CVA Flashcards
1
Q
What does CVA stand for?
A
Cerebrovascular Accident
Also referred to as a stroke.
2
Q
What is a sudden loss of brain function due to?
A
Loss or disruption of blood supply to part of the brain
This can lead to various neurological deficits.
3
Q
What are the results of a CVA?
A
Functional CNS abnormalities
These abnormalities can vary depending on the area of the brain affected.
4
Q
CVA results in _______ due to loss of blood supply.
A
functional CNS abnormalities
5
Q
CVA is a joint commissioned care measure aid measure and national standard of care meaning ->
A
specific standard set of guidelines on how we treat, assess, and educate patients post-stroke
6
Q
Goal of CVA joint commissioned core measure and national standard of care
A
Improve quality of stroke patients and set guidelines
7
Q
What is the consequence of lack of blood supply?
A
Lack of oxygen leading to death of tissue
This highlights the critical role of blood supply in maintaining tissue viability.
8
Q
What functional changes can occur due to a stroke?
A
Thinking, sensation, movement, action
These changes can significantly impact daily life and require rehabilitation.
9
Q
What does the phrase ‘time is brain’ imply?
A
The urgency of treating strokes to minimize brain damage
This emphasizes the importance of rapid response in stroke management.
10
Q
What is the location of the Anterior Cerebral Artery?
A
On top of the brain
Supplies blood to the anterior portions of the brain.
11
Q
What area does the Middle Cerebral Artery supply?
A
Middle brain tissue
Supplies blood to the lateral aspects of the cerebral hemispheres.
12
Q
Where is the Posterior Cerebral Artery located?
A
Bottom of the brain
Supplies blood to the posterior portions of the brain.
13
Q
What is ischemic stroke caused by?
A
From a thrombosis or embolism
14
Q
Define thrombosis.
A
Blood clot formed in blood vessel due to blockage
15
Q
What is an embolism?
A
Blood clot formed somewhere else in the body that breaks loose and travels to the brain
16
Q
What causes a hemorrhagic stroke?
A
From an aneurysm, where a weakness in a blood vessel in the brain balloons out and can burst due to HTN
17
Q
What percentage of people who have strokes can activate the EMS system?
A
Only 30%
18
Q
How should a stroke be treated?
A
As a medical emergency whether bystander or medical professional
19
Q
What does the brain need for its function?
A
Constant flow of blood supply
20
Q
Fill in the blank: The brain cannot store _______ or glucose.
A
O2
21
Q
What is atherosclerosis?
A
A condition that decreases cerebral perfusion, hardening and thickening of blood vessels
22
Q
What is the primary effect of atherosclerosis on the brain?
A
Narrowing of blood vessels leading to ischemia, hypoxia, and hypoglycemia
23
Q
What is the outcome of cerebral ischemia?
A
Cerebral infarction
24
Q
What causes thrombolic strokes?
A
Atheromatous plaques that occlude cerebral arteries
25
What causes embolic strokes?
Dislodged thrombi (emboli) that occlude cerebral arteries
26
What causes hemorrhagic stroke?
Cerebral arterial wall rupture
27
What conditions are related to hemorrhagic stroke?
* Hypertension
* Cerebral aneurysms
28
What happens when blood bleeds into cerebral tissues?
Increases intracranial pressure (ICP) and causes tissue anoxia
29
Fill in the blank: Atherosclerosis leads to _______ in the brain.
ischemia
30
True or False: Thrombolic strokes are caused by dislodged thrombi.
False
31
True or False: Hemorrhagic stroke can result from hypertension.
True
32
What is the highest risk factor for both types of strokes?
HTN
## Footnote
HTN stands for hypertension, which significantly increases the risk of both ischemic and hemorrhagic strokes.
33
What is the primary cause of ischemic stroke?
Thrombotic plaque
## Footnote
Thrombotic plaque is associated with the buildup of atherosclerotic plaque in arteries.
34
What does atherosclerosis stenosis refer to?
Narrowing of an artery due to atherosclerotic plaque
## Footnote
This plaque is made up of fatty deposits, cholesterol, and other substances.
35
List the risk factors for ischemic stroke.
* Hypertension
* Diabetes
* High cholesterol
* Smoking
* Sedentary lifestyle
* Obesity
* Excessive alcohol consumption
* Certain heart conditions
* Prior stroke history
## Footnote
These factors contribute to the likelihood of experiencing an ischemic stroke.
36
What is a key characteristic of hemorrhagic stroke?
Caused by bleeding in the brain
## Footnote
Hemorrhagic strokes can lead to significant complications due to the pressure from the bleeding.
37
What are key risk factors for hemorrhagic stroke?
* High blood pressure
* Older age
* Blood vessel abnormalities (aneurysms, arteriovenous malformations)
* Smoking
* Excessive alcohol consumption
* Certain medical conditions (like diabetes)
## Footnote
These factors increase the risk of bleeding in the brain.
38
What is a primary cause of embolic stroke?
Atrial Fibrillation
## Footnote
Atrial Fibrillation leads to improper blood ejection from the heart chambers, causing blood to sit and form clots.
39
How do blood clots travel in the case of atrial fibrillation?
Clots can travel to the lungs or brain
## Footnote
This can result in an embolic stroke.
40
What heart condition can lead to an embolic stroke?
Heart malformation
## Footnote
Specifically, a hole in the heart can cause blood clots to form and travel to the brain.
41
Fill in the blank: If blood is not ejecting correctly from the heart, blood clots can form and travel to the _______.
brain
42
True or False: Atrial Fibrillation causes blood to be ejected correctly from the heart.
False
## Footnote
Atrial Fibrillation results in improper ejection of blood.
43
What happens when blood clots travel to the brain?
It creates a stroke
## Footnote
This is a critical outcome of embolic strokes.
44
What is a hemorrhagic stroke also known as?
Arterial 'blowout'
## Footnote
Hemorrhagic stroke occurs when an artery in the brain breaks open.
45
What are the primary causes of a hemorrhagic stroke?
HTN or aneurysm
## Footnote
HTN refers to hypertension, and an aneurysm is a weakened area in an artery wall.
46
What happens to an artery in the brain during an aneurysm?
The artery balloons out and breaks open
## Footnote
This leads to bleeding in the brain.
47
What is a consequence of bleeding in the brain from a hemorrhagic stroke?
Causes pressure in the brain
## Footnote
The skull does not allow the brain to swell, leading to tissue death.
48
What is a hallmark symptom of a hemorrhagic stroke?
Sudden onset headache (worst ever)
## Footnote
This headache does not go away and may feel like the brain is being split open.
49
Fill in the blank: A hemorrhagic stroke causes pressure which leads to _______.
brain tissue death
## Footnote
This occurs because the skull limits the brain's ability to swell.
50
True or False: Aneurysms can lead to hemorrhagic strokes.
True
## Footnote
An aneurysm is a significant risk factor for hemorrhagic strokes.
51
What is the consequence of bleeding in the brain?
Loss of blood flow = ischemia -> infarction/necrosis - death of brain tissues
## Footnote
Ischemia refers to insufficient blood supply to tissues, leading to potential tissue death.
52
What are the locations of intracranial hemorrhages?
