NACP Test 4: Strokes

NIHSS; higher

The __________ (stroke scale) is the most common tool used for neurological assessment. --> The _____________ the value, the more severe the stroke.

hemorrhagic

Types of Stroke A _______________ stroke results from bleeding into the brain tissue itself or into the subarachnoid space or ventricles.

ischemic

Types of Stroke An _______________ stroke results from inadequate blood flow to the brain from partial or complete occlusion of an artery.

pons

Hemorrhagic Strokes - Hemorrhage in the ________ is the most serious because basic life functions (e.g. respiration) are rapidly affected.

feel; see

If a patient has unilateral neglect AND homonymous hemianopsia it is a huge issue because they cannot _________ OR _______ that part of the body.

reminders; see

Other Important Info Regarding Strokes To treat unilateral neglect with homonymous hemianopsia give verbal _________________ and when they are eating put all their food on the side where they can __________.

contraindicated; hypertension; maintain; aneurysm

Acute Care for HEMORRHAGIC stroke - Anticoagulants and antiplatelets are _________________ in patients with a hemorrhagic stroke. - The main drug therapy for pts experiencing a hemorrhagic stroke is management of ________________. - Oral and IV agents may be used to ___________ BP within a normal to high-normal range (SBP < 160 mmHg) - Surgical interventions for hemorrhagic stroke include immediate evacuation of _____________-induced hematomas or cerebellar hematomas larger than 3 cm.

onset; life; damage; disability; circulation; breathing; oxygenation; neurological; deficit; elevated; 220; 120; 185/110; 180/105; correct; controlled; hydrated; overhydration; priority; urine output

Acute Care for ISCHEMIC Stroke - During initial evaluation, the single most important point in the patient's history is the time and _____________ of symptoms. - Interprofessional goals during the acute phase of a stroke are preserving _______, preventing further brain ____________, and reducing ___________________. 1) In the unresponsive person, acute care begins with assessing ______________, airway, and _______________. 2) Maintaining adequate __________________ is important. ---> O2 administration, artificial airway insertion, intubation, or mechanical ventilation may be needed. 3) Baseline _______________ assessment is carried out, and patients are monitored closely for signs of increasing neurologic _____________. 4) _____________ BP is common immediately after a stroke. ---> It may be a protective response to maintain cerebral perfusion, however, it can be detrimental. ---> In patients with an ischemic stroke who do not receive fibrinolytic therapy the use of drugs to lower BP are only recommended if the BP is markedly increased (SBP > _________ mmHg and DBP > _________ mmHg). ---> In a patient who is going to have fibrinolytic therapy, the BP must be less than _______/_______ mmHg then maintained at or below _______/_______ mmHg for at least 24 hours after fibrinolytic therapy. ---> Although low BP right after a stroke is uncommon, we ______________ hypotension and hypovolemia if present. 5) Fluid and electrolyte balance must be _______________ carefully. ---> The goal is to keep the patient adequately _____________ to promote perfusion and decrease further brain injury. ---> _________________ may compromise perfusion by increasing ICP and cerebral edema. ---> Adequate fluid intake is a _____________. Monitor _________ ___________ to ensure patient does not become dehydrated.

NPO

After experiencing a stroke the patient should be put on _________ status ESPECIALLY if they present with dysphagia until ability to swallow is evaluated.

neurologic; motor; bladder; bowel; personality; sensation; swallowing; communication; artery; area

Clinical Manifestations of a Stroke (Card 1 - Textbook) - _______________ manifestations do not significantly differ between ischemic and hemorrhagic stroke. ---> The reason for this is that the destruction of neural tissue is the basis for neurologic dysfunction caused by both types of stroke. - A stroke can affect many body functions such including ____________ activity, ____________ and _____________ elimination, intellectual function, spatial-perceptual changes, _______________, affect, ______________, __________________, and __________________. - The functions affected are directly related to the ____________ involved and the _________ of the brain it supplies.

motor; mobility; respiratory; swallowing; speech; gag; self-care; voluntary; movements; tone; reflexes; hyperreflexia; flaccidity; spasticity; opposite

