Cva

Front 1

CVA is characterized by?

Back 1

A gradual or rapid, non- convulsive onset of neurologic deficits related directly or indirectly to a deficiency of the cerebral blood supply.

Front 2

CVA is the leading cause of?

Back 2

Long term disability

Front 3

What is the #1 risk factor for CVA?

Back 3

HTN

Front 4

What are some risk factors for CVA?

Back 4

- Age
- Cardiac disorders
- Diabetes
- Smoking
- Alcohol
- Blood lipid abnormalities
- Obesity
- Family history
- Drug abuse
- Birth control pill > 30 and smokes

Front 5

What are the two types of CVA?

Back 5

- Ischemic injury: blockage of a vessel
- Hemorrhagic: rupture of a vessel

Front 6

Transient Ischemic Attack (TIA) is?

Back 6

Episodes of reversible neurologic deficits that appear for moments, or hours then disappears

Front 7

S/S of TIA

Back 7

- Visual loss or blurring
- Motor weakness or numbing
- Speech difficulties or slurring
- Vertigo

Front 8

What is the significance of a TIA?

Back 8

- Signals the existance of significant cerebrovascular disease
- Serves as a warning of potential danger

Front 9

What are the two types of ischemic CVA?

Back 9

- Thrombosis
- Embolus

Front 10

What is the difference between TIA and CVA?

Back 10

- TIA: Ischemia occurs without infarction
- CVA: Infarction and cell death occur

Front 11

Thrombosis CVA is often due to?

Back 11

Atherosclerosis

Front 12

What are the charateristics of thrombosis CVA?

Back 12

- tends to develop while asleep or within one hour of rising
- step like progression of symptoms, "Stroke in Evolution"

Front 13

What are possible clinical findings of thrombosis CVA?

Back 13

- Bruits in neck from blood going around obstructions
- other evidence of atherosclerotic disease (angina, PVD)

Front 14

What are lacunar infarcts?

Back 14

Thrombotic CVA's affecting the smaller penetrating arteries. The affected areas slough off leaving a small cavity or lake in the brain tissue.

Front 15

Thombosis vs Embolism
The extent of damage is often less severe in which?

Back 15

Embolism

Front 16

What can alot of lacunar infarcts cause?

Back 16

Dementia

Front 17

True or False
Recovery is more rapid in an embolism CVA?

Back 17

True

Front 18

Embolism CVAs are associated with what? why?

Back 18

- Heart disease becuase clots or vegetations break off from heart and travel to cerebral circulation

Front 19

Characteristics of an Embolism CVA are?

Back 19

- Symptoms develop rapidly and are unrelated to activity
- No warning or may be preceded by headache

Front 20

Possible clinical findings for Embolism CVAs are?

Back 20

- Bruit heard over the heart
- History of heart disease or thrombophlebitis

Front 21

The two hemorrhagic types of CVAs are?

Back 21

- Intracerebral hemorrhage
- Subarachnoid hemorrhage

Front 22

Hemorrhage CVAs usually have the most _____ effects and _____ recovery.

Back 22

Residual
Slow

Front 23

What type of CVA is the most common cause of death?

Back 23

Hemorrhage

Front 24

Intracerebral hemorrhage is?
Where does it bleed?

Back 24

- Rupture of an artheriosclerotic vessel in the presence of hypertension
- Bleeding into brain tissue itself

Front 25

Intracerebral hemorrhage is usually seen in what population?

Back 25

Older

Front 26

Subarachnoid hemorrhage is?
Where does it bleed?

Back 26

- Rupture of a cerebral aneurysm or arterio-venous malformation
- Bleeding into the subarachnoid space.

Front 27

Subarachnoid hemorrhage is usually seen in what population?

Back 27

Younger

Front 28

Hemorrhage CVAs characteristics are?

Back 28

- Develops abruptly with a severe headache
- Occurs during active waking hours

Front 29

What kind of CVA would most likely be found in a person stating, " worst of headache of my life"?

Back 29

Subarachnoid hemorrhage

Front 30

Clinical findings of hemorrhage CVAs include?

Back 30

- Nuchal rigidity (stiff neck)
- Bloody cerebrospinal fluid
- May see vomiting, photophobia, seizures

Front 31

Cerebral edema is a result of?peaks at?

Back 31

- Result of injury to brain tissue which sets inflammatory process in motion
- Peaks at about 2-4 days after injury

Front 32

What are the goals of treatment for cerebral edema?

