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NURS 3000 > Week 6 > Flashcards

Week 6 Flashcards

(61 cards)

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1
Q

What is stroke (cerebro-vascular accident)?

A

Occurs when there is ischemia to a part of the brain or hemorrhage into the brain that results in death of brain cells.

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2
Q

What are common long-term disabilities for stroke?

A

Hemiparesis (paralysis of half body), inability to walk, complete or partial dependence in ADLs, aphasia, depression.

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3
Q

What major arteries supply the brain with blood?

A

Internal carotid arteries (anterior circulation) , and vertebral arteries (posterior circulation).

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4
Q

What areas of the brain do the carotid arteries supply?

A

Frontal, parietal, temporal lobes, basal ganglia, thalamus and hypothalamus.

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5
Q

What parts of the brain do the vertebral arteries supply?

A

Middle, lower part of temporal lobes, occiptial lobe, cerebellum, brain stem, and part of the diencephalon.

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6
Q

What is the rate blood flow must be maintained for optimal brain functioning?

A

750 to 1000 mL/min or 20% of cardiac output.

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7
Q

What mechanism protects the brain from changes in blood pressure?

A

Cerebral autoregulation.

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8
Q

What factors affect blood flow to the brain?

A

Systemic BP, cardiac output, blood viscocity.

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9
Q

How does atherosclerosis cause stroke?

A

When a cerebral artery becomes blocked and blood supply to the brain beyond the blockage is occluded.

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10
Q

What is the ischemic cascade?

A

Results from cerebral infarction. Inadequate ATP, loss of ion homeostasis, release of excitatory amino acids, free radical formation, and cell death.

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11
Q

What is the area called where ischemia may be reversed if caught within 3 hours?

A

Penumbra.

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12
Q

What are some non-modifiable risk factors for stroke?

A

Age, gender, ethnicity, race, family history, low birth weight.

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13
Q

Which gender is more at risk for stroke?

A

Men, but mortality rates are higher for women.

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14
Q

Which ethnicities have a higher risk of stroke?

A

African, Latin American, South Asian and Indigneous people, due to underlying risk factors.

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15
Q

What personal health practices and coping skills can increase the risk of stroke?

A

Illicit drug use, central obesity, physical inability, excessive alcohol consumption, smoking, unhealthy diet, stress.

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16
Q

What are modifiable risk factors for stroke?

A

Asymptomatic carotid stenosis, arteriovenous malformation, DM, heart disease, alcohol use, hypercoagubulity, illicit drugs, dyslipidemia, hypertension, obesity, oral contraceptive use, physical inactivity, sleep apnea, smoking.

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17
Q

What are the 3 types of strokes?

A

Thrombotic stroke, embolic stroke, hemorrhagic stroke.

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18
Q

What is thrombotic stroke?

A

Cerebral thrombosis is narrowing of the artery by plaque, which causes a clot to form and blocks artery.

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19
Q

What is embolic stroke?

A

Embolus is a blood clot or other debris circulating in the blood, when it reaches an artery in the brain that is too narrow, it blocks blood flow.

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20
Q

What is a hemorrhagic stroke?

A

A burst blood vessel, which allows blood to seep into tissues and damage tissues until clotting shuts off leak.

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21
Q

What is an ischemic stroke?

A

Result from inadequate blood flow to brain from partial or complete occlusion of an artery. 87% of strokes are ischemic.

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22
Q

What is a transient ischemic attack?

A

Temporary episode of neurlogical dysfunction by focal brain, spinal cord, or retinal ischemia, but without acute infarction of brain.

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23
Q

What are the symptoms of a carotid TIA?

A

Temporary loss of vision, transient hemiparesis, numbness or loss of sensation, sudden inability to speak.

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24
Q

What are the symptoms of a vestibular TIA?

A

Tinnitus, vertigo, darkened or blurred vision, dilopia, ptosis (droopy eyelids), dysarthria (funny muscle speech), dysphagia, ataxia and unilateral/bilateral weakness/numbness.

