Unit 7 CNS-Stroke Flashcards
Is alertered mental status and LOC a disease
no, it is a symptom
Ranges of causes for LOC
Relitively benign: Alcohol intoxication
Reversibility: hypoglycemia
Permanent: Stroke
Life-threatening: Menengitis
TIPPS of LOC
T: trauma
I: infection
P: psych
P: Poison
S: shock stroke
Vowel of LOC
A: alcohol acidosis
E: Epilepsy
I: insulin
O: Opiates oxygen
U: uremia
Components of Neuro assessment
Cerebral function
Brainstem function
Motor and Cerrebellar funtction
Cerebral Function of Neuro assessment
LOC, mental status, cognitive function, behvaior, speech
Brainstem Function of Neuro assessment
cranial nerve, pupillary exam, eye movement, cough/gag reflex
Motor and cerebellar function of neuro assessment
strength, movement, gait, posture
Sensory function of neuro assessment
tactile and pain sensation
Reflexes
superfocail and deep tendon reflexes
Neuro rechecks
Pupils, glassglow scale, vital signs, limb movement (hand grip, arms, legs)
Ipsilateral
on the same side of the body as another structure or given point ex. sensation arises from right side adn travels to right
Contralateral
On the opposite side of the body ex. sensation arises from the left and travels to the right
Alert means
awake, oriented, respins appropriately
Lethargic (somnolent) means
drowsy, appripriate but slow/fuzzy thinking
Obtunded
sleeps most of the time, difficult to arouse, confused
Stupor (Semi-Comatose)
Motor response only to vigorious shake or pain grumbles, and moans
Components of the Glassglow scale
Eye opening, Verbal response, Best motor response
Components of eye opening
spontaneous, to speech, pain, none
Compenents of verbal response
orientated, confised conversation, words (inappropriate) sounds (incomprehensible) sounds (Incomprehensive), none
Components of best motor response
obey comands, localise pain, flexion normal or abnormal, extend, none
what indicates a coma
Less than 8 intubate
Typically a pateint who is deteriorating will lose orientation in what order
time, place, and person
When assessing motor response be sure you are assessing
bilaterally
Intracranial causes of change in LOC
Space-occupying lesions, head injury, hemmorhage, seizure, degneration disease, secondary insults
Extracranial causes for change in LOC
Electrolyte imbalance
EndocrineL hypo/hyperglycemia liver or renal dysfunction, hypoxia, hypotension, drugs
Ischemia to a part of the brain means
restricted blood supply
Hemmorrhage into the brain means
acute loss of blood from damage blood vessels
what does ischemia and hemmorgae results in
cell death
Stroke is the blank leading cause of death in canada
3rd
The economis impact of stroke in canada is approximately
3.6 dollars
High risks for stroke include
Hypertension, Smoking, obesity, diabetes, Afib
Stroke prevention includes
Keeping Bp control, maintain healthy diet, quit smoking, be physically active
What does FAST stand for
Facail droop, Arms (are they able to raise both of them), Speech (is it slurred), Time (to call 911, when did this begin)
Non modifiable risk factors for stroke
Age, Priors, gender, ethnicity, fm hx, gender (men)
Modifiable risk factors for stroke
comorbidities, inactivuty, Alcohol, sleep apnea, cholesterol, obesity, preganancy, carotid stenosis
VAN stands for
Vision (left gaze, right), Aphasia (naming difficulty), Neglect (ingnoring one side of the body
Why shoudl we perform a lgucose test when a pateint comes in with stroke signs
to rule out hypo or hyperglycemia (stroke mimics)
When to provide oxygen for a pateint who is suspected of stroke
when SPO2 is less then 94%
What percent of strokes are ischmic vs Hemorrhagic
80-85% are Ischmic
15% are hemmorhagic
Ischmic Stroke (Thrombotic)
Most common stroke 61%
Local clot, usually formed along plaque, atherosclerotic plaque is disrupted,
Who is most likely to have ischemic Stroke (Thrombotic)
2/3 have diabetes and or HTN
Ischemic Emolic stroke
2nd most common stroke 24%, Travelling clots, swept into cerebral circulation, majority are cardiac origin, Embolus lodges in cerebral artery infarction and edema SUDDEN ONSET
No Oxygen mean
Cellular death within 5 minutesI
Penumbra
Area of viable but at risk tissue, marginal perfusion, unless blood flow is restored quicly the tissue within the pneumbra will be lost
Resuscitation of the Penumbra is a
MAJOR GOAL
1.9 million brain cells
die after every minute after stroke
Canadian stoke best practice recommenation for acute stroke management is
Neurovacular brain and vascular imaging
All patients with suscpeted acute stoke should undergo braina dn vascular imaging CT or MRI