* Subdural
* Intracerebral
* Epidural hematoma
## Footnote
These locations indicate where bleeding can occur within the layers of the brain.
53
Fill in the blank: Bleeding puts pressure in the brain and loss of tissue perfusion leads to _______.
ischemia
54
True or False: Infarction in the brain is a result of adequate blood flow.
False
## Footnote
Infarction occurs due to a lack of blood flow, leading to tissue death.
55
What does an intracranial hemorrhage result in?
Loss of blood flow leading to ischemia and possibly infarction/necrosis
## Footnote
Intracranial hemorrhages can occur in various locations, each with its own implications.
56
What does TIA stand for?
Transient Ischemic Attack
57
What is a TIA?
Temporary interruption of blood flow to the brain
58
What does a TIA often indicate?
Raises risk for CVA in 2-5 years
59
How long does a TIA typically resolve?
Usually within 24 hours
60
What are common risk factors for TIA?
* HTN
* Atherosclerosis
* Cardiac disease
* Atrial fibrillation
* Cerebral aneurysm
* Diabetes Mellitus
61
True or False: A TIA is a permanent condition.
False
62
Fill in the blank: A TIA resolves within a few _______.
minutes to hours
63
What should you do if at high risk of stroke?
Need to talk to provider immediately
## Footnote
Immediate consultation with a healthcare provider is crucial for individuals identified as high risk for stroke.
64
What actions should be taken with caution risk for stroke?
Make changes now:
* Quit smoking
* Lower cholesterol
* Decrease weight
* Get BP under control
* Get afib under control
* Get DM under control
* Exercise
## Footnote
These lifestyle modifications can significantly reduce the risk of stroke.
65
What is the lead factor for both types of stroke?
HTN
## Footnote
HTN stands for hypertension.
66
How does smoking affect the risk of stroke?
Doubles risk for ischemic stroke and triples risk for subcranial hemorrhage
## Footnote
Smoking is a significant modifiable risk factor.
67
What condition doubles the risk for stroke in individuals with uncontrolled blood glucose?
DM
## Footnote
DM stands for diabetes mellitus.
68
What is the relationship between weight and stroke risk?
Direct link between obesity and stroke
## Footnote
Obesity is a modifiable risk factor.
69
What lifestyle change can reduce stroke risk by 30 minutes of activity per day?
Exercise
## Footnote
Regular physical activity is crucial for reducing stroke risk.
70
What is the direct link between alcohol and stroke?
Alcohol use increases stroke risk
## Footnote
Moderation is key to lowering this risk.
71
What does AFib stand for?
Atrial fibrillation: Risk for stroke
## Footnote
AFib involves disorganized electrical signals in the heart.
72
What is CAD an abbreviation for?
Coronary artery disease
## Footnote
CAD is a significant risk factor for stroke.
73
What are some risk factors of stroke that we can modify?
Medications and lifestyle changes
## Footnote
Modifiable factors include exercise, diet, and smoking cessation.
74
Which ethnicities may have varying risks for stroke?
*African Americans
*Pacific Islanders
*Hispanics
- though some studies show this risk diminishes when demographic and socioeconomic factors are considered.
*South Asians may have higher stroke mortality.
## Footnote
Certain ethnic groups may have higher predispositions to stroke.
75
What does TIA stand for?
Transient Ischemic Attack
76
What is a TIA?
Transient loss of blood flow to the brain resulting in temporary neurologic function (several minutes to 24 hours)
77
What can precipitate a TIA?
Exertion, rising from lying to standing, or strenuous exercise
78
What is the usual outcome after a TIA?
Usually complete recovery
79
What does a TIA warn of?
Impending CVA within 2-5 years
80
How should TIA be treated?
Like a stroke unless ruled out
81
What does TIA indicate about blood pressure?
BP may be sky high
82
What is a CTA of the brain?
CT Angiography, a medical imaging technique that uses X-rays and a special dye to create detailed pictures of the blood vessels in the brain
83
What is the primary use of brain CTA?
Diagnosing and evaluating conditions affecting the brain's blood supply, such as aneurysms, blockages, and blood clots
84
True or False: A TIA lasts longer than 24 hours.
False
85
Fill in the blank: TIA is a warning of impending _______.
CVA
86
What are the symptoms of TIA that are similar to a stroke?
Temporary visual, motor, sensory, speech deficits; confusion
## Footnote
Symptoms of TIA can mimic those of a stroke, indicating a need for immediate medical evaluation.
87
What is a carotid bruit?
A turbulent blood flow from the carotid artery that cuts off blood flow to the brain
an abnormal swis
## Footnote
A carotid bruit can be detected with a stethoscope and indicates atherosclerosis in the carotid arteries.
88
What causes a carotid bruit?
Turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery
## Footnote
This abnormal sound can indicate potential cardiovascular issues.
89
What may be needed if a patient has significant atherosclerosis in the carotid arteries?
Carotid endarterectomy
## Footnote
This surgical procedure clears out atherosclerotic tissue to restore blood flow.
90
What can diminished carotid pulses indicate?
Decreased blood flow to the brain
## Footnote
Diminished pulses can be a sign of significant vascular issues.
91
True or False: TIA can cause permanent damage to the brain.
False
## Footnote
TIA symptoms are temporary and do not cause permanent brain damage, unlike a stroke.
92
Fill in the blank: A _______ is generated by turbulent flow of blood in an artery.
bruit
## Footnote
Bruit is also known as a vascular murmur.
93
What is a carotid endarterectomy (CEA)?
A surgical procedure to remove plaque buildup from the carotid arteries
94
What does CEA help improve?
Blood flow and reduce the risk of stroke
95
What is plaque in the context of CEA?
A buildup of fat and cholesterol in the carotid arteries
96
Why is CEA performed?
To remove plaque that narrows the arteries, restricting blood flow and increasing stroke risk
97
How is CEA performed?
An incision is made on the neck, the artery is opened, plaque is removed, and the artery is closed
98
Who typically needs a carotid endarterectomy?
Individuals with carotid artery stenosis and symptoms of reduced blood flow or high stroke risk
99
What happens when blood flow is restored after CEA?
Syncope if the patient stands too quickly and fluctuating blood pressure
100
What can happen if a doctor does not remove 100% of atherosclerosis during CEA?
At risk for re-stroke and may have headaches
101
Fill in the blank: CEA involves surgically removing _______ from the carotid arteries.
plaque
102
True or False: CEA is only recommended for patients with carotid arteries that are completely blocked.
False
103
What does the acronym BE FAST stand for in recognizing stroke signs?
Balance, Eyes, Face, Arms, Speech, Time
## Footnote
Each letter represents a specific sign to look for when assessing a possible stroke.
104
What should you assess regarding 'Balance' when checking for signs of a stroke?
Is the person unsteady on their feet?
## Footnote
Unsteadiness can indicate a problem with coordination or balance, which may be a sign of a stroke.
105
What does 'Eyes' refer to in the context of stroke signs?
Have they lost vision in one or both eyes?
## Footnote
Sudden vision loss can be a critical symptom of a stroke.
106
What facial feature should you examine to check for signs of a stroke?
Does the person's face look uneven?
## Footnote
Asking the person to smile can help identify facial droop, a common sign of stroke.
107
What should you observe about the arms for stroke detection?
Is one arm hanging limp?
