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Stroke
| Question | Answer |
|---|---|
| inadequate blood flow | ischemia |
| Occurs when there is ischemia to a part of the brain, or 2. hemorrhage into the brain that results in death of brain cells. | Stroke |
| The severity and loss of function varies acording to the | location and extent of brain damage |
| who is more likely to die from a stroke women or men? | women |
| what arteries supply the brain with blood? | cartoid arteries and verterbral arteries |
| The anterior and posterior circulation is connected at the_______ by the anterior and posterior communicating arteries | Circle of willis |
| requires continous supply of oxygen and glucose needed to function | the brain |
| how much of CO for optimal functioning? | 20% |
| neurologic metabolism is altered in? | 30 seonds |
| metabolism stops in | 2 minutes |
| cellulatr death occurs in | 5 minutes |
| the brain is protected from changes in mean systemic arterial blood pressure over a range from 50-150 known as | cerebral autoregulation |
| involves changes in the diameter of cerebral blood vessels in response to changes in pressure so that the blood flow to the brain stays constant | cerbral autoregulation |
| carbon dioxide is a | dilator |
| increase carbon dioxide | increase cerebral blood flow |
| decreased co2 | decreased cerebral blood flow |
| very low O2 like less than 50 pao2 then | increase cerebral blood flow. |
| Sytemic BP, CO and blood viscosity affect | blood flow to the brain |
| Cardiac output has to be reduced by ____ before cerebral blood flow is reduced | 1/3 |
| Decreased viscosity | increased flow |
| Individual differences in _______ determines the degree of damage and functional loss when a stroke occurs | Collatteral circuation |
| alternative route | colateral circulation |
| blood streams of the internal basilar system meet in the posterior communicating arterres | in normal situations |
| Increased Intracrainial pressure causes brain compression and | reduced cerbral blood flow |
| age, gender, ethnicity or race and family history or heredity | Nonmodifable risk factors |
| 2/3rds of all stokes occur in | people over 65 |
| higher incidence of stokes | African americans |
| can be potentially altered through lifestyle changes and medical treatment, thus reducing the risk of stoke | modifiable risk factors. |
| hypertension, heart disease, smoking, excessive alchol, diabetes, obesity, sleep apnea, metabolic syndrome, lack of exercise, poor diet and drug abuse | modifiable risk factors |
| metabolic syndrome | modifiable |
| sleep apnea | modifiable |
| heart disease | modifiable |
| diabetes | modifiable |
| stroke can be reduced by ____ with treatment of hypertension | 50% |
| Heart disease including a fib, MI, cardiomyopathy, cardiac valve abnormalities and cardiac congenital defects. | risk for stroke |
| responsible for about 20% of stokes | atrial fib |
| increased cholesterol | modifiable risk for stroke |
| how much activitiy is needed to have beneficial impact | even light to moderate |
| what kind of diet increases risk for stroke? | high in fat and low in fruits and vegetables |
| Hyperhomocystemia | modifiable risk for stroke |
| migraine headahces and inflamatory conditions and sickle cell | modifiable risk for stroke |
| ischemia without infarction | TIA |
| a treansient episode of neurologic dysfunction caused by focal brain, spinal cod or retinal ischemia but without acute infarction of the brain | Transient ischemic attack |
| clinical syptoms typically last less than ___ in TIA | 1 hour |
| symptoms lasting less than ____ in TIA in the past | 24 hours |
| may be due to microemboli that temporarily block blood flow | TIA |
| Warning sign of progressive cerbrovascular disease | TIA |
| loss of vision in one eye, hemiparesis, numbness or loss of sensation or a sudden inability to speak | In a TIA if the cartoid system is involved |
| Amaurosis fugax | loss of vision in one eye |
| tinitus, vertigo, darkened or blurred vision, diplopia, ptosis, dysarthria, dysphagia, ataxia, and unilateral or bilateral numbness or weakness | If TIA effects verterbrobasilar system |
| results in infarction and cell death | Stroke |
| results from inadequate blood flow to the brain from partial or complete occlusion of an artery. | ischemic |
| 80% of strokes are | ischemic |
