Stroke

Question 1

why does stroke occur

Answer 1

• Stroke occurs when there is ischemia or hemorrhage into the brain that results in death of brain cells.
• Normal blood flow to brain is interrupted.

Question 2

stroke also know as

Answer 2

Brain attack
Cerebrovascular accident (CVA)

Question 3

stroke classifications

Answer 3

hemorrhagic stroke
ishemic stroke

Question 4

hemorrhagic stroke

Answer 4

occur secondary to a ruptured artery or aneurysm.

Question 5

prognosis of hemorrhagic stroke

Answer 5

• The prognosis is poor due to the amount of ischemia and increased ICP caused by the expanding collection of blood.
• If it is caught early and evacuation of the clot can be done with cessation of the active bleed, the prognosis of a hemorrhagic stroke improves significantly.

Question 6

thrombotic stroke

Answer 6

is an ischemic stroke that occurs secondary to the development of a blood clot that shuts off the artery and causes ischemia

Question 7

manifestations of a thrombotic stroke how long does it evolve

Answer 7

evolve over a period of several hours to days.

Question 8

what is an embolic stroke

Answer 8

• Embolic is an ischemic stroke caused by an embolus traveling from another part of the body to a cerebral artery.
• Blood to the brain distal to the occlusion is immediately shut off causing neurologic deficits or a loss of consciousness to instantly occur

Question 9

extent of an ischemic stroke depends on

Answer 9

Rapidity of onset
Size of the lesions

Question 10

what proceeds an thrombotic stroke

Answer 10

Thrombotic strokes are preceded by TIAs

Question 11

what stroke can be reversed

Answer 11

• Ischemic strokes (thrombotic or embolic) can be reversed with fibrinolytic therapy using alteplase(tPA)
  -Give within 3 to 4.5 hr of the initial symptoms (unless contraindicated by factors such as presence of active bleeding).

Question 12

health promotion and disease prevention for strokes

Answer 12

• Hypertension, diabetes mellitus, smoking, and other related disorders can increase a client’s risk for a stroke.
• Early treatment of hypertension, maintenance of blood glucose within expected range, and refraining from smoking will decrease these risk factors.
• Maintaining a healthy weight and getting regular exercise can also decrease the risk of a stroke.

Question 13

risk factors

Answer 13

• Cerebral aneurysm
  ● Arteriovenous malformation (AV)
  ● Diabetes mellitus
  ● Obesity
  ● Hypertension
  ● Atherosclerosis
  ● Hyperlipidemia
  ● Hypercoagulability
  ● Atrial fibrillation
  ● Use of oral contraceptives
  ● Smoking
  ● Cocaine use

Question 14

tpa vs platlet agrregites

Answer 14

agrregates prevents platlets from agregating and tpa unravels clot and can promote bleeding and can turn into little clots

Question 15

modifiable risk factors

Answer 15

Hypertension
Heart disease
Serum cholesterol
Smoking
Excess alcohol consumption
Obesity
Sleep apnea
Lack of physical exercise
Poor diet
Drug abuse

Question 16

stroke expected findings

Answer 16

• Some clients report transient manifestations, such as visual disturbances, dizziness, slurred speech, and a weak extremity.
• These manifestations can indicate a transient ischemic attack (TIA), which can be a warning of an impending stroke.

Question 17

what can prevent the subsequent occurrence of stroke

Answer 17

Antithrombotic medication and/or surgical removal of atherosclerotic plaques in the carotid artery

Question 18

what is the left cerebral hemisphere responsible for

Answer 18

for language, mathematics skills, and analytic thinking

Question 19

findings from left side

Answer 19

• Expressive and receptive aphasia (inability to speak and understand language)
• Agnosia (unable to recognize familiar objects)
• Alexia (reading difficulty)
• Agraphia (writing difficulty)
• Right extremity hemiplegia (paralysis) or hemiparesis (weakness)
• Slow, cautious behavior
• Depression, anger, and quick to become frustrated
• Visual changes, such as hemianopsia (loss of visual field in one or both eyes) use eyepatch

Question 20

right cerebral hemoshphere responsible for

Answer 20

visual and spatial awareness and proprioception.

