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110 Cards in this Set
- Front
- Back
SCI Initial mechanical disruption ofaxons as a result of stretch or laceration |
Primaryinjury |
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SCI Ongoing, progressive damage that occurs after initial injury ____ (cell death) for weeks or months after initial injury |
Secondary injury Apoptosis |
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SCI Completecord damage related to auto destruction ___ appear within 1 hour ____ by 4 hours By≤24 hours, permanent damage may occur because of ____. |
Hemorrhages Infarction edema |
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SCI Prognosiscannot be determined for at least ____ hours until swelling has gone down |
72 |
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____: characterizedby decreased reflexes, loss of sensation and flaccidity below level of injury |
Spinal Shock |
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____:loss of vasomotor tone caused by injury and is characterized by hypotension andbradycardia |
Neurogenic shock |
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_____injury of the cervical spine ruptures the posterior ligaments. |
•A, Flexion |
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____ injury of the cervical spine ruptures the anterior ligaments. |
•B, Hyperextension |
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_____ crush the vertebrae and force bony fragments into the spinal canal. |
•C, Compression fractures |
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_____ injury of the cervical spine often results in tearing of ligamentous structures that normally stabilize the spine. |
•D, Flexion-rotation |
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_____:loss of sensation in the legs Part of spine __2__ |
¡Paraplegia Thoracic / Lumbar |
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____:paralysisof all four limbs Part of spine ___ |
Tetraplegia (quadraplegia) cervical |
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Degree of SC Injury ____ Total loss of sensory and motor function below levelof injury |
Complete |
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Degree of SC Injury ____ Mixed loss of voluntary motor activity and sensation Some tracts intact |
Incomplete (partial) |
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Damageto central spinal cord Mostcommonly cervical region Morecommon in older adults Motorweakness and sensory loss Upperextremities affected more than lower |
Incomplete SCI Central Cord Syndrome |
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•injury causingacute compression of anterior portion of the spinal cord, often a ___ injury like ___ •__3___ below the level of injury •Because posterior cord tracts arenot injured, sensations of touch, position, vibration, and motion remainintact.¡ |
Anterior Cord Syndrome Whiplash Motor paralysis and loss of pain and temperature sensation |
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Incomplete SCIBrown-Séquard Syndrome Damageto___ of cord Caused by __ -- __2__ |
one-half Penetrating trauma - Gunshot wound, stabs |
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Incomplete SCIBrown-Séquard Syndrome Type of injury ___(same side of injury) ___3___ ___(opposite side of injury)___2__ |
Ipsilateral loss of motor function and position and vibration sense
Contralateral loss of pain and temperature sensation |
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•Results fromcompression or damage to the posterior spinal artery • Very rare condition • |
Incomplete SCI Posterior Cord Syndrome |
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•resulting in loss of proprioception. May have unsteady gait • •Pain, temperature sensation, and motor function below the level of the injury remain intact. |
Incomplete SCI Posterior Cord Syndrome |
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¡Resultfrom damage to very lowest portion of spinal cord (conus)and lumbar and sacral nerve roots (cauda equina) |
Conus Medullaris Syndrome/ Cauda Equina Syndrome |
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Injuryto these areas produces flaccid paralysis of lower limbs and areflexic(flaccid) bladder and bowel. |
Conus Medullaris Syndrome/ Cauda Equina Syndrome |
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Level of injury
____Total loss of respiratory muscle function →mechanicalventilation |
Above level of C4 |
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Level of injury' ____ Diaphragmaticbreathing→respiratory insufficiency |
Below level of C4 |
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__2__ injuries Paralysis of abdominal andintercostal muscles → ineffectivecough →atelectasis or pneumonia ↑Riskfor infection -Cant move around a lot, cough, etc |
Cervical and thoracic |
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Level of injury' ____↓influence of sympathetic nervous system This causes __3__ |
Injury above level T6 Bradycardia, Peripheral vasodilation → hypotension |
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SCI Cardiacmonitoring necessary ____ to ↑heart rate and prevent hypoxemia, which is a ____ drug |
Atropine |
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Spinal shockAcutephase Urinary____ Bladderatonic and over distended use ___ |