## Footnote
Asking the person to put arms straight out and close their eyes can help assess arm drift.
108
What speech-related issue should you listen for when assessing a stroke?
Are they having trouble speaking?
## Footnote
Difficulty in speech may indicate a stroke affecting the language centers of the brain.
109
What action should you take if you observe any signs of stroke?
Call 911.
## Footnote
Immediate medical attention is crucial when stroke symptoms are present.
110
What are the Sudden symptoms related to a stroke?
The Sudden symptoms include:
* Sudden numbness or weakness of the face, arm, or leg
* Sudden confusion, trouble speaking, or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness or loss of balance/coordination
* Sudden severe headache
## Footnote
These symptoms are critical indicators of a potential stroke.
111
What should you do if you suspect someone is having a stroke?
Call the designated stroke team at the hospital
## Footnote
Most hospitals have a specific team for stroke emergencies.
112
What does ABC stand for in nursing?
Airway, Breathing, and Circulation
## Footnote
ABCs are used as a rapid assessment method in emergency situations to prioritize patient care.
113
What is the first component of the ABCs?
Airway
## Footnote
Nurses assess for a clear, unobstructed airway to ensure adequate oxygen intake.
114
What should nurses assess when evaluating Breathing?
Respiratory effort, rate, and oxygen saturation
## Footnote
They may need to administer supplemental oxygen or assist with ventilation.
115
What parameters are assessed under Circulation?
Heart rate, blood pressure, and perfusion
## Footnote
This includes monitoring skin color, capillary refill, and level of consciousness.
116
What is the significance of a non-contrast CT scan in stroke diagnosis?
It determines the way to diagnose a stroke and what type of stroke it is
## Footnote
Types include thrombosis, embolism, hemorrhage, and cerebral edema.
117
What imaging technique is used to assess tissue perfusion in the brain?
MRI/MRA
## Footnote
These scans are used to look at brain tissue and its perfusion.
118
What does EEG stand for and what is its purpose in stroke diagnosis?
Electroencephalogram; it looks for seizures to rule out stroke
## Footnote
EEG helps differentiate between stroke and seizure activity.
119
What do the acronyms PT, PTT, and INR stand for in lab tests?
Prothrombin Time, Partial Thromboplastin Time, International Normalized Ratio
## Footnote
These tests assess how quickly blood clots and are crucial for monitoring anticoagulants.
120
What do H&H refer to in a complete blood count (CBC)?
Hemoglobin and hematocrit
## Footnote
H&H measures red blood cells and their hemoglobin content.
121
Fill in the blank: The ABCs help nurses quickly identify and address the most ______ problems first.
critical
## Footnote
The ABCs provide a structured approach to initial patient assessment.
122
CT Scan VS MRI difference
CT scans are preferred for initial stroke evaluation due to:
-Faster turnaround time
-Wider availability in hospitals
-Crucial in time-sensitive situations
MRIs offer:
-Superior accuracy in detecting early ischemic changes
-Better sensitivity in identifying infarct size and location
-CT scans quickly exclude:
-Hemorrhagic stroke, which is important for avoiding clot-busting therapies.
123
What does MRA stand for?
Magnetic Resonance Angiography
## Footnote
MRA is a specialized type of MRI focused on blood vessels.
124
What is the primary purpose of an MRA?
To provide pictures of blood vessels inside the body
## Footnote
MRA uses a magnetic field and radio wave energy.
125
How does MRA differ from a standard MRI?
MRA provides a better picture of blood vessels and blood flow
## Footnote
Standard MRI is not effective for visualizing blood vessels.
126
Which areas of the body are commonly assessed by MRA?
* Head and Neck
* Chest
* Abdomen
* Limbs
## Footnote
Each area focuses on specific arteries relevant to the examination.
127
What specific conditions can MRA help diagnose?
* Aneurysms
* Blockages and Narrowing (Stenosis)
* Arteriovenous malformations
* Aortic Dissection
* Stroke
* Atherosclerosis
## Footnote
MRA identifies various vascular abnormalities.
128
What is an aneurysm?
An abnormal widening or ballooning of blood vessel walls
## Footnote
Aneurysms can pose serious health risks if they rupture.
129
What does stenosis refer to in the context of MRA?
Reduced blood flow due to plaque buildup
## Footnote
Stenosis can lead to serious cardiovascular issues.
130
What are arteriovenous malformations?
Abnormal connections between arteries and veins
## Footnote
These malformations can disrupt normal blood flow.
131
What is an aortic dissection?
A tear in the inner lining of the aorta
## Footnote
This condition can be life-threatening and requires immediate medical attention.
132
True or False: MRA can help identify the cause of a stroke.
True
## Footnote
MRA is useful in diagnosing vascular causes of stroke.
133
Fill in the blank: MRA is sometimes used to plan a _______.
[surgery or procedure]
## Footnote
MRA provides critical information for surgical planning.
134
What is the gold standard for stroke damage assessment?
National Institutes of Health Stroke Scale (NIHSS)
## Footnote
The NIHSS is widely recognized for its effectiveness in assessing the severity of strokes.
135
Name a scale used to assess consciousness in patients.
Glasgow Coma Scale
## Footnote
The Glasgow Coma Scale measures a patient's level of consciousness and is critical in neurological assessments.
136
What type of document is a Neurological Flow Sheet?
A document used to record neurological assessments
## Footnote
Neurological Flow Sheets help track changes in a patient's neurological status over time.
137
What is the NIH Stroke Scale used for?
To assess stroke severity and deficits.
138
What does a low score on the NIH Stroke Scale indicate?
A better outcome or less severe deficits.
139
What are the components of the NIH Stroke Scale?
* Level of Consciousness
* LOC questions
* LOC commands
* Best Gaze
* Visual fields
* Facial Palsy
* Left Arm
* Right Arm
* Left Leg
* Right Leg
* Limb ataxia
* Sensory
* Best Language
* Dysarthria
* Extinction -> Neglect
140
What does limb ataxia on the NIH Stroke Scale indicate?
No limb coordination leading to lack of balance and coordination.
141
What is assessed under 'Best Language' in the NIH Stroke Scale?
The patient's ability to communicate effectively.
142
What is the significance of a high score on the NIH Stroke Scale?
Indicates a more severe stroke and poorer outcomes.
143
What does dysarthria refer to?
Difficulty in speech.
144
What is meant by extinction in the context of the NIH Stroke Scale?
The patient forgets they have an arm or leg.
145
Fill in the blank: A score of _____ on the NIH Stroke Scale indicates a severe stroke.
higher
146
What aspect of consciousness is evaluated in the NIH Stroke Scale?
Level of Consciousness, LOC questions, and LOC commands.
147
True or False: A lower score on the NIH Stroke Scale indicates a more severe stroke.
False
148
What is the purpose of the Glasgow Coma Scale (GCS)?
Quickly assesses neurological function
## Footnote
The GCS is mainly used to evaluate the consciousness level of a patient.
149
What scale is used more often than the Glasgow Coma Scale?
NIH stroke scale
## Footnote
The NIH stroke scale provides a more comprehensive assessment for stroke patients.
150
What is the best possible score on the Glasgow Coma Scale?
15 points
## Footnote
A score of 15 indicates a fully alert and awake patient.
