Ischemic Stroke: Patho, Types
Patho:
-thrombotic or embolitic
- lack of perfusion - decrease BF and Q
- Low O2
Thrombotic - stationary and slow onset
Embolic - sudden, appears like TIA
Hemorrhagic Stroke: Patho, Cause, S/Sx, Complications
1 HTN (>140)
Patho:
Bleeding –> Increased Pressure –> Edema –> Ischemia
Cause:
#2 Trauma
#3 AV malformation
#4 Annyeurism
Dx:
CT will show midline shift
S/Sx:
- “Worst headache of life”
- HTN
Complications:
- Increased ICP/edema push on brain stem –> VS decrease
Stroke Signs
“FAST”
Face drooping
Arm weakness
Speech difficulty
Time to call 911
Pupil change
Right Brain Stoke
R = reckless, really creative
Affects LEFT side
- Behavioral Change
- Lack of impulse control
- Left-sided weakness/hemiparesis (new/sudden arm drift)
- Left-side neglect/one-side neglect
- Visual/spatial deficit
- Left homonymous hemianopsia
Left Brain Stroke
L = language
Affects right side
- Issues w/ language (dysphasia & aphasia)
- Right-Sided weakness (hemiparesis, new, sudden, arm drift)
- Reading/writing problems
Ischemic Stroke Interventions
1 ABC - give O2
#2 CT w/ in 2- minutes to assess TYPE of stroke. Ischemic will have normalish CT and require MRI
#3 Medications -
Fibrinolytic/Clot-blusting (-ase) medication w/ in 45-minutes (or 4.5 hours of symptom onset) - alteplase or streptokinase - NO longer beneficial after 3-4.5 hours and will require endovascular therapy
Anticoag b/c we removed all clotting factors and body will try to compensate with new ones - heparin, warfrin, antiplatlet, ASA/plavix
Betablocker - labetol to slowly decrease BP
Statin
- EKG
- Initial Neuro Assessment
-Labs: troponin, pt, ptt, inr, ABG, CBC, chem 12 - Seizure precautions
- Frequent neuro assessment
- cluster care to minimize stimuli
When are “clot busting” drugs like alteplase contraindicated?
- systolic > 180
- Increased INR
- Active bleeding
What is the intervention for systolic BP >200?
- Keep systolic >170 mm Hg for 1st 24-48 hours
- Lower pressure slowly
dysphaGia & intervention
difficulty swallowing
Intervention:
- Thicken foods
- Pureed
- Allow time to eat
DysphaSia
Difficulty speech
“S” for speech
aphaSia
W/o Speech
Broca and Wernicke
aTAXIa
Difficulty walking
Broca’s Aphasia: What it is, S/Sx
- Expressive aphasia
- B= big mouth
- Understands BUT not able to talk back
S/Sx:
- easily frustrated when trying to speak
- limited speech
- short phrases
- gibberish
Wernicke’s Aphasia: What is it? S/Sx?
- Receptive aphasia
- Not able to understand or comprehend
May misunderstand verbal cues
Hemorrhagic Stroke Interventions
1) ABC
2) CT w/ in 20 minutes to determine type of shift. Will show midline shift
3) PRIORITY is to stop bleeding - NO fibrinolytic drugs
4) Medication
- Labetol to slowly decrease BP
- Nimodapine to prevent edema induced vasospasm
- Stool softener
5) Seizure Precautions - HOB >30
6) Strict bedrest to prevent increased ICP.
