a temporary blockage of blood to the brain that causes transient neuro impairment
Are the risk factors for a TIA the same as for a full blown stroke?
about ____ of patients that have a TIA will have a stroke in the future.
When is it determined that a TIA was actually a stroke?
if it causes permanent damage to the brain
What is the focus of treatment for a TIA?
preventing a full stroke
Stroke is our nation's number ___ killer.
What 2 things are essential for the survival of the brain?
o2 and glucose (it cannot store it so it needs a constant supply)
healthy tissue that surrounds an infarct in the brain in which the brain tissue is stunned and can be revived if perfused
strokes are classified as _______ or _______.
what kind of stroke is most common?
What are the 2 kinds of ischemic strokes?
this kind of stroke occurs when the blood supply to the brain is blocked or significantly slowed
this stroke occurs when an occlusion builds up in an artery until it significantly decreases or stops blood to the brain
where do a lot of thrombotic strokes occur?
this stroke is typcially caused by a blood clot that is created somewhere in the body and travel through the arteries until it becomes trapped in a smaller vessel. Usually in a cerebral artery.
this kind of stroke is caused by the rupture of a cerebral blood vessel that allows blood to escape into brain tissue and not travel beyond the point of rupture
What are the 2 kinds of hemorrhagic strokes?
this type of stroke occurs on the surface of the brain and is most often the result of a ruptured cerebral aneruysm. These are very serious, require surgery, often fatal.
THIS TYPE OF STROKE OCCURS IN THE DEEPER TISSUES OF THE BRAIN AND USUALLY IS CAUSED FROM UNCONTROLLED HYPERTENSION.
A patient can have multiple undetected instances of this, with minimal deficits noted. However, damage will eventually accumlate and major defecits will develop.
What is the goal for pts who have had an intracerebral hemorrhage?
maintain bp below 120/80
Risk factors for ischemic strokes are classified as _______ and _________
every ___ points of systolic bp over 120 doubles the risk of a stroke.
what are the 5 s/sx of stroke?
(all sudden onset) 1. numbness or weakness of face, arm or leg on one side 2. confusion or trouble speaking 3. trouble seeing in one or both eyes 4. trouble walking or with coordination 5. severe headache with no known cause
Keeping blood sugar steady is a _______ risk factor for stroke.
Why is atrial fibrillation a risk factor for stroke?
the afibrillation can create blood clots
asymptomatic carotid stenosis is caused by?
What is the best route of action to follow if you observe a stroke victim?
call EMS for an ambulance. They are treated faster (within 2 hours of symptom onset)
What does the acronym FAST (used to recognize stroke) mean?
Facial droop (ask person to smile) Arm drift (close eyes with arm out in front and one drifts downward) Speech (is their speech affected?) Time (time is of the essence!)
What is the window for treatment from the onset of stroke symptoms?
when both expressive AND receptive aphasia is present, it is called
slurred or indistinct speech because of a motor problem is referred to as
motor disturbances of stroke are:
paralysis weakness numbness
What is often the first evidence of paralysis or weakness after stroke?
feeling of clumsiness or heaviness in limb
motor disturbances are felt on the _______ side of the body from the damaged area of brain.
deficits of stroke may appear in both sides of the body if the stroke was a _______stroke
brainstem or vertebrobasilar
______ is caused by damage to the cerebellum during stroke.
ataxia (unsteady gait)
What should you do before you give a stroke victim ANYTHING by mouth?
pt should pass a swallow test to prevent possible aspiration
When assessing stroke damage in relation to swallowing ability, what should you look for?
weakness or asymmetry of facial features
If a stroke victim does not show facial weakness or asymmetry, how much water do you give to see if they can tolerate it?
what side of the body do visual distrubances occur after a stroke?
the SAME side as the brain damage.
how do pts describe vision loss from stroke?
curtain dropping fog gray out or black out vision
What is the first test performed in the ER if stroke is suspected?
What is the purpose of the initial CT scan in the ER to check for stroke?
to see if the stroke was hemorrrhagic. Ischemic strokes will not be visible till several days after the event.
After a CT in the ER for suspected stroke, the pt may have and ECG to check for:
atrial fibrillation or heart disease that may increase the risk of thrombus formation
Tests that may be done is stroke is suspected
CBC blood glucose BMP blood typing PT INR serum pregnancy (if applicable) stools and emesis checked for blood cardiac monitor and pulse oximeter
a stroke scale to determine the patients neurologic defeicit level. 11 point scale that determines severity of stroke.
national institues of health stroke scale
How is stenosis of the carotid arteries detected?
carotid doppler testing
Initial emergent care of a stroke is _____ while test results are pending. ABC's are monitored.
When is 02 administered to a potential stroke pt?
a temp > than _____ is treated in suspected stroke cases.
What kind of fluids are NOT given to potential stroke patients?
solutions with glucose that could cause hyperglycemia
if stroke is suspected, the dr. will make a decision regarding thrombolytic therapy within ____ hour of arriving.
When must thrombolytic therapy be given to prevent permanent brain damage?
within 3 hours of symptom onset
thrombolytic agents lyse a thrombus by causing conversion of plasminogen to ______.
thrombolytics are associated with a significant risk of __________, so all risk of bleeding must be ruled out before these drugs will be considered.
What is the body's natural response to lack of perfusion to areeas of the brain due to stroke?
to increase the systolic bp in order to perfuse the brain
If the pt is to receive TPA, the bp must be maintained below______ to reduce the risk of bleeding.