Question 21

right cerebral hemisphere findings

Answer 21

• Altered perception of deficits (overestimation of abilities)
• Unilateral neglect syndrome (ignore left side of the body: cannot see, feel, or move affected side, so client unaware of its existence).
• Loss of depth perception
• Poor impulse control and judgment
• Left hemiplegia or hemiparesis
• Visual changes, such as hemianopsia

Question 22

vital signs

Answer 22

• Monitor vital signs every l to 2 hr.
• Notify the provider immediately if blood pressure exceeds a systolic greater than 180 mm Hg or a diastolic greater than 110 mm Hg. (can restroke do to not enough blood leaving heart
  This can indicate the client is experiencing an ischemic stroke.
• Monitor the client’s temperature.
  A fever can cause an increase in intracranial pressure.
• Provide oxygen therapy to maintain oxygen saturation level greater than 92%, or if the client’s level of consciousness is decreased.

Question 23

nursing care

Answer 23

• Place the client on a cardiac monitor to detect arrhythmias.
• Monitor for changes in level of consciousness (increased ICP sign).
• Elevate the head of the bed approximately 30° to reduce ICP and to promote venous drainage.
• Avoid extreme flexion or extension of the neck, and maintain the client’s head in the midline neutral position.
• Institute seizure precautions.

Question 24

nursing care with communication

Answer 24

• Assist with the client’s communication skills if speech is impaired.
• Assess the ability to understand speech by asking the client to follow simple commands.
• Observe for consistently affirmative answers when the client actually does not comprehend what is being said.
• Assess accuracy of yes/no responses in relation to closed-ended questions.
• Supply the client with a picture board of commonly requested items/needs.
• For expressive and receptive aphasia speak slowly and clearly, use one-step commands.

Question 25

nursing care with swallowing

Answer 25

- Assist with safe feeding. - Assess swallowing and gag reflexes before feeding. - the speech-language pathologist (SLP) may request a swallowing study that can involve swallowing a barium substrate and radiography of the peristaltic activity of the esophagus.

Question 26

types of liquid consistencies

Answer 26

- thin (water, juice) - nectar-like (cream soups, nectars) - honey-like (honey, yogurt) - spoon-thick (pudding, cooked cereals)

Question 27

food levels for dysphagia

Answer 27

pureed, mechanically altered, advanced/mechanically soft, and regular.

Question 28

nursing care on eating

Answer 28

- Have the client eat in an upright position and swallow with the head and neck flexed slightly forward. - Place food in the back of the mouth on the unaffected side. - Have suction on standby. - Maintain a distraction-free environment during meals. - Collaborate with dietitian to ensure appropriate caloric intake, because weight loss is common following stroke.

Question 29

preventing complication

Answer 29

- Prevent complications of immobility, such as atelectasis, pneumonia, pressure sores, and deep-vein thrombosis (DVT). - Clients who have experienced strokes are ambulated as soon as possible to prevent complications. - Maintain skin integrity. - Reposition the client frequently and use padding.

Question 30

nursing care of extremities

Answer 30

- Monitor bony prominences, paying particular attention to the affected extremities. - If the client has one-sided neglect, teach to protect and care for the affected extremity to avoid injuring it in the wheel of the wheelchair or hitting/ smashing it against a doorway. - Encourage passive range of motion every 2 hr to the affected extremities and active range of motion every 2 hr to the unaffected extremities

Question 31

transporting

Answer 31

- Elevate affected extremities to promote venous return and reduce swelling. - Maintain a safe environment to reduce the risk of falls. - Assistive devices, such as transfer belts and sliding boards, should be used during transfers. - Sit-to-stand lifts can also facilitate transfers and reduce strain on the care provider’s body

Question 32

ADLs care

Answer 32

- Provide assistance with ADLs as needed. - Instruct the client to dress the affected side first and sit in a supportive chair that aids in balance. - Have occupational therapy assess the client for adaptive aids, such as a plate guard, utensils with built-up handles, a reaching tool to pick things up, and shirts and shoes that have hook and loop fasteners or tape instead of buttons and ties. - Provide frequent rest periods from sitting in the wheelchair by returning the client to bed after therapies and meals. - When sitting the client up in bed or in the wheelchair, leaning to the affected side typically occurs and should be countered with some manner of support. - Support the client during periods of emotional lability and depression.

