1
Q
Neurologic deficits Ischemic or hemorrhagic Neurologic deficits vary; 3rd leading cause of death in North America Survivors have some degree of impairment Highest incidence in people more than 65
A
Stroke or Brain Attack
2
Q
Brain is 2% of body wt but requires 20% of Cardiac output and requires 20% of body’s oxygen consumption
- Cerebral blood flow is self regulated (Autoregulation)
- Maintains a constant blood flow despite changes in systemic blood pressure.
- Autoregulation is lost when
- systemic BP less than 50 mmHg or above 160 mmHg
- Cerebral Blood flow increases with increase CO2 concentration, increased hydrogen ion concentration and decreased oxygen conc.
A
Perfusion required/ stroke
3
Q
Blood flow and oxygenation decreased
- to cerebral neurons
- cellular metabolism ceases
- cells swell
- Dead/dying cells surrounded by Penumbra
- neurologic deficits used to identify location
- contralateral deficits
A
Pathophysiology and Etiology stroke
4
Q
- Ischemic but still viable cerebral tissue
- This region will die if reperfusion is not established during the early hours.
- The penumbra is where pharmacologic interventions are most likely to be effective.
sm. time frame given for TPA (3 to 4.5 hrs)
A
Penumbra; the partially shaded outer region of the shadow cast by an opaque object.
5
Q
Ischemic strokes; blood clots, stenosis
- transient ischemic attack (TIA)
- mini stroke
- Thrombotic stroke
- occlusion of large vessel by thrombus; plaque build up over years.
- Embolic stroke
- blood clot or matter through cerebral vessels
A fib; emoblic stroke clots in atrium and embolizes
A
Pathophysiology and Etiology; Stroke
6
Q
Hemorrhagic stroke *Intracranial hemorrhage; worst headache of my life. pass out *Ruptured cerebral blood vessel *form that is most fatal -Types: Intracerebral Subarachnoid #1 cause HTN
A
Pathophysiology and Etiology; Stroke
7
Q
Hypertension Heart disease Diabetes mellitus Sleep apnea Blood Cholesterol levels Smoking Sickle Cell disease Substance abuse Living in stroke belt; southeastern US. greasy foods; soul foods
A
Risk Factors of Stroke
8
Q
Fam hx Obesity Sedentary lifestyle Recent infections Hx of TIA's Oral contraceptives Pregnancy Childbirth Menopause Migraines with aura Autoimmune disorders Clotting disorders Previous stroke
A
Other Risk Factors for Stroke
9
Q
Cerebral artery involved; varies
Area of brain affected; varies
Focal; one-sided
A
Stroke clinical manifestations
10
Q
Weakness of face, arm, leg Numbness of one side Loss of vision Speech difficulties Sudden severe headace Difficulty balancing
FAST; face, arm drop, speech, time
**Quicker TPA better they will do. 3-4.5 hr window
A
Clinical Manifestations of Stroke
Call 911 immediately
11
Q
Sensory Perceptual deficits:
- Hemianopsia; 1/2 visual field
- Agnosia; can’t recognize objects
- Apraxia; clumsiness. romberg test
- Neglect syndrome; right sided CVA; don’t recognize left side of body is theirs.
- Pain
A
Complications of stroke
12
Q
Cognitive and behavioral changes;
- changes in consciousness
- emotional lability
- loss of self-control
- decreased tolerance for stress
- intellectual changes
A
Complications of stroke cont.
13
Q
Communication disorders:
- Result of stroke affecting dominant hemisphere. Left side/language
- Aphasia;
- expressive; can’t express
- receptive; hearing
- mixed or global
- dysarthria; movement
A
Complications of stroke
14
Q
Motor deficits: *mild weakness to severe limitation *weakness, paralysis, spasticity *Specific deficits; -hemiplegia, -hemiparesis -flaccidity -spasticity Elimination disorders; -partial loss of sensations that trigger elimination; Contractures from old strokes Flaccidity from new strokes
A
Complications of stroke
15
Q
Motor deficits on right side Right visual field deficits Language deficits; aphasia, agraphia or alexia Slow and cautious behavior style Anxiety before new skills attempt Frustration, anger, depression, worrisome Sense of guilt or worthlessness Difficulties with memory Chewing or swallowing problems
A
Left sided CVA
16
Q
Motor deficits on left side Left visual field deficit Spatial perceptual deficits -unilateral spatial Neglect USN; don't approach a cripple from their crippled side Impulsiveness Easily distracted Denial or unawareness of deficits Poor judgement, overestimation of abilities Euphoria, constant smiling ***impulsive safety risk
A
Right sided CVA
17
Q
Three treatment stages: *prevention *acute care *rehabilitation Goals of stroke care *rapid recognition and reaction to warning *rapid emergency medical services dispatch *rapid EMS transport and prenotification *Rapid diagnosis and treatment
A
Collaboration; Stroke care
Check blood sugars
too high or too low could indicate stroke symptoms
TPA wouldn’t work
Elevated bp; perfusion, don’t bring Bp too low
18
Q
Stroke scale -NIH stroke scale CT scan Cerebral arteriography; down the line Transcranial Doppler ultrasound MRI PLAC blood test (phospholipase A2); increase risk for reoccurance of stroke Lumbar puncture (relieve pressure in ischemic stroke)
A
Diagnostic tests for Stroke
19
Q
Prevention: Antiplatelet agents Low-dose aspirin *Acute stroke -ischemic stroke-anticoagulant therapy -thrombotic stroke-fibrinolytic therapy TPA; activator clot buster in central lines; 30% will help; 6% chance make it worse; hemorrhage
A
Pharmacologic therapies for Stroke
20
Q
Carotid endarterectomy
Extracranial intracranial bypass
Carotid angioplasty with stenting
A
Surgery for Stroke victims
21
Q
Physical Therapy
Occupational therapy (masters level)
Speech therapy
A
Rehabilitation for stroke victims
22
Q
Stoke prevention: Control HTN!!
