CVA

Question 0

Modifiable factors

Answer 0

•Those factors that can be eliminated or controlled e.g. diet, smoking, activity level

Question 1

•Non-modifiable factors

Answer 1

• Risk factors that cannot be changed
• Age -  with each decade beyond age 55 years.
• Race - African American  CVA compared to other groups
• Gender - men have greater risk than women
• Heredity - family history  risk for CVA

Question 2

Sudden, brief episode of neurologic impairment caused by a temporary interruption in cerebral blood flow

Answer 2

Transient Ischemic Attack

Question 3

Pathology of TIA

Answer 3

Blood vessels occluded by spasms, fragments of plaque, or blood clots
Causes: atherosclerosis, arteriosclerosis, cardiac disease, diabetes
TIAs are a warning that a cerebrovascular accident (CVA) can occur in the near future;
40% of people who experience a TIA will have stroke;
Nearly ½ of these strokes will occur within the first few days after a TIA.

Question 4

S/S of TIA

Answer 4

•sudden onset, usually lasting 10-20 minutes, but no longer than an hour.
•numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body;
ptosis (drooping eyelid), drooping mouth (uneven smile)
•dizziness
•momentary confusion or trouble understanding simple statements
•sudden trouble speaking (speech difficult 2nd to muscle weak)
•sudden problems with walking or balance.
•tinnitus
•sudden visual disturbances
•. dysphagia,

Question 5

Medical treatment of TIA

Answer 5

• Depends on the location of the narrowed vessel and the degree of narrowing
• Acetylsalicylic acid (aspirin), ticlopidine hydrochloride (Ticlid), extended-release dipyridamole (Aggrenox), or clopidogrel bisulfate (Plavix) decrease platelet clumping
• Warfarin (Coumadin) and heparin

Question 6

An abrupt impairment of brain function resulting in a set of neurologic signs and symptoms that are caused by impaired blood flow to the brain and last more than 24 hours (less than 24 hrs = possibleTIA)

Answer 6

Stroke (CVA)

Question 7

Blood vessel in brain ruptures and bleeding into the

brain cccurs.

Answer 7

Hemorrhagic stroke

Question 8

occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.

Answer 8

Subarachnoid hemorrhage (SAH)

Question 9

occurs when a blood vessel bleeds into the tissue deep within the brain.

Answer 9

Intracerebral hemorrhage (ICH)

Question 10

Obstruction of a blood vessel by atherosclerotic plaque, blood clot, or a combination of the two, or by other debris released into vessel that impedes blood flow to an area of the brain

Answer 10

Ischemic stroke

Question 11

Afib is

Answer 11

• a leading risk factor for stroke
• more common in people over age 60
• often asymptomatic, making it difficult for people to know that they have it

Question 12

It’s is Important to note about Afib

Answer 12

• Afib can be successfully managed with the help of a
healthcare professional.
• About 15 percent of all people who have strokes also have
Afib.
• Knowing about and properly managing your Afib can prevent
you from having a stroke.
• Up to 80 percent of strokes in people with Afib can be
prevented.

Question 13

Hemorrhagic stroke s/s

Answer 13

• Occurs suddenly; may include severe headache described as “the worst headache of my life”, dizziness, nausea, vomiting usually followed by a rapid loss of consciousness
• If the ruptured aneurysm produces a slow leak, a stiff neck, headache, visual disturbances, intermittent nausea develop, latent loss of consciousness
• Other symptoms: seizures

Question 14

•Embolic (clot) stroke s/s

Answer 14

• Appear without warning
• One or more of the following signs and symptoms:
• one-sided weakness
• numbness
• visual problems
• confusion and memory lapses
• headache
• dysphagia
• language problems

Question 15

•A defect in the use of language; speech, reading, writing, or word comprehension

Answer 15

Aphasia

Question 16

•The inability to speak clearly

Answer 16

Dysarthria

Question 17

Difficulty swallowing

Answer 17

Dysphasia

Question 18

•The partial inability to initiate coordinated voluntary motor acts

Answer 18

Dyspraxia

Question 19

•Defined as paralysis of one side of the body
•Perceptual disturbances
affect ability to safely move in
environment

Answer 19

Hemiplegia

Question 20

•Unable to feel touch, pain, or temperature in affected body parts

Answer 20

Sensory impairment

Question 21

Unilateral neglect

Answer 21

Do not recognize one side of the body as belonging to them

Question 22

Perceptual problem: involves loss of one side of field of vision

Answer 22

•Homonymous hemianopsia

Question 23

• Neurogenic bladder
• Flaccid bladder
• Bowel incontinence

Answer 23

Elimination disturbances

Question 24

Complications with stroke

Answer 24

• Constipation, dehydration, contractures, urinary tract infections, thrombophlebitis, decubitus ulcers, and pneumonia • Sensory losses put patient at risk for traumatic and thermal injuries • Swallowing difficulties place patient at risk for pulmonary complications, such as choking and aspiration pneumonia

Question 25

Prognosis of stroke

Answer 25

* Prognosis for TIA or stroke increasingly hopeful * Critical variables for recovery: * patient’s condition before the stroke, * time between stroke and diagnosis, treatment and support in acute phase (usually the first 48 hours), * severity of patient’s symptoms, and * access to rehabilitative therapy * Long-term recovery may depend on the care received immediately after the stroke * Most recovery takes place in the first 3-6 months, but progress often continues long after that

Question 26

Acute phase of stroke medical treatment

Answer 26

* Begins with the onset of signs and symptoms and continues until vital signs, particularly blood pressure and neurologic condition, stabilize * This phase usually lasts 24 to 48 hours * Many medical management interventions are directed at minimizing complications and deterioration of the patient’s condition after a stroke * Major focus areas * Hypertension * Oxygenation * Hyperthermia * Hyperglycemia

Question 27

Drug therapy

Answer 27

Tissue plasminogen activator (rt-PA, alteplase, Activase) Given to dissolve clots in acute ischemic strokes Mannitol (diuretic, potent) Reduction of intracranial pressure Nimotop (calcium channel blocker) Relaxes (dilates) blood vessels and improves blood flow to prevent brain damage resulting from an aneurysm Phenytoin (Dilantin) and phenobarbital for seizures Acetylsalicylic acid (aspirin), ticlopidine hydrochloride (Ticlid), Aggrenox, and clopidogrel (Plavix