Exam 2: Stroke (aka: CVA/"Brain attack")

Question 1

What are the 2 types of Strokes ?

Answer 1

• Ischemic

- Hemmorrhagic

Question 2

Ischemic strokes are due to what ?

Answer 2

Thrombolic or Embolic

Question 3

What is a Thrombus ?

Answer 3

Is a blood clot that FORMS in a vein

Question 4

What is an Embolus ?

Answer 4

A clot that MOVES through the blood vessels, until it reaches a vessel that is too small to let it pass.

Question 5

What is an Ishemic stroke ?

Answer 5

Inadequate blood flow due to a clot

Question 6

What are manifestations of an Ischemic stroke ?

Answer 6

• SUDDEN weakness or numbness on one side of the body
• SUDDEN confussion (change n LOC), trouble speaking or understanding
• SUDDEN vision changes in one or both eyes
• SUDDEN trouble walking, dizziness, or loss of balance
• SUDDEN severe headache

Question 7

What is a Hemorrhagic stroke ?

Answer 7

• Bleeding in the space either between the brain & the tissue covering the brain (Subarachnoid bleed)
  OR
• A bleed in the brain tissue itself

Question 8

Hemorrhagic strokes can be either _____________ or _______________ ?

Answer 8

• Intracerebral

- Subarachnoid

Question 9

How do pt’s with hemorrhagic strokes appear ?

Answer 9

Appear more seriously ill

Question 10

True or False: Pt’s with hemorrhagic strokes, deteriorate more rapidly ?

Answer 10

True

Question 11

How do Hemorrhagic strokes present ?-

Answer 11

• More severe headaches
• Display more marked disturbances in consciousness
• Have more sever nausea & Vomiting
  (vomiting = projectile)

Question 12

What type of Stroke occurs when an obstruction blocks blood flow to a part of the brain ?

Answer 12

Ischemic Stroke

Question 13

What type of stroke occurs when a weekend vessel wall ruptures causing bleeding in the brain ?

Answer 13

Hemorrhagic Stroke

Question 14

What are the warning signs of a stroke ?

Answer 14

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
• Sudden confusion or trouble speaking, or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or loss of balance or coordination
• Sudden severe headache with no known cause

Question 15

What is the Acronym used for the identification of a stroke ?

Answer 15

Act FAST

Question 16

What does the acronym FAST stand for

Answer 16

F: Face, facial drooping
A: Arms, weakness, drift
S: Speech difficulties
T: Time, any of these things call 911

Question 17

What are Non-modifiable risk factors for strokes ?

Answer 17

• Gender
• Age
• Race
• Heredity - sickle cell

Question 18

What are potentially modifiable risk factors for strokes ?

Answer 18

• Cardiac disease
• Blood lipid abnormalities
• Lifestyle: smoking/obesity
• TIA
• HTN
• Diabetes
• A-fib

Question 19

Which sex is at an increased risk for having a stroke ?

Answer 19

Males

Question 20

True or False: The chances of having a stroke increase with age ?

Answer 20

True

Question 21

Which race is 2x more likely of having a stroke ?

Answer 21

African Americans

Question 22

Many of the modifiable risk factors for strokes can be controlled how ?

Answer 22

• Diet
• Exercise
• Medications

Question 23

When trying to diagnose a stroke, what is the first thing we want to do ?

Answer 23

Want to try an establish a timeline !

• Determine when the pt. was last seen well/acting normal

Question 24

What diagnostics are used to detect strokes ?

Answer 24

• CT scan (bleed vs. ischemic)
• MRI (size, location, etc)
• 12 lead EKG
• CXR
• Pulse Oximetry
• Labs: BMP with ionized calcium, CBC, INR, PTT
• Find etiology

Question 25

What is the main thing were looking to do (treat) with ischemic strokes ?

Answer 25

Restore perfusion !

Question 26

What is tPA ?

Answer 26

Tissue Plasminogen Activator AKA: Clot buster

Question 27

What is the immediate Tx for a stroke if the onset of symptoms is < 4.5hrs & there are no contraindications ?