retention Indwelling catheter |
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Level of injury' ____ Paralyticileus Gastricdistention May give ___ or use ____ |
¡AboveT5→hypo-motility Metoclopramide(Reglan)* Nasogastrictube |
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Level of injury' Neurogenic bowel |
Injury level of T12 or below |
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Bothareflexicand reflexicneurogenic bowel can be managed successfully with a ____ coordinated with the gastrocolicreflex to minimize fecal incontinence. |
regular bowel program |
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↓Abilityto sweat or shiver Morecommon with high cervical injury Inabilityto regulate temperature |
nursing |
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¡NGsuctioning →metabolic ____ ¡Monitor____ |
alkalosis Electrolyte imbalances |
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SCI ____ gold standard to locate thedegree of injury |
CT scan |
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SCI Initialcare__6__ in order |
Ensure patent airway. Stabilize cervical spine. Log roll/C-collar Administer oxygen. Establish IV access. Assess for other injuries. Control external bleeding. |
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SCI Usea hard cervical collar, and a backboard to stabilize the neck to prevent____ |
lateral rotation Performturning so that the patient is moved as a unit |
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SCI OngoingmonitoringVS,LOC, O2sat, cardiac rhythm, urine output Keepwarm. Monitorfor urinary retention, hypertension. Anticipateneed for intubation if no gag reflex. |
Nursing |
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____ Earlysurgery indicated ifEvidenceof cord compression |
laminectomy |
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____Vasopressoragent Usedto maintain mean arterial pressure ____ |
dopamine
> 90 mm Hg |
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with neck braces and traction __2___ |
Checkfor skin integrity around braces and pin care. |
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____ critical with all types of immobilization |
¡Meticulous skin care |
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____ Mayincreased during first 48 hours of SCI Mayneed intubation and mechanical ventilation ↑Riskfor ___2___ Interventions: 6 |
Respiratory Dysfunction pneumonia and atelectasis RegularassessmentAggressivechest physiotherapyAdequateoxygenationProperpain managementAssistedcoughing TrachealsuctioningIncentivespirometry |
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Cardiovascular Instability with SCI Riskfor ____ and cardiac arrest Chronic___ blood pressure with postural hypotension ↑Riskfor___ |
bradycardia low DVT |
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SCI Bowel Management 3 |
Dailyrectal stimulant Digital stimulation or manual evacuation Uprightposition when able |
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Massiveuncompensated cardiovascular reaction mediated by sympathetic nervous system •Vitalsigns change Hypertensionand bradycardia |
Autonomic Dysreflexia |
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Level of injury ____ ____ caused by Autonomic Dysreflexia |
T6and higher insult Hypertension and bradycardia |
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¡Mostcommon precipitating factor is distended bladder or rectum. HypertensionThrobbingheadache Markeddiaphoresis above level of injuryBradycardia |
Autonomic Dysreflexia |
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when someone has a throbbing headache |
( take blood pressure) |
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Autonomic Dysreflexia Nursinginterventions Elevatehead, notify HCP 3 |
immediatecatheterization removestool impaction if cause removeconstrictive clothing and tight shoes |
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Areflexic(flaccid), hyperreflexic(spastic), or dyssynergia Commonproblems : Urgency,frequency, incontinence, inability to void, and high bladder pressuresresulting in reflux of urine into kidneys |
Neurogenic Bladder |
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____ Bowel Voluntarycontrol may be lost. interventions 7 |
Neurogenic Bowel High-fiber diet / Adequate fluid intake / Suppositories / Small-volume enemas / Digital stimulation /Stoolsoftener /Oralstimulant laxatives |
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Thebrain requires a continuous supply of blood to provide the___2___ that neurons need to function. A ____ occurs when there is an interruption,either from ischemia to a part of the brain or hemorrhage into the brain, inthe blood supply that results in the death of brain cells. |
oxygen and glucose stroke, CVA |
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•Followingthe onset of a stroke, immediate ___ is crucial to decreasedisability and death. |
medical attention |
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Stroke •Loss of function varies according to__2__ |
the location and extent of brain tissue involved. |
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Control thinking, memory, behavior, movement |
frontal lobe |
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controls hearing, learning, and feelings |
temporal lobe |
