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chapter 67 management of pts with cerebrovascular disorder

Terms in this set (42)

agnosia
loss of ability to recognize objects though a particular sensory system, may be visual, auditory, or tactile
aneurysm
weakening or bulge in an arterial wall
aphasia
inability to express oneself or to understand language
apraxia
inability to perform previously learned purposeful motor acts on a voluntary basis
dysarthria
defects of articulation due to neurologic causes
dysphagia
difficulty swallowing
expressive aphasia
inability to express onself, often associated with damge to the left frontal lobe area
hemianopsia
blindness of half of the field of vision in one or both eyes
hemiparesis
weakness of one side of the body or part of it, due to an injury in the motor area of the brain
hemiplegia
paralysis of one side of the body, or part of it due to an injury in the motor are of the brain
infarction
tissue necrosis in an area deprived of blood supply
penumbra region
area of low cerebral blood flow
receptive aphasia
inability to understand what someone else is saying, often associated with damage to the temporal lobe area
cerebrovascular disorder
Functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted
non modifiable risk factors
age over 55, male gender, african americans , doubles each decade
modifiable risks
HTN, cardiovascular disease, high cholesterol or elevated hct, obesity , diabetes, oral contraceptives, smoking and drugs
stroke
A sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted
two types of strokes
ischemic 87% and hemorrhagic 13%
ischemic stroke
Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of brain tissue
Large artery thrombosis
A type of ischemic stroke that occurs due to atherosclerosis of the large blood vessels within the brain and thrombosis formation. 20%
small penetrating artery thrombosis
Also called lacunar stroke; a type of ischemic stroke that affects one or more small vessels. The most common form of ischemic stroke. 25%
Cardiogenic embolism
usually afib 20%
cryptogenic
unknown origin, type of ischemic stroke 30%
manifestations of ischemic stroke
Symptoms depend upon the location and size of the affected area
Numbness or weakness of face, arm, or leg, especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance or coordination
Sudden, severe headache
Perceptual disturbances
FAST
Face drooping
Arm weakness
Speech difficulty
Time to call 911
transient ischemic attack
temporary neurologic deficit resulting from a temporary impairment of blood flow
warning of tia
big stroke is coming
TIA
sudden loss of motor, sensory, or visual function . lasts 1-2 hr, 15% of strokes are preceded by
medical management prevention
control of hypertension
medical management
treatment of vasospasm, increased ICP, HTN, potential seizures, prevention of further bleeding
assessment of stroke
NIHSS assessment tool
thrombolytic therapy
drugs to dissolve clots are injected into the bloodstream
TPA goal
with in 60 min of reaching er, intra arterial after 6hr (directly to clot)
TPA function
digests the fiber in fibrogen breaking the clot
hemorrhagic stroke
bleeding into brain tissues, the ventricles, or subarachnoid space : compression or secondary ischemia from reduced profusion and vasoconstriction causes injury to brain tissue
manifestation of hemorrhagic stroke
similar to ischemic, severe HA, early and sudden changes in LOC, vomiting and bleeding
potential complications of ischemic stroke
decreased cerebral blood flow, inadequate oxygen delivery to brain , pneumonia vasospasm, seizure, hydrocephalus, rebleeding, hyponatremia
vasospasms
HA, decreased LOC, asphasia or partial paralysis
hydrocephalus
blood in subarachnoid space of ventricles, impede circulation
rebleeding
recurrent hemorrhage (HTN most serious)
hyponatremia
found with onset of vasospasm can lead to SIADH
aneurysm precautions
non stimulating non stressful environment , absolute bedrest HOB 30, avoid all activity that may increase ICP, stool softener and mild laxatives, visitors restricted
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