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Stroke

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Question
Answer
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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