Stroke

Question 1

Stroke that is due to brain bleed from a broken blood vessel. Excessive swelling

Answer 1

hemorrhagic stroke

Question 2

causes of hemorrhagic stroke

Answer 2

brain aneurysm bursts, uncontrolled hypertension, old age (vessels not resilient)

Question 3

Mini stroke. S/S lasts minutes to hours

Answer 3

Transient Ischemic Stroke (TIA)

Question 4

S/S of TIA “Strokes Happen”

Answer 4

Smoking, Thinners, Rhythm (AFib), Oral contraceptives, Kin, Excessive weight, Senior Citizens. Hypertension, Atherosclerosis, Physical inactivity, Previous TIA, Elevated blood glucose (DM), aneurysm brain

Question 5

Type of stroke that is a blockage of blood vessels, narrowing, and lack of blood flow to an area. “Brain Attack”

Answer 5

Ischemic stroke

Question 6

why do ischemic strokes happen?

Answer 6

Embolism, thrombus clot forms within artery wall in neck or brain, seen in pt. with hyperlipidemia or atherosclerosis

Question 7

what are the two types of ischemic stroke?

Answer 7

thrombotic and embolic

Question 8

type of ischemic stroke that is acute occlusion by blood clots secondary to atherosclerosis which narrow the lumen of the artery (stenosis)

Answer 8

thrombotic

Question 9

type of ischemic stroke where a clot breaks off, travel and blocks blood flow resulting in infarct/death of tissue distal to the embolism

Answer 9

embolic stroke

Question 10

what heart condition is transient ischemic attacks similar to

Answer 10

angina

Question 11

risk factors for embolic stroke

Answer 11

plaque, faulty heart valves (pooling of blood), and cardiogenic embolisms

Question 12

weakness, sensory loos on one side of the body, unilateral visual deficits, loss of speech, facial droop

Answer 12

neurological signs of stroke

Question 13

clinical manifestations of stroke

Answer 13

sudden weakness, numbness, difficulty talking, difficulty understanding, severe headaches with no known cause

Question 14

which part of the brain would you have weakness of left extremities and face

Answer 14

motor area of the right cerebral hemisphere

Question 15

which part of the brain would you have loss of coordination on right extremities

Answer 15

left parietal lobe

Question 16

which part of the brain would you have unsteadiness and poor coordination

Answer 16

cerebellum

Question 17

which part of the brain would you have receptive dysphasia

Answer 17

Wernicke’s area

Question 18

which part of the brain would you have expressive dysphasia

Answer 18

Broca’s area

Question 19

Three part of Glascow coma scale

Answer 19

Eye opening response (1-4), Best Verbal response (1-5), and Best Motor response (1-6)

Question 20

GCS eye opening response list

Answer 20

Spontaneously (4), To speech (3), To pain (2), Unresponsive (1)

Question 21

GCS verbal response list

Answer 21

Oriented to time, place and person (5), Confused (4), Inappropriate words (3), Incomprehensible sounds (2), No response (1)

Question 22

GCS motor response list

Answer 22

Obeys commands (6), Moves to localized pain (5), Flexion withdraw from pain (4), Abnormal flexion (decorticate) 3, abnormal extension (decerebrate) 2, No response (1)

Question 23

LOC: alert and oriented x 3, good verbal and written comprehension and expression, socially acceptable responsible behavior

Answer 23

fully conscious

Question 24

LOC: disoriented to time, place, or person, short attention span, memory difficulties, difficulty following commands and change in agitation, restlessness, or irritability

Answer 24

confusion

Question 25

LOC: speech, mental processes, motor activities are slower

Answer 25

lethargy

Question 26

LOC: around with tactile stimuli, responds with one or two works, follows simple commands only when stimulated

Answer 26

obtundation

Question 27

LOC:minimal spontaneous movement except with vigorous and constant stimuli are applied, moaning/groaning, responds purposefully when noxious stimuli are applied

Answer 27

stupor

Question 28

LOC: total absence or awareness of self and environment

Answer 28

Coma

Question 29

Ask the client to smell and identify the smell of cologne with each nostril separately and with the eyes closed.

Answer 29

Cranial nerve I (olfactory)

Question 30

Provide adequate lighting and ask client to read from a reading material held at a distance of 36 cm. (14 in.).

Answer 30

Cranial nerve II (optic). Visual acuity/visual fields

Question 31

Reaction to light:
Using a penlight and approaching from the side, shine a light on the pupil. Observe the response of the illuminated pupil. Shine the light on the pupil again, and observe the response of the other pupil.

Answer 31

Cranial nerve III (oculomotor). Eye and lid moment, pupil constriction , lens accommodation

Question 32

Reaction to accommodation:
Ask client to look at a near object and then at a distant object. Alternate the gaze from the near to the far object. Next, move an object towards the client’s nose.

Answer 32

Cranial nerve III (oculomotor). Eye and lid moment, pupil constriction , lens accommodation

Question 33

Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally.

Answer 33

Cranial nerve IV (trochlear). Eye movement

Question 34

While client looks upward, lightly touch lateral sclera of eye to elicit blink reflex.
To test light sensation, have client close eyes, wipe a wisp of cotton over client’s forehead.
To test deep sensation, use alternating blunt and sharp ends of an object. Determine sensation to warm and cold object by asking client to identify warmth and coldness.

Answer 34

Cranial nerve V (trigeminal). Corneal reflex, mastication, facial sensation

Question 35

Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight through the six cardinal fields of gaze.

Answer 35

Cranial nerve VI (abducens). Eye movement, eye muscles

Question 36

Ask client to smile, raise the eyebrows, frown, and puff out cheeks, close eyes tightly. Ask client to identify various tastes placed on the tip and sides of tongue.

Answer 36

Cranial nerve VII (facial). Facial expression, salivation, tearing, taste, ear sensation.

Question 37

Have the client occlude one ear. Out of the client’s sight, place a tickling watch 2 to 3 cm. ask what the client can hear and repeat with the other ear.
Ask the client to walk across the room and back and assess the client’s gait.

Answer 37

Cranial nerve VIII ,acoustic: hearing and equilibrium

Question 38

Ask the client to say “ah” and have the patient yawn to observe upward movement of the soft palate.
Elicit gag response.
Note ability to swallow

Answer 38

Cranial nerve IX (Glossopharyngeal). Taste, swallowing, gag, sensation of tongue and pharynx

Question 39

Ask the patient to swallow and speak (note hoarseness)

Answer 39

Cranial nerve X (vagus).

Question 40

Ask client to shrug shoulders against resistance from your hands and turn head to side against resistance from your hand (repeat for other side).

Answer 40

XI. Accessory. Sternocleidomastoid and trapezius muscles

Question 41

Ask client to protrude tongue at midline and then move it side to side.

Answer 41

XII. Hypoglossal, Movement of tongue

Question 42

which medication has many set limits on whether you can use it due to bleeding

Answer 42

t-PA (streptokinase)

Question 43

antiplatelet medications: inhibit platelet adhesion and aggression

Answer 43

Aspirin, Clopidogrel (Plavix). Monitor for bleeding, bruise, petechiae, coffee ground emesis, tarry stool, frank blood

Question 44

anticoagulant therapy

Answer 44

warfarin (Coumadin) - monitor PT/INR.

Question 45

osmotic diuretic

Answer 45

Mannitol

Question 46

hyperosmolar treatment to reduce cerebral edema

Answer 46

hypertonic solution for cerebral edema