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218 Cards in this Set
- Front
- Back
|
what causes stroke
|
redux in cerebral BF & O2
|
|
|
when is recovery from stroke considered complete
|
when circulation returns to normal
|
|
|
what is a common warning sign of impending stroke
|
TIA
|
|
|
how long do TIA usually last
|
30 secs to 24 hrs
|
|
|
name some common causes of stroke
|
thrombosis
embolism hemmorhage |
|
|
what is the MOST COMMON cause of stroke
|
thrombosis
|
|
|
60-80% of clients with strokes are caused by
|
thrombosis due to atherosclerosis
|
|
|
what is 2nd most common cause of stroke
|
embolus
|
|
|
what puts pts at risk for embolus
|
A-fib, orthopedic surgery
|
|
|
what is 3rd most common cause of stroke
|
hemorrhage
|
|
|
a pt w/ A-fib has _____ greater risk of stroke
|
5x
|
|
|
what is the MOST IMPORTANT modifiable risk factor for stroke
|
HTN
|
|
|
what BMI is obese
|
30 or >
|
|
|
other than HTN what are some modifiable risk factors for stroke
|
incr abd fat
obesity alcohol sedentary life smoking DM incr cholesterol |
|
|
non-modifiable risk factors for stroke
|
age
gender race |
|
|
what age are at greater risk for stroke
|
55 or > (double incidence)
|
|
|
what races are at greater risk for stroke
|
african american
hispanic american indian |
|
|
objective s/s of stroke
|
hemiplegia
hemiparesis dysphagia alexia agraphia aphagia - expressive/receptive dysarthia homonymous hemianopia proprioception reflexes poor judgement emotions - fear, anger, confusion |
|
|
what is rtPA
|
recombinant tissue plasminogen activator
|
|
|
how soon must rtPA be administered
|
within 3 hrs of s/s of stroke
|
|
|
if a pt has a L cerebral stroke, what side of the body will be affected
|
everything on the R except for ptosis
|
|
|
if a pt has a R cerebral stroke, what side of the body will have ptosis
|
right
|
|
|
what kind of drugs should a pt w A-fib be on
|
anticoags to prevent thrombi
|
|
|
what is the difference btw heparin and rtPA
|
heparin PREVENTS new clots
rtPA BREAKS clots |
|
|
name some common medical interventions for stroke
|
heparin
thrombolytics anti-platelet aggregation |
|
|
how do antiplatelets work
|
prevent platelets from aggregating on damaged vessel walls
|
|
|
are platelet drugs used for non-cardioembolic causes of TIA
|
yes
|
|
|
what nursing intervetions are used for stroke pts
|
same as caring for an unconscious pt
|
|
|
what reflexes are evaluated for stroke pts
|
gag/swallow
|
|
|
who evaluates pts ability to eat
|
speech therapy
|
|
|
what is important to remember about nutrition for stroke pts
|
place food in unaffected side of mouth
high fowlers during/after eating solid foods/thick liquids |
|
|
safety measure for stroke pts
|
keep clutter minimal
organized environment good lighting items within reach |
|
|
what is important to remember about hemianopsia
|
approach client on unaffected side
place items on unaffected side teach pt to scan |
|
|
what is important to remember about pt positioning with strokes
|
proper position prevents deformities
elevation prevents edema active/passive ROM q4hrs rehab |
|
|
how often should ROM be done for stroke pts
|
q 4 hrs
|
|
|
when should rehab begin for stroke pts
|
day 1
|
|
|
what is important to remember about dressing stroke pts
|
start on AFFECTED side
|
|
|
nursing interventions for bowel/bladder control for stroke pts
|
provide adequate fluid
diet w enuf roughage for BMs monitor for fecal impaction |
|
|
nursing interventions for family coping
|
monitor for depression in all family members
|
|
|
nursing interventions for expresive aphagia
|
associate words w/ physical objects
|
|
|
there will be LOTS of questions about hemianopsia - know this forwards and backwards
|
L side stroke means hemianopsia on R side
L side stroke - approach on L side, place personal items on L side, place food on L side of plate, etc |
|
|
how do SCDs help stroke pts
|
prevent further DVTs
|
|
|
nursing interventions for receptive aphagia
|
nonverbal techniques
slow commands |
|
|
MOST COMMON s/s of PAD
|
intermittent claudicaton
|
|
|
describe intermittent claudication
|
muscle aches and cramps, numbness - mostly in the legs
|
|
|
what is LEADING cause of PAD
|
atherosclerosis
|
|
|
other than intermittent claudicaton what are other s/s of PAD
|
smooth shiny skin w/o hair