Back 32

- reduce edema
- prevent penumbra from infarcting

Front 33

What are factors that determine the nature and extent of neurological defects with a CVA?

Back 33

- Size of area involved
- Location of brain injury
- Adequacy of collateral circulation
- How quickly the person gets to the ER

Front 34

What are the nursing management for acute care of a patient with CVA?

Back 34

- Patent airway (HOB up)
- Adequate O2
- Keep neck in good alignment to improve venous drainage
- F & E balance
- Frequent V/S, neuro checks
- Seizure precautions
- Monitor ICP
- Baseline assessment

Front 35

What is the purpose of diagnostic testing in CVA?

Back 35

- Distinguishes between vascular pathology and generalized conditions
- Determines location of injury and type of CVA

Front 36

What test is done first and can tell if CVA is ischemic or hemorrhage?

Back 36

CT scan

Front 37

What are the general medical management measure done for CVA?

Back 37

- Hyperosmotic diuretics
- Anticonvulsants
- Antipyretics
- Measurement of ICP
- Measurement of partial pressure of brain tissue oxygen (PbO2)

Front 38

What are the medical management measures specific to ischemia CVA?

Back 38

- Platelet aggregation inhibitors
- Anticoagulants
- Thrombolytic therapy (tPA)
- Control BP
- Oxygen
- Prevent progression of occulsive cerebrovascular disease

Front 39

Where do you want to keep the BP for an ischemic CVA?

Back 39

Normal to high normal level

Front 40

True or False
For a patient to recieve thrombolytic therapy they have to reach a certain critieria.

Back 40

True

Front 41

What is the dosage of Aspirin that would indicate it is being used as a platelet aggregation inhibitor?

Back 41

81 or 325 mg/ day

Front 42

What are medical management measure specific to hemorrhagic CVA?

Back 42

- Antihypertensive drugs
- Calcium channel blockers (for vasospasms)
- Decrease activity level
- Avoid straining

Front 43

What functions does the frontal lobe have?

Back 43

- motor function of opposite sode of body
- intellectual activites
- mature judegement
- social inhibition
- motor speech center

Front 44

What functions does the parietal lobe have?

Back 44

- body image
- sensory impulses from other side of body

Front 45

What functions does the temporal lobe have?

Back 45

- hearing
- taste
- smell
- short term memory
- sensory speech area

Front 46

What functions does the occipital lobe have?

Back 46

- visual stimuli

Front 47

What part of the brain controls vital functions?

Back 47

Hypothalamus

Front 48

What part of the brain controls rhythmic breathing?

Back 48

Pons

Front 49

What is dysarthria?

Back 49

Disturbance in the muscular control of speech, resulting in poor articulation.

Front 50

What is aphasia?

Back 50

Lost or diminshed ability to use or understand language

Front 51

What is expressive aphasia?

Back 51

Lost or diminished ability to use speech or written word (Broca's area)

Front 52

If a patient is having expressive aphasia what lobe has been damaged?

Back 52

Frontal

Front 53

What is receptive aphasia?

Back 53

Lost or diminished ability to decode or understand auditory and/ or written words (Wernicke's area)

Front 54

If a patient is having receptive aphasia what lobe has been damaged?

Back 54

Usually left temporal lobe but can also be right

Front 55

What is diplopia?

Back 55

Double vision

Front 56

What is homonymous hemianopsia?

Back 56

Defective vision or loss of vision in one half of each visual field

Front 57

What is agnosia?

Back 57

Inability to recognize sensory stimuli by sound, touch, sight, or taste.
- Does not know what an object is but knows how to use it

Front 58

What is apraxia?

Back 58

Inability to perform skilled and purposeful movements on command
- Knows what the object is and how it is use but can not use it correctly

Front 59

What is seen in a left sided injury with emotional lability?

Back 59

- Depressed
- Apathetic
- Cautious

Front 60

What is seen in a right sided injury with emotional lability?

Back 60

- Cheerful
- Euphoric
- Impulsive

Front 61

What are manifestations of right brain damage from a stroke?

Back 61

- Paralyzed left side
- Left sided neglect
- Spatial perceptual deficits
- Tends to deny or minimize problems
- Rapid performance
- Short attention span
- Impulsive (could be a safety problem)
- Impaired judgement
- Impaired time concepts

Front 62

What are manifestations of left brain damage from a stroke?

Back 62

- Paralyzed right side
- Impaired speech/ language aphasias
- Impaired R/L discrimination
- Slow performance, cautious
- Aware of deficits, depression, anxiety
- Impaired comprehension related to language, math