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35 Cards in this Set

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what vessel usually breaks going to the brain that causes a stroke?
carotid artery
the main thing that causes a stroke is ...
HTN

hypertension
what is a vasospasm?
cerebral artery shuts off for a sec. and the opens up causing a TIA ( a mini stroke )
CVA is called ...
Cerebro vascular Disease
Again, things that cause CVA are

arteriosclerosis (plack buildup)
hypertensive changes
Vasospasm (on/off thing in brain
Inflammatin (swelling/coagulation in arteries in the brain
Embolism. what is an Embolism?
blood, air, or fat plack travels to lungs, heart, or brain. A fat emboli can even get to the kidneys, heck anywhere in body
it takes about 4 minutes for a blood shut off to do irrepruble damage, like to the brain. So, a stroke will always result in ...
permanent disability
and permenant brain damage
*****************************
3rd largest cause of death in US
TIA means transient Eschemic Attack

what is this?
TIA used to be called a mini stroke...*****************
DEF: TIA=a stroke that resolves itself in 24 hours.
********************************
can be a warning sign of an impending stroke. So TIA says "something has happened! Something happened, from lipids, a spasm, a tiny clot went thru, (a clotting problem, or a tiny embolism) or maybe a cardiovascular problem. Trauma to a long bone, or marrow or fat from that got loose. A warning sign bigger thing is going on.
ataxia means
ability to move muscles

so muscle movement
what does paresthsias mean
not normal feelings like tinglings bugs crawling on you
TIAs *************************
what ae need to know is that they are RAPID ONSET
sO... A PT SAID "i PASSED OUT, DOWN AND THEN FELT TINGLES ON MY LEFT SIDE AND MY SPEECH WAS SLURRED BUT THAT ALL WENT AWAY YESTERDAY. WHAT WOULD THE DOCTOR ORDER?
A CT CAT SCAN

AN MRI
IT CAN LOOK AT THE BRAIN AND CARATOIDS.
MAYBE ORDER A CARTIAC WORKUP
SO WE ARE DOING A HISTORY OF THIS PT, WHAT DO WE LOOK FOR?
Hx OF SMOKING
ALCOHOL
COCAINE (IN THE YOUNG& TIAs)
SAY WHAT WERE YOU DOING WHEN THIS HAPPENED. HOW LONG DID IT LAST? YOU SAID YOU WERE NUMB ON THE LEFT SIDE? DIFFICULTLY WALKING? SO ONSET DURATION INTENSITY OF THIS EVENT FIRST TIME THIS HAS HAPPENED TO YOU?
SO THE PT COMES INTO THE ER AND TELLS ALL THIS STUFF. THE MD ORDERS A MRI, CT SCAN, LOOKING THE HEART FOR THINGS LIKE AF OR ATRIAL FIBLUATION WHY? THE HEART?
THE VALVES B/C LOOKING FOR ATRIAL FIBULATION B/C VALVE Dx CAN CAUSE CLOTS SO THEY WILL DO DOING CARDIO WORKUPS AND PUT THEM ON
HEPARIN IMMEDIATELY B/C THEY DON'T WANT THE BLOOD TO CLOT
WHEN SENT HOME MIGHT GIVE THEY PUT THEM ON PLAVIX,ASPIRIN, TO KEEP CLOTS FROM FORMING
WHAT WOULD A NURSE ASK SOMEONE WHO JUST HAD A TIA AND IS GOING HOME?
DO YOU LIVE ALONE?
DO YOU HAVE STAIRS?COULD BE GOOD
DO YOU HAVE A PHONE?
ARE YOU RETIRED?
SAFETY ISSUES
what kind of labs would we be looking for with TIAs?
lipid count
platlets for clotting factors
we want a complete blood count
a glucose level
bleeding time (clotting factors)
we do a blood glucose and its normal what then?

