MedSurg Mod 4: Stroke Flashcards Preview

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Flashcards in MedSurg Mod 4: Stroke Deck (100)
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1

Most strokes are ___

ischemic (85%)

2

What are the 2 main types of Ischemic Stroke

Thrombotic

Embolic

3

Embolic Stroke

Clump of something like a thrombus, fat, or cells move to the brain and block flow

ex: Cells can be anything from infection lodging on valves of the heart, or chunks and pieces of cellular debris, when people inject non sterile materials into their veins, etc

4

Thrombolic Stroke

Results from vascular sclerosis --> Narrowing of the artery

5

TIA

transient ischemic attack

type of thrombotic stroke

occlusion of a small artery

resolves quickly within 24 hours and with little residual deficit

6

Another term for stroke

CVA

7

CVA occur when ...

blood supply to the brain is disrupted

8

___ is the primary cerebrovascular disorder and the ___ leading cause of death in the US

stroke; 3rd

9

Non Modifiable risk factors and patient profile for strokes

age (>55)

gender

ethnicity (higher in African American pop. d/t diabetes, vascular disorders, HTN risk)

10

Modifiable risk factors and patient profile for strokes

lifestyle issues like diet, SMOKING, alcohol, lack of physical activity

drug use - cocaine, amphetamines, OTC cough and cold drugs (SUDDEN VASOCONSTRICTION)

11

What are some lifestyle related diseases that increase stroke risk

HTN - #1 - risk for both ischemic and especially hemorrhagic stroke

Hyperlipidemia

Obesity

Diabetes

Periodontal Disease because gingivitis can lead to generalized body inflammation

A Fib - quivering causes blood pool stasis and clotting that can move from L ventricle --> aorta --> brain

OC - Oral contraceptives

12

How does smoking contribute to CVA

it has a role in blood vessel damage

it damages the endothelium lining in particular causing inflammation and increasing the chance for plaque and blood clots to form

13

A healthy lifestyle can reduce CVA risk by ___%

50% (to even 80%)

14

An ounce of ___ is worth a pound of cure

prevention

15

Transient Ischemic Attack

form of thrombotic stroke that occludes a very small artery or arteriole

affects only a small portion of the brain tissue meaning there usually is no permanent neurological compromise

lasts <5 minutes and symptoms must resolve within 24 hours

Despite minor issues, do not ignore this

16

Why should TIA not just be ignored for being not very serious itself?

because TIA is considered a forewarning for further stroke issues

17

What is the Approach to Care after a TIA

*Same as Stroke Prevention*

1. Lifestyle - focus on modifiable areas intensively

2. Medications - aspirin and other antiplatelet; anticoagulants if A Fib

3. Surgical/Catheter Interventions - endarterectomy, stenting, etc

18

Carotid Endarectomy

Removal of plaque from the lining of carotid arteries thus reopening the blood vessels

Indicated as a surgical response to TIA or Mild CVA with 70-99% carotid blockage and significant risk for stroke

It is reserved for significant occlusion though since there is a chance to damage the vessel wall

19

Carotid Stenting

Less invasive surgical procedure indicated for TIA or mild CVA

Used for those with high surgical risk - must less invasive than an endarectomy

Mesh tubes are inserted in the vessel allowing trapping of clots and allowing blood to get through - the tube prevents collapse and the filter will grab and break the clots

20

What is involved in the post op nursing care for stroke surgeries and for what reason?

Monitor VS/neuro status (cranial nerve impairment?)

Facial Pulses (Adequate circulation?)

Assess incision for edema, hematoma, tracheal deviation (Airway compromise?; Neck edema --> tracheal deviation --> airway obstruction?)

Elevate HOB and position off operative side (promote drainage and wound visibility)

Notify MD if VS are not within parameters

Worry about cranial nerves

21

Warning signs and symptoms of CVA`

trouble walking

trouble speaking and understanding

paralysis or numbness of the face, arm, or leg

trouble with seeing in one or both eyes

HA

22

FAST`

signs of stroke

Face - does it look uneven

Arm - does one arm drift down

Speech - does their speech sound strange

Time - if you notice F A or S then call 911

23

What are the human responses to the acute phase of CVA

change in LOC or responsiveness

presence or absence of voluntary or involuntary movements

change in quality/rates of pulse and respiration

change in ability to speak

presence of bleeding

vital signs / O2 saturation

visual changes

abnormal movements that may mimic a seizure even

24

What are the human responses to the post acute phase for CVA

mental status changes - judgment and behavior in general changed

loss of motor control -- uni or bilateral

swallowing ability impairment - do not feed until evaluated

self care compromises

sensation and perception changes

changes in nutritional and hydration status

skin - because of immobility

25

S/S of CVA

*RELATIVELY INDEPENDENT OF CAUSE*

It depends on the size of the lesion, amount of pre existing collateral blood flow, and the location of the lesion (is it a lobe of the brain or an entire hemisphere?)

26

Frontal Lobe

movement and personality!!!

motor area for speech, emotional behavior and complex intellectual abilities

27

Parietal Lobe

Sensations!!!

pain, cold, pressure, size, shape, texture, location and intensity of stimuli, awareness of body parts

28

Temporal Lobe

Senses!

hearing, taste, smell, interpretations of sound

29

Occipital

Vision!

visual stimuli

30

Do s/s of stroke depend on whether it is ischemic or hemorrhagic?

no it depends on the size of the lesion, how much is affected, and what parts of the brain is blocked off