acute stroke

Question 1

what does timely out of bed activities prevent

Answer 1

• DVT
• pulmonary emboli
• pneumonia
• falls

Question 2

why is orthostatic hypertension so bad for CVA pts

Answer 2

• because it decrease blood perfusion and O2 to the brain
• do not avocate for high intensity in acute care only rehab

Question 3

types of stokes

Answer 3

• embolic
• lacunar
• athero-thrombotic

Question 3

what does the lacunal strokes affect

Answer 3

• motor due to lack of O2 during stroke to internal capsule
• usually involves the posterior limb of the internal capsule
• no sensory, aphasia, or visual field abnormalities
• dysarthria might be present

Question 3

lacunar stroke or lacunar infarct pathology

Answer 3

• most common type of ischemic stroke
• resulting from the osculation of small penetrating arteries the provide blood to the brains deep structures (internal capsule)
• etiology of chronic hypertension

Question 4

signs and symptoms to review prior to out of bed activities

Answer 4

• nausea
• vomiting
• dizziness
• light-headedness
• loss of alertness
• confusion
• headache
• ringing in ears
• sweating

Question 5

location of the internal capsule

Answer 5

• subcortical structures that include: internal capsule, caudate, putamen, globus pallidus, thalamus, brainstem
• anterior limb separates the caudate nucleus and lenticular nucleus
• the posterior limb separates the thalamus and lenticular nucleus

Question 6

type of fibers in the internal capsule

Answer 6

• anterior limb: frontopontine fibers, thalamocortical fibers
• genu: corticobulbar fibers
• posterior limb: corticospinal fibers (cortex to spine), sensory fibers

Question 7

blood supply to the internal capsule

Answer 7

• anterior limb: lenticulostriate branches of MCA and ACA
• Genu: lenticulostriate branches of MCA
• posterior limb: lenticulostriate branches of MCA and anterior choroidal artery

Question 8

clinical findings in internal capsular stroke

Answer 8

• weakness of the face, arm and or leg (test CN 7 and 2)
• UMN signs: hyperreflexia, babinski sign, hoffman present, clonus, spasticity

Question 9

watershed infarctions

Answer 9

• infarcts in areas where this is reduced profusion due to blockage of the ACA, MCA, or PCA.
• occurs with internal carotid artery blockage or a carotid artery blockage

Question 10

Transient Ischemic Attacks (TIA)

Answer 10

• typically less then 10 minutes
• longer then 10 minutes tissue cells will start to die
• TIA lasting longer then an hour will cause small infarcts
• requires an ER visit
• Early warning sign for a larger stroke

Question 11

Etiology of TIA

Answer 11

• thrombus emerging
• vasospasm
• small emboli: dissolves

Question 12

signs and symptoms of a TIA

Answer 12

• high BP
• weakness on one side of the body
• vision problems
• slurred speech

Question 13

treatment of TIA

Answer 13

medication, surgery, and healthy lifestyle changes

Question 14

cerebral edema

Answer 14

• internal pressure within the cortex from hemorrhage or inflammation
• fluid can push the brain contents to the other side
• serious consequence of stroke that can lead to early mortality

Question 15

cerebral perfusion pressure (CPP)

Answer 15

the net pressure gradient that drives oxygen delivery to cerebral tissue

Question 16

intracranial pressure (ICP)

Answer 16

• measured invasively though an intracranial pressure transduction device (intraventricular monitor)
• mean arterial pressure - ICP = cerebral perfusion pressure

Question 17

normal CPP

Answer 17

55 to 60

Question 18

normal ICP

Answer 18

5 to 15
ICP values of 20 to 30 represent intracranial hypertension

Question 19

hemorrhagic stroke

Answer 19

leads to increased pressure in teh brain and reduces cerebral perfusion

Question 20

tumors in the brain

Answer 20

create cortical pressure and reduce brain perfusion

Question 21

infection of the brain

Answer 21

changes in the regulation of cerebral perfusion may occur

Question 22

CARE for individual with CVA

Answer 22

stage 1: hospital and acute care
stage 2: inpt rehab or SNF
stage 3: At home health care
stage 4: outpt care
stage 5: after discharge

Question 23

goldilocks : u shaped curve

Answer 23

make sure the ex is an appropriate level of intensity so the BP does not get too high or too low

Question 24

tissue plasminogen activator (tPA)

Answer 24

- clot buster and timely management of high BP - when administered 3 hrs after a sroke it helps to restore blood flow to brain regions affected by a stroke, thereby limited the risk of damage and functional impairment

Question 25

what is tPA associated with

Answer 25

- more frequent independent ambulation at discharge - discharge to home - reduced mortality and symptomatic intracerebreal hemorrhage

Question 26

not a candidate for IV tPA or IAT

Answer 26

BP up to 220/120 may be permitted to allow for maximal perfusion unless otherwise contraindicated

Question 27

candidate for IV tPA or IAT

Answer 27

lower BP to less them 185/110 prior to giving tPA or in preperation for the angiography suite

Question 28

hypotension in the intial setting of stroke care

Answer 28

no formal guidelines exist for a lower limit of BP, hypotension is associated with worse outcomes. ensure that it is not related to volume depletion, cardiac abnormalities or shock

Question 29

during IAT

Answer 29

maintain systolic BP at 140-180

Question 30

incomplete reperfusion after tPA

Answer 30

maintain BP of greater then 180/105 consider induces hypertension

Question 31

successful reperfusion of tPA

Answer 31

- consider a lower threshold of systolic less then 140-160 - monitor closely for changes in neurologic examination which can suggest reperfusion injury

Question 32

mobility after acute ischemic stroke

Answer 32

pt should receive mobility 13-24 hours after receiving tPA SBP should be between 140-160

Question 33

what is the recommendation for out of bed activities

Answer 33

Early lower- dose out of bed activities first day: 10-20 minutes

Question 34

Preparing for out of bed activities

Answer 34

- receive orders from MD - review the chart (look for type of stroke, location and meds)

Question 35

PT area if assessment and decision making

Answer 35

- skin integrity: ER and one floor - Mobility: out of bed with PT - Caregiver availability (education) - spasticity - durable medical equipment - recommendation regarding transition to appropriate level of care

Question 36

rapid large falls in BP can reduce

Answer 36

cerebral blood flow leading to extension of the cerebral infarction or perihematomal ischemia

Question 37

what is the general goal for CVA patients BP

Answer 37

less then 180. 20 point role fro systolic

Question 38

deterioration

Answer 38

change in orientation - symptoms: new headache, acute hypertension, nausea or vomiting, changes in pulse ox or 02 sat, SOB, syncope

Question 39

when should BP start to return back to nomal after tPA

Answer 39

48 hrs after given

Question 40

outcome measures for stroke

Answer 40

- 6 minute walk - TUG - 5 TSTS - 10 MWT