151
What score on the Glasgow Coma Scale indicates a coma?
7 points
## Footnote
A score of 7 or below typically indicates a severe impairment of consciousness.
152
What is the purpose of the Neurological Assessment Flow Sheet?
To assess, monitor, and record specific neurological signs/status following an injury resulting in suspected or actual head trauma.
## Footnote
This sheet helps in tracking critical neurological functions.
153
What are the key areas assessed in the Neurological Assessment Flow Sheet?
* Level of Consciousness
* Pupil Response
* Motor Functions
## Footnote
These areas are crucial for evaluating the neurological status of a patient.
154
True or False: The Neurological Assessment Flow Sheet is used only for patients with confirmed head trauma.
False
## Footnote
It is used for both suspected and actual head trauma.
155
Fill in the blank: The Flow Sheet prompts clinician assessment of _______.
[Level of Consciousness, Pupil Response, Motor Functions]
## Footnote
These assessments are vital for monitoring neurological status.
156
What should clinicians familiarize themselves with regarding the stroke flow sheet?
Different things they assess
## Footnote
Understanding the specific assessments can improve patient care.
157
What is the challenge in identifying the affected side of the brain in a CVA?
It is hard to differ which side of the brain is affected
## Footnote
CVA stands for cerebrovascular accident, commonly known as a stroke.
158
What factors influence the severity of signs and symptoms in a CVA?
The severity of signs and symptoms is related to where the CVA is occurring and the extent of the damage
## Footnote
Different brain regions are responsible for various functions, impacting symptom presentation.
159
How might signs and symptoms present differently in the elderly during a CVA?
Signs and symptoms might be obvious or subtle
## Footnote
Elderly patients may exhibit atypical symptoms or less pronounced signs.
160
What are the main functions of the Frontal Lobe?
Decision-making, personality, movement, speech (Broca’s area)
## Footnote
The frontal lobe is critical for higher cognitive functions and motor control.
161
What are the stroke symptoms associated with the Frontal Lobe?
Weakness or paralysis (especially on one side), difficulty with planning or problem-solving, changes in personality or behavior, trouble speaking or forming words (if Broca’s area is involved)
## Footnote
Symptoms can vary based on the specific area affected within the frontal lobe.
162
What is the primary function of Broca’s Area?
Speech production
## Footnote
Broca’s area is usually located in the left hemisphere of the frontal lobe.
163
What are the stroke symptoms related to Broca’s Area?
Expressive aphasia, frustration due to knowing what to say but being unable to say it
## Footnote
Comprehension remains intact despite the inability to express language.
164
What are the functions of the Motor Areas in the frontal lobe?
Voluntary muscle movement
## Footnote
Located in the precentral gyrus, these areas control voluntary movement.
165
What stroke symptoms are associated with the Motor Areas?
Weakness or paralysis on the opposite side of the body, trouble with coordination or fine motor skills
## Footnote
Damage to these areas can significantly affect physical capabilities.
166
What functions are associated with the Sensory Area in the parietal lobe?
Sensation (touch, pain, temperature)
## Footnote
Located in the postcentral gyrus, this area processes sensory information.
167
What are the stroke symptoms linked to the Sensory Area?
Numbness or reduced sensation on one side, difficulty recognizing objects by touch (astereognosis)
## Footnote
Affects the ability to perceive sensory inputs accurately.
168
What functions does the Parietal Lobe serve?
Spatial awareness, sensation, perception
## Footnote
Involved in integrating sensory information and spatial orientation.
169
What stroke symptoms may arise from damage to the Parietal Lobe?
Difficulty with spatial orientation, neglect of one side of the body, difficulty with math or writing (acalculia, agraphia)
## Footnote
Symptoms can indicate the specific side affected by the stroke.
170
What are the primary functions of the Temporal Lobe?
Hearing, memory, understanding language (Wernicke’s area)
## Footnote
Essential for processing auditory information and language comprehension.
171
What stroke symptoms are associated with the Temporal Lobe?
Memory problems, difficulty recognizing faces or objects, trouble understanding spoken language (if Wernicke’s area is involved)
## Footnote
Impacts both memory and language processing abilities.
172
What is the function of Wernicke’s Area?
Language comprehension
## Footnote
Located in the left hemisphere of the temporal lobe, crucial for understanding language.
173
What are the stroke symptoms linked to Wernicke’s Area?
Receptive aphasia, inability to understand spoken or written language
## Footnote
Individuals may speak fluently but their speech may lack meaning.
174
What is the primary function of the Occipital Lobe?
Vision
## Footnote
This lobe is responsible for processing visual information.
175
What stroke symptoms may occur with damage to the Occipital Lobe?
Visual field cuts, visual hallucinations or illusions, difficulty recognizing objects
## Footnote
Visual processing can be severely disrupted.
176
What are the functions of the Cerebellum?
Balance, coordination, fine motor control
## Footnote
Critical for maintaining balance and coordinating movements.
177
What stroke symptoms are associated with the Cerebellum?
Unsteadiness, dizziness, difficulty with coordination (ataxia), nausea, vomiting, trouble walking or grabbing objects accurately
## Footnote
Symptoms reflect the cerebellum's role in motor control.
178
What are the main functions of the Brain Stem?
Basic life functions (breathing, heartbeat), consciousness, motor/sensory relay
## Footnote
Vital for survival, controlling many automatic functions.
179
What stroke symptoms may result from damage to the Brain Stem?
Double vision, facial weakness, difficulty swallowing or speaking, dizziness, loss of balance, possible coma or death, locked-in syndrome
## Footnote
Affects both voluntary and involuntary functions, with severe consequences.
180
What are the effects of a Right brain CVA?
Left body side effects
181
What are the effects of a Left brain CVA?
Right body side effects
182
What percentage of the stroke population is affected by Left-Sided Stroke?
Approximately 80%
183
Which side of the body is affected by a Left-Sided Stroke?
Right side of the body
184
What areas of the brain are often impacted in a Left-Sided Stroke?
Broca’s or Wernicke’s area
185
What is Aphasia?
Trouble speaking or understanding language
186
What is Apraxia?
Difficulty with motor planning
187
What is Agraphia?
Inability to write
188
What is Acalculia?
Inability to calculate
189
What is Alexia?
Inability to read
190
What psychological states are often observed in Left-Sided Stroke patients?
Depressed, cautious, anxious, frustrated
191
What is a common characteristic of Left-Sided Stroke patients regarding their deficits?
Very aware of deficits
192
What type of weakness or paralysis is common in Left-Sided Stroke patients?
Right-sided weakness or paralysis
193
What is the rehab prognosis for Left-Sided Stroke patients?
Can be challenging due to communication issues
194
What cognitive skills are usually preserved in Left-Sided Stroke patients?
Spatial awareness
195
Which side of the body is affected by a Right-Sided Stroke?
Left side of the body
196
What cognitive aspects are often impacted by a Right-Sided Stroke?
Attention, perception, and visual-spatial skills
197
What is neglect syndrome in the context of a Right-Sided Stroke?
Unawareness of deficits on the left side
198
What behaviors might be observed in Right-Sided Stroke patients?
Euphoric, very impulsive, in denial
199
What is left-side neglect?
