Stroke

Question 1

Stroke occurs when there is _________ to a part of the brain that reults in the death of brain cells

Answer 1

Ischemia

Question 2

Stroke is the ____ leading cause of death in canada

Answer 2

3rd

Question 3

Cerebral blodd lfow myust be mainatianed at ______ % of cardiac output

Answer 3

20%

Question 4

Cellular death in the brain can occur in as few as ______ in the event of no blood flow

Answer 4

5 minutes

Question 5

Cerebral autoregulation

Answer 5

Changes in diameter of cerebral blood vessels in response to changes in pressure so the pressure in the brain stays constant
May be impaired following cerebral ischemia

Question 6

Circle of Willis

Answer 6

A redundancy of the brain that allows blood to continue to flow through the brain, even if a major vessel is blocked

Not necessarily entirely effective, especially over long period of time

Question 7

Common areas where athersclerosis will build up

Answer 7

Plaque builds up along forks in the blood vessels

Question 8

How does HTN affect blood flow to the brain?

Answer 8

Reduceds blood flow by vasoconstirction and vessel stiffening (stenosis)

Question 9

Factors affecting blood flow to brain

Answer 9

Cardiac output (Must decrease by 1/3 before brain is affected
Blood viscosity (Increased = less flow to the brain)

Question 10

What causes cerebral ischemia

Answer 10

Thrombosis, mostly caused by athersclerosis

Plaque builds up in stiffened vessels, platelets form thrombus on plque until vessel is obstructed

Question 11

Embolic stroke

Answer 11

Embolus that forms outside of the brain (usually plaque), then travels up and occludes vessel in brain

associated with chronic Afib
- Blood pools in atrium forming small clots that travel through circulation and enter brain

Question 12

Sources of embolism

Answer 12

Afib (Allowing for pooling of blood in atrium forming clots)

Mechanical valve (rougher surface increasing risk for clots)

Bacterial/non endocarditis

Tumors that break

Air

Fat

Question 13

Hemmorhagic Stroke

Answer 13

Rutprue of vessels caused by increased pressure

Most common cause is HTN

Slowest recovery

Question 14

Ischemic strokes include

Answer 14

TIA (precursor)
Thrombotic (develops in the brain)w
Embolic (embolus

Question 15

Hemmorrhagic Stroke, types and commonality

Answer 15

Intracerebral
Subarachnoid (bleeding in this space)

15% of all strokes

Question 16

Anuerysm

Answer 16

Pouching of artery due to HTN

Question 17

Which type of stroke results in decreased crervral perfusion and incread ICP?

Answer 17

All strokes can

Question 18

TIA

Answer 18

Precursor

Temporary loss of neuro function

Usually lasting less than 15 minutes

Don’t know if it’s going to resolve or if it will progress into full Ischemic stroke

Question 19

Ischemic stroke

Answer 19

85% of strokes

61% are thrombotic

24% are embolic

Question 20

Symptoms of embolic strokes

Answer 20

Symptoms sudden, no chance to develop collateral circulation

Question 21

Thrombotic stroke symptoms

Answer 21

Slow and progressive

may not have changes in LOC in 1st 24 hrs.

Question 22

Extent of stroke dependent on

Answer 22

Size of lesion
presence of collateral circulation

Question 23

Prognosis of embolic stroke?

Answer 23

Dependtant on amount and location of brain tissue affected

Question 24

Intracerebral stroke

Answer 24

10% of H strokes

HTN is sig risk factior

Occurs DURING activity

Sudden onset with progression of symptoms of min-hours b’c of bleeding
- headache, n/v, sudden alteration in LOC, hypertension
Poor prognosis

Question 25

Subarachnoid stroke

Answer 25

Intracranial bleeiding into CSF space Often rupture of cerebral aneurysm (silent killer), can also be trauma or cocaine headache, n/v, sudden alteration in LOC, hypertension Poor prognosis Hemiplagia, neck stiffness, Loss of consciousness 40% will die within first episode

Question 26

Brocas aphasia

Answer 26

People with Broca's aphasia have a clear understanding of language, but have trouble finding and saying the right words.

