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  1. What is a CVA?
    • Stroke or brain attack
    • Neurologic deficits occur as a result of decreased blood flow to localized area of brain
    • Onset may be rapid or gradual
  2. Etiology & patho
    • Ischemia followed by cell death
    • Result of severe and prolonged cerebral blood flow obstruction
    • Resulting deficits predict location of stroke
  3. What are 4 types of brain attack?
    • Transient ischemic attack (TIA)
    • Thrombotic CVA
    • Embolic CVA
    • Hemmorhagic CVA
  4. What is a TIA?
    • Brief period of neurological deficits that reslove within 24hrs
    • Frequently precursors to a permanent CVA
    • Causes- inflammatory arterial disorders, sickle cell anemia, atherosclerotic changes in cerebral vessels, thrombosis, emboli
  5. What is a thrombotic CVA?
    • Caused by thrombus occluding a cerebral vessel
    • Tend to form atherosclerotic plaque in larger arteries wile BP is lower-sleep/rest
    • Thrombosis occurs quickly but deficits progress slowly
  6. What is an embolic stroke?
    • Caused by traveling blood clot
    • Source of clot is elsewhere in body
    • Sudden onset eith immediate symptoms
    • If embolus not absorbed, deficits will be persistent
  7. What is a hemmorhagic CVA?
    • Intracranial hemmorhage occurs when a blood vessel ruptures
    • Often occurs in presence of long-term, poorly controlled hypertension
    • Causes- ruptures intracranial aneurysm, embolic CVA, tumors, arteriovenous malformations, anticoagulant therapy, liver disease, DIC, thrombocytopenia
    • This form often fatal due to rapidly increasing ICP
    • Onset of symptoms is rapid
    • Loss of consciousness usually occurs
  8. Clinical maifestations
    • Vary according to cerebral vessel involved
    • Sudden weakness, numbness or paralysis in your face, arm, or leg-typically on one side of your body
    • Gait disturbance
    • Slurred or garbled speech or difficulty understanding others
    • Sudden blindness in one or both eyes, blurred, tunnel or double vision
    • Dizziness, loss of balance or coordination
  9. Diagnostic & lab findings
    • CT/MRI- demonstrate hemorrhage, tumors, ischemia, edema, tissue necrosis
    • Cerebral angiography detects abnormal vessel structure, vasospasm, stenosis of carotid artery/loss of vessel wall integrity
    • Ultrasound evaluates blood flow
    • Blood tests- CBC, Chem 7, firenogen level, PT aPTT
  10. Therapeutic management
    • Drug therapy-anti-platelet or anti-coagulant
    • Imperitive NOT to disrupt clot that has formed following hemmorhagic CVA
    • Surgery usually not indicated as treatment modality
    • Rehab is crucial to improve deficits
    • Stabilize pt
    • Neurochecks, lab work, ECG, CT
  11. Medication therapy
    • Antiplatelet agents
    • Thrombolitic therapy
    • Anticoagulant therapy
    • Osmotic diuretics
    • Diuretics
    • Anticonvulsants
  12. Stroke risk factors
    • HTN, obesity, sedentary lifestyle, atherosclerosis,A-fib, valvular disease, smoking, heavy alcohol use, cocaine,
    • diabetes, high stree level, hyperlipidemia (LDL), high triglyceride, oral contraceptives, black males, over 55 yrs
  13. Stroke prevention
    • 81 mg asa
    • monitor BP
    • anti-hypertensives
    • annual physical
    • regular exercise
    • stop smoking
    • decrease alcohol intake
    • diet changes (low fat, low cholesterol)
  14. F.A.S.T.
    • Face-does face look uneven? Ask them to smile.
    • Arm-Does one arm drift down? Ask them to raise both arms.
    • Speech-Does their speech sound strange? Ask them to repeat a phrase.
    • Time-Every second brain cells die. Call 911 at any sign of stroke.
  15. Left/Right sided stroke
    If stroke occurs on left then stroke manifestations occur on the right and affect behaviors controlled by the right hemisphere of the brain
  16. L and R hemispheres
    • Left- dominant, center for language, math skills, analytical thinking, aphasia, dyslexia, agraphia, acalculia, possible memory deficit
    • Right- visual and spatial awareness, proprioception, pt disorientation to time and place, unaware of changes, personality changes
  17. Stroke treatments
    • Airway, oxygen therapy
    • Thromolytics- if trtmnt sought within 3 hrs of ischemic stroke (streptokinase)
    • Anticoagulants- heparin, lovenox, coumadin, arixtra, pradaxa
    • Antiplatelets- plavix, ticlid
    • TED hose
  18. Stroke complications
    • Paralysis, loss of muscle mvmnt
    • Difficulty talking or swallowing
    • Memory loss, trouble understanding
    • Pain
    • Changes in behavior/self care
  19. Goