WK 5: CVA

Question 1

Modifiable & non-modifiable risk factors for stroke

Answer 1

Nonmodifiable Risk Factors
○ Age
○ Sex
○ Ethnicity and race
○ Heredity/family history
○ Personal circumstances
○ Arteriovenous malformation
· Modifiable Risk Factors
○ Hypertension
○ Diabetes mellitus
○ Heart disease
○ Increased serum cholesterol
○ Heavy alcohol consumption
○ Oral contraceptive use
○ Physical inactivity
○ Smoking
○ Substance use
○ Obesity

Question 2

What is ischemic Stroke?

Answer 2

· Inadequate blood flow to the brain from partial or complete occlusion of an artery
The majority of all strokes are ischemic strokes.

Question 3

What is a hemorrhagic Stroke?

Answer 3

· Account for approximately 15% of all strokes
· Result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles
· Often a sudden onset of symptoms, with progression over minutes to hours because of ongoing bleeding
Most important cause of hemorrhagic stroke is hypertension

Question 4

What is a TIA?

Answer 4

Transient ischemic attack (TIA)
○ usually a precursor to ischemic stroke.
○ Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction of the brain
Symptoms last <1 hour.

Question 5

What are the clinical manifestations of stroke?

Answer 5

· Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
· Sudden confusion, trouble speaking, or difficulty understanding speech.
· Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, loss of balance, or lack of coordination.

Question 6

What is expressive aphasia

Answer 6

Occurs when there is damage to the part of the brain that controls speech production (Broca’s area).

Question 7

What is receptive aphasia

Answer 7

When someone is able to speak well and use long sentences, but what they say may not make sense.

Question 8

What is global aphasia

Answer 8

Profound impairment of all modalities of receptive and expressive language.

Question 9

What is ataxia

Answer 9

Poor muscle control that causes clumsy voluntary movements.

Question 10

What is agnosia

Answer 10

Neurological disorder characterized by an inability to recognize and identify objects or persons using one or more of the senses.

Question 11

What is dysarthria

Answer 11

Where you have difficulty speaking because the muscles you use for speech are weak

Question 12

What is apraxia

Answer 12

The loss of ability to execute or carry out skilled movement and gestures, despite having the physical ability and desire to perform them

Question 13

What is dysphagia

Answer 13

The medical term for swallowing difficulties

Question 14

Why are CT scans important in evaluating acute stroke?

Answer 14

· CT scans can show areas of abnormalities in the brain, and can help determine if these areas are caused by insufficient blood flow (ischemic stroke), a ruptured blood vessel (hemorrhage), or another issue entirely.

Question 15

Assessments of Acute Stroke

Answer 15

· Monitoring BP
· Monitor Vital Signs
· Level of consciousness
· Motor and sensory function
· Pupil size and reactivity
· O2 saturation
· Cardiac rhythm

Question 16

Patient positioning of Acute Stroke

Answer 16

○ The patient is usually discharged from the acute care setting to home, an intermediate or long-term care facility, or a rehabilitation facility.
○ Ideally, discharge planning starts early in the hospitalization
○ Rehabilitation is the process of maximizing the patient’s capabilities and resources to promote optimal functioning.
□ Physical, mental, and social well-being
○ Cognition, coping, physical deficits, and emotional lability are difficult for the patient and family.
Speech th

Question 17

tPA administration for Acute Stroke

Answer 17

○ Used to re-establish blood flow through a blocked artery to prevent cell death in patients with acute onset of ischemic stroke symptoms
○ Must be administered within 4.5 hours of onset of clinical signs of ischemic stroke
○ tPA is administered IV.
○ No antiplatelet or anticoagulants may be given with tPA.
If tPA is expected as a treatment option, the nurse should be proactive by inserting a Foley catheter and multiple IVs before tPA administration.

Question 18

What are contraindications to tPA administration

Answer 18

· tPA increases the risk of intracranial hemorrhage

Question 19

Why is it important to monitoring BP and neurologic assessment in the stroke patient?

Answer 19

· Blood pressure that is too low can also cause problems, such as dizziness and fainting, which can increase the risk of falls and further injury.
· Therefore, it is important to maintain blood pressure within a healthy range to reduce the risk of stroke and other complications

Question 20

What are signs of increasing intracranial pressure

Answer 20

· Headache.
· Blurred vision.
· Confusion.
· High blood pressure.
· Shallow breathing.
· Vomiting.
· Changes in your behavior.
· Weakness or problems with moving or talking.

Question 21

Nursing management in the care of a patient post-CVA

Answer 21

· skin integrity
· bowel management
· Communication
· Nutrition
· Coping
· managing risk factors

Question 22

Antiplatelets for stroke

Answer 22

o chosen treatment to prevent further stroke in patients who have had a TIA.
o Aspirin is the most frequently used antiplatelet agent.
· The common dose for Aspirin is 81–325 mg/day.
· May also use clopidogrel (Plavix)

Question 23

Statins for stroke

Answer 23

o (simvastatin [Zocor], lovastatin [Mevacor])
o are effective in the prevention of stroke for individuals who have experienced a TIA in the past.

Question 24

Oral anticoagulants for stroke

Answer 24

o apixaban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto) is the treatment of choice for individuals with atrial fibrillation (AF) who have had a TIA.