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Complex Care > Stroke > Flashcards

Stroke Flashcards

1
Q

Expressive Aphasia

A

Damage to Broca’s area in frontal cortex

Able to understand speech but left with limited language

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2
Q

Receptive Aphasia

A

Damage to Wernicke’s area in temporal lobe

Impaired language comprehension

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3
Q

Two major classifications of stroke

A

Ischemic and Hemorrhagic

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3
Q

Stroke definition

A

Acute neurologic deficit due to impaired blood flow to an area of the brain resulting in tissue injury

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4
Q

Subclassifications of ischemic stroke

A

embolic and thrombotic

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5
Q

Subclassifications of hemorrhagic stroke

A

aneurysm, AV malformation, HTN

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6
Q

What percent of cardiac output does the brain receive?

A

15-20%

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7
Q

What arteries perfuse the anterior portion of the brain?

A

R+L internal carotid arteries

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8
Q

What does a transient ischemic attack precede?

A

Thrombotic/ischemic stroke

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8
Q

What arteries perfuse the posterior portion of the brain?

A

R+L vertebral arteries

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9
Q

When assessing patient to see if they have had a TIA in the past, what symptoms should you ask about?

A
  1. dim/impaired vision
  2. weakness, numbness, tingling
  3. headache
  4. vertigo
  5. speech problems
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10
Q

What 2 things can cause a TIA?

A
  1. microemboli that temporarily block blood flow
  2. carotid stenosis
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11
Q

What the penumbra?

A

Area surrounding infarcted zone where neurons are minimally perfused but still viable

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12
Q

Describe the Cincinnati Pre-Hospital Stroke Scale

A
  1. presence/absense of facial palsy
  2. unilateral arm weakness
  3. speech: you can’t teach an old dog new tricks
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13
Q

What 3 things does the Canadian Neurological Scale assess?

A
  1. mentation
  2. motor function
  3. motor response
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14
Q

4 Clinical Manifestations of a Stroke

A
  1. Numbness/weakness of face and arms
  2. difficulty with balance and speech
  3. unilateral loss of vision
  4. contralateral hemiparesis
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15
Q

Symptoms indicative of a left-sided stroke

A
  • right sided hemiplegia
  • impaired speech/language
  • impaired right sided discrimination
  • slow, cautious performance
  • aware of deficits
  • impaired language/math comprehension
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15
Q

Symptoms indicative of a right-sided stroke

A
  • left side hemiplegia
  • left side neglect
  • spatial/perceptual problems
  • denies/minimizes problems
  • rapid performance
  • short attention span
  • impulse/safety problems
  • impaired judgment/concept of time
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16
Q

8 Key Points of Assessment of a Post Stroke patient

A
  1. General appearance
  2. Behaviour
  3. LOC/GCS
  4. PERRLA
  5. Dizziness, vision, tremors
  6. Body position, posture, gait
  7. Pain/headache
  8. MSK (sensation and strength)
17
Q

Gold standard diagnostic procedure for stroke

A

CT

17
Q

What 3 things does GCS assess?

A
  1. spontaneous eye opening
  2. appropriate verbal response
  3. follows motor commands
18
Q

Why is PTT/INR important to assess post stroke?

A

Patients on anticoagulant therapy post stroke are at increased risk of bleed

18
Q

What can a CBC show post stroke?

A
  1. Increased RBC/HgB = polycythemia = increased risk for thrombotic event
  2. decreased platelets; patients on thrombolytic therapy post stroke at increased risk of bleed
19
Q

Why is creatinine/BUN assessed post stroke?

A

May show increased levels
> Mild to moderate renal dysfunction is an independant risk factor for ischemic stroke
> May be associated with poor prognosis in patients with ischemic stroke

20
Q

Why is a pregnancy test given to women of child bearing age in assessment of stroke?

A

tPa is harmful to fetus

21
Q

Why is a lipid profile ran for stroke patients?

A

Increased LDL and triglycerides increase risk of thromboembolic event

22
Q

Why is an electrolyte panel ran on stroke patients?