| occurs from injury to a blood vessel wall and formation of a blood clot | Thrombotic stroke |
| develops readily where atherosclerotic plaques have already narrowed blood vessels | thrombosis |
| results of narrowing of the blood vessel | Thrombotic stroke |
| most common cause of stoke | thrombosis |
| why are hypertension and diabetes risks for stroke? | it accelerates atherosclerosis |
| 30-50% of thrombotic strokes are | preceded by TIA |
| Many patients with ischemic stroke ______ have a decreased level of concousness in first 24 hours | DO NOT |
| Ischemic stroke symptoms mat progress in the first ______ as infarction and cerbral edema increase | 72 hours |
| occurs when an embolus larges in and occludes a cerbral artery, resulting in infarction and edema of the area supplied by the involved vessel | Embolic stroke |
| atrial fibrilation, MI, infective endocardities, rheumatic heart disease, valvular prosstheses and atrial septal defects | Heat conditions associated with emboli |
| air and fat fro long bone fracutres | Can cause embolic stroke but is less common |
| Severe clinical symptoms that occur suddenly | Embolic stroke |
| second most common cayse of stroke | Embolism |
| Where does most emboli originate? | the endocardal (inside) layer of the heart, with plaque braking off from endocardium and entering circulation |
| Warning signs are ____ common with embolic stroke than with thromotic stroke | less |
| What generally happens during an embolic stroke | patient usually remains consious, although he or she may have a headache. |
| prognosis of an embolic stroke is r/t | the amount of brain tissue deprived of its oxygen supply. |
| The effects of emboli are initally charecterized by | severe neurologic defects |
| T OR F recurrence of emboli are common | T |
| results from bleeding into the brain tissue itself (intracerbral or intraparenchymal) or into the subarachnoid space of ventricles (subarachnoid or intraventricular) | Hemorraghic stoke |
| bleeding within the brain caused by rupture of a vessel | Intracerebral hemmorhage |
| Prognois of intracerebral hemmorrhage | poor |
| most common cause of intracerbral hemmorage | Hypertension |
| commonly occurs during periods of activity | hemmorhage |
| sudden onset of symptoms with progression over minutes to hours | intracerebral hemmorhage |
| neurologic deficts, headache, nausea, vommiting, decreased LOC and hypertension | manifestations of intracerbral hemorhage |
| a blood clot within the closed skill can result in a mass that causes pressure on brain tissue, displaces brain tissue and decreases cerbral blood flow, leading to iscemia and infarction | Intracerbral hemmorhage |
| initially what is expereinced in an intracerbral hemmorhage? | Severe headache with nausea and vomiting |
| Weakness of one side, slurred speech, deviation of the eyes | putaminal and internal capsule bleeding |
| hemiplegia, fixed and dilated pupils, abnormal body posturing and coma | Severe hemmorahge |
| more sensory than motor loss | thalmamic hemmorhage |
| problems with vision and eye movement | subthalmic hemmorhage |
| severe headach, vomiting, loss of ability to walk, dysphagia, dysarthria, and eye movement disturbances | cerebelar hemmorhages |
| nost serous place of hemmoraghe | pons |
| If a hemmorhage occurs here then life functions such as breathing are effected | pons |
| hemiplegia, complete paralysis, coma, abnormal body posturing, fixed pupils, hyperthermia and death | hemmorage in pons |
| occurs when there is intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater membranes of the brain | Subatachnoid hemorrhage |
| Where does bleeding in subarachnoid hemmorhage occur? | CSF between arachnoid and pia mater mebranes of the brain |
| commonly caused by rupture of a cerebral aneurysm | Subarachnoid hemmorrhage |
| congential aquired weakness and ballooning of vessels | aneurysm |
| The majority of aneurysms are in the | circle of Willis |
| Besides anurysms what are other causes of subarachnoid hemmorhage? | trauma and illicit drug use |
| who has a higher incidence of subarachnoid hemoragic strokes | Women |
| in general cerebral aneusyms are viewed as | silent killers but can hace warning signs |
| worst headache of ones life | ruptured aneuysm and this subarachnoid hemmorrhage stroke |
