Week 9 - Stroke Assessment & Meds Flashcards
“time is brain” what does it mean
- every minute without blood flow & intervention can lead to loss of more brain cells & increased risk of permanent damage
define ischemia
- restriction of blood supply to tissues
define infarction
- tissue death due to inadequate blood supply
define atherosclerosis
- build up of plaque on the artery walls which can restrict blood flow
define arteriosclerosis
- thick & stiff arteries that can result in restriction of blood flow
define transient ischemic attack
- temporary episode of neurologic dysfunction caused by ischemia
define ischemic stroke
- classification of stroke that results from inadequate blood flow
define hemorrhagic stroke
- classification of stroke that results from bleeding into the brain
define thrombotic stroke
- type of stroke that occurs when a blood clot forms in a diseases or narrowed blood vessel
define embolic stroke
- type of stroke that occurs when an embolus lodges in & occludes a cerebral artery
what is type of stroke associated w a cerebral aneurysm
- hemorrhagic
what are risk factors for formation of fatty deposits in arteries & plaque formation (5)
- high BMI
- alcohol
- hyperlipidemia
- diabetes
- family history
what are risk factors for hypercoaguable blood (3)
- sedentary lifestyle
- atrial fibrillation
- birth control pills
what are risk factors for shearing stress & epithelial injury (2)
- HTN
- FHx
what is a risk factors for arterial spasms & sudden decrease in blood flow
- recreational drugs
what is a risk factor for weakened or stretched blood vessels to burst, resulting in bleeding (2)
- AVM
- aneurysm
what is a risk factor for catecholamine release, which increases HR, vasoconstriction, and BP (2)
- smoking
- stress
what is FAST
- a tool to assess for stroke
what does FAST sign for
Facial droop
Arm (palmar drift)
Slurred speech
Time (to get help)
what are CVA warning signs (6)
- 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
what are immediate priorities with a CVA which must be done within the first 4.5 hrs (6)
- note onset of symptoms
- assess/manage airway
- assess/manage breathing
- assess/manage circulation
- CT scan
- treatment
what are late signs of stroke (5)
- coma
- posturing
- absent motor responses
- fixed/dilated pupils
- apneic periods
what is happening in the brain when a coma occurs during stroke
- RAS affected
what is happening in the brain when we get posturing (decorticate or decerebrate) during a stroke
- massive infarct
what is happening in the brain when we get absent motor responses during a stroke
- massive infarct
what is happening in the brain when we get fixed/dilated pupils during a stroke
- damage to CN3
what is happening in the brain when we get apneic periods during a stroke
- brainstem pressure & cell death
the late signs of a stroke are due to (2)
- cell death due to ischemia/infarction
- increased ICP (herniation)
what should you assess regarding subjective data for stroke assessment (5)
- assess onset, duration, nature, and changes
- underlying causes/comorbidities
- history of similar symptoms
- meds
- risk factors
what is the highest priorty for a pt with a stroke
ABCs
why would you want to assess BG during a stroke assessment (2)
- hypo/hyperglycemia can mimic stroke/neuro issues
- stroke causes BG to fluctuate = deterioration of prognosis
describe what to assess during a neuro check (10)
- ABCs
- GCS
- vitals
- LOC
- orientation
- pupils
- gag/cough/swallow reflex
- speech (expressive & receptive)
- motor function & response (face & all limbs)
- drift
what is the connection between neuro & airway (2)
- damage to CN 9&10 = difficulty swallowing = risk of aspiration
- resp centers & hypothalamus can be depressed in CNS emergency
what are the protective nervs
9 and 10
why are CVA diagnostics used (3)
- to differentiate a stroke diagnosis vs another brain injury/lesion
- identify the cause
- guide or treatment
what are 2 CVA diagnostics
- CT
- MRI
what do CVA diagnostics provide (3)
- location
- size of lesion
- differentiate between ischemic & hemorrhagic
what kind of treatment is used for ischemic stroke
- thrombolytics
what kind of treatment is used for hemorrhagic stroke
- surgery
what kind of blood work do we get for CVA (8)
- CBC
- coagulation studies
- BG
- hgb
- A1C
- renal function labs
- liver function labs
- lipid profile
what are coagulation studies important for?
