Stroke

Question 2

What are strokes?

Answer 2

Strokes are focal neurological deficits (loss of function affecting a specific region of the nervous system) due to disrupted blood supply to the brain.

Question 3

What are the main types of strokes?

Answer 3

The main types of strokes are Ischemic Stroke and Hemorrhagic Stroke.

Question 4

What is an Ischemic Stroke?

Answer 4

An ischemic stroke occurs when something blocks blood flow to the brain, typically resulting from thrombosis or embolism.

Ischemic strokes can cause permanent brain damage and death.

Question 5

What percentage of strokes are ischemic?

Answer 5

Ischemic strokes account for 80% of all strokes.

Question 6

What is a Hemorrhagic Stroke?

Answer 6

A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and bleeds. Divided into intracerebral and subarachnoid hemorrhage.

Question 7

What percentage of strokes are hemorrhagic?

Answer 7

Hemorrhagic strokes account for 20% of all strokes.

Question 8

What is an Intracerebral hemorrhage?

Answer 8

Intracerebral hemorrhage is characterized by bleeding into the brain parenchyma. May look like an ischemic stroke

Question 9

What is a Subarachnoid hemorrhage?

Answer 9

Subarachnoid hemorrhage is bleeding in the space between the brain and its covering membranes, often caused by a ruptured aneurysm.

SAHs are commonly caused by head trauma and/or a ruptured brain aneurysm

Question 10

Layers in brain

Answer 10

Your brain has three membrane layers or coverings (called meninges) that lie between your skull and your brain tissue. The outermost layer of your meninges is called the dura mater, the middle layer is the arachnoid and the layer closest to your brain is the pia mater. Subarachnoid hermorrhage happens when there’s bleeding below the arachnoid layer.

Question 11

Risk factor, treatment and prognosis for SAH

Answer 11

Risk factors: Hypertension, use of blood thinner (Warfin)smoking and alcohol consumption, cocaine or meth use, Paralysis is rare.

Treatment: Surgery

Prognosis: With fast surgery patients usually recover well and risk for a new bleeding is low.

Question 12

Intracerebral Versus Subarachnoid Hemorrhage

Answer 12

Subarachnoid
* Bleeding into subarachnoid
space
* Usually caused by aneurysm
rupture
* Stiff neck
* Photophobia (may be present in
both, but most common in SAH)
* “Thunderclap headache”: often
described as the worst headache
of the patient’s life

Intracerebral
* Bleeding into brain tissue
* Caused by arterial rupture
* Often presents like ischemic
stroke
* Focal neurological deficits
* Altered consciousness
* Nausea and vomiting
* Seizures due to irritation of brain
tissue

Question 13

Atherosclerosis definition and characteristics

Answer 13

Atherosclerosis is a disease involving the buildup of plaque
in the arteries. When there is atherosclerosis in the cerebral
arteries, the risk for stroke or TIA is increased.

Arterial plaque composed of fat and cholesterol are very
unstable, meaning that they rupture more frequently. The
presence of plaque fragments causes blood to clot, which
can cause blockages.
o This happens because collagen is exposed to blood, which
activates platelets, causing coagulation of the blood.
o This is also due to the body’s inflammatory response, meaning that
immune cells such as macrophages are attracted to the site of
rupture. These cells help to stabilize the clot.

Question 14

What are the risk factors for strokes?

Answer 14

Hypertension,

atrial fibrillation - The atria are fibrillating and not beating in a coordinated way → Blood in the atria becomes stagnant and can form clots. Atrial fibrillation can lead to stasis of blood in the left atrium → This allows blood clots to form → If a piece of clot breaks off and travels to an artery in the brain, it can block the blood flow through the artery, causing a stroke.

type 2 diabetes (3x at risk),

smoking(2x at risk), alcohol, obesity, inactivity. Approx. 20% of strokes are caused by these.

High cholesterol, atherosclerosis, and carotid artery disease

age, gender -After the age of 55 stroke risk doubles for every decade a person is alive, gender - Men under 75 y have double risk for stroke compared to women, who usually get stroke older and women over 85 y have bigger risk for stroke than men.

family history, and prior strokes.

Question 15

What is TIA?

Answer 15

Transient Ischemic Attack (TIA): Temporary stroke symptoms (usually <1 hour), without evidence of acute cerebral infarction are termed a transient ischemic attack (TIA)

Question 16

What are common causes of ischemic strokes?

Answer 16

Common causes include atherothrombotic occlusion of large arteries

Embolic Infarction: Cerebral embolism, in which blood clot forms somewhere else and travels to the brain.
Presents similarly to atherothrombotic occlusion of large vessels. Cardioembolic stroke is diagnosed when no other
apparent cause is found.

