Test #6 - CVA & PVD Flashcards Preview

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Flashcards in Test #6 - CVA & PVD Deck (70):

What is the etiology and causes of CVA?

Basic process=Ischemia of the brain occurs due to an interrupted blood supply

Arterial Spasm


What are some risk factors for CVA?

Atherosclerosis: Primary prob in thrombotic strokes

Hypertension: Major prob for ischemic and hemorrhagic strokes. Oral contraceptives, alcohol can cause

Embolic Risks: Anything that activates the clotting process. Plaque, artificial heart valve, septic emboli, air emboli, fat emboli (fracture of long bone)

Diabetes Mellitus: Due to vascular changes

Hypercoagulable States


Surgery or Major Trauma: Inflammatory process


Pathophysiology for CVA:

Disruption in bloodflow occurs. (May be gradual, may be abrupt)

Brain requires a constant supply of O2, glucose, etc; has no reserve

Brain normally regulates bloodflow through systemic mechanisms and locally by constricting and dilating arteries

Brain cell death occurs within 3-10 min

Surrounding tissue is compromised and inflamed and does not funtion properly. Without intervention, it may die also

Neuro changes result from dead or impaired tissue


What is a Transient Ischemic Attack (TIA-Related to CVA)?

Temporary neurologic dysfunction: Last <24hr; often 5-20 min

Occurs suddenly

Between episodes, neuro assess WNLs

Major complication=1/3 of people will have CVA in <5years


What is an evolving stroke?

Neuro deficit develop over 1-2 days

Gradual worsening because affected area is enlarging


What is a completed strok?

Neuro deficits established and consistent; no further deterioration

Usually reached in 2-3 days

Damage is complete and permanent; although neuro deficits from inflamed tissue may reverse or improve


What are the signs and symptoms of a Thrombosis CVA?

Best prognosis

Affects middle aged and elderly most often

Gradual onset and symptom development (hours/days)

Develops during sleep or just after arising

Pattern of Hypertension

Typical presentation=hemiparesis(weakness), loss of speech, and hemisensory loss

Hx of atherosclerosis, DM or hypertension


What are the Signs and symptoms of an emolism CVA?

Can affect any age group

Sudden onset and symptom development (sec to min)

Unrelated to time of day or activity


Typical Presentation=Same as thrombotic stroke

Hx of rheumatic fever, dysrhythmias or surgery


What are the signs and symptoms of a hemorrhage CVA?

Worst Prognosis

Can affect any age group

Rapid onset and symptom development - blood accumulates and compresses brain tissue (min - 1 hour)

Occurs during active, waking hours

Have hypertension

Typical presentation=Severe occipital or nuchal HA, vertigo or syncope, paresthesias, paralysis, eepistaxis, retinal hemorrhages, and rapid LOC

HX of uncontrolled hypertension, cocain use or aneurysm


What are some general Left sided Signs and symptoms of CVA?

Right side of body affected

Speech & language deficit

Slow, cautious behavior style

Language memory deficit


What are some general Right sided Signs and symptoms of CVA?

Left side of body affected

Spatial and perceptual deficits

Quick, impulsive behavior style

Performance Memory deficits (Can no longer do simple tasks that they use to be able to do)


What is paralysis of half of the body (L/R)?

Hemiplegia (Motor Deficit)


What is weakness of half?

Hemiparesis (motor)


What is the lack of muscle tone?

Flaccidity (motor)


What is the increased resistance as an extremity stretches?

Spasticity (motor)


What is uniform resistance to stretching throughout movement?

Rigidity (motor)


What are some sensory perceptual deficits when pertaining to CVA?

Dec ability to integrate, interperret and attend to sensory data

Alterations in vision, hearing, taste, smell or equiliibrium

Change in perceptions: vibration, pain, heat, cold, pressure

Change in proprioception


What are some cognitive and behavioral changes when pertaining to CVA?

Mild confusion to coma

Emotional lability

Loss of self-control (language and acts)

Memory Loss

Poor attention span

Poor judgement

Loss of abstract thought

Agnosia (Failure to recognize objects)


What are some other changes after a CVA?


Increased intracranial pressure

Dysphasia (difficulty swallowing)

Apraxia (inability to carry out a skilled taks due to lack of motor integration)

Unilateral neglect


Dysarthria (difficulty articulating words; may slur words; no problem in sentence structure or grammar)


What are some Communication changes (Aphasia) as pertaining to CVA?

