Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NURS353 - Practice of Nursing 2 > MedSurg Mod 4: Stroke > Flashcards

MedSurg Mod 4: Stroke Flashcards

1
Q

Most strokes are ___

A

ischemic (85%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 main types of Ischemic Stroke

A

Thrombotic

Embolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Embolic Stroke

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Thrombolic Stroke

A

Results from vascular sclerosis –> Narrowing of the artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TIA

A

transient ischemic attack

type of thrombotic stroke

occlusion of a small artery

resolves quickly within 24 hours and with little residual deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Another term for stroke

A

CVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CVA occur when …

A

blood supply to the brain is disrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

stroke; 3rd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non Modifiable risk factors and patient profile for strokes

A

age (>55)

gender

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Modifiable risk factors and patient profile for strokes

A

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

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some lifestyle related diseases that increase stroke risk

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does smoking contribute to CVA

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A healthy lifestyle can reduce CVA risk by ___%

A

50% (to even 80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

An ounce of ___ is worth a pound of cure

A

prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Transient Ischemic Attack

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

because TIA is considered a forewarning for further stroke issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Approach to Care after a TIA

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Carotid Endarectomy

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Carotid Stenting

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Warning signs and symptoms of CVA`

A

trouble walking

trouble speaking and understanding

paralysis or numbness of the face, arm, or leg

trouble with seeing in one or both eyes

HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

FAST`

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the human responses to the acute phase of CVA