Lacunar Infarction: Nonthrombotic occlusion of smaller, deep cerebral arteries. Often occurs in patients with DM2 and hypertension. Lesion is very small (generally <1.5 cm in diameter)

Hemodynamic Stroke: Proximal arterial stenosis with hypotension that decreases cerebral blood flow in arterial
watershed zones (ie, stroke is caused by hypoperfusion, or decreased blood flow through the vessels. Involves systemic (blood loss) causes or structural (stenoses) causes.

• Thrombotic stroke occurs when blood clots form in cerebral arteries.
• Embolic stroke occurs when blood clots form elsewhere in the
  body and migrate to the cerebral arteries

Question 17

Causes of hermorrhagic strokes.

Answer 17

Brain aneurysms, Brain tumors, Moyamoya disease, Cerebral amyloid angiopathy, Head injuries, COVID-19, Ischemic strokes that cause bleeding during or after the stroke

Question 18

What are the symptoms of an Ischemic Stroke?

Answer 18

headache possible vomiting, weakness/paralysis, often on one side of the body, confusion, vision loss, slurred speech or inability to speak, dizziness, seizures, difficulty walking, coordination problems in the arms, irregular breathing, coma.

Question 19

What are the symptoms of a Hemorrhagic Stroke?

Answer 19

severe headache, vomiting, unconsciousness, and seizures. Intracerebral hemorrhage.

Question 20

What are the symptoms of a Subarachnoid hemorrhage?

Answer 20

Sudden severe headache, stiff neck, light sensitivity, vomiting, seizures, eye sensitivity (photophobia). and decreased consciousness.

Question 21

Signs of brain aneurysm

Answer 21

Pain surrounding the eye, Changes in your vision, Dilated pupils, Weakness or numbness on one side of your body, Loss of hearing or trouble with balance, Seizures, Trouble with memory

Question 22

What percentage of stroke patients experience depression?

Answer 22

30-50% of stroke patients experience depression. Its common during the first year after the stroke.

Question 23

What factors increase the risk of depression after a stroke?

Answer 23

disabilities affecting functional ability, cognitive impairment, prior depression before stroke, severity of stroke, and anxiety.

Question 24

Depression in acute phase

Answer 24

In the acute phase (1-3 weeks after the stroke), depression can be caused by changes in the brain. This type of depression usually disappears during the first month after the stroke without any special treatment.

Depression is common also among spouses!

Question 25

What is FAST?

Answer 25

FAST helps identify stroke symptoms quickly: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services. Also: BEFAST (adds Balance and Eyes e.g. double vision or blurred vision for early detection). SIPULI: Silmat, Puhe, Liike

Question 26

What is Suppea Neurologinen Status?

Answer 26

Suppea Neurologinen Status (Basic Neurological Exam) includes monitoring vital signs, assessing consciousness (Glasgow Coma Scale), checking pupil reactions, limb movement and strength, reflexes, coordination, and speech evaluation. Conducted hourly until the patient stabilizes.

Question 27

What is the treatment during the first days after an ischemic stroke?

Answer 27

prevent a new stroke, monitoring vitals and neurological symptoms (standard neurological status can be done each 1 h until patient is stable), managing elevated blood pressure, positioning and mobilization(help reduce muscle pain, spasms, slowness, or stiffness, prevents pressure ulcers), preventing aspiration, pneumonia, and blood clots (heparin, anti embolic socks), blood sugar control, beginning passive and active motion exercises, pain management, and stroke unit care for early rehab.

Question 28

What are the main treatments for ischemic strokes?

Answer 28

Endarterectomy, angioplasty or stenting, oral antiplatelets (Aspirin, Clopidogrel), oral anticoagulants (cardioembolic strokes: warfarin, Dabigatran, Apixaban, Rivaroxaban), and statins, treating risk factors such as hypertension, DM2, atrial fibrillation, Non pharmacological interventions include reducing alcohol consumption, quitting smoking, maintaining a healthy diet, and increasing exercise.

Question 29

What is the acute treatment for ischemic strokes?

Answer 29

Recombinant tPA (Tissue plasminogen activator, alteplase) within 4.5–9 hours after symptoms. Invasive procedures may include thromolysis-in-situ and mechanical thrombectomy. Pharmacologic: oral antiplatelet drugs: Aspirin, dual antiplatelet therapy (aspirin plus Clopidogrel), anticoagulants, statins Non-pharmacologic: Stroke unit, rehab, lifestyle changes

Question 30

What are the treatments for hemorrhagic strokes?

Answer 30

Surgery (e.g., aneurysm clipping), controlling blood pressure, and preventing rebleeding. The main goal of treating especially a subarachnoid hemorrhage which is a medical emergency is to stop the bleeding. Often, a doctor may do surgery to place a small clip on the blood vessel to stop blood from leaking into the brain.