Lack of awareness of the left side of body or space
200
What difficulties may arise from a Right-Sided Stroke?
Difficulty with problem-solving or judgment, impulsive behavior
201
What is the rehab prognosis for Right-Sided Stroke patients?
Can be more difficult if unaware of deficits
202
Is speech and language usually affected in Right-Sided Stroke patients?
No, usually remain intact
203
In summary, what is a key difference in rehab engagement between Left-sided and Right-sided stroke patients?
Left-sided stroke: Better engagement due to preserved insight; Right-sided stroke: Harder due to lack of awareness and impulsivity
204
What is decussation?
Crossover that occurs in the medulla oblongata and the spinal cord
## Footnote
This process is crucial for understanding how brain injuries affect the body.
205
Where does decussation occur?
In the medulla oblongata and the spinal cord
## Footnote
These areas are critical for the crossing of neural pathways.
206
What typically happens when there is a brain injury or stroke on one side of the brain?
It typically causes paralysis on the other side of the body
## Footnote
This phenomenon is due to the decussation process.
207
What are the deficits associated with the right hemisphere?
L-sided deficits
## Footnote
Includes visual/spatial sense, proprioception, intuitive understanding, disorientation, visual/spatial/depth perception deficits, and neglect syndrome.
208
What is a common characteristic of individuals with right hemisphere deficits?
Unaware of deficits and neglect of the left side
## Footnote
Often impulsive, poor judgment, euphoric, and may be in denial about their condition.
209
What is the prognosis for rehabilitation with right hemisphere damage?
Worse prognosis; more difficult to rehab
## Footnote
Recovery is generally harder compared to left hemisphere damage.
210
What are the deficits associated with the left hemisphere?
R-sided deficits
## Footnote
Dominant in 80% of the population, responsible for language, math, and analytic thinking.
211
What is aphasia?
Inability to comprehend or formulate language
## Footnote
Can be receptive and/or expressive.
212
What is agraphia?
Inability to write
## Footnote
Often seen in individuals with left hemisphere damage.
213
What is alexia?
Inability to read
## Footnote
A common deficit associated with left hemisphere injuries.
214
What is acalculia?
Inability to calculate
## Footnote
Reflects deficits in mathematical processing linked to left hemisphere damage.
215
What emotional states are common in individuals with left hemisphere deficits?
Depressed, cautious, anxious, frustrated, aware of deficits
## Footnote
They often recognize their limitations.
216
What is the prognosis for rehabilitation with left hemisphere damage?
Better prognosis for rehab
## Footnote
Individuals are generally more aware of their deficits, aiding recovery.
217
What is a common cognitive effect of a Left (Brain) CVA?
Frustration/pessimistic behavior
## Footnote
This indicates a tendency towards negative emotional responses following a left-sided stroke.
218
What is a common cognitive effect of a Right (Brain) CVA?
Denial/↓ attention span, unaware
## Footnote
This reflects a lack of awareness regarding the extent of the deficits after a right-sided stroke.
219
What motor symptoms are associated with a Left (Brain) CVA?
Right sided weakness
## Footnote
This is due to the left hemisphere controlling motor functions for the right side of the body.
220
What motor symptoms are associated with a Right (Brain) CVA?
Left sided weakness
## Footnote
This is due to the right hemisphere controlling motor functions for the left side of the body.
221
What are some sensory effects of a Right & Left (Brain) CVA?
Visual field cuts, ↓ pain/temp sensation, Agnosia
## Footnote
These symptoms affect the ability to perceive sensory information accurately.
222
What are some sensory effects of a Left (Brain) CVA?
Right visual field cut
## Footnote
This indicates a loss of vision in the right visual field due to damage in the left hemisphere.
223
What language/speech issues are associated with a Left (Brain) CVA?
Receptive/Expressive Aphasia
## Footnote
This condition affects the ability to understand or produce language.
224
What language/speech issues are associated with a Right (Brain) CVA?
Language intact / ↓ HumorLanguage intact / ↓ Common Sense
## Footnote
Individuals may have intact language skills but struggle with nuances like humor.
225
What memory issues are common after a Left (Brain) CVA?
Difficulty with new information
## Footnote
This reflects challenges in learning and retaining new concepts.
226
What behavior characteristics are associated with a Right (Brain) CVA?
Emotionally Labile - Unpredictable/Inappropriate
## Footnote
This indicates a tendency for emotional responses to be erratic or not suitable for the context.
227
Fill in the blank: A common behavioral characteristic of a Left (Brain) CVA is _______.
Underestimates abilities / Afraid
## Footnote
This reflects a lack of confidence in one's capabilities after a stroke.
228
Fill in the blank: A common behavioral characteristic of a Right (Brain) CVA is _______.
Overestimates abilities / Impulsive
## Footnote
This indicates a tendency to misjudge abilities, leading to impulsive actions.
229
What are some common physical symptoms after a CVA?
Hemiparesis, Ataxia (imbalance), Incontinence, Apraxia(difficult speech), Dysphagia
## Footnote
These symptoms reflect various motor and coordination deficits following a stroke.
230
What spatial difficulties are associated with a Right (Brain) CVA?
Spatial difficulties
## Footnote
This includes challenges in understanding spatial relationships and navigating the environment.
231
What loss is indicated by 'loss of tone differentiation' after a Right (Brain) CVA?
Difficulty with orientation to environment
## Footnote
This affects the ability to perceive and interpret spatial and environmental cues.
232
What is hemiparesis?
A condition characterized by one-sided weakness affecting either the right or left side of the body.
## Footnote
It can impact the face, arms, legs, and hands, causing difficulty with balance, coordination, and fine motor skills. The most common cause of hemiparesis is a stroke.
233
What are the effects of hemiparesis?
Difficulty with balance, coordination, and fine motor skills.
## Footnote
It can affect the face, arms, legs, and hands.
234
What is ataxia?
A neurological sign characterized by a lack of coordination and control of voluntary muscle movements.
## Footnote
It can manifest as unsteady gait, difficulty with fine motor skills, slurred speech, and impaired eye movements.
235
What causes ataxia?
Damage to the cerebellum.
## Footnote
The cerebellum is the part of the brain that coordinates movement and balance.
236
What is agnosia?
A rare disorder whereby patients cannot recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses.
## Footnote
Memory, attention, language problems, or unfamiliarity with the stimuli cannot explain the deficit.
237
What is aphasia?
A language disorder resulting from damage to the brain's language centers affecting a person's ability to express or understand language.
## Footnote
It can manifest in various ways, from difficulty finding words to struggling with comprehension or even complete loss of language function.
238
What are common manifestations of aphasia?
Difficulty finding words, struggling with comprehension, complete loss of language function.
## Footnote
Aphasia can affect both expressive and receptive language abilities.
239
True or False: Hemiparesis can affect both sides of the body.
False.
## Footnote
Hemiparesis specifically affects one side of the body.
240
Fill in the blank: _______ is often caused by damage to the cerebellum.
[Ataxia]
241
Fill in the blank: Agnosia is characterized by the inability to recognize objects, persons, or sounds using _______.
[one or more of their senses]
242
What is homonymous hemianopsia?
A visual field deficit where half of the visual field is lost in both eyes, affecting the same side of the visual field
## Footnote
This condition results in half of the vision being gone.
