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Terms in this set (48)
What is a RIND?
It is like a TIA, but the sx resolve within a week
How does stroke rank in mortality?
It is the 3rd leading cause of death in the USA
What type of onset do thrombotic strokes have?
What is an arteriovenous malformation?
Uncommon abnormality of tangled arteries and veins in brain, started during embryonic development
Does drugs increase risk of stroke?
Yes, like cocaine....so we see young ppl coming in with strokes more as we have more IV drug abusers
Which race has the highest prevalence of stroke?
Blacks more than whites
Mexican Americans with a fib have more recurrent strokes than whites
How much does sleep apnea increase risk of stroke?
3 to 6 times
When do ischemic strokes tend to happen?
When do hemorrhagic strokes happen?
During activity; rapid
If sx have gotten worse after initial onset, what type of stroke is it probably?
If sx have gotten better after initial onset, what type of stroke is it probably?
In the ER quickly should a stroke patient be evaluated?
Within 10 minutes
The right cerebral hemisphere is more involved with....
Visual and spatial awareness and proprioception
A patient with left hemisphere stroke will have what types of issues?
Aphasia, dyslexia, agraphia (difficulty writing), and difficulty with mathematical calculations
What is agnosia?
Inability to use an object correctly
What is apraxia?
Inability to carry out a purposeful motor activity or speech
What is ptosis?
What is amaurosis fugax?
Brief episode of blindness in one eye, results from retinal ischemia
What is hemianopsia?
Blindness in half of the visual field
What is homonymous hemianopsia?
Blindness on the same side of both eyes
What would abnormal eye movements like nystagmus indicate>
Damage to the brainstem
What function comes from cranial nerve 5?
What function comes from cranial nerve 9 and 10?
What function comes from cranial nerve 8?
What function is interrupted from cranial nerve 9?
Absent gag reflex
What cardiac assessment findings may be notes with embolic stroke?
Heart murmur, dysrhythmias (usually a fib), and hypertension
Should blood pressure be high with stroke?
We want it high to allow cerebral perfusion, but not higher than 150/100. But above that they are at risk again for stroke
Why are Hct and Hgb elevated with stroke?
Compensate for lack of oxygen
For intial dx of stroke, should CT scan be with or without contrast?
For a patient that is having an ischemic stroke, what is the standard practice?
Start 2 IV lines with non-dextrose isotonic saline. Assess the patient continually for increased ICP while you do this
What is the standard windown to be eligible for tpa?
3 hours from the last time seen normal
How is fibrinolytic therapy dosage decided on?
It is based on patient's actual weight
What are nursing intervnetions during and after giving rtPA?
Administer rtPA 0.9 mg/kg (max dose 90 mg) over 1 hour with 105 of the dose given as a bolus over 1 minute
Get them to ICU
Perform neuro assessments every 10 to 15 minutes during, and every 30 minutes after
If BP greater than 180 systolic or 105 diastolic- give antihypertensives
Do not place NG tube or catheter until pt is stab;e to prevent bleeding
STOP infusion if the pt reports severe headache, hypertension, bleeding, N + V.
Get a follow up CT before starting antiplatelets/anticoags
What is embolecotmy?
Clot removal. Good for pts that have missed the 3 hour window. They must have come in within 8 hours though
If pt has risk for increased ICP, why should we avoid extreme hip flexion?
This increases intrathoracic pressure which in turn may increase ICP
What degree angle should we elevate HOB for pt with increased ICP
25 to 30 degrees, avoid extreme hip flexion
What effect does suctioning have on ICP?
Before suctioning ICP patient, what should you do?
Why should we monitor temp for a patient at risk for increased ICP?
Fever may cause increased ICP; while hypothermia may cause decreased cerebral perfusion
How far apart do aspirin and rtPA need to be given?
Must be given at least 24 hours apart
What is a complication of carotid artery angioplasty with stent?
Hyperperfusion syndrome, which has a high morbidity and mortality rate. S/S are HTN, seizures, and focal/neuro deficits
What should we do with the a patient who has a flaccid arm from stroke?
Support the affected arm and put a pillow to prevent it from hanging freely
What is dysarthria?
What is the other name for expressive aphasia?
Broca's aphasia (motor)
What is the other name for receptive aphasia?
Wernickes aphasia (sensory)
How should you begin a bladder training program?
Place the patient on a bedpan or offer comode/urinal every 2 hours.
From which side should you approach a stroke patient, from the affected or unaffected side?
What should be in bath tub and shower?
Should have anti-skid patches or strips and there should be grab bars...all to prevent slipping
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