Stroke

An emergency department nurse is awaiting the arrival of a client with signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. What is the treatment window for thrombolytic therapy?

3 hours

A client is following up after a visit to the emergency department where testing indicated that the client had suffered a transient ischemic attack. What lifestyle changes would the nurse include in teaching to prevent further reoccurrence?

Blood pressure control, weight loss (DASH and Mediterranean diets), engage in physical activity, and smoking cessation

A 76-year-old client is brought to the clinic by his daughter. The daughter states that her father has had two transient ischemic attacks (TIAs) in the past week. The physician orders carotid angiography, and the report reveals that the carotid artery has been narrowed by atherosclerotic plaques. What treatment option does the nurse expect the physician to offer this client to increase blood flow to the brain?

Carotid endarterectomy or Balloon angioplasty of the carotid artery followed by stent placement

FAST

Face drooping Arm weakness Speech difficulty Time to call 911

A client has been diagnosed as having global aphasia. The nurse recognizes that the client will be unable to perform which action?

Form words that are understandable or comprehend spoken words

A stroke victim is experiencing memory loss and impaired learning capacity. The nurse knows that brain damage has most likely occurred in which lobe?

Frontal

Which disturbance results in loss of half of the visual field?

Homonymous hemianopsia

The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regimen, to maintain a healthy weight, and to adopt a reasonable exercise program. This advice is based on research data that shows the most important risk factor for stroke is

Hypertension

A client is receiving an IV infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To confirm that this drug is producing its therapeutic effect, the nurse should consider which finding most significant?

Increased urine output

NIHSS

a standardized assessment tool that helps evaluate stroke severity; ranges from 0 (normal) to 42 (severe stroke)

t-PA

anticoagulant used to treat ischemic strokes; dissolves blood clots *contraindicated in hemorrhagic stroke

Signs of hemorrhagic stroke

"worst headache of my life," N/V, altered LOC, seizures

right hemispheric stroke symptoms

-Paralysis or weakness on left side of body -Left visual field deficit -Spatial-perceptual deficits -Increased distractibility -Impulsive behavior and poor judgement -Lack of awareness of deficits

left hemispheric stroke symptoms

-Paralysis or weakness on right side of body -Right visual field deficit -Aphasia (expressive, receptive, or global) -Altered intellectual ability -Slow, cautious behavior

What interventions would be recommended for a client with dysphagia?

-assist the client with meals -test the gag reflex before offering food or fluids -allow ample time to eat -place food on unaffected side of mouth

what methods are used to reduce ICP?

-osmotic diuretics such as mannitol -HOB elevation (30 degrees) -hypertonic saline -stool softener/mild laxative to prevent constipation

CT scan for stroke

-performed stat after arrival to ED -will identify whether symptoms are caused by hemorrhagic stroke so treatment can be started -ischemic stroke changes not visible on CT scan

nursing interventions after stroke

-reposition every 2 hours -ROM on affected extremities to prevent painful shoulder, regain motor control, enhance circulation -OOB as soon as possible with assistive devices -splints to support proper positioning and prevent contractures -encourage patient to participate in ADLs -assistive devices to enhance self care -approach on side where vision is still intact -swallow assessment by speech therapist -speak slowly, give one instruction at a time, allow patient time to process -seizure precautions

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings?

Left-sided cerebrovascular accident (CVA)

A patient who has suffered a stroke begins having complications regarding spasticity in the lower extremity. What ordered medication does the nurse administer to help alleviate this problem?

Lioresal (Baclofen)

The nurse is caring for a client diagnosed with a hemorrhagic stroke. The nurse recognizes that which intervention is most important?

Maintain a patent airway

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient?

Semi-Fowler's

A client is hospitalized when presenting to the emergency department with right-sided weakness. Within 6 hours of being admitted, the neurologic deficits had resolved and the client was back to his presymptomatic state. The nurse caring for the client knows that the probable cause of the neurologic deficit was what?

Transient ischemic attack

common side effect of t-PA

bleeding

Transient Ischemic Attack (TIA)

brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment); often precedes a CVA

Complications of hemorrhagic stroke

cerebral hypoxia, decreased blood flow, vasospasm, increased ICP

agnosia

failure to recognize familiar objects perceived by the senses

goal of t-PA

given within 45 minutes of arrival in ED

risk factors of stroke

hemorrhagic: cerebral aneurysm, arteriovenous malformation (AVM), HTN ischemic: DM, atherosclerosis, a fib, hyperlipidemia, smoking, obesity, sickle cell disease, smoking, cocaine use, excessive alcohol consumption, cardiomyopathy, oral contraceptives, HTN

aphasia

inability to express oneself or to understand language

The nurse is caring for a client admitted with a stroke. Imaging studies indicate an embolus partially obstructing the right carotid artery. What type of stroke does the nurse know this client has?

ischemic

priority for a client who is unconscious following a stroke

maintain patent airway

signs of ischemic stroke

numbness or weakness in face/arm/leg especially on one side, aphasia, vision loss

hemiplegia

paralysis of one side of the body

causes of hemorrhagic stroke

ruptured artery, aneurysm, HTN, arteriovenous malformation

Baclofen (Lioresal)

skeletal muscle relaxant

A nurse in a rehabilitation facility is coordinating the discharge of a client who is tetraplegic. The client, who is married and has two children in high school, is being discharged to home and will require much assistance. Who would the discharge planner recognize as being the most important member of this client's care team?

spouse

causes of ischemic stroke

thrombosis and embolism where blood flow is cut off

most common cause of hemorrhagic stroke

uncontrolled hypertension