Unit 14 Stroke Flashcards by Tony Maselli

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

Cerebrum

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

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

Temporal lobe (Wernick’s area) comprehension of speech

Occipital lobe

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What does the cerebellum control?

balance

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

the 2nd

Mid-brain
pons
medulla

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What is each hemisphere of the brain associated with?

Left: language-2 speech centers

Right: perceptual/spatial relationships

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The Glasgow Coma Scale assess what 3 areas?

Eye opening
Motor response
Verbal Response

Total score is up to 15

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What are ways to assess to for painful stimulation?

Central stimulation

Supraorbital pressure
Trapezius squeeze
Sternal rub

Peripheral stimulation
-Nail bed squeeze

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What does decorticate mean?

low level brain function

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What are assessments for motor response?

Obeys
Localizes 
Withdraws 
Abnormal flexion (decorticate posturing)
Abnormal extension (decerebrate posturing)

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What is NOT part of the GCS?

Strength

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What is an early sign of stroke?

drift

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Define the following. 
Paresis
Plegia
Contralateral
Ipsilateral

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

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

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

How many points needed to administer tPA?

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

Minimum 4 points for tPA

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What is the primary reason for adult disability?

Stroke

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What is the definition of a CVA?

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

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What are the modifiable/controllable risk factors of stroke?

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

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

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

What are warning signs of a stroke?

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

What are the 2 categories and sub categories of stoke?

Ischemic and Hemorrhage
>Thrombotic
>Embolic

Describe thrombotic strokes.

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

Describe Embolic strokes.

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

Describe Hemorrhagic stroke.

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

Affects younger people

Hypertension can cause it

Sudden

What is a Ischemic stroke penumbra?

Area around the ischemic spot

- There will be cellular death around area of injury

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

Time is crucial We want to interrupt stroke cascade

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

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

Within how many hours can tPA be administered?

4 1/2 hrs

What diagnostic exam is done to rule Hemorrhage stroke?

CT scan (no contrast for time reasons)

Describe Recombinant Tissue Plasminogen Activator (tPA)

- 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

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

Heparin, steroids, treat symptoms

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

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

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

-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

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

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

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

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

What is neglect in Homonymous Hemianopsia?

Denial of side of the body, visual spatial neglect Seen with RIGHT hemisphere damage

What are nursing interventions with neglect?

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

What is expressive aphasia?

Inability to speak correctly (to get right words out)

What is receptive aphasia?

Inability to understand words being said

What is global aphasia?

A mix between expressive and receptive

What is Apraxia and can you give an example?

Inability to perform previously known action EX: PT uses toothbrush to comb hair

What is Agnosia and can you give an example?

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

What damage is seen in left brain stroke?

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

A TIA typically resolves within how many minutes?

60 min. 1 hr.

What is seen in right brain stroke?

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