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55 Cards in this Set

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Ischemic stroke is ...
normal blood flow to brain is disrupted. most common stroke, usually a cardiod artery problem like throws a clot from all the turbulence.q
stroke is 3rd largest cause of death in USA. whats a tranient stroke?
transit is a mini stroke. now called a TIA and resolves itself in 24 hours.
TIA may be a warning sign of an impending stroke. Most TIA people will mean 20% will have a big stroke. TIA means
your having a clotting problem, or some cardio vascular problem.
slurred speech
double vision
what's ataxia?
muscle movement.
what's parathesia? prickly bugs crawling on you feeling.
risk factors for TIA are:

(other than rapid onset)
type 1 diabetes
Hx smoking
family Hx of stroke
age related symptoms
what causes stroke/TIA with young people?
cocaine causes TIA
access w/ questios the stroke occurance. onset, duration, flucuation, intensity of symptoms. is this first time?
so someone who threw a clot would be put on a drug like Plavix. what else can make someone throw a clot?
what kind of labs would we look for in this TIA
lipid count
platlet count for
we want a complete blood count
a glucose level? if its hi, w\ history of diabtetes, then we have sticky blood cells, then do a CT and MRI to examine carodids to see how die flows thru brain.
are we going to get an IV into this pt w/ the TIA
yes we want direct access to venal system. could do it again, watch the airway.
why is smoking bad in regards to stroke?
smoking decrease your hi density level of proteins (i think)
this stroke person could be put on ace inhibitors. why?
its an anti hypertensive medicine, to lower their blood pressure. makes them excrete sodium and dialate peripheral vasular system, also excrete sodium and water.
they'll be giving anti coagulants, put on anti hypertensives, etc. what are some nursing diagnosis?
fall risks. the carodid artery has to work well why? it provides flow to the brain!
we would check the tongue why?
cranial nerve damage. tongue has to come out straight not crooked.
where are the barrel recptors?
on the carotid arteries. so we manipulated the carotid artery w/ sugery so we could of damaged the barrel receptor (a pressure receptor) so could end up w/ really hi blood pressure or really low blood pressure.
nurse management: looking for
close cardiac monitoring
pupil eye response, visual field
what is thrombolitic therapy:?
lytic means break down so thrombolytic means break down a clot. must be given within 3 hours of the stroke.
what does an MRI or CT tell you about the stroke:?
what kind of stroke it was!
why would we don't want to have their head up in the gurney? getting heperon (anti coagulation Tx) to decrease inner cranial pressure to the head.
but we don't want the blood pressure too low b/c of hypoxia. this causes edema to the brain! we want the blood pressure to be around
< 180/< 100
because if its high you are going to increase the risk of bleeding and more ishcmeic damage. 1
how about this one
pt comes in stable but then"
develop a headache
or nauseated and vomiting
or a sudden change in normacy
whats happening?
having another stroke
a change in consciouness
tachycardia and hypotensive
cool clammy skin they are in shock because of systemic bleed somewhere. look at VS and assess assess. diaphoresis is shaky cool clamy skin
this person w/ the stroke will get an osmotic diuretic in order to ...
dehydrate the brain. this osmostic diuretic acts on the proxial tubules. that means everyting gets dumped. so a hi concentration of sugar (manatow) IV so this hi concentration goes into vascular system, and go right into vascular spaces and this will draw water into the vessels to dehydrated them diuress them to drop inner cranial pressure. but the inner pressure will go UP for a little bit (transient spike in B/P) b/f going back down.
also, all this fluid overload to the heart, the lungs will fill up. this is called transient pulmonary edema. so, when they have that tranient B/P happens and plural effusion, have o2 avaliable for this event.
and they will need good renal fusion too so I&O on this pt down to the last drop.
they could also put this person on a ventilator too, so this person is theraputically hyperventilated why? to blow off co2. why. you want them hypokapneic. NOT too much carbon dioxide. also do we want this person to be constipated?
no. the pressure! no valsalva manuvers. if we don't decrease the inner cranial pressure, the brain can herniate.
CT scan and MRI . what do we need to know? we need to know something about the test. where do we find this?
in the lab book.
so this pt is in your room, what would I be doing to prevent contractors?
every time you walk in, you do passive range of motion to the affected side. so passive ROM is first thing I'll be doing. and do this carefully so as not to dislocate an elbow.
what artery usually is the culprit in a stroke?
the carotid artery.
