paralysis
Contralateral- opposite side
Ipsilateral- same side

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13
Q

What are the three signs used for the Cincinnati Stroke Scale and what happens if the PT displays any one of them?

A 
Acronym FAST:
Face 1
Arms 2
Speech 3
Time

If PT shows signs of any one of them they should be transported to a hospital immediately

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14
Q

What does the NIH stroke scale measure and how many points are there total?

How many points needed to administer tPA?

A

The NIH stroke scale measures several aspects of brain function; total 42 points

Minimum 4 points for tPA

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15
Q

What is the primary reason for adult disability?

A

Stroke

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16
Q

What is the definition of a CVA?

A

sudden loss of brain functioning from a disruption of blood supply to a part of the brain

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17
Q

What are the modifiable/controllable risk factors of stroke?

A 
HTN*
cholesterol 
Smoking*
Obesity
Heavy alcohol consumption
Diabetes 
A-fib
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18
Q

What are the uncontrollable/non-modifiable risk factors for stroke?

A

Age >55
Male- higher risk
Family Hx
African-American

19
Q

What are warning signs of a stroke?

A

Numbness, weakness, paralysis (more so on one side)
Loss of balance/coordination
Sudden vision changes
Difficulty speaking
“TIA” *last from a few minutes to an *hour

20
Q

What are the 2 categories and sub categories of stoke?

A

Ischemic and Hemorrhage
>Thrombotic
>Embolic

21
Q

Describe thrombotic strokes.

A 
Commonly caused
by atherosclerosis
Does not develop
suddenly
Mainly affects
older people
History of TIA’s
22
Q

Describe Embolic strokes.

A
  • Caused by a clot usually from the heart
  • Sudden onset
  • Usually no TIA’s
  • Common among older people
23
Q

Describe Hemorrhagic stroke.

A

Caused by a “breakage” or “blowout” or cerebral artery

Affects younger people

Hypertension can cause it

Sudden

24
Q

What is a Ischemic stroke penumbra?

A
  • Area around the ischemic spot

- There will be cellular death around area of injury

25
Q

What is CRUCIAL regarding stroke and what do we want to prevent/interrupt with stroke?

A

Time is crucial

We want to interrupt stroke cascade

26
Q

During the 1st hours of a stroke what is usually done?

A

Call EMS
Activates team at hospital
Arrive at hospital-rapid triage invovling:
-Bloodwork, CT, BP control, NIH stroke scale, Criteria for tPA

27
Q

Within how many hours can tPA be administered?

A

4 1/2 hrs

28
Q

What diagnostic exam is done to rule Hemorrhage stroke?

A

CT scan (no contrast for time reasons)

29
Q

Describe Recombinant Tissue Plasminogen Activator (tPA)

A
  • Thrombolytic enzyme
    -Needs to be given within 4 ½** hours of onset
    of ischemic stroke
    -Not given with hemorrhagic stroke
    -Reduces the size of the clot
    -Many other criteria that would exclude the use of rtPA
30
Q

If a PT is not a candidate for tPA, what is the usual protocol?

A

Heparin, steroids, treat symptoms

31
Q

What is MERCI and who would be an option for it?

A

MERCI is the mechanical removal of an embolus

  • For PT not candidate for tPA
  • Long thin wire threaded through catheter into the femoral artery, up to the carotid artery. Pulls the clot out.

New procedures call Solitaire FR or Trevo

32
Q

What is a Carotid Endarterectomy and how is the blockage diagnosed?

A

-Surgery done when there is plaque at
bifurcation of carotids

-Symptomatic TIA’s

-70% stenosis is “magical”
number for hemodynamic
compromise (when they would perform this surgery)

-% diagnosed with doppler

33
Q

What is the post-op care for a Carotid Endarterectomy?

A

Monitor BP frequently (we want it high)
Maintain head alignment
Neuro assessments
Assess neck for swelling

34
Q

What is Homonymous Hemianopsia and which part of the brain CVA is this usually seen?

A

PT sees 1/2 visual field out of each eye

Example: Right side brain stroke, PT cannot see out of left eye left side and right eye left side

Usually seen with RIGHT CVA

35
Q

What is neglect in Homonymous Hemianopsia?

A

Denial of side of the body, visual spatial neglect

Seen with RIGHT hemisphere damage

36
Q

What are nursing interventions with neglect?

A

Remind PT of deficit, to move to affected side
Move head to scan
Place objects where PT can see them
Approach/talk to PT from side he sees on

37
Q

What is expressive aphasia?

A

Inability to speak correctly (to get right words out)

38
Q

What is receptive aphasia?

A

Inability to understand words being said

39
Q

What is global aphasia?

A

A mix between expressive and receptive

40
Q

What is Apraxia and can you give an example?

A

Inability to perform previously known action

EX: PT uses toothbrush to comb hair

41
Q

What is Agnosia and can you give an example?

A

Inability to recognize object by touch or site

EX: You have PT close eyes and hand him a watch, he/she cannot tell you what object is

42
Q

What damage is seen in left brain stroke?

A 
paralyzed RIGHT side
language deficits
slow, cautious
more aphasia 
distress/depression RT disability bc aware
43
Q

A TIA typically resolves within how many minutes?

A

60 min. 1 hr.

44
Q

What is seen in right brain stroke?

A 
paralyzed LEFT side
spatial-perceptual deficits
quick impulsive
short attention span
indifference to disability (denies)

Nursing 2 Exam 3 (5 decks)

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