What does diagnostic tests dictate
CT: is it a stroke, what type od stroke , add on perfusion
MRI: More specific, extent of the injury
Number one treatment of Ischmic stroke
Thrombolytic therapy
-Decreases stroke severity
-Change of increased intracerebral bleed
-
How soon should someone get Thrombolytic therapy
whtin 4.5 hours from onset of symptoms
Nursing managament of IV thrombolysis
CBC, aPTT< INR, K, CL, Creatinine, BUN, GLucose, ALT, AST< ALP, CK, BP Target is less then 180/105, Large bore IV access x2
Post Tenecteplase admin
Continuous montioring for a minimum of 2 hours
-Bed rest for 24 hours, then AAT, Vitals, signs of bleeding, q15, q30, them q4 hours
-Hold Labetalol if HR is less then 60 bpm
When to do a second head ct after a stroke
24 hours after tenecteplace admin
Things not to do after Tenecteplase admin
No antiplatelet agents or oral anticoagulants, avoid nasal swabs for 6 ours, avoid IM, Centeral venous access, arterial puncture, Avoid NG tubes, avoid catheterization,
When should a pateint receive Endovascular thrombectomy
within 6 hours
Thrombotic stroke prevention: carotis stenosis
CT: is it a stoke, what kind
Carotid UltrasoundL extent of atheroscleriosis
Endarterectomy
Treatment for sympomatic patient with atleast 70% stenosis of the internal carotid artery
-The plaque is removed to restore patency and arterial flow to the brain
Thromotic stroke prevention
Aspirin (ASA)
Are Hemorrhagic strokes more severe then Ischemic?
Yes they are
Intraceberal bleed (Hemorrhagic stroke)
Ruptured vessels, bleed into brain tissue
Cause of Intraceberal bleed
HTN, AV malformations, thrombolytic/Coag therapy
Signs and symptoms of Intraceberal bleed
Sudden onset, severe headache, neuro defiticits, N and V, Increase ICP< Hypertensive, Decreased LOC in half patients
Subarachnoid bleed
BLeed into subarachnoid space, caused by a ruptured aneurysm,
Signs and Symptoms of a Subarachnoid bleed
“Worst heaedache of my life” LOC change, nuchal rigidy
Aneurysm repair
Leave, Clip, or coil
Surgical (clip)
ENdovascular (angioplasty or stent) (coil)
Cerebral Vasospasm
Narrowing of the large blood vessels at the base of the brain.
At risk 7-10 days post SAH
-Interaction of metabolites within the vessels = endothelial damage = vasospasm
Clinical manifestations of a stroke
Motor function, communicatio, affect, intellectual function, spatial perceptual alterations, elimination
Right brain damage leads to
paralysis of left side
Spatial perceptual deficit
tends to deny or minimize problems
Rapid performance short attention span
Impulsive
Imparied judgement
impaired time concepts
Left brain damage leads to
paralyzed right side, imparied speech language aphsia, slow performance, depression and anxiety, impaired comprehension related to language, math
anterior cerebral involvment for stroke
Motor or sensory deficit or both, sucking or rooting reflex, gait problems, loss of proprioception, fine touch
Middle cerebral involvement for stroke
Dominant side: Aphasia, motor and sensory deficit, hemianopia (Blindness over half the feild of vision)
Nondominent side: Neglect, motor and sensory deficit, hemianopia
Posterior cerebral
Hemianopia, visual hallucination, spontaneous pain, motor deficit
Vertebral
Cranial nerve deficit, diplopia, dizziness, nausea, vomitting, dysarthria, dysphasia, coma
Priorites for Nursing
ABC, BP, Fluid, lytes, temp, seizure
Head CT
IV Bolus TNK
Montior
Which gender is more likely to have a Ischemic stroke
men
Which gender is more likely to have a hemorrhagic stroke
women
Onset for thrombotc stroke
often during or after sleep
Warning sign for thrombotic stroke
TIA (30-40% of cases)
Onset for Embolic stroke
Lack of relationsip to activity, very sudden!!
Course of action for Thromcotic Stroke
Stepwise progression, signs and symptoms develop slowly, usually some improvement, recurrence in 20-15% of survirors
Course of action for Embolic stroke
Single event, signs and symptoms develop quickly, usually soem improvemnt, reccurence common without aggressive treatment of underlying disease
Warning/onset of intracerebral hemorrhagic stroke
Headaches
Course of intracerebral hemorrhagic stroke
Progressice over 24 hours fatility more likley presence of stroke
Hemorrhagic stroke onset is typically
activity
Subarachnoid stroke course
Acute onset, usually single sudden event, as the worst headache of their life, fatility with presence of coma
TIA S/S
Confusion, Vertigo, dysrarthis, transient hemiparesis, temporary vision changes, lasts a few minutes to 24 hours