243
What happens to vision cuts in homonymous hemianopsia for a left cerebrovascular accident (CVA)?
Right vision cuts
## Footnote
This indicates that the vision cuts are opposite for the eyes.
244
What happens to vision cuts in homonymous hemianopsia for a right cerebrovascular accident (CVA)?
Left vision cuts
## Footnote
This shows that the vision cuts correspond to the opposite brain hemisphere damage.
245
How does damage to the brain affect visual fields in homonymous hemianopsia?
Damage to the opposite brain hemisphere affects the visual field
## Footnote
Crossover occurs in the visual pathways.
246
What are scanning strategies after a stroke?
Involves a patient repeatedly locating different targets in both the 'seeing' and 'blind' sides of their visual field
## Footnote
This strategy can increase awareness of the 'blind side'.
247
What is a goal of visual scanning training?
To encourage patients to actively look at the affected side
## Footnote
This can be paper-based or computer-based.
248
What is an important safety consideration when approaching a patient with homonymous hemianopsia?
Approach the patient on the unaffected side
## Footnote
This helps ensure safety when interacting with the patient.
249
Fill in the blank: Half of the vision is _______.
impaired
## Footnote
This statement summarizes the effect of homonymous hemianopsia.
250
What is the normal size range for pupils?
2-5mm
251
What shape should pupils normally be?
Round
252
What does an oval pupil indicate?
Increased ICP
253
What does fixed and dilated pupils indicate?
Severe damage to the brain
254
What should the reaction to light be for pupils?
Brisk and consensual
255
What does a sluggish response to light suggest?
Increased pressure on third cranial nerve
256
True or False: We want the pupils to be oval.
False
257
What are common signs and symptoms of increased ICP?
* Headache
* Nausea / Vomiting
* BP ↑
* Confusion
* Fixed pupils & dilated
* Seizures
* Loss of consciousness
## Footnote
Increased intracranial pressure (ICP) can manifest through various neurological symptoms and changes in vital signs.
258
What is a critical nursing assessment for increased ICP?
Increased ICP is an emergency.
## Footnote
Timely recognition and intervention are vital to prevent severe complications.
259
What are common surgical interventions for increased ICP?
* Drilling holes (burrholes)
* Craniectomy
## Footnote
These procedures help relieve pressure within the cranial cavity.
260
What are the major categories of functional deficits?
Motor, Sensory, Memory, Speech/Language, Mood/Behavior
## Footnote
These categories are used to classify deficits based on location and type of damage.
261
What are some motor deficits associated with damage?
Flaccid, Paralysis, Spasms, Bowel/Bladder issues, Dysphagia, Gait/Coordination
## Footnote
Dysphagia refers to difficulties in swallowing and can affect gag reflex.
262
What sensory deficits can occur due to damage?
Vision, Hearing, Tactile/Proprioception, Neglect Syndrome
## Footnote
Neglect Syndrome involves a lack of awareness of one side of space.
263
What types of memory deficits are noted?
Short Term Memory, PPTE
## Footnote
PPTE stands for Post-Personal Trauma Experiences.
264
What are the types of speech/language deficits?
Aphasia (Expressive vs. Receptive), Alexia, Agraphia, Acalculia
## Footnote
Expressive aphasia affects speech production, while receptive aphasia affects understanding.
265
What emotional/behavioral changes may occur?
Emotional lability, Frustration
## Footnote
Emotional lability refers to rapid and intense emotional fluctuations.
266
Fill in the blank: A deficit in the ability to write is called _______.
Agraphia
## Footnote
Agraphia is specifically related to writing difficulties.
267
True or False: Paralysis is a type of sensory deficit.
False
## Footnote
Paralysis is classified under motor deficits.
268
What is the difference between expressive and receptive aphasia?
Expressive affects speech production, Receptive affects understanding
## Footnote
Both types of aphasia impact communication but in different ways.
269
What is the PENUMBRA?
Part of the brain that is progressively at risk for infarction
270
What happens to the PENUMBRA if repurposed in a timely manner?
It can restore the area
271
What is the role of the PENUMBRA in acute ischemic stroke?
It is at risk for infarction
272
What can happen to the PENUMBRA besides infarction?
It can revascularize and stop the bleed
273
What are the compartments of infarct development?
* Penumbra: moderate ischemia delayed infarction
* Core: dense ischemia, early infarction
274
What is the definition of an infarct?
Dead tissue; nothing can change this
275
Fill in the blank: The PENUMBRA is at risk for _______.
infarction
276
True or False: The core compartment experiences moderate ischemia.
False
277
What does TIA stand for?
Transient Ischemic Attack
## Footnote
TIA is a temporary disruption of blood flow to the brain.
278
How can a TIA be compared to a cardiac condition?
Can be compared to unstable angina and treated like unstable angina.
279
What is the definition of a TIA?
A temporary disruption of blood flow to the brain, causing stroke-like symptoms.
280
What is the typical duration of symptoms in a TIA?
Symptoms usually last for a few minutes to a few hours.
281
How long does it take for the effects of a TIA to fully resolve?
Within 24 hours.
282
What are some lifestyle changes recommended before a patient has a stroke?
Safety precautions, seeking medical aid, modifying diet.
283
What type of medications are used for managing TIA?
Anticoagulants, Antiplatelet Agents, Lipid Lowering Agents, Antihypertensive Medications.
284
Name two examples of Antiplatelet Agents used to treat TIA.
Plavix, ASA.
285
What is a recommended intervention for TIA management?
Carotid Endarterectomy, Angioplasty.
286
Fill in the blank: To manage TIA, it is important to get ______ under control.
Blood pressure.
287
What is one dietary recommendation for TIA prevention?
Modify diet.
288
What is the primary goal in treating an ischemic stroke?
Re-perfuse the brain tissue
## Footnote
This can involve busting the clot if the treatment is administered in time.
289
What is the time limit to use a clot buster (tPA) for an ischemic stroke?
3 hours
## Footnote
A CT scan should be obtained and read within 20 minutes, with tPA ideally given within 60 minutes.
290
What is the target systolic blood pressure (SBP) during ischemic stroke treatment?
140-150
## Footnote
It is recommended to keep blood pressure somewhat high.
291
In the case of an unwitnessed stroke, what should be estimated?
When the patient was last well
## Footnote
This estimation helps determine when the clot may have started.
292
What are the primary goals in treating a hemorrhagic stroke?
Stop the bleeding, plug the leak, watch for increased intracranial pressure
## Footnote
These steps are crucial for managing a hemorrhagic stroke.
293
What is the recommended blood pressure management for hemorrhagic stroke?
Keep blood pressure moderately low
## Footnote
A target is typically <140/90.
294
What should be checked in the management of a hemorrhagic stroke?
Clotting times
## Footnote
Monitoring clotting times is essential in hemorrhagic stroke management.
295
True or False: For ischemic stroke, the goal is to keep blood pressure low.
False
## Footnote
The goal is to keep blood pressure somewhat high.
296
Fill in the blank: The time to administer tPA after a stroke is ______.
3 hours
297
Fill in the blank: For hemorrhagic stroke, blood pressure should be kept under ______.
<140/90
298
What is the target systolic blood pressure for a patient with high blood pressure recovering from a stroke?
