Show:
Definitions
Symptoms
Stroke risk
Assessment
Mostly tPA (lol)
100
Name the types of stroke
What is hemorrhagic and ischemic (embolic and thrombotic)
100
Name the first symptom you will likely see in a hemorrhagic stroke
What is change in level of consciousness
100
Why are patients with a fib at high risk for stroke?
What is blood pulls in atria because it isn’t being pumped effectively. This blood can clot. The clot can dislodge and go to the brain
100
What type of blood pressure would you expect to see in a someone having a stroke?
What is likely to be elevated. Do not quickly decrease the blood pressure because the increased pressure is helping to perfuse the brain.
100
What must you know before administering tPA?
What is symptom onset time
200
What are TIAs?
What is transient ischemic attacks-episode of neurological symptoms that last less than 24 hours. These are warning signs that a stroke may occur.
200
Name three symptoms of TIAs
What is Sensory Deficits: Paresthesia (numbness, tingling), vertigo Speech Deficits: Aphasia (loss of ability to understand or express speech), dysarthria (slurred speech) Vital signs: BP elevated, pulse may be rapid & bounding Visual: blurred vision, double vision, blindness in one eye, tunnel vision. Motor deficits: weakness (arm, leg, hand), gait disturbance (ataxia)
200
Name three modifiable risk factors for stroke
What is hypertension, heart disease, atherosclerosis, A-Fib, smoking, diabetes, high total cholesterol, obesity, sleep apnea, physical inactivity, diet, postmenopausal hormone therapy, oral contraceptives, TIA
200
Why is it important to keep temperature regulated?
What is temperature extremes increase metabolic need. Want temperature to be normal so brain does not have increased metabolic needs
200
Name three safety concerns post stroke
What is falls (gait disturbance, impaired spatial perception, weakness), pressure ulcers from immobility, nutrition and fluid imbalances, aspiration, DVT, atelectasis, pneumonia
300
Explain thrombotic stroke
What is blockage within a vessel decreasing the blood flow past that area. Usually involves carotid arteries. Could just involve arteries within brain. Slow buildup of blockage.
300
What is a quick test to see if a patient is having a stroke?
What is ask the patient to close their eyes and hold their arms out. Arm will drift down on affected side. Must close eyes because they will raise drooping arm if they see it falling. Ask the patient to smile. One side of the face will droop. Assess the patient’s speech for slurred words, using the wrong words, or the inability to speak.
300
Name three non-modifiable risk factors for stroke
What is gender, age, family history, race, history of myocardial infarction, prior stroke, sickle cell disease, Berry aneurysms
300
Why is it important to assess blood sugar?
What is stroke victims with hyperglycemia have poor outcomes. Hypoglycemia can mimic stroke symptoms.
300
Within what time frame can tPA be given?
What is tPA must be given within 4.5 hours of symptom onset. Not helpful past this.
400
Explain embolic stroke
What is a clot formed somewhere else but broke off and made its way to the brain. Sudden blockage. Can be caused by DVT or afib.
400
Explain the difference between broca's aphasia, wernicke's aphasia, and global aphasia
What is Broca’s aphasia- difficulty with expression, speaking and writing Wernickes- difficulty understanding spoken and written word. Speech often meaningless and may make up words. Global/ mixed- both
400
Are men and women at equal risk for stroke?
What is men are at higher risk for stroke, but more women die from them.
400
What scale must be repeatedly assessed by the nurse?
What is the NIH stroke scale. Must do entire scale. Will complete about every 5 minutes for an hour to track pt status.
400
Name three contraindications for tPA.
What is recent bleeds (GI, intracranial), recent surgery—within 14 days, recent trauma—within 3 months, history of hemorrhagic stroke, age—Usually 85 and younger, pregnancy, coagulation disorder
500
Explain hemorrhagic stroke
What is bleeding within the brain from a ruptured vessel. The area beyond this is not getting adequate blood flow. Blood build up increases intracranial pressure.
500
Describe the difference in symptoms between left and right sided strokes
What is Right hemisphere damage typically causes difficulty in the performance of visual-perceptual or spatial-perceptual tasks, problem solving Left hemispheric damage generally causes memory deficits and changes in the ability to carry out simple tasks
500
What drugs can be taken to decrease the risk of ischemic stroke?
What is warfarin (particularly with afib), aspirin or plavix (antiplatelets)
500
How can the nurse deduce which side of the brain a patient had a stroke in?
What is assessing cranial nerves bilaterally. Affected side is opposite the side of stroke location.
500
Describe tPA dosing
What is Dosage—0.9 mg/kg (maximum dose 90 mg) Total dose given over 60 minutes 10% given as bolus over 1 minute Remaining 90% given over remaining 59 minutes