OA: Stroke

Question 1

TIA

Answer 1

mini stroke - do not call it that

Transient ischemic attack

Question 2

Hemorrhagic stroke

Answer 2

• 15% of strokes

- bleeding into the brain tissue, subarachnoid space, or ventricles

Question 3

Warning signs of stroke

Answer 3

• numbness
• tingling
• difficulty with speech
• weakness
• dizziness
• sudden intense headache
• sudden nausea and vomiting
• sudden inability to remember events
• heavy arm
• facial dropping

Question 4

What happens with a hemorrhagic stroke?

Answer 4

-accumulation of blood causes pressure on brain tissue leading to ischemia and infarction

Question 5

CVA

Answer 5

Cerebrovascular Accident or Stroke

Question 6

When does a stroke occur

Answer 6

when there is ischemia to a part of the brain or hemorrhage into the brain that results in death of brain cells

Question 7

Stroke Risk Factors

Answer 7

• HTN
• Heart disease
• Diabetes Mellitus
• Sleep Apnea
• Blood Cholesterol Levels
• Smoking
• Substance abuse
• Living in the SE US

Question 8

Types of Strokes

Answer 8

classified on the basis of underlying pathophysiologic findings

1. Ischemic
2. Hemorrhagic

Question 9

Ischemic

Answer 9

lack of blood flow to brain cells

Question 10

first goal of potential stroke patient

Answer 10

CT scan

Question 11

CT scan

Answer 11

primary diagnostic test and the first priority after stabilizing the patient

Question 12

When symptoms of a stroke occur, diagnostic studies are done to..

Answer 12

• confirm that it is a stroke

- identify the likely cause of the stroke (Hemorrhagic vs. Ischemic)

Question 13

Treatment options for hemorrhagic

Answer 13

• Evacuate the bleeding

- BP control (more focused on MAP and Cerebral Perfusion Pressure)

Question 14

Treatment options for ischemic

Answer 14

-tPA administration

Question 15

tPA

Answer 15

• VERY strict criteria

- Dose is based on pt’s weight…so get an exact weight (always kg)

Question 16

Clinical Manifestations of Stroke

Answer 16

• do not significantly differ between ischemic and hemorrhagic stroke
• destruction of neural tissue is the bass for neurologic dysfunction caused by both types of stroke

Question 17

Brain components

Answer 17

10%: Cerebrospinal fluid
12%: Intravascular blood
78%: Brain tissue

Question 18

Modified Monro-Kellie hypothesis

Answer 18

If volume of any one of the cranial vault components increases, the volume from another component is displaced, but the total intracranial volume will not change

Question 19

ICP

Answer 19

Intracranial Pressure

-pressure inside the skull and thus the pressure on the CSF, brain matter, vasculature, and cerebral blood flow

Question 20

Normal ICP is maintained through…

Answer 20

balance of the CSF, brain tissue, and intravascular blood volume

Question 21

Factors that worsen ICP

Answer 21

• pain
• head not midline
• increased intrathoracic pressure
• cerebral edema
• bright lights/loud noises
• supine or high Fowlers position (HOB at 30 degrees is ideal)

Question 22

Clinical Manifestations: Motor Function

Answer 22

• loss of skilled voluntary movement
• impairment of integration of movements
• Alterations in muscle tone
• Alterations in reflexes

Question 23

GCS

Answer 23

Glasgow Coma Stroke

1. Best Eye Opening Response (1-4) no response to spon.
2. Best Motor Response (1-6) no resp to obeys verbal comm.
3. Best Verbal Response (1-5) no resp. to oriented x3

Question 24

NIH Stroke Scale/Score

Answer 24

• well validated, reliable scoring system specific to stroke
• quantifies stroke severity (0-42)
• objectively tracks changes and provides standard language amongst healthcare professionals

Question 25

NIH Scoring

Answer 25

Mild: 0-5 Mod: 5-15 Mod-Severe: 15-20 Severe: 21-42

Question 26

Who completes the NIH Stroke Scale?

