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Unit 2 > Perfusion: Stroke > Flashcards

Perfusion: Stroke Flashcards

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1
Q

Types of strokes

A

Ischemic stoke: thrombotic stroke or embolic stroke; hemorrhagic stroke: intracerebral hemorrhage, subarachnoid hemorrhage, or arteriovenous malformation

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2
Q

Ischemic stoke

A

Caused by a thrombus (clot) or embolus (dislodged clot)

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3
Q

Thrombotic stroke

A

Associated with atherosclerosis in intracranial or extracranial arteries; have a gradual occlusion (commonly at the bifurcation of the common carotid artery and the vertebral arteries); slow onset (minutes to hours)

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4
Q

Embolitic stroke

A

Caused by a thrombus or thrombi that breaks off from one area of the body and travels to the cerebral arteries via the carotid artery or the vertebrobasilar system; usual source of the embolus is the heart; may be plaque that breaks off from the carotid sinus or interior carotid artery; middle cerebral artery is most commonly involved; sudden development

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5
Q

Hemorrhagic stroke

A

Intracerebral hemorrhage; subarachnoid hemorrhage

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6
Q

Intracerebral hemorrhage

A

Bleeding into the tissue resulting from hypertension; damage to the brain occurs from bleeding, causing edema, distortion, and displacement, which are direct irritants to the brain; occur most often with sudden dramatic increases in blood pressure

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7
Q

Subarachnoid hemorrhage

A

More common; results from bleeding into the subarachnoid space; usually caused by a ruptured aneurism or arteriovenous malformation

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8
Q

Aneurism

A

Abnormal ballooning or blister along a normal artery; causes bleeding into the subarachnoid space, ventricles, and/or intracerebral tissues

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9
Q

Vasospasm

A

Sudden and periodic constriction of a cerebral artery; results from a cerebral hemorrhage due to an aneurism rupture; blood flow to the distal areas of the brain is diminished leading to cerebral ischemia and infarction and further neurological damage

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10
Q

Arteriovenous malformation

A

Occurs during embryonic development; tangled or spaghetti-like mass of malformed, thin walled, dilated vessels; vessels may rupture causing bleeding into the subarachnoid space or into the intracerebral tissue

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11
Q

Evolution of thrombotic stroke

A

Intermittent or stepwise improvement between episodes of warning; completed stoke

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12
Q

Onset of thrombotic stroke

A

Daytime; gradual (minute to hours)

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13
Q

LOC affected by thrombotic stroke

A

Preserved

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14
Q

Contributing associated factors to thrombotic stoke

A

Hypertension; atherosclerosis

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15
Q

Prodromal symptoms of thrombotic stoke

A

Transient ischemic attack

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16
Q

Neurological deficits of thrombotic stroke

A

Deficits during the first few weeks; slight headache; speech deficits; visual problems; confusion

