The severity and loss of function varies acording to the

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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

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