no edema thickened nails cool, pale, mottled, cyanotic skin decr peripheral pulses |
|
|
what are some predisposing factors for PAD
|
HTN
hi cholesterol DM smoking |
|
|
how is PAD diagnosed
|
Ankle Brachial Pressure Index
|
|
|
why are pulses less palpable w/ PAD than with DVTs
|
pulses run thru arteries NOT veins - if arteries are affected (occluded) pulses will be less palpable - if DVT are present, pt will have edema which might make pulses harder to find, but they will still be present
|
|
|
how is ABPI taken
|
brachial BP over ankle BP - BP should be higher in legs
|
|
|
why should pts w/ PAD walk
|
walking causes vasodilation and will im
|
|
|
what causes "rest pain"
|
O2 deprivation during periods of inactivity
|
|
|
how long should pts w PAD walk each day
|
30-45 mins
|
|
|
how could nifedipine help a pt w/ Raynauds
|
dilates arteries and improves circulation
|
|
|
what are some interventions/tx for PAD
|
legs level w/ heart
NO elastic stockings palpate pulses distally stop smoking walking 30-45 mins/day antiplatelet drugs (ASA, plavix) PTA |
|
|
describe PTA
|
percutaneous transluminal angioplasty - balloon catheter passed thru artery
|
|
|
how are arteries affected in a pt w/ Raynauds
|
vasoSPASMS of digital arteries
|
|
|
s/s of raynauds
|
usually affects hands/feet
color change white/blue/red |
|
|
predisposing factors for raynauds
|
pressure to fingertips
smoking hand held vibrating equipment |
|
|
what forms a clot in pts w DVT
|
platelets, RBC and fibrin
|
|
|
how is DVT dx
|
ultrasound
D-dimer |
|
|
what 3 things make up Virchows triad
|
stasis
vascular damage hypercoagulability |
|
|
name some cause of veinous stasis
|
A-fib
orthopedic surgery prolonged immobility |
|
|
what are some causes of endothelial damage
|
trauma
surgery infections meds sclerosing catheters |
|
|
what causes hypercoag of blood
|
smoking
anemias pregnancy estrogen therapy birth control |
|
|
what is the antidote of heparin
|
protamin sulfate
|
|
|
what lab values are used to monitor heparin
|
PTT
|
|
|
what lab values are used to monitor coumadin
|
INR
|
|
|
what is the antidote of coumadin
|
vitamin K
|
|
|
s/s of DVT
|
edema
mescle tenderness warmth pain homans sign (dorsiflexion pain) malaise fever 50% are asymptomatic |
|
|
know what food groups are high in Vit K
|
for NCLEX know what foods are high in Vit K
|
|
|
what are some sudden initial s/s of DVT
|
sudden onset tachycardia
tachypnea anxiety hypoxia |
|
|
what is MOST IMPORTANT reason for tx DVT
|
preventing PE
|
|
|
what drugs should b used for DVT tx
|
anticoags
heparin lovenox coumadin |
|
|
why is it important to overlap heparin and coumadin tx
|
coumadin tx is delayed 5 days
|
|
|
how does coumadin work
|
blocks prothrombin formation by interfering w/ Vit K synthesis
|
|
|
what labs are used to monitor lovenox
|
platelets
CBC |
|
|
how often should pts on coumadin have INR checked
|
q 4-6 wks
|
|
|
when is thrombectomy used
|
when thrombus is RECENT and in LARGE vessel
|
|
|
should PAD pts have legs elevated above heart
|
NO
|
|
|
should DVT pts have legs elevated above heart
|
YES
|
|
|
should DVT pts get leg massages
|
no
|
|
|
what resp factors should the nurse monitor in DVT pts
|
s/s of PE
|
|
|
what antidotes should be on hand for pts coumadin, heparin and lovenox
|
protamin sulfate for heparin/lovenox
Vit K for coumadin |
|
|
are elastic stockings used for PAD pts
|
no
|
|
|
are elastic stockings used for DVT pt
|
yes
|
|
|
preventions for DVT
|
early ambulation post op
ROM avoid standing/sitting change IV tubing/catheters TEDs |
|
|
how are PEs most commonly caused
|
a DVT clot breaks loose
|
|
|
predisposing factors for PE
|
same as DVT
|
|
|
what can be done for a pt w/ recurrent DVT
|
vena cava surgery - filter/umbrella/clip installed to catch migrating thrombi
|
|
|
describe post-thrombotic syndrome
|
develops in 40-60% DVT pts
red-brown skin discoloration stasis ulcers - chronic, irregular borders, hard to heal |
|
|
what does a D-dimer test measure
|
degradation fragments generated by fibrinolysis
|
|
|
what causes stroke
|
redux in cerebral BF & O2
|
|
|
when is recovery from stroke considered complete
|
when circulation returns to normal
|
|
|
what is a common warning sign of impending stroke
|
TIA
|
|
|
how long do TIA usually last
|
30 secs to 24 hrs
|
|
|
name some common causes of stroke
|
thrombosis
|
|
|
embolism
|
blockage of...