185/110 (through use of labetalol or nicardipine)
allowing the bp to remain high for a period of time to help salvage brain tissue from stroke is called
When permissive hypertension is allowed to help perfuse infarcted brain tissue, when are antihypertensives given?
What are the common antiplatelet drugs?
aspirin plavix aggrenox
drugs that prolong the time to form clots are
what are the common anticoagulants used for stroke?
warfarin (monitor INR) heparin (bleeding times)
what are some common statin drugs used with stroke?
zocor pravachol lipitor mevacor
what is a common side affect of statin drugs?
what is a common side affect of antiplatelet and anticoagulant drugs?
bruising, change in LOC
according to the ASA, pts who have had a TIA should receive antiplatelet therapy how soon after symptom onset?
What drug does a stroke patient receive who is in atrial fibrillation?
coumadin (to prevent clots)
statins are ordered for the stroke patient who has a cholesterol level > _____
statins may have a ________ effect.
Why are stroke pts at risk for respiratory complications?
r/t an IICP prone to aspiration
procedure done in patients with significant carotid artery occlusion to remove the carotid occlusion
If a pt is no a good candidate for a carotid endarterectomy, a carotid _____ may be placed during a carotid angiogram.
paresthesia and paralysis are common long term effects of strokes that were not treated with a ________ agent.
the side of the body opposite the cerebral infarct is affected because:
nerve fibers cross over as they pass from the brain to the spinal cord
impaired motor function due to stroke puts people at high risk for _____
If a stroke affects the _____- lobe, the speech center will likely be affected.
stroke damage also causes emotional ______.
lability (emotional instability)
all pts who have had a stroke, in particular those with ____-_____ brain lesions present a high safety risk. Pts may have poor understanding of their limitations.
If the frontal lobes are involved in stroke, learned _____ behaviors may be lost.
social (may have personality changes)
the phenomenon of unilateral neglect is seen predominantly in pts who have _____ hemishphere infarcts.
right (so pts need to be taught to be more aware of where their left limbs are located)
a weakness in the wall of a cerebral artery that may be congenital, traumatic or the result of disease.
where in the brain do most aneurysms occur?
circle of willis (at a bifurcation of an artery)
It is believed that irritation from blood breakdwon after a cerebral aneurysm is the major cause of __________.
vasospasm (a common complication of subarachnoid hemmorrhage caused by anuerysm)
when a cerebral aneurysm ruptures, it causes a
some pts experience a small hemorrhage before diagnosis of a subarachnoid hemorrhage. This leakage of blood may cause the following 3 symptoms
mild headache vomitting disorientation
the most common presentation of rupture of an aneurysm is
sudden, severe headache (and sensitivity to light)
When someone has a cerebral aneurysm, what is it that causes a decreased LOC?
What tests are done to diagnose cerebral aneurysm?
CT is done first, then a cerebral angiogram
why is monitoring bp so important after a cerebral aneurysm?
high bp=possibility of re-rupture low bp=ischmia of brain tissue
There is no cure for subarachnoid hemmorhage. Treatment consists of treating the cause of the hemmorhage by performing a _______.
what kind of aneurysm has a neck that can be clamped off?
why would you wrap steril plastic or muslin around an aneurysm?
to provide stability to keep it from rupturing
pts who have had a cerebral aneurysm are at risk of rebleed until it is _______.
blood in the ventricular system caused by a cerebral aneurysm interferes with the absorption of CSF and _______ may develop.
hydrocephalus (treated by inserting an external ventricular drain or ventriculoperitoneal shunt)
_______ is responsible for most long term complications of subarachnoid hemorrage due to cerebral aneurysm.
signs/sx of decreased cerebral perfusion:
decreased LOC irritability or restlessnes dizziness syncope blurred or dimmed vision diplopia unequal pupil, sluggish or absent reactions to lt parestheisa motor weakness paralysis seizures
after a cerebral incident, assess vitals every ______ until stable, then every 4 hours.
elevated glucose is associated with worsening of infarct and hemorrhage, so blood glucose > than _____ should be reported.
you should monitor for signs of hemorrhage for ___ to ___ hours following thrombolytic therapy.
following a stroke, a limb or muscle group can be retaught to function using a technique called ______ therapy.
when feeding a pt who has had a stroke, you should:
stay with pt during meals ensure pt is fully alert before feeding place in high fowlers avoid use of straws thicken liquids place food on unaffected side teach to swallow twice after each bite check for pocketing of food have suction equipment available avoid foods with multiple textures give only a 1/2 teaspoon at a time
priority nursing diagnosis for stroke:
ineffective cerebral tissue perfusion ineffective airway clearance risk for injury
this group of neurologic conditions is crhonic a nd degenerative in nature.
neuromusculare disorders involve a disruption of the tranmission of impulses between neurons and the ______they stimulate. This breakdown causes muscle ______.
What are the 4 neuromuscular disorders
MS MG ALS GBS
a choronic progresssive degenerative disease that affects the myelin sheath of the neurons in the CNS.
what is responsible for the smooth transmisison of nerve impulses?
with MS, the myelin sheath begins to break down as a result of activation of the body's ______ system.
With MS, the degeneration of the myelin sheath causes the nerve to become inflamed and causes impulses to the muscles to ____ down.
as MS progresses, the degeneration and slowing of impulses causes _____ or scar tissue that damages the nerves permanentlyl.
eventually in MS, the scar tissue and sclerosis causes nerve impulses to become completely ______.
MS is thought to be from an autoimmune process, but may also be related to heredity and ______ infection.
the environmental triggers that seem to exacerbate MS are:
extreme hot or cold fatigue infection physical or emotional stress hormonal changes after pregnancy