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Module 4 (MedSurg 2) > CVA > Flashcards

CVA Flashcards

1
Q

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the
nurse to address?
A) The patient works at a desk and relaxes by watching television
B) The patient’s usual blood pressure (BP) is 170/94 mm Hg.
C) The patient is 25 lbs above the ideal weight.
D) The patient drinks a glass of red wine with dinner daily

A

B) The patient’s usual blood pressure (BP) is 170/94 mm Hg.

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2
Q

Stroke aka

A

CVA/Cerebrovascular Accident/ Brain attack

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3
Q

A pt with L-sided weakness that started 60 mins ago is admitted to the ED & tests are ordered.
Which test is done 1st?

A) Computed tomography (CT) scan
B) Chest radiograph (chest x-ray)
C) Complete blood count (CBC)
D) 12-Lead electrocardiogra
(ECG)

A

A) Computed tomography (CT) scan

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4
Q

A pt with history of TIA states,”I don’t need the aspirin today, I don’t have fever”. Which action should the RN take?

A) Document that the aspirin was refused by the patient.
B) Explain that the aspirin is ordered to decrease the risk of stroke.
C) Tell the patient that the aspirin is used to prevent a fever.
D) Call the health care provider to clarify the medication

A

B) Explain that the aspirin is ordered to decrease the risk of stroke.

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5
Q

A pt w/ stroke has progressively increasing weakness and decreasing LOC. Which pt problem has the highest priority?

A) risk for aspiration related to inability to protect airway
B) Disturbed sensory perception related to brain injury
C) Risk for impaired skin integrity related to immobility
D) Impaired physical mobility related to weakness

A

A) risk for aspiration related to inability to protect airway

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6
Q

What are the 2 different types of strokes?

A

Ischemia (inadequate blood flow to the brain)
Hemorrhage (bleed in brain)

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7
Q

What is the acronym for remembering strokes?

A

FAST
face
arms
speech
tongue/time

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8
Q

Stroke is a medical

A

emergency

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9
Q

When someone is having a stroke, always

A

Call 911 (so pt can get through faster and directly to CT scans)
Immediate tx decreases neurologic deficit and lowers permanent damage

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10
Q

Stroke results in

A

brain cell death

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11
Q

Most effective way to decrease burden of stroke is

A

prevention and teaching
reduce morbidity and mortality

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12
Q

Non-modifiable Risk Factors

A

age (2x each decade after 55)
gender (more common in men, more women die)
AA and ???????
Hereditary 1st degree

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13
Q

Stroke is more common in what gender?

A

men
but women die more form them

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14
Q

What is the single most common preventative modifiable risk factor?

A

HTN

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15
Q

As one of your clinical assignments, you are assisting an RN with health screening at a health fair. Which individuals is at the greatest risk for experiencing a stroke?
a) 46 y/o white female with HTN and oral contraceptive use for 10 years
b) 58 y/o white male salesman who has a total cholesterol level of 285
c) 42 y/0 AA female with DM who has smoked for 30 years
d) 62 y/o AA male with HTN who is 25 lbs. overweight

A

d) 62 y/o AA male with HTN who is 25 lbs. overweight***

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16
Q

Modifiable Risk Factors for CVA

A

Hypertension***
Heart disease (Afib 25%) – need blood thinners
Diabetes 5x higher
Serum high cholesterol – blockage in arteries
Contraseptives
Smoking
Obesity
Sleep apnea – deprived from O2
Metabolic syndrome
Lack of physical exercise
Poor diet
Drug and alcohol abuse

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17
Q

TIA means

A

Transient Ischemic Attack

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18
Q

Ischemic Types of CVA

A

THROMBOTIC
EMBOLIC

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19
Q

Hemorrhagic Types of CVA

A

Intracerebral
Subarachnoid

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20
Q

TIA

A

WARNING SIGN of further cerebrovascular disease
- acute infarction of the brain with symptoms lasting
- no outcome prediction (1/3 another TIA, 1/3 progress to stroke

