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CVA Management Flashcards

1
Q

Supportive Care of Ischemic Stroke

A
  1. Maintain airway
  2. Control Fever
  3. Assess for arrhythmia
  4. Maintain blood pressure to maintain cerebral perfusion
  5. Maintain Blood Glucose of 140-180
  6. Prevent hospital related complications
  7. Initiate secondary prevention strategies to prevent recurrent stroke
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2
Q

Ways to maintain airway in Ischemic Stroke

Rationale?

A

Supplemental Oxygen
Ventilator Support

Prevent Hypoxia. Prevent Recurrent Stroke. Prevent Aspiration.

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3
Q

Ways to control fever in Ischemic Stroke

Rationale?

A

TTM
Anti-Pyretics

Prevent worse outcomes

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4
Q

Monitor for arrhythmias in Ischemic Stroke

Rationale?

A

MI
AF
Most common with ischemic stroke

Identify arrhythmias that can potentiate a CVA

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5
Q

Blood Pressure Management in Ischemic Stroke

Rationale?

A

Avoid treatment unless SBP >220 or DBP >120

Maintain CPP

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6
Q

Drug of choice for Hypertension in Ischemic Stroke

A
  1. Labetalol
  2. Hydralazine
  3. Nicardipine
  4. Nitroprusside (Last Resort)
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7
Q

When should you avoid thrombolytics in Ischemic Stroke

A

SBP >185 and DBP>110

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8
Q

Blood Glucose Management in Ischemic Stroke

A

Normal Saline
Intravenous or Subcutaneous Regular Insulin
Maintain target range of 140-180

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9
Q

Most commmon complication of Ischemic Stroke Management

A
  1. Aspiration Pneumonia
  2. CAUTI
  3. CLABSI
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10
Q

Medical Management of Acute Ischemic Stroke

A
  1. Thrombolytics
  2. Anticoagolants
  3. Antiplatelets
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11
Q

Risk Factors for Ischemic Stroke

A
  1. Hypertension
  2. Diabeties Mellitus
  3. Dyslipidemia
  4. Smoking
  5. Alcoholism
  6. Obesity
  7. Sedentary Lifestyle
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12
Q

Reccomendations for Hypertension

A

Maintain SBP of <140 and DBP <90

Diuretics, ACEi

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13
Q

Reccomendations for Diabeties Mellitus

A
  1. Maintain SBP of <130 and DBP <80
  2. Maintain GLU <126 or A1C <7%

ACEi, ARBs, Hypoglycemics, Insulin

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14
Q

Reccomendations for Lipids

A
  1. Maintain LDL <100 for Low Risk
  2. Maintain LDL <70 for High Risk

Statins, Niacin, Gemfibrozil

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15
Q

Reccomendations for Cigarette Smoking

A
  1. Smoking Cessation
  2. Nicotine cessation products
  3. Counseling
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16
Q

Reccomendations for Alcoholism

A
  1. Decrease Alcohol intake
  2. Provide formal alcohol cessation programs
  3. Reccomend <2 drinks per day
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17
Q

Reccomendations for Obesity

A
  1. Goal BMI of 18.5-24.9
  2. <35 waist for women
  3. <40 waist for men
  4. Weight Reduction programs
18
Q

Reccomendations for Sedentary Lifestyle

A

30 minutes of moderate-high intensity exercise

19
Q

Reccomendations for CAD, Dysrhythmia, CHF, and valvular disease

A

Treat diease and the underlying etiology

20
Q

Thrombolytics

Rationale?

A

Alteplase (rt-PA)
0.9 mg/kg (MD: 90 mg)
10% Bolus with 1H infusion

Restore CBF, Reduce Ischemia, Limit Neurological Disability

21
Q

Anticoagulants

A

IV Heparin

Not reccomended after rt-PA administration

22
Q

Antiplatelets

A
  1. ASA
  2. Ticlopidine
  3. Clopidogrel
  4. Dipyridamole
23
Q

Reccomendations for ASA after Ischemic Stroke

A
  1. 162-324 within 48h
  2. Not an alternative to rt-PA
  3. Abciximab is not reccomended
24
Q

Surgical Interventions for Ischemic Stroke

A
  1. Craniectomy
  2. Carotid Endarterectomy
  3. EC-IC bypass through the STA to the MCA
  4. Rehabilitation

EC-IC bypass is not reccomended

25
Nursing Management of Intracranial Hemorrhage (ICH)
1. Assessment and Monitoring 2. Implementation and Titration of Protocols 3. Safety and Prevention of Complications related to Immobilization 4. Early Rehabilitation and Recovery
26
ICH Assessment and Monitoring
1. Comprehensive Neurological Assessment 2. Vital Signs 3. GCS 4. ECG 5. ICP level
27
Complications related to Immobilization in ICH
1. Hypoxemia 2. Hypoglycemia 3. Hyperglycemia 4. Increased ICP 5. Paresis 6. Paresthesia 7. Paralysis 8. Gastrointestinal Bleeding 9. Hypertension 10. Reperfusion Injury 11. Electrolyte Imbalances 12. Dysrhythmias 13. DVT 14. PE 15. ATC Therapy effects 16. Thrombolytic Therapy effects
28
Early Rehabilitation and Recovery
Begin rehab as early as possible
29
# Nursing Diagnoses IS/ICH
Ineffective airway clearance Ineffective breathing pattern Risk of aspiration Altered Cerebral Tissue Perfusion Risk of Infection Impaired Verbal Communication Impaired Physical Mobility Risk for DVT/PE Nutrition Deficit Altered Urinary Elimination Altered Role Performance Unilateral Neglect Disuse Syndrome
30
Performance Measures for ICH
1. Baseline NIHSS 2. Coagulopathy Reversal 3. VTE Prophylaxis 4. Admission Unit 5. Dysphagia Screening within 24h 6. Passed Dysphagia Screening Test before initial intake 7. Long-Term Blood Pressure Treatment 8. Assessment for Rehab 9. Avoidance of corticosteroid use
31
Performance Measure: Coagulopathy Reversal
INR >1.4 and recieved vitamin K within 90 minutes
32
Performance Measure: VTE Prophylaxis
Lower limb pneumatic compression on Day One
33
Performance Measure: Dysphagia Screening
Completed within 24 hours of admission
34
Performance Measure: Long-Term B/P Control
BP <130/80 by discharge
35
Putaminal Hemorrhage
Hematoma into the putamen of the basal ganglia
36
Thalamic Hemorrhage
Hematoma into the thalamic region
37
Pontine Hemorrhage
Hematoma into the pons
38
Cerebellar Hemorrhage
Hematoma into the cerebellum
39
Diagnostics for ICH
Noncontrast CT CT Angiography MRI
40
Blood Pressure Management in ICH
150-220 SBP with no contraindications
41
Surgical Intervention in ICH
Hematoma Evacuation Decompression Craniectomy with or without Hematoma evacuation

Clinical One (8 decks)

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