Clinical Manifestations of a Stroke (Card 2 - Textbook) Motor Function - ____________ deficits are the most obvious effect of a stroke. Include Impairment of: (1) _______________ (2) ______________ function (3) ________________ and ___________ (4) _______ reflex (5) ________-___________ abilities - The characteristic motor deficits include loss of skilled _________________ movement (akinesia), impaired integration of ________________, changes in muscle ________, and altered ________________. ---> The initial hyporeflexia progresses to ________________ for most patients. - An initial period of _____________ (weakness) may last from days to several weeks and is related to nerve damage. - ________________ of the muscles, which follows the flaccid stage, is related to interruption of upper motor neuron influence. - A lesion on one side of the brain affects motor function on the ______________ side of the body.

receptive; expressive; global; dominant; dysphasia; nonfluent; fluent; dysarthria

Clinical Manifestations of a Stroke (Card 3 - Textbook) Communication - The patient may have aphasia. ---> _____________ aphasia: Loss of comprehension. ---> _____________ aphasia: Inability to produce language. ---> ___________ aphasia: Total inability to communicate. **Aphasia occurs when a stroke damages the _______________ hemisphere of the brain. --> (Left hemisphere in right-handers. Right hemisphere in left-handers) - The term ______________ refers to impaired ability to communicate and in most settings is used interchangeably with the term aphasia. However, aphasia is the more common term used. - Aphasia may be classified as _____________ (minimal speech activity with with slow speech that requires obvious effort) or _________ (speech is present but but has little meaningful communication). **Most types of aphasia are mixed, with impairment in both expression and understanding. - Many stroke patients have _____________, a problem with the muscular control of speech. ---> This does not affect the meaning of communication or comprehension of language, but does affect the mechanics of speech.

emotions; depression; frustration

Clinical Manifestations of a Stroke (Card 4 - Textbook) Affect - A patient who has had a stroke may have a hard time controlling their ________________. **Emotional responses may be exaggerated and unpredictable. - ________________ and feelings associated with changes in body image and loss of function can make this worse. - Mobility and communication problems increase ____________________.

memory; judgement; left; right; learn

Clinical Manifestations of a Stroke (Card 5 - Textbook) Intellectual Function - A stroke may impair both _____________ and ______________. - A _______ brain stroke is more likely to result in memory problems related to language. However, they are usually cautious in making judgements. - The patient with a ________ brain stroke tends to be impulsive and move quickly. - Patients with either type of stroke may find it hard to make generalizations, interfering with their ability to _________.

self; illness; neglect; homonymous hemianopsia; spatial; agnosia; apraxia

Clinical Manifestations of a Stroke (Card 6 - Textbook) Spatial-Perceptual Problems Spatial-Perceptual Problems can be divided into 4 categories: (1) It causes patient to have an incorrect perception of ________ and ____________. ---> Patient may deny their illnesses or not recognize their own body parts. (2) A patient may _____________ all input from the affected side. ---> This may be worsened by __________________ _____________, in which blindness occurs in the same half of the visual fields of both eyes. ---> The patient also has difficulty with ______________ orientation, such as judging distances. (3) _____________: The inability to recognize an object by sight, touch, or hearing. (4) _____________: The ability to carry out learned sequential movements on command. ***The patient may or may not be aware of their spatial-perceptual problems. You need to assess for this potential problem as it will affect rehabilitation and recovery.

temporary; excellent; constipated; scheduled; removed

Clinical Manifestations of a Stroke (Card 7 - Textbook) Elimination - Most problems with urinary and bowel elimination are __________________. - When a stroke affects ONE hemisphere of the brain, the prognosis for normal bladder function is _______________. - At first the patient may have frequency, urgency, and incontinence. Although motor control of the bladder is usually not a problem, patients are often _________________. - Constipation is associated with immobility, weak abdominal muscles, dehydration, and decreased response to the defecation reflex. Elimination problems may also be related to inability to state the need to eliminate and difficulty managing clothing (resulting in incontinence). - _________________ toileting and clothes that are easily ______________ encourage independence.

blood thinners; surgery; 185; platelet; blood glucose; hypoglycemia; neurologic

Contraindications for Beginning Fibrinolytic Therapy (tPA) 1) If the patient is on _______ ______________. This increases their risk for having a hemorrhagic stroke. 2) If the patient has had major ___________ in the past 14 days. They will bleed out. 3) If the patient has a systolic BP greater than ________. It must be lower than this number to start therapy and controlled throughout the therapy for 24 hours. 4) If ___________ count is lower than normal. These help to clot blood. If patient does not clot easily, then they don't need a clot buster. 5) If the patient's ______ __________ is low. Symptoms of _________________ can mimic the signs of a stroke. 6) If the patient is showing improving _____________ status. If mental status is already improving, let the patient's body do the work on its own.

confirm; cause; therapy; onset; ischemic

Diagnosis Studies for Stroke (Card 1) - When manifestations of a stroke occur, diagnostic studies are done to (1) _______________ that it is a stroke and not another type of brain lesions and (2) Identify the likely _________ of the stroke. - Diagnostic study results also guide decisions about _______________. - A key assessment is to determine the time of the ____________ of symptoms. This is important for all types of strokes, especially _______________ strokes since the time can affect treatment decisions.

noncontrast CT; MRI; ischemic; hemorrhagic; time; location; MRI; CT scan; serial; CT angiography; cardiac imaging; blood

Diagnosis Studies for Stroke (Card 2) - Once the person suspected of a TIA or stroke arrives in the emergency department, it is important for the patient to rapidly undergo either a _____________ ______ or _______. These important diagnostic tests can rapidly distinguish between an _______________ and a _______________ stroke. The help determine the _________ and ______________ of the stroke. - A _______ is more effective in identifying an ischemic stroke. However, a _____ __________ is a rapid diagnostic tool to rule out hemorrhage. - _______________ scans may be used to assess the effectiveness of treatment and to evaluate recovery. - A _____ _____________ provides visualization of cerebral blood vessels. It can be done at the same time as the noncontrast CT scan. CTA can give an estimate of perfusion and detect filling defects in the cerebral arteries. - If the suspected cause of a stroke includes emboli from the heart, diagnostic cardiac tests should be done. _____________ _____________ is recommended because many strokes are caused by blood clots from the heart. - __________ tests can help identify conditions contributing to stroke and to guide treatment.

delayed; tissue plasminogen activator; plasmid; substituted; IV; 3; 4.5; vital signs; neurologic; 185; hemorrhage; aspirin

Drug Therapy for ISCHEMIC Stroke - Fibrinolytic therapy should not be ___________. - _____________ ______________ _______________ (tPA) is used to produce localized fibrinolysis by binding to the fibrin in the thrombi. The fibrinolytic action of tPA occurs once the plasminogen is converted to ___________, whose enzymatic action then digests fibrin and fibrinogen, thus breaking down the clot. - Other fibrinolytic agents CANNOT be ______________ for tPA. - tPA is given ______ to reestablish blood flow through a blocked artery to prevent cell death in patients with acute onset of ischemic stroke. - tPA must be given within _____ - ______ hours of the onset of signs of ischemic stroke. - During tPA infusion carefully monitor the patients' _________ _________ and _____________ status to assess for improvement or potential deterioration related to intracerebral hemorrhage. - Control of BP (SBP < _______ mmHg) is CRITICAL during tPA treatment and 24 hours following. - The use of anticoagulants (e.g. heparin) in the emergency phase after an ischemic stroke is NOT RECOMMENDED because of the risk for intercranial ________________. - ___________ at a dose of 325 mg may be started 24-48 hours AFTER the onset of an ischemic stroke..

protective; perfusion; gradually

Extremely high BP >200 is actually ______________ during a stroke. Proves brain is still getting _____________. If BP goes really low while individual is having a stroke it is concerning, means brain is no longer getting perfusion. Actually a good sign if BP is really high, need to work on bringing it down, but _________________ (prevent sudden drops in BP).

diet; weight; exercise; smoking; alcohol; blood pressure; assessments; risk factors

Interprofessional Care for Stroke (Card 1) Preventative Therapy - Primary prevention is a priority for decreasing morbidity and mortality risk from stroke. - The goals of stroke prevention include health promotion for a healthy lifestyle and management of modifiable risk factors. Health Promotion (1) Healthy _______ (2) ________ control (3) Regular _____________ (4) No ______________ (5) Limiting _____________ consumption (6) ________ ______________ management (7) Routine health __________________. **Patients with known _______ _____________ (e.g. diabetes, hypertension, obesity, high serum lipids, cardiac dysfunction) need close management.

aspirin; warfarin; coumadin; statins

Interprofessional Care for Stroke (Card 2) Preventative Drug Therapy - Measures to prevent the development of a thrombus or embolus are used in patients with TIAs since they are at high risk for a stroke. - Antiplatelet drugs are usually the chosen treatment to prevent stroke in patients who had a TIA. ---> ____________ at a dose of 81 mg/day, is the most often used antiplatelet agent. - For patients with atrial fibrillation, oral anticoagulation can include ____________ (_____________) and the direct factor Xa inhibitors. ---> Patients on warfarin will need close monitoring and dosage adjustments which sometimes makes direct factor Xa inhibitors more favorable. - ______________ (simvastatin, lovastatin) are effective stroke prevention for those with high cholesterol levels who had a TIA.

weight

Ischemic Stroke Treatment The dosing of tPA is _________ based.

activase

Ischemic Stroke Treatment ______________ is another name for tPA

atrial fibrillation; anticoagulants; hypertension; modifiable; hyperlipidemia

Leake's Listed Important Risk Factors for Strokes - _________ _______________: Blood clots form, travel to brain, cause stroke. ---> Patient should be on __________________ to prevent blood clots. - ________________: Increases pressure in the body against the walls of the arteries. ---> MOST _______________ risk factor for strokes. - _________________: Causes clogging of the arteries, restricting blood flow.

aspirin; ticlopidine; antiplatelet; warfarin; anticoagulant; statins

Medication Review - ____________ or ______________ AKA ________________ drugs are the chosen treatment to prevent strokes in patients who have had a TIA. - _____________ or factor Xa inhibitors AKA _______________ drugs are given to patients with atrial fibrillation to prevent strokes. - ____________ are effective in stroke prevention for those with high cholesterol levels who had a TIA.

bladder training

Other Important Info Regarding Strokes For incontinence, put a timing on their bathroom time. Also called ___________ _____________.

severe headache

Other Important Info Regarding Strokes The biggest difference in the S&S between ischemic and hemorrhagic stroke is a ___________ _________________ which is more common with HEMORRHAGIC strokes.

healthy; teaching; BP screening; adhere; smoking; early symptoms

Nursing Implementation Health Promotion - Promote a ___________ lifestyle. - ______________ should focus on stroke prevention, especially in persons with known risk factors. - Uncontrolled or undiagnosed hypertension is the primary cause of a stroke. Therefore, you should be involved in _____ _____________ and ensuring patients ____________ to using their antihypertensive medications. - Encourage/help patients to stop ____________ as this is a major risk factor for strokes. - Teach patients and families the _________ ____________ associated with a stroke or a TIA so they will know when to seek help.

homeostasis; efficiency; orthostatic; vital signs; intake; output; sounds; thrombus

Nursing Implementation: Acute Care Cardiovascular System - Nursing goals for the cardiovascular system are aimed at maintaining __________________. - Fluid retention, overhydration, dehydration, or BP changes may effect cardiac _________________. - Monitor for ______________ hypertension before ambulating the patient for the first time. - Monitor __________ ________. - Record ____________ and _____________. - Monitor lung and heart ____________. - Keep patient moving to prevent the formation of a ____________ (VTE).

speak; understand; gestures; speech

Nursing Implementation: Acute Care Communication - Assess the patient for both ability to ___________ and ability to ________________ language. - If patient cannot understand words, use ________________ to support verbal cues. - Collaborate with _________ therapist to assess and formulate plan of care to enhance communication.

family; threat; explanations; arranging; demeanor; touch; simple; one; boards; interrupting

Nursing Implementation: Acute Care Coping - A stroke is usually a sudden, extremely stressful event for the patient, caregiver, and family. - Stroke is often a ___________ disease affecting them emotionally, socially, and financially and changing roles and responsibilities within the family. - The stroke patient and family may percieve the stroke as a ________ to their life and accustomed lifestyle which results in the reactions of: Fear, apprehension, denial of the severity of the stroke, depression, anger, and sorrow. - Give ______________ to the patient about what has happened and the diagnostic and therapeutic procedures should be clear and understandable. - Family members may need help with ________________ care for their loved one since a stroke is sudden. Social services referral is often helpful. - It is challenging to keep patients with aphasia informed. Use _______________ and ___________ to convey support. Keep questions _____________, present _______ thought or idea at a time, and speak in a normal volume or tone. Use writing and communication ___________ and refrain from __________________ the patient to decrease frustration.

constipation; fluid; fiber; times

Nursing Implementation: Acute Care Gastrointestinal System - The most common bowel problem for the stroke patient is _________________. - ________ and ___________ intake goals are determined with the stroke team based on the patients' nutritional and fluid status. **Try to establish normal bowel elimination ________ by working with the patient.

breakdown; 30; 2; pressure

Nursing Implementation: Acute Care Integumentary System - The skin of the patient with stroke is susceptible to _______________ related to loss of sensation, decreased circulation, and immobility. - Position the patient on weak or paralyzed side for only _______ minutes. - Position changes every ______ hours. - Controlling _____________ is the main factor in both preventing and treating skin breakdown.

optimal function; ROM; ambulate

Nursing Implementation: Acute Care Musculoskeletal System - The nursing goal for the musculoskeletal system is to maintain ____________ ____________ by preventing joint contractures and muscular atrophy. - Get the patient up and moving!!! Can be done by performing _______ or helping them to ________________. **Pay special attention to paralyzed or weak side when positioning the patient.

neurological assessments; vital signs; intracranial pressure

Nursing Implementation: Acute Care Neurologic System - Perform ongoing ____________ ______________, including the NIHSS, mental status, pupillary response, and extremity movement and strength. - Closely monitor ________ _________. - A decreasing level of consciousness may indicate an increasing level of _______________ ______________.

fluid; electrolyte; NPO; gag reflex; dietician; self-feeding

Nursing Implementation: Acute Care Nutrition - The patient may initially receive IV infusions to maintain _________ and _________________ balance and to give drugs. - Many patients have dysphagia after a stroke. Keep patients ________ until speech therapist performs a swallow evaluation. - Before starting feeding assess _______ ___________. - A ______________ can help to determine the appropriate daily caloric intake based on the patient's size, weight, and activity level. - The inability to feed oneself can be frustrating, so try to promote _______-___________ by incorporating assistive devices and encouraging the patient.

adequate; airway; oxygenation; dysphagia; NPO

Nursing Implementation: Acute Care Respiratory System - Stroke patients are vulnerable to respiratory problems. - Nursing interventions to support ______________ respiratory function are tailored to meet the patient's specific needs. - Nursing interventions include frequently assessing ____________ patency and function, providing _________________, suctioning, promotion patient mobility, positioning patient to prevent aspiration, and encouraging deep breathing. - Risk for aspiration pneumonia is high because _____________ after a stroke is common. - Keep patients _______ until dysphagia is ruled out.

verbally; simple; remind; perceptual field

Nursing Implementation: Acute Care Sensory-Perception Problems - Patients with this deficit best understand directions given ______________. - Break down tasks into ___________ steps for ease of understanding. - You may need to help ___________ the patient to dress the weak or paralyzed side or shave the forgotten side of the face. - Homonymous Hemianopsia: Common after a stroke. Help patient compensate by arranging environment within the patient's _____________ _______.

incontinence; normal

Nursing Implementation: Acute Care Urinary System - In the acute stage of a stroke, the primary urinary problem is poor bladder control resulting in _________________. - Take steps to promote ________________ bladder function an avoid the use of indwelling catheters. ***Bladder training for incontinence.

