week 2: CVA

Question 1

what do we do when we suspect a stroke

Answer 1

get a head CT stat

Question 2

what are modifiable risk factors of CVA

Answer 2

HYPERTENSION***
Diabetes mellitus
Heart disease
Afib
Carotid stenosis
Hyperlipidemia
Obesity
Oral contraceptive use
Heavy alcohol use
Physical inactivity
Smoking

Question 3

what is the main etiology of strokes

Answer 3

A fib
(irregular, no p wage, tight and narrow QRS)

Question 4

etiology of hemorrhagic stroke

Answer 4

HTN*
Anticoagulant drug therapy*
Trauma
Arteriovenous malformations
Ruptured aneurysms

Question 5

treatment of TIA

Answer 5

• medication to prevent platelet aggregation (ASA, Plavix)*
• oral anticoagulants

Question 6

Diagnostics of stroke

in order

Answer 6

Tests for emergent evaluation of the patient CVA:
History and FOCUSED physical exam - vitals/telemetry
National Institute of Health Stroke Scale (NIHSS) score
CT head without contrast w/i 20 MIN of ARRIVAL
(Can distinguish between ischemic and hemorrhagic, and indicate size and location of stroke)
Start IV and draw labs - chemistry panel, CBC, Coag panel (PT,PTT,INR)
EKG
Carotid ultrasound of warranted
MRI possibly if needed
Ensure LKWT is documented

Question 7

Nursing action for acute CVA

starred actions only

Answer 7

• ensure patient airway
• aspirattion precautions
• maintain BP/ permissive HTN
• neuro assessment and NIH stroke scale
• CT stat
• position hehad midline with HOHB 30 (if no shock/ injury)
• anticipate thrombolytic therapy for ischemic stroke

stroke code, VS, obtain IV and blood work, seizure precaution

Question 8

what should you do if you can’t give fibrinolytics

Answer 8

observe pt

Question 9

when is the most crucial time

Answer 9

first 3 hours

lack of blood flow -> ischemia -> cerebral infarction

Question 10

when does alteplase (tPA) need to be administer

Answer 10

• must be given within 3-4.5 hrs of onset of ischemic stroke
• before 3 hr: possible benefit of thrombolytic outweighs the possibility of intracranial bleed
• after 3 hr: risk outweigh benefit

Question 11

what should be done post tPA administration

Answer 11

neuro assessment q15min for 2 hours then q30min for 6 hours

monitor for sxs of intracerebral hemorrhage

Question 12

what is permissive HTN

Answer 12

allowing HTN patients with ischemic stroke to 200-220mmHg systolic (often by withhholding meds) to protect tissue that would otherwise by hypoxic

Question 13

tPA patient’s SBP should be

Answer 13

less than 185mmHg

Question 14

what is the main CVA nursing goals

Answer 14

attain max self care activites and skills

Question 15

what is aphasia and what is the goal/ intervention?

Answer 15

def: impaired verbal communication

goal: increase communication

intervention: speak in normal tone, allow time for response, use yes/ no Q, use picture and text

Question 16

what is expressive aphasia

Answer 16

when you know what you want to say. but have trouble saying or EXPRESSING your thoughts

Question 17

what is receptive aphasia

Answer 17

affects the ability to read and understand speech

you can hear waht people say or see words on a page but hahve trouble making sense of what they mean

Question 18

main intervention for impaired swallowing

Answer 18

• check for food pockets, especially on affecvted side
• never leave client withh food in mouth
• position upright
• suction readily available
• minimize distraction

Question 19

what is ischemic stroke

Answer 19

caused by inadequate blood flow tot the brain from partial or complete occulsion of an artery

Question 20

hemorrhagic stroke

Answer 20

caused by bleeding into the brain tissue itself

Question 21

what is TIA

Answer 21

• not an actual stroke, but prestroke
• transient episode of neurologic dysfunction caused ischemia without acute infarction

Question 22

thrombotic stroke

Answer 22

occlusion of cerebral vessel by thrombus

Question 23

main concern for pt with impaired physical mobility

Answer 23

make sure physical therapist is ordered and visiting

Question 24

embolic stroke

Answer 24

emoblus become lodges in vessel and cause occulsion

**cause by a fib, recent MI, endocarditis, valvualr disorder, athehrosclerotic lesion, vasculitis

Question 25

arteriovenous malformation

Answer 25

tangled mass of arteries and veins that can cause seizures

Question 26

The incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with the administration of
A. furosemide (Lasix)
B. lovastatin (Mevacor)
C. daily low-dose aspirin (ASA)
D. nimodipine (Nimotop)

Answer 26

daily low dose aspirin