Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
CVA
pn 141 test 2 book: med surg nursing pg 924
| Question | Answer |
|---|---|
| other names for CVA (AKA) | brain attack, stroke |
| why is there a neurological deficit | because of decreased blood supply to a local area in the brain |
| who does it occur most often in | males , ppl over 65, and ppl with a family hx of it, african americans |
| risk factors | HTN, DM, obesity, atrial fibrillation, atheroslerosis, smoking, high cholesterol, excessive use of alcohol and cocaine/ heroin |
| what med that young women take put them at a high risk for CVAs? | oral contraceptives |
| What is a transient ischemic attack (TIA) | a brief episode of reversable neurologic deficits |
| TIA: how long can they last | a few minutes to 24 hours |
| TIA: what happens to the blood flow | a temporary reduction of blood flow to a specific area of the brain |
| TIA: what is the cause of it | atherosclerosis, small ebolus, which obstructs a small cerebral vessel |
| TIA: it is a warning for what | for a future CVA |
| TIA: s/s | dizziness, visual loss in one eye, one-sided numbness or weakness, of the fingers, arms or legs or aphasia |
| CVA: what is it | the sudden loss of neurologic function |
| CVA: what are the three causes | thrombus, embolus, hemorrhage |
| CVA: the ones caused by thrombus occur most often in whom | older adults who are resting or sleeping |
| CVA: when the blood flow is decreased to the brain what happens | the oxygen levels to the brain supplied by the involved BVs decreases |
| def of anoxia | lack of oxygen to the brain |
| irreversable damage occurs when the brain experiences anoxia for >_____ minutes | 10 minutes |
| what type of blood supply can decrease the amount of damage | collateral circulation |
| how does collateral circulation occur in the brain | it occurs when areas of the brain have decreased blood flow over a long period of time; so that smaller blood vessels develop to supply blood to areas with reduced blood supply |
| large areas of infarction usually result in what | severe disability and death |
| what happens to neurologic function when the cerebral blood supply is altered | there is temporary or permanent loss of neurologic function |
| what do the s/s of a CVA depend on | area of brain involved, size of the area, collateral blood flow |
| typical s/s of a CVA | atered movement, sensation, thought, memory, behavior, speech |
| CVA s/s:three motor deficits | hemiparesis, hemiplegia, facial droop |
| CVA s/s: Speech deficits (4) | exressive aphasia, receptive aphasia, global aphasia, dysrhythmias |
| CVA s/s: Sensory perceptual deficits (3) | agnosia, apraxia, Neglect syndrome |
| CVA s/s: cagnitive an behavioral s/s | memory loss, short attention span, poor judgment, poor problem solving, emotional lability, depression |
| Thrombotic CVA: usual cause of it | atherosclerosis of large cerebral arteries |
| Thrombotic CVA: when does the onset of it occur | during or after sleep |
| Thrombotic CVA: pathophys of it | atherosclerosis causes plaque to build up in cerebral arteries. If plaque is not removed or treated, a thrombus or clot develops. this leads to ischemia in the brain tissue supplied by the vessels |
| Embolic CVA: usual cause of it | Heart problems: Atrial fibrillation, CHF, rheumatic heart disease, mitral valve disease, endocarditis |
| Embolic CVA:when does the onset of it occur | sudden onset w/ immediate deficts |
| Embolic CVA:pathophys of it | embolus travels to a cerebral artery from a distant site, especially the heart. it lodges in a narrow portion of a cerebral artery causing necrosis |
| Hemorrhagic CVA: usual cause of it | HTN |
| Hemorrhagic CVA: when does the onset of it occur | occurs suddenly, often during some activity |
| Hemorrhagic CVA: pathophys of it | HTN weakens a cerebral blood vessel causing it to rupture. This leads to bleeding into the brain tissue or subarachnoid space. |
| CVA: do they occur in normally one or both hemispheres | one |
| Right hemisphere CVA s/s: | left, hemiplegia, Left visual field deficit, spatial perceptual deficits, denies or unaware of deficits, easily ditracted poor judgment, impulsive |
| Left hemisphere CVA s/s: | right hemiplegia, right visual field deficits, aphasia, aware of deficits, impaired intellectual ability, slow cautious behavior, high levels of frusteration over loss |
| CVA: def of contralateral | opposite side deficit. When the CVA is located in the left, the deficit occurs in the right side of body (visa-versa) |
| CVA s/s: what sided CVA (L or R) has spatial perceptual deficits | Right |
| CVA s/s: what sided CVA (L or R) has aphasia | left |
| CVA s/s: what sided CVA (L or R) denies or is unaware of deficits | right |
| CVA s/s: what sided CVA (L or R) is easily distracted | right |
| CVA s/s: what sided CVA (L or R) is aware of deficits | left |
| CVA s/s: what sided CVA (L or R) has impaired intellectual ability | left |
| CVA s/s: what sided CVA (L or R) has poor judgment | right |
| CVA s/s: what sided CVA (L or R) has slow cautious behavior | left |
| CVA s/s: what sided CVA (L or R) is impulsive | right |
| CVA s/s: what sided CVA (L or R) has high levels of frusteration over losses | left |
| cva s/s: def of hemiparesis | weakness of the left or right half of the body |
| cva s/s: def of hemiplegia | paralysis of left or right half of body |
| cva s/s: hemiplegia- intially the affected arm & leg are ________; then they become _______ in 6-8 weeks | flaccid, spastic |
| cva s/s: hemiplegia- what can spasticity lead to | adduction of the shoulder, flexion of the fingers, wrist, elbow and knee, external rotation of the hips |
| cva s/s: hemiplegia- this limits the pt ____ | mobility |
| cva s/s: imobility can increase the risk for what | thrombophlebitis, orthostatic Hypotension, aspiration PNA, contractures, Decubitus ulcers |
| CVA s/s: what side of the brain is normally the dominent side | left (b/c we are usually right handed) |
| CVA s/s: speech deficits usually result from a CVA affecting what side of teh brain (dominent or nondominent) | dominent |
| CVA s/s: def of expressive aphasia | an inability to speak or write due to damage of Broca's area. PT can understand what is being said |
| CVA s/s: what area is damaged with expressive aphasia | Broca's area. |
| CVA s/s: def of receptive aphasia | an inabiltiy to understand the spoken word due to damage of the wernick's area. the pt can speak but the words do not make sense |
| CVA s/s: what area is damaged with receptive aphasia | wernick's area |
| CVA s/s: def of global aphasia | a combo of expressive and receptive aphasia |
| CVA s/s: def of dysarthria | difficulty in speech caused by paralysis of the muscles that control speech |
| CVA s/s: vision impairement is caused by damage to what lobes | the parietal and temporal |
| CVA s/s: def of diplopia/ homonymous hemianopia | loss of vision in half of the eye. pt sees only half of the normal vision and must turn head to see the enviornment |
| CVA s/s: def of proprioception | awareness of the body's position |
| CVA s/s: def of agnosia | the inability to recognize a familiar object (a toothbrush) |
| CVA s/s: def of apraxia | inability to carry out a familiar routine even when paralysis is not present )ex: combing hair) |
| CVA s/s: def of Neglect syndrome/ unilateral neglect | pt ignores the affected side of the body. they tend to bump into walls, walk to one side, fail to dress affected side |
| CVA s/s: damage to the right hemisphere frontal lobe causes what cagnitive losses | memory loss, decreased attention span, poor judgment, an inability to solve problems |
| CVA s/s: def of emotional lability | pt may laugh or cry inaproppriately |
| CVA s/s: when stroke damages only one hemisphere, bladder and bowel problems are short or long term; | short |
| CVA s/s: what are the short term bladder problems | urinary frequancy, urgency, incontinence |
| CVA s/s: why does constipation develop | it is a result of immobility |
| CVA s/s: complications of dysphagia | choking, drooling, aspiration, regurgitation |
| CVA s/s: what is the nursing care focused on for a pt with dysphagia | preventing aspiration and promoting adequate nutrition |
| TIA tx: what is done and why | surgery and meds to prevent stroke |
| CVA tx: what does the medical team first concentrate on (2 things) | Dx the type of CVA, and perserving life |
| CVA tx: why are meds ordered | to decrease IICP and prevent neurologic deficits |
| CVA tx: after acute phase, what is pt care focused on | rehab |
| CVA diagnostic tests: CT scan- what does it do | identifies the size and location of the CVA, useful to differentiate between an infarction and hemorrhage |
| CVA diagnostic tests: CT scan- nursing interventions | NPO 8 hours before test, give meds 2 hours before test, identify allergies to iodine, remove hairpins clips and earrings, explain what test is (a narrow circular enclosure w/ a round opening, it is painless, it makes a loud clicking noise) |
| CVA diagnostic tests: MRI - what does it show | detects areas of infarction earlier than a CT scan |
| CVA diagnostic tests: Cerebral arteriography - what does it show | indentifies vessel abnormalities such as an aneurysm |
| CVA diagnostic tests: dopplar ultrasound - what does it show | evals the flow of blood through the carotid arteries and identifies if a vessel is partially or completely occluded |
