32 terms

Management of Stroke- Adult Health 1, Exam 1

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Ischemia
Inadequate blood flow
Stroke
Ischemia to a part of the brain that results in death of brain cells
Non-Modifiable Risk Factors of Stroke
Age
Gender
Ethnicity/race
Heredity/family history
Modifiable Risk Factors
Hypertension
Heart disease
Serum cholesterol
Smoking
Excess alcohol consumption
Post-op care for intravascular procedures
Neurovascular assessment
BP management (systolic shouldn't be higher than 160)
Transient Ischemic Attack
*Associated with an increased risk of stroke
*Usually a precursor to an ischemic stroke
A transient episode of neurologic dysfunction caused by temporary ischemia but without acute infarction of the brain
Types of Stroke
Ischemic
Hemmorhagic
Underlying disease for ischemic stroke
Atherosclerosis
Ischemic Strokes
Inadequate blood flow to the brain from partial or complete occlusion of an artery
80% of all strokes are:
Ischemic Strokes
Two types of ischemic strokes
Thrombotic and Embolic
Thrombotic Stroke
Occurs from injury to a blood vessel wall and formation of a blood clot
*Result of thrombosis
*Most common cause of stroke
Embolic Stroke
Occurs when an embolus lodges in and occludes a cerebral artery
*Results in infarction and edema of the area supplied by the involved vessel
Signs of an Embolic Stroke
Rapid occurrence of severe clinical symptoms
Onset is usually sudden
Patient usually remains conscious
Hemorrhagic Stroke
Results from bleeding into:
Brain tissue
Subarachnoid space or ventricles
Intracerebral hemorrhage
Bleeding within brain caused by rupture of a vessel
Signs of Intracerebral Hemorrhage
Sudden onset of symptoms
Usually preceded by a severe headache prior to losing consciousness
Subarachnoid hemorrhage
Intracranial bleeding into cerebrospinal fluid-filled space between the arachnoid and pia mater
*Caused by rupture of cerebral aneurysm, drug abuse, or trauma
"Worse headache of my life"
Subarachnoid hemorrhage
Right-brain damage
Paralyzed left side: hemiplegia
Left-sided neglect
Spatial-perception deficits
Impulsive
Left-brain damage
Paralyzed right side: hemiplegia
Impaired speech/language aphasias
Impaired right/left discrimination
Aware of deficits; depression/anxiety
Diagnostic Studies: Stroke
CT scan should be obtained w/in 25 min and read after 45 min of arrival at ER
Which stroke can be treated with tPA?
Embolic
Recombinant tissue plasminogen activator (tPA)
Used to reestablish blood flow through a blocked artery to prevent cell death
*Must be administered within 3 to 4.5 hours of onset of clinical signs of ischemic stroke
Nursing Diagnoses for Stroke
Decreased cerebral perfusion
Risk for aspiration
Impaired physical mobility
NIHI Stroke Scale
Ongoing assessment to evaluate immediate and possible advancing symptoms
Glasgow Coma Scale
The higher the score, the more alert the patient is
*On a scale of 1-6
Nursing Interventions: Musculoskeletal Function
Turn, reposition every two hours
Initiate balance training
Assistive equipment may be needed
Toileting Interventions
Implement a bowel management program:
Bowel control
Constipation
Incontinence
Urinary Elimination
Use Foley
Institute bladder retraining program
Nutrition
Assess for gag/swallowing reflex
Note dysphagia
Avoid thin liquids
Place food on unaffected side
Perceptual Deficits
Homonymous hemianopsia ( blindness in the same half of each visual field) - persistent disregard of objects in a part of the visual field