Wednesday, 8-24-Stroke-Hon

Question 1

What are some causes of ischemic stroke?

Answer 1

• large artery atherosclerosis with thromboembolism
• small vessel (lacunar) disease
• cardioembolism
• nonatherosclerotic vasculopathies (i.e., syphyilis)
• hypercoagulable states

Question 2

What are some risk factors for stroke?

Answer 2

Increasing age
Previous TIA or stroke
Atherosclerosis --> HTN, smoking, DM, hyperlipidemia
Genetics
Cardiac disorders
Drug abuse
OC's
Pregnancy/postpartum period
Fibromuscular dysplasia
Hypercoagulable states
Inflamm disorders

Question 3

How is a stroke generally managed?

Answer 3

Primary prevention
Management of acute stroke itself (major area of change)
Prevention or control of medical complications (Med complications account for 50% of deaths attributable to stroke such as pneumonia, DVT, PE, UTI, decubitus ulcers)
Rehab
Prevent recurrent stroke

Question 4

Acute HTN is common in __ stroke and in most cases should NOT be treated

Answer 4

Acute ischemic

Question 5

All stroke pts need to have IV access. What should IVF not include?

Answer 5

Glucose as hyperglycemia is associated with worse neurologic outcomes

Question 6

If tPA is a consideration, how many IV access sites are needed?

Answer 6

2-to eliminate venipuncture after infusion

Question 7

A NIH stroke scale score 20 indicates __ % risk of hemorrhage

Answer 7

2-3%

17%

Question 8

Summarize the evaluation and tx of acute stroke:

Answer 8

• ABC’s
• Elevated HOB to 30 degrees (to decrease ICP)
• O2 at 2 liters per NC
• Obtain vital signs and establish IV with NS (NO GLUCOSE!)
• Obtain labs: CBC, PT, PTT, Chem profile
• EKG
• Obtain pt weight
• try to ID cause and treat fever if present
• Obtain history

Question 9

What are some clinical situations in which warfarin is generally indicated?

Answer 9

• a fib
• prosthetic valve
• atrial septal defect
• hypercoagulable state
• large vessel disease (e.g., carotid or vertebral dissection or large artery intracranial stenosis)

Question 10

The majority of strokes are of this type:

Answer 10

Ischemic=80%

Hemorrhagic=20%