Question 31

What are the treatments for TIA?

Answer 31

Antiplatelets, statins, risk factor control, and lifestyle changes. Short-term measures focus on stabilization and clot removal, while long-term measures focus on rehab and preventing recurrence.

Question 32

Identifying stroke?

Answer 32

Drooping face and/or one-sided weakness Odd speech patterns (aphasia) Disturbances with voluntary movements (apraxia)

Question 33

What are the main aims for treating strokes?

Answer 33

Save brain tissue, restore blood flow, prevent complications, improve functional recovery, prevent recurrence, support psychological well-being.

Question 34

What can be done to prevent strokes

Answer 34

Control hypertension, diabetes, cholesterol, monitor body temperature, anticoagulants for atrial fibrillation, smoking/alcohol cessation, healthy diet and exercise, stroke education and regular follow-ups.

Question 35

What is a risk for aspiration in stroke patients?

Answer 35

Ability to swallow is examined before starting oral nutrition. Sometimes an i.v antibiotic is started to prevent aspiration pneumonia. It helps prevent complications from a stroke.

Question 36

What are some monitoring practices to prevent complications in stroke patients?

Answer 36

Monitoring blood sugar and treatment of elevated blood sugar levels, monitoring temperature, maintaining a normal body temperature, immobilization for 24 hours to prevent pulmonary emboli using low molecular weight heparin Fragmin or Klexane to prevent blood clots, Antiemboli socks

Question 37

How can a stroke be detected in a patient?

Answer 37

Recognize symptoms (FAST), neurological exam, CT/MRI imaging, blood tests, ECG, carotid ultrasound.

Question 38

What are the diagnosis and examinations necessary for ischemic strokes?

Answer 38

CT, MRI, ECG, blood tests, carotid ultrasound.

Question 39

What are the diagnosis and examinations necessary for hemorrhagic strokes?

Answer 39

CT/MRI, angiography, lumbar puncture. Subarachnoid – MRI, CT scan, Spinal tap, Angiogram.

Question 40

What are the diagnosis and examinations necessary for TIA strokes?

Answer 40

Imaging, cardiac evaluation, blood work.

Question 41

What is the first step in emergency care for strokes?

Answer 41

Call emergency services immediately.

Question 42

How is a stroke diagnosed in the emergency unit?

Answer 42

A neurologist confirms the diagnosis by distinguishing ischemic stroke from other causes of similar focal deficit using CT and other scans.

Question 43

What types of scans are used to diagnose a stroke?

Answer 43

CT angiography, CT perfusion scanning, MRI, carotid duplex scanning, digital subtraction angiography, and sometimes a lumbar puncture. ECG, THX

Question 44

What blood tests are taken during stroke assessment?

Answer 44

CBC, coagulation tests, blood lipid tests, blood glucose, electrolytes, P-Krea, P-CRP, and cardiac enzymes (to make sure there is no heart attack)

Question 45

What vital signs should be monitored in stroke care?

Answer 45

Oxygen supply, respiratory rate, pulse, breathing frequency, temperature, and consciousness. Hypertension is not treated unless it is over 220/120 mmHg, consciousness

Question 46

What is the recommended position for a stroke patient?

Answer 46

Immobilize but keep half-sitting.

Question 47

What should not be given to a stroke patient during emergency care?

Answer 47

Do not give food or drink.

Question 48

Emergency care and first aid for strokes?

Answer 48

Call emergency services immediately Ensure open airway, breathing, circulation Monitor vitals Monitor blood sugar levels, too high levels are related with higher risk of death Immobilize but keep half-sitting Do not give food/drink Transport to stroke unit At emergency unit the diagnosis is confirmed by a neurologist, they must distiguish ischemic stroke form other causes of similar focal deficit by using computer tomography (CT) and other scans Blood smaples are taken. ECG,THX.

Question 49

What should be done in the form of nursing assessment, nursing interventions, and general nursing care of a patient that experienced a stroke?

Answer 49

**Nursing care and assessment: ** * Regular neuro checks * Set up visits to speech therapist * Analyze voiding pattern and offer urinal or bedpan on patient’s voiding schedule. * Positioning to avoid pressure sores * Monitor swallowing, blood sugar, temperature * Manage Pain and assess skin. * Encourage mobility four to five times a day to maintain joint mobility, personal hygiene * Consistent routines and support memory * Nutrition and hydration assessment, remember swallowing reflex * Educate the population or patients to recognize stroke symptoms * Support with mental health of those affected and to change people’s attitudes about strokes to reduce delay in treatment * Prevent venous stasis. Exercise is helpful in preventing venous stasis, which may predispose the patient to thrombosis and pulmonary embolus. * Regain balance. Teach patient to maintain balance in a sitting position, then to balance while standing and begin walking as soon as standing balance is achieved * Personal hygiene. Encourage personal hygiene activities as soon as the patient can sit up. * Manage sensory difficulties. Approach patient with a decreased field of vision on the side where visual perception is intact. * Be consistent with the patient’s activities. Be consistent in the schedule, routines, and repetitions; a written schedule, checklists, and audiotapes may help with memory and concentration, and a communication board may be used

Question 50

What are the key components of patient education and self-management for stroke patients?