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control breathing, hr, and temp |
brain stem |
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controls language and touch |
parietal lobe |
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control sight |
occipital lobe |
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control balance and coordination |
cerebellum |
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•Most effective way to decrease theburden of stroke is __2__ |
prevention and teaching. |
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Stroke
•____ is the single most important modifiable risk factor, but it is still oftenundetected and inadequately treated. |
Hypertension |
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LipidPanel •Cholesterol – ___ •Triglyceride – ____ •Low density lipoprotien– ____ •High density lipoprotien–____ |
less than 200 less than 150 less than 100-139 more than 40 |
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• waist circumference: >40 men and >35 women• • triglycerides: > 150• • HDL: >40• •Hypertension: >135/85• •Fastingblood glucose > 110 |
MetabolicSyndrome |
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•____ is responsible for about 20% of all strokes; incidence increaseswith age. àthese can be large clots and cause major damage |
Atrial fibrillation |
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•____ is a transient episode of neurologic dysfunction caused by focal brain, spinalcord, or retinal ischemia, but withoutacute infarction of the brain. should be treated as ___ |
TIA medical emergency |
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•____ may be due to microemboli thattemporarily block the blood flow. they are a warning sign of progressivecerebrovascular disease. •Symptomstypically last ___. •___will progress to an ischemic stroke. |
TIAs < 1 hour 1/3 |
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•Strokesare classified based on the underlying pathophysiologic findings: •___: blood flow restriction •___: bleeding out |
Ischemic Hemorrhagic |
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•____,a hardening and thickening of arteries, is the major cause of ischemic stroke.It can lead to thrombus formation and contribute to emboli. |
Atherosclerosis |
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•____ stroke•Occurs from injury to a bloodvessel wall and formation of a blood clot Most common cause of stroke 60% •Signsand symptoms develop slowly |
Thrombotic |
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•____ stroke occurs when an emboluslodges in and occludes a cerebral artery, resulting in infarction and edema ofthe area supplied by the involved vessel. •This accounts for about 24% ofstrokes. |
Embolic |
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•Patient with an ___ strokecommonly has a rapid occurrence of severe clinical manifestations. |
embolic |
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• _____ is one cause of embolic stroke in young to middle-aged adults. Anembolus arising from an atherosclerotic plaque is more common in older adults. |
Rheumatic heart disease |
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•Prognosisis poor with a 30-day mortality rate of 40-80%. •Bleeding within brain caused byrupture of a vessel•Sudden onset of symptoms |
HemorrhagicStroke |
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HemorrhagicStroke •____ is most common cause. •Hemorrhage occurs during activity. |
Hypertension |
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•Intracranial bleeding intocerebrospinal fluid–filled space between the arachnoid and piamater •Commonly caused by rupture of acerebral aneurysm, trauma, or drug abuse |
•Subarachnoidhemorrhage (SAH) stroke |
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•Majority of aneurysms are in the___ |
Circle of Willis. |
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•____the ballooning artery applies pressure to brain tissue minor warningsymptoms may result from leaking before major rupture. Viewed as a “____r” as individuals donot have warning signs until rupture has occurred. |
aneurysm silent killer |
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S/S ofruptured aneurysm – 5 Med Emergency |
Suddensevere headache Visionproblems Nauseaand vomiting Confusion Stiffor painful neck |
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A lesion on the right of the brain There is effects on the____ |
left side |
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•Most obvious effect of stroke •Includeimpairment of•Mobility•Respiratory function•Swallowing and speech•Gag reflex•Self-care abilities |
Motor Function |
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Stroke Drug therapy 3 |
•Commondose for aspirin is 81 to 325 mg/day. Other drugsinclude clopidogrel(Plavix)* Forpatients who have atrial fibrillation, oral anticoagulation can includewarfarin (Coumadin)* •Statins(simvastatin [Zocor],* have also been shown to be effective in the prevention of stroke forindividuals who have experienced a TIA in the past. |
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•In a ____, the atheromatous lesion is removed from the carotidartery to improve blood flow. |
carotid endarterectomy (CEA) |
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o Neurogenic shock: Give 2 |
atropine and dopamine |
