week 8 pharm Flashcards
what are some issues that may cause hemorrhagic stroke
anticoagulants, head injuries, clotting issues (from the liver), hypertension
what are the 5 levels of coma
lethargy (v drowsy)
obtunded (needs moderate stimulation to wake them up)
stuporous (lots of stimulation to rouse the patient, v drowsy)
coma
what is mentation
mental status (i.e. what is a patients mentation?)
what do catecholamines do
they increase heart rate, cause vasoconstriction, and increase blood pressure
what types of substances produce catecholamines
drugs, smoking, alcohol
how do statins help with stroke
they lower the amount of lipids in the blood which could help with thrombotic (ischemic) stroke because they help prevent atherosclerosis
which labs should be monitored for an individual on atorvastatin?
liver function tests (LFTs)
renal function tests (urea/creatinine)
Creatinine kynase (to check for myopathy)
how does ASA help with stroke
basically thins he blood to prevent cardiovascular disease, promote blood flow around blocked site, prevent MI
what is a FAST assessment
an assessment you would do on a stroke patient to see how bad it is
Face: get them to smile and look for asymmetry
arms: get them to look up their arms and look for positive pronator drift
speech: look for slurring and wierdness
Time to get help
how many positive findings in the FAST assessment would indicate that its time for help
if a person is experiencing one or more stroke symptoms
whats the most important question to ask an individual presenting with a stroke
when did the symptoms first begin? (determines how much time they have to save them and determines which type of stroke theyre experiencing)
what are some immediate priorities in acute stroke
- note the onset of symptoms
- cardiac status
- respiratory status
- neurological assessment
- blood sugar
which cranial nerves are involved with gag, cough, and swallow reflex
cranial nerves 9, 10, 12
how many hours does one have before intense brain damage to the penumbra
4.5 Hours
what is a separate condition that must be ruled out in a hyper-acute stroke patient
hyperglycemia
what are the highest and lowest scores of the GCS
highest: 15
lowest: 3
which score of the GCS would be concerning
anything under 14 is bad
what are the late signs of stroke
coma, posturing, absent motor reflexes, dilated/fixed pupils, apneic periods
what does PERRLA stand for
pupils equal, round, reactive to light and accommodation
which cranial nerve is involved with assessing pupils
cranial nerve 3
if a pupil is dilated to 8-9mm, what does that mean?
it means they have a blown pupil (v bad)
what are some diagnostic that can tell the diff between an ischemic and hemmorhagic stroke
CT and MRI
what are some blood work findings we look at for stroke
CBC, coagulation studies, Blood glucose, renal/liver labs, lipid profile
what may happen to BP and blood sugar following a stroke
they will both increase
what range should we keep BP for ischemic stroke patients who are candidates for TPA
under or equal to 185/110
what range should we keep BP for ischemic stroke patients who are NOT candidates for TPA
under 220/120
how would an individual with ischemic stroke be a candidate for TPA
if theyre symptoms started less than 4.5 hours ago and its confirmed ischemic through CT or MRI
what range should you keep systolic BP in a patient with hemmorhagic stroke
140-160
what drug do we use to control BP in stroke patients
Labetolol
which route is Labetolol/trandate given
IV
what is an important thing to remember when giving labetolol
patient must lay supine for 3 hours after admin because its very potent
why shouldnt you abruptly withdraw labetolol
it could cause life threatening arythmias, hypertension, or MI
what are some absolute contraindications when taking TPA
- stroke longer than 4.5h
- bp over 185/110
- brain bleed
- any active bleeds
what do you need to know about a patient before taking TPA
-type of stroke they have
- BP
- CBC (platelets, clotting factors)
how can one prevent bleeding after administering TPA
- monitor BP
- check clotting factors
- don’t hurt them
- Q1H neurochecks and vitals
what type of stroke to we treat with TPA
Ischemic
with is the MOA of TPA
it breaks down literally all clots occurring in the body
what is door to needle time
once their in the door it should be less than one hour before they get this drug
what are the most common sites of bleeding
- recent wounds
- sites of needle puncture
- sites of invasive procedures/surgery
what is the point of giving TPA for a stroke
it will re establish blood flow through a blocked artery
why does blood pressure need to be more closely controlled for a hemorrhagic stroke compared to an ischemic stroke
because the the blood pools in the brain it could raise ICP and cause ischemia
why would we give anticoagulant to a stroke patient
to prevent DVT because there likely immobile. also so that the stroke patient doesn’t develop new clots (ischemic only obvi)
what should you be worried about if you notice weak gag reflex in a stroke patient
it could cause aspiration, and aspiration pneumonia
what is expressive aphasia
partial loss of ability to produce words
what is receptive aphasia
difficult understanding language
whats apraxia
inability to preform learned tasks on command
what is Ataxia
lack of muscle control or coordination of voluntary movements
what is dysarthria
muscles in speech are weak, paralyzed or damaged
what is hemianopia
loss of vision in half the visual field
what is hemiparesis
weakness on one side of the body
what is hemiplegia
paralysis on one side of the body
what is neglect
becoming unaware of one side of the body
what should you assess before giving PO meds to a stroke patient
gag, cough, and swallow reflex
what is the main cause for stroke complications
destruction of brain tissue and cell death
which cranial nerves would be abnormal if a stroke patient had issues with speech
9, 10, 12
which ADLs are speech and communication closely linked to
breathing, eating, swallowing, gagging
whats the brocas aphasia
expressive aphasia
whats wernickes aphasia
receptive aphasia
which area of the brain is affected during wernickes and brocas aphasia
the left side
what are nurses most concerned about in terms of stroke complications
aspiration
DVT
constipation
UTI
depression
what are some sensory clinical manifestiations with sub acute stroke patients
- pain, numbness, heavy limb
- paresthesia
- loss of bladder/bowel control
- proprioception issues
- change in vision
what is the first priority of a patient with a positive FAST assessment
schedule a STAT CT scan