Answer 50

Recognize stroke signs (FAST/BEFAST), medication adherence, risk factor management, healthy lifestyle education, support groups, counseling, safety at home, avoid falls.

Question 51

15. What does rehabilitation from a stroke consist of?

Answer 51

Begins early, in a stroke unit once patient’s condition is stable Beneficial for weeks, months or even years following a stroke All patients with acute stroke should have an initial functional assessment to determine rehabilitation needs and receive an individualized rehabilitation plan. Therapy should include repetitive and intense use of tasks that challenge the patient to acquire the necessary skills needed to perform functional tasks and activities Patients should be made aware of their increased risk for falls Exercises to regain mobility, communication Occupational and speech therapy Goal-setting with patient and family

Question 52

What is the goal-setting process in stroke rehabilitation?

Answer 52

Goal setting is the process by which the person with stroke and their family or carers, along with the stroke team, identify individual treatment goals.

Question 53

What characteristics should rehabilitation goals have for stroke patients

Answer 53

Goals should be meaningful and relevant to them, focus on activity and participation, be challenging but achievable, include both short-term and long-term elements, and involve the person with stroke and their family in the discussion.

Question 54

What factors are assessed in stroke rehabilitation?

Answer 54

Patient's previous functional abilities, psychological functioning impairments (cognitive, emotional and communication), body function impairments, activity limitations and participation restriction, participation restrictions, environmental factors, orientation, ambulation: Positioning, moving, exercise program , swallowing, eating, continence and bladder control, and communication.

Question 55

What are the neuropsychological disorders related to stroke?

Answer 55

Aphasias, Apraxias, Neglect syndrome, Memory disorders, Anosognosia, Mood disorders, Dysphagia, Dysarthria, and special difficulties related to impersonation

Question 56

What are Aphasias?

Answer 56

Aphasias are speech/language disorders characterized by difficulty in using language and speech

Question 57

What are Apraxias?

Answer 57

Apraxias are disorders of voluntary movement, causing difficulty in making the movements you want to make

Question 58

What is Neglect syndrome?

Answer 58

Neglect syndrome is characterized by a loss of awareness and attention to one side of the body and the environment, often the left side. This means individuals may not notice, respond to, or recognize stimuli on the neglected side, even if they have normal sensory and motor function. ## Footnote For example, a sick person can only wash the right side of his face.

Question 59

What are memory disorders related to stroke?

Answer 59

Memory disorders or amnesias can occur, though a single cerebrovascular disorder rarely causes a serious general memory disorder. Even mild memory disorders can greatly affect the ability to work

Question 60

What is Anosognosia?

Answer 60

Anosognosia is a lack of symptom awareness, where the individual does not recognize or downplays the symptoms caused by a disease

Question 61

What are mood disorders associated with stroke?

Answer 61

Mood disorders can include depression, anxiety, and sadness.

Question 62

What is Dysphagia?

Answer 62

Dysphagia is a swallowing disorder caused by functional deficits or paralysis of the mouth and pharyngeal area, or slowness or failure of reflexes.

Question 63

What is Dysarthria?

Answer 63

Dysarthria is a motor speech disorder caused by abnormal functioning of the movements needed to produce speech.

Question 64

What are special difficulties related to impersonation?

Answer 64

Patients may have difficulty recognizing previously familiar things, such as faces, distances, and times.

Question 65

What are the complications that can arise from a stroke?

Answer 65

Recurrent stroke, aspiration pneumonia, deep vein thrombosis, paralysis or weakness, swallowing issues, depression, cognitive decline, seizures, and speech impairment.

Question 66

What are subarachnoid hemorrhage complications?

Answer 66

Swelling in the brain, hydrocephalus, and irritation or damage to the brain's other blood vessels, causing them to tighten, which can reduce blood flow to the brain and potentially lead to another stroke.

Question 67

Emergency care: Nursing interventions

Answer 67

Secure vital signs: as SpO2% may be low, oxygen should be supplemented as needed. * Treatment of hypotension (to ensure sufficient bloodflow) * After ischemic stroke, hypertension is not treated unless it is over 220/120mmHg * Monitor vital signs (SpO2, RR, pulse, breathing frequency, level of consciousness with GCS, temperature) * Patient should be immobilized, in a half-sitting position. * Blood sugar levels should be monitored: elevated blood sugar are associated with higher mortality.