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65 Cards in this Set
- Front
- Back
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Names the types of ischemic strokes
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TIA, Cerebral Thrombus, Cerebral Embolism, Lacunar Infarct
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Describe a TIA
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TIA is a "warning stroke" that may happen before a major stroke. It happens when blood flow through the brain artery is blocked or reduced for a short time.
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Describe a cerebral thrombus
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Caused by atherosclerotic plaques, leading to the BV narrowing and/or a tear of a weakened wall, and/or may trigger the clotting process, which leads to the narrowing of blood vessles.
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Discuss the pathophysiology of an ischemic stroke
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thrombus formation, atherosclerosis causing damage to the inner layer of the BV, a plaque forms, platelets adhere to the area, the vessel narrows, the flow diminishes to distal vessels.
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descibe a lacunar ischemic stroke
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a thromobis of a small penetrating artery
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describe a ischemic stroke
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emboli travel from other parts of the body and block cerebral vellels.
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describe a cerebral embolism
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it is a traveling clot tha toriginates from the thrombi in the heart of aortic arch. It becomes jammed in the cerebral vessels and obstructs blood flow.
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descibe a lacunar infarct
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a thromotic occlusion in the small deep cerebral arteries. It produces small lesions, oval in shape (thus the name lacunar). Lesions pit. These usually develop in the pons or thalamic pathway and are purely motor or sensory defects.
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Describe a brain stem stroke.
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Results in locked in syndrome.
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How many internal carotid arteries are there?
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Two for anterior circulation (internal carotid arteries, ICA)
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How many vertebral arteries are there?
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Two for posterior circulation.
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Describe the clinical manifestation of a R hemisphere infarct.
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1. Neglect. body part of loss of function not acknowleged. FX L side of body.
2. L visual field defects 3. Flat affect 4. Apraxia 5. L hemiplegia/hemisensory loss. |
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Describe the clinical manifestation of a L hemisphere infarct.
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1. Speech changes--expressive (brocas--can't get it out), receptive (don't understand) or global.
2. L lateral gaze preference 3. R visual field deficitts 4. R hemiplegia/hemisensory loss. |
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With___ brain damage one will have a quick and impulsive behavioral style.
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Right
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With ___ hemisphere brain damage one will have deficits on the left side.
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Right
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With L side brain damage one will have a _______ or _______ behavioral style.
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Slow or cautious.
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With ___ side brain damage one will have memory deficits R/T performance
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Right
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With left sided brain damage one will have memory deficits R/T ____________
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Language
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with ______ sided brain damage one has indifference to the disability.
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Right
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With Left sided brain damage one has ________ or _______ R/T the disability.
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Depression and/or distress
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Right Brain damage = ________ side paralysis.
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Left
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Describe R brain damage:
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Paralyzed L side, R brain damage, spatial-perceptual deficits, behavioral style is quick and impulsive, memory deficits R/T performance, one sided- neglect.
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Right side of the brain helps with:
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decision making, judgement, planning, emotions, visual awareness, understanding of the world, problem solving, memory.
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With a R brain stroke the pt will exhibit which of the following (describe):
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impulsivity
rambling speech of actions decreased attn memory deficits left side neglect lack of insight into deficits **these behaviors make this pt a safety risk. The pt should NOT be left alone w/out close supervision. |
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Describe L brain damage:
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R sided paralysis, speech-language deficits, cautious, anxious and disorganized, memory deficits.
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Describe receptive aphasia:
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pt does not understand what is being said
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Describe the L side of the brain and what it does:
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helps w/thinking, calculation (math), analyzing, problem solving, planning, organizational skills
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Why should L brain stroke patients not be left alone?
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communication difficulties, expressive aphasia, movement disorder, vision and touch deficit, thought process deficit, behavior-related deficits
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What is the clinical presentation of a brain stem stroke or the carotid artery?
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hemiplegia/quadriparesis
loss of sensory in 1/2 of body or all four limbs dysarthria, disphasgia, ataxia, N/V, CN changes |
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What is amaurosis fugax?
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fleeting blindness
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What clinical manifestation would one see with Anterior cerebral artery insufficiency?
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personality changes, confusion, incontinence, leg weakness more than arm weakness, difficulty tracking, motory or sensory changes on the other side of the body.
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What clinical manigestation would one see with Middle cerebral artery insufficiency?
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motor/sensory changes on the opposite side of the body, arm weakness greater than leg weakness, same side visual changes, if on the left would see speech changes and on the R would have issues w/knowing where body parts are.
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One would see arm weakness greater than leg weakness in:
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middle cerebral artery insufficiency.
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With a Anterior cerebral artery vessel insufficiency one would see ____ weakness greater than ____ weakness.
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one would see leg weakness greater than arm weakness.
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What would one see with a posterial cerebral artery insufficiency?
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opposite side sensory loss, same side vision loss, if left: communication deficit, if R deficit knowing where body parts are, graying of vision.
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Name symptoms of vertebrobasilar vessel insufficiency:
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dizziness, nausea, vomiting, ataxia, dysarthria, dysphagia, eye movement, facial weakness, hearing loss
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when can thromolytic therapy be administered?
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if within 3 hours of witnessed onset of symptoms.
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___ is the only thrombolytic drug approved for ischemic stroke
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t-PA (activase)
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What are the criteria for administration of T-PA?
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1. CT negative for blood (no hem)
2. >18 3. onset symptoms <3 hours 4. symptoms not resolve spontaneosly 5. SBP <185 and DBP <110 6. "other causes" R/O 7. Symptoms not minor and/or isolated 8. No Hx of intracranial injury in past 3 mos 9. No Hx head trauma 10. No Hx previous isc or hem stroke 11. No MI 12. No GI or GU bleed within 3 wks 13. No Hx major surg within 2 wks 14. No hx arterial puncture at noncompressalbe site within 7 days 15. No evidence acute bleeding or acute trauma 15. No seizure w/postictal residual neuro deficits |
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instructions for EEG include:
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no caffeine, wash hair before and after procedure, sleep may be withheld prior to test and may be induced before test, may be asked to take deep breaths or be exposed to flashes of strobe light during test.
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How does a client know they are going to have a seizure?
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may experience aura prior to seizure. Type of aura indiates origin to area of seizure in brain (olfactory, visual, auditory).
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Which nursing interventions are appropriate during seizures?
A. provide privacy B. Ease client to floor if standing C. make immediate environment safe D. loosen client's clothing E. Insert oral airway F. Protect head w/padding G. Restrain the client to protect from injury |
A. Provide privacy
B. Ease client to floor if standing C. make immediate environment safe D. Loosen clients clothing F. Protect head with padding |
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name priority interventions following generalized seizure?
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keep client in side lying position to prevent aspiration
ensure patent airway reorient pt to environment. reasure client who is agitated posttictal. |
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describe stage 1 of alzheimers disease:
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ST memory loss
decreased attn span subtle personality changes mile cognitive deficits difficulty w/money, numbers, and bills difficulty w/depth perception |
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describe stage 2 of alzheimers disease:
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obvious meory loss
confusion re: time and place worsen wandering behavior confrabulation "sundowning" irritabilty and agitation decreased spatial orientation impaired motor ckills impaired judgment imapired self-care deficit |
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describe stage 3 of Alzheimer's disease:
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absent and or severe impairment of all cognizitve abilities.
disorientated to time and place disturbed sleep patterns impaired and/or absent motor skills and communication bowel and bladder incontinence inability to recognize family and friends |
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identify the stage of alzheimers disease:
confusion re: time and place worsen |
stage 2
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identify the stage of alzheimers disease:
subtle personality changes |
stage 1
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identify the stage of alzheimers disease:
decreased spatial orientation |
stage 2
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identify the stage of alzheimers disease:
disturbed sleep patterns with increased sleep time |
stage 3
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identify the stage of alzheimers disease:
inabilty to recognize family and friends |
stage 3
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difficulty with numbers, money, and bills
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stage 1
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____ side of the brain helps with decision making, planning, emotions, visual awareness and understanding of the world around us, problem solving, memory
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Right side
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These areas can be identified in a ___ brain stroke: impulsivity, rambling speech or actions, decrased attention, memory deficits, left neglect, lack of insight into deficits
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Right side
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------ brain damage will manifest as speech language deficits, cautious, anxious, and disorganized along with memory deficits.
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Left brain damage
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This side of the brain helps with thinking, calculation, math, analyzing, problem solving, planning, org skills
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left side
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This type of brain damage will manifest as slow cautious behavior, disorganized, anxious, underestimating ability.
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Left side
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With Anterior cerebral artery insufficiency one will see:
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personality changes, confusion, incontinence, leg weakness greater than arm weakness, difficulty tracking, motor or sensory changes on the opposite side of the body.
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One will see arm weakness greater than leg weakness, same side visual changes, motor/sensory changes on the opposite side of the body.
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Middle cerebral artery
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One will see same side vision loss with
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posterior cerebral artery
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what does the frontal lobe do?
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thinking, planning, and organizing
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The _______ lobe assists with processing sensory and spatial information.
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parietal
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Temporal lobe helps with:
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communication, especially receptive language.
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the _________ lobe helps with visual information processing
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occipital
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Criteria for thrombolytic therapy administration:
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1.>18
2. symptom onset <3hrs 3. symptoms not resolving spontaneously 4. SBP <185 and DBP <110 5. Other causes ruled out 6. Symptoms not minor and isolated 7. Within past 3 mos: No hx of Intracranial surg, head trauma, previous ischemic or hem. stroke, MI 8. No hs of (within 21 days) GI or GU bleed 9. No hx of major surg w/in 14 days 10. No hx any following w/in 7 days: arterial puncture at noncompress site 11. No evidence acute bleeding or acute trauma 12. No seizure w/postictal residual neuro deficits |