Question 27

Global Aphasia

Answer 27

Loss of expressive and receptive

Question 28

Clinical manifestations of stroke

Answer 28

Motor function Communication Affect Intellectual function Spatial-perceptual alterations Elimination

Question 29

Risk factors for stroke (Non-mod)

Answer 29

Age Gender Race Family Hx (First degree releative)

Question 30

Modifiable Factors for stroke

Answer 30

Smoking Alcohol Obesity Inactivity High Cholesterol Illicit drug use Oral contraceptives & HRT

Question 31

Secondary dx that contirbute to increased risk factor for stroke

Answer 31

HTN - single most contributing factor to stroke DM Heart Disease/CAD

Question 32

All symptoms of stroke are contralateral EXCEPT

Answer 32

pupil dialation

Question 33

Right-brain damage

Answer 33

Left hemiplegia Left side neglect Spatial perceptual deficits Tends to deny/minimize problems Rapid performance, short atention span

Question 34

Diagnostics for stroke (IMPORTANT) **

Answer 34

When s/s of stroke appears - Diag. studies confirm it's a stroke - Identify likely cause of stroke CT is primary diagnostic

Question 35

Spinal tap for a stroke?

Answer 35

RBC in CSF

Question 36

LAb diagnostics for stroke

Answer 36

APT, PT, INR (Low more at risk for stroke, high means more at risk for bleeding) Platlets

Question 37

Collaborative Care prevention

Answer 37

Management of those with high risk Drug therapy Antiplatelet drugs Aspirin Statins Surgical therapy carotid endarterectomy. transluminal angioplasty. stenting. extracranial–intracranial bypass.

Question 38

Carotid endarterectom

Question 39

Brain Stent

Question 40

Hallmark s/s of stroke

Answer 40

Weakness/numbness Trouble speaking Vision problems Headache Dizziness

Question 41

Goals in stroke response

Answer 41

Preserving life Prevent further brain damage Reduce disability

Question 42

Single most improtant point in a stroke pt hx is___hours after onset

Answer 42

3-4.5

Question 43

What is important to assess when you suspect a pt has a hd a stroke

Answer 43

ABCs VS GCS (Neuro exam), PERRLA, LOC

Question 44

Assessment findings in stroke

Answer 44

Altered LOC Weakness, numbness, or paralysis Speech/visual disturbances Severe headache HR change Pupil differsences Resp Distress HTN Facial droop Difficulty swallowing Seizures incontinence N/v Vertigo Fever

Question 45

Projectile vomit is a sign of

Answer 45

Increased ICP

Question 46

Our stroke intervention goal is

Answer 46

ABCD

Question 47

Additional interventions for stroke

Answer 47

Open Airway (remove dentures) Start IV CT scan

Question 48

Why is baseline importnat to establish at onset of stroke

Answer 48

To see if they are improving or getting worse

Question 49

Interventions to HTN for ACUTE ischemic stroke

Answer 49

Response to maintain cerebral perfusion - Use of BP medications are not recommended unless BP is markedly increased (systolic >220mmhg or MAP > 130mmhg why? `

Question 50

Interventions for fluid electrolyte blaance in stroke

Answer 50

Adequate hydration to help perfusion Hypotonic fluid can WORSEN cerebral edema Fluid restriction (1.5-2L

Question 51

Nursing response to cerebral edema

Answer 51

lift HOB Decrease pain Avoid seizures don't increase metabolsim of brain

Question 51

Preventing aspiration in a stroke pt

Answer 51

Raise HOB Pureed Diet (NPO until swallowing assessment) Thickened fluids

Question 52

Temperature and the brain

Answer 52

Every temp increase is 10% more increase metabolism in the brain

Question 53

Medication intervention for ischemic stroke

Answer 53

tPA (alteplase) Must be given 3-4.5 hours of onset of symptoms Aspirin Anticoagulant and antiplatlet Assess neuro Assess BP

Question 54

Surg interventions for ischemic

Answer 54

Endovasculat TS (allows clot to be removed

Question 55

Interventions for hemorrhagic stroke

Answer 55

Keep blood pressure in a normal to high normal range <160 Close monitoring for patients on blood thinner May have reverse medication Medication Treatment Nimodipine Surgical intervention can be considered Clipping & coiling

Question 56

Manifestations of acute changes in cerebral perfusion

Question 57

Cushings Triad

Answer 57

Systolic BP increase Pulse decrease Resp decrease

Question 58

Nursing invterventions for ICP

Answer 58

Medically induced coma Decreased stimulation Manitool Hypertonic NS Steroids (Reduce inflam) BP meds

Question 59

Why does ischemic stroke still increase ICP

Answer 59

primarily due to cerebral edema, which is brain swelling caused by the lack of blood flow to the affected area, leading to an increase in brain tissue volume within the rigid skull, thereby elevating pressure