Week 10 - Stroke Flashcards
what are 2 types of strokes
- hemorrhage
- ischemic
what is a hemorrhagic stroke
- stroke d/t a burst blood vessel which may allow blood to seep into and damage brain tissues
what are 2 types of ischemic strokes
- thrombotic
- embolic
what is a thrombotic stroke
- narrowing of the artery by fatty deposits (plaque), which causes a clot to form and blocks the passage of blood thru the artery
what is an embolic stroke
- 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
what is a major cause of ischemic stroke
- atherosclerosis
what is a major way to prevent ischemic stroke
- prevent atherosclerosis thru CVS health
describe what is included in prevention of ischemic stroke (8)
- control & treat HTN
- control & treat DM
- control & treat heart disease
- control & treat high cholesterol
- lifestyle modifications
- drug therapy
- surgical intervention
- observe warning signs (TIA)
what lifestyle modifications can be made to prevent ischemic stroke (4)
- healthy diet
- exercise
- smoke cessation
- limit alcohol
what drug therapy plays a role in prevention of ischemic stroke (if have risk factors or have had one) (3)
- anti plt meds (ASA, plavix (clopidogrel)
- anticoagulants for a fib
- statins for high cholesterol (lovastatin)
what med is used as an anticoag for a-fib
- rivaroxaban (Xarelto)
what surgical intervention plays a role in preventing ischemic stroke (2)
- transluminal angioplasty
- carotid endarterectomy
what is a transluminal angioplasty
- involves insertion of a catheter via femoral artery
- stent/balloon is threaded to blocked carotid artery to move plaque out of the way
what is a carotid endarterectomy
- 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
what is a risk associated w carotid endarectomy
- plaque can break off & travel
describe the timing of acute care intervention of ishcemic stroke
- treatment within 4.5 hours from symptom onset
what is included in acute care of an ishcemic stroke (6)
- ABCs
- LOC
- fluid & electrolyte balance
- ICP
- meds
- surgical therapy
what is the goal O2 for an ischemic stroke? describe BP mngmt for an ischemic stroke
- keep O2 sats >95%
- BP: monitor and maintain within ordered/goal parameters (want to make sure it is high enough to ensure cerebral perfusion)
describe fluid & electrolyte balance for an ishemic stroke
- maintain enough fluid for perfusion without causing cerebral edema
at what point does ICP peak in a pt with an ischemic stroke
- in 72 hrs
describe nursing care r/t ICP for a pt with ischemic stroke (6)
involves interventions to manage IICP:
- give mannitol
- pt positioning
- prevent hyperthermia
- prevent seizures
- prevent pain
- prevent constipation
what type of meds are used for acute care of an ischemic stroke
- thrombolytic therapy
what is an example of thrombolytic therapy for an ischemic stroke ? describe how it is given for an ischemic stroke
- recombinant tissue plasminogen activator (TPA)
- given IV to lyse the clot within 4.5 hrs of symptoms
describe mngmt and monitoring r/t TPA admin for an ischemic stroke (3)
- S&S of bleeding
- prevent bleeding
- neuro checks
what surgical therapy may be done for treatment of an ischemic stroke
- merci retriever removal of blood clots via a long thin wire threaded thru a catheter in the femoral artery which pulls the clot out
what are examples of causes of hemorrhagic stroke (4)
- head injury
- spontaneous
- intracerebral hemorrhage
- subarachnoid hemorrhage
what is an intracerebral hemorrhage
- bleeding in the brain caused by a ruptured vessel
describe the severity of symptoms w hemorrhagic stroke
- extent of symptoms vary depending on the extent of the bleed and location
what is the treatment for hemorrhagic stroke r/t intracerebral hemorrhage (3)
- repair the bleeding vessel
- remove the blood
- treat for IICP
what is a subarachnoid hemorrhage
- bleeding into the cerebrospinal fluid in the subarachnoid space
what is the most common cause of a subarachnoid hemorrhage
- aneurysm
what are common symptoms of a subarachnoid hemorrhage (6)
- “worst headache ever”
- NV
- stiff neck
- seizures
- passing out
- LOC changes that range depending on size of bleed
what is the treatment for hemorrhagic stroke r/t subarachnoid hemorrhage (SAH) (4)
- repair aneurysm (surgery)
- treat for IICP
- external ventricular drain (EVD)
- prevent vasospasm
what does an EVD do
- drain CSF and blood
what are contraindicated in treatment of a hemorrhagic stroke r/t SAH
- anticoags
- plts
what is a serious risk/complication of a SAH
- vasospasm (d/t blood causing irritation)
why is a SAH serious? what indication does this have?
- the brain tissue needs oxygenated blood supply (vasospasm prevents this)
= prevent and treat to decrease chance of brain damage
at what point does vasospasm occur w SAH
`- 6-20 days post bleed
what med can be used to prevent vasospasm
- calcium channel blockers
what is an example of a calcium channel blocker
- Nimodipine
how often & how long are calcium channel blockers given to prevent vasospasm w SAH
- q4h
- from time of rupture for 21 days (prophylactic)
what is used to treat vasospasm r/t SAH (3)
- IV vasodilator once vasospasm confirmed
- maintain homeostasis of fluids & electrolytes
- “push thru” the spasming vessel
what is an example of an IV vasodilator
- milrinone (Primicor)
how is vasospasm confirmed
- cranial doppler
how do we “push thru” the spasming vessel to treat vasospams
- may put BP higher than normal
what does FAST stand for r/t strokes
= signs of a stroke
- Face (drooping?)
- Arms (can you raise both?)
- Speech (slurred?)
- Time (is of the essence, call 911, do not wait)
a nursing diagnosis r/t stroke is decreased intracranial adaptive capacity . what nursing interventions may be used for this (5)
- 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)
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)
- 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
a nursing diagnosis r/t stroke is impaired physical mobility. what nursing interventions can help w this? (4)
- 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
a nursing diagnosis r/t stroke is impaired verbal communication. what nursing interventions can help w this (5)
- listen attentively
- provide positive reinforcement
- use simple words and short sentences
- use alternative communication aids as needed
- provide verbal prompts and reminders
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)
- 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
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)
- 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
a nursing diagnosis r/t stroke is impaired swallowing. what are nursing interventions for this (6)
- 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
