Exam 5 Stroke

Front 1

FAST recognition of stroke

Back 1

F-face - are both sides equal? is smile equal?
A-arms - can the client raise both arms equally?
S-speech - is speech slurred? can the client make a sentence?
T-time - get help now. there is a small window of opportunity

Front 2

Affects of a left CVA

Back 2

paralyzed right side hemiplegia
impaired speech & language
slow performance
visual field deficits
aware of deficits - depression & anxiety
impaired comprehension

Front 3

Affects of a right CVA

Back 3

paralyzed left side hemiplegia
spacial-perceptual deficits
tends to minimize problems
short attention span
visual field deficits
impaired judgment
impulsive
impaired time concept

Front 4

2 classifications of stroke

Back 4

ischemia
hemorrhagic

Front 5

which occurs more commonly - ischemic or hemorrhagic stroke?

Back 5

ischemic - 80-85%
hemorrhagic only 10-15%

Front 6

results from obstruction of blood vessels & decreased brain perfusion

Back 6

ischemic stroke

Front 7

disruption of blood flow to the brain which results in ischemia

Back 7

"brain attack"

Front 8

causes of ischemic strokes

Back 8

thrombus
embolus

Front 9

which type of stroke accounts for the highest mortality

Back 9

hemorrhagic stroke

Front 10

2 causes of hemorrhagic stroke

Back 10

subarachnoid hemorrhage
intracerebral hemorrhage (more common)

Front 11

important components of algorithm for stroke pts

Back 11

similar to that of heart attack but:
O2 given only if needed
check glucose level (hypoglycemia mimics stroke)
perform neurologic assessment
order CT

Front 12

if CT scan shows a hemorrhage what is the plan of tx?

Back 12

consult neurosurgeon/transfer

Front 13

if CT scan does not show hemorrhage what is the plan of tx?

Back 13

probably acute ischemic stroke so consider fibrolytic therapy
if not a candidate, admin aspirin
if a candidate, give tPA

Front 14

what is the single most important point in the patient's history according to guidelines for early mgmt of ischemic stroke

Back 14

time of symptom onset

Front 15

diagnostic studies for early mgmt of ischemic stroke

Back 15

CT or MRI
blood glucose
electrolytes/renal function tests
ECG
cardiac markers
CBC
PT/INR/PTT
O2 saturation
also may consider:
toxicology screen, pregnancy test, ABGs, chest xray

Front 16

treatment of choice for thrombolysis in acute stroke is for early mgmt of ischemic stroke

Back 16

rtPA

Front 17

when can aspirin therapy of 325 mg be initiated for early mgmt of ischemic stroke

Back 17

24-48 hrs after stroke onset (decr risk of intracranial hemorrhage)

Front 18

standardized measures for stroke care at stroke centers include

Back 18

tPA consideration
Screening for dysphagia
DVT prophylaxis
Lipid profile
smoking cessation
education about stroke
plan for rehab
antithrombotic meds w/in 48 hrs

Front 19

what is the window of opportunity to use tPA to improve recovery of stroke?

Back 19

3 hrs

Front 20

treatment for TIAs include

Back 20

90 day risk for acute stroke is 10% most w/in 2 days
ASA 325 mg loading dose then 81 mg daily
plavix for 30 days

Front 21

3 most important acute neurological complications of stroke are:

Back 21

swelling of ischemic tissue
hemorrhagic transformation of the infarct
seizures

Front 22

what is the leading cause of death after a major ischemic stroke

Back 22

cerebral edema

Front 23

post discharge complications from stroke include:

Back 23

falls
pneumonia (most frequent cause)
respiratory illness
MI
recurrent stroke

Front 24

most important risk w/intracerebral hemorrhage

Back 24

hypertension

Front 25

which is the most serious form of stroke - 35-52% mortality at 1 month w/half dying in first 48 hrs

Back 25

intracerebral hemorrhage

Front 26

clinical manifestations of intracerebral hemorrhage

Back 26

sudden onset
headache
elevated BP (200-250/100-150)
decreased LOC
N/V

Front 27

medical mgmt of intracerebral hemorrhage

Back 27

control hypertension
vasodilators - Nitroprusside
maintain ICP <20 mmHg
maintain fluid/electrolyte balance
prophylactic seizure prevention
cooling blanket/tylenol for fevere
sedation (propofol) if agitated
glucose controle
DVT prevention
rehab asap

Front 28

best way to prevent stroke

Back 28

control BP

Front 29

causes of subarachnoid hemorrhage

Back 29

rupture of cerebral aneurysm (85%)
arterial-venous malformation

Front 30

clinical manifestations of subarachnoid hemorrhage

Back 30

abrupt onset w/worst headache imaginable
brief loss of consciousness
N/V

Front 31

collaborative mgmt for stroke

Back 31

differentiate cause of stroke (ischemic, subarachnoid, aneurysm, intracerebral bleed)
implement tx based on bleed
protect airway
frequent neuro assessments
assess for complications
provide comfort & emotional support
design rehab program
educate pt & family

Front 32

treatment for ischemic stroke

Back 32

thrombolytic therapy
BP control

Front 33

tx for subarachnoid hemorrhage

Back 33

surgical aneurysm clipping or AVM excision

Front 34

tx for intracerebral bleed

Back 34

BP control

Front 35

complications to assess for w/stroke

Back 35

cerebral edema
cerebral ischemia
rebleeding
impaired swallowing
neurologic deficits