stroke/cva

Question 1

3 primary types of strokes

Answer 1

-ischemic
-hemorrhagic
-transischemic

Question 2

ischemic strokes

Answer 2

result of a thrombus or lack of blood flow to the brain

Question 3

hemorrhagic strokes

Answer 3

caused by bleeding within or around the brain

Question 4

transischemic strokes

Answer 4

“mini stroke”

Question 5

a stroke is

Answer 5

an anoxic event & a lack of blood supply to a specific area of the brain du to a blood clot or ruptured blood vessel causing focal neurological deficit

Question 6

s/s

Answer 6

-fast test
-numbness
-confusion
-trouble seeing
-trouble walking
-severe headache

Question 7

FAST test

Answer 7

-F; face drooping
-A; arm weakness
-S; speech difficulty
-T; time to call 911

Question 8

physical assessment

Answer 8

-neuro exam
-focal deficits
-weakness esp on 1 side
-gait
-speech
-lack of movement in face, arm, or leg
-aphasia
-mental status exam
-test LOC
-careful assessment of head, neck, & eyes
-hr , heart sounds, & rhythm
-palpate carotid, radial, & femoral pulses
-abc’s

Question 9

NIH stroke scale

Answer 9

-0= no stoke
-1-4= minor stroke
-5-15= moderate stroke
-16-20= moderate to severe
-21-42= severe

Question 10

hx

Answer 10

-fam hx
-med hx
-hx of TIA’s

Question 11

1A stroke assessment scale sample

Answer 11

-category: LOC
-description & score:
·alert=0
·drowsy=1
·stuporous=2
·coma=3

Question 12

1B stroke assessment scale sample

Answer 12

-category: LOC q’s, month/age
-description & score:
·answers both correctly=0
·answers 1 correctly=1
·incorrect on both=2

Question 13

1C stroke assessment scale sample

Answer 13

-category: LOC commands (open & close eyes, grip & release non-paretic hand)
-description & score:
·obeys both correctly=0
·obeys 1 correctly=1
·incorrect on both=12

Question 14

2 stroke assessment scale sample

Answer 14

-category: best gaze, (follow finger)
-description & score:
·normal=0
·partial gaze palsy=1
·forced deviation=2

Question 15

3 stroke assessment scale sample

Answer 15

-category: best visual
-description & score:
·no visual loss=0
·partial hemianopia=2
·bilateral hemianopia=3

Question 16

diag studies

Answer 16

-digital subtraction angiography; for defining vascular lesions/occlusions
-carotid duplex scan; defines cause of stroke
-MRI; good structural detail & early cerebral edema
-lumbar puncture; used to rule out meningitis or subarachnoid hemorrhage
-noncontrast CT; most common for acute eval

Question 17

lab studies

Answer 17

-blood glucose
-coag studies
-CBC
-basic chem panel
-cardiac markers
-tox screen
-lipid profile
-sed rate
-preg test
-ana
-rheumatoid factor
-homocysteine lvl
-rapid plasma reagent

Question 18

acute care med management

Answer 18

-assessment
-stabilization
-complete initial eval
-all 3 of the above should be done within 60 mins of arrival
-aspirin 325mg should be given within 24-48 hrs of ischemic stroke onset

Question 19

medical care goals

Answer 19

-preserve tissue in ischemic penumbra to starve off infarction
-limit duration of ischemia
-restore blood flow to compromised area
-address comorbid conditions
-administer iv fluids, vasopressor therapy, to improve blood flow
-eval for & tx hypo-hyperglycemia
-initiate thrombolytic, aka t-PA to restore cerebral blood flow in pts who meet inclusion criteria within 3-4.5 hrs of stroke of stroke

Question 20

fibrinolytic therapy (t-PA)

Answer 20

-restores cerebral blood flow in some pts w acute ischemic stroke
-may lead to improvement or resolution of neurologic deficits

Question 21

t-PA complications

Answer 21

-unfortunately, fibrinolytic’s may cause symptomatic intracranial hemorrhage
-extracranial hemorrhage
-angioedema
-allergic reactions

Question 22

t-PA inclusion guidelines

Answer 22

-diag of ischemic stroke causing measurable neurologic deficit
-neurologic signs not clearing spontaneously to baseline
-symptoms do not indicate subarachnoid hemorrhage
-no head trauma or MI in 3 months
-bp less than 185/110
-pt not taking anticoag
-platelet count greater than 100000 uL
-blood glucose greater than 50mg

Question 23

surgical management

Answer 23

-mechanical thrombectomy:
·remove clot
·done in first 6-16 hrs
-merci retriever
·corkscrew shaped device that captures/engages clot
-penumbra
·aspirates & extracts the clot
-solitare or trevo devices
·opens blocked arteries using stent to expand artery walls & retrieving the cot
·improves blood flow immediately

Question 24

acute phase goals of care

Answer 24

-rapid assessment & triage on admission including abc’s & stroke symptoms
-start IV
-obtain labs
-supplemental o2 prn for o2 stats less than 92%
-ekg
-stat cxr
-12 lead ekg
-dysphagia screen
-decrease bp to less than 185/110 b4 administering tpa

Question 25

b4 or @ discharge goals of care

Answer 25

-regain pre-stroke strength, speech, & activities -assess need for rehab or palliative care -determine need for anti-coag. & statin therapies

Question 26

nursing care of pt w a stroke

Answer 26

-careful, ongoing assessment -neuro checks for @ least 24-36 hrs -observe for severe hypertension -severe headaches -change in loc -nausea/vomiting -in first 12-24 hrs, monitor temp & tx hyperthermia which has been associated w poor functional outcomes -supportive care for pts who do not meet inclusion criteria for t-pa -goal is to decrease bp by 15% in 1st 24hrs for pts who are not t-pa candidates -monitor for swallow safety -administer PO or rectal ASA as ordered -educate ab risks, benefits, possible complications of therapy

Question 27

secondary prevention

Answer 27

-antiplatelet &/or anticoag therapy -stress importance of smoking cessation & reg exercise -manage bp w antihypertensives or statins, cholesterol, & diabetes -aspirin therapy -encourage diet w plenty of fruits, veg, whole grains, low fat, low salt, to prevent stroke recurrance & possibly prevent vascular dementia -weight loss if needed decrease alcohol consumption -screeen for sleep apnea, diabetes, obesity, & afib