Expressive or motor (Broca's) Aphasia:
Affects speech production, writing, and ability to make signs
CVA involves frontal lobe

Receptive or sensory (Wernicke's) aphasia:
Affects speech comprehension, including written or printed
CVA involves temporal lobe

Global Aphasia:
Affects speech comprehension and production
May simply repeat sounds they hear and have poor comprehension


Computed Tomography (CT) Scan is a diagnostic test for CVA, what is it?

Used initially to differentiate between ischemic and hemorrhagic strokes (no contrast)

Usues X-Ray's to visualize damaged brain tissue or the abnormal presence of blood

May use IV contrast dye for better visualization once a hemorrhage has been ruled out

If dye is used, client must not be allergic to iodine and should be NPO prior to test

Infarcted areas may not be visualized until several hours have passed


Magnetic Resonance Imagin (MRI) is a diagnostic test used for CVA, what is it?

Superior to CT for most CNS problems, especially 8-12 hours after a stroke

Uses strong magnets to visualize differences in soft tissues

No prep and client is not NPO

Client's size may prevent test

Anti-Anxiety meds may be given prior to test to minimize claustrophobic effects

Client or nurse can not have any metal in or on their body; including orthopedic devices


Cerebral Angiography is a diagnostic test used for CVA, what is it?

Uses X-Ray and intra-arterial contrast dye to visualize cerebral arterial system

Client is NPO

Client must not be allergic to iodine (shellfish)


What are some peripheral tests that might be ordered?

Carotid Doppler Study


Electrocardiogram (ECG) - Rythym

Electroencephalogram (EEG) - Electrical Activity


Used to identify contributing factors that might be treated


What are some Labs that might be ordered when pertaining to CVA?

CBC (RBC< WBC< Hgb, Hct, & platelets)- Thrombolytics and infection

PT, PTT - Anticoagulation therapy

Kidney Function (BUN, Creatine) - IV dye use


What are thrombolytics, examples and nursing interventions??

Deissolve/degrade a thrombus or emboli; restores bloodflow through cerebral arteries

Does not reverse cell ddeath but may prevent further cell death

Must be started within 3 hours of symptom onset

Examples=tPA, Retavase

Nursing Interventions:
Observe for bleeding from all sources
Avoid invasice procedures-arterial and venous sticks, NG placement, IM injections.


What are Antiplatelet aggregation agents & anticoagulant examples and nursing interventions??

Antipllatelet Agents - Interfere with clot formation by affecting platelets
Example: ASA, Persantine, Plavix

Anticoagulants - Interfere with clot formation by affectinjg clotting factors and enzymes
Examples: Heparin, Coumadin, Lovenox

Used to prevent stroke from extending or re-occuring

Usually held for 24 hours if thrombolytic is used


What are vasodilators, examples and nursing interventions?

Relaxes vascular smooth muscle which dec arterial resistance which dec BP, In cardiac output, and inc cerebral bloodflow

Examples: Nipride, Apresoline

Nursing Interventions:
Observe for HA, Hypotension or cerebral Hypoperfusion
Frequent BP checks (every 5-15 min)


What are osmotic diuretics, examples and nursing interventions?

Inc osmotic pressure of plasma, diffusion of fluid in tissues back into vascular space, diuresis; net effect=reduces cerebral edema


Nursing Interventions:
Must be given IV through a filter; watch for precipitates
Observe for F/E imbalances, especially hyponatremia & dehydration


A ventriculostomy is a surgical intervention for CVA, what is it?

Used to relieve pressure from cerebrospinal fluid (CSF) accumulation

Burr holeinto skull; catheter is placed into lateral ventricle to allow for controlled drainage of CSF.


A Evacuation of Hematoma is a surgical intervention for CVA, what is it?

Surgical removal of large hematoma that is causing compromise due to compression


A Carotid endartectomy is a surgical intervention for CVA, what is it?

Opening of the carotid artery to remove obstructing and embolizing plaque


A Carotentid angioplasty and stenting is a surgical intervention for CVA, what is it?

Uses a bolloon0tipped catheter inserted retrograde through femoral artery into carotid

Balloon is inflated several times to compress plaque

Stent may be inserted to prevent re-stenosis


What are some interventions for CVA? LOTS OF THEM!!

