Flashcards in Adult Health Chapter 45 Neuro Deck (72)
What are some non-modifiable risk factors for ischemic stroke?
2/3 over 65
Race-Higher incidence AA, NA, Hispanic than caucasian
Heredity-Family history, Previous TIA/CVA
What are some modifiable risk factors for ischemic stroke?
Asymptomatic carotid stenosis
Oral contraceptive use
Heavy alcohol use
Describe a hemorrhagic stroke.
Rupture of vessel
What is the patho behind a hemorrhagic stroke.
Blood will enter brain tissue, cerebral ventricles, &/or subarachnoid space
Tissue compression, blood vessel spasm, and edema occur
Blood is irritant to tissues, causing inflammatory reaction and affecting CSF circulation/absorption
What are the 2 kinds of hemorrhagic stroke?
Describe a SAH- Subarachnoid hemorrhage.
SAH: much more common and results from bleeding into subarachnoid space
Usually caused by ruptured aneurysm, AVM or trauma
Describe ICH- intracerebral hemorrhage
ICH: Intracerebral hemorrhage is bleeding into brain tissue
Usually caused by severe or sustained HTN
HTN damages arterial wall and will weaken over time
What is the subarachnoid space?
space between the pia mater and the arachnoid layers of the meninges
Describe the etiology of a hemorrhagic stroke.
Ruptured aneurysm (usually subarachnoid)
Drugs ex. Cocaine
Transformation of ischemic stroke
Physical exertion, Pregnancy
What are the 5 most common symptoms of stroke?
Sudden difficulty speaking
Sudden numbness/weakness in arm, leg, face
Sudden trouble seeing in one or both eyes
Sudden dizziness, trouble walking or loss of balance or coordination
Sudden severe headache ‘worst headache of my life’ associated with SAH
Describe a neuro assessment and prioritization..
Transport patient to stroke center; ABC’s is the priority
Focused history- is the pt. on any anticoagulants?
When did the stroke begin? What were they doing? Hemorrhagic tends to be more abrupt; thrombotic more gradual
What are some specific assessments for neuro?
Cognitive changes: LOC, (r/o hypoglycemia, and hypoxia)
Sensory changes- LOC, speech,
Cranial nerve assessment - shrug shoulders, blow cheeks, smile, tongue symetrical
Do NIH stroke scale upon arrival to ED
What is the NIH stroke scale score?
Current NIH Stroke Score guidelines for measuring stroke severity:
Points are given for each impairment.
0= no stroke
1-4= minor stroke
5-15= moderate stroke
15-20= moderate/severe stroke
21-42= severe stroke
A maximal score of 42 represents the most severe and devastating stroke
What does the NIH stroke scale score mean?
It is a standardized method which measures the degree of stroke r/t impairment and change in a patient over time.
Measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language not measured by Glasgow coma scale.
Describe the NIH stroke scale table and what it includes.
Assesses 11 areas including:
Motor; arms and legs
Limb atxia (gait disturbance)
Neglect (ex. does not recognize one’s own hand)
What does a low scale on the Glasgow coma scale mean?
Close to a coma or inability to respond
What diagnostic test is most important for confirming the dx of a stroke?
Head CT without contrast- negative result =ischemic stroke
MRI shows an ischemic stroke sooner
What are some labs to indicate a stroke?
check for infection, coagulation, pt, ptt, INR, 12 lead EKG, and enzymes rule out any cardiac problems
What is the treatment for stroke?
IV or IA thrombolytic therapy Alteplase/Activase t-PA (for ischemic)
Eligibility criteria: time of onset of stroke 3 hours, up to 4.5 hrs. Longer for IA (6 hours)
Describe nursing care with t-PA .
ABC’s, VS, Two IV lines with non-dextrose solution, monitor for increasing ICP, screening criteria for thrombolytic therapy (anticoagulants, recent surgery, elevated INR, past 4 hours and 30 minute time frame, age, hypertension, any recent GI bleeding, any hx of hemorrhagic stroke/just stroke, trauma patient), No antiplatelet or anticoagulant therapy should be administered for 24 hours following tPA, and first do f/u CT
What is a embolectomy?
retrieval of clot with special instrument and suction
What is a carotid endarterectomy?
preventive > 100,000/year
removal of atheromatous lesions, stent placement
What is the treatment of AV malformations?
craniotomy to remove, bypass AVM, and radiosurgery (gamma knife) to thicken the AVM vessel walls to keep from enlarging
What are the different ways to fix an aneurysm?
clipping, wrapping, coiling
Describe some drug therapy.
Anticoagulants including anti-platelet drugs like aspirin (325mg given within first 24-48 hours within onset of stroke)
Clopidogrel (Plavix), also has been used, especially in patients who are intolerant or to aspirin. Aspirin is sometimes combined with a second anti-platelet agent, dipyridamole (Persantine, Aggrenox), to prevent strokes.
Anti-coagulants: heparin, warfarin are used in presence of atrial fibrillation
Describe traumatic Brain injury
Blow or jolt to head causing damage to brain
May be open or closed injury, direct or indirect
ex. Direct blow to head vs. indirect injury from brain moving within cranial vault from force of injury.
Can cause laceration within brain, contusion, bleeding, tearing/rotation of brain from brainstem
Describe an acceleration injury
external force contacting the head suddenly
Describe a deceleration injury
when that force suddenly stops or hits a stationary object
Describe open vs. closed brain injury
Open vs. closed head injuries
Open- skull fracture present, integrity of brain and dura is open to contaminants
Closed: contusion at site of impact (coup) and opposite site (counter-coup), tearing of vessels can lead to secondary hemorrhage