| LOC may change or not, neurologic defict including crainial nerve deficts,nausea, vommtiting, seizures and stiff neck. | SAH |
| In SAH peak time of vasospasm is | 6-10 days after inital bleed |
| narrowing of blood vessels | cerebral vasospasm |
| cerebral vasospasm is a complication of | SAH |
| The neurologic manifestations________ significantly differ between ischemic and hemmorhagic stroke | DO NOT |
| Clinical manifestations are related to the | location of the stroke |
| The functions affected in a stroke are r/t the | artery involved and area of brain it supplies |
| most important thing to ask? | time of onset of symptoms |
| impairment of mobility, respiratory function, swallowing and speech, gag reflex, and self care abilities | motor defict |
| What causes motor deficts? | the destruction of motor neurons in the pyramidal pathway |
| nerve fibers from the brain that pass though the spinal cord to the motor cells | pyramidal pathway |
| loss of skilled voluntary movement | akinesia |
| loss of skilled voluntary movement, impairment of integration of movements, alterations in muscle tone and alterations in reflexes | charecteristic motor deficts |
| progression of reflexes for stroke patients, | hyporeflexes then hyperreflexes |
| A lesion on one side of the brain affects motor function on the opposite side of the body | contralateral |
| Why is a stroke seen contralateral? | because the pyramidal pathways cross |
| What hemisphere is dominant for language skills | Left hemisphere |
| loss of comprhension | receptive aphasia |
| inability to produce language | Expressive aphasia |
| total inability to communicate | global aphasia |
| occurs when a stroke damages the dominant hemisphere of the brain | aphasia |
| damage to frontal lobe | Brocas |
| Damage to temporal lobe | Wernickes |
| damage to extensive portions of language areas of the brain | Global |
| results from damage to different language areas in the brain | Other |
| Types on nonfluent aphasia | brocas, global |
| Type of fluent aphasia | Wernickes |
| Refers to impaired ability to communicate | Dysphasia |
| Minimal speech activity with slow speech that requires obvious effor | nonfluent aphasia |
| speech is present but contains little meaningful communication | Fluent aphasia |
| a disturbance in the muscular control of speech | Dysarthia |
| Impairement may involve pronuciation, articulation and phonation, does not affect the meaning of communication or comprehension of language just mechanics of speech | dysathia |
| in a stroke emotional responses may be | exagerated or unpredictable |
| What parts of intelectual function may be prepared after a stroke? | memory and judgment |
| A left brain stroke is more likely to result in | memory problems related to language |
| cautious in making judgements | Left brain stroke |
| impulsive and move quickly | Right brain stroke |
| Who will have more problems with spatial-perceptual orientation? | right side brain stroke |
| may deny their illnesses or own body parts if damage to the | parietal lobe |
| Homonymous hemianopsia | blindness occurs in the same half of the visual fields in both eyes |
| Agnosia | inability to recognize object by sight, touch, or hearing |
| problem with spatial orientation example | judging distances |
| Apraxia | inability to carry out learned sequential movements on command |
| When stroke affects one hemi of the brain the prognois for bladder control is | excellent |
| initially after a stroke a patient may experience what in regards to bladder? | frequeny, urgency and incontinence |
| bowel problem r/t stroke | constipation |
| What tests can be done to immediatly distinguish between ischemic or hemmoragic stroke | noncontrast CT or MRI |
| This can provide an estimate of perfusion and detect filling defects in the cerebral artery | CT angiography |
| can detect vascular lesions and blockages similar to CTA | magnetic resonance imaging MRA |
| Many strokes are caused by blood clots from the | heart |
| can identify cervical and cerebrovascular occlusion, atherosclerotic plaques and malformation of vessels | Angiography |
| definitive study to identify the source of SAH | Cerebral angiography |
| involves the injection of a contrast agent to visualize blood vessels in the neck and large vessels of the circle of willis | digitial subtraction angiography |
