WK 5: CVA Flashcards
Modifiable & non-modifiable risk factors for stroke
Nonmodifiable Risk Factors
○ Age
○ Sex
○ Ethnicity and race
○ Heredity/family history
○ Personal circumstances
○ Arteriovenous malformation
· Modifiable Risk Factors
○ Hypertension
○ Diabetes mellitus
○ Heart disease
○ Increased serum cholesterol
○ Heavy alcohol consumption
○ Oral contraceptive use
○ Physical inactivity
○ Smoking
○ Substance use
○ Obesity
What is ischemic Stroke?
· Inadequate blood flow to the brain from partial or complete occlusion of an artery
The majority of all strokes are ischemic strokes.
What is a hemorrhagic Stroke?
· Account for approximately 15% of all strokes
· Result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles
· Often a sudden onset of symptoms, with progression over minutes to hours because of ongoing bleeding
Most important cause of hemorrhagic stroke is hypertension
What is a TIA?
Transient ischemic attack (TIA)
○ usually a precursor to ischemic stroke.
○ Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction of the brain
Symptoms last <1 hour.
What are the clinical manifestations of stroke?
· Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
· Sudden confusion, trouble speaking, or difficulty understanding speech.
· Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
What is expressive aphasia
Occurs when there is damage to the part of the brain that controls speech production (Broca’s area).
What is receptive aphasia
When someone is able to speak well and use long sentences, but what they say may not make sense.
What is global aphasia
Profound impairment of all modalities of receptive and expressive language.
What is ataxia
Poor muscle control that causes clumsy voluntary movements.
What is agnosia
Neurological disorder characterized by an inability to recognize and identify objects or persons using one or more of the senses.
What is dysarthria
Where you have difficulty speaking because the muscles you use for speech are weak
What is apraxia
The loss of ability to execute or carry out skilled movement and gestures, despite having the physical ability and desire to perform them
What is dysphagia
The medical term for swallowing difficulties
Why are CT scans important in evaluating acute stroke?
· CT scans can show areas of abnormalities in the brain, and can help determine if these areas are caused by insufficient blood flow (ischemic stroke), a ruptured blood vessel (hemorrhage), or another issue entirely.
Assessments of Acute Stroke
· Monitoring BP
· Monitor Vital Signs
· Level of consciousness
· Motor and sensory function
· Pupil size and reactivity
· O2 saturation
· Cardiac rhythm
Patient positioning of Acute Stroke
○ The patient is usually discharged from the acute care setting to home, an intermediate or long-term care facility, or a rehabilitation facility.
○ Ideally, discharge planning starts early in the hospitalization
○ Rehabilitation is the process of maximizing the patient’s capabilities and resources to promote optimal functioning.
□ Physical, mental, and social well-being
○ Cognition, coping, physical deficits, and emotional lability are difficult for the patient and family.
Speech th
tPA administration for Acute Stroke
○ Used to re-establish blood flow through a blocked artery to prevent cell death in patients with acute onset of ischemic stroke symptoms
○ Must be administered within 4.5 hours of onset of clinical signs of ischemic stroke
○ tPA is administered IV.
○ No antiplatelet or anticoagulants may be given with tPA.
If tPA is expected as a treatment option, the nurse should be proactive by inserting a Foley catheter and multiple IVs before tPA administration.
What are contraindications to tPA administration
· tPA increases the risk of intracranial hemorrhage
Why is it important to monitoring BP and neurologic assessment in the stroke patient?
· Blood pressure that is too low can also cause problems, such as dizziness and fainting, which can increase the risk of falls and further injury.
· Therefore, it is important to maintain blood pressure within a healthy range to reduce the risk of stroke and other complications
What are signs of increasing intracranial pressure
· Headache.
· Blurred vision.
· Confusion.
· High blood pressure.
· Shallow breathing.
· Vomiting.
· Changes in your behavior.
· Weakness or problems with moving or talking.
Nursing management in the care of a patient post-CVA
· skin integrity
· bowel management
· Communication
· Nutrition
· Coping
· managing risk factors
Antiplatelets for stroke
o chosen treatment to prevent further stroke in patients who have had a TIA.
o Aspirin is the most frequently used antiplatelet agent.
· The common dose for Aspirin is 81–325 mg/day.
· May also use clopidogrel (Plavix)
Statins for stroke
o (simvastatin [Zocor], lovastatin [Mevacor])
o are effective in the prevention of stroke for individuals who have experienced a TIA in the past.
Oral anticoagulants for stroke
o apixaban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto) is the treatment of choice for individuals with atrial fibrillation (AF) who have had a TIA.
