Strokes

Question 1

Ischemic strokes are caused by what?

Answer 1

interruption in blood flow caused by a blood clot or narrowing of the arteries

Question 2

Ischemic Strokes are divided into what 3 categories?

Answer 2

Large-artery thrombotic stroke
Embolic Stroke
Small penetrating artery thrombotic stroke

Question 3

What are Hemorrhagic Strokes?

Answer 3

A ruptured artery resulting is bleeding in or around the brain

Question 4

Causes of Hemorrhagic Strokes

Answer 4

• aneurysm bursts
• uncontrolled HTN
• old age

Question 5

What happens with Ischemic Cascade?

Answer 5

The brain cells switch to anaerobic metabolism, generating large amounts of lactic acid/glautamate causing a change in pH

Question 6

What are Large-artery Thrombotic Strokes caused by?

Answer 6

Atherosclerotic plaques in the large blood vessels of the brain

Question 7

Thrombus formation/occlusion can occur at the site of the atherosclerosis and result in what?

Answer 7

Ischemia and Infarction

Question 8

What is the most common type of ischemic stroke?

Answer 8

Small Penetrating Artery Thrombotic Stroke

Question 9

Small penetrating artery thrombotic strokes are typically caused by what?

Answer 9

• longstanding HTN
• hyperlipidemia
• diabetes

Question 10

Cardiac Embolic strokes are associated w/ what?

Answer 10

• Arrhythmias like A-fib
• valvular heart disease
• left ventricular thrombus

Question 11

What are Cryptogenic Strokes?

Answer 11

Strokes w/ no identifiable cause

Question 12

Strokes from Other Causes

Answer 12

drugs (cocaine)
coagulopathies
migraine
spontaneous dissection

Question 13

Risk Factors for Stroke (STROKES HAPPEN)

Answer 13

S-smoking
T-thinners
R-rhythms
O-oral contraceptives
K-kin/family 
E-excessive weight
S-senior citizens
H-HTN
A-atherosclerosis
P-physical inactivity
P-previous TIA
E-elevated glucose (diabetes)
N-aNeurysm

Question 14

What is a TIA?

Answer 14

“Mini Stroke”

a brief episode of neurologic dysfunction

Question 15

TIA are results from what?

Answer 15

Focal cerebral ischemia, but NOT associated w/ permanent cerebral infarction

Question 16

What are the 2 subtypes of Hemorrhagic Strokes?

Answer 16

Intracerebral and subarachnoid

Question 17

How long does a nurse have to administer TPA to help break up the clot and resolve the stroke?

Answer 17

3 hours from the time the S/S start

Question 18

S/S of Strokes (FAST)

Answer 18

F-face-drooping/asymmetric 
A-arms-numb or weak 
S-speech-slurred
T-time to act 
-aphasia
-dysarthria 
-apraxia 
-agraphia 
-alexia 
-agnosia
-dysphagia 
-hemianopia

Question 19

Aphasia

Answer 19

unable to speak or comprehend speech

-receptive and expressive

Question 20

Receptive Aphasia

Answer 20

unable to comprehend speech

Werincke’s Area

Question 21

Expressive Aphasia

Answer 21

comprehends speech but can’t respond back w/ speech

Broca’s Area

Question 22

Intracerebral Hemorrhage are commonly results of what?

Answer 22

Trauma

Question 23

Dysarthria

Answer 23

unable to speak clearly due to weak muscles

Question 24

Apraxia

Answer 24

can’t perform voluntary movements

Question 25

Agraphia

Answer 25

loss ability to write

Question 26

Alexia

Answer 26

loss ability to read-cannot understand or see words

Question 27

Subarachnoid Hemorrhage is commonly associated w/ what?

Answer 27

intracranial aneurysms trauma arteriovenous malformations

Question 28

Agnosia

Answer 28

doesn't understand sensations or recognize known objects/people

Question 29

Dysphagia

Answer 29

issues swallowing

Question 30

Hemianopia

Answer 30

limited vision

Question 31

Primary ICH from spontaneous rupture of small arteries is commonly caused by what?

Answer 31

Uncontrolled HTN

Question 32

How are Strokes diagnose?

Answer 32

CT scan | MRI

Question 33

TPA (Altepase) is used only for what type of stroke?

Answer 33

Ischemic Strokes

Question 34

How does TPA work?

Answer 34

dissolves the clot by activating the protein that causes fibrinolysis

Question 35

Criteria for Receiving TPA (Altepase)

Answer 35

- CT scan negative for bleeding - Labs w/ normal limits - BP controlled < 185/110 - Hasn't recently received Heparin or other anticoagulants

Question 36

Nursing Interventions for TPA (Altepase)

Answer 36

- monitor for bleeding - Neuro checks around the clock - BP meds if needed for HTN - vital signs/labs - bedrest - avoid sticks and IM injections - ICU to be monitored

Question 37

Patients w/ ruptured AVM will typically present w/ what?

Answer 37

sudden severe headache and sudden LOC

Question 38

What is the most common motor dysfunction resulting from stroke?

Answer 38

Hemiparesis-weakness on one side of body

Question 39

What is the most common visual impairment after stroke?

Answer 39

Hemianopia-visual field loss

Question 40

Dysphagia can lead to what types of problems?

Answer 40

aspiration pneumonia dehydration poor nutrition

Question 41

Optimal Medical Therapy for prevention of more strokes includes prescribing what Meds?

Answer 41

- anti-platelet - a statin - antihypertensive - anticoagulant

Question 42

Carotid Endarterectomy (CEA)

Answer 42

removal of atherosclerotic plaque or thrombus from the ICA to prevent recurrent stroke

Question 43

What is an alternative to a CEA when surgery poses a high risk?

Answer 43

Carotid Angioplasty and stenting

Question 44

When are CEA's or Carotid Angioplasty's recommended?

Answer 44

When the patient is hemodynamically stable and w/in 2 weeks following event