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NURS 2514 > week 8 pharm > Flashcards

week 8 pharm Flashcards

1
Q

what are some issues that may cause hemorrhagic stroke

A

anticoagulants, head injuries, clotting issues (from the liver), hypertension

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2
Q

what are the 5 levels of coma

A

lethargy (v drowsy)
obtunded (needs moderate stimulation to wake them up)
stuporous (lots of stimulation to rouse the patient, v drowsy)
coma

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3
Q

what is mentation

A

mental status (i.e. what is a patients mentation?)

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4
Q

what do catecholamines do

A

they increase heart rate, cause vasoconstriction, and increase blood pressure

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5
Q

what types of substances produce catecholamines

A

drugs, smoking, alcohol

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6
Q

how do statins help with stroke

A

they lower the amount of lipids in the blood which could help with thrombotic (ischemic) stroke because they help prevent atherosclerosis

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7
Q

which labs should be monitored for an individual on atorvastatin?

A

liver function tests (LFTs)
renal function tests (urea/creatinine)
Creatinine kynase (to check for myopathy)

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8
Q

how does ASA help with stroke

A

basically thins he blood to prevent cardiovascular disease, promote blood flow around blocked site, prevent MI

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9
Q

what is a FAST assessment

A

an assessment you would do on a stroke patient to see how bad it is

Face: get them to smile and look for asymmetry
arms: get them to look up their arms and look for positive pronator drift
speech: look for slurring and wierdness
Time to get help

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10
Q

how many positive findings in the FAST assessment would indicate that its time for help

A

if a person is experiencing one or more stroke symptoms

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11
Q

whats the most important question to ask an individual presenting with a stroke

A

when did the symptoms first begin? (determines how much time they have to save them and determines which type of stroke theyre experiencing)

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12
Q

what are some immediate priorities in acute stroke

A
  • note the onset of symptoms
  • cardiac status
  • respiratory status
  • neurological assessment
  • blood sugar
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13
Q

which cranial nerves are involved with gag, cough, and swallow reflex

A

cranial nerves 9, 10, 12

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14
Q

how many hours does one have before intense brain damage to the penumbra

A

4.5 Hours

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15
Q

what is a separate condition that must be ruled out in a hyper-acute stroke patient

A

hyperglycemia

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16
Q

what are the highest and lowest scores of the GCS

A

highest: 15
lowest: 3

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17
Q

which score of the GCS would be concerning

A

anything under 14 is bad

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18
Q

what are the late signs of stroke

A

coma, posturing, absent motor reflexes, dilated/fixed pupils, apneic periods

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19
Q

what does PERRLA stand for

A

pupils equal, round, reactive to light and accommodation

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20
Q

which cranial nerve is involved with assessing pupils

A

cranial nerve 3

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21
Q

if a pupil is dilated to 8-9mm, what does that mean?

A

it means they have a blown pupil (v bad)

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22
Q

what are some diagnostic that can tell the diff between an ischemic and hemmorhagic stroke

A

CT and MRI

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23
Q

what are some blood work findings we look at for stroke

A

CBC, coagulation studies, Blood glucose, renal/liver labs, lipid profile

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24
Q

what may happen to BP and blood sugar following a stroke

A

they will both increase

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25
Q

what range should we keep BP for ischemic stroke patients who are candidates for TPA

A

under or equal to 185/110

26
Q

what range should we keep BP for ischemic stroke patients who are NOT candidates for TPA

A

under 220/120

27
Q

how would an individual with ischemic stroke be a candidate for TPA

A

if theyre symptoms started less than 4.5 hours ago and its confirmed ischemic through CT or MRI

28
Q

what range should you keep systolic BP in a patient with hemmorhagic stroke

A

140-160

29
Q

what drug do we use to control BP in stroke patients

A

Labetolol

30
Q

which route is Labetolol/trandate given

A

IV

31
Q

what is an important thing to remember when giving labetolol

A

patient must lay supine for 3 hours after admin because its very potent

32
Q

why shouldnt you abruptly withdraw labetolol

A

it could cause life threatening arythmias, hypertension, or MI

33
Q

what are some absolute contraindications when taking TPA

A
  • stroke longer than 4.5h
  • bp over 185/110
  • brain bleed
  • any active bleeds
34
Q

what do you need to know about a patient before taking TPA

A

-type of stroke they have
- BP
- CBC (platelets, clotting factors)

35
Q

how can one prevent bleeding after administering TPA

A
  • monitor BP
  • check clotting factors
  • don’t hurt them
  • Q1H neurochecks and vitals
36
Q

what type of stroke to we treat with TPA

A

Ischemic

37
Q

with is the MOA of TPA

A

it breaks down literally all clots occurring in the body

38
Q

what is door to needle time

A

once their in the door it should be less than one hour before they get this drug

39
Q

what are the most common sites of bleeding

A
  • recent wounds
  • sites of needle puncture
  • sites of invasive procedures/surgery
40
Q

what is the point of giving TPA for a stroke

A

it will re establish blood flow through a blocked artery

41
Q

why does blood pressure need to be more closely controlled for a hemorrhagic stroke compared to an ischemic stroke

A

because the the blood pools in the brain it could raise ICP and cause ischemia

42
Q

why would we give anticoagulant to a stroke patient

A

to prevent DVT because there likely immobile. also so that the stroke patient doesn’t develop new clots (ischemic only obvi)

43
Q

what should you be worried about if you notice weak gag reflex in a stroke patient

A

it could cause aspiration, and aspiration pneumonia

44
Q

what is expressive aphasia

A

partial loss of ability to produce words

45
Q

what is receptive aphasia

A

difficult understanding language

46
Q

whats apraxia

A

inability to preform learned tasks on command

47
Q

what is Ataxia

A

lack of muscle control or coordination of voluntary movements

48
Q

what is dysarthria

A

muscles in speech are weak, paralyzed or damaged

49
Q

what is hemianopia

A

loss of vision in half the visual field

50
Q

what is hemiparesis

A

weakness on one side of the body

51
Q

what is hemiplegia

A

paralysis on one side of the body

52
Q

what is neglect

A

becoming unaware of one side of the body

53
Q

what should you assess before giving PO meds to a stroke patient

A

gag, cough, and swallow reflex

54
Q

what is the main cause for stroke complications

A

destruction of brain tissue and cell death

55
Q

which cranial nerves would be abnormal if a stroke patient had issues with speech

A

9, 10, 12

56
Q

which ADLs are speech and communication closely linked to

A

breathing, eating, swallowing, gagging

57
Q

whats the brocas aphasia

A

expressive aphasia

58
Q

whats wernickes aphasia

A

receptive aphasia

59
Q

which area of the brain is affected during wernickes and brocas aphasia

A

the left side

60
Q

what are nurses most concerned about in terms of stroke complications

A

aspiration
DVT
constipation
UTI
depression

61
Q

what are some sensory clinical manifestiations with sub acute stroke patients

A
  • pain, numbness, heavy limb
  • paresthesia
  • loss of bladder/bowel control
  • proprioception issues
  • change in vision
62
Q

what is the first priority of a patient with a positive FAST assessment

A

schedule a STAT CT scan

NURS 2514 (31 decks)

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