Week 10 - Stroke

Question 1

what are 2 types of strokes

Answer 1

• hemorrhage

- ischemic

Question 2

what is a hemorrhagic stroke

Answer 2

• stroke d/t a burst blood vessel which may allow blood to seep into and damage brain tissues

Question 3

what are 2 types of ischemic strokes

Answer 3

• thrombotic

- embolic

Question 4

what is a thrombotic stroke

Answer 4

• narrowing of the artery by fatty deposits (plaque), which causes a clot to form and blocks the passage of blood thru the artery

Question 5

what is an embolic stroke

Answer 5

• when an embolus reaches an artery in the brain that is too narrow to pass thru, it lodges there, and blocks the flow of blood

Question 6

what is a major cause of ischemic stroke

Answer 6

• atherosclerosis

Question 7

what is a major way to prevent ischemic stroke

Answer 7

• prevent atherosclerosis thru CVS health

Question 8

describe what is included in prevention of ischemic stroke (8)

Answer 8

• control & treat HTN
• control & treat DM
• control & treat heart disease
• control & treat high cholesterol
• lifestyle modifications
• drug therapy
• surgical intervention
• observe warning signs (TIA)

Question 9

what lifestyle modifications can be made to prevent ischemic stroke (4)

Answer 9

• healthy diet
• exercise
• smoke cessation
• limit alcohol

Question 10

what drug therapy plays a role in prevention of ischemic stroke (if have risk factors or have had one) (3)

Answer 10

• anti plt meds (ASA, plavix (clopidogrel)
• anticoagulants for a fib
• statins for high cholesterol (lovastatin)

Question 11

what med is used as an anticoag for a-fib

Answer 11

• rivaroxaban (Xarelto)

Question 12

what surgical intervention plays a role in preventing ischemic stroke (2)

Answer 12

• transluminal angioplasty

- carotid endarterectomy

Question 13

what is a transluminal angioplasty

Answer 13

• involves insertion of a catheter via femoral artery

- stent/balloon is threaded to blocked carotid artery to move plaque out of the way

Question 14

what is a carotid endarterectomy

Answer 14

• involves insertion of a tube above & below the blockage to reroute blood flow
• atherosclerotic plaque in the common carotid artery is removed
• once the artery is stitched closed, the tube can be removed

Question 15

what is a risk associated w carotid endarectomy

Answer 15

• plaque can break off & travel

Question 16

describe the timing of acute care intervention of ishcemic stroke

Answer 16

• treatment within 4.5 hours from symptom onset

Question 17

what is included in acute care of an ishcemic stroke (6)

Answer 17

• ABCs
• LOC
• fluid & electrolyte balance
• ICP
• meds
• surgical therapy

Question 18

what is the goal O2 for an ischemic stroke? describe BP mngmt for an ischemic stroke

Answer 18

• keep O2 sats >95%
• BP: monitor and maintain within ordered/goal parameters (want to make sure it is high enough to ensure cerebral perfusion)

Question 19

describe fluid & electrolyte balance for an ishemic stroke

Answer 19

• maintain enough fluid for perfusion without causing cerebral edema

Question 20

at what point does ICP peak in a pt with an ischemic stroke

Answer 20

• in 72 hrs

Question 21

describe nursing care r/t ICP for a pt with ischemic stroke (6)

Answer 21

involves interventions to manage IICP:

• give mannitol
• pt positioning
• prevent hyperthermia
• prevent seizures
• prevent pain
• prevent constipation

Question 22

what type of meds are used for acute care of an ischemic stroke

Answer 22

• thrombolytic therapy

Question 23

what is an example of thrombolytic therapy for an ischemic stroke ? describe how it is given for an ischemic stroke

Answer 23

• recombinant tissue plasminogen activator (TPA)

- given IV to lyse the clot within 4.5 hrs of symptoms

Question 24

describe mngmt and monitoring r/t TPA admin for an ischemic stroke (3)

Answer 24

• S&S of bleeding
• prevent bleeding
• neuro checks

Question 25

what surgical therapy may be done for treatment of an ischemic stroke

Answer 25

- merci retriever removal of blood clots via a long thin wire threaded thru a catheter in the femoral artery which pulls the clot out

Question 26

what are examples of causes of hemorrhagic stroke (4)

Answer 26

- head injury - spontaneous - intracerebral hemorrhage - subarachnoid hemorrhage

Question 27

what is an intracerebral hemorrhage

Answer 27

- bleeding in the brain caused by a ruptured vessel

Question 28

describe the severity of symptoms w hemorrhagic stroke

Answer 28

- extent of symptoms vary depending on the extent of the bleed and location

Question 29

what is the treatment for hemorrhagic stroke r/t intracerebral hemorrhage (3)