A

Increased/decreased levels of sodium, potassium, or calcium may mimic symptoms
> dehydration causes altered LOC

23
Q

Why are blood glucose levels assessed for a stroke patient?

A

Hyperglycemia is associated with a poor prognosis

Hypoglycemia can mimic stroke symptoms

The brain needs a very constant supply of glucose to function properly

24
Q

Following an acute stroke, why would blood glucose be slightly elevated?

A

1/3 of stroke patients have diabetes

Stress hyperglycaemia mediated by release of cortisol and norepinephrine

25
Q

Purpose of transesophageal echocardiography for stroke

A

Will be ordered if concerned about embolic event; can look into right atrium to see clotting

Usual source of embolus causing stroke is dysrhythmia, murmur, HTN

26
Q

Why is a lumbar puncture performed for stroke patients?

A

When CT is clear but still suspicious something is going on

> r/o meningitis and subarachnoid hemorrhage

27
Q

4 Priorities for Stroke

A
  1. Inadequate perfusion r/t interruption of arterial blood flow to brain
  2. Decreased mobility r/t impaired cognition/neuromuscular changes
  3. Sensory perception deficits r/t altered neurological changes
  4. Aphasia or dysarthria r/t decreased circulation or muscle weakness
28
Q

10 Important Things to Monitor Post Stroke

A
  1. Oxygenation
  2. Glucose
  3. BP
  4. Fever
  5. ECG
  6. Seizure
  7. ABG
  8. Sats
  9. LOC
  10. Bloodwork
29
Q

Why monitor oxygenation post stroke?

A

The brain is highly sensitive to oxygen change and cerebral hypoxia can mimic symptoms of stroke

The brain cannot store oxygen or glucose and thus need a ready supply

Impaired swallowing/gag reflex increases risk for aspiration pneumonia which can lead to poor oxygenation

30
Q

Why monitor serum glucose post stroke?

A

Hyperglycemia secondary to metabolic stress r/t cortisol and catecholamine release. Increased blood sugars can cause further damage in brain (edema, bleeding rx)

Hypoglycemia can mimic symptoms of stroke

31
Q

Why monitor BP post stroke?

A
  • cerebral blood flow regulation (need adequate perfusion)
  • identification of hemorrhage
  • uncontrolled BP can exacerbate edema causing secondary injury
32
Q

Why monitor fever post stroke?

A

Fever increases oxygen needs of brain

Can indicate inflammation/infection

33
Q

Why monitor ECG post stroke?

A
  • patients post stroke are at increased risk for cardiac complications
  • arrhythmias are source of embolic stroke (stroke reoccurence)
  • Stroke can affect the autonomic nervous system and lead to changes in heart rate and blood pressure. These changes may result in cardiac ischemia (insufficient blood flow to the heart muscle). Monitoring the ECG can help identify ischemic changes
34
Q

Why monitor for seizure activity post stroke?

A

Early detection because patients are at increased risk for post-stroke/late-onset seizures

35
Q

When must tPA be started and why?

A

Within 4.5hr of onset of symptoms; outside of this outcomes get worse and risks increase

36
Q

What symptoms would cause you to stop a tPA infusion?

A

Nausea, vomiting, headache, acute hypertension

37
Q

When should patients with acute ischemic stroke/TIA start aspirin?

A

Within 48 hours of onset

38
Q

What are patients on tPA at increased risk for?

A

bleedings

39
Q

What are contraindications for aspirin?

A

allergy, GI bleed

40
Q

Besides aspirin, what other anti-platelets may a stroke patient be on?

A
  • Plavix
  • Apixaban
  • Rivaroxaban
41
Q

What must be avoided for 24 hours after tPA treatment?

A

Anticoagulants

42
Q

What 3 surgeries could stroke patients undergo?

A
  1. cerebral angioplasty with stent placement
  2. carotid endarterectomy
  3. aneurym clipping or coiling

Complex Care (9 decks)

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