Physical Therapy
The recommended percentage of HR max when training stroke survivors.
A)10-30%
B) 85-100%
C) 30-50%
D) 50-85%
Answer: What is D) "50-85%"
Rationale: An exercise intensity of 50–80% of the HRmax is recommended by the American Heart Association and the American College of Sports Medicine as appropriate for aerobic training in patients with stroke. Aerobic training intensity at 50–60% HRmax is also associated with a low rate of adverse events.
What is the right time to start teaching patient, family and staff about paralytic arm positioning?
What is "Immediately" - to promote recovery and prevent deformity
This is a swallowing disorder which at times necessitates patients to be on a modified diet.
What is "dysphagia?"
True or False: Rhythmic entrainment is a music therapy technique that involves synchronizing movement to a rhythm. stroke survivors can use rhythmic entrainment to improve their gait, their stride length, and cadence by walking along to a steady beat.
What is "True"
Source: https://www.dcconferences.com.au/wcnr2012/pdf/Music_Perception_Abiru_RAS_Final.pdf
What are the 2 types of strokes?
What are "Ischemic and Hemorrhagic"
The nurse or health care provider asks the patient to read or repeat words from a list of words. According to NIH stroke scale, what is being tested?
What is "dysarthria"
Dysarthria = slurred speech
NIHSS (The national institute of health stroke scale)
The NIHSS is an assessment tool used by health care providers to quantify the impairment caused by a stroke.
Dysarthria is one of the items being tested in the NIH stroke scale.
The NIHSS measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language.
The levels of stroke severity as measured by the NIHSS ranges from zero= no stroke, 1-4 minor stroke, 5-15 moderate stroke, 15-20 moderate to severe stroke, and 21-42 severe stroke.
When testing for dysarthria an adequate sample of speech must be obtained by asking the patient to read or repeat words from a list of words.
Score:
0= normal
1= mild to moderate dysarthria. Patient slurs at least some words and, at worst can be understood with some difficulty.
2= severe dysarthria. Patient’s speech is so slurred as to be unintelligible.
UN= (untestable) Patient is intubated or another physical barrier.
References
https://www.nihstrokescale.org/
https://www.stroke.nih.gov/documents/NIH_Stroke_Scale_508C.pdf
This diet, which is low in fat, cholesterol, and sodium, is recommended for patients what has experienced and to prevent a stroke...
What is a "Cardiac Diet" - Or a diet low in fat, cholesterol, and sodium.
Questions were derived from Nutrition and Diagnosis-Related Care 8th edition page 269-272.
What is the name of the medication that must be administered within 4.5 hours from the first onset of symptoms for an ischemic stroke?
What is "Activase (alteplase)"
The type of walker primarily ordered for stroke patients?
What is a "Rolling walker"
The primary functional limitation correlated to stroke survivors’ perceived disability.
What is "Decreased gait speed"
Rationale: Patients with subacute stroke who increase gait speed ≥0.16 m/s are more likely to experience a meaningful improvement in disability level than those who do not. Clinicians can use this reference value to develop goals and interpret progress in patients with subacute stroke.
Source: Tilson JK, Sullivan KJ, Cen SY, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. Phys Ther. 2010;90(2):196-208. doi:10.2522/ptj.20090079
True or false: It is not necessary to support the affected Arm during short transfers.
What is "False" - The arm needs be supported at all times to prevent sub-laxation
This protocol allows patients to have thin liquids in between meals even though they are on thickened liquid ...
What is the "Frazier Free Water Protocol"
Rationale: Research shows in order to help patients remain hydrated it is ok for them to have water only in small amounts in between meals after doing strict oral care so that even though they will likely aspirate it is not as noxious and harmful to the lungs compared to food particles or bacteria in the oral cavity going into the lungs.
True or False: While speech is a function regulated by the left side of the brain, singing is regulated by the right.
What is "False" - studies show that singing and active music making engage neural processes in the whole brain, not just the right side!
True or False: Avoiding and reducing stress is an important factor in preventing and reducing the risk of having a stroke.
What is "True"
The nurse assesses the earliest sign or neurological change. What is the nurse assessing?
What is "altered level of consciousness"
Rationale: Consciousness is the earliest and most sensitive indicator of neurological change. This is because the brain is sensitive to slight hypoxia or change in adequate blood supply.
Consuming too much of this mineral could lead to high blood pressure and increase your risk of having a stroke
What is "sodium/salt"
Rationale:
-Salt/sodium is known to contribute to high blood pressure, which is a known stroke risk factor. Table salt, sea salt, seasoning salt, and celery salt all contain high amounts of sodium.
Questions were derived from Nutrition and Diagnosis-Related Care 8th edition page 269-272.
Activase is a weight-based dosing medication for Ischemic strokes. Calculate the bolus dose and Infusion dose for a patient weighing 90 kg.
A: Bolus Dose: 8.1 mg administer over 1 minute
B: Infusion: 72.9 mg administer over 60 minutes
The insurance covered service ordered when a patient is homebound?
What is "Home Health Care"?
The one therapeutic intervention proven to show improved outcomes with all functional mobility in stroke survivors.
Answer: What is "High intensity gait training"
Rationale: Delivery of large amounts of stepping practice with focus on achieving higher cardiovascular intensities may result in greater locomotor performance and selected non-locomotor gains (balance, strength, barthel index, sleep, pain, fatigue, depression) as compared to usual care during inpatient stroke rehabilitation.
Source: Moore JL, Nordvik JE, Erichsen A, Rosseland I, Bø E, Hornby TG; FIRST-Oslo Team. Implementation of High-Intensity Stepping Training During Inpatient Stroke Rehabilitation Improves Functional Outcomes. Stroke. 2020 Feb;51(2):563-570. doi: 10.1161/STROKEAHA.119.027450. Epub 2019 Dec 30. PMID: 31884902; PMCID: PMC7034641.
A patient comes with left neglect and right gaze. Which of the following scenarios is the correct room allocation?
A) The patient is strategically placed to face the door on the right to make it easy to see people coming in and out.
B) The patient is strategically placed facing away from the door to promote awareness of the neglected side.
What is "B) The patient is strategically placed facing away from the door to promote awareness of the neglected side."
This is the area of the brain that makes sure language is understood and this is the part of the brain that makes speech fluent.
What is "Wernickes and Broca's areas"
True or false: Studies have found that listening to music for at least an hour per day helped stroke survivors improve verbal memory and focused attention (compared to those who only listened to audio books or received no listening).
What cognitive functions can a stroke affect?
A) Memory
B) Attention
C) Language
D) Executive functioning/problem solving
E) All of the above
What is "E) All of the above"
This is a top priority in care that the nurse implements for a patient with altered LOC who may have suffered a stroke. (Hint one of the ABCs)
What is "Maintaining the airway"
Rationale: The patient should no be left lying on his or her back because of the increased possibility of aspiration. We should position the patient to facilitate drainage of oral secretions.
These types of meat are best to consume following and to prevent a stroke.
What are "Lean meats"
Rationale: Lean meats including lean ground beef, turkey, chicken, and fish provide a good source of protein that is low in fat. A diet high in fat is a known stroke risk factor.
Questions were derived from Nutrition and Diagnosis-Related Care 8th edition page 269-272.
Prior to Activase administration, patient’s blood pressure should be less than?
What is SBP<185mmHg, DBP<110 mmHg
Name the step down facility patients are sent to when not meeting goals in acute rehab...
What is an "SNF (Skilled Nursing Facility)?"