Exam 2 Flashcards
(160 cards)
Ischemic stroke patho
Disruption in blood supply that lasts more than 24 hours
Two types- thrombotic and embolitic
Thrombotic stroke-ischemic stroke
Due to atherosclerosis
S/s occur SLOWLY and develop over time; often have TIA before stroke
-slight headache
-speech deficits
-visual disturbances
-confusion
why may thrombotic s/s occur slowly over time?
My have collateral circulation
Embolitic stroke-ischemic
Embolus usually from the heart (A-fib)
Clot breaks off and travels to smaller vessels
SUDDEN onset
-facial droop
-slurred speech
-paralysis
-expressive aphasia
More likely to die as clot travels producing more s/s
Hemorrhagic stroke Patho
Occurs during activity due to BP and increased pressure on the vessels
Causes: aneurysm, AV malformation
S/s occur quickly:
-headache
-lethargy
-stupor
-coma
-seizures
What is the most common cause of hemorrhagic strokes?
AV malformation
AV malformation
Arteries shunt directly into veins instead of capillaries
What are the two causes of hemorrhagic strokes?
Aneurysm ruptures and AV malformation
TIA patho
Transient decrease in blood flow to the brain “halfway to CVA”. Transient focal deficits lasts no longer than 24 hrs
Evaluated with carotid ultrasound and EKG
-drooping, slurred speech, vision changes
Ischemic vs hemorrhagic vs TIA
Ischemic=lack/low blood flow to brain, s/s slowly and develop over time or sudden depending on type (thrombotic vs embolitic)
Hemorrhagic= structural or pathological causes
S/s quickly
TIA= warning sign, s/s no longer than 24 hrs
Ischemic stoke assessment findings
Hemorrhagic stroke assessment findings
S/s occur quickly
Doesn’t look like FAST
-collapse, high BP, increased ICP, decreased LOC, s/s bleeding:enlarged neck, deviated trachea, respiratory distress, dysphagia
TIA assessment findings
Ischemic stroke management
restore the blood flow-> t-PA
Monitor LOC
Monitor RR and depth
Maintain airway
Hemorrhagic stroke management
Too much blood- stop the bleeding!
-control HTN
-complete bed rest HOB elevated, quiet dark room, no stimuli, no caffeine, no hot/cold fluids
-sedate PRN
-NO restraints
-monitor for severe headache, N/V, dec LOC
TIA management
Safety concerns w management post CVA
Physical limitations for post CVA management and safety concerns
Psychosocial concerns post CVA and management safety concerns
Early recognition of s/s stroke
First thing- what time did s/s start? (4 hr time frame)
-sudden weakness/numbness (face, arm, leg unilateral)
-sudden confusion
-sudden trouble walking
-dizziness or loss of balance/coordination
-sudden severe headaches with no known cause
F.A.S.T assessment
Facial drooping - “smile”
Arm weakness/drift-close eyes and extend both arms palms up for 10 sec… drift?
Speech difficulty/slurred-“you cant teach an old dog new tricks”
Time to call 911- 4 hr window for t-PA
Actions to take when recognizing a stroke
Call 911 immediately and have EMS call stroke code to clear CT machine; note the time s/s started
Eligibility criteria for t-PA adminstration (Tissue plasminogen activator)
Contraindications: other thinners, pregnant, any bleeding, bleeding disorder, recent surgery (neuro/brain.. but all), AV malformation, uncontrolled BP, within 3-4 hour window form onset of s/s, assessed with NIHSS
t-PA