salt; sodium; weight; saturated fats; alcohol; 140; 40; 3; 4; smoking; glucose; diabetes; plan

Promoting Population Health Stroke Prevention 1) Reduce _________ and _____________ intake. 2) Maintain a normal body _________. 3) Follow a diet low in ________________ _______ and high in fruits and vegetables. 4) Limit ______________ use to moderate levels. 5) Maintain an SBP of less than ________ mmhg 6) Exercise for ______ minutes ____-____ days per week. 7) Avoid ______________ 8) Maintain a normal blood _____________ and manage _______________. 9) Follow the prescribed treatment __________ for diagnosed cardiac problems.

disability; optimal function; physiatrist; acute

Rehabilitation Care - After the stroke patient has stabilized for 12-24 hours, interprofessional care shifts from preserving life to lessening _____________ and reaching _____________ ____________. - The patient may be evaluated by a _______________ (a physician who specializes in physical medicine and rehabilitation). - Remember that some aspects of rehabilitation begin in the _________ care phase as soon as the patient is stable. Possible Members of the Rehabilitation Team - Nurses - Physicians - Psychiatrist - Physical Therapist - Occupational Therapist - Speech Therapist - Registered Dietician - Respiratory Therapist - Vocational Therapist - Recreational Therapist - Social Worker - Psychologist - Pharmacist - Chaplain

65; men; women; african americans; family history

Risk Factors for Stroke (Card 1) Non-Modifiable - Age (>____ yo) - Gender (strokes are more common in ________, but ___________ are more likely to die from a stroke). - Race/Ethnicity (____________ ____________ have twice the incidence of stroke and a higher death rate from stroke compared to any other ethnic group). - Genetics (A person with a ___________ ___________ of a stroke has an increased risk of having a stroke).

hypertension; atrial fibrillation; diabetes; smoking; alcohol; cocaine; obesity; inactivity; birth control pills; migraine; aura

Risk Factors for Stroke (Card 2) Modifiable - __________________ (Single most important modifiable risk factor. Keeping it under control reduces stroke risk up to 50%). - Heart Disease (Especially ________ _______________: Responsible for about 25% of all strokes. People with this disease are 5 times more likely to have a stroke than those with a normal heart rhythm). - ______________ (Significant risk factor. People with this condition are 5 times more likely to have a stroke than the general population). - _______________ (Nearly doubles the risk for an ischemic stroke. Four times more likely to have a hemorrhagic stroke.) - ________________ (Risk depends on amount consumed). - Illicit Drug Use (Especially ________________ use). - ______________ (Increases risk for ischemic stroke. Nutrition teaching important to these patients). - ________________ (Pts should be doing 40 minutes of exercise 3-4 days per week to reduce risk of stroke). - _______ __________ __________ (Especially those with high levels of estrogen and progesterone, and even more so if combined with smoking. - Women who have ___________ with an ________ have an increased risk for stroke. - Other Risk Factors: Inflammatory disorders (rheumatoid arthritis), sickle cell disease, and blood clotting disorders.

neurological; ischemia; infarction; one hour; resolve; progress; cerebrovascular; emergency; ABCD; age; blood pressure; clinical features; duration; diabetes

Risk Factors for Stroke (Card 3) Transient Ischemic Attack (TIA) - Another risk factor associated with stroke is a history of a transient ischemic attack (TIA). - A TIA is a transient episode of _______________ dysfunction caused by focal brain, spinal cord, or retinal ______________, but WITHOUT acute _______________ of the brain. - Symptoms typically last LESS THAN _______ ________. - It is important to teach patients to seek treatment for any stroke symptoms, since there is no way to predict if a TIA will ______________ or if it will ______________ to a stroke. - TIAs are a warning sign of progressive ___________________ disease. - The signs and symptoms of a TIA depend on the blood vessel that is involved and the area of the brain that is ischemic. - A TIA is treated as a medical _______________ since it can lead to an ischemic stroke. - The __________ score is a tool used to predict stroke risk for a person after a TIA. --> A: _______ --> B: ________ _____________ --> C: _____________ ________________ of TIA. --> D: ______________ and ______________

ischemia; hemorrhage; affected area; brain attack; cerebrovascular accident; crucial; fifth; leading cause; hemiparesis; walk; dependence; aphasia; survivor; family

