class 13 stroke

Question 1

what is intracranial pressure (ICP)

Answer 1

the pressure exerted in the skull by the total volume from three components within the skulls
1.brain tissue
2.blood
3.cerebrospinal fluid (CSF)

Question 2

normal ICP measurement

Answer 2

5-15 mmHg

Question 3

increased ICP can cause:

Answer 3

-decreases in CSF
-cerebral edema
-brain shift

Question 4

what is monro-kellie hypothesis

Answer 4

the body is able to balance ICP on it’s own by compensating for increases or decreases in the 3 components that make ICP

Question 5

what is the glascow coma scale

Answer 5

assesses level of consciousness
-eye opening response
-verbal response
-motor response

Question 6

increased ICP manifestations

Answer 6

-changes in LOC
-H/A
-N/V
-papilledema
-pupillary dysfunction
-dec GCS
-oculomotor/vision dysfunction
-motor impairment
-changes in speech
-seizures
-large gap between sys & dias (cushing’s triad)
-abnormal posturing (decerebrate/decorticate)

Question 7

goals of care for increased ICP

Answer 7

-identify cause
-ABC’s
-peserve cerebral perfusion
-dec ICP
-prevention of complications

Question 8

medications for increased ICP

Answer 8

-diuretics
-hypertonic saline
-corticosteroids
-H2 receptor antagonist/PPI
-anti-seizure
-antipyretics
-barbiturates
-stool softener
-sedation

Question 9

nursing management for inc iCP

Answer 9

-neuro assessment
-maintain resp function
-fluid & lytes balance
-ICP monitoring
-body positioning (HOB 30)
-protection from injury
-VS monitoring
-GCS
-psychological considerations

Question 10

what is a stroke

Answer 10

disruption of normal blood supply to the brain

Question 11

types of stroke

Answer 11

ischemic (thrombolytic/embolic)
hemorrhagic

Question 12

how long does blood flow in the brain have to be interrupted for complications to occur

Answer 12

-neurological metabolism altered in 30 sec
-metabolism stops after 2 mins
-cellular death occurs after 5 min

Question 13

what is an ischemic stroke

Answer 13

occlusion of the cerebral artery by thrombus or embolus
50-60% are thrombotic 20-30% are embolic

Question 14

what is a transcient ischemic attack

Answer 14

“mini strokes”
a temporary episode of neurological dysfunction without acute infarction of the brain
-s&s typically last <1h & depend on area of occlusion
-emergency, once it starts its impossible to know if its a TIA or true stroke
“angina of the brain”

Question 15

signs and symptoms of TIA

Answer 15

-temporary loss of vision in 1 eye
-transient hemiparesis
-numbness or loss of sensation
-sudden inability to speak
-tinnitus
-vertigo
-darkened or blurred vision
-dysphagia
-diplopia
-ptosis
-dysarthria
-ataxia

Question 16

what is a thrombotic ischemic stroke

Answer 16

-occurs when a blood clot forms in a diseased and narrowed blood vessel in the brain
-narrowed lumen of the blood vessel becomes occluded, and infarction occurs
-often associated with HTN or DM

Question 17

what is an embolic ischemic stroke

Answer 17

-embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved
-embolus travels upward to the cerebral circulation and lodges where a vessel narrows or bifurcates
-onset of an embolic stroke is usually sudden

Question 18

non-modifiable risk factors of stroke

Answer 18

-age
-gender
-race

Question 19

modifiable risk factors for stroke

Answer 19

-HTN
-CV disease
-DM
-hyperlipidemia
-smoking
-oral contraceptives
-sedentary lifestyle
-substance abuse/ETOH
-hypercoagulation disorders

Question 20

signs and symptoms of stroke

Answer 20

-numbness/weakness of the face/arm/leg
-confusion/changes in mental status
-trouble speaking
-visual disturbances
-difficulty walking, dizziness, loss of balance, or coordination
-sudden severe headache

