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35 Cards in this Set

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FAST recognition of stroke
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
Affects of a left CVA
paralyzed right side hemiplegia
impaired speech & language
slow performance
visual field deficits
aware of deficits - depression & anxiety
impaired comprehension
Affects of a right CVA
paralyzed left side hemiplegia
spacial-perceptual deficits
tends to minimize problems
short attention span
visual field deficits
impaired judgment
impulsive
impaired time concept
2 classifications of stroke
ischemia
hemorrhagic
which occurs more commonly - ischemic or hemorrhagic stroke?
ischemic - 80-85%
hemorrhagic only 10-15%
results from obstruction of blood vessels & decreased brain perfusion
ischemic stroke
disruption of blood flow to the brain which results in ischemia
"brain attack"
causes of ischemic strokes
thrombus
embolus
which type of stroke accounts for the highest mortality
hemorrhagic stroke
2 causes of hemorrhagic stroke
subarachnoid hemorrhage
intracerebral hemorrhage (more common)
important components of algorithm for stroke pts
similar to that of heart attack but:
O2 given only if needed
check glucose level (hypoglycemia mimics stroke)
perform neurologic assessment
order CT
if CT scan shows a hemorrhage what is the plan of tx?
consult neurosurgeon/transfer
if CT scan does not show hemorrhage what is the plan of tx?
probably acute ischemic stroke so consider fibrolytic therapy
if not a candidate, admin aspirin
if a candidate, give tPA
what is the single most important point in the patient's history according to guidelines for early mgmt of ischemic stroke
time of symptom onset
diagnostic studies for early mgmt of ischemic stroke
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
treatment of choice for thrombolysis in acute stroke is for early mgmt of ischemic stroke
rtPA
when can aspirin therapy of 325 mg be initiated for early mgmt of ischemic stroke
24-48 hrs after stroke onset (decr risk of intracranial hemorrhage)
standardized measures for stroke care at stroke centers include
tPA consideration
Screening for dysphagia
DVT prophylaxis
Lipid profile
smoking cessation
education about stroke
plan for rehab
antithrombotic meds w/in 48 hrs
what is the window of opportunity to use tPA to improve recovery of stroke?
3 hrs
treatment for TIAs include
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
3 most important acute neurological complications of stroke are:
swelling of ischemic tissue
hemorrhagic transformation of the infarct
seizures
what is the leading cause of death after a major ischemic stroke
cerebral edema
post discharge complications from stroke include:
falls
pneumonia (most frequent cause)
respiratory illness
MI
recurrent stroke
most important risk w/intracerebral hemorrhage
hypertension
which is the most serious form of stroke - 35-52% mortality at 1 month w/half dying in first 48 hrs
intracerebral hemorrhage
clinical manifestations of intracerebral hemorrhage
sudden onset
headache
elevated BP (200-250/100-150)
decreased LOC
N/V
medical mgmt of intracerebral hemorrhage
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
best way to prevent stroke
control BP
causes of subarachnoid hemorrhage
rupture of cerebral aneurysm (85%)
arterial-venous malformation
clinical manifestations of subarachnoid hemorrhage
abrupt onset w/worst headache imaginable
brief loss of consciousness
N/V
collaborative mgmt for stroke
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
treatment for ischemic stroke
thrombolytic therapy
BP control
tx for subarachnoid hemorrhage
surgical aneurysm clipping or AVM excision
tx for intracerebral bleed
BP control
complications to assess for w/stroke
cerebral edema
cerebral ischemia
rebleeding
impaired swallowing
neurologic deficits