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67 Cards in this Set
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Acute Stroke Care |
Frequent neuro assessment and vital signs Cardiac monitoring and BP goals Proper oxygenation-More than 94percent saturation Pain assessment and management Blood glucose management Targeted temperature management |
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Hyperglycemia in stroke |
Hyperglycemia occurs in 30-40 percent of all stroke patients Injured brain does not tolerate hyperglycemia and inflammatory response In SAH ,hyperglycemia after stroke have worse outcomes In ICH hyperglycemia in the first 72hrs is associated with increased mortality |
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Targeted Temperature management |
Fever independently contributes death and disability at 30 days in stroke ,ICH and SAH |
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Neurologic Assessment Ischemic stroke |
Full NIHSS should be performed before and after tPA 15minsx 2hrs 30minsx6hrs 1hr x24hrs |
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Angioedema Ischemic Stroke |
can occur in 1-2percent of tPA receipients on ACE inhibitors |
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Carotid endarterectomy |
ex. choice for 70percent or more stenosis |
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Carotid stenting |
not the preferred treatment for carotid stenosis |
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Patent foramen ovale management |
antiplatelet/anticoagulant,surgical managemeny |
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Blood pressure management of Hemmorhagic stroke |
BP less than 140-160 systolic |
HTN associated with rebleed and worse outcome |
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ICH management in hemmorhagic stroke |
VTE prophylaxis |
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Cavernous Angioma |
Hemangioma or series of adjacent capillaries with slow blood flow that may occur in central nervous system(congenital) |
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Intraventricular hemorrhage |
Extension into ventricle from ICH or SAH can cause hydrocephalus CSF diversion via EVD or VP Shunt(management) |
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Cerebral venous thrombosis |
clot in dural sinus,typically younger individual affected Treatment: Acute anti coagulation(heparon) |
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Vasculitis |
inflammatory disease causes cell wall death(treatable) |
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Acute care for elders Unit |
hospital specializing geria patients |
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Inpatient Rehab |
Post acute care setting most commonly used Patient must be able to tolerate 3hrs of therapy a day 5days /week |
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Sub acute Rehab Care facility |
Post acute care setting less intense option-less stringent guidelines |
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Skilled Nursing Facility |
Post acute care setting nursing homes |
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Long term acute care hospital |
Post acute care setting acute care for patienys who require more than 25 days usually multiple acute or chronic condition usually temporary until placed in rehab |
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Assisted living Center |
Post acute care setting intended for someone who cannot live independently |
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Board and care |
post acute care setting non medical community based residential settinh that houses 2or more unrelated adults and provide some services such as meals,medical supervision etc |
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Day treatment Care program |
post acute care setting
day time supervision |
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Independent living/Senior living apartments |
post acute care setting live independently but need additional resources to share with other residents |
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Outpatient Rehab |
post acute care setting offered at a linic or other facility prescribed rehab is done here |
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Home health Care |
post acute care settinh licensed community based service that provides predominant medical related services in home setting |
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International Classification of Functioning Disability and Health(ICF) |
use to guide members interdiaciplinary team in plan of care |
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Inpatient Rehab Facility Patient Assessment Instrument |
Data collection tool |
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CMS minimum data set |
Clinical Assessment of nursong home resident to screen for unrecognized or unevaluated condition |
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Barthel Index |
0-100 The higher the score,the more independent |
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Outcome and Assessment Information Set |
Represent core items of comprehensive assessment for an adult home care patient |
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Constraint Induced Movement therapy |
restrain non affected side of the body to force use of affected limb |
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Neuro Optometrics |
Various therapies to minimize visual impairment left as a consequence of a stroke |
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Stroke primary prevention |
blood pressure reducyion tobacco cessation |
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Stroke secondary prevention |
prevention of another stroke -targets treatment for change once disease is present that is recognition of signs and symptoms |
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how much of the body's oxygen supply does the brain require? |
20percent of body's oxygen supply |
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how much of the cardiac output dies the brain require? |
15percent of the cardiac output |
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neroplasticity |
remodeling process of brain -makes new pathways to control speech ,motor,vision and hearing |
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how soon after stroke does neuroplasticity begin? |
1-3days but takes months to years |
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Success of neuroplasticity and recovery post stroke depends on: |
1.repetition 2.robotic therapy 3.desire |
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How much CSF does the body produce an hour |
approximately 20ml/hr |
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Where is CSF produced? |
chorid plexus in the lateral ,3rd and 4rth ventricles |
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What are the 7D's of stroke care |
Detection Dispatch Delivery Door Data Decision Drug |
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How long does an emergency doctor have to see a stroke patient? |
less than 10 minutes |
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How soon does a CT need to be done for stroke patieny upon arrival to hospital? |
less than 25minutes |
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How long does the stroke team have to get the CT read for a stroke patient? |
less than 45 minutes |
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How long does the emergency department have to administer tPA for stroke patients? |
less than 60minutes |
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How fast does the stroke patient need to be admitted to a stroke unit from emergency department |
less than 3hrs |
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What does hyperdense MCA sign mean? |
big clot in MCA with white lines -patient needs tPA,mechanical thrombectomy,possibly OR for decompressive craniectomy |
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An ICH score of 5 or 6 gives the patient what mortality risk? |
100percent mortality |
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What do you follow the tPA dose immediately with? |
50-100ml of NS at the same rate |
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possible side effect of tPA |
ICH-stat head CT if there is change in LOC |
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How do you treat angiedema related to post tPA administration? |
Histamine antagonist (benadryl) and corticosteroids |
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What is the potential complication of elevated BP after tPA |
spontaneous ICH |
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Cause of secondary brain injury |
hypoxia |
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What kind of fluids should be avoided after stroke or injury to the brain? |
hypotonic fluids D5, 0.45 saline exacerbates cerebral edema |
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If patient has a large vessel occlusion and received IV tPA without improvement after 60 min.,what is the next step? |
consider intra-arterial thrombolysis delivered by catheter directly to clot |
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Door to catheter across clot goal time |
90-120 minutes |
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Nursing management of elevated ICP |
HOB elevation neutral head position |
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What is the purpose of putting a ventriculostomy? |
Drain CSF Manage pressure |
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How much CSF is circulating at any given time? |
125-150ml 20percent in lateral ventricles |
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how does hypertonic saline(3 percent) work to decrease ICP |
pulls fluid into vascular space Monitor: chemistry every 4-6 hrs |
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Benefits of barbiturate coma therapy |
decreased cerebral metabolic rate and oxygen consumption decreased cerebral blood flow decrease excitation neurotransmitter release |
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When it is appropriate to use barbiturate coma to decrease ICP? |
used when patient is non responsive to other ICP treatment modalities |
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Risk associated with barbiturates |
direct myocardial depressant hypotension due to venous pooling and dilation |
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When does the risk of vasospasm peak? |
7-10 days following SAH |
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How quickly does FFP(fresh frozen plasma) works? |
within 2-4 hrs |
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How quickly does vit.K works |
within 6hrs |
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