- smoking cessation
- avoid drug use
- normal weight
- diet
- exercise
- cholesterol levels
- Treat cardiovascular disorders
A
Nursing Process:Assessment, Stroke prevention
23
Q
Increase awareness of warning signs
- sudden weakness/numbness face, arm, leg
- confusion, difficulty speaking, understanding
- sudden trouble walking
- dizziness
- lack of coordination
- sudden difficulty with vision in one/both eyes
- sudden severe headache without cause
A
Assessment nursing process
24
Q
Health hx -risk factors -previous stroke -drug use; cocaine, heroin -smoking Physical assessment -LOC, communication -Motor strength
A
Assessment nursing process; Stroke
25
```
Ineffective Tissue Perfusion: Cerebral
Impaired Physical Mobility
Self Care Deficity
Impaired Verbal Communication
Impaired Urinary Elimination
Risk for Constipation
Impaired Swallowing
```
Nursing Diagnosis; Stroke
26
Blood pressure within normal range
Participate in rehabilitation
No complication from immobility
Nutritional needs met.
Plan; Nursing Stroke
27
```
Monitor respiratory status and airway patency
Suction as necessary
Side-lying position
Oxygen as ordered
Assess mental status and LOC
```
Monitor
- strength and reflexes
- Cardiac status
- Temperature increase; increase ICP
- Intake and output
- Seizure activity
Implementation: Ineffective Tissue Perfusion: Cerebral; Stroke
28
Encourage ROM for nonaffected side
Passive ROM to affective side
Turn and reposition every 2 hours
Assess lower extremities for thromboembolism formation
-Physical therapy consult
Implementation: Impaired Physical Mobility; Stroke
29
Encourage use of unaffected limb for self-care
* Teach to dress affected side first
* Occupational therapy consult
- Stand strong walk weak
Implementation; Self-Care Deficit-Stroke
30
* Approach/treat client as adult
* Do not; assume client has hearing deficit
* Talk with raised voice
- Allow time for client to respond
- Face client and speak slowly
Implementation: Impaired Verbal Communication; Stroke
31
If unable to understand speech
- be honest and say so
- use short, simple statements, questions
- accept frustration and anger
- try alternative methods of communication.
Implementation: Impaired Verbal Communication; Stroke
32
-Assess for urinary frequency, urgency, incontinence, nocturia
-Encourage bladder training
-Teach kegel exercises
-Use positive reinforcement
-Discuss pre-stroke bowel habits
bladder training q. 2hrs on pan or commode.
Implementation: Impaired Urinary Elimination and Risk for Constipation; Stroke
33
Encourage Fluids up to 2000 ml/day
- high fiber diet
- increase physical activity as tolerated
- assist with using toilet facilities, same time
- administer prescribed stool softeners
Implementation: Impaired Urinary Elimination and Risk for Constipation: Stroke
34
Dysphagia can cause choking, drooling aspiration, regurgitation
- monitor swallow studies
- ensure safety when eating
- upright position with neck slightly flexed
- pureed or soft foods
- liquids consistency of honey
Implementation: Impaired Swallowing; stroke victims
35
```
Eating/swallowing techniques
Assess for coughing with eating or drinking
Have suction equipment at bedside
Monitor lung sounds
Minimize distractions
```
Implementation: Impaired Swallowing; stroke victims
36
Client participates in rehab
Client communicates needs
Client receives adequate family/communication support
Client experiences no complications
Evaluation; nursing stroke victims
37
The nurse assesses for which predisposing factor for embolic stroke in the history of the client admitted to the hospital after having a brain attack?
Atrial fibrillation
38
Which point of care testing should be performed early when someone is having signs and symptoms of stroke?
Blood sugar
@ Nur 180 Exam 2
flashcards
Decks in class (6)
# Cards
