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Flashcards in stroke management Deck (42)
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1

what age group does majority of stroke occur in?

over 65

2

after six months what things can still be challenging for a person who had stroke?

cannot walk indoors
need help to dress
need to be fed
need help with toileting

3

common symtpoms of stroke?

Right side of mouth drooping, drooling saliva
Able to raise left arm, but not right arm or active right leg
Difficulty communicating and finding words: expressive dysphasia
Right homonymous hemianopia (visual field defect)

4

why is scan essential before treating stroke patient?

exclude haemorrhage so thrombolysis can be given

5

what is given if swallowing is seen to be unsafe?

NG tube

6

what weakness is caused by stroke?

Contralateral weakness of limbs -->Extent of stroke determines degree of arm and leg weakness

Weakness and incoordination of oropharyngeal muscles:

Dysarthria: slurred, indistinct speech
Incoordination of swallowing

7

what are the language problems involved in speach? In right handed patients

If Broca's areas damage then --> Flow of speech: stilted, difficult + Expressive dysphasia.
Reading, writing and comprehension relatively intact

If Wernicke's area damaged then --> speech is fluent but Neologisms (“made up” words)
Comprehension, reading and writing impaired

8

Antihypertensive treatment is not recommended after acute stroke, unless?

Intracerebral haemorrhage with systolic BP >200,
Hypertensive encephalopathy/ nephropathy/ cardiomyopathy
Aortic dissection
Eclampsia/ pre-eclampsia (a condition of pregnancy:

9

what is hypertensive nephropathy?

the high blood pressure damages the kidney

10

what is hypertensive cardiomyopathy?

damage to the heart due to high blood pressure

11

when is oxygenation recommended?

Supplemental oxygen is recommended if saturations fall below 95% on air

12

what is system used to help set goals for rehabilitation after a stroke?

SMART: Specific, Measurable, Achievable, Relevant, Time-limited
Set within 5 days of admission, review regularly

13

what is the assessment for swallowing?

Position patient correctly, ensure they are alert
1) Give a single teaspoon of water
2) Give 2 further teaspoons of water
3) 50ml water
SAFE SWALLOW
Allow normal diet and fluids

14

what actions will make the patient fail the swallowing assessment and what will be the outcome?

Drooling from mouth?
Coughing or choking?
Wet voice or cough?

UNSAFE SWALLOW -->Keep Nil By Mouth +Feed by NG tube

15

why is DVT caused in hospital, how can it be prevented and treatment?

Risk factors include immobility and sepsis ( Stasis of blood in leg veins leads to thrombosis)
Prevention: Consider injections of low molecular weight heparin
Treatment: warfarin for 6 months

16

what is the risk factors of pressure ulcers and how is it caused?

Risk factors

Immobility, malnutrition, diabetes, smoking, terminal illness, sensory impairment

Pathogenesis

Sustained pressure, often over bony prominence
Friction and shear forces when moving patient
Moisture: incontinence, sweating

17

why might shoulder subluxation occur after a stroke? How is it managed?

Weakness of rotator cuff muscles on stroke side
Neglect of affected limb (in right hemisphere stroke only)

Management: optimise positioning, support shoulder

18

what pre-conditions can be exacerbate due to overuse of one side of the body?

Chronic back pain
Osteoarthritis
Rheumatoid arthritis

19

what occurs in post stroke pain?

Damage to sensory cortex leads to contralateral sensory disturbance

Negative phenomena
Decreased sensation in one or more modalities

Positive phenomena:
Paraesthesia, burning, shooting pains
Dysaesthesia: altered perception (e.g. soft touch felt as prickly pain

20

what type of drugs don't work on post stroke pain

analgesic drugs

21

what drugs will patients reply to when having post stroke pain?

Pregabalin or Gabapentin: anti-epileptic agents
Amitriptyline: a type of antidepressant

22

after a stroke what might be the causes of incontinence?

Communication
Immobility: can’t reach toilet in time
Constipation with overflow
Medication: on laxatives, diuretics
Other medical problems: diabetes mellitus (polyuria), urinary tract infection, prostatic hypertrophy

23

what is the management of incontinence?

General:
Communication strategies to allow him to summon help when needed

Bowels:
Regular toileting
Managed bowel regimen: use suppositories to open bowels at predictable intervals

Bladder:
Is he able to manipulate bottles?
Convene: sheath as opposed to indwelling catheter
Long term catheter

24

what factors might make a person depressed aftera stroke? How common is it

adjustment to disability
financial problems
medical condition
relationship with family/partner
communication
Up to 50% of people

25

assessment and mangement of depression post stroke patient?

Assessment
History
Observation of behaviour: crying, withdrawal
Standardised assessments: some suitable for use in dysphasic patients
DON’T FORGET SUICIDE RISK ASSESSMENT!

Management:
Counselling: supported conversation approach
Drugs: (selective serotonin reuptake inhibitors) second line

26

what recoverys occurs in the first few days after stroke? physiologically

natural recovery
Resolution of oedema
Reperfusion of ischemic penumbra

27

what recoverys occurs in the weeks and months after stroke? physiologically

Neuronal plasticity, cortical remodelling
Dendrite sprouting, synaptic remodelling

28

in what type of stroke does neglect take place in?

Neglect is a feature of RIGHT hemisphere stroke

29

what occurs in neglect post stroke?

May be visual or somatosensory
Problem of attention: failure to attend to/ monitor left side

30

what is Agnosias?

Modality-specific inability to access semantic knowledge of an object