Answer 29

- repair the bleeding vessel - remove the blood - treat for IICP

Question 30

what is a subarachnoid hemorrhage

Answer 30

- bleeding into the cerebrospinal fluid in the subarachnoid space

Question 31

what is the most common cause of a subarachnoid hemorrhage

Answer 31

- aneurysm

Question 32

what are common symptoms of a subarachnoid hemorrhage (6)

Answer 32

- "worst headache ever" - NV - stiff neck - seizures - passing out - LOC changes that range depending on size of bleed

Question 33

what is the treatment for hemorrhagic stroke r/t subarachnoid hemorrhage (SAH) (4)

Answer 33

- repair aneurysm (surgery) - treat for IICP - external ventricular drain (EVD) - prevent vasospasm

Question 34

what does an EVD do

Answer 34

- drain CSF and blood

Question 35

what are contraindicated in treatment of a hemorrhagic stroke r/t SAH

Answer 35

- anticoags | - plts

Question 36

what is a serious risk/complication of a SAH

Answer 36

- vasospasm (d/t blood causing irritation)

Question 37

why is a SAH serious? what indication does this have?

Answer 37

- the brain tissue needs oxygenated blood supply (vasospasm prevents this) = prevent and treat to decrease chance of brain damage

Question 38

at what point does vasospasm occur w SAH

Answer 38

`- 6-20 days post bleed

Question 39

what med can be used to prevent vasospasm

Answer 39

- calcium channel blockers

Question 40

what is an example of a calcium channel blocker

Answer 40

- Nimodipine

Question 41

how often & how long are calcium channel blockers given to prevent vasospasm w SAH

Answer 41

- q4h | - from time of rupture for 21 days (prophylactic)

Question 42

what is used to treat vasospasm r/t SAH (3)

Answer 42

- IV vasodilator once vasospasm confirmed - maintain homeostasis of fluids & electrolytes - "push thru" the spasming vessel

Question 43

what is an example of an IV vasodilator

Answer 43

- milrinone (Primicor)

Question 44

how is vasospasm confirmed

Answer 44

- cranial doppler

Question 45

how do we "push thru" the spasming vessel to treat vasospams

Answer 45

- may put BP higher than normal

Question 46

what does FAST stand for r/t strokes

Answer 46

= signs of a stroke - Face (drooping?) - Arms (can you raise both?) - Speech (slurred?) - Time (is of the essence, call 911, do not wait)

Question 47

a nursing diagnosis r/t stroke is decreased intracranial adaptive capacity . what nursing interventions may be used for this (5)

Answer 47

- monitor neuro status --> ICP and LOC at least hourly - calculate and monitor CPP - monitor resp status - admin and titrate vasoactive meds as ordered - avoid neck flexion or hip/knee flexion (to avoid obstruction of arterial and venous blood flow)

Question 48

a nursing diagnosis r/t stroke is ineffective airway clearance d/t decreased LOC, absent gag & swallowing reflexes. what nursing interventions can help w this (6)

Answer 48

- auscultate breath sounds - remove secretions by encouraging coughing or suctioning - encourage DB & C - encourage turning - position pt in a sitting position - keep pt NPO until swallow eval completed

Question 49

a nursing diagnosis r/t stroke is impaired physical mobility. what nursing interventions can help w this? (4)

Answer 49

- collab with PT and OT - encourage ROM - provide restful enviro for pt after periods of exercise - determine pt's readiness to engage in physical activity

Question 50

a nursing diagnosis r/t stroke is impaired verbal communication. what nursing interventions can help w this (5)

Answer 50

- listen attentively - provide positive reinforcement - use simple words and short sentences - use alternative communication aids as needed - provide verbal prompts and reminders

Question 51

a nursing diagnosis r/t stroke is unilateral neglect r/t visual acuity and sensory loss on one side of body. what are nursing interventions for this (5)

Answer 51

- monitor for abnormal responses to the 3 primary types of stimuli: sensory, visual, and auditory - rearrange the enviro to use the right or left visual field - touch unaffected shoulder when initiating convo - gradually move personal items to affected side as the pt demonstrates an ability to compensate for neglecy

Question 52

a nursing diagnosis r/t stroke is stroke is impaired urinary elimination r/t impaired impulse to void, inability to reach the toilet. what are nursing interventions for this (6)

Answer 52

- keep a continence specification record for 3 days to establish a voiding pattern - establish interval of initial toileting schedule, based on voiding schedule - assist to toilet or remind pt to avoid at prescribed intervals - teach pt to consciously hold urine until scheduled toileting time - discuss daily record of continence w staff - give positive feedback when they void at scheduled voiding times

Question 53

a nursing diagnosis r/t stroke is impaired swallowing. what are nursing interventions for this (6)

Answer 53

- assist pt to sit up for feeding - assist pt to maintain sitting position for 30 min after completing meal - instruct pt and family on emergency measures for choking - check mouth for pocketing of food after eating - provide mouth care after meals and as needed - monitor body weight