hemorrhagic stroke
what is the pharmacology for ischemic stroke
- thrombolytic
- antiHTN
- antiepileptic
what thrombolytic is used for ischmeic strokes
- tpa (alteplase)
what are the indications for alteplase (3)
- ischemic stroke
- acute ST-elevation myocardial infarction
- pulmonary embolism
what is the MOA of alteplase
- binds to fibrin in a blood clot & activates plasminogen to form plasmin (fibrinolytic enzyme) = breaks down & dissolves clot
what are contraindications for alteplase (9)
- bleeding disorders
- active bleeding
- history of cerebral aneurysm
- AV malformation
- history of cerebral hemorrhage
- head trauma
- peptic ulcer disease
- pregnancy
- anticoag use
what must be monitored while a pt is on alteplase (3)
- vitals
- EKG
- for bleeding
what must be screened before a pt is given alteplase
- confirmation of ischemic stroke
- history taken
- coagulation blood work sent
how is alteplase given
IV
when is alteplase administered
- within 3-4.5 hrs of symptom onset
what is the “door to needle” time for alteplase
<60 min
what effect do ischemic strokes have on BP
- elevated BP due to cushing’s triad
at what point are antiHTNs given for a ischemic stroke
- if >220 mhg
what antiHTN is given for ischemic stroke
- intravenous labetalol
what do ischemic strokes have a risk of causing
- seizures
when is there a risk of seizures r/t stroke
- within the first 24 hr
what antiepileptic is used for ischemic strokes
- should be started on a prophylactic AED such as dilantin (phenytoin)
what pharmcology is used for hemorrhagic stroke
- antiHTN
- AED
- osmotic diuretics
what is the goal BP for a hemorrhagic stroke
- systolic < 160 mmHg
why does blood pressure need to be more closely controlled for a hemorrhagic stroke compared to an ishcmeic
- a hemorrhage in the brain will worsen w increased blood flow
- therefore, increased BP will cause increased bleeding & ICP
- can also cause a rebleed
what antiepileptic drug is used for hemorrhagic strokes
- stroke may cause seizure in the first 24 hr
- use a prophylactic AED such as dilantin (phenytoin)
why might osmotic diuretic may be used for hemorrhagic stroke
- hemorrhagic stroke causes increased ICP
what is an osmotic diuretic used for hemorrhagic stroke
- mannitol
what does mannitol do
- the sugar in mannitol pulls fluid from the brain tissue which is then removed via the kdienys
why are osmotic diuretics used for hemorrhagic stroke
- to reduce cerebral edema
define expressive aphasia
- partial loss of the ability to produce spoken & written words
define receptive aphasia
- difficulty understanding spoken & written language
define apraxia
- inability to perform learned tasks on command
define ataxia
- lack of muscle control or coordination of voluntary movements
define dysarthria
- slurred speech
- muscles involved in speech are weak, paralyzed, or damaged
define dysphagi
- difficulty swallowing
define dysphasia
- difficulty generating speech
define hemianopia
- loss of vision in half the visual field
define hemiparesis
- weakness of one side of the body
define hemiplegia
- paralysis on one side of the body
define neglect
- becoming unaware of one side of the body
what causes the clinical manifestations of a stroke
- destruction of brain tissue & cell death
what determines the symptoms of a stroke
- the location of the stroke
stroke symptoms can affect: (6)
- motor function
- speech/communication
- affect
- intellectual function
- spatial/perception
- sensory
what causes the changes in motor function during a stroke
- destruction of motor neurons (nerve fibres from the brain, passing thru the spinal cord to motor cells
is stroke is on the left side of the brain, what side of the body would you see symptoms
- on the opposite side (contralateral)
what are some motor signs of a stroke
- hemiparesis
- paralysis
- loss of voluntary movement
- difficult swallowing
- loss of control of body movement
what speech/communication signs might you see in a stroke
- problems w speaking, writing, and understanding both writen & spoken word
- expressive & receptive aphasia
what else, in addition to a stroke, can cause aphasia (4)
- strokes
- head injuries
- conditions that damage the brain over time (like alzheimers)
- brain tumor
what causes expressive aphasia
- damage to broca’s area
= damage to left hemisphere
what are the manifestations of expressive aphasia
- speech requires effort
- several pauses in speech
- difficulty producing grammatical sentences
- trouble “finding the right words”
- difficulty writing
what is still intact during expressive aphasia
- understanding of spoke & written words
what causes receptive aphasia
- damage to wernicke’s
= damage to left hemisphere
what are signs of receptive aphasia
- what saying does not mean sense
- not understanding what you are saying/writing
- may not realize they are using the wrong words
what is still intact during receptive aphasia
- can produce words & speak fluenty
what effect can strokes have on affect (7)
- depression
- fear
- anger
- sadness
- frustration
- grief
- emotionally labile
damage to the frontal lobe during a stroke may have what effect on affect
- may impact pt’s emotional reactions
what impact can strokes have on intellectual function (8)
can impact:
- memory
- learning
- judgement
- awareness
- difficulty making plans
- difficulty comprehending
- difficulty learning new tasks
- difficulty engage in complex mental activities
what impact can strokes have on spatial-perception
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)
what is anosognosia
- inability to preceive the relatities of one’s condition
what impact can strokes have on sensory (7)
- pain
- numbness
- tingling, prickling, pins/needles
- loss of bladder/bowel control
- loss of feeling of temp & touch
- changes in vision
- loss of propioception
see seminar notes for some interventions related to stroke but theres lots & mostly common sense
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