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41 Cards in this Set
- Front
- Back
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What are some neurological clinical manifestions of stroke?
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Flaccid paralysis - loss of all muscle tone - lasts up to 48 hours.
Brainstem stroke - swallowing effected > aspiration risk. Incontinence of both bladder/bowel. Constipation |
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Can bladder/bowel be retrained following stroke?
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Yes, if only one hemisphere is affected and had continence before stroke.
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Which hemisphere is dominant for language in all right-handed people and most left-handed people?
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Left hemisphere.
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Which hemisphere strokes affect communication most?
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Left
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Aphasia -
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absence of language communication. Can be global - nothing understood or communicated.
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Receptive Aphasia
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Words - spoken and written - are not comprehended. Speech is inappropriate jargon, sounds. Can't write words.
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What area of the brain is the auditory speech center?
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Wernick's area: involves interpretation and memory.
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Where is Wernicke's area?
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Center of brain. Overrides temporal and parietal lobe - supplied by anterior cerebral artery.
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Echolalia
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Repeat what you say > picture board
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Expressive aphasia
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Involves formation of words. Words are usually comprehended; speech is garbled, nonsense syllables, perhaps inappropriate words.
Don't lose profanity. Can read but may not be able to write words > picture board. |
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A stroke in what area of the brain would be associated with expressive aphasia?
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Middle cerebral artery stroke - surface area of brain.
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Dysarthria -
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Difficulty articulating; a problem with motor control for pronunciation of words.
Comprehension not a problem Speech is slurred Communicate well by writing |
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What area is dysarthria associated with?
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problem with post cerebral artery > brainstem stroke.
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What is a persons affect or emotional status after a stroke?
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emotionally labile; depression common.
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What emotional changes occur following anterior cerebral artery strokes
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Peronality changes > limbic system. May be more outgoing or more quiet.
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How can intellect be affected?
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Left hemisphere - dominant for language, memory, judgement, reasoning. Actions become slow and conscious.
Right hemisphere - dominant for spiritually nonverbal communication, spacial perception. Pt. tends to be impulsive in actions. |
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How is spatial perception affected?
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Right hemisphere infarct causes most problems and results in pt. who is indifferent to or ignores a body part so that he neglects that side . left sided neglect.
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What are some other effects of spacial-perception problems.
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Can't tell up from down, left from right.
Agnosia Apraxia Homonymous hemianopia |
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Agnosia
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can't recognize objects by sight, sound, touch.
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Apraxia
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Can't carry out sequential learned behavior (tie shoes)
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Homonymuos hemianopia
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loss of half the visual field, same half in both eyes due to lesions in optic chiasm before fibers cross.
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When is homonymous hemianopia especially a problem?
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when it is combined with left sided neglect.
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What is medical management of stroke?
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dx problems and potential risks
CT, MRI Lumbar puncture arteriogram |
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Will a CT show necrotic tissue?
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No, MRI will.
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What could blood in CSF indicate?
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Hemorrhage
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What can be done to prevent strokes?
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#1 is control of reversible factors in pts. at risk:
Control HTN Control Diabetes - contributes to HTN and Artherosclerosis Cardiac problems - dig, plavix, aspirin - for prevention of clots. Lower Cholesterol |
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What is the #2 treatment for prevention of strokes?
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Surgery - endarterectomy for TIAs.
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What is endarterectomy?
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Ream out vessels with a lot of plaque. Wait until it's 80-90% occluded. Surgery must out weigh riks.
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What is the risk involved with an endarterectomy?
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Surgery can cause emboli.
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What are the signs of an emboli?
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Change in LOC, change in VS, weakness.
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Where will most emboli go?
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To middle cerebral artery.
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What management of pt. should be done following an endarterectomy?
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Monitor BP; check for occult blood - hemorrhage would be at site of occlusion. Hematoma under skin could block airway - respiratory problems.
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If there are problems from an endarterectomy when will they usually occur?
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Diring 1st 24 hours.
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What is involved with acute management of stroke?
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Maintain patent airway
Circulation Monitor Neurological changes so treatment can be adjusted as needed. Prevent further Damage. |
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What is involved with maintaining a patent airway?
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Oral airway, NT tube, suctioning management, when ICP not an issue. HOB elevated, not on side.
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What is involved with circulation mangagement?
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When BP lowered, brain not perfused as well. Make sure pt. has enough fluids to be normotensive for that pt.
SIADH - Anterior cerebral artery Diabetes Insipidus - anterior cerebral artery. |
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What medication is given for thrombotic strokes?
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Anticoagulants - Heparin, TPA - treat as quickly as possible.
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What is a hemorrhagic stroke?
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Vessel has problem with vasospasms to decrease perfusion.
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What med can be used to treat hemorrhagic strokes?
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Antifibrolytic - Amicar
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How does Amicar work?
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Allows blood to clot so doesn't break down. Use fluid to keep vessel open. The pressure of fluid in vessel keeps vessel open.
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How can further damage from stroke be prevented?
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Decrease edema
Decrease cerebral metabolism Increase cerebral blood flow but control IICP. Anticoagulants Antifibrolytics |
