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NURS 2514 > Week 9 - Stroke Assessment & Meds > Flashcards

Week 9 - Stroke Assessment & Meds Flashcards

1
Q

“time is brain” what does it mean

A
  • every minute without blood flow & intervention can lead to loss of more brain cells & increased risk of permanent damage
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2
Q

define ischemia

A
  • restriction of blood supply to tissues
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3
Q

define infarction

A
  • tissue death due to inadequate blood supply
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4
Q

define atherosclerosis

A
  • build up of plaque on the artery walls which can restrict blood flow
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5
Q

define arteriosclerosis

A
  • thick & stiff arteries that can result in restriction of blood flow
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6
Q

define transient ischemic attack

A
  • temporary episode of neurologic dysfunction caused by ischemia
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7
Q

define ischemic stroke

A
  • classification of stroke that results from inadequate blood flow
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8
Q

define hemorrhagic stroke

A
  • classification of stroke that results from bleeding into the brain
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9
Q

define thrombotic stroke

A
  • type of stroke that occurs when a blood clot forms in a diseases or narrowed blood vessel
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10
Q

define embolic stroke

A
  • type of stroke that occurs when an embolus lodges in & occludes a cerebral artery
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11
Q

what is type of stroke associated w a cerebral aneurysm

A
  • hemorrhagic
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12
Q

what are risk factors for formation of fatty deposits in arteries & plaque formation (5)

A
  • high BMI
  • alcohol
  • hyperlipidemia
  • diabetes
  • family history
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13
Q

what are risk factors for hypercoaguable blood (3)

A
  • sedentary lifestyle
  • atrial fibrillation
  • birth control pills
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14
Q

what are risk factors for shearing stress & epithelial injury (2)

A
  • HTN

- FHx

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15
Q

what is a risk factors for arterial spasms & sudden decrease in blood flow

A
  • recreational drugs
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16
Q

what is a risk factor for weakened or stretched blood vessels to burst, resulting in bleeding (2)

A
  • AVM

- aneurysm

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17
Q

what is a risk factor for catecholamine release, which increases HR, vasoconstriction, and BP (2)

A
  • smoking

- stress

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18
Q

what is FAST

A
  • a tool to assess for stroke
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19
Q

what does FAST sign for

A

Facial droop
Arm (palmar drift)
Slurred speech
Time (to get help)

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20
Q

what are CVA warning signs (6)

A
  • sudden numbness or weakness of one side of the body
  • sudden confusion, or trouble understanding
  • sudden change in speech
  • sudden change in vision
  • sudden trouble walking, balance, coordination
  • sudden & severe headache with no known cause
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21
Q

what are immediate priorities with a CVA which must be done within the first 4.5 hrs (6)

A
  • note onset of symptoms
  • assess/manage airway
  • assess/manage breathing
  • assess/manage circulation
  • CT scan
  • treatment
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22
Q

what are late signs of stroke (5)

A
  • coma
  • posturing
  • absent motor responses
  • fixed/dilated pupils
  • apneic periods
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23
Q

what is happening in the brain when a coma occurs during stroke

A
  • RAS affected
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24
Q

what is happening in the brain when we get posturing (decorticate or decerebrate) during a stroke

A
  • massive infarct
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25
Q

what is happening in the brain when we get absent motor responses during a stroke

A
  • massive infarct
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26
Q

what is happening in the brain when we get fixed/dilated pupils during a stroke

A
  • damage to CN3
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27
Q

what is happening in the brain when we get apneic periods during a stroke

A
  • brainstem pressure & cell death
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28
Q

the late signs of a stroke are due to (2)

A
  • cell death due to ischemia/infarction

- increased ICP (herniation)

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29
Q

what should you assess regarding subjective data for stroke assessment (5)

A
  • assess onset, duration, nature, and changes
  • underlying causes/comorbidities
  • history of similar symptoms
  • meds
  • risk factors
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30
Q

what is the highest priorty for a pt with a stroke

A

ABCs

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31
Q

why would you want to assess BG during a stroke assessment (2)

A
  • hypo/hyperglycemia can mimic stroke/neuro issues

- stroke causes BG to fluctuate = deterioration of prognosis

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32
Q

describe what to assess during a neuro check (10)