Question 33

respiratory system risk for

Answer 33

Management of the respiratory system is a nursing priority. - Risk for atelectasis - Risk for aspiration pneumonia - Risks for airway obstruction

Question 34

Most obvious effect of stroke include impairment of:

Answer 34

Most obvious effect of stroke include impairment of: - Mobility - Respiratory function - Swallowing and speech - Gag reflex - Self-care abilities

Question 35

home care/ambulatory care

Answer 35

Toileting interventions - Implement a bowel management program for problems with - Bowel control: q2hr - Constipation: hydration, fiber, stool softner - Incontinence - High-fiber diet and adequate fluid intake

Question 36

preventive drug therapy

Answer 36

used in patients at risk for stroke. - Antiplatelet drugs are used in patients who have had a TIA related to atherosclerosis. - Aspirin is the most frequently used antiplatelet agent.

Question 37

aspirin

Answer 37

- Low-dose aspirin is given within 24 to 48 hr following a stroke to prevent further clot formation. - Other antiplatelets, such as clopidogrel, are not recommended

Question 38

Recombinant tissue plasminogen activator (tPA)

Answer 38

- drug used for ischemic stroke - Used to reestablish blood flow through a blocked artery to prevent cell death. - Must be administered within 3 to 4.5 hours of onset of clinical signs of ischemic stroke. - Intra-arterial tPA can be given within 6 hours.

Question 39

anticoagulants

Answer 39

- heparin sodium - Enoxaparin/ lovenox - warfarin/ cumodin Use of anticoagulants is controversial and not recommended due to the high risk of intracerebral bleeding.

Question 40

Antiepileptics

Answer 40

- Phenytoin/ dylintin - Gabapentin/ nurontin - These medications are not commonly given following a stroke unless the client develops seizures. - Gabapentin can be given for paresthetic pain in an affected extremity.

Question 41

Therapeutic Procedures for Hemorrhagic Stroke

Answer 41

Surgical interventions used to treat hemorrhagic strokes include: - Resection or Clipping of an aneurysm - Evacuation of hematomas - Procedure is chosen based on the cause of the stroke.

Question 42

intra arterial TPA

Answer 42

- restores cerebral blood flow. - Must be administered within 6 hr of onset of symptoms. - It is contraindicated for treatment of a hemorrhagic stroke and for clients who have an increased risk of bleeding due to anticoagulant therapy or other bleeding anomaly. - Possibility of hemorrhagic stroke is ruled out with an MRI prior to the initiation of thrombolytic therapy.

Question 43

Carotid artery angioplasty with stenting (CAS)

Answer 43

Inserting a catheter in the femoral artery and placing a protection device to catch clot debris

Question 44

Carotid endarterectomy removes atherosclerotic plaque.

Answer 44

This procedure is performed when the carotid artery is blocked or when the client is experiencing TIAs.

Question 45

Dysphagia

Answer 45

- can result from damage to cranial nerves that innervate the face, tongue, soft palate, and throat. - As a result, the client’s risk of aspiration is great. - Not all clients who have a stroke have dysphagia, but all should be evaluated prior to reestablishing oral nutrition and hydration

Question 46

what do assess for for dysphasia

Answer 46

- Assess gag reflex - If the gag reflex is present, give the client a small sip of water to determine if choking occurs - If the client exhibits difficulty managing food or fluids, a swallowing evaluation should be done by an SLP - Keep the client completely NPO until evaluated by the SLP.

Question 47

eating with dysphagia

Answer 47

- Begin with the prescribed liquid-consistency and observe closely for choking. - Have suction equipment available, but feed with care because suctioning increases ICP. - Initial feedings should be done by an RN, - Some clients require an eating environment without distractions to prevent choking.