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NURS 3512 - Class 7-12 > Week 10 - Stroke > Flashcards

Week 10 - Stroke Flashcards

1
Q

what are 2 types of strokes

A
  • hemorrhage

- ischemic

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2
Q

what is a hemorrhagic stroke

A
  • stroke d/t a burst blood vessel which may allow blood to seep into and damage brain tissues
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3
Q

what are 2 types of ischemic strokes

A
  • thrombotic

- embolic

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4
Q

what is a thrombotic stroke

A
  • narrowing of the artery by fatty deposits (plaque), which causes a clot to form and blocks the passage of blood thru the artery
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5
Q

what is an embolic stroke

A
  • when an embolus reaches an artery in the brain that is too narrow to pass thru, it lodges there, and blocks the flow of blood
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6
Q

what is a major cause of ischemic stroke

A
  • atherosclerosis
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7
Q

what is a major way to prevent ischemic stroke

A
  • prevent atherosclerosis thru CVS health
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8
Q

describe what is included in prevention of ischemic stroke (8)

A
  • control & treat HTN
  • control & treat DM
  • control & treat heart disease
  • control & treat high cholesterol
  • lifestyle modifications
  • drug therapy
  • surgical intervention
  • observe warning signs (TIA)
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9
Q

what lifestyle modifications can be made to prevent ischemic stroke (4)

A
  • healthy diet
  • exercise
  • smoke cessation
  • limit alcohol
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10
Q

what drug therapy plays a role in prevention of ischemic stroke (if have risk factors or have had one) (3)

A
  • anti plt meds (ASA, plavix (clopidogrel)
  • anticoagulants for a fib
  • statins for high cholesterol (lovastatin)
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11
Q

what med is used as an anticoag for a-fib

A
  • rivaroxaban (Xarelto)
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12
Q

what surgical intervention plays a role in preventing ischemic stroke (2)

A
  • transluminal angioplasty

- carotid endarterectomy

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13
Q

what is a transluminal angioplasty

A
  • involves insertion of a catheter via femoral artery

- stent/balloon is threaded to blocked carotid artery to move plaque out of the way

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14
Q

what is a carotid endarterectomy

A
  • involves insertion of a tube above & below the blockage to reroute blood flow
  • atherosclerotic plaque in the common carotid artery is removed
  • once the artery is stitched closed, the tube can be removed
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15
Q

what is a risk associated w carotid endarectomy

A
  • plaque can break off & travel
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16
Q

describe the timing of acute care intervention of ishcemic stroke

A
  • treatment within 4.5 hours from symptom onset
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17
Q

what is included in acute care of an ishcemic stroke (6)

A
  • ABCs
  • LOC
  • fluid & electrolyte balance
  • ICP
  • meds
  • surgical therapy
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18
Q

what is the goal O2 for an ischemic stroke? describe BP mngmt for an ischemic stroke

A
  • keep O2 sats >95%
  • BP: monitor and maintain within ordered/goal parameters (want to make sure it is high enough to ensure cerebral perfusion)
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19
Q

describe fluid & electrolyte balance for an ishemic stroke

A
  • maintain enough fluid for perfusion without causing cerebral edema
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20
Q

at what point does ICP peak in a pt with an ischemic stroke

A
  • in 72 hrs
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21
Q

describe nursing care r/t ICP for a pt with ischemic stroke (6)

A

involves interventions to manage IICP:

  • give mannitol
  • pt positioning
  • prevent hyperthermia
  • prevent seizures
  • prevent pain
  • prevent constipation
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22
Q

what type of meds are used for acute care of an ischemic stroke

A
  • thrombolytic therapy
23
Q

what is an example of thrombolytic therapy for an ischemic stroke ? describe how it is given for an ischemic stroke

A
  • recombinant tissue plasminogen activator (TPA)

- given IV to lyse the clot within 4.5 hrs of symptoms

24
Q

describe mngmt and monitoring r/t TPA admin for an ischemic stroke (3)

A
  • S&S of bleeding
  • prevent bleeding
  • neuro checks
25
Q

what surgical therapy may be done for treatment of an ischemic stroke

A
  • merci retriever removal of blood clots via a long thin wire threaded thru a catheter in the femoral artery which pulls the clot out
26
Q

what are examples of causes of hemorrhagic stroke (4)

A
  • head injury
  • spontaneous
  • intracerebral hemorrhage
  • subarachnoid hemorrhage
27
Q

what is an intracerebral hemorrhage

A
  • bleeding in the brain caused by a ruptured vessel
28
Q

describe the severity of symptoms w hemorrhagic stroke

A
  • extent of symptoms vary depending on the extent of the bleed and location
29
Q

what is the treatment for hemorrhagic stroke r/t intracerebral hemorrhage (3)

