Med Surg Chapter 62 Cva

Front 1

Define cerebrovascular disorders?

Back 1

functional abnormality of the CNS caused by disruption of normal blood supply to the brain

Front 2

What are the two types of strokes?

Back 2

ischemic and hemorrhagic

Front 3

What is a "brain attack"?

Back 3

sudden loss of function resulting from disruption of the blood supply to a part of the brain

Front 4

What are the 5 types of ischemic strokes?

Back 4

large artery thrombotic (atherosclerosis), small penetrating artery thrombotic (lacunar), cardiogenic embolic strokes (cardiac dysrh), cryptogenic MAJORITY(unknown cause), other

Front 5

Explain the patho of ischemic stroke?

Back 5

￬ cerebral blood flow to <25 ml/100g/min
anaerobic resp---lactic acid buildup and change in pH
￬ ATP
 intracellular Ca+ and release of glutamate causing vasoconstriction and cell membrane destruction

Front 6

What is the penumbra region?

Back 6

ischemic brain tissue that may be salvaged with timely intervention

Front 7

General s/s of stroke?

Back 7

numbness, weakness, confusion, speech disruption, visual disturbances, loss of coordination/balance, sudden severe headache

Front 8

What do the clinical manifestations depend on?

Back 8

location and size of affected area

Front 9

Define hemiplegia?

Back 9

paralysis of one side of the body
MOST COMMOM MOTOR DYSFUNCTION

Front 10

Define hemiparesis?

Back 10

weakness of one side of the body

Front 11

Define ataxia?

Back 11

unsteady gait

Front 12

Define dysarthria?

Back 12

difficulty forming words

Front 13

Define dysphagia?

Back 13

difficulty swallowing

Front 14

Define dysphasia and aphasia?

Back 14

impaired speech, loss of speech (expressive, receptive, global)

Front 15

Define apraxia?

Back 15

inability to perform previously learned action

Front 16

Define homonymous hemianopsia?

Back 16

loss of half of the visual field

Front 17

Define agnosias?

Back 17

inabilityt o recognize previously familiar objects by one or more of the senses

Front 18

Common effects of left hemispheric stroke?

Back 18

aphasia, altered intellect, slow and cautious behavior

Front 19

Common effects of right hemispheric stroke?

Back 19

spatial perception deficit, increase distractibility, impulsive behavior, lack of awareness

Front 20

What are the nonmodifiable risk factors assoc with stroke?

Back 20

Age (>55), male gender, african american race

Front 21

What are modifiable risk factors for stroke?

Back 21

hypertension, CVD, hyperlipidemia, smoking, diabetes, obesity, elevated hematocrit, oral contraceptives

Front 22

What are other preventive strategies for stroke?

Back 22

treatment of periodontal disease, carotid endarterectomy (removal of plague or thrombus), anticoagulation therapy (coumadin), antiplatelet therapy (asprin, plavix), statins, antihypertensive meds

Front 23

Medicial management of acute phase of stroke?

Back 23

maintaine airway, neuro assess, promit diagnosis (CT scan), cardio status, NIHSS, eligibility for thrombolytic agents,

Front 24

What is a TIA?

Back 24

transient ischemic attack last less then 24 hours, warning of impending stroke- 20% within 3 years

Front 25

What is the NIHSS?

Back 25

National Institutes of Health Stroke Scale
0-42 to rate severity of stroke

Front 26

Eligibility Criteria for t-PA (thrombolytic) administration?

Back 26

>18, diagnosis of severe stroke, <3 hours since onset, BP <185/110, no sezure, not taking coumadin, prothrombin time < 15 secs, no heparin in last 48 hours, platelet count >100000, no major surgery in last 14 days, no GI/GU bleeding in last 21 days, no previous head injury, stroke, intracranial surgery, intracranail hemorrage, neoplasm, aneurysm

Front 27

What is the proper dosage and frequency of t-PA?

Back 27

0.9 mg/kg with max dose of 90 mg.
10% given IV bolus over 1 minute the rest via IV over 1 hour

Front 28

How should you monitor the patient receiving t-PA?

Back 28

VS every 15 mins, BP <180-105, airway management, continuous cardiac/hemodynamic monitoring, continuous neuro ass, ICP, inc HOB

Front 29

What are side effects of t-PA?

Back 29

bleeding, delay NG tube, foley, intra arterial pressure catheters for hours,
watch for intracranial bleeding for those with NIHSS >20, older then 70, glucose 300

Front 30

What are potential complications of a carotid endarterectomy?

Back 30

cranial nerve injury, stroke, infection, hypotension, hypertension--cerebral hemorrhaging, hematoma and excessive edema that can restrict airway.

Front 31

What is a hemorrhagic stroke?

Back 31

bleeding in the brain tissue, ventricles or subarachnoid space

Front 32

What causes a hemorrhagic strokes?

Back 32

rupture of small vessels, HYN, ruptured intracranial aneurysm, cerebral amyloid angioplasty, AV malformations, intracranial neoplasms, medications

Front 33

Explain the patho of a hemorrhagic stroke?

Back 33

Brain metabolism is disrupted by exposure to blood, increase in ICP, causing ischemia of the brain from dec perfusion and vasospasm

Front 34

What causes intracerebral hemorrhage?

Back 34

HYN, cerebral atherosclerosis, rupture of blood vessels, brain tumors, medications

Front 35

What causes intracranial aneurysm?

Back 35

weakness of arterial wall, HYN, head trauma, age, genetics
Usually occurs in circle of Willis

Front 36

What is an AVM?

Back 36

arteriovenous malformation- tangle of arteries and veins, occurs in young

Front 37

what causes a subarachnoid hemorrhage?

Back 37

AVM, cranial aneursym, trauma, HYN
most common cause is leaking aneurysm

Front 38

What are the s/s of hemorrhagic stroke?

Back 38

severe headache, sudden changes in LOC, vomiting, all others similar to ischemic stroke

Front 39

How is a hemorrhagic stroke diagnosed?

Back 39

CT scan cerebral angiography, maybe a lumbar puncture to confirm ICP
Hunt Hess classificatio system is guide for rating severity of aneurysmal bleed

Front 40

What is a preventative measure for hemorrhagic stroke?

Back 40

Control HYN

Front 41

What are complications of hemorrhagic stroke and how do you prevent them?

Back 41

cerebral hypoxia- O2, IV fluids, stable BP
Vasospasm (leads to ischemia)- Ca+ channel blockers
Increased ICP (hydrocephalus)- CSF drainage, mannitol
potential SZ- meds
further bleeding
hyponatremia

Front 42

What is the medical management of hemorrhagic stroke?

Back 42

dec risk of rebleeding, treat complications, bedrest, sedation, analgesics, compression devices, surgery

Front 43

During acute phase of stroke what do you want to assess?

Back 43

LOC, swallowing, musculoskeletal, pupillary rx, resp problems, VS, inc ICP

Front 44

What are aneurysm precautions?

Back 44

absolute bed rest, HOB 30° to promote venous drainage, avoid all activity that may inc ICP, exhale when voiding to avoid valsalva manuever, nonstimulating environment, nurse provides all personal care