CVA
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| Cerebrovascular Disorder | Functional abnormality of the CNS that occurs when the blood supply is disrupted
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| What is the primary cerebrovascular disorder and the third leading cause of death in the United Stated? | Stroke
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| What is agnosia? | failure to recognize familiar objects perceived by the senses
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| Non-modifiable risk factors | age (older than 55), male gender, and African American
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| Modifiable risk factors | hypertension, cardiovascular disease, elevated cholesterol and hematocrit, obesity/diabetes, oral contraceptive use, smoking and drug and alcohol abuse
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| True or False Ischemic stroke account for 80% to 85% of strokes, and hemorrhagic stroke accounts for 15% to 20%. | True
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| Stoke | "Brain Attack", sudden loss of function resulting from a disruption of the blood supply to a part of the brain
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| Two types of stroke | Ischemic and hemorrhagic
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| Ischemic stroke | disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of brain tissue
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| Types of Ischemic strokes | large artery thrombosis, small penetrating artery thrombosis, cardiogenic embolism (afib clots), cryptogenic (uncertain origin), and other
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| thrombosis | attached, stays where it is at
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| embolism | moves, not attached
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| Manifestations of Ischemic stroke | numbness or weakness of face, arm, or leg, especially on one side; depends on location and size of the affected area; confusion, change in mental status, trouble speaking or understanding speech, difficulty walking, dizziness, loss of balance, visual prob
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| Hemiplegia | paralysis of one side of the body or part of it, due to an injury in the motor area of the brain
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| Hemiparesis | weakness of one side of the body, or part of it, due to an injury in the motor area of the brain
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| Aphasia | expressive aphasia, receptive aphasia
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| Hemianopsi | blindness of half of the field of vision in one or both eyes
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| Dysarthria | difficulty in speaking
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| Dysphasia or aphasia | partial or complete impairment of language resulting from brain injury, affecting spoken language and comprehension
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| Aproxia | inability to perform a previously learned action such as difficulty putting sounds and syllables together in the correct order to form words, to produce speech
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| Homonymous hemianopsia | loss of half of the visual field
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| Amorphosynthesis | the patient with homonymous hemianopsia turns away from the affected side of the body and tends to neglect that side and the space on that side
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| Transient Ischemic Attack (TIA) | temporary neurologic deficit resulting from a temporary impairment of blood flow; "Warning of an impending stroke"; resolves in bout 60 minutes or less, usually
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| acute care phases | hyper-acute phase- the first 24 hours of care
acute phase care during hospitalization
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| Medical management for Ischemic stroke | thrombolysis with recombinant tissue plasminogen activator (rtPA)
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| Medical management for hemorrhagic stroke | measures are taken to lower ICP, possibly including surgery, NO tPA!!!
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| tPA dose | 0.9 mg/kg with maximum does of 90 mg; 10% given as IV bolus and the remaining 90% given of 1 hour
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| Patient monitoring during thrombolytic therapy | ICU or acute stroke unit where continuous cardiac monitoring and frequent neuro assessments are conducted, frequent VS with attention to BP, monitor for bleeding
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| Interventions during acute phase of stroke | elevate head of bed unless contraindicated, maintain airway and ventilation, continuous hemodynamic monitoring and neurologic assessment
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| Improving mobility and preventing joint deformities | turn and position in correct alignment every 2 hours, use of splints, passive or active ROM four or five times a day, positioning of hands and fingers, prevention of flexion contractures, prevention of shoulder abduction, do not lift by flaccid shoulder
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| Hemorrhagic stroke | caused by bleeding into brain tissue, the ventricle, or subarachnoid space, may be caused by rupture of small vessels primarily related to hypertension, subarachnoid hemorrhage or intracerebral hemorrhage
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| Manifestations of Hemorrhagic stroke | similar to ischemic stroke, Severe HEADACHE, early and sudden changes in LOC, and vomiting
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| Aneurysm Precautions | absolute bed rest, elevate HOB 30 degrees, avoid all activity that may cause increased ICP or BP, exhale through mouth when voiding or defecating to decreased strain, prevent constipation, visitors limited, nonstimulating, nonstressful environment
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| What are the expected outcomes for a patient recovering from a hemorrhagic stroke? | exhibits absence of vasospasms
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| What intervention would not be included in aspiration precautions for a patient in the acute phase of a stroke? | Raise HOB to 30 degrees when feeding
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| True or False Disturbances in the left visual field and spatial perceptual deficits are most frequently seen in patient with left hemisphere damage. | False
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| True or False The goal for thrombolytic therapy for patients with ischemic stroke is to administer IV t-PA within 2 hours of arriving to the ER. | False
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| True or False The main surgical procedure for selected patients with TIAs and mild stroke is carotid endarterectomy. | True
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| True or False Approximately 80% of patients with stroke suffer severe shoulder pain preventing them from achieving balance and performing transfers and self-care activities. | True
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| True or False Hypertension is the most common cause of intracerebral hemorrhage. | True
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| An______ stroke, cerebrovascular accident, or "brain attack" describes a sudden loss of function resulting from disruption of the blood supply to a part of the brain. | Ischemic
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| The dosage for t-PA is ___ mg/kg with a maximum does of 90 mg. | 0.9
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| ____________ strokes, which account for 15-20% of cerebrovascular disorders, are primarily caused by intracranial or subarachnoid hemorrhage. | Hemorrhagic
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| An intracranial __________ is a dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall. | aneurysm
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| Cerebral __________ is a serious complication of subarachnoid hemorrhage and is a leading cause of morbidity and mortality in those who survive the initial hemorrhage. | vasospasm
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