A
  • repair the bleeding vessel
  • remove the blood
  • treat for IICP
30
Q

what is a subarachnoid hemorrhage

A
  • bleeding into the cerebrospinal fluid in the subarachnoid space
31
Q

what is the most common cause of a subarachnoid hemorrhage

A
  • aneurysm
32
Q

what are common symptoms of a subarachnoid hemorrhage (6)

A
  • “worst headache ever”
  • NV
  • stiff neck
  • seizures
  • passing out
  • LOC changes that range depending on size of bleed
33
Q

what is the treatment for hemorrhagic stroke r/t subarachnoid hemorrhage (SAH) (4)

A
  • repair aneurysm (surgery)
  • treat for IICP
  • external ventricular drain (EVD)
  • prevent vasospasm
34
Q

what does an EVD do

A
  • drain CSF and blood
35
Q

what are contraindicated in treatment of a hemorrhagic stroke r/t SAH

A
  • anticoags

- plts

36
Q

what is a serious risk/complication of a SAH

A
  • vasospasm (d/t blood causing irritation)
37
Q

why is a SAH serious? what indication does this have?

A
  • the brain tissue needs oxygenated blood supply (vasospasm prevents this)
    = prevent and treat to decrease chance of brain damage
38
Q

at what point does vasospasm occur w SAH

A

`- 6-20 days post bleed

39
Q

what med can be used to prevent vasospasm

A
  • calcium channel blockers
40
Q

what is an example of a calcium channel blocker

A
  • Nimodipine
41
Q

how often & how long are calcium channel blockers given to prevent vasospasm w SAH

A
  • q4h

- from time of rupture for 21 days (prophylactic)

42
Q

what is used to treat vasospasm r/t SAH (3)

A
  • IV vasodilator once vasospasm confirmed
  • maintain homeostasis of fluids & electrolytes
  • “push thru” the spasming vessel
43
Q

what is an example of an IV vasodilator

A
  • milrinone (Primicor)
44
Q

how is vasospasm confirmed

A
  • cranial doppler
45
Q

how do we “push thru” the spasming vessel to treat vasospams

A
  • may put BP higher than normal
46
Q

what does FAST stand for r/t strokes

A

= signs of a stroke

  • Face (drooping?)
  • Arms (can you raise both?)
  • Speech (slurred?)
  • Time (is of the essence, call 911, do not wait)
47
Q

a nursing diagnosis r/t stroke is decreased intracranial adaptive capacity . what nursing interventions may be used for this (5)

A
  • monitor neuro status –> ICP and LOC at least hourly
  • calculate and monitor CPP
  • monitor resp status
  • admin and titrate vasoactive meds as ordered
  • avoid neck flexion or hip/knee flexion (to avoid obstruction of arterial and venous blood flow)
48
Q

a nursing diagnosis r/t stroke is ineffective airway clearance d/t decreased LOC, absent gag & swallowing reflexes. what nursing interventions can help w this (6)

A
  • auscultate breath sounds
  • remove secretions by encouraging coughing or suctioning
  • encourage DB & C
  • encourage turning
  • position pt in a sitting position
  • keep pt NPO until swallow eval completed
49
Q

a nursing diagnosis r/t stroke is impaired physical mobility. what nursing interventions can help w this? (4)

A
  • collab with PT and OT
  • encourage ROM
  • provide restful enviro for pt after periods of exercise
  • determine pt’s readiness to engage in physical activity
50
Q

a nursing diagnosis r/t stroke is impaired verbal communication. what nursing interventions can help w this (5)

A
  • listen attentively
  • provide positive reinforcement
  • use simple words and short sentences
  • use alternative communication aids as needed
  • provide verbal prompts and reminders
51
Q

a nursing diagnosis r/t stroke is unilateral neglect r/t visual acuity and sensory loss on one side of body. what are nursing interventions for this (5)

A
  • monitor for abnormal responses to the 3 primary types of stimuli: sensory, visual, and auditory
  • rearrange the enviro to use the right or left visual field
  • touch unaffected shoulder when initiating convo
  • gradually move personal items to affected side as the pt demonstrates an ability to compensate for neglecy
52
Q

a nursing diagnosis r/t stroke is stroke is impaired urinary elimination r/t impaired impulse to void, inability to reach the toilet. what are nursing interventions for this (6)

A
  • keep a continence specification record for 3 days to establish a voiding pattern
  • establish interval of initial toileting schedule, based on voiding schedule
  • assist to toilet or remind pt to avoid at prescribed intervals
  • teach pt to consciously hold urine until scheduled toileting time
  • discuss daily record of continence w staff
  • give positive feedback when they void at scheduled voiding times
53
Q

a nursing diagnosis r/t stroke is impaired swallowing. what are nursing interventions for this (6)

A
  • assist pt to sit up for feeding
  • assist pt to maintain sitting position for 30 min after completing meal
  • instruct pt and family on emergency measures for choking
  • check mouth for pocketing of food after eating
  • provide mouth care after meals and as needed
  • monitor body weight

NURS 3512 - Class 7-12 (49 decks)

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