CVA pt.2 (Exam 4) Flashcards
Stroke: Management of Modifiable Risk Factors
Healthy diet
Weight control
Regular exercise
No smoking
Limiting alcohol consumption
BP management
Routine health assessments
Preventive Drug Therapy
Antiplatelet drugs w/ patient who have had TIA
81 mg aspirin once daily is most used
Surgical Intervention for TIA’s r/t carotid disease
Carotid Endarterectomy (remove plaque in carotid artery)
Stenting
Transluminal angioplasty (balloon procedure)
Are strokes treatable?
yes most strokes are treatable
(time is of the essence)
What is KEY when treating a stroke?
Time of onset
FDA approves 3 hours
ASA endorse extension to 4.5 hours under certain criteria
Acute Ischemic Stroke: Intervention
IV fibrinolytic therapy
IV alteplase
IV Fibrinolytic Therapy: Timing
FDA approves administration of within 3 hours of stroke
ASA edorese extension to 4.5 hours under certain criteria
Ischemic Stroke: Endovascular interventions to improve perfusion
Mechanical embolectomy w/ stent placement
Carotid artery angioplasty w/ stent placement
What information is critical when it comes to a stroke patinet?
Time of onset of symptoms
Stroke Managing Begins with
Circulation
Airway
Breathing
Baseline Neurologic Assessment: Monitor closely for….
-signs of increasing deficit
-many patients worsen in the first 24-48 hours
Why is elevated BP common immeditaley after a stroke?
It may be a protective response to maintain cerebral perfusion
Ischemic Stroke: Fluid and Electrolyte balance is important to
Promotes perfusion
Decrease further brain injury
Ischemic Stroke: Recombinant Tissue Plasminogen Activator (tPA)
Given to reestablish blood flow through a blocked artery to prevent cell death
Must be started within 4.5 hours of onset of clinical signs of ischemic stroke
Patient are carefully screened
Post tPA after the patient has been stabilized and to prevent further clot formation, patients with strokes caused by thrombi and emboli may be treated with
Anticoagulants and platelet inhibitors
-ASA
-ticlopidine
-clopidogrel
-dipyridamole
Endovascular / Mechanical Thrombectomy: Stent Retrievers
A way of managing ischemic stroke
-catheter used to guid the small stent into affected artery in brain
-stent expands interior walls of artery and allows blood flow to brain
-clot seeps mech of stent
-stent and clot removed together
Hemorrhagic Stroke: Manage
Airway
Breathing
Circulation
ICP
Hemorrhagic Stroke: Surgical Interventions
Evacuation of hematoma
Resection and / or radiosurgery
Clipping / coiling of aneurysms
Guglielmi Detachable Coil (GD Coil)
A coil is used to occlude an aneurysm
Coils are made of soft, springlike platinum
The softness of the platinum allows the coil to assume the shape of irregularly shaped aneurysms while posing little threat of rupture of the aneurysm
Catheter is inserted through artery in the leg. Then threaded up to the cerebral blood vessels
Platinum coils attached to a thin wire are inserted into the catheter and then placed in the aneurysm until the aneurysm is filled with coils. Packing with coils prevents blood blow from circulating through the aneurysm reducing the chance of rupture