| measures the velocity of blood flow in the major cerebral arteries, effective in detecting Microemboli, vasospasm and ideal for SAH | Transcranial doppler |
| measures brain oxygenation and temp | LINCOX |
| Chosen treatment to prevent stroke for those with TIAs | Antiplatlet, aspirin |
| TIA treatment person who has AFIB | anticoagulation |
| Surgical interventions for TIA due to cartoid disease include? | cartoid endarerectomy, transluminal angioplasty, stenting, and EC-IC bypass |
| Treatment for TIA, the atheromatous lesion is removed from the cartoid artery to improve blood flow | cartoid endarterctomy |
| TIA treatment- Insertion of a baloon to open up a stenosed artery in the brain and improve blood flow | transluminal angiplasty |
| baloon is threaded up to the cartoid artery via a catheter inserted in the femoral artery. | Transluminal angioplasty |
| TIA treatment, attempt to maintain patency of the artery | Stenting |
| TIA treatment, this involves anastomosing a branch of an extracranial artery to an intrcranial artery beyond area of obstruction to increase cerebral perfusion | EC-IC bypass |
| SINGLE MOST IMPORTANT! point in patients history is? | time of onset of symptoms |
| goals of care during acute phase is? | preserving life, preventing further brain damage and reducing disability |
| 25% of patiients with a stroke have neurologic deficts worsen in the first | 24-48 hours |
| Someone after an ischemic stroke, no use of thrombolytics, dont treat BP unless higher than? | 220/120 |
| If going to have fibrolytic therapy then the BP needs to be less than | 185/110 and maintained at 180/105 for 24 hours after therapy |
| High BP follwing a stroke is? | a good thing! |
| IV solutions with what are AVOIDED during acute phase of a stroke? | glucose and water |
| should hyperglycemia be treated in acute phase of stroke? | Yes |
| How would you manage increased ICP | practices that improve venous drainage such as elevating head of bed, maintaing neck and head alignment, and avoiding hip flexion, managment of hyperthermia |
| What stroke would you use TPA? | Ischemic |
| produces localized fibrinolysis by binding to the fibrin in the thrombi | Tissue plaminogen activator TPA |
| lyses clots | fibrolytics/TPA |
| Administered IV to restablish blood flow through a blocked artery to prevent cell death in patients with acute onset of ischemic stroke | TPA |
| How long after the clinical signs of iscemic stroke MUST tPA be administered? | 3-4.5 hours of the onset of clinical signs |
| if head trauma within last 3 months, major surgery within 14 days then.. | cant give tpa |
| Intrarterial tPA can be administered how long after stroke symptoms? | 6 hours |
| The use of anticoagulants in the emergency phase of an ischemic stroke is generally | NOT reccomended |
| After patient is stabilized and had ischemic stroke | Treated with anticoagulants and aspirin, statins |
| A way of opening blocked arteries in the brain by using a removable stent system used in ischemic stroke | Stent retreivers |
| The clot seeps into the mesh of the stent | Stent retreiver |
| Allows the suregeon to go inside the blocked artery of a patient who is experiencing ischemic stroeks, the corkscrew device reaches the clot in the brain, the device penetrates the clot allowing it to be removed | MERCI retriver |
| Platlet inhibitors are contraindicated in | Hemorraghic strokes so are anticoagulatants |
| Main drug therapy for patients with hemorrhagic stroke is the managment of | hypertension |
| In a hemorrhagic stroke BP is maintained within | normal to high range systolic less than 160 |
| immediate evacuation of aneurysm-induced hematomas or cerebellar hemotoms larger than 3 cm | Surgical for hemmorhagic |
| Treatmen of anteriovenous malformation seen in hemmorhagic stroke? | Surgical resction or radiosurgery |
| Usually caused by ruptured aneurysm | SAH |
| treatment of anurysm induced Hemoraghic stroke | clipping or coiling |
| aneuysm is sealed off from patent vessel | Coiling |
| bleeding into ventricles of brain produces | hydrocephalus so do csf drainage |
| decription of current illness with point to onset of symptoms, history of similar experiences, current meds, H/O risk factors and family history | primary assesment |
| comprehensive neurologic examination | secondary assesment |
| used to avaluate the effect of an acute stroke | National insitutes of health stroke scale |