| CVA diagnostic tests: positron emission tomography (PET) - what does it show | indetifies the amount of tissue damage following a CVA |
| CVA diagnostic tests: lumbar puncture - why is it done | used to obtain CSF for exam, |
| CVA diagnostic tests: lumbar puncture - what does blood in the CSF indicate | a hemmorrhagic CVA |
| CVA meds: what med is most commonly ordered | antiplatelet meds |
| CVA meds: why are antiplatelet meds give n | b/c platelets can collect in the cerebral arteries and potentially black a vessel |
| CVA meds: what does a daily low dose of aspirin do | it effectively reduces clot formation |
| CVA meds: names for antiplatelet meds | aspirin, dipyridamole (persantine), ticlopidine (Ticlid), clopidogrel (plavix) |
| CVA: why are they referred to a brain attacks | so everyone knows the urgency of seeking medical attention |
| CVA meds: what type of CVAs are thrombolytic meds given | if it is a thrombotic and embolic stroke |
| CVA meds: what is the thrombolytic drug name | alteplase (Activase r-tpa) |
| CVA meds: alteplase (Activase r-tpa)(thrombolytic) - what is the action | dissolves blood clots, increases blood flow, and prevents damage to brain cells |
| CVA meds: alteplase (Activase r-tpa)(thrombolytic) - to be effective within how many hours should it be given | with in three hours |
| CVA meds: what does anticoagulant therapy do | it does not dissolve an existing clot, but but prevents new clots from forming |
| CVA meds: anticoagulants are never given to whom | pt with bleeding in the brain |
| CVA meds: anticoagulants: names | heparin, warfarin (coumadin) |
| CVA meds: what is the name for the newer low-molecular weight heparin | Lovenox |
| CVA meds: anticoagulants: they are started _____ hours after thrombolytic therapy | 24 hours |
| CVA meds: why are antihypertensive meds used | to control BP, b/c HTN can increase area of infarction |
| CVA meds: what meds are used for IICP; what do they do | mannitol (osmotic diuretic), furosemide (loop diuretic); used to decrease cerebral edema |
| CVA meds:why is an anticonvulsant given | to prevent or control seizures |
| CVA surgery: carotid endarterectomy- who gets this | ppl with a Hx of TIAs, or in danger of having another CVA |
| CVA surgery: carotid endarterectomy- what is done | the occluded area is clamped off and an incision is made in the artery, plaque is removed from the inner layer of the artery. A graft is then inserted |
| CVA surgery: carotid endarterectomy- nursing care post op | supine position w/ head and neck in midline alignment, elavate HOB 30 degrees. support head with hands when changing postion, monitor for hemmorrhage, RR, cranial nerve impairment, carotid artery occlusion or CVa,HTN or hypotension |
| CVA surgery: carotid endarterectomy- what to do when monitoring for hemorrhage | assess for hematoma, bleeding at incision site, assess neck size and check for drainage under pt neck and shoulder |
| CVA surgery: carotid endarterectomy- what to do when monitoring for respiratory distress | check RR, rhythm, depth, effort. difficulty swalowing, tracheal deviation, restlessness |
| CVA surgery: carotid endarterectomy- what to do when monitoring for cranial nerve impairment | facial drooping, hoarseness, dysphagia, tongue deviation, speech difficulty, shoulder sag |
| CVA surgery: carotid endarterectomy- what to do when monitoring for CVA | assess for confusion, dizziness, slurred speech, hemiparesis |
| CVA surgery: transluminal angioplasty- what is it | a nonsurgical procedure that compresses plaque againtst the arterial wall, it increases the blood flow to the cerebrum, a stent may be placed |
| CVA meds: what foods can suppress platelet aggregation and increase risk for bleeding for those taking aspirin and anticoagulants | feverfew, garlic, ginger root, ginkgo |
| CVA warning s/s | numbeness orweakness of face, arm and leg, especially on one side of the body, sudden confusion, trouble speaking |
| TIA: how many people that get them are then followed by a stroke | 1/3 |
| TIA: is there necrosis in one | no |
| TIA: what is the goal of Tx | prevent a stroke |
| CVA: what drugs increase the risk of one | one that increases the risk for blood clots |
| TIA: meds to treat | antiplatelets and anticoagulants |
| CVA: who male or female don't revover as well | females |
| CVA: what are the two types of eschemic | thrombolitic and embolitic |
| CVA: what type of stroke is the most common cause of a CVA | a thrombolytic (from atherosclerosis) |
| CVA: hemorrhage- what weakens the cerebral vessel | HTN |