Over 170 mmHg for the first 24-48 hours.
299
What is the intervention for systolic blood pressure over 200 mmHg in patients with high blood pressure?
Keep systolic blood pressure over 170 mmHg for the first 24-48 hours.
300
Fill in the blank: For a patient with high blood pressure recovering from a stroke, systolic blood pressure should be kept over _______.
170 mmHg
301
What is the recommended time frame for administering Tissue Plasminogen Activator after stroke symptoms onset?
3 - 4.5 hours
## Footnote
Administering beyond this time frame increases the risk of complications.
302
What are potential risks associated with administering Tissue Plasminogen Activator?
Brain bleeds, GI bleeds, death
## Footnote
These risks necessitate careful consideration before administration.
303
True or False: Tissue Plasminogen Activator can be administered anytime after stroke symptoms onset.
False
## Footnote
It must be given within a specific time frame to minimize risks.
304
What is the primary medication used as a clot-buster in ischemic stroke treatment?
t-PA
## Footnote
t-PA is administered via peripheral IV.
305
What is the requirement regarding blood thinners after t-PA administration?
Cannot give blood thinner (aspirin, heparin) within 24 hours of t-PA administration
## Footnote
This is to prevent bleeding complications.
306
What is an alternative to t-PA for treating ischemic stroke?
Thrombolysis with Urokinase
## Footnote
Urokinase is administered intra-arterially via a catheter directly to the site of thrombosis.
Urokinase activates plasminogen to form plasmin, a fibrinolytic enzyme that dissolves blood clots
307
What must be known before administering a clot-buster?
Baseline clotting factors: PT, PTT, INR
## Footnote
These factors help assess the risk of bleeding.
308
Fill in the blank: Urokinase is administered _______ via a catheter.
intra-arterially
309
True or False: Aspirin can be given within 24 hours of administering t-PA.
False
## Footnote
Aspirin and other blood thinners are contraindicated within this time frame.
310
Inclusion/Exclusion Factors for TPA
311
What is the MERCI procedure?
The MERCI procedure, or Mechanical Embolus Removal in Cerebral Ischemia, is an endovascular treatment for acute ischemic stroke that uses the Merci Retriever device to physically remove blood clots from the brain.
## Footnote
The procedure involves inserting a catheter through a small incision in the groin, guiding it to the blocked artery in the brain, and deploying the retriever to capture and remove the clot.
312
What device is used in the MERCI procedure?
Merci Retriever device
## Footnote
This device is designed for mechanical embolus removal during an ischemic stroke.
313
What is the primary indication for carotid angioplasty with stenting?
Carotid atherosclerosis
## Footnote
This procedure is used to treat narrowing (stenosis) in the carotid arteries.
314
How does carotid angioplasty with stenting work?
It involves using a balloon catheter to open the narrowed artery and a stent to keep it open.
## Footnote
This is a minimally invasive procedure aimed at restoring blood flow to the brain.
315
What is the purpose of the Merci procedure?
To physically remove blood clots from the brain during an acute ischemic stroke.
## Footnote
This procedure is indicated when TPA cannot be administered.
316
True or False: Carotid angioplasty with stenting is a highly invasive procedure.
False
## Footnote
It is a minimally invasive procedure.
317
What type of device does the MERCI procedure use?
A corkscrew device
## Footnote
This device helps in the mechanical removal of emboli.
318
What is a preventative measure for aneurysm surgical treatment?
Coil it and clip it
## Footnote
Clipping requires a craniotomy to access the aneurysm.
319
What surgical procedure is necessary for clipping an aneurysm?
Craniotomy
320
What are key monitoring practices for ischemic stroke treatment?
Monitor ICP – watch for changes in ICP
## Footnote
ICP stands for intracranial pressure, which is crucial to monitor in stroke patients.
321
What medications are commonly used in the treatment of ischemic stroke?
Thrombolytic Therapy, Anticoagulants, Antiplatelet Agents, Anticonvulsants, Antihypertensives
## Footnote
Thrombolytic therapy includes medications like t-PA (tissue plasminogen activator) and intra-arterial thrombolysis using urokinase.
322
What is t-PA in the context of ischemic stroke treatment?
t-PA - tissue plasminogen activator
## Footnote
t-PA is a thrombolytic agent used to dissolve blood clots in ischemic stroke patients.
323
What is the MERCI Procedure?
Clot Retrieval - MERCI Procedure
## Footnote
The MERCI procedure is a mechanical thrombectomy technique used to remove clots from blood vessels in the brain.
324
What surgical interventions are available for hemorrhagic stroke?
Craniotomy, Aneurysm Clipping
## Footnote
These procedures aim to repair blood vessels and alleviate pressure in the brain.
325
What complications should be monitored after a hemorrhagic stroke?
Watch for Hydrocephalus, Increased ICP
## Footnote
Hydrocephalus is an accumulation of cerebrospinal fluid that can increase intracranial pressure.
326
Fill in the blank: Intra-arterial thrombolysis utilizes _______ for clot dissolution.
Urokinase
## Footnote
Urokinase is a type of thrombolytic agent used specifically in intra-arterial treatments.
327
What factors should be assessed before administering thrombolytic therapy?
PT, PTT, INR – Clotting Factors
## Footnote
These are tests to assess the blood's ability to clot before starting thrombolytic therapy.
328
True or False: Antihypertensives are used in the management of ischemic strokes.
True
## Footnote
Antihypertensives help manage blood pressure, which is critical in stroke management.
329
What is the purpose of carotid artery angioplasty in stroke treatment?
To open narrowed arteries and improve blood flow to the brain
## Footnote
Carotid artery angioplasty is performed to reduce the risk of stroke caused by carotid artery stenosis.
330
What is STK-1 in the context of stroke core measures?
Ischemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission
## Footnote
VTE stands for Venous Thromboembolism, which is a condition that can occur in patients with stroke.
331
What does STK-2 measure?
Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge
## Footnote
Antithrombotic therapy is crucial for preventing further thrombotic events.
332
What is the focus of STK-3?
Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge
## Footnote
Atrial fibrillation increases the risk of stroke, and anticoagulation helps mitigate this risk.
333
What criteria does STK-4 specify?
Acute ischemic stroke patients who arrive at the hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well
## Footnote
t-PA (tissue Plasminogen Activator) is a clot-busting medication.
334
What does STK-5 stipulate regarding antithrombotic therapy?
Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2
## Footnote
Timely administration of therapy is critical for stroke management.
335
What does STK-6 require for ischemic stroke patients?
Ischemic stroke patients with LDL greater than or equal to 100 mg/dL, or LDL not measured, or who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge
## Footnote
Statins help lower cholesterol levels and reduce the risk of future strokes.
336
What educational materials must be provided according to STK-8?
Ischemic or hemorrhagic stroke patients or their caregivers should receive educational materials addressing:
* activation of emergency medical system
* need for follow-up after discharge
* medications prescribed at discharge
* risk factors for stroke / warning signs
## Footnote
Education is essential for improving patient outcomes and preventing future strokes.
337
What does STK-10 indicate about stroke rehabilitation?
Stroke rehabilitation should begin as soon as the diagnosis is confirmed and life-threatening concerns have been addressed
## Footnote
Early rehabilitation can significantly improve recovery outcomes for stroke patients.