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17
Q

Cerebrospinal fluid in thrombotic stoke

A

Normal; possible presence of protein

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18
Q

Seizures with thrombotic stoke

A

None

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19
Q

Duration of thrombotic stroke

A

Improvements over weeks to months; permanent deficits possible

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20
Q

Evolution of embolic stroke

A

Abrupt development of completed stroke; steady progression

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21
Q

Onset of embolic stroke

A

Daytime; sudden

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22
Q

LOC with embolic stroke

A

Preserved

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23
Q

Contributing associated factors with embolic stroke

A

Cardiac disease

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24
Q

Prodromal symptoms with embolic stroke

A

None

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25
Neurological deficits with embolic stroke
Maximum deficit at onset; paralysis; expressive aphasia
26
Cerebrospinal fluid with embolic stroke
Normal
27
Seizure with embolic stroke
None
28
Duration of embolic stroke
Rapid improvements
29
Evolution of Hemorrhagic stroke
Usually abrupt onset
30
Onset of hemorrhagic stroke
Daytime; sudden, may be gradual if caused by HTN
31
LOC in hemorrhagic stroke
Deepening stupor or coma
32
Contributing associated factors with hemorrhagic stroke
Hypertension; vessel disorders
33
Prodromal symptoms with hemorrhagic stroke
None
34
Neurological deficits with hemorrhagic stroke
Focal deficits; severe, frequent
35
Cerebrospinal fluid in hemorrhagic stroke
Bloody
36
Seizures in hemorrhagic stroke
Usually
37
Duration of hemorrhagic stroke
Variable; permanent neurological deficits possible
38
Modifiable risk factors of stroke
Smoking, substance abuse, obesity, sedentary lifestyle, oral contraceptive use, heavy alcohol use, use of phenylpropanolamine found in antihistamine drugs
39
Nonmodifiable risk factors for stroke
Age, sex, family history, race, history of MI, history of migraine headaches, prior stroke, sickle cell disease, berry aneurysms
40
Risk factors for stroke that can be modified with collaborative management
High BP, high cholesterol levels, TIAs, cardiovascular disease, diabetes, blood clotting disorders, sleep apnea
41
Recommended diet for those at risk for stroke
High in fruits and vegetables and low in saturated and trans fats
42
Lab assessment for stroke
Elevated HGB and HCT levels; elevated WBC; PT, PTT, INR to establish baseline; serum electrolytes including blood glucose, BUN, and creatinine; CBC with diff and platelet count
43
Imaging assessment for stroke
CT without contrast; ischemic stroke CT may be negative for 24 hrs, after which it will show progressive changes of ischemia, infarction, and cerebral edema; MRI demonstrated ischemic injury earlier than CT; ultrasonography and echocardiography help determine cardiovascular risks
44
Other diagnostic assessments for stroke
12-lead electrocardiogram and eval of cardiac enzymes; might see inverted T-wave, ST depression, and prolongation of the QT interval
45
Priority problems for pts with stoke
Inadequate perfusion to the brain; impaired swallowing; impaired physical mobility; self-care deficit; aphasia or dysarthria; urinary and/or bowel incontinence; sensory changes; unilateral body neglect syndrome
46
Improving cerebral perfusion interventions
Start 2 IV lines; non-dextrose isotonic saline; continuously monitor for increasing ICP; fibrinolytic therapy; endovascular interventions; ongoing supportive care; prevent and monitor for early signs of complications (hyperglycemia, UTI, pneumonia); prevent pt falls
47
Fibrinolytic therapy
Standard of practice to improve blood flow to or through the brain; success depends on the time the pt was last seen normal (LSN) and available treatment
48
IV fibrinolytic therapy: recombinant tissue plasminogen activator (rtPA)
Only drug approved for the tx of acute ischemic stroke; standard window of eligibility is 3-4.5 hrs from LSN; dosage is based on actual weight
49
Interventions during or following IV admin of rtPA
Infuse 0.9 mg/kg over 60 minutes with 10% given as a bolus over the first minute; admit to cc or stroke unit; perform neuro assessments and VS every 10-15 during and every 30 following for 6 hrs; if BP >180/105 give anti hypertensive drugs as prescribed; do not place invasive tubes until pt is stable to prevent bleeding; discontinue the infusion in case of reaction; obtain follow up CT scan before starting anti-platelet or anticoagulants; no IM injections
50
Endovascular interventions for stroke
Intra-arterial thrombolysis (drug therapy), and embolectomy (clot removal)
51
Intra-arterial thrombolysis
delivers the fibrinolytic directly into the thrombus within 6 hrs of the stroke's onset; beneficial for those who arrive in the ED after the window for rtPA
52
Mechanical embolectomy
Removes the clot by suction or other method; admitted to CC; may be performed if pt arrives less than 8 hrs after the time LSN
53
Changes in the brain r/t stoke
If blood supply is interrupted for more than a few minutes, cerebral tissue dies and disability occurs depending on the area of damage and the amount of brain tissue affected
54
Right-side brain damage
Paralyzed left side; left side neglect; spatial/perceptual deficits; tends to deny or minimize problems; rapid performance, short attn span; impulsive safety probs; impaired judgement; impaired time concept
55
Left-side brain damage
