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Neuro Exam- Stroke
Question | Answer |
---|---|
Disruption of the cerebral blood flow d/t an obstruction. | Ischemic Stroke aka Brain Attack or Cerebrovascular Accident (CVA) |
Complex series of metabolic events which occurs in stroke | Ischemic Cascade |
During ischemic cascade, large amount of ______ causes pH of blood, which causes _______ not to fx, which leads to ___________ and cells stop functioning. | Lactic acid, neurons, electrolyte imbalance |
The _______ region is centered around the infarction can be salvaged with timely intervention at each step. | Penumbra |
Ischemic brain ages _____ years each hour without treatment | 3.6 |
Ischemia from diminished 02 results in | necrosis of brain tissue |
Early treatment with _________ provides better outcomes, which is why knowing ________ is SO VITAL! | thrombolytics, when CVA began |
Most common motor dysfunction with CVA | Hemiplegia |
Paralysis of one side of the body | Hemiplegia |
Weakness of one side of the body | Hemiparesis |
Difficulty walking, unsteady gait, loss of balance or coordination | Ataxia |
DTRs usually reappear after ___ hours along with spasticity, increased tone, on the affected side | 48 |
Difficulty in speaking from paralysis of speech muscles | Dysarthia |
Impaired speech | Dysphasia |
Loss of speech | Aphasia |
Broca's area affected. Inability to express oneself. | Expressive aphasia |
Wernicke's are affected. Inability to understand language. | Receptive aphasia |
Mixed type of aphasia | Global aphasia |
Inability to perform a previously learned action. Seen when pt makes verbal substitutions for words. | Apraxia |
The ability to interpret sensation | Perception |
Visual-perception dysfunctions are problems between the eye and ________ | Visual cortex |
Loss of half the visual field | Homonymous Hemianopsia |
Problems with perceiving the relationship of 2 or more objects in spacial area are frequently seen in pts with _________hemispheric damage. | right |
Sensory loss. Problem interpreting by sight, touch, or hearing. | Agnosia |
If damage to the _________ lobe, learning capacity, memory, or other higher cortical intellectual functions impaired. | Frontal |
Abrupt change in emotional behavior from crying to laughing. | Emotional incontinence |
#1 Diagnostic test for CVA is _______ to R/O ______ | Non-contrast CT, Ischemic or hemorrhage stroke |
What two tests, other than CT, used for Dx CVA | EKG (source of thrombus) and Carotid US |
Temporary neuro s/s lasting less than 1 hour | TIA |
Warning sign of stroke | TIA |
Sudden loss of motor, sensory, and/or visual function | TIA |
Primary major, modifiable risk factor for stroke | HTN |
Three non-modifiable risk factors for stroke | Age (>55), Gender (M), and Race (AA) |
Used ONLY for ischemic strokes | Thrombolytics |
t-PA must be given within _______ of s/s onset | 3 hours |
What is the max dose of t-PA? | 90 mg |
t-PA is given ____mg/kg | 0.9 |
#1 SE t-PA | Bleeding |
t-PA eligibility requirements state person may not have heparin ___ hours prior and platelet count must be at least _______ or greater | 48 hours, 100,000 |
t-PA eligibility requirements state person may not have major sx with ____ days, no stroke, head injury, or intracranial sx within ____ months | 14 days, 3 months |
t-PA eligibility requirements state person must have a BP less than | 185/110 |
Three assessment priorities | Airway, Cardiac, Neuro |
Name three non-thrombolytic therapies | Anticoagulants, Anitplatelet, symptomactic treatment |
Two Anticoagulant therapies and their labs | IV Heparin (aPTT) and IV Coumadin (INR, PT) |
Position HOB at _____ and have _____ available to manage secretions. | 25-30, suction |
______ muscles are stronger than extensor | Flexor |
Prevent shoulder ________ with correct positioning. | Adduction |
Distal joints should be ________ than proximal. | Higher |
What labs should we look at for nutrition? | Albumin and protein |