| CVA: hemorrhage- what can happen to the cerebral BV | IT CAN RUPTURE or bleed into brain tissue ot subarachnoid space |
| CVA: what does contralateral deficts mean | that the deficits take place on the opposite side of the body |
| CVA: are the s/s temporary or permanent | can be both |
| CVA:Neglect syndrome: what sided hemisphere of the brain does it affect | R side |
| CVA:Neglect syndrome: are they purposely ignoring the side | no, they just don't know that it exists |
| CVA: CT- what type of CVA will show up immediately; what one will take a few hours | hemmorragic; ischemic |
| CVA: what are some abnormale things you might see on a PHysical assessment | HA, change in LOC< pupil change, temp |
| CVA: what can you not do until a swallow screen is done | eat |
| CVA: INR lab- what is a therapuetic range for a pt using a thrombolytic; what is a normal range | 2-3; 1-2 |
| CVA: why are osmotic diuretics given | to release pressure |
| CVA: why are anticunvulsants given | bc pt is at risk for seizures |
| CVA: will INR change when pt is getting an antiplatelet | no |
| CVA: why are antiplatelets used | to prevent and treat acute ischemic CVas, for tIAs |
| CVA: adverse effects for antiplatelets | thrombocytopenia, GI and abdominal pain, monitor for s/s of bleeding |
| CVA: med- aspiriin: uses | alagesic, antipyretic, anti-inflammatory, stroke prevention |
| CVA: med- aspiriin: adverse reactions | N/V, epigastric distress, GI bleeding, tinnitus, allergic and anaphylactic reactions |
| CVA: med- aspiriin: how many grams can you have a day | 8 |
| CVA med: plavix (clopidogrel)- class | antiplatelet |
| CVA med: plavix (clopidogrel)- use | recent MI, stroke, acute coronary syndrome |
| CVA med: plavix (clopidogrel)- adverse reactions | dizziness, skin rash, chest pain, constipation |
| CVA med: dipyridamole (persantine)- class | antiplatelet |
| CVA med: dipyridamole (persantine)- use | post op thromboembolytic prevention in valve replacement |
| CVA med: dipyridamole (persantine)- adverse reactions | dizziness, abd. distress, HA |
| CVA: what antiplatelet is cheapest | aspirin |
| CVA: two types of anticoagulant therapy | warfarin (coumadin) and lovenox |
| CVA: what are anticoagulants used for | embolic stroke, ischemic, and prevent a second CVA, for cardiembolic |
| CVA: what is a diet high in Vit k | spinich, leafy greens, |
| CVA: why is vit k relative | it leads to clotting |
| CVA: what happens to INR if diet decreases in Vit K; what if it increases | INR increases; INR decreases |
| CVA: if pt is on anticoagulant what is goal for pt diet in vit k | KEEP DIET the SAME |
| CVA: adverse reactions of anticoagulants | bleeding |
| CVA: med enoxaparin (lovenox): class | anticoagulant |
| CVA: med enoxaparin (lovenox): use | DVT, PE tx, unstable angina |
| CVA: med enoxaparin (lovenox): adverse reactions | bleeding bruising, rash, fever, erythema, irritation at site of injection |
| CVA: what anticoagulant is costly | lovenox |
| CVA: med warfarin (coumadin) class | anticoagulant |
| CVA: med warfarin (coumadin) use | prophylaxis, Tx of venous thrombos, CVA |
| CVA: med warfarin (coumadin) adverse reactions | bleeding fatigue, dizziness, abd cramping |
| meds: thrombolytic drugs- what do they do (action) | the drug dissolves blood clots by breaming down the fibrin clots by converting plasminogen to plasmin (plasmin is an enzyme that breaks down the firbrin of a blood clot) |
| meds: thrombolytic drugs- what is another name for them | fibrolytic |
| meds: thrombolytic drugs- names for thrombolytics | recombinant (activase), streptokinase (streptase), TNKase |
| meds: thrombolytic drugs- what is the big complication for these | bleeding |
| meds: thrombolytic drugs- use | acute MI, blood clots from PE and DVT |
| meds: thrombolytic drugs- who are they contraindicated in | active bleeding, Hx of stroke, anerysm, recent IC surger, pt who had surgery in the last ten days, HTN, diabetic retinopathy, GI bleed, INR <1.7 |
| meds: thrombolytic drugs- how are they admin for CVA | IV |
| meds: thrombolytic drugs- within how many hours should they be given | with in 3 hours |
| meds: thrombolytic drugs- what type of hemmorhage do these meds have | ICH |
| meds: thrombolytic drugs- when should they stop the med | severe HA, N/V, acute HTN |
| meds: thrombolytic drugs- when is it more effective | when initiated closer to onset |
| surgery: carotid endarterectomy- surgery is not done until > ___________ % of th e artery blocks | 70 |
| surgery: carotid endarterectomy- what are major complications | bleeding, airway |
| surgery: carotid endarterectomy- why is a pt airway a concern in this srugery | b/c swelling occurs around it |
Created by:
jmkettel
Popular Nursing sets