Week 7 Wednesday Stroke II

Question 1

Anosognosia

Answer 1

Neglect or denial of disability

Question 2

Prosopagnosia

Answer 2

Difficulty recognizing faces

Question 3

Pseudobulbar Affect

Answer 3

Sudden outburst of emotion

Question 4

Homonymous Hemianopia

Answer 4

Visual unaware of environment on affected side

Question 5

Hemiplegia

Answer 5

Paralysis on affected side

Question 6

Hemiparesis

Answer 6

Weakness on affected side

Question 7

Aphasia

Answer 7

Difficulty with language

Question 8

Apraxia of Speech

Answer 8

Difficulty with communication

Question 9

Dysphagia

Answer 9

Difficulty swallowing

Question 10

LEFT hemisphere stroke

Answer 10

1. Effects RIGHT side of the body - visual, paralysis or weakness
2. Speech and language
3. Aphasia(receptive, expressive, -Wernicke’s center, Apraxia (speaking))
4. Slow , cautious behavior, angry, frustrated
5. Memory problems
6. Altered intellectual ability
7. Head eyes deviate to left
8. Depression
9. Altered intellectual ability

Question 11

Agraphia

Answer 11

Writing

Question 12

Alexia

Answer 12

Reading

Question 13

RIGHT Hemisphere stroke

Answer 13

1. Effects left side of body - left visual field, paralysis or weakness on left side of body
2. Spatial or perceptual abilities, loss of depth perception, proprioception
3. Impulsive, unaware of their impairments, poor judgement, outbursts
4. Left-sided neglect
5. Short-term memory problems
6. Often non-dominant

Question 14

Ischemic Stroke Thrombotic/embolic Tx

Answer 14

• Thrombolytics/heparin
• If treated with tPA, monitor for BLEEDING
• No antithrombotic for 24 hours
• If given antithrombotic in first 24 hours, not eligible for tPA

Question 15

Hemorrhagic Tx

Answer 15

Antihypertensive meds

• ICP monitoring critical
• S/s of increasing ICP
• Headache, N/V, Increase BP, Dec HR, LOC, vision, keep HOB up, avoid valsalva, neck flexion rotation, non stressful environment, limit visitors, stool softeners
• May require Burr holes
• May require craniotomy
• Monitor HCT, Hg levels

Question 16

Frontal Lobe

Answer 16

Thinking
Speaking
Memory
Movement

Question 17

Temporal Lobe

Answer 17

Hearing
Learning
Feeling

Question 18

Parietal Lobe

Answer 18

Language

Touch

Question 19

Occipital Lobe

Answer 19

Vision

Color perception

Question 20

Cerebellum

Answer 20

Balance

Coordination

Question 21

Brain Stem

Answer 21

Breathing
Heart Rate
Temperature

Question 22

Glasgow Coma

Answer 22

Eye 4
Verbal 5
Motor 6

Question 23

Early signs of ICP

Answer 23

Headache
N/V
Increase BP, Temp
Widening pulse pressure
Decrease mental abilities
Confusion
Changes in speech
Double vision
Infants: Bulging of fontanels,  increased head circumference, high pitch cry

Question 24

Late signs of ICP

Answer 24

Decreased respirations
Bradycardia rotating with tachycardia
Loss of consciousness to comatose
Pupillary/eye movement changes & papillaedema
Seizures, projectile vomiting
Loss of reflexes (corneal, gag, swallowing)
Motor changes: decorticate/decerebrate/flaccid
Herniation

Question 25

Where do you see Cushing’s triad?

Answer 25

Late sign of ICP
Cushing's Triad
1. Decrease Pulse
2. Increase BP
3. Irregular breathing pattern, slow respirations
Cheyene-stokes respirations

Question 26

How to screen for visual neglect

Answer 26

1. Draw a clock
2. Read a paragraph from book
3. Observe eating, only eats on one side of the plate
4. Remind pt to touch, use, and work on improving use of extremity at risk