|
|
|
what is the MOST COMMON cause of stroke
|
thrombosis
|
|
|
60-80% of clients with strokes are caused by
|
thrombosis due to atherosclerosis
|
|
|
what is 2nd most common cause of stroke
|
embolus
|
|
|
what puts pts at risk for embolus
|
A-fib, orthopedic surgery
|
|
|
what is 3rd most common cause of stroke
|
hemorrhage
|
|
|
a pt w/ A-fib has _____ greater risk of stroke
|
5x
|
|
|
what is the MOST IMPORTANT modifiable risk factor for stroke
|
HTN
|
|
|
what BMI is obese
|
30 or >
|
|
|
other than HTN what are some modifiable risk factors for stroke
|
incr abd fat
|
|
|
obesity
|
20%
|
|
|
alcohol
|
ETOH
|
|
|
sedentary life
|
COUCH
|
|
|
smoking
|
UP 400 %
|
|
|
DM
|
AS WITH EVERYTHING ELSE
|
|
|
incr cholesterol
|
incr stroke
|
|
|
non-modifiable risk factors for stroke
|
age
|
|
|
gender
|
W Male w/stress
|
|
|
race
|
wht
|
|
|
what age are at greater risk for stroke
|
55 or > (double incidence)
|
|
|
what races are at greater risk for stroke
|
african american
|
|
|
hispanic
|
hemmoragic
|
|
|
american indian
|
hemmoragic
|
|
|
objective s/s of stroke
|
hemiplegia
|
|
|
aphagia
|
- expressive/receptive
|
|
|
what is rtPA
|
recombinant tissue plasminogen activator
|
|
|
how soon must rtPA be administered
|
within 3 hrs of s/s of stroke
|
|
|
if a pt has a L cerebral stroke, what side of the body will be affected
|
everything on the R except for ptosis
|
|
|
if a pt has a R cerebral stroke, what side of the body will have ptosis
|
right
|
|
|
what kind of drugs should a pt w A-fib be on
|
anticoags to prevent thrombi
|
|
|
what is the difference btw heparin and rtPA
|
heparin PREVENTS new clots
|
|
|
name some common medical interventions for stroke
|
heparin
|
|
|
how do antiplatelets work
|
prevent platelets from aggregating on damaged vessel walls
|
|
|
are platelet drugs used for non-cardioembolic causes of TIA
|
yes
|
|
|
what nursing intervetions are used for stroke pts
|
same as caring for an unconscious pt
|
|
|
what reflexes are evaluated for stroke pts
|
gag/swallow
|
|
|
who evaluates pts ability to eat
|
speech therapy
|
|
|
what is important to remember about nutrition for stroke pts
|
place food in unaffected side of mouth
|
|
|
safety measure for stroke pts
|
keep clutter minimal
|
|
|
what is important to remember about hemianopsia
|
approach client on unaffected side
|
|
|
what is important to remember about pt positioning with strokes
|
proper position prevents deformities
|
|
|
how often should ROM be done for stroke pts
|
q 4 hrs
|
|
|
when should rehab begin for stroke pts
|
day 1
|
|
|
what is important to remember about dressing stroke pts
|
start on AFFECTED side
|
|
|
nursing interventions for bowel/bladder control for stroke pts
|
provide adequate fluid
|
|
|
nursing interventions for family coping
|
monitor for depression in all family members
|
|
|
nursing interventions for expresive aphagia
|
associate words w/ physical objects
|
|
|
there will be LOTS of questions about hemianopsia - know this forwards and backwards
|
L side stroke means hemianopsia on R side
|
|
|
how do SCDs help stroke pts
|
prevent further DVTs
|
|
|
nursing interventions for receptive aphagia
|
nonverbal techniques
|
|
|
MOST COMMON s/s of PAD
|
intermittent claudicaton
|
|
|
describe intermittent claudication
|
muscle aches and cramps, numbness - mostly in the legs
|
|
|
what is LEADING cause of PAD
|
atherosclerosis
|
|
|
other than intermittent claudicaton what are other s/s of PAD
|
smooth shiny skin w/o hair
|
|
|
decr peripheral pulses
|
S/S bleeding internal
|
|
|
what are some predisposing factors for PAD
|
HTN
|
|
|
hi cholesterol
|
Stroke incr
|
|
|
smoking
|
bad bad 400% so
|
|
|