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21
Q

Pathophysiology of Stroke

A

Circle of Willis provides blood to the anterior and posterior brain through arteries
safety valve
Stroke occurs due to an artery block preventing O2 and nutrients

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22
Q

TIA tx medication

A

aspirin XL
-GI upset a/e

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23
Q

Ischemic Stroke

A

inadequate blood flow to the brain from partial or complete occlusion of an artery
(Thrombotic or Embolic)

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24
Q

Ischemic: Thrombotic Stroke

A
  • **plague build-up and a clot forms
    Results from thrombosis or narrowing of a blood vessel (blocking artery)
    Occurs from injury to a blood vessel wall and formation of a blood clot
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25
The extent of the stroke depends on the
onset Size of damaged area presence of lateral circulation
26
What is the most common cause of thrombotic strokes? (60%)
DM and HTN preceded by a TIA
27
Ischemic: Embolic Stroke
Embolus dislodges & occludes a cerebral artery resulting in infarction & edema
28
Embolic stroke originates mostly in
endocardial layer of the heart
29
Embolic strokes have a hx of
a-fib valve replacements MI atrial septal defects least common in long bone fx
30
Embolic stroke pts need a
anticoagulant (stroke occurs due to stopping for a surgery)
31
Embolic pts
sudden onset conscious c/o HA symptoms could be tied to the clot breaking up and flowing through
32
Is the recurrence of thrombotic and embolic stroke common?
yes, unless the underlying cause is tx
33
Embolic stroke prognosis
is related to how much brain tissue is deprived of O2
34
Hemorrhagic Stroke
caused by **bleeding** into the brain tissue, ventricles or subarachnoid space
35
Hemorrhagic stroke pts have what type of recovery
severe and long deficits
36
Hemorrhagic stroke causes
HTN aneurysm (artery wall weakens and ruptures) intracranial neoplasm (abnormal growth) Arterial venous malformation **occur during activity**
37
In hemorrhagic stroke, 50% of death occurs within
48 hours poor prognosis
38
Intracranial Hemorrhage
bleeding within the brain caused by **rupture** of a vessel (vasoganglia) -sudden onset within 48 hours - progresses minutes to hours with ongoing bleeding
39
Intracranial hemorrhage prognosis
poor with a 30-day mortality of 40-80%
40
Intracranial Hemorrhage S/S
decrease of LOC HA N/V HTN varies depending on amount, local, and duration
41
Most common cause of Intracranial hemorrhage
HTN during activity
42
Subarachnoid Hemorrhage
Intracranial bleeding into cerebrospinal fluid-filled space between arachnoid and pia mater
43
Subarachnoid Hemorrhage is caused commonly by
cerebral aneurysm rupture - Circle of Willis increase risk with age and higher in women
44
Which stroke is known as the silent killer?
SAH
45
S/S of Subarachnoid Hemorrhage
N/V seizures stiff neck
46
Complications for Hemorrhagic Stroke
neuro and systemic **Cerebral Vasospasm - narrow of blood vessels** Hyponatremia MI Infarction ARDS
47
Cerebral Vasospasm needs administration of
Nimodipine Ca Channel Blocker
48
S/S of Stroke = motor function
Hemiplegia Hemiparesis Ataxia elimination urinary and bowel problems
49
Hemiplegia
paralysis in one side of the body
50
Hemiparesis
partial weakness in one side of the body
51
Ataxia
lack control of voluntary movements
52
S/S of Stroke = communication
Dysarthria Dysphasia Aphasia
53
Dysarthria
difficulty articulating
54
Dysphasia
difficulty speaking
55
Aphasia
expressive (unable to) and receptive (unable to receive the language), global, dysphagia (aspiration possible)
56
If the pt has a stroke on the left side of their brain, what side of the body?
right side hemiplegia
57
S/S of Stroke = cognitive impairment
memory loss **low attention span poor reasoning altered judgement**
58
S/S of Stroke = psychological
loss of self-control **depression emotional lability**
59
Emotional lability
