Term
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Definition
| Caused by reduced cerebral blood flow that leads to brain cell death and functional disability |
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Term
| What are the 2 types of stroke? |
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Definition
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Term
| What is an ischemic stroke? |
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Definition
| stroke results from an occluded artery that deprives blood flow to a certain part of the brain |
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Term
| What is a hemorrhagic stroke? |
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Definition
| caused by a ruptured artery, resulting in bleeding in or around the brain |
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Term
| What is the pathophys. of an ischemic stroke? |
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Definition
| ischemic cascade of pathological metabolic events – plaque buildup then free clot |
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Term
| What is the pathophys of a TIA? |
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Definition
| transient ischemic attack. the same pathophysiologic mechanism as in the ischemic cascade but symptoms are transient. |
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Term
| What is the pathophys of the hemorrhagic stroke? |
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Definition
| The bleeding associated with a hemorrhagic stroke interferes with normal brain metabolism |
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Term
| What are the modifiable risk factors of strokes? |
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Definition
| - Hypertension, smoking, diabetes, dyslipidemia, atrial fibrillation, diet, obesity, sleep apnea, and lack of exercise, birth control |
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Term
| What are the non modifiable risk factors of stroke? |
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Definition
| Family history, age, and race |
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Term
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Definition
| Formation of clot in vessel. Usually in area affected by plaque—atherosclerosis |
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Term
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Definition
| Blood vessel/ artery occluded by partial clot, tumor, fat, bacteria, air enters brain |
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Term
| What is important to note about the eyes after a stroke? |
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Definition
• Eyes follow side of brain affected by stroke, side of body effected is the opposite then the side of the brain effected
o EX: Left sided stroke – Right side weakened, eyes go to left side |
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Term
| What are the symptoms of a stroke? |
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Definition
• Numbness or weakness of the face, arm, or leg, especially on one side of the body
• Confusion or change in mental status
• Trouble speaking or understanding speech
• Visual disturbances
• Difficulty walking, dizziness, or loss of balance or coordination
• Sudden, severe headache |
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Term
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Definition
• F – ace. Ask the client to smile and look for drooping.
• A – rms. Should be raised together to look for weakness and inability.
• S – peak. Say name and address for slurring.
• T – ime. If any of the first 3 are there, call 911. |
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Term
| How are types of strokes determined? |
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Definition
| based on CT (or MRI) and blood chemistries, coagulation studies, blood cell counts, and cardiac rhythm status |
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Term
| What is the medical management of an ischemic stroke? |
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Definition
Thrombolysis with recombinant tissue plasminogen activator (rtPA)
Go home on anticoag/blood thinner |
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Term
| What is the medical management of a hemorrhagic stroke? |
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Definition
Measures are taken to lower ICP, possibly including surgery
Go home on BP medications |
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Term
| What is important to note about PT/INR times for a patient on Warfarin? |
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Definition
o PT 1.5 to 2 times control
o INR 2 to 3
o INR 3 – 4.5 for mechanical valves
• Higher because they’re prone to clots |
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Term
| What is the antedote for Warfarin? |
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Definition
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Term
| What is the action of Heparin? |
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Definition
| Prevent formation of clots |
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Term
| What are the indications for Heparin? |
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Definition
| DVT, PE, evolving ischemic CVA, MI |
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Term
| What are the contraindications for Heparin? |
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Definition
Surgeries of eye, brain, spinal cord, hemorrhagic CVA, and blood anomalies (thrombocytopenia)
o Caution with PUD |
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Term
| What is the antedote for Heparin? |
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Definition
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Term
| What is the big caution with Heparin? |
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Definition
HIT!
Heparin induced thrombocytopenia |
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Term
| What is the major risk associated with Heparin? |
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Definition
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Term
| What is different about LMW Heparin? |
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Definition
o Longer half life than heparin so only get it 2 times a day
o Do not aspirate Sub-Q heparins
o No need to monitor aPTT with LMWH; anti-Xa level
o Do not take ASA while on LMWH
o Cultural sensitivity: Heparin is a pork product |
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Term
| What are some anti platelets? |
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Definition
o Aspirin
o Clopidogrel
o Cilostazol
o Dipyridamole
o Abciximab IV
o G’s make you bleed – Ginko, Garlic
o Fish oil |
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Term
| What to antiplatelets do/ |
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Definition
| • Prevent platelet aggregation |
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Term
| What is important to note about aspirin? |
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Definition
| • ASA may be ototoxic and may reduce antihypertensive effect of Beta blockers |
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Term
| What does a thrombolytic do? |
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Definition
| • Attack and dissolve clots |
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Term
| What is the window of time for tPA? |
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Definition
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Term
| What is the antedote for TPA? |
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Definition
| Whole blood, PRBC, FFP, Aminocaproic acid |
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Term
| What is the major risk with TPA? |
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Definition
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Term
| What is administered to prevent GI bleed? |
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Definition
| H2 antagonists (Ranitidine) or PPI (Omeprazole) |
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Term
| What are the contraindications to TPA? |
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Definition
• Any prior intracranial hemorrhage
• AVM
• Aortic dissection
• Active internal bleeding
• CHI or facial trauma within 3 months
• Acute pericarditis
• Brain tumor
• Age
• B/P |
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Term
• What aspect of an individual’s unhealthy diet is associated with an increased risk of stroke?
o Excess intake of simple carbohydrates
o Excess salt intake
o Protein deficit
o Malnutrition |
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Definition
o Excess salt intake
• High sodium intake has been identified as a modifiable risk factor for stroke. Protein deficits, malnutrition, and excess intake of simple carbohydrates are not directly linked to stroke. |
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Term
• Is the following statement true or false?
o The immediate nursing priority in the care of a patient presenting with a suspected stroke is assessment of motor function. |
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Definition
• False
• Rationale: Nursing assessment includes motor and sensory function, but the immediate assessment priorities are airway, breathing, and circulation. |
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Term
• In order to prevent the development of shoulder pain during recovery from a stroke, the nurse should:
o Avoid contact with the patient’s weak arm whenever possible
o Avoid taking the patient’s blood pressure on the affected arm
o Support the patient’s weak arm on a pillow or table
o Let the patient’s weak arm hang loose whenever possible |
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Definition
• C. Support the patient’s weak arm on a pillow or table
• Rationale: Many shoulder problems can be prevented by proper patient movement and positioning. The flaccid arm should be positioned on a table or with pillows while the patient is seated. Letting the weak arm dangle without support can result in injury. It is not always necessary to avoid contact or measuring blood pressure on the affected arm. |
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Term
• Which of the following patients is at greatest risk for a CVA?
o An obese, 32 year old Native American female with hypertension, diabetes and taking oral contraceptives.
o A 69 year old white male who smokes a pack of cigarettes a day and has no family history of strokes.
o A 24 year old African-American female on oral contraceptives.
o A 45 year old white male with a history of hypertension that is currently controlled with medication. |
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Definition
• An obese, 32 year old Native American female with hypertension, diabetes and taking oral contraceptives.
• More risk factors |
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Term
• A nurse is conversing with a patient with a stroke and aphasia. Which of the following strategies is appropriate? Select all that apply
o Speak to the patient at a slower rate.
o Look directly at the patient during speech.
o Allow plenty of time for the patient to answer.
o Complete sentences that the patient can not answer.
o Break tasks into parts and give instructions one step at a time.
o Consult a speech and language therapist. |
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Definition
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Term
• Items for the nurse to review when teaching a patient about warfarin therapy include
o Increase the amount of green, leafy vegetables in your diet.
o Rinse your mouth instead of brushing your teeth.
o Follow up with laboratory tests such as PT or INR to regulate warfarin dose.
o Use a new razor blade each time you shave. |
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Definition
• Follow up with laboratory tests such as PT or INR to regulate warfarin dose.
• Laboratory tests such as PT or INR are performed to regulate warfarin (Coumadin) dose. The patient should avoid consuming large amounts of green, leafy vegetables; broccoli; legumes; soybean oil; coffee; tea; cola; excessive alcohol; and certain nutritional supplements such as coenzyme Q10. patients are encouraged to perform oral hygiene and use a soft tooth brush to prevent gums from bleeding. patients should be instructed to use an electric razor when shaving. |
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Term
• A patient manifests symptoms of a thrombolic stroke. The emergency department nurse is aware that thrombolytics need to be administered in this situation within how many hours of the onset of symptoms?
o 1 hour
o 2 hours
o 3 hours
o 4 to 6 hours |
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Definition
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Term
• A patient is on heparin therapy secondary to deep vein thromboses. The nurse has the following antidote on hand in case it is needed:
o Vitamin K
o Warfarin
o Protamine sulfate
o Aminocaproic acid (Amicar) |
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Definition
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Term
• Which of the following is not a contraindication to the use of thrombolytics?
o Use of acetaminophen
o Severe hypertension
o Recent cerebral vascular accident
o Warfarin therapy |
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Definition
• Use of acetaminophen
• Acetaminophen (Tylenol) does not interfere with the coagulation system. Contraindications for use of thrombolytics include a recent CVA, active bleeding, severe hypertension, recent history of traumatic injury, especially head injury, and anticoagulant therapy. The nurse should report if the patient takes aspirin or NSAIDs. |
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Term
• A patient on statin medications should be counseled to watch for which of the following, which may indicate a life-threatening adverse reaction?
o Fatigue
o Muscle aches
o Vomiting
o Scomata |
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Definition
• Muscle Aches
• The serious skeletal muscle adverse effect known as rhabdomyolysis has been reported with use of the statin drug class. patients should be advised to promptly report to the health care provider any unexplained muscle tenderness or weakness, especially if accompanied by fever or malaise. |
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Term
• Patients who are ordered to receive atorvastatin should have which of the following laboratory tests periodically monitored?
o Complete blood count
o Serum electrolytes
o Liver function studies
o Renal function studies |
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Definition
• Liver function studies
• Serum liver enzymes should be monitored for all patients taking statins such as atorvastatin (Lipitor); also, an annual eye examination is needed, because cataract formation may result.
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Term
| What is important for caring of a post stroke patient? |
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Definition
| assisting with feeding (aspiration risk), 2 hours for toileting, fluids, etc., side lying with head elevated if you cannot breathe, ROM exercises (active and passive), put things on not affected side, position them so their muscles are stretched out (palms up/arms out), consult for PT and speech |
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Term
| What is the goal of therapy post TIA? |
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Definition
Lifestyle modification.
You know it's a TIA because it resolves in 1 hr or less. |
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Term
| Strokes with symptoms of ICP (n/v/headache) are usually what kind? |
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Definition
| HERMORRHAGIC! There is an increase in ICP with the increase of fluid in the brain. |
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