Paralyzed right side; impaired speech/language; impaired left/right discrimination; slow performance, cautious; depression/anxiety; aware of deficits; impaired comprehension r/t language and math
56
Paroxysmal atrial fibrillation
Electrical signals and rapid HR begin suddenly and then stop on their own; symptoms can be mild or severe; last less than 24 hrs up to 1 wk
57
Persistent atrial fibrillation
The abnormal heart rhythm continues for more than a week; may stop on its own or with treatment
58
Permanent atrial fibrillation
Normal heart rhythm can't be restored with treatment; paroxysmal and persistent may become more frequent and turn into permanent a-fib
59
Cardioversion
Most direct treatment for a-fib; success can be enhanced with careful attn to details (electrode placement and skin prep); must be synced with the r-wave; start with 200 joules and increase as needed
60
Atrial fibrillation characteristics on ECG
No p-waves before the QRS; irregular heart rate caused by irregular impulses that. The ventricles are receiving; baseline will have waves; think "Jazz hands"
61
F.A.S.T.
Face drooping; Arm weakness; Speech deficiency; Time to call 911
62
Most obvious effects of stroke include:
Mobility, respiratory function, swallowing and speech, gag reflex, self-care abilities
63
Characteristic motor deficits of stroke
Loss of skilled voluntary movement, impairment of integration of movement, alterations in muscle tone, alterations in reflexes, an initial period of flaccidity followed by spasticity of the muscles r/t interruptions in upper motor neuron influence
64
Rate control medications
Beta-blockers, calcium channel blockers, cardiac glycosides
65
Rhythm control medications
Flecainide, propafenerone, quinidine, sotalol, amiodarone, dronedarone
66
Time interval: door to doctor
10 minutes
67
Time interval: access to neurological expertise
15 minutes
68
Time interval: door to CT scan
25 minutes
69
Time interval: door to CT scan interpretation
45 minutes
70
Time interval: door to treatment
60 minutes
71
Time interval: admission to ICU
3 hrs
72
Indications for craniotomy
Subdural hematoma, aneurysm clipping, AVM
73
Peri-operative care: Craniotomy
Explain pre-op labs, tests, procedures, anesthesia, est length of procedure, how long in recovery, ICU, pts appearance after procedure, what to expect post-op regarding dressings, catheter, ETT, IVs, IS, pain management; nearest relative may need to sign consent; scalp prep; baseline neuro assess; address anxiety
74
Post-op meds: craniotomy
Anticonvulsants; corticosteroids; histamine blockers; analgesics; antibiotics; calcium channel blocker
75
Post-op complications: craniotomy
Increased ICP; hematomas; hypovolemic shock; hydrocephalus; atelectasis; hypoxia; pneumonia; neurogenic pulmonary edema; infection; meningitis; dehydration; hyponatremia; seizures; CSF leak; cerebral edema; do not cluster care; watch BS with corticosteroids
76
Clinical manifestations: cerebral edema
Change in LOC; change in VS; cushions triad (widening PP, bradycardia, HTN); ocular signs; decrease in motor function; decerebrate posturing; decorticate posturing
77
Glasgow Coma Scale
Score of 13-14: mild deficit; 9-12: moderate deficit;
78
Ventriculostomy
CSF can be drained when ICP exceeds the upper pressure parameter set by the physician; intermittent drainage via 3-way stopcock to allow CSF to flow into the drainage bag for brief periods (30-120 s) until the pressure is below the upper pressure parameters
79
ICP collaborative care
Supplemental O2; mannitol; hypertonic saline; corticosteroids; barbiturates; quiet environment; do not overstimulate; do not cluster care; increased need for glucose; keep pt normovolemic; early and aggressive nutritional support; TPN or feeding tube
80
Broca's aphasia
Expressive; ability to comprehend ; language is retained but the pt has trouble expressing words or naming objects; gestures, groans, swearing, or nonsense words may be used
81
Wernicke's aphasia
Receptive; inability to recognize or comprehend spoken words; as if foreign language I'd being spoken or if the pt had word deafness; often good at responding to nonverbal cues
82
Global aphasia
Combination of spoken and comprehensive difficulty
83
Homonymous hemianopsia
Blindness in the same side of both eyes; pt does not see entire visual field without turning head to scan environment
84
Unilateral neglect
Unawareness of the paralyzed side of the body; place items on the affected side and approach from the affected side in order to bring awareness to the affected side
85
Dysphasia
Impairment of speech and of comprehension of speech
86
Dysphagia
Difficulty swallowing
87
Coping tasks of stroke pts
Modify routine and lifestyle; obtain knowledge and skill; maintain normalcy; maintain positive health; adjust relationships; grieve losses; deal with role changes; handle physical discomfort; comply with tx regimen; confront inevitability; deal with social stigma; maintain feeling of control; maintain hope
88
Physical therapy
Walking, ROM
89
Occupational therapy
Taking care of oneself
90
Speech language therapy
Communication skill, swallowing, cognition
91
Recreational therapy
Cooking, gardening, etc
92
Mobility training
Balance/sitting/standing; walking (level, stairs, parallel bars to walker progression; wheelchair skills; transfer skills; increase strength and endurance
93
Pt/family teaching
Caregiver training; positioning; transfer training; bowel/bladder management; fall prevention
94
Stroke prevention
Health promotion for the well individual; education and management of modifiable risk factors; anti platelet drugs to prevent further stroke in pts who have had TIA

Unit 2 (3 decks)

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