Unable to control feelings Laugh at funerals and cry at wedding
60
Speech Pathologist is the first to be called to help with pts after
stroke due to motor deficits communication and eating
61
Spatial-Perceptual Alterations
Homonymous hemianopsia Loss of peripheral vison -severity Agnosia Apraxia
62
Homonymous hemianopsia
blind in one side of the body
63
Agnosia
inability to recognize and object by sight, touch
64
Apraxia
– inability to learn abilities on command
65
What dx tests are done for strokes
CT - confirm MRI - size and location, differentiate between ischemic and hemorrhagic EEG
66
After a CT scan, why does a pt need to go for an MRI?
determine where the bleeding is
67
Management for Ischemic Stroke
Thrombolytic Therapy within 3 hours of S/S - **TPA**
68
How do you determine the time of onset of a stroke?
when they were last seen normal FAST
69
TPA (Tissue Plasminogen Activator) is used for what types of strokes?
Ischemic
70
TPA (Tissue Plasminogen Activator)
Breaks up clots blood test coagulation no contrast CT
71
TPA contraindications
recent GI bleed in the past 3 months Mjr surgery in last 14 days recent stroke head trauma within last 3 months
72
The single most important point of pt's hx is the _______ of stoke onset s/s
Time
73
TPA is given through
IV with 3-4 hours of s/s
74
What should the nurse do to the pt who is going to receive TPA?
Platelet count prep pt 2 Large bore IVs 18 g Safety fall bundle bed alarm Foley
75
Post-TPA monitor
BP critical for 24 hours transfer to ICU then neuro floor
76
Management of stroke surgeries
Carotid endarterectomy Carotid stenting Aneurysm clipping, coiling Resection of arteriovenous malformation (AVM)
77
Carotid Endarterectomy
**prevent impending cerebral infarction** The plaque is removed and stitched closed
78
Stenting
opens up the artery and is permanently placed to hold the artery open and improve the flow of the blood
79
Coiling
coil placed in an aneurysm prevent blood circulating back into and reduce the risk of rupture
80
Preventative Care of Stroke
healthy lifestyle management risk factors with diet, weight control, exercise, take meds BP management
81
Prevention drug therapy for stroke
Warfarin for a-fib **Aspirin as anticoagulant = 1st** statins - cholesterol Antihypertensives
82
Nursing Interventions and MonitoringAcute for CVA
support respirations neuro exams cardio system ROM passive skin breakdown constipation and promote normal **bladder function (potty training getting up every 2 hours and after meals)** nutrition
83
Acute nursing Interventions regarding pt and family needs
clear an understandable explanations
84
Goals of pt and family after CVA
mobility improve avoid shoulder pain self-care communication restore functioning of family skin integrity autonomy through assistive devices bladder control thought process increases **Rehab common**
85
How to help a pt achieve self-care
personal hygiene start with affected side when dressing morale clothing larger than normal
86
Attain Bladder control
retraining avoid distension schedule avoid indwelling catheter upright posture and standing position
87
Achieve Communication after CVA
speech therapist **Treat like an adult** moral support **consistent schedule, routines, and repetition** speak slowly and attention
88
In stroke what is the order of importance?
Circulation (perfusion and intracranial capacity) Airway (aspiration, swallowing) Breathing (mobility, communication) low self-esteem
89
Pt with a left brain stroke suddenly burst into tears went his family walked in, What information is necessary for the family to know? a) calm voice to tell them to stop the crying behavior b) Explain to the family that depression is normal following a stroke c) Have family members leave the pt alone for a few minutes d) Teach the pt that emotional outbursts are common after a stroke
d) Teach the pt that emotional outbursts are common after a stroke -Emotional lability

Module 4 (MedSurg 2) (36 decks)

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