A
  • ABCs
  • GCS
  • vitals
  • LOC
  • orientation
  • pupils
  • gag/cough/swallow reflex
  • speech (expressive & receptive)
  • motor function & response (face & all limbs)
  • drift
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33
Q

what is the connection between neuro & airway (2)

A
  • damage to CN 9&10 = difficulty swallowing = risk of aspiration
  • resp centers & hypothalamus can be depressed in CNS emergency
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34
Q

what are the protective nervs

A

9 and 10

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35
Q

why are CVA diagnostics used (3)

A
  • to differentiate a stroke diagnosis vs another brain injury/lesion
  • identify the cause
  • guide or treatment
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36
Q

what are 2 CVA diagnostics

A
  • CT

- MRI

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37
Q

what do CVA diagnostics provide (3)

A
  • location
  • size of lesion
  • differentiate between ischemic & hemorrhagic
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38
Q

what kind of treatment is used for ischemic stroke

A
  • thrombolytics
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39
Q

what kind of treatment is used for hemorrhagic stroke

A
  • surgery
40
Q

what kind of blood work do we get for CVA (8)

A
  • CBC
  • coagulation studies
  • BG
  • hgb
  • A1C
  • renal function labs
  • liver function labs
  • lipid profile
41
Q

what are coagulation studies important for?

A

hemorrhagic stroke

42
Q

what is the pharmacology for ischemic stroke

A
  • thrombolytic
  • antiHTN
  • antiepileptic
43
Q

what thrombolytic is used for ischmeic strokes

A
  • tpa (alteplase)
44
Q

what are the indications for alteplase (3)

A
  • ischemic stroke
  • acute ST-elevation myocardial infarction
  • pulmonary embolism
45
Q

what is the MOA of alteplase

A
  • binds to fibrin in a blood clot & activates plasminogen to form plasmin (fibrinolytic enzyme) = breaks down & dissolves clot
46
Q

what are contraindications for alteplase (9)

A
  • bleeding disorders
  • active bleeding
  • history of cerebral aneurysm
  • AV malformation
  • history of cerebral hemorrhage
  • head trauma
  • peptic ulcer disease
  • pregnancy
  • anticoag use
47
Q

what must be monitored while a pt is on alteplase (3)

A
  • vitals
  • EKG
  • for bleeding
48
Q

what must be screened before a pt is given alteplase

A
  • confirmation of ischemic stroke
  • history taken
  • coagulation blood work sent
49
Q

how is alteplase given

A

IV

50
Q

when is alteplase administered

A
  • within 3-4.5 hrs of symptom onset
51
Q

what is the “door to needle” time for alteplase

A

<60 min

52
Q

what effect do ischemic strokes have on BP

A
  • elevated BP due to cushing’s triad
53
Q

at what point are antiHTNs given for a ischemic stroke

A
  • if >220 mhg
54
Q

what antiHTN is given for ischemic stroke

A
  • intravenous labetalol
55
Q

what do ischemic strokes have a risk of causing

A
  • seizures
56
Q

when is there a risk of seizures r/t stroke

A
  • within the first 24 hr
57
Q

what antiepileptic is used for ischemic strokes

A
  • should be started on a prophylactic AED such as dilantin (phenytoin)
58
Q

what pharmcology is used for hemorrhagic stroke

A
  • antiHTN
  • AED
  • osmotic diuretics
59
Q

what is the goal BP for a hemorrhagic stroke

A
  • systolic < 160 mmHg
60
Q

why does blood pressure need to be more closely controlled for a hemorrhagic stroke compared to an ishcmeic

A
  • a hemorrhage in the brain will worsen w increased blood flow
  • therefore, increased BP will cause increased bleeding & ICP
  • can also cause a rebleed
61
Q

what antiepileptic drug is used for hemorrhagic strokes

A
  • stroke may cause seizure in the first 24 hr

- use a prophylactic AED such as dilantin (phenytoin)