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
31
Hemiplegia
Hemi - Half Plegia - paralysis Cannot move half the body
32
Hemiparesis
paresis - weakness Half weak but it can move still
33
Dysarthria
difficulty expressing language due to issues neurologically which effect the muscles of the jaw, tongue, etc trouble with speech
34
Aphasia
"without understanding"
35
Expressive Aphasia
trouble expressing oneself speaking non sense but it makes sense in their head
36
Receptive Aphasia
cannot understand the incoming words
37
Global Aphasia
elements of both expressive and receptive aphasia
38
Hemianopsia
loss of vision in half of the visual field ex: cannot see out the right side of both eyes
39
What may damage to the left hemisphere look like
paralysis and weakness on the Right side Right visual field deficit Aphasia - expressive, receptive, or global Altered intellectual ability Slow cautious behavior
40
What may damage to the right hemisphere look like
paralysis and weakness on the left side left visual field deficit spatial perceptual deficits increased distractibility impulsive behavior poor judgment lack of awareness of deficits
41
Why do we say left hemisphere CVA patients are LEFT BEHIND
because these lesions tend to cause more slow, cautious, and behaviorally slow to perform s/s
42
Why do we say right hemisphere CVA patients are ALWAYS RIGHT
because they are distractible, have spatial perceptual issues, and are unaware of their deficits so they always feel like they are right without issue
43
What is the first test done if stroke s/s appear
CT Scan
44
CT Scan for CVA
Done with or without contrast Details tissue and bone images Can detect hemorrhage, tumor, fracture, abscesses hydrocephalus, edema, ventricular or vascular anomalies
45
The standard of care for CVA CT scans means it must be done within what time period
within 30 minutes of a suspected stroke
46
Cerebral Angiogram
Angio = Blood vessels ; Gram = picture Used to assess vasculature in the brain A contrast dye is injected into an artery and a series of images is obtained from perfusion through the entire brain a blockage will be seen as an area without vessels
47
What 2 things are required prior to a cerebral angiogram?
1. Written consent | 2. NPO prior to test
48
What is preferred, cerebral angiogram or CT for CVA patients?
CT Scan
49
What are some other diagnostic procedures that can be done for CVA/neurological issues
lumbar puncture CT scan PET scan MRI Angiography EEG
50
When is a lumbar puncture done
if there is suspicion something is wrong with the CSF
51
When is a PET done and why?
It is more specific but it can give an idea of metabolic activity in regions of the brain including blood flow and other metabolic activities
52
Why use an MRI
it is more detailed than a CT - but it may not be needed for a stroke assessment it can show size and location of a lesion
53
Why use an EEG
more so for seizure activity not so much stroke assesses localized damage so if local damage is affecting electric signals this may be done
54
What diagnostic test always supercedes others for CVA?
CT Scan looking for edema, lesions, and structure
55
What are the goals of acute medical care of a CVA patient
prevent/minimize the risk of re-bleeding OR remove blood clot AND re-vascularize affected brain tissue assess initial injury prevent and treat complications
56
What sort of complications can occur from a CVA that we must monitor for
seizures bleeding bradycardia respiratory compromise
57
What sort of ways can we manage acute medical care for a CVA patient
sedation reduce intracranial edema and pressure intubation to preserve the airway surgical intervention if indicated t=PA administration clot retrieval
58
Why do we sedate CVA patients
to lower the metabolic demand of the brain
59
Why do we worry about respiratory compromise in CVA
because if the respiratory centers were affected in the brain if can have dire impacts
60
In what ways do we reduce intracranial edema and pressure for CVA
osmotic diuretics maintain CO2 range of 30-35 position to avoid hypoxia elevate the HOB
61
Why give osmotic diuretics to a CVA patient
because it can rid of extra fluid in the brain that is contributing to pressure
62
Why is it important to manage CO2 levels between 30-35 in CVA patients
because if the brain is sensing there is less O2, it will naturally attempt to compensate via vasodilation which will bring blood flow in while increasing pressure
63
What is the indication for surgical intervention with a CVA
1. Hematoma exceeding 3 centimeters AND 2. Glasgow Come Scale score decreases * may need to surgically remove clot to fix this*
64
What is a classic thrombolytic agent the body makes that is also given to break up clots
t-PA
65
t-PA - Tissue Plasminogen Activator
Thrombolytic agent that dissolves the BLOOD clot - not other clots like fat or cells Given via IV within 3 hours of symptom onset Requires accurate identification of CVA pathology
66
What is the window of opportunity for t-PA
within 3 hours (to 6) of the onset of symptoms Risk though is that revascularizing necrotic tissue can increase the risk of cerebral edema and hemorrhage so we give early to minimize dead cell perfusion
67
Why is it so important to know CVA pathology before giving t-PA?
It should only be given for ischemic strokes (with blood clots) and not hemorrhagic strokes stroke scale can determine severity as well to allow us to know direness of the situation
68
What are some contraindications for giving t-PA
recent trauma recent surgery cancer CVA GI/GU Bleed INR > 1/7 BP >185/110 *This is all due to risk of causing vessels to burst due to perfusion occurring from clot breakdown*
69
Before giving t-PA do a ...
CT scan
70
Once admitted to the ICU/CCU and given t-PA, what must be done?
Frequent monitoring of VS/neuro status (Q15 min to start) Continuous cardiac monitoring serial labs serial CT scans seizure precautions
71
Why do we not give t-PA after CPR
because some ribs may be broken and there is bleeding occurring and we do not want continued bleeding after
72
What are some Nursing Interventions after t-PA is given