Answer 26

MD prior to tPA admin

Question 27

How does blood sugar relate to stroke?

Answer 27

low blood sugar can result in stroke like symptoms such as confusion

Question 28

tPA Administration

Answer 28

- IV - Tissue Plasminogen Activator - Fibrinolytic Agent ("clot buster")

Question 29

FDA & tPA

Answer 29

tPA is the first FDA approved acute ischemic stroke treatment in 1996

Question 30

tPA has better outcomes associated with....

Answer 30

earlier intervention

Question 31

tPA is indicated for...

Answer 31

management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability

Question 32

Activase; Alteplase

Answer 32

tPA drugs

Question 33

Bolus dose for tPA

Answer 33

10% of total dose and given over 2 minutes followed by continuous infusion

Question 34

Who verifies tPA?

Answer 34

dual verified by two RNs and pharmacist

Question 35

What is monitored with tPA patients?

Answer 35

improvement in stroke symptoms and/or S/S of bleeding

Question 36

Why are surgeries performed for stroke patients?

Answer 36

- prevent occurrence of a stroke - restore blood flow when a stroke has already occurred - repair vascular damage or malformations

Question 37

What types of surgeries are performed for stroke patients?

Answer 37

1. carotid endarterectomy 2. extracranial-intracranial bypass 3. carotid angioplasty with stenting

Question 38

carotid endarterectomy

Answer 38

- done at the carotid artery bifurcation | - removes atherosclerotic plaque

Question 39

extracranial-intracranial bypass

Answer 39

-done when occluded or stenotic vessel is not directly accessible

Question 40

carotid angioplasty with stenting

Answer 40

- newer option for treating cerebral stenosis - opens narrowed carotid arteries. -aka CAS (carotid artery stenting)

Question 41

Dysarthria

Answer 41

disturbance in the muscular control of speech that may involve: - pronunciation - articulation - phonation

Question 42

Prevent Aspiration

Answer 42

- NPO until swallowing assessed - observe facial drooping, asymmetry, drooling, hoarseness, incomplete mouth closure, or cranial nerve palsies - check gag reflex - check cough reflex - thickened liquids - position while eating - patient education

Question 43

Promote Mobility

Answer 43

- encourage independence as much as possible - refer to PT - provide ordered DVT prophylaxis/sequential stockings - reposition every two hours - provide ROM to decrease contractures

Question 44

Promote Communication

Answer 44

- one idea in each sentence - simple one step commands - speak slowing, not loudly - use cues and gestures - avoid yes and no questions - tell the patient if you dont understand, don't guess - implement other forms of communication

Question 45

Promote Elimination

Answer 45

- start bowel and bladder training - ensure adequate PO intake - provide juices, dietary fiber and laxatives as tolerated - scan bladder after voiding

Question 46

Hemianopsia

Answer 46

-unilateral neglect - increased risk of falls - encourage patient to touch and use both sides of body - dress affected side first - teach to turn head from side to side

Question 47

Discharge Planning

Answer 47

-case management arranges followup care based on patient ability

Question 48

Care could take place at...

Answer 48

rehab center, skilled nursing facility, home, or hospice

Question 49

Care is based on...

Answer 49

needs and tolerance of therapy

Question 50

Care will include...

Answer 50

- PT - OT - Speech - Neuropsychiatric counseling - family education and support

Question 51

Stroke prevention

Answer 51

- lifestyle changes - medication management to reduce risk factors - surgery - platelet inhibitors - anticoagulants

Question 52

Anticoagulants are contraindicated for....

Answer 52

patients with hemorrhagic stroke

Question 53

Collaborative care

Answer 53

work as an interdisciplinary team to care for stroke patient

Question 54

Stroke Alert protocol

Answer 54

1. call stroke alert 2. get help from charge RN, CNA, or other RNs 3. Ensure ABC's are adequate, if not, stabilize 4. Check blood sugar 5. Take patient for CT STAT 6. implement prescribed interventions