CVA

Question 1

There are 2 main classifications of stroke.
1.
2.

Name each. Explain what each is?

Answer 1

1. Ischemic Stroke
   (blood clot or blockage of blood to brain tissue)
2. Hemorhhagic (burst or bleeding blood vessel in the brain)

Question 2

Which one of the two types of strokes would be d/t a rupture blood vessel in the brain, causing bleeding in the brain?

Answer 2

Haemorrhagic Stroke

Question 3

Define Transient Ischemic Attack

Answer 3

AKA, TIA.

Intermittent lack of blood flow to the brain d/t small temporary blockage

Question 4

How long would a patient who is suffering from a TIA show signs of a stroke?

Answer 4

1-2 hours

Question 5

Are TIA’s an increased risk of a person then suffering from a major stroke?

Answer 5

Yes

Question 6

What are the Non- Modifiable risk factors for CVA?

Answer 6

Age, sex, ethnicity

Question 7

What are the modifiable risk factors for CVA?

Answer 7

Atherosclerosis
HTN
A Fib
Obesit
Hyperlipidemia
Obesity 
Smoking
Diabetes

Question 8

Explain how the follow are risk factors for CVA..

1. HTN
2. Hyperlipidemia/Obesity
3. Smoking
4. Diabetes
5. Atrial Fibrillation

Answer 8

1. HTN = sets the stage for atherosclerosis (vessel then has impeded blood flow)
2. Contributes to atherosclerosis
3. Reduces amount of 02 in the blood causing the heart to work harder AND increases atherosclerosis and vasconstriction of the artery
4. Hyperglycemia = damages endothelium of vessels (thickening)
5. A FIb, abnormal rhythm of the heart can causes blood to pool, which can lead to a blood clot forming

Question 9

What are the Signs of a stroke?

1. F/A/L
2. Brain
3. Eyes
4. Stomach
5. Body
6. Legs

Answer 9

1. Face, arm, leg (on one side) will be numb or weak
2. Confusion, trouble talking or understanding speech, diziness, loss of balance, bad headache
3. Trouble seeing in one or both eyes
4. Throwing up
5. Feel tired
6. Trouble walking

Question 10

The following acrynoynm is used to assess if a CVA is occuring.
Explain what each letter means.
FAST

Answer 10

F. Face (drooping on one side?)
A. Arms (unable to raise one arm)
S. Speech (say a simple phrase… do they have slurring or strange speech?)
T. Time (call 911 stat, time = brain!)

Question 11

If the CVA is in the left hemisphere, what side of the body would symptoms present?

Answer 11

The right side

Question 12

A Patient suffering from a stroke has motor loss. Define the following terms.

1. Hemiparesis
2. Hemiplegia
3. Ataxia
4. Dysphagia

Answer 12

1. Weakness
2. Paralysis
3. Unsteady gait
4. Difficulty swallowing

Question 13

A patient suffering from a stroke has communication loss. Define the following terms

1. Dysarthia
2. Dysphasia
3. Aphasia
4. Apraxia

Answer 13

1. Problems with speeh
2. Problems with swallowing
3. Problems with receptive or expressive
4. Inability to perform learned tasks

Question 14

A person undergoing a CVA has perceptual changes. Explain this

Answer 14

Visual- perceptual dysnfuncations are due to disturbances of the primary sensory pathways between the eye and visual cortex

Question 15

A person undergoing a CVA has sensory loss. Explain what 2 proccess this involves.

Answer 15

1. Touch impairment

2. Difficulty interpreting stimuli

Question 16

When you are assessing a patient who has a CVA, what are 3 things you assess for?

Answer 16

1. Airway
2. Cardiovascular status
3. Gross neurological losses

Question 17

What is a CT differentiating between in regards to stroke?

Answer 17

Ischemic vs. Hemmorhagic

Question 18

A patient undergoing a Ischemic Stroke could recieve thrmbolytic therapy if they meet the proper critera. What would thrombolytic therapy include (what drug?)

Answer 18

TPA

Tissue Plasminogen Activator

Question 19

What does TPA (tissue plasminogen activator) do?

Answer 19

Dissolves the blood clot that is blocking blood flow to the brain

Question 20

What criteria is there for a patient undergoing an ischemic CVA to meet before being able to have TPA therapy? (7)

Answer 20

1. Time
2. BP
3. Ischemic stroke only
4. Not on Warfarin
5. Blood Glucose
6. Not post surgery / trauma / bleeding
7. Patients weight needed for dosing

Question 21

The criteria for Tissue Plasminogen Activator therapy involves. Explain what the ranges should be.

1. Time
2. BP
3. Can it be a TIA or hemmorhagic stroke?
4. Not on Warfarin (INR less than what?)
5. Blood glucose
6. What about bleeding/trauma/surgery?
7. What about the patients weight?

Answer 21

1.

Question 22

When a patient presents to the ER having a CVA, what would be the process of assessing the patient’?

Answer 22

1. What happened? Why are you here? LOTARP
2. VITALS
3. Neuro Assessment
4. Carotid bruit, Weight, Temp, Glucose

Question 23

In the neuro assessment, what signs are you looking for?

Answer 23

F
A
S
T

Question 24

Why would you take a patients weight if they are prsenting with a stroke?

Answer 24

If they need TPA, weight based dosing

Question 25

Why would you assess for carotid bruit?

Answer 25

Assess for blood flow to the brain

Question 26

1. What is the purpose of the Glasgow coma scale? 2. When is it used? 3. What would a declining glasgow coma scale mean?

Answer 26

1. To assess the LOC (gauge the patients brain injury) 2. Used when a patients LOC presents to be altered, or there is a suspicion for brain injury 3. A decline in the patients LOC or brain injury occurring

Question 27

The lower the score of a glasgow coma scale.. good or bad?

Answer 27

The lower the score, the more impairment there is.

Question 28

What diagnostic testing would be done to a patient who is presenting with signs of a CVA? (5) Keep in mind some of the testing (2) relate to meeting the criteria for a patient to have TPA therapy.

Answer 28

1. CT scan 2. Possible MRI? 3. Coagulation (blood work) 4. ECG (looking for AFIB?) 5. Blood glucose levels

Question 29

What is a carotid ultrasound looking at?

Answer 29

The blood supply to the brain. Looking to assess for blocked or narrow carotid arteries

Question 30

What is a cerebral angiography looking for?

Answer 30

To see how blood is flowing through the brain

Question 31

The care planning for a patient with CVA involves priorities. Explain what they are.

Answer 31

1. Return blood flow to the brain 2. Apply O2 (reduce 02 demands) 3. Patient is NPO (risk d/t dysphagia) 4. Assess if patient has potentinal to have TPA therapy?

Question 32

What is the nursing care (salience nursing care) that can be provided?

Answer 32

- O2 - Rest - IV (since NPO) - TPA eligibility - Patient may become agitated d/t not follow understanding what is occurring. try to calm the patient down, if you can have family around to try and help with this, do it!

Question 33

After a person has had a stroke, often times the patient then faces struggles such as impaired mobility, self-care deficits, impaired swallowing and communication, urinary incontienece, disturbed thought process. Why is it important a nurse knows this?

Answer 33

So that when caring a patient, you are able to understand the importance of knowing their challenges, as well as how this affects family members.

Question 34

What are some potential complications that be can be associated with strokes?

Answer 34

- Aspiration - DVT - Pressure Ulcers - Malnutrition - Contractures - UR / UTI - Depression

Question 35

What are ways that strokes can be prevented?

Answer 35

- prevent clot in patient with AF - prevent DVT - prevent atherosclerosis

Question 36

What is the pharmacology involved in preventing strokes? (4)

Answer 36

1. Lipid-lowering agent 2. Anti-hypertensives 3. Anti-platelets 4. Anti- Coagulants