Patho/clinical manifestations
What is the difference between ischemic CVA and hemorrhagic?
Ischemic is a lack of oxygenated blood perfusing the brain/parts of it
Hemorrhagic is blood gets into the cranial space from vascular space, typically by aneurysm
How should the nurse position the patient with a CVA?
30 degrees HOB, support affected limbs, SZ precautions (lower bed, bed rails up, etc.)
What is the main risk/complication for CVAs?
rebleeding or another one occurring!
What is the first Dx test to perform with someone suspected of having a CVA? What are they looking for?
CT to rule out hemorrhagic
Why is stool softener common for CVA patients? Is it more common for ischemic or hemorrhagic?
To prevent straining which can dislodge a clot
more common with hemorrhagic
What is the difference between thrombotic and embolic CVA?
interruption of blood flow to the brain by clot (embolic) or occlusion from atherosclerotic vessels (thrombotic)
What are some diet-related interventions?
i.e. Type of diet, eating precautions, things to monitor, etc.
dysphagia diet, increased fiber, sit upright and chin tuck for eating, monitor for asphyxiation
when would you use a thrombolytic/TPA?
first 3 hrs of onset of ischemic stroke
Why would a provider request an MRI scan for a patient with suspected CVA?
To get a clearer image of where the ischemic stroke is or to identify with vessel has been occluded
Explain what a CBC (w/o diff) can help identify in regards to CVAs?
Hgb can identify bleeds
Can identify potential cause of CVA
What are the S/S to watch for when assessing for CVA/stroke?
BONUS (extra 100) what are the tests to assess each?
BEFAST (Balance, HA, dizziness, Eyes blurry vision, facial drooping, arm/leg weakness, slurred speech, time is tissue)
Balance - romberg
Eyes - snellen chart
Facial drooping - visual assessment
Arm/leg - arm drift test with eyes closed
Speech - auditory assessment
How long is recovery for a CVA patient?
Depends, typically years
when a patient is bedridden with a CVA, what do you NOT do in regards to positioning them?
pull on affected extremity (can dislocate)
pivot on affected extremity (fall risk)
not account for deficits and not take fall precautions
Do a dance!
yay! 300 points to you
Where is the most common place for an aneurysm to occur?
Circle of Willis
What is aphasia? Is aphasia common for L or R sided CVA?
BONUS (double points!) - what are the types?
Aphasia - difficulty with speech
common on L sided CVA
Expressive (Broca’s) understands what they hear, unable to express, word salad
receptive (wernicke’s) difficulties understanding verbal/written speech but speech is usually normal, ask them to repeat back
Global is where both are impacted
Consultations are common with any patient you treat, who should you request consultation from for the patient?
OT, PT, Speech therapist, family
what medications are common for the treatment of ischemic CVA?
Why wouldn't it be the same for hemorrhagic?
thrombolytic TPA (only first 3 hrs of onset), Heparin, Coumadin, ASA, Plavix
Anticoags, anti-platelet aggregates
If we gave blood thinners to a patient with a brain bleed (hemorrhagic), it would make it worse...
Risk factors for ischemic vs hemorrhagic CVA?
Hemorrhagic: HTN, cerebral aneurysm, anticoagulant use
Ischemic: TIA hx, smoking, a-fib, HTN, MI, CAD, Heart disease, stress, low HDL, polycythemia, diabetes
What S/S are associated with the onset of a hemorrhagic stroke?
Severe HA, hearing a pop, LOC changes, nuchal rigidity, photophobia, irritability, N/V, pupil changes, eye deviations
Write out S/S for both R and L sided CVA!!!
nursing interventions for pre/post care for angiogram AND carotid doppler
angiogram: catheter that goes into heart from large vein/artery to visualize vessels/structures
Pre: labs, assessment, ensure pt. has fasted 8-12 hrs and has transport for after
Post: assess radial/femoral site, for radial ensure pat has no activity for 2-6 hrs, can sit up. For femoral, bed rest for up to 6 hours, legs straight, semi-fowlers, pt. cannot bend/strain/lift for 24 hrs
Carotid doppler: ultrasound of carotid arteries to show blood flow and visualize vessels to ID stenosis, occlusion, etc.
no pre or post op care! noninvasive :)
What are the treatment options for ischemic vs. hemorrhagic?
Ischemic: thrombolytic TPA (only first 3 hrs of onset), Heparin, Coumadin, ASA/Plavix, Carotid endarterectomy, strictly bedridden, permissive HTN
Hemorrhagic: clip aneurysm with surgery, treat HTN with Rx, Ca++ channel blockers to prevent vasospasms
Name all Dx tests for Ischemic vs Hemorrhagic CVA
Ischemic: CT (to rule out hemorrhagic), MRI (ID occluded vessel), angiogram, carotid doppler, CBC
Hemorrhagic: CT (w/o contrast), MRI, PT/PTT/INR, CBC (decreased Hct and Hgb)
What are some nursing considerations for prep/during/post care for CT, MRI, LP, carotid doppler
checking allergies prior to giving drugs or CT
check metformin with contrast dye use
check ferrous metals in MRI
Risks for infection, clots and bleeding post operatively.
LP - lie flat 6-8 hrs post, monitor for bleeding, infection, nerve damage, HA most common