62
Q

why might osmotic diuretic may be used for hemorrhagic stroke

A
  • hemorrhagic stroke causes increased ICP
63
Q

what is an osmotic diuretic used for hemorrhagic stroke

A
  • mannitol
64
Q

what does mannitol do

A
  • the sugar in mannitol pulls fluid from the brain tissue which is then removed via the kdienys
65
Q

why are osmotic diuretics used for hemorrhagic stroke

A
  • to reduce cerebral edema
66
Q

define expressive aphasia

A
  • partial loss of the ability to produce spoken & written words
67
Q

define receptive aphasia

A
  • difficulty understanding spoken & written language
68
Q

define apraxia

A
  • inability to perform learned tasks on command
69
Q

define ataxia

A
  • lack of muscle control or coordination of voluntary movements
70
Q

define dysarthria

A
  • slurred speech

- muscles involved in speech are weak, paralyzed, or damaged

71
Q

define dysphagi

A
  • difficulty swallowing
72
Q

define dysphasia

A
  • difficulty generating speech
73
Q

define hemianopia

A
  • loss of vision in half the visual field
74
Q

define hemiparesis

A
  • weakness of one side of the body
75
Q

define hemiplegia

A
  • paralysis on one side of the body
76
Q

define neglect

A
  • becoming unaware of one side of the body
77
Q

what causes the clinical manifestations of a stroke

A
  • destruction of brain tissue & cell death
78
Q

what determines the symptoms of a stroke

A
  • the location of the stroke
79
Q

stroke symptoms can affect: (6)

A
  • motor function
  • speech/communication
  • affect
  • intellectual function
  • spatial/perception
  • sensory
80
Q

what causes the changes in motor function during a stroke

A
  • destruction of motor neurons (nerve fibres from the brain, passing thru the spinal cord to motor cells
81
Q

is stroke is on the left side of the brain, what side of the body would you see symptoms

A
  • on the opposite side (contralateral)
82
Q

what are some motor signs of a stroke

A
  • hemiparesis
  • paralysis
  • loss of voluntary movement
  • difficult swallowing
  • loss of control of body movement
83
Q

what speech/communication signs might you see in a stroke

A
  • problems w speaking, writing, and understanding both writen & spoken word
  • expressive & receptive aphasia
84
Q

what else, in addition to a stroke, can cause aphasia (4)

A
  • strokes
  • head injuries
  • conditions that damage the brain over time (like alzheimers)
  • brain tumor
85
Q

what causes expressive aphasia

A
  • damage to broca’s area

= damage to left hemisphere

86
Q

what are the manifestations of expressive aphasia

A
  • speech requires effort
  • several pauses in speech
  • difficulty producing grammatical sentences
  • trouble “finding the right words”
  • difficulty writing
87
Q

what is still intact during expressive aphasia

A
  • understanding of spoke & written words
88
Q

what causes receptive aphasia

A
  • damage to wernicke’s

= damage to left hemisphere

89
Q

what are signs of receptive aphasia

A
  • what saying does not mean sense
  • not understanding what you are saying/writing
  • may not realize they are using the wrong words
90
Q

what is still intact during receptive aphasia

A
  • can produce words & speak fluenty
91
Q

what effect can strokes have on affect (7)

A
  • depression
  • fear
  • anger
  • sadness
  • frustration
  • grief
  • emotionally labile
92
Q

damage to the frontal lobe during a stroke may have what effect on affect

A
  • may impact pt’s emotional reactions
93
Q

what impact can strokes have on intellectual function (8)

A

can impact:

  • memory
  • learning
  • judgement
  • awareness
  • difficulty making plans
  • difficulty comprehending
  • difficulty learning new tasks
  • difficulty engage in complex mental activities
94
Q

what impact can strokes have on spatial-perception

A

difficulty

  • drawing or copying objects
  • recognizing objects
  • telling lef from right
  • doing mathematics
  • analyzing & remembering visual info
  • manipulating or constructing objects
  • awareness of body in space (ex. climbing stairs)
  • perception of enviro (following directions)
95
Q

what is anosognosia

A
  • inability to preceive the relatities of one’s condition
96
Q

what impact can strokes have on sensory (7)

A
  • pain
  • numbness
  • tingling, prickling, pins/needles
  • loss of bladder/bowel control
  • loss of feeling of temp & touch
  • changes in vision
  • loss of propioception
97
Q

see seminar notes for some interventions related to stroke but theres lots & mostly common sense

A

…

NURS 2514 (75 decks)

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