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25
What is a thrombotic stroke?
Occurs when a blood clot forms in a diseased and narrowed blood vessel in the brain. Most common type of ischemic stroke.
26
What is a lacunar stroke?
A stroke from occlusion of small penetrating artery that supplies blood to tissues deep within the brain. Occurs in the basal ganglia, thalamus, internal capsule or pons.
27
What are the symptoms of a lacunar stroke?
Pure motor hemiplegia, pure sensory stroke, contralateral leg and face weakness with arm and leg ataxia, isolated motor sensory stroke.
28
What is embolic stroke?
Occurs when an embolus lodges and occludes a cerebral artery. Second most common type. Leg fractures may cause this type of stroke.
29
What is a intracerebral hemorrhage?
Rupture in brain vessel. 10% of all strokes.
30
What is the most important risk factor for intraceberal hemorrhage?
Hypertension.
31
What are other risk factors for intracerebral hemorrhage?
Cerebral amyloid angiopathy, vascular malformations, coagulation disorders, anticoagulant and thrombolytic drugs, trauma, brain tumors, ruptured aneurysms.
32
What are symptoms of intracerebral hemorrhage?
Neurological deficits, headache, vomiting, nausea, decreased LOC, hypertension.
33
Where do 50% of intracerebral hemorrhages occur?
Putamen, internal capsule. central white matter, thalamus, cerebellar hemispheres, pons.
34
what are cerebellar hemorrhages characterized by?
severe headache, vomiting loss of ability to walk, dysphagia, dysarthia, eye movement disturbances.
35
What are hemorrhages in the pons characterized by?
Hemiplegia leading to paralysis, coma, abnormal body posturing, fixed pupils, hyperthermia, death.
36
What is subarachnoid hemorrhage?
Occurs when there is intracranial bleeding into the cerebro-spinal fluid space between the arachnoid and pia matter membranes on the surface of the brain.
37
What are the stroke manifestations for the anterior cerebral artery?
Motor/sensory deficit, sucking/ rooting reflex, rigidity, gait problems, loss of prprioception, fine touch.
38
What are the stroke manifestations for the middle cerebral artery?
Dominant side: aphasia, motor and sensory deficit, hemianopia. Nondom side: neglect, motor and sensory deficit, hemianopia.
39
What are the stroke manifestations for posterior cerebral artery?
Hemianopia, visual hallucinations, spontaneous pain, motor deficit.
40
What are the stroke manifestations for vertebral arteries?
Cranial nerve deficits, diplopia, dizziness, N/V, dysarthias, dysphagia, coma.
41
What are motor deficits for stroke?
a) Mobility b) Resp function c) Swallowing and speech d) Gag reflex e) Self-care abilities
42
What are the 4 categories of aphasia?
a) expressive aphasia- difficulty expressing thoughts through speech and writing. b) Receptive aphasia- difficulty understanding spoken or written language. c) Anomic or amnesic aphasia- word finding problems. d) Global aphasia- loss of expressive and receptive function.
43
How do pts w/ stroke struggle with affect?
May have difficulties controlling and expressing their emotions. Expressions may be exaggerated or unpredictable.
44
How is intellectual function impaired by stroke?
Memory and judgement may be impaired, LB may be very cautious and have trouble making decisions. RB stroke may be very impulsive and move too quickly.
45
What are the 4 categories of spatial perceptual alterations?
a) Incorrect perception of self and illness. Results from damage to the parietal lobe. Pt denies their illness. b) Impaired perception of self in space. Can't judge distances etc. c) Agnosia- inability to recognize an object by sight, tough or hearing. d) Apraxia- inability to carry out learned sequential movements on command.
46
What diagnostic tests are used for stroke?
CT, CTA, MRA, MRI.
47
How is stroke prevented with health management?
a) BP control b) blood glucose control c) diet and exercise d) smoking cessation e) limiting alcohol consumption f) routine health assessments
48
What is transluminal angioplasty?
Insertion of a balloon to open a stenosed artery and improve blood flow.
49
What are some important interventions for emergency stroke management?
AIRWAY, call stroke code, pulse ox, make sure of IV access, foley, CT scan, baseline lab values, institute seizure precautions. Keep pt NPO.
50
What drug is used to treat ischemic stroke?
Recombinant tPA. Used to re-establish blood flow through a blocked artery to prevent cell death. Converts plasmogin to plasmin, which digests fibrin, destroying the clot.
51
What type of surgical treatment is used to treat ischemic stroke?
Endovascular treatment. Balloon and corkscrew device inserted, goes through clot and destroys it.
52
What does drug therapy look like for hemorrhagic stroke?
Management of hypertension. Once BP is stable, low-dose anticoagulant can be started for DVT prophylaxis.
53
What surgical therapy is used for hemorrhagic stroke?
Evacuation of the aneurysm and guglielmi coils?
54
What causes hydrocephalus in stroke pts?
Intracrerebral hemorrhage can bleed into ventricles, increasing the ICP.
55
What can relieve hydrocephalus and stablize ICP in stroke pts?
Inserting an external ventricular drain to drain CSF.
56
What are the acute care goals for stroke?
Preserving life, preventing brain damage, reducing disability.
57
What is some important health history in pts w/ suspected stroke?
Hypertension, TIA, cardiac diseases, hormone therapy, diabetes, anti-platelet therapy, anticoag drugs, illigal substances.
58
What are symptoms of stroke?
Anorexia, nausea, vomiting, dysphagia, change in bowel/bladder patterns, loss of movement, sensation, syncope, weakness, mouth droop, weakness, numbness, tingling, loss of memory, alteration in speech, pain, headache, visual disturbances.
59
What are some nursing diagnosis for pts w/ stroke?
Decreased intracranial adaptive capacity, risk for aspiration, impaired physical mobility, unilateral neglect, impaired urinary elimination, impaired swallowing, situational low self-esteem.
60
What are your nursing priorities while managing stroke?
RESP system- risk for pneumonia, dysphagia. Neuro- ICP, vasospasm, neuro vitals etc. CV-maintain homeostasis, fluid retention, BP. Musco-skeletal- maintain function. Integumentary- relieve pressure, good hygiene. GI- monitor for constipation GU-incontinence Nutrition- monitor, dysphagia.
61
What is homonymous hemianopia?
Blindness in the same half of each visual field. Happens after stroke.

NURS 3000 (6 decks)

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