| Primary cause of stroke? | uncontrolled or undiagnosed hypertension |
| Place the stroke patient on NPO untill | Dyspagia has been rulled out |
| If on mechanical ventilation, oral care every ______ reduces ventilator- assisted pnumonia | 2 hours |
| with unclipped or uncoiled anurysm dont.... | DONT suction as it can increase ICP, dont cough |
| Measures stroke severity, predictor of both short and long term outcomes of stroke patients | NIHSS |
| A decreasing LOC may show | increasing ICP |
| Becuase hypertension is seen after a stroke monitor for | othostatic hypotension when ambulating for first time |
| Since a patient is at risk for VTE after a stroke what may be given as prophlaxis? | LMWH |
| nursing goal for musculoskeletal | prevent joint contracutures and muscular atrophy |
| How to position if someone is paralyzed on one side? | each joint higher than the joing proximal to it to prevent dependent edema |
| Trochanter roll is used in stroke patients to | prevent external rotation of the hip |
| hand roles prevent | hand conracures |
| How long can a person be positioned on paralyzed side? | 30 minutes |
| in acute stage of stroke the primary urinary problem is? | poor bladder conrol, resulting in incotinence |
| associated with communication difficulties, undressing and dressing | Functional incotinence |
| Patients may initially recieve | iv infusion to maintain fluids/electrolytes, |
| majority of patients experience | dysphasia after a stroke |
| How long after feeding should someone with dysphagia remian sitting upright? | 30 minutes |
| What diets avoid in stroke patients? | purreed, thin liquids and milk |
| How do you know if dieatary program is effective? | maintence of weigh, adequate hydration, a patient satisfaction |
| If the patient cannot understand then | use gestures to support verbal cues |
| Difficultu judging position, distance and rate of movement | stroke on right side of brain |
| Impulseive, impatient and deny problems related to stroke | stroke on right side |
| at higher risk for injury because of mobility difficulties | right brain stroke |
| What is the best way to give directions for activities for comprhension for someone who had a right sided brain stroke? | Verbally |
| one sided neglect is common for people with | right sided brain stroke |
| slower in organization and performance of task | left sided stroke |
| they tend to have impaired spatial discrimination | Left sided stroke |
| The patients admit to defects, are fearful and anxiour | left sided stroke |
| What is helpful for comprehension of instructions for those who suffer a left sided stroke? | Non verbal cues |
| Persistent disregard of objects in part of the visual field should alert you to this | Homonymous hemianopsia |
| neglect sydrome or visual field cut may affect | both left and righ sided stroke |
| drooping eylid | ptosis |
| Process of maximizing the patients capabilities and resources to promote optimal functioning related to physical, metal and social well being | Rehabilitation |
| prevent deformity and maintain and improve function | Goals of rehab |
| The first year of recovery after a stroke is where the patient will see | the maxmum benifit of rehab |
| If muscles are still _________ several weeks after the stroke the prognois for rehab is poor | flaccid |
| Patient has voluntary control of isolated muscle groups | final stage of recovery from stroke |
| inital step in recovery | balance training |
| encourages the patient to use the weakned extremity by restricting movement of normal extremity | Constraint-induced movement therapy |
| exagerated mood swings are especially seen in | stroke on left side of brain |
| When the patient does not maintain optimal functioning fro self care, family responsibiliries, secion making or socialization | Maladjusted dependece with inadeqaute coping |
| highest incidence of stroke occurs among | older adults |
| determines patency of cerebral blood vessels | angiography |
| Caused by a ruptured blood vessel | Intracerebral Hemorhagic stroke |
| Intracerebral hemmorhage can result in | creation of a mass that compresses the brain |
| Impaired judgment is most likely the result of | right sided brain damage |
| inability to remeber words is most likely the result of | Left sided brain damage |
Created by:
rebo14