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Nursing Acutely Ill > Stroke > Flashcards

Stroke Flashcards

(60 cards)

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1
Q

Estimated % of population that have a stroke per year

A

10%

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2
Q

What are 10 examples of modifiable risk factors associated with stroke?

A 
Smoking 
Activity level 
BP control 
Weight 
Hypertension 
T2DM 
Education 
Atrial fibrilation 
Alcohol intake 
Cholesterol
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3
Q

What are 7 examples of non-modifiable risk factors associated with stroke?

A 
Aneurysm 
Genetics 
Diabetes 
Blood disorders 
Race 
Low birth weight 
Increasing age
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4
Q

What are the 5 major causes of ischaemic stroke?

A 
Embolism 
Blood clots 
Thrombus 
Hypertension 
Diabetes
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5
Q

What are the 5 major causes of haemorrhagic stroke?

A 
Trauma 
Aneurysm 
Hypertension 
Arteriovenous malformation (AVM) 
Subarrachnoid haemorrhage
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6
Q

What does TIA stand for and mean?

A

Transient Ischaemic Attack. Causes a temporary interruption to the blood supply to an area of the brain.

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7
Q

What are the two major pairs of arteries that supply the brain?

A

Right and left carotid arteries

Right and left vertebral arteries

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8
Q

What does FAST stand for?

A

Face
Arms
Speech
Time

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9
Q

How quickly should a CT scan be performed on a pt with suspected stroke?

A

Immediately

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10
Q

In a pt going for thrombolysis what drug, what dose over how long?

A

A tissue plasminogen activator (tPA) such as Alteplase is given at a dose of 0.9mg/kg up to a max dose of 90mg. Administrated as 10% in a bolus over 1 minute to see the effect on the pt. Then the rest given via IV through a pump over 1 hour.

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11
Q

What % of pts will have a permanent disability following stroke?

A

40-50%

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12
Q

Define the term ischaemia

A

Inadequate blood supply to an organ or tissue

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13
Q

What % of strokes occur to the under 65 age group?

A

25%

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14
Q

Which type of stroke isn’t suitable for thrombolysis?

A

Haemorrhagic

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15
Q

What are 4 contraindications for thrombolysis being given?

A

Trauma <2weeks
Lumbar puncture <2weeks
Taking anticoagulants
NSAIDS

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16
Q

Define dysphasia/what occurs in dysphasia?

A

Inability to speak

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17
Q

Define dysphagia/ what occurs in dysphagia?

A

Inability to swallow

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18
Q

What % of stroke pts aren’t suitable for rehabilitation?

A

15%

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19
Q

What are the 4 diagnostic criteria for stroke?

A

Sudden onset
Focal/neurological defects
Vascular origin
Symptoms lasting >24 hours

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20
Q

What may thrombosis occur as a result of?

A

Large artery atherosclerosis.

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21
Q

What may cause an embolism to occur?

A

Atrial fibrillation
Prosthetic valves
Post MI

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22
Q

What is the more prevalent type of stroke ischaemic or haemorrhagic?

A

Ischaemic

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23
Q

Diagnostic criteria for a TIA

A

Sudden onset
Focal/ cerebral deficit
Vascular origin
Symptoms lasting <24 hours

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24
Q

What are the 5 stages in the mechanism of iscaehemic stroke?

