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NRS G240 Exam #3 > Stroke > Flashcards

Stroke Flashcards

1
Q

Ischemic stroke -3

A
  • disruption of blood supply to part of the brain
  • obstruction of cerebral blood flow
  • causes ischemia to brain tissue
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2
Q

What is the penumbra region?

A

Ischemic brain tissue that can still be salvaged

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3
Q

Stroke Symptoms

A

-HA
-mental changes
-aphasia
-Respiratory problems
-decrease cough and swallow reflex
-Agnosia
-Incontinence
-seizures
-Hemiparesis or hemiplegia
-emotional lability
-visual changes
-Horners syndrome
-vomiting
-perceptual defects
-HTN
-Apraxia
-

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4
Q

Hemiparesis

A

Weakness on one side of the body

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5
Q

Hemipalegia

A

Paralysis on one side of the body

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6
Q

Where does motor loss happen in a CVA pt?

A

On opposite sides body of brain injury

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7
Q

Agnosia

A

difficulty interpreting sensory stimuli

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8
Q

Ataxia

A

Impaired balance or coordination

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9
Q

Dysarthria

A

Difficulty forming words

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10
Q

Dysphagia

A

Difficulty swallowing

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11
Q

Expressive aphasia

A

Unable to form words that are understandable

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12
Q

Receptive aphasia

A

Inability to understand language

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13
Q

Transient Ischemic Attack —> what is it? How long does it last? What is it a warning of? Does it show up on scans?

A
  • temporary neurological deficit resulting from a temporary impairment of blood flow
  • temporary neurological symptoms lasting 1-2 hours
  • warning sign of impending stroke
  • no evidence of ischemia on brain images
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14
Q

What is the biggest question to ask when someone comes in with signs of stroke?

A

When was the last time they were seen normal?

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15
Q

Why do we want the BP to be slightly elevated in a stroke patient?

A

To maintain adequate perfusion (want it to be around 140/90)

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16
Q

Initial ex tool for CVA

A

Non-contrast CT (determines if stroke is ischemic or hemorrhagic, determines where the blockage is)

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17
Q

Other dx tests for stroke

A
  • MRI angiogram
  • Transesophageal echocardiogram
  • carotid ultrasound
18
Q

Anticoags used for stroke

A

Warfarin, apixiban, rivaroxaban

19
Q

What is the target INR for warfarin

A

2-3

20
Q

What to check for when pt is on anticoags

A

BLEEDING (nose bleeds, blood in urine)

21
Q

ex of statin

A

Simvastatin

22
Q

WHen should statins be given?

A

At night

23
Q

When should t-PA be given?

A

Within 3 (up to 4.5 hours)

24
Q

what to monitor for when giving t-PA

A

Bleeding

25
Q

Delay for what when pt is on t-PA

A

24 hour delay in placement of NG tubes, catheters and intra-arterial pressure catheters

26
Q

What is the goal for t-PA?

A

Effective revascularization

27
Q

In regard to t-PA why can’t it be given after 4.5 hours?

A

The risks of bleeding outweigh the benefits of therapy…at this point the distal clot probably wont recover

28
Q

T-PA contraindications (3)

A
  • onset greater than 3 (4.5) hours
  • pt with INR > 1.7
  • pt with recent intracranial pathogen in the last three months
29
Q

ischemic stroke nursing interventions (8)

A
  • ROM exercises
  • frequent repositioning
  • assist with ambulatory
  • promote self care
  • monitor for dysphagia
  • establish bowel/bladder control
  • assist with improving communication
  • promote effective coping strategies
30
Q

Stroke prevention (5)-healthy lifestyle

A
  • low fat diet
  • exercise
  • no smoking
  • maintain healthy weight
  • moderate alcohol consumption
31
Q

High risk groups for stroke (3)

A

Men

Age > 55

African American

32
Q

Stroke prevention —> manage chronic health conditions (3)

A
  • HTN
  • Afib
  • Carotid stenosis
33
Q

Potential stroke complications - 6

A
  • increased ICP
  • decreased cerebral blood flow
  • PNA
  • UTI
  • seizures
  • pressure ulcers
34
Q

Can t-PA be used for a hemorrhagic stroke?

A

NO

35
Q

Causes of hemorrhagic stroke (9)

A
  • HTN (most common)
  • DM
  • atherosclerosis
  • brain tumor
  • illicit drug use
  • anticoags therapy
  • cerebral aneurysm
  • head trauma
  • Arteriovenous malformation
36
Q

Clinical manifestations of hemorrhagic stroke (7)

A
  • severe headache (most commonly reported symptom)
  • N/V
  • sudden change in LOC
  • seizures
  • loss of consciousness
  • pain/rigidity of back of neck
37
Q

Dx of hemorrhagic stroke (4)

A
  • CT or MRI
  • CT angiogram
  • Lumbar puncture (if ct is negative)
  • tox screen
38
Q

Medical management of hemorrhagic stroke (8)

A
  • prevent risk of additional bleeding
  • reverse anticoag if bleeding was caused by warfarin (vitamin K)
  • allow brain to rest and recover
  • intermittent pneumatic compression stockings
  • anticonvulsants if seizures present
  • control BP to avoid HTN
  • surgical management
39
Q

Hemorrhagic stroke nursing interventions (10)

A
  • monitor neuro status, patient at risk for rebleeding
  • provide a quiet, non-stimulating environment
  • minimize patients anxiety
  • seizure precautions
  • monitor for HA
  • assess s/s vasospasm
  • assess drowsiness, stupor, changes in behavior (hydrocephalus)
  • monitor for hyponatremia
  • promote self care
  • promote coping
40
Q

Potential complications of hemorrhagic stroke

A
  • additional bleeding
  • cerebral hypoxia
  • vasospams
  • increased ICP
  • hydrocephalus
  • seizure
41
Q

How to prevent cerebral hypoxia (3)

A
  • administer supplemental O2
  • maintain adequate hydration
  • keep BP slightly elevated
42
Q

Prevention of increased ICP (4)

A
  • mannitol may be given
  • fluid balance monitored
  • elevate HOB to 30 degrees
  • avoid hypo/hyperglycemia

NRS G240 Exam #3 (11 decks)

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