Strokes - A stroke occurs when there is (1) ______________ to part of the brain or (2) _____________ into the brain that results in death. - In a stroke, functions such as movement, sensation, thinking, talking, or emotion that were controlled by the ______________ _________ of the brain are lost or impaired. ---> The severity of loss of function varies depending according to the location and extent of the brain damage. - The terms _________ ____________ and _________________ __________ are also used to describe a stroke. - After the onset of a stroke immediate medical attention is _____________ to decrease disability and the risk for death. - Stroke is a major public health concern and is currently the _________ most common cause of death in the United States. - Stroke is the _______________ _________ of serious long-term disabilities. ---> Common long-term disabilities include ______________ (paralysis on one side of the body), inability to ________, complete or partial ______________ for activities of daily living, ___________ (dysfunction in communication), and depression. - A stroke is a life-long change for both the stroke _______________ and the ______________. Be mindful of this impact when caring for patients who survive a stroke.

ischemic; hemorrhagic

Strokes are classified as either _____________ or ________________ based on the cause and underlying pathophysiologic findings.

surgical; clipping; coiling

Summary: Acute Care of Hemorrhagic Stroke - ______________ decompression if indicated. - ____________ or ___________ of aneurysm

plasminogen; tpa; endovascular

Summary: Acute Care of Ischemic Stroke - Tissue ________________ activator (_______) - ______________ therapy (stent to open up artery).

aphasia; dysphasia

Terms to Know _____________/_____________: Difficulty speaking

hemiplegia

Terms to Know _______________: Total paralysis on one side.

Flaccidity

Terms to Know ________________: Weakness

dysphagia

Terms to Know _________________: Difficulty swallowing

hemiparesis

Terms to Know _________________: Weakness on one side

intracerebral; subarachnoid

Types of Stroke Hemorrhagic Stroke Types - An _________________ hemorrhage is bleeding within the brain caused by rupture of a vessel. ---> Half of deaths occur within first 48 hours. ---> Prognosis for pts with this type is poor. - A _________________ hemorrhage occurs when there is intracranial bleeding into the cerebrospinal fluid (CSF) - filled space between the arachnoid and pia mater membranes on the surface of the brain. ---> Often caused by rupture of a cerebral aneurysm (congenital or acquired weakness and ballooning of vessels). ---> Many patients with this type die almost immediately. Survivors may be left with significant morbidity, including cognitive problems.

thrombotic; embolic

Types of Stroke Ischemic Stroke Types - A ____________ stroke occurs from injury to a blood vessel wall and formation of a blood clot. ---> Accounts for 60% of strokes. ---> Common in older adults especially those with high cholesterol, atherosclerosis, or diabetes. ---> Most of these strokes are associated with hypertension or diabetes. ---> Many times a TIA precedes these strokes. - A _____________ stroke occurs when an embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved vessel. ---> Second most common cause of a stroke. ---> Often severe manifestations that occur suddenly. ---> Warning signs are less common than stroke described above. ---> Most emboli originate in the endocardial (inside) layer of the heart, when plaque breaks off from the endocardium and enters the circulation.

150; 400

Values to Keep in Mind - Normal Platelet Count: _______-_______ k

face drooping; arm weakness; speech difficulties; time to call 911

Warning Signs for a Stroke F: ________ _____________ A: ________ _______________ S: _________ _______________ T: ________ _____ _________ ________

opposite; contralateral

When a patient has a stroke, weakness/paralysis occurs on the ________________ or __________________ side of the body from the area of the brain where the stroke occurred.

blood sugar; oxygenation; mimic

When someone comes into the ED with stroke symptoms they will also check their _________ ____________ and ___________________. ---> Low oxygen and low sugar can ___________ the signs of a stroke.

kill

tPA SHOULD NOT be given to someone having a hemorrhagic stroke, it will _________ them by making them bleed more!!!!!!!!