Question 21

what is a hemorrhagic stroke

Answer 21

-interruption vessel integrity
-intracerebral or subarchnoid hemorrhage
-brain etabolism is disrupted by exposure to blood
-ICP increases because of blood in the subarachnoid space
-rupture aneurysm or arteriovenous malformation
-cerebral aneurysms are viewed as a “silent killer”

Question 22

clinical manifestations of hemorrhagic stroke

Answer 22

-sudden SEVERE headache
-quick change in LOC
-nausea,vomiting,seizures
-nuchual rigidity (stiff neck)
-motor, cognitive, visual, sensory, communication, emotional effects

Question 23

motor deficits with hemorrhagic stroke

Answer 23

-hemiparesis
-hemiplegia
-ataxia
-apraxia
-dysarthria
-dysphagia
-hypo/hyper reflexia
-loss bowel/bladder

Question 24

sensory deficits with hemorrhagic stroke

Answer 24

-paresthesia
-difficultly with proprioception
-unilateral neglect
-difficulty with spatial orientation
-agnosia (visual, auditory)

Question 25

visual deficits with hemorhagic stroke

Answer 25

-hemianopia
-loss of peripheral vision
-dilopia
-pupillary abnormalities
-ptosis

Question 26

communication deficits with hemorrhagic stroke

Answer 26

-aphasia
*global
*expressive (Broca’s)
*receptive (Wernicke’s)
-alexia
-agraphia
-dysarthria
-dysphagia

Question 27

cognitive deficits with hemorrhagic stroke

Answer 27

-short/long term memory loss
-decreased attention span
-inability to concentrate
-altered judgement
-poor reasoning ability

Question 28

emotional deficits with hemorrhagic stroke

Answer 28

-loss of self control (impulsive)
-labile emotions
-feeling of isolation
-depression
-hostility and anger

Question 29

s&s of right sided brain damage

Answer 29

-paralyzed on left side
-left-sided neglect
-spatial perceptual deficits
-tends to deny or minimize problems
-rapid performance, short attention span
-impulsive, safety problems
-impaired judgment
-impaired time concepts

Question 30

s&s left-sided brain damage

Answer 30

-paralyzed right side: hemiplegia
-impaired speech-language
-impaired right-left discrimination
-slow performance
-aware of deficits: depression, anxiety
-impaired comprehension related to language, math

Question 31

diagnostic studies for stroke

Answer 31

-carotid angiography
-carotid duplex scanning
-cerebral angiography
-digital subtraction angiography
-transcranial doppler ultrasonography

Question 32

cerebral blood flow studies

Answer 32

-cardiac markers (trop, CK-MB)
-chets radiograph

Question 33

cardiac assessment studies

Answer 33

-echocardiography (transthoracic, transesophageal)
-electrocardiogram

Question 34

medical management of TIA

Answer 34

-meds (AF, HTN, anticoag, antiplatelet)
-carotid endarterectomy (plaque removed)

Question 35

medical management for stroke

Answer 35

-depends on type and extent
-thrombolytics
-management airway & HTN
-anticoags & antiplatelets
-anticonvulsants, stool softeners, analgesics, anxiolytics

Question 36

nursing management for suspected stroke

Answer 36

-assess VS & N/S
-monitor for inc ICP
-elevate HOB 30, head midline, neutral posture
-avoid activities that inc ICP
-quiet dark environment
-GCS

Question 37

surgical management for stroke

Answer 37

-endarterectomy
-extracranial-intracranial bypass
-AV malformation (embolize involved arteries)
-aneurysm (clipped or clamped, wrapped to reinforce, or coiling)

Question 38

nursing management for stroke

Answer 38

passive ROM q2-3h affected extremities
-active ROM on unaffected side
-positioning/splinting to maintain alignment/prevent contracture
-monitor & prevent DVT
-approach from unaffected side
-prevent injury
-orientate to person, place, time
-prevent aspiration
-bladder and bowel training