A
A patient suffers hemorrhagic stroke. What is the earliest sign of increased ICP?
Cushing's triad (widening PP, irreg resps, bradcardia) is a late sign!
When assessing the level of awareness the nurse notes the patient arouses, but not fully and simply moans. How should the nurse describe this level of consciousness?
•Stuporous
what are the two types of stroke?
ischemic (embolic) and hemorrhagic (SAH - subarachnoid hemorrhage, ICH - intracerebral hemorrhage)
What is the pathophysiology of atherosclerosis?
Vessel damage --> Inflammatory response --> Hard, thick vessels due to formation of plaques which ultimately -->, Decreases internal diameter & reduces blood flow
Left sided hemiparesis
What is BE FAST stand for?
E - Eyes (vision disturbance)
F - Face (asymmetric)
A - Arms (drift)
S - Speech (slurred/abnormal/absent)
T - Time (3 hours! 4.5 max!)
A patient takes hydrochlorothiazide (HCTZ) for hypertension. What are two teaching points related to this medication?
Can cause low BP (monitor BP and also dangle on side of bed before getting up in a.m. - 5 min)
Can cause hypokalemia (consume foods high in potassium such as bananas, avocado, potatoes, broccoli, spinach, oranges)
Can cause hyperglycemia, so occasionally screen BG (but not a daily intervention).
The nurse assesses the plantar reflex (Babinski's sign) by taking the heel of the reflex hammer and stimulating the outside sole of the foot.
What is an abnormal finding? what does it indicate?
a positive Babinski sign happens when the big toe bends up and back to the top of the foot and the other toes fan out.
This can mean there is an underlying nervous system or brain condition causing reflexes to react abnormally.
What is the name of the scale used to assess stroke before and after thrombolytic therapy to evaluate progress of treatment?
NIHSS (National Institute of Health Stroke Scale)
A patient taking metoprolol, lisinopril and diltiazem develops bradycardia, hypotension and symptoms of heart failure exacerbation. Which medication must be stopped and why?
While the metoprolol should be looked at closely if the HR is profoundly low (<50), the diltiazem which is a calcium channel blocker must not be used with heart failure. As it stops calcium ions it not only slows the HR, but it also decreases the strengh of contraction of the heart which would worsen the SV and CO.
The patient returns post cerebral angiogram. What are three (3) interventions required post angiogram?
monitor site for hematoma,
neurovascular assess affected limb (5 Ps)
fluids to clear contrast,
VS to monitor for hemorrhage,
limb straight 4-6 hours,
HOB flat and progress to 90 over time
How will you explain to a patient with stroke symptoms why they need carotid dopplers and an echocardiogram? (they will ask..."Its my brain, not my heart - right?")
Carotid artery atherosclerosis can limit blood flow to the brain and cause stroke the carotid dopplers will detect this.
as can clots from the heart due to dysrhythmias such as atrial fibrillation and the echo will detect this.
What is the less invasive surgical option to open narrowed blood vessels related to PAD?
angiogram with angioplasty and stent placement
Bypass grafting will be considered if angioplasty is unsuccessful or occlusion is too narrow; however, there is high risk (hemorrhage, reocclusion, infection, clots, etc.) as with major surgeries
Be sure to monitor 5Ps! Will need a doppler. Mark the pulses with indelible marker so everyone knows where they are!
The nurse administers cilostazol and pentoxifylline. How will the nurse evaluate efficacy of these medications?
Assess for improved symptoms related to PAD (IC, color, pulse, etc.)
Name three lifestyle changes associated with the treatment of hypertension.
Weight loss to normal range (first goal is to get under BMI of 30 no longer obese)
DASH (Dietary Approaches to Stop Hypertension) - high in fruits, vegetables, and low-fat dairy products
Alcohol Consumption — 2 drinks per day men, 1 drink per day women
Exercise —90 to 150 minutes per week of aerobic activity. Dynamic and isometric resistance exercise is also recommended.
Stress —breathing exercises, progressive relaxation, and meditation
Name four (4) symptoms of stroke other than BEFAST.
Hemiparesis or hemiplegia
Heminopia
Dysphagia
Dysphasia/aphasia
Loss or decreased sensation one side of body
Facial asymmetry
Inability to manage oral secretions
Dizziness
Ataxia
Tinnitus
When administering cholestyramine:
a. how will you explain the action of this medication?
b. how will you assess efficacy
a. bind cholesterol in the GI tract
b. total cholesterol less than 200, triglycerides less than 150, LDL less than 100, HDL >40
Angiotension is a potent vasoconsrictor therefore both ACE and ARB interrupting it's action result in vasodilation. They both also limit aldosterone.
What affects does aldosterone have on potassium and therefore what abnormality may occur?
Aldosterone enhances potassium (K) excretion which increases vasoconstriction by closing K channels.
So, stopping aldosterone would potentially cause hyperkalemia by "not enhancing" it's excretion.
Advise patients not to consume salt substitutes as they contain high levels of potassium.
A. What is t-PA (alteplase)?
B. what is the expected outcome?
C. What is the time limit?
d. Most dangerous complication?
a. thrombolytic dissolves the clot at site and restores blood flow
b. improved stroke symptoms
c. Must present within 3 hours (4.5 of symptom onset).
d. ICH (Occurs in 6.7% of patients), for hemorrhage FFP, cryoprecipitate. Aminocaproic acid (Amicar) may be used as an antidote.
Nursing Considerations – NIHSS, frequent VS, Explain need for bedrest and minimal handling during therapy to avoid injury. Avoid all unnecessary procedures such as shaving, vigorous tooth brushing, IM injections or arterial punctures. Apply pressure to all arterial and venous puncture sites for at least 30 min.
The nurse is assessing a patient with massive stroke using the Glascow coma scale.
a. What is the maximum and minimum score?
b. When assessing the motor movement the nurse progresses from least to most noxious stimulus. There is no response until the nurse performs a nailbed pinch. In response the patient extends the arms toward the pain. What is this called? (
a. 3 is minimum; 15 is maximum - 8 indicates severe brain.
b. extension to pain - decerebrate posturing It is an ominous sign