Chapter 62 - Stroke

Front 1

Hemorrhagic strokes

Back 1

15-2% of cerebrovascular disorders

Front 2

Hemorrhagic strokes are primarily caused by

Back 2

intracranial or subarachnoid hemorrhage

Front 3

Hemorrhagic strokes are caused by

Back 3

bleeding into the brain tissue
ventricles
subarachnoid space

Front 4

Primary intracerebral hemorrhage from a spontaneous rupture of small vessels accounts for

Back 4

approximately 80% of hemorrhagic strokes - CHIEFLY CAUSED BY HYPERTENSION

Front 5

Subarachnoid hemorrhage result from a ruptured intracranial aneurysm

Back 5

IN ABOUT HALF THE CASES

Front 6

Treatment carotid stenois

Back 6

carotid endarterectomy

Front 7

Atrial fibrillation (increasing the risk of emboli)

Back 7

administration of warfarin (Coumadin) an anticoagulant may prevent thrombotic and embolic strokes

Front 8

Modifiable risk factors ISCHMEIC STROKES;

Back 8

Hypertension
Atrial fibrillation
Hyperlipidemia
DM
Smoking
Asymptomatic carotid stenosis
Obesity
Excessive alcohol

Front 9

INR target is

Back 9

2-3

Front 10

Warfarin contraindicated...

Back 10

aspirin

Front 11

Statins, ACE, thiazides

Back 11

reduce coronary events and srokes

Front 12

thrombolytic agents are used to treat ischemic strokes by

Back 12

dissolving the blood clot that is blocking blood flow the brain

Front 13

3 hour window for

Back 13

thrombolytic therapy or revascularization of necrotic tissue (which develops after 3 hours)

Front 14

NO THROMBOLYTIC THERAPY

Back 14

Greater than 3 hours
INR above 1.7
If candidate - no anticoagulants for next 24 hours

Front 15

National Institutes of Health Stroke Care

Back 15

0 (normal) 42 (severe stroke)

Front 16

The dosage for t-PA is 0.9mk/kg, with a max dose of 90mg

Back 16

10% is administered as IV bolus over one minute
90% IV over 1 hours

Front 17

T-PA administration criteria

Back 17

18 years old
3 hours or less
185/110
Not minor
No seizure activity at time of stroke
No warfarin
Prothrombin <15 sec or INR < 1.7
No heparin last 48
Platelet >100,000
No surgical procedures 14 days
No stroke 3 months
No GI bleed 21 days

Front 18

Stroke - Vital Signs

Back 18

every 15 minutes for first 2 hours
every 30 minutes for next 6 hours
every hour until 24 hours

Front 19

BP - Stroke - should be maintained at

Back 19

less than 180/105

Front 20

Stroke - Airway

Back 20

maintain ABG values

Front 21

Bleeding is the most common side affect of

Back 21

t-PA

Front 22

Potential complications after stroke

Back 22

UTI
cardiac dysrhythmia
complications of immobility