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