Ongoing assessment (Focused Neuro)

Set Client specific goals:
Return client to optimal level of functioning
Preven injury
Address lower and higher needs

Maintain airway & prevent aspiration

Keep HOB up 30 deg to reduce cerebral edema

Frequent reposition with skin care; insure proper body alignment

Address vital sign changes promptly, esp. temp and BP

Provide for F/E and dietary needs (IV, NG, or feeding tube may be necessary)

Provide rest/sleep and activity/ROM as indicated

Address bowel and bladder concers, esp. incontinence (Foley and bowel/bladder training may be necessary)

Approach client from unaffected side

Encourage independence but assist is needed

Facilitate communication

Support family and friends; involve them in client's care when they are ready

Teach, teach, teach


What is the RN responsible for with CVA's?

During acute phase, close monitoring and frequent changes in client status deman RN direct involvement

If stroke is evolving, direct one-on-one care by RN is ideal


What is the LPN responsible for with CVA's?

As client stabalizes, portions of care may be delegated


Steroidal Anti-Inflammatory agents are used for CVA's, what do they do?

Disrupts inflammatory process by arious means including reducing capillary dilation and permeability= Dec cerebral edema

Example: Decadron

Nursing Interventions: May cause hyperglycemia or delayed wound healing
Causes immunosuppression, protect client from infection


Anti-Convulsants are used for CVA's, what do they do?

Reduce voltage, frequency and spread of electrical discharges within the motor cortex.

Examples: ilantin, Penobarbital

Nursing Implications: 
Observe for cardiovascular collapse (bradycardia, hypotension)
May mask changing neuro S/S (Dec LOC, confusion, headache)


What are some community resources for CVA pt?

Home Health

Meals on Wheels

American Stroke Association

National Stroke Association

Stroke Support Groups

Church Groups

Local Service Groups


What are some cultural and spirituality considerations for CVA?

Be aware that losses may be perceived as punishment

Client's sense of value and signifigance may be severely threatened despite their religious beliefs

Client's role within a family or social group may be threatened depending on that client's culture


Peripheral Vascular Disease is primarily caused by atherosclerosis, what happens?

Lower limbs most susceptible

May progress to complete occlusion of medium and large arteries:
-Embolism-MOST COMMON, usually cardiac in orgin (AFIB)

Complete occlusion causes tissue hypoxia/damage


PVD may cause intermittent claudication, what happens if this occurs?

Pain occuring when a muscle had inadequate supply of oxygen and nutrients; often in calf or arch of foot

Usually occurs with walking or exercise; may be relieved with rest

Pain is consistent, reproducible, and not positional; different than lower extremity pain from other diseases


What are some S/S of PVD?

Hairless extremity

Thick toenails

Arterial ulcers


Possible cyanosis or edema

Pallor on elevation & Rubor in dependent position

Decreased or Absent pulses


What are some nursing interventions for PVD?

Assess 6 P's of ischemia

Assess pain and precipitating factors

Monitor skin integrity

Provide client-specific exercise

Elevate legs to level of heart to promote perfusion and reduce swelling

Position of comfort & bloodflow


What are some health teachings for PVD?

Proper foot care

Exercise to claudication, stop, rest and then proceed

Don't cross legs

Avoid cold and wear socks or insulated shoes

Avoid direct heat to limb


What is Buerger's Disease (Thromboangitis Obliterans)?

Inflammatory disease of small and medium arteries and veins of the extremities.

May be a hypersensitivity reaction to nicotine

Lesions and thrombi's are formed


What are some S&S of Beurger's Disease?

Pain is the outstanding one

Other S/S as PVD

Rynaud's Phenomenon



What are some nursing interventions for Buerger's Disease?

Same as PVD

Promote body image (if amputation occurs)

Health Teaching: 
Stop Smoking
Avoid precipitating factors such as stress and temperature extremes


What is Raynaud's Syndrome?

Condition in which small arteries and arterioles constrict in response to various stimuli
-Cold, nicotine, caffeine, stress

Usually involves uppper extremities but may affect toes, ears and nose; It is bilaterally symmetrical

Color changes in response to stimuli

Normal color and sensation can be restored with heat

Other S/S: 
Numbness, Tingling, Burning, Pain


There are two types of Raynaud's Syndrome, The disease(Vasospastic) and Phenomenon (obstructive), what are they?