Hypertension #1 leading cause of stroke by the way
why is carotid artery all this causing a stroke?
arteriosclerosis; plack & calcium buildup in arterial lines. Hypertensive changes. cerebral arteries shuts off for just a second and TVA happens
what does arteritis mean and so what?
inflammation of arteries in tiny arterioles leading to stroke from swelling & coagulation
what is an embolism?
blood air fat (plack) travels to lungs, heart, or brain. Fat emboli can even travel to kidneys anyhwhere
what causes a TIA
neurological dysfunction caused by ischemia in the brain
signs & symptoms of TIA vary depending where they hit in the brain! is TIA a warning? of what?
of impending stroke! 20% will stroke after this TIA
there are anterior and posterior TiA. what is w/ the anterior TIA (carotid)
slurred speech, aphasia, one sided weakness results
posterior circulation (vestebrobasilar) what does this act like?
diplopia (double vision)
ataxia (muscle movement)
dysphagia (swallow)
parethsias (not normal feelings) like buzzing all over
what are some risks that lead to TIA
type 1 diabetes
what are some nursing considerations of stroke:?
primary prevention...recognize risk factors and stop what we can.
2nd - prevent complications and decrease risk factors
tertiary prevention-bad stuff happened now we deal w/ it...
what is a carotid Endarterectomy?
removal of artherosclerotic plague or thrombus from the carotid artery to prevent stroke in pts. w/ occlusive Dx of extracranial cerebvral arteries. lst ditch effort risky manuvere
what came come from this procedure?
cranial nerve injury
hematoma of the wound
carotid aretery disruption
so what about nurse management of stroke?
close cardiac monitoring
assess cranial nerves like swallowing etc
watch for baroreptor damage
whos at risk for CVA
hi closeterol folk
females over 65
old people
anyone w/ heart disease...AF, Valve Dx, etc
looking at labs what would be a clue to CVA ?
check hematocrits, how many RBCs there are in solution, b/c more hematocrits (RBC) more clotting
what is an Ischmeic
clot in blood vessel to brain
cerebral embolism clot or air or fat clot.
Ischemia to the brain is an arterial spasm that doesn't release
Multi infarct dementia.
what is it
several small lasting strokes that cause severe damage over time resulting in dementia. symptoms are confusion w/ hallucinations, sight, hearing, feelings in skin
what is or causes Hemorrhagic?
a rupture of cerebral blood vessel w/ bleeding into brain tissue or spaces around brain
hemorrhagic strokes are bleeding in epidural. b/t dura mater and skull also b/t perisoteum and dua.
arteriovenous malformations
aneurysm rupture
what are usuall symptoms of stroke?
numbness/weakness one side of body
change in mental status
trouble speaking or understanding
visual disturbances
difficulty walking
severe headaches
CVA causes all kind of shit:
visual field devicits
motor deficits
sensory deficits
what else?
cognitive deficits
verbal deficits
emotional deficits
there are also emotional dificits w/ stroke like >>>
expressive aphasia- can't express to you
receptive aphasia - can't understand you
global aphasia - having both
oh yea, the emotional stuff. withdrawl, depression, crying
what are the problems w/ left hemisheric stroke:? remember: l stroke not in their r mind:?
r sided paralysis
r visual field deficit
aphasia-can't communicate
altered intellectual ablility
slow cautious behavior
what are r hemipheric stroke characteristics?
L sided paralysis
L visual deficits
spacial perceptual deficits-not knowing where midline is
not aware of own deficits!!!
impulsive behavior/poor judgements
risk factors are:
men higher in males
age older the more risk
race - blacks
do what to prevent this:?
quit smoking'
lose weight
stop salt
no booze
physical exericse
fruits veggies
hi fiber diet
lo cholesterol
regulate diabetes
decrease stress
keep HTN in control
what is thrombolytic Tx
dissolve thrombus
CT scan first
has to be given w/in 4 hrs
blood pressure should be where?"
<180 systolic
<100 diastolic
what would the following things make you think was the matter:
sudden change in LOC
intracranial bleeding hemorrhage
pt comes in with what you think is cerebral edema. what to look for?
change in LOC
reflex hypertension
low BP then it spikes
worsening neurologic status
How to fix in the ER:
Mannitol osmotic diuretic, dumps everything out kidneys, BUT can cause sudden drop in BP so be ready for that too.
Maintian PaCo2 b/t 30-35 mmHg
avoid hypoxia
how to manage dysphagia
swallow eval
thick liquids
upright position
tube feedings
ethical things
why would a stroke patien have bladder/bowel problems?
constipation cause bowel stoppage stuff
fiber in diet
lots of fluids
regular time scedule for potty