how is PAD diagnosed
|
Ankle Brachial Pressure Index
|
|
|
why are pulses less palpable w/ PAD than with DVTs
|
pulses run thru arteries NOT veins - if arteries are affected (occluded) pulses will be less palpable - if DVT are present, pt will have edema which might make pulses harder to find, but they will still be present
|
|
|
how is ABPI taken
|
brachial BP over ankle BP - BP should be higher in legs
|
|
|
why should pts w/ PAD walk
|
walking causes vasodilation and will im
|
|
|
what causes "rest pain"
|
O2 deprivation during periods of inactivity
|
|
|
how long should pts w PAD walk each day
|
30-45 mins
|
|
|
how could nifedipine help a pt w/ Raynauds
|
dilates arteries and improves circulation
|
|
|
what are some interventions/tx for PAD
|
legs level w/ heart
|
|
|
stop smoking
|
++++
|
|
|
walking 30-45 mins/day
|
+++++
|
|
|
describe PTA
|
percutaneous transluminal angioplasty - balloon catheter passed thru artery
|
|
|
how are arteries affected in a pt w/ Raynauds
|
vasoSPASMS of digital arteries
|
|
|
s/s of raynauds
|
usually affects hands/feet
|
|
|
predisposing factors for raynauds
|
pressure to fingertips
|
|
|
what forms a clot in pts w DVT
|
platelets, RBC and fibrin
|
|
|
how is DVT dx
|
ultrasound
|
|
|
what 3 things make up Virchows triad
|
stasis
|
|
|
name some cause of veinous stasis
|
A-fib
|
|
|
prolonged immobility
|
dvt
|
|
|
what are some causes of endothelial damage
|
trauma
|
|
|
what causes hypercoag of blood
|
smoking
|
|
|
estrogen therapy
|
incr %
|
|
|
birth control
|
incr %
|
|
|
what is the antidote of heparin
|
protamin sulfate
|
|
|
what lab values are used to monitor heparin
|
PTT
|
|
|
what lab values are used to monitor coumadin
|
INR
|
|
|
what is the antidote of coumadin
|
vitamin K
|
|
|
s/s of DVT
|
edema
|
|
|
mescle tenderness
|
ACIDOSIS LACTIC
|
|
|
warmth
|
REACTION
|
|
|
pain
|
6 th V/S
|
|
|
homans sign (dorsiflexion pain)
|
Nerves
|
|
|
malaise
|
body's S/S
|
|
|
fever
|
inflammation
|
|
|
know what food groups are high in Vit K
|
for NCLEX know what foods are high in Vit K
|
|
|
what are some sudden initial s/s of DVT
|
sudden onset tachycardia
|
|
|
tachypnea
|
breath fast
|
|
|
anxiety
|
icreased
|
|
|
hypoxia
|
No O/2
|
|
|
what is MOST IMPORTANT reason for tx DVT
|
preventing PE
|
|
|
what drugs should b used for DVT tx
|
anticoags
|
|
|
heparin
|
lwmh
|
|
|
lovenox
|
dvt
|
|
|
coumadin
|
blood
|
|
|
why is it important to overlap heparin and coumadin tx
|
coumadin tx is delayed 5 days
|
|
|
how does coumadin work
|
blocks prothrombin formation by interfering w/ Vit K synthesis
|
|
|
what labs are used to monitor lovenox
|
platelets
|
|
|
how often should pts on coumadin have INR checked
|
q 4-6 wks
|
|
|
when is thrombectomy used
|
when thrombus is RECENT and in LARGE vessel
|
|
|
should PAD pts have legs elevated above heart
|
NO
|
|
|
should DVT pts have legs elevated above heart
|
YES
|
|
|
should DVT pts get leg massages
|
no
|
|
|
what resp factors should the nurse monitor in DVT pts
|
s/s of PE
|
|
|
what antidotes should be on hand for pts coumadin, heparin and lovenox
|
protamin sulfate for heparin/lovenox
|
|
|
are elastic stockings used for PAD pts
|
no
|
|
|
are elastic stockings used for DVT pt
|
yes
|
|
|
preventions for DVT
|
early ambulation post op
|
|
|
how are PEs most commonly caused
|
a DVT clot breaks loose
|
|
|
predisposing factors for PE
|
same as DVT
|
|
|
what can be done for a pt w/ recurrent DVT
|
vena cava surgery - filter/umbrella/clip installed to catch migrating thrombi
|
|
|
describe post-thrombotic syndrome
|
develops in 40-60% DVT pts
|
|
|
what does a D-dimer test measure
|
degradation fragments generated by fibrinolysis
|