A 
Occlusion of blood vessel 
Two zones of local injury 
Ischaemic core 
<10-20% blood flow, inadequate O2 and glucose supply 
Death of brain cells known as infarction
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25
In ischaemic stroke what is the mechanism of brain injury to the ischaemic penumbra?
Time limited circulatory reserve Lack of adequate perfusion Results in larger area of infarction
26
What are the names of the two areas of injury following an ischaemic stroke?
Ischaemic core | Ischaemic penumbra
27
What is the mechanism of brain injury due to haemorrhagic stroke?
Blood vessel rupture Bleed into surrounding brain tissue Reduction in perfusion of oxygen and glucose to the brain cells Increase in pressure to surrounding tissues Cerebral oedema resulting in further cell death
28
What is the ROSIER scoring system used for?
Recognition of stroke
29
What are 11 important areas of assessment required for identifying stroke?
``` ROSIER scoring Time of onset Full blood screen Blood glucose measurement Full vital signs PMHX (current, past and meds) Full neurological assessment Physical examination ECG CT scan National institutes Health stroke scale ```
30
What does ROSIER stand for?
Recognition Of Stroke In the Emergency Room
31
What are the 7 components of the ROSIER score?
``` Loss of consciousness Seizure activity Onset of asymmetrical arm weakness Onset of asymmetrical face weakness Onset of asymmetrical leg weakness Speech disturbance Visual field defect ```
32
What is the range in score for ROSIER?
-2 to +5
33
What ROSIER score indicates a stroke?
>0
34
What are the two treatment options for ischaemic stroke?
Thrombolysis or intra-arterial thrombectomy
35
What is the exclusion criteria for thrombolysis?
``` >3-4.5 hrs since stroke onset >80 years of age Have coagulation disorder On anticoagulants Have had haemorrhagic stroke ```
36
What is the name of the route and drug given in thrombolysis?
IV infusion of alteplase
37
What is the dosage of the drug alteplase?
0.9mg/kg of pt
38
What is mechanical clot retrieval designed to do?
Recanulise obstructed arterial vessels in order to reperfuse the ischaemic penumbra.
39
For how long does a patient following thrombolysis require 1-1 care?
6 hours
40
What are the 6 signs of an adverse reaction to thrombolysis?
``` Urticarial rash Periorbital swelling Oro lingual angioedema (tongue swelling) Tachypnoea Dyspnoea Tachycardia ```
41
What should be avoided 24 hours prior to thrombolysis?
Arterial/intravenous blood samples Intravenous line Urinary catheters NG tubes
42
What is the frequency of obs following thrombolysis treatment?
Every 15 mins for 2 hours Every 30 mins for 6 hours Hourly for 16 hours
43
Alternative treatment to thrombolysis?
Intra-arterial thromboectomy
44
In terms of respiratory, what are warm, cyanosed hands an indication of?
Retention of CO2
45
What is clubbing?
Painless, bolbus enlargement of the fingers with a soft nail bed and no nail angle
46
What is a way to check for clubbing?
No diamond shape when fingernails pressed together
47
What may be the cause of clubbing?
Lack of O2 rich blood to peripheries
48
Use of bronchodilators may cause what due to receptors on skeletal muscle?
Finger tremors
49
What are the signs in the hands of carbon dioxide retention?
Warm cyanosed hands. | Warm, sweaty flapping tremor hands
50
At what O2% does cyanosis occur?
85%
51
What causes central cyanosis?
Disease of heart such as ventricular failure. Disease of lungs such as pulmonary fibrosis. Lead to deoxygenated blood leaving left side of heart.
52
What is a sign of central cyanosis?
Blue mucous membranes such as the lips and tongue
53
What causes peripheral cyanosis?
Decrease in circulation and increased O2 requirements of tissues.
54
During peripheral cyanosis blood leaving the left side of the heart has normal oxygenation. True or false?
True
55
What is the normal angle of the ribs compared to the spine?
45 degrees
56
What does auscultation of the lungs involve?
Pt takes deep breath through mouth. Each side f the chest is listened to with a stethoscope.
57
What does a peak flow measure?
The max rate of airflow which can be achieved from sudden forced expiration of a full inspiration. AKA peak expiratory flow rate
58
What is peak flow commonly used to measure condition wise?
Asthma
59
What is peak expiratory flow rate?
Maximum speed of expiration.
60
What would the normal features of the lungs on a chest xray be?
Vessels decreasing in size towards the periphery Hair line fissures Diaphragm, chest wall

Nursing Acutely Ill (11 decks)

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