I mean the symptoms are like hypoglycemia and passed out
it isn't diabetes related to the episode so it could of been a TIA
but we need to rule out low blood sugar.
what does diabetes or hi blood sugar have to do with TIA so what does hi blood sugar and clotting have to do w/ this?
sticky blood! RBCs are sticky
they may do a cerebrial angiography (angiogram) watch how die profuses thru the brain
if they throw one clot it can happen again so where would we look? in the lungs? Ausculate for anxiety from decreased oxyngenation? get an IV started? for immediate IV access!
so we have the pt in front of us we need serial neurological exams to establish ...
a basline
tests like PERRLA
vital signs
neuro ck 12 cranial nerves for fields of vision
why would a md put a pt on ace inhibitors?
its a anti hypertensive med

it dialates vascular system
pt will be put on anticoagulants
put on antihypertensives ...
what are some nursing Dx?
ineffecive coping "i just had a little fall, im ok now"
fall risks
knowledge deficit is a biggy
so MD might order a carotid Endarterectomy what is this
rooter router surgery to remove plaque. its dangerous so they put it off to last b/c it can cause a stroke
what would be complications from a Carotid Endarterectomy?
stroke
cranial nerve injury
infection
hematoma of wound
carotid artery disruption
so the nurse management part
we will:
close cardiac monitoring (ask if there is a Hx of coronary artery disease)
ck their tongue...why?
hypoglossal nerve & swallowing
cking the cranial nerves ...remember A&P
the risk factors for this TIA stroke are like:
hypertension in blacks
hi cloresterol & hi triglyerides
aging
any disease process
what else?
diabetes
cardiovasular Dx
obesity
elevated hematocrit
0ral contraceptives
alcohol use
ischemic something w/ a stroke

ischemic is kind of like hypoxia but instead of lack of o2 to tissue it means ...
total blockage or a lack of blood flow to an organ. this can happen from TIA.Ischemica results from a thrombus (clot) in a blood vessel in the brain or cerebral embolism (a clot of stuff like air or fat
Ischemia to the brain is an arterial spasm that diesn't release
what is multi infarct dementia?
from lots of small strokes which cause severe damage over time causing dementia
symptoms are:
HALLUCINATIONS LIKE SIGHT,HEARING,FEELING ON THE SKINOR SMELL
there is hemorrhagic in a stroke
results from:
a rupture of a cerebral blood vessel w/ bleeding into the brain tissue or spaces around there
hemorrhagic strokes:
bleeding in the epidural or subarachnoid or intracerebrally
where is this bleeding in the epidural?
b/t dura mater & skull &
b/t periosteum & dura
hemorrhagic stroke in the subdural hemorrahge
bleeding b/t dura matter & arachnoid membrane
subdural is like a edidural except involves a brigding ..
vein is torn
hemmorrhage strokes

intracerebral hemmorrhage is ...
bleeding in the brain or cerebral tissue w/ displacement of the surrounnding tissues

common in pts w/ HTN & cerebral artherosclerosis
manifestations of CVA:
homonymous hemianopsia
what is this
loss of half of visual field
loss of peripheral vision
diplopia-double vision
stroke folk can experience paresthesia. what is this?
unpleasent sensation such as numbness or tingling, feeling hot water or creepy crawly all over
cognitive deficits:

memory loss
decreased attention span
what about verbal deficits?
expressive aphasia = can't express to YOU
receptive aphasia=can't understand you
global aphasia=having both
emotional deficit
name a few
withdrawal
depression
spontaneous crying
THE LEFT HEMI STROKE

yeilds:
r sided paralysis
r visual field deficit
aphasia = unable to communicate
altered intellectual ability
slow cautious behavior
any thing else?
*****************************
needs lot of encouragement
incidence of depression-cry b/c depressed
what we can do and not do to stop strokes
what can we not stop?
gender=higher in males
age-increases w/ age
race=blackes get this
heredity=due to family incidence of risk factors: diabetes,cardiovascular disease