Monitor all invasive lines for bleeding - IV, catheter, NG tube etc - anything we put in and can bleed Monitor all output for signs of bleeding Delay any invasive treatment for 24 hours (injections, lab draws, IV restarts) Monitor for s/s of intracranial bleeding like HA, LOC change, loss of function, etc monitor VS and labs monitor medications for interactions that can cause bleeding and prevent clotting
73
____ is something you should not give to someone on t-PA
aspirin
74
Clot Retrieval
Approach for ischemic CVA where a micro catheter is guided beyond a thrombus, proximal loops are deployed through the thrombus, and a balloon is inflated to prevent blood flow while the thrombus is retracted into a catheter with aspiration Basically a catheter will vac suction the clot out of the blood stream Fast. no bleeding problems or med issues
75
Nursing Interventions after Clot Retrieval
t-PA interventions AND... Keep flat for 4-6 hours to prevent dislodging of a clot at the femoral access site monitor pulse distal to the access site (pulse, movement, temperature)
76
The access site for a clot retrieval is ___, so we should watch for pulses in the ___
femoral; feet
77
How to prevent CVA
diet, exercise, and attention to periodontal disease carotid endarectomy anticoagulant therapy (w/ something like A Fib) antiplatelet therapy like aspirin, Plavix, and others "Statins" antihypertensive medications (prevent hemorrhagic stroke and long term HTN damage to vessels) Clipping of Aneurysm
78
Purpose of Statins
often thought regarding cholesterol plaque in the heart but it also prevents plaque in the brain vessels (and other peripheral vessels) too - and vessels are never isolated from each other throughout the body so this can be beneficial at preventing an embolus
79
Aneurysm
When a person has weakness in the vessel wall and blood flows into there it makes the vessel bulge like a balloon and if it bursts it becomes a hemorrhage
80
Aneurysm Clipping
a procedure where a clip is placed at the base of an aneurysm vessels so blood continues to go through the vessel normally instead of getting caught up in the out pouch
81
Aneurysms are a source for ___ stroke
hemorrhagic
82
Who tends to have aneurysms?
No one in particular we know of - even younger people get them Sometimes they are found incidentally as we cannot do angiograms and CT scans for everyone
83
Aneurysm Coiling
a procedure where an aneurysm is spotted as a large black balloon looking out pouch on CT scan so the surgeon will fill the aneurysm with soft metals like platinum It is a silly string like metal material that goes into the out pouch and prevents blood from going in because it is full - so no blood going in now causes a clear and non dark area on CT scan clipping alternative
84
If a man's left side has something wrong with it and is drooping....
then there must be a right hemisphere problem
85
Garbled speech means ___
dysarthria
86
Glasgow Coma Scale
a scale for neurological checks that has some issues but is a great quick screening tool (used in other areas while more intensive neuro settings have better scales) Has 3 Areas: Eyes, Verbal, Motor with Eyes being scored 1 to 4, Verbal 1 to 5, and Motor 1 to 6 Higher scores mean more function while 1-2 means no function at all
87
What are some major considerations to make when a CVA patient is recovering
potential for aspiration Aphasia - expressive, receptive, global Coping Dysphagia - speech therapy and pneumonia potential Mobility - PT enhancing self care - occupational therapy sensory or cognitive impairment bowel and bladder control - and retraining skin care
88
Dysphagia and CVA
one must consider if the patient can eat and swallow safely
89
What is one of the first complications considered by the CVA patient
mobility issues
90
Ways to improve Mobility for the CVA pt
encourage pt to exercise unaffected side establish a regular exercise routine muscle exercises recommended by PT assist the patient OOB ASAP; assess balance; move slowly
91
Functional Independence Measure (FIM)
instrument which provides information about current mobility, social, and cognitive function It is used to evaluate a person holistically and let you know how independent and functional they are on their own May indicate if they need intensive or gentle rehabilitation and where a person goes and what insurance coverage they get via the score
92
What is the importance of the wall suction unit for CVA patients
The CVA patient is at high risk for aspiration so this can allow suctioning to prevent issues of aspiration The color determines how high the pressure is of suction but we usually do not leave green as high pressure damages mucosa Yellow and slightly higher may be ok for sticky secretions but orange and red are too high for mucous secretion normally
93
What is the importance of the suction canister for CVA patients
it attaches to the bottom of the wall suction unit via small tubing and the long tubing has a suction catheter which actually does the suctioning and goes into the patient the material will enter the canister and when you swing it the cap will cap off and it can be disposed of
94
What is the importance of the suction catheter for CVA patients
it connects to the blue port of the long tubing of the suction canister it is soft and can suction the mouth, airway in the lungs, and the nose if there is aspiration, trouble swallowing or choking this will help get things out
95
Yankauer Suction
"Tonsil Tip Suction" A rigid plastic larger opening catheter It can suction up the secretions in the mouth or back of the throat
96
What is the issue with the Yankauer suction
it is rigid so it should only go as far as the back of the throat an now down into the airway like a soft catheter suctioning beyond the back of the throat can damage tissue in the airways
97
Issue with FAST
It can miss posterior circulation issues involving the vertebrobasilar arterial system Strokes from this area have an 85% mortality rate or higher
98
BE-FAST
A newer updated version of fast that can detect the posterior circulation strokes FAST cannot
99
What does BE FAST stand for
Balance (Are they suddenly losing balance?) Eyes (loss of vision in any eye?) Face (drooping? uneven?) Arms (Is one weak or numb?) Speech (Slurred? confused?) Time (Call 911!)
100
What are the losses seen for BEFAST like?
they are sudden losses NOT gradual ones

NURS353 - Practice of Nursing 2 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions