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118 Cards in this Set

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  • Back
What does complete recovery of stroke depend on?
circulation returning to normal
This is often a warning sign of a stroke.
transient ischemic attack
What is the most common cause of stroke?
thrombosis due to atherosclerosis
Who is most at risk for embolus?
individuals with a-fib, orthopedic surgery
What is the most important modifiable risk factor for stroke?
hypertension
Obesity is defined as BMI > ___.
30
What are non-modifiable risk factors for stroke?
age, gender, race
What is dysphagia?
impaired swallowing
What is agraphia?
loss of ability to write
_____ aphasia is difficulty making thoughts known to others.
Expressive
____ aphasia is difficulty understanding what others tries to communicate.
Receptive
What is dysarthria?
paralysis of the facial muscles
What does the affected side of vision correspond with?
paralyzed side of body
What is homonymous hemianopia?
loss of half of visual field
What is proprioception?
awareness of body position on space
What does the extent of injury with a stroke depend on?
artery location
What type of medical intervention is needed for stroke if A-fib is present?
anticoagulant therapy
This treatment dramatically improves the chance of survival?
rtPA--> recombinant tissue plasminogen activator
How soon should rtPA be administered?
within the 3 hours of s/s
What is rtPA contraindicated in?
active or history of bleeding, low platelet count, taking anticoagulants
What is there a huge risk for if gag reflex is decreased?
aspiration
____ therapy will help evaluate the pts ability to eat safely
Speech
What type of foods are tolerated best for stroke patients?
semi-solid
What position should stroke patient be in for meals?
High-Fowler's
How long should stroke patient stay in High-Fowler's after eating?
45-60 minutes
For homonymous hemianopia, where should personal belongings be placed?
on unaffected side
How do you prevent edema in the lower extremities?
elevation of limbs
When should rehab begin?
day 1
What should the patient do as much of as possible, even though it can be time consuming?
self-care
What is a bowel complication associated with stroke?
fecal impaction
This affects the legs more often than the arms.
peripheral vascular disease
What is the patho of PVD?
occluded arterial blood flow due to atherosclerosis
What is the most common s/s of PVD?
intermittent claudication; may have numbness in leg muscles
What is the skin appearance with PVD?
skin may be smooth and shinny with hair loss
PVD decreases ___ ____.
peripheral pulses
What is a major predisposing factor for PVD?
hypertension
This identifies the severity of occlusive disease.
Ankle Brachial Pressure Index
What is a major intervention for treating PVD?
legs should be kept level with the heart; wear well fitted shoes
What should be checked distal to occlusion in PVD?
pulses
These have been reported to decrease progression of atherosclerosis in pts with peripheral arterial occlusive disease.
antiplatelet agents (ASA)
What is Raynaud's disease?
vasospasms of digital arteries
What might individuals with Raynaud's later develop?
connective tissue disease
What does Raynaud's usually affect?
hand
What is the treatment for Raynaud's?
abstention from tobacco; cover extremities involved when exposed to cold
What is deep vein thrombophlebitis?
inflammation of a vein that has formed a clot
What forms a clot in DVT?
platelets, RBC, fibrin
What are the three factors that contribute to the development of DVT?
stasis, vascular damage, and hypercoagulability
What are the causes of venous stasis?
A-fib, orthopedic surgery, prolonged immobility
What are the causes of hypercoagulability of blood?
cigarette smoking, pregnancy
What are the s/s that occur with DVT that only happen when the clot completely obstructs blood flow?
swelling, muscle tenderness, warmth of the affected extremity, pain, malaise, fever
What is the most common symptom with DVT?
pain
How is post-thrombotic syndrome characterized?
skin changes (ankle reddish-brown discoloration), ulceration (stasis ulcer)
What are some of the diagnostics for DVT?
venous ultrasonography, d-dimer
This is an unreliable diagnostic for DVT?
Homan's sign--> pain during dorsiflexion of the foot
What is the most important reason for treating DVT?
prevention of PE
What is the cornerstone for DVT therapy?
Heparin, Lovenox, and Coumadin
Why is lab monitoring easier with Lovenox therapy?
longer half-life
With lovenox injections what might the patient notice?
small, purple hemorrhage area on the upper abdomen
What is important to overlap heparin treatment with?
Coumadin
Coumadin blocks ____ ____.
prothrombin synthesis
What does Coumadin interfere with?
Vitamin K
How often should INR be checked for patients on Coumadin?
q 4-6 weeks
How should the involved extremity be positioned to avoid edema?
above the heart to increase venous return
What should you avoid doing to keep the clot from moving?
rubbing the leg or ambulating the client
Which labs should be monitored if taking Lovenox?
CBC and platelet
What is the antidote for Heparin and Lovenox?
Protamine Sulfate
What is the antidote for Coumadin?
Vitamin K
What should you tell the patient on anticoagulant therapy to avoid regarding OTC drugs?
aspirin; obtain physician's permission
When ambulating what should the client with DVT use?
elastic stockings
What are some preventative measures for DVT?
early ambulation in post-op patients, passive or active ROM for bedridden patients, change IV tubing q24-48 hours and IV catheter q48-96 hours, avoid sitting or standing for long time, TED stockings
What is one of the most common preventable diseases?
pulmonary embolism
What is the cause of a PE?
usually when a thrombus in the deep veins of the lower extremities loosens or dislodges and moves to the pulmonary system
What is a major s/s of PE?
pleuritic chest pain
What type of diet should be ordered for a stroke patient?
provide adequate fluid intake; diet with enough roughage for sufficient quantity of bowel content (increase fiber)
What is PVD?
progressive narrowing and degenerative disease of the blood vessels in the peripheral circulation
What is the leading cause of PVD in pts over 40?
atherosclerosis
What have antiplatelets been reported to do?
decrease progression of atherosclerosis in patients with peripheral arterial occlusive disease
What is the treatment for Raynaud's?
abstention from tobacco; cover extremities involved when exposed to cold
What are some causes of venous stasis?
advanced age, A-fib, orthopedic surgery, prolonged immobility
What are some causes of endothelial damage?
trauma, IV medications, abdominal surgery
What are some causes of hypercoagulability?
cigarette smoking, pregnancy, estrogen therapy
This develops in 40-60% of clients with DVT?
post-thrombotic syndrome
How is post-thrombotic characterized?
chronic leg pain, edema, skin changes (ankle reddish-brown discoloration) ulceration
What does doppler ultrasound measure?
velocity of blood flow in veins
What does D-dimer measure?
fibrin degredation fragments
A patient with DVT should be put on __ ___ so the clot wont embolize.
bed rest
What causes atherosclerosis?
HTN, high cholesterol (fatty foods)
What are the primary causes of stroke?
thrombosis, embolus, hemorrhage
What has been shown to be an independent risk factor for stroke?
obesity and abdominal fat
Why is A-fib a risk factor for stroke?
because of venous stasis--> more potential for clotting
What is the only s/s you will see on the same side as the stroke?
dropping eyelid (ptosis)
If you have a left-sided stroke what are the s/s on the right side?
hemianopia and paralysis
What is a nursing intervention for hemianopsia?
teach the patient to scan (turn the head to see things on affected side)
For a left-sided stroke where might the dysarthia be manifested?
on the right side
What is the diagnostic for stroke?
MRI and CT scan
What are the nursing interventions for acute care patients with stroke?
neuro checks, monitor for increased ICP, observe face for symmetry
What is "arm drift"
try to keep your hands up and they drift down
What is the best way to prevent aspiration?
assess for gag reflex (but the presence of a gag reflex is not guarantee against aspiration)
What type of diet should the patient be on until gag reflex is evaluated?
NPO
How should the nurse approach a client with hemianopsia?
on the unaffected side
WHy should we keep stroke client in prone position for 15 minutes?
prevent contractions
Why do contractures occur?
arms have not been moved; no ROM has been performed q4' on all extremities
What is important for the clients and family members?
referrals (family coping strategies)
What is a major NI for expressive aphasia?
associate words with physical objects
What is very helpful for a patient with receptive aphasia?
nonverbal communication
What disorder is commonly associated with PVD?
diabetes
What type of treatment might be best for PVD?
antiplatelets (ASA)
What is the name of the pain for PVD?
intermittent claudication (relieved with rest)
How should the legs be positioned with PVD?
level with the heart
What should a client avoid wearing with a venous disease (PVD).
TED hose
How should the legs be positioned with DVT?
above the heart
What are some NI for arterial occlusive disease?
wash legs with warm water, do not wear ted hose, apply moisturizing cream to feet
What is rest pain with arterial occlusive disease?
his legs are deprived of oxygen during periods of inactivity
Why is Nifedipine a treatment for Raynaud's?
helps with arterial dilation
What should be monitored on a patient taking Coumadin?
intake of vitamin K rich foods (green leafy vegetables)
What is HIT?
an allergy against heparin; develop antibodies against heparin
What does HIT do to platelets?
they are dropped by 50%
What is the most important NI for prevention of DVT in pre-op patients?
in bed ROM