Raynaud's Disease:
Benign Primary Disorder

Raynaud's Phenomenon:
Secondary to another disease or cause (Lupus, Scleroderma, or Rheumatoid Arthritus)


What are some nursing interventions for Raynaud's Syndrome?

Same as PVD and Buerger's

Hand and foot care

Heath Teaching:
-avoid precipitating factors
-Keep hands and feet warm
-Stress management and relaxation


What are some labs for Raynauds Syndrome?

Any lab that pertains to Atherosclerosis
(Lipid profile, Homocysteine, C Reactive Prot)

Coagulation Studies
(PT, PTT) Especially prior to therapy


What are 3 diagnostic tests for Raynauds?

Doppler Ultrasound

Exercise or Stress Test



Red Blood Cell Modifier's are used for PVD, what do they do?

Decrease viscosity of blood and improve bloodflow=dec tissue hypoxia

Example: Trental

Nursing Implications: 
observe for inc in walking performance (time/duration)
Observe for bleeding
Monitor coagulation studies (PT/INR)


Vasodilators/Antiplatelet Agents are used for PVD, what are they?

Improves blood flow to extremities y vasodilation and inhibiting platelet aggregation

Example: Pletal

Nursing Implications: 
Observe for HA & GI complaints
Observe for improved exercise tolerance
Teach to avoid grapefruit/juice (Inc blood Levels)


Calcium Channel Blockers are used for PVD, what do they do?

Interferes with Ca++ movement across cell membranes = Vasodilation in coronary nd peripheral arteries

Example: Procardia

Nursing Implication:
Observe for HA, Dizziness, light-headedness, and dec BP
Monitor Liver function test


Non-steroidal anti-inflammatory agents are used for PVD, what do they do?

Disrupt inflammatory process by various means including blocking prostaglandin synthesis.  Often have analgesic, antipyretic and antiplatelet effects

Example: Ibuprofen, Naprosyn

Nursing Implications:
Observe for occult blood loss and ototoxicity
Monitor liver function test
Be aware of possible cross-sensitivity between NSAIDS


What are some cultural considerations when dealing with PVD?

Chronic Pain and disability can have spiritual implications for some clients

Some Native Americans may want any amputated limbs in orer to have them buried with client


Which type of CVA has the following items:

Affects any age group
Sudden Onset
Unrelated to time of day or activity
Presentation=Hemiparesis, loss of speech, and hemisensory loss
Hx of rheumatic fever, dysrhythmia,or surgery

Emoli CVA


What type of CVA has the following characteristics?

Affects middle-aged and elderly most often
Gradual onset and symptom development
During sleep or just after sleep
Presentation=Hemiparesis, loss of speech and hemisensory loss
Hx of atherosclerosis, Diabetes, or hypertension

Thrombosis CVA


Which type of CVA has the following characteristics?

Affects any age grouP
Rapid onset and symptom development
During active, waking hours
Presentation=Severe occipital or nuchal HA, vertigo or syncope, paresthesias, paralysis, epistaxis, retinal hemorrhage, and rapid LOC
Hx of uncontrolled hypertension, cocaine use or aneurysm



In PVD the pulse will be _____ or ______ if arterial and _____ on the venous side

In PVD the pulse will be ABSENT or WEAK if arterial and PRESENT on the venous side


Temp with PVD on the arterial side would be _____ and on the venous side ______

Temp with PVD on the arterial side would be COOL and on the venous side WARM


Edema with PVD would be ________ on the arterial side but PRESENT on the venous side but would improve with _______

Edema with PVD would be ABSENT on the arterial side but PRESENT on the venous side but would improve with ELEVATION


What would you see in the legs/feet on the arterial side of PVD?

Dependent rubor (redness) that changes to pallor with elevation

Thick toenails

Thin shiny skin


Atrophied muscle


What would you see in the legs/feet on the venous side of PVD?

Brown ankles

Normal Toenails

Dependent Cyanosis


What would you see in ulcers on the arterial side of PVD?

Pale base

Sharp edges

Very painful


What would you see in ulcers on the venous side of PVD?

red Base

Irregular border edges



Pain on the arterial side would be what in PVD?

intermitten claudication
(Calf pain during ambulation)


Pain on the venous side of PVD would be?