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o ___ – Mini stroke, med emergency, should go backto normal w/in 1 hr |
TIA |
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§ ____ stroke starts as a plaque build up· FROM High ___ |
Thombotic cholesterol |
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§ ____ stroke – blood clot· ____cause· ____ is cause in children |
Embolic A fib Rheumatic heart disease |
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o ___ stroke – burst blood vessel § __2__ cause Severe throbbing headache that is persistent “Thunderclap” |
Hemorrhagic HTN & cerebral aneurysm |
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ClinicalManifestations of Stroke are related to ___ |
location of stroke |
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o R/L Brain Stroke Right side: ____ Left side: __3__ |
very impulsive people slow, cautious, aware of impairment |
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•Most obvious effect of stroke ___ includes __5__ |
Motor Function Includeimpairment ofMobilityRespiratoryfunctionSwallowingand speechGagreflexSelf-careabilities |
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•Loss of skilled voluntary movement |
•Akinesia |
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•___ occurs when stroke damages dominant hemisphere of the brain and affectslanguage. •___ – loss of comprehension •___ – loss of production oflanguage •___ – total inability tocommunicate |
Aphasia Receptive Expressive Global |
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•___ refers to impaired ability to communicate. |
Dysphasia |
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•Patients who suffer a stroke may havedifficulty controlling their emotions. •Emotionalresponses may be exaggerated or unpredictable. |
nursing |
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•Strokeon the right side of the brain is more likely to cause problems in____ |
spatial-perceptual orientation. - •Incorrect perception of self andillness•Unilateral neglect•Agnosia•Apraxia |
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Stroke prevention
•Goalsinclude management of modifiable risk factors •Healthy diet•Weight control•Regular exercise•No smoking•Limited alcohol consumption•Routine health assessments |
nursing |
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•Antiplatelet drugs are used in patients who have had a TIA related toatherosclerosis. •___ is the most frequently usedantiplatelet agent. |
Aspirin |
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•Forpatients who have atrial fibrillation, oral anticoagulation can include___) |
warfarin (Coumadin |
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•Carotidendarterectomy isperformed to prevent impending cerebral infarction. •A, Atube is inserted above and below the blockage to reroute the blood flow. •B,Atherosclerotic plaque in the common carotid artery is removed. •C,Once the artery is stitched closed, the tube can be removed. A surgeon may alsoperform the technique without rerouting the blood flow. |
nursing |
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•Brainstent used to treat blockages in cerebral blood flow. •A, Aballoon catheter is used to implant the stent into an artery of the brain. •B, Theballoon catheter is moved to the blocked area of the artery and then inflated.The stent expands due to the inflation of the balloon. •C, Theballoon is deflated and withdrawn, leaving the stent permanently in placeholding the artery open and improving the flow of blood. |
nursing |
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o Affect is ___2__ with stroke |
unpredictable (may be depression) |
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•___ is common immediately after a stroke. |
Elevated BP •TheUse ofdrugs to lower BP is recommended only if BP is markedly increased (meanarterial pressure greater than 130 mm Hg or systolic pressure greater than 220mm Hg). In the case of an acute stroke, |
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•Must be administered within 3 to4.5 hours of onset of clinical signs ofischemic stroke |
•Recombinanttissue plasminogen activator (tPA)(Immediate use) |
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Stroke o Diagnostic: ___ |
CT scan |
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CEA Postoperative care is important 4 |
o Neurovascular assessment o BP management o Assessment of stent occlusion o Keep legs straight * |
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Stroke Pt o Make sure pt is adequately hydrated – *do notuse ___ like ___2___ |
hypotonic solutions These include 0.45% NS AND D5W |
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· After stroke, patient is at risk for ___ becausethey are not moving as much |
VTE |
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•Sensory-perceptualalterations •Patients with stroke on ___ side ofbrain•Difficulty in judging position,distance, and movement•Impulsive, impatient, and denyproblems related to stroke•Respond best to directions givenverbally |
right |
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•Sensory-perceptualalterations•Patients with stroke on ___ side ofbrain•Slower in organization andperformance of tasks•Impaired spatial discrimination•Have fearful, anxious response tostroke•Respond well to nonverbal cues |
left |