338
What is the nursing diagnosis for inadequate blood flow to the brain?
Ineffective Tissue Perfusion: Cerebral
339
What nursing diagnosis involves the risk of aspiration and difficulty swallowing?
Risk for aspiration / Impaired Swallowing
340
Which nursing diagnosis is characterized by altered thought processes and disturbed sensory perception?
Altered thought processes / Disturbed sensory perception
341
What nursing diagnosis refers to limitations in physical movement?
Impaired physical mobility
342
Fill in the blank: A nursing diagnosis indicating a patient's inability to perform personal care is called _______.
Self-care deficit
343
What nursing diagnosis indicates a risk for skin damage?
Risk for impaired skin integrity
344
What nursing diagnosis relates to loss of control over urination or bowel movements?
Urinary incontinence, Bowel incontinence or Constipation
345
What nursing diagnosis indicates a potential for harm?
Risk for injury
346
What nursing diagnosis is associated with right cerebrovascular accident (CVA)?
R CVA – Unilateral neglect
347
What nursing diagnosis is associated with left cerebrovascular accident (CVA)?
L CVA – Impaired verbal communication
348
What nursing diagnosis may involve feelings of fear or anxiety?
Fear or Anxiety
349
What nursing diagnosis involves a lack of social interaction?
Social isolation
350
What are the goals for patient outcomes in nursing care? List three.
* Have adequate cerebral blood flow
* Maximize functional abilities and purposeful movements
* Accept residual deficits and learn to adapt
351
True or False: It takes months to fully understand the long-term effects of nursing diagnoses.
True
352
What should nurses be creative in when working with patients?
Ways patients can communicate
353
What is the timeframe for acute interventions after a brain attack?
1st 72 hrs
## Footnote
This is critical for effective management of the patient.
354
What is the recommended oxygen saturation level to maintain?
SaO2 > 93%
## Footnote
This is essential for ensuring adequate oxygenation.
355
What position should an unconscious patient be placed in?
Side lying with HOB degrees elevated
## Footnote
This helps maintain airway patency.
356
What are essential checks to perform during acute interventions?
VS/Neuro Checks
## Footnote
Vital signs and neurological checks are crucial for monitoring the patient's condition.
357
What should be monitored and maintained in the acute phase?
Fluids and Electrolytes
## Footnote
Proper hydration and electrolyte balance are important for recovery.
358
What precautions should be taken for seizure management?
Padded rails, bed low
## Footnote
These measures help prevent injury during a seizure.
359
What types of medications are commonly administered in the acute phase?
Diuretics, anticoagulants, anticonvulsants, antihypertensives
## Footnote
Each medication serves a specific purpose in managing the patient's condition.
360
When does the rehab phase start after a brain attack?
The day of the Brain Attack
## Footnote
Early rehabilitation can improve outcomes.
361
What are some dysphagia precautions to consider?
Gag reflex, HOB 30-45 degrees, NPO until swallowing evaluation
## Footnote
These precautions help ensure safe swallowing.
362
What should be done if a patient cannot swallow?
May need tube feeding (NG tube if can't swallow)
## Footnote
This ensures the patient receives necessary nutrition.
363
What action can be taken to facilitate swallowing?
Massage throat
## Footnote
This technique can help stimulate swallowing reflexes.
364
What is the protocol after a swallowing evaluation if the patient is cleared?
May start on thickened liquids
## Footnote
This is a safer alternative to regular liquids for those with swallowing difficulties.
365
Who conducts the swallow screen test?
Specially trained RN or Speech Therapist
366
What should be done with the patient before the swallow screen?
Keep patient NPO until screen done
367
What position should the patient be in during the swallow screen?
Have patient sit up 90 degrees
368
What is the procedure for the swallow screen?
Have patient swallow spoonful of liquid
369
What are the signs indicating a successful swallow screen?
No coughing, choking, altered voice tone, gurgling, dribbling, watery eyes
370
What should be checked in the patient's throat during the swallow screen?
Larynx should rise as patient swallows
371
What should be done if the patient fails the swallow screen?
Keep NPO, must have Swallow Evaluation by Speech Therapist
372
What is Virchow’s Triad?
It is the triad of three factors that contribute to thrombosis:
* Endothelial injury
* Hypercoagulability
* Venous stasis (abnormal blood flow)
## Footnote
None
373
What is 'endothelial injury' in Virchow's Triad?
Damage to the inner lining of the blood vessel, which can trigger clot formation.
Examples: Surgery, trauma, central lines, atherosclerosis.
## Footnote
None
374
What does 'hypercoagulability' mean in Virchow's Triad?
Increased tendency of blood to clot.
Examples: Cancer, pregnancy, oral contraceptives, genetic disorders (e.g., Factor V Leiden).
## Footnote
None
375
What is 'venous stasis' in Virchow’s Triad?
Sluggish or slow blood flow, often in the lower extremities.
Examples: Immobility, bed rest, long flights, heart failure.
## Footnote
None
376
Why is Virchow’s Triad clinically important?
It helps identify risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE).
VTE prophylaxis essential in patients with stroke.
## Footnote
Also use pneumatic compression stockings/boots or TED. Best is AROM of ankles.
377
What is the purpose of a laxative regimen in post-stroke care?
To reduce straining and decrease intracranial pressure (ICP)
## Footnote
May need formal bladder/bowel training program
378
What are key practices for skin and mouth care in stroke patients?
Frequent turning and cleaning the mouth before eating
## Footnote
Risk for skin breakdown is high
379
What should be assessed in communication for stroke patients?
Deficits in communication and collaboration with Speech Therapy
## Footnote
Approach from the unaffected visual side
380
How should communication be conducted with stroke patients?
Be patient, speak slowly, clearly, and use brief simple/single instructions
## Footnote
Utilize a communication board
381
What emotional care strategies are important for stroke patients?
Consistent schedule, involvement of family, and grief support
## Footnote
Realistic expectations as patients may experience emotional changes
382
What does ROM stand for in the context of stroke rehabilitation?
Range of Motion
## Footnote
Patients should perform their own passive/active ROM
383
What is the recommended approach to body mechanics during patient mobilization?
Approach from the unaffected side
## Footnote
Strong side goes first when mobilizing
384
What is a significant risk for patients post-CVA?
High risk for falls
## Footnote
Cane should be used on the unaffected side
385
What are the three stages of recovery after a stroke?
1. Acute Phase 2. Subacute Phase 3. Chronic Phase
## Footnote
Each phase has distinct focuses and activities
386
What is the focus during the Acute Phase of stroke recovery?
Medical stabilization, preventing complications, initial assessment
## Footnote
Duration is typically the first few days after the stroke
387
What is emphasized during the Subacute Phase of stroke recovery?
Intensive rehabilitation to regain lost function
## Footnote
This phase lasts several weeks to months
388
What activities are involved in the Chronic Phase of recovery?
Ongoing therapy, managing chronic conditions, participating in support groups
## Footnote
This phase can last months or even years
389
How long does it take for cerebral edema to resolve after a stroke?
About four weeks
## Footnote
Circulation to ischemic area restores in about 3 months
390
How long may it take for healthy neurons to form and compensate after a stroke?
About 6 months
## Footnote
This is part of the recovery process