Answer 27

IV tPA

Question 28

What is intra-arterial tPA ?

Answer 28

They insert a thin catheter right up into the femoral artery and put it right against the area of the clot and actually inject tPA right into the clot

Question 29

When can Intra-arterial tPA be given when a stroke is suspected ?

Answer 29

When the onset of the symptoms is between 3-6 hours

Question 30

When can Mechanical clot removal be used with a suspected stroke?

Answer 30

Up to 8hrs post symptom onset

Question 31

What are we monitoring very closely with Hemorrhagic strokes ?

Answer 31

ABCs

Question 32

What other treatments used for Hemorrhagic strokes ?

Answer 32

- Reverse anticoagulants (give clotting factors via fresh frozen plasma) - Correct bleeding - Strict BP control (want systolic kept below 160mmHg)

Question 33

Injury to the right side of the brain from a stroke damages what side of the body ? which includes what type of things ?

Answer 33

Left side of body - creativity - Music - Spatial Orientation - Artistic awareness

Question 34

Injury to the left side of the brain from a stroke damages what side of the body ? Which includes what types of things ?

Answer 34

Right side of the body - Spoken language - Reasoning - Number skills - Written language

Question 35

What area of the brain is responsible for speech ?

Answer 35

Broca's area

Question 36

Which area of the brain is responsible for speech comprehension

Answer 36

Wernicke's area

Question 37

What are the 2 types of Aphasia ?

Answer 37

- Expressive | - Receptive

Question 38

What is Expressive Aphasia ?

Answer 38

The pt can't say what they want to say

Question 39

When somebody has expressive aphasia, where in the brain, is the damage ?

Answer 39

Broca's area (Motor)

Question 40

What is Receptive Aphasia ?

Answer 40

The inability to understand what is being said to them

Question 41

When somebody has receptive aphasia, where in the brain, is the damage ?

Answer 41

Wernicke's area (sensory)

Question 42

What is Dysarthria ?

Answer 42

Muscle control of speech - The pt. may have slurring/unintelligible speech d/t dysarthria

Question 43

Spatial Perceptual problems related to a stroke, are more common with what ?

Answer 43

Right hemisphere strokes

Question 44

What are Manifestations of Spatial Perceptual problems associated with a stroke (most commonly R hemisphere) ?

Answer 44

- Deny illness or body parts - Neglect all input from the affected side - Homonymous hemianopsia (loss of 1/2 of visual field, on the same side of both eyes) - Agnosia - Apraxia

Question 45

What is Agnosia ?

Answer 45

Inability to recognize objects by sight, touch, or hearing

Question 46

What is Apraxia ?

Answer 46

Inability to carryout learned, sequential movements - things they have done in the past

Question 47

What is the Management for Ischemic strokes ?

Answer 47

- Anti-platelet therapy - Aspirin* - Clopidogrel (plavix)* - Anticoagulants for A-fib - Coumadin (warfarin) - Eliquis - Tx carotid artery stenosis/intracranial stenosis - "Statin" therapy for LDL >70 - BP management - Dysphagia screening - DVT prophylaxis - PT/OT/Speech

Question 48

What is the management for Hemorrhagic strokes ?

Answer 48

- ABC's - Reverse anticoagulants - Correct bleeding disorders - Strict BP control - Monitor of NIHSS (stroke scale) & VS - Monitor for increased ICP - Monitor for cerebral vasospasms - Possible ventricular drain - Elevate HOB 30 degrees - Seizure prevention - Temperature management

Question 49

What things are used to reverse anticoagulants ?

Answer 49

- Vitamin K - Fresh frozen plasma (has clotting factors right in it)

Question 50

What things are done for the prevention of strokes ? (collaborative management)

Answer 50

- Manage modifiable risk factors - Platelet inhibitors - Anticoagulants for A-fib - Surgery - Carotid angioplasty or endartectomy - Acute care & Rehabilitation - depends and area & extent of stroke