Stroke

Question 1

Ischemic stroke -3

Answer 1

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

Question 2

What is the penumbra region?

Answer 2

Ischemic brain tissue that can still be salvaged

Question 3

Stroke Symptoms

Answer 3

-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
-

Question 4

Hemiparesis

Answer 4

Weakness on one side of the body

Question 5

Hemipalegia

Answer 5

Paralysis on one side of the body

Question 6

Where does motor loss happen in a CVA pt?

Answer 6

On opposite sides body of brain injury

Question 7

Agnosia

Answer 7

difficulty interpreting sensory stimuli

Question 8

Ataxia

Answer 8

Impaired balance or coordination

Question 9

Dysarthria

Answer 9

Difficulty forming words

Question 10

Dysphagia

Answer 10

Difficulty swallowing

Question 11

Expressive aphasia

Answer 11

Unable to form words that are understandable

Question 12

Receptive aphasia

Answer 12

Inability to understand language

Question 13

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

Answer 13

• 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

Question 14

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

Answer 14

When was the last time they were seen normal?

Question 15

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

Answer 15

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

Question 16

Initial ex tool for CVA

Answer 16

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

Question 17

Other dx tests for stroke

Answer 17

• MRI angiogram
• Transesophageal echocardiogram
• carotid ultrasound

Question 18

Anticoags used for stroke

Answer 18

Warfarin, apixiban, rivaroxaban

Question 19

What is the target INR for warfarin

Answer 19

2-3

Question 20

What to check for when pt is on anticoags

Answer 20

BLEEDING (nose bleeds, blood in urine)

Question 21

ex of statin

Answer 21

Simvastatin

Question 22

WHen should statins be given?

Answer 22

At night

Question 23

When should t-PA be given?

Answer 23

Within 3 (up to 4.5 hours)

Question 24

what to monitor for when giving t-PA

Answer 24

Bleeding

Question 25

Delay for what when pt is on t-PA

Answer 25

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

Question 26

What is the goal for t-PA?

Answer 26

Effective revascularization

Question 27

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

Answer 27

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

Question 28

T-PA contraindications (3)

Answer 28

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

Question 29

ischemic stroke nursing interventions (8)

Answer 29

- 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

Question 30

Stroke prevention (5)-healthy lifestyle

Answer 30

- low fat diet - exercise - no smoking - maintain healthy weight - moderate alcohol consumption

Question 31

High risk groups for stroke (3)

Answer 31

Men Age > 55 African American

Question 32

Stroke prevention —> manage chronic health conditions (3)

Answer 32

- HTN - Afib - Carotid stenosis

Question 33

Potential stroke complications - 6

Answer 33

- increased ICP - decreased cerebral blood flow - PNA - UTI - seizures - pressure ulcers

Question 34

Can t-PA be used for a hemorrhagic stroke?

Answer 34

NO

Question 35

Causes of hemorrhagic stroke (9)

Answer 35

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

Question 36

Clinical manifestations of hemorrhagic stroke (7)

Answer 36

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

Question 37

Dx of hemorrhagic stroke (4)

Answer 37

- CT or MRI - CT angiogram - Lumbar puncture (if ct is negative) - tox screen

Question 38

Medical management of hemorrhagic stroke (8)

Answer 38

- 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

Question 39

Hemorrhagic stroke nursing interventions (10)

Answer 39

- 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

Question 40

Potential complications of hemorrhagic stroke

Answer 40

- additional bleeding - cerebral hypoxia - vasospams - increased ICP - hydrocephalus - seizure

Question 41

How to prevent cerebral hypoxia (3)

Answer 41

- administer supplemental O2 - maintain adequate hydration - keep BP slightly elevated

Question 42

Prevention of increased ICP (4)

Answer 42

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