CVA/Aneurysm

Question 1

4 different types of CVA’s

Answer 1

ischemic
hemorrhagic
TIA
Aneurysm

Question 2

when dx CVA

Answer 2

determine whether its a true CVA
determine if its ischemic or hemorrhagic
*CT of head w/o contrast - GOLD STANDARD
cardiac workups - syncope related?

Question 3

single most modifiable risk factor for CVA

Answer 3

HTN

Question 4

Prevention interventions for CVA’s

Answer 4

HTN management - blood pressure screenings
take meds daily (beta blockers)
smoking cessation
diabetes control
ongoing medical mgmt.
cholesterol (r/t ischemic stroke - plaque build-up)

Question 5

Pharmacologic interventions for CVA’s

Answer 5

focus on TIA’s - prevent from full out stroke
anti-platelets
ASA/Plavix/Coumadin

Question 6

with a TIA pt. WILL have an ischemic stroke, t or f

Answer 6

true, its just a matter of when

Question 7

what do we want to tell our pt. on Coumadin/blood thinners

Answer 7

freq blood test (INR)

pt. safety - falls (avoid injury)

Question 8

what dx test will pt. receive if presenting with TIA

Answer 8

Doppler scan of carotid arteries

Question 9

if occlusion of carotid artery(s) what are 2 options for trt

Answer 9

carotid endarterectomy(CEA)"rotorooter" of carotid artery
transluminal angioplasty w/stenting

Question 10

a brief hospital stay is required with CEA/stenting procedure. t or f

Answer 10

true

Question 11

what happens in a carotid endarterectomy (CEA)

Answer 11

general anesthesia - incision - rid of plaque/open lumen

Question 12

problems r/t CEA carotid endarterectomy

Answer 12

BP drops (used to having to be elevated) - VS frequently 
risk for ischemic stroke - neuro checks q15/sev. hrs.

Question 13

Thomas Jefferson is admitted to the ED after his coworker noticed Mr. Jefferson begin experiencing unilateral weakness when trying to pour his coffee. He is brought to JHN by EMT. Once arriving in the ED, the first priority for Mr. Jefferson is to have a _____ to determine if he is having a ____stroke or a _____stroke.

Answer 13

CT Scan - Ischemic - Hemorrhagic

Question 14

if CT scan confirms ischemic stroke what will be done

Answer 14

tPA (tissue plasminogen activator) - protein=clot buster

Question 15

when is tPA administered

Answer 15

within 3 hrs. of stroke - very good prognosis

if time is unknown not a candidate for tPA

Question 16

is tPA given for pt w/hemorrhagic stroke

Answer 16

no - never

Question 17

contraindications w/tPA

Answer 17

ANY BLEED (head trauma, GI bleed, recent surgery)

Question 18

risks for tPA

Answer 18

hemorrhagic stroke

Question 19

how is tPA administered

Answer 19

IV - bolus then continuous
PLAN AHEAD  (Foley/2 additional iv sites - additional sticks bleed profusely)

Question 20

nurse mgmt. while admin. tPA

Answer 20

manage VS and neurologic status

Question 21

mgmt. of acute ischemic stroke phase

Answer 21

monitor elevated BP
fluid balance
nutritional needs
monitor for hyperglycemia/hyperthermia (ice packs)
seizure precautions (prophylactic care)

Question 22

mgmt. for aneurysm

Answer 22

clipping (saccular aneurysm cutting off blood flow)
wrapping- synthetic material reinforces wall
coiling - catheter through femoral artery

Question 23

IICP is more common in pt. w/hemorrhagic stroke, t or f

Answer 23

true

Question 24

interventions for hemorrhagic stroke

Answer 24

Calcium channel blocker (nimodipine)

prepare for OR

Question 25

to assess severity of a stroke use

Answer 25

NHISS - Health Stroke Scale (the higher the number the more likely long term disability effects)

Question 26

right vs. left sided infarct presentation

Answer 26

right-sided damage - see left sided sequela (more impulsive/safety concern) left-sided damage - see rt. sided sequela (more aware = depression - more cautious)

Question 27

most obvious sign of stroke

Answer 27

motor deficit akinesia - loss of skilled voluntary movements swallowing deficit

Question 28

when pt. receives thickened fluids/food for the 1st time do this

Answer 28

assess gag reflex - worried for aspiration sit pt. up - maintain for 30 min. after eating take small bites ensure food isn't stuck in pockets of mouth provide oral care

Question 29

don't feed anyone without a gag reflex, t or f

Answer 29

true

Question 30

communication with stroke

Answer 30

aphasia - dominant hemisphere of brain is effected dysphasia - difficulty understanding or using language (partial disruption/loss) dysarthria - trouble pronouncing words

Question 31

care of pt w/communication issues r/t stroke

Answer 31

ask yes or no questions | take your time - don't rush them

Question 32

care of pt w/impaired urinary issues

Answer 32

establish good i/o and toileting routine/schedule | usually come back with time (Foley initially)

Question 33

long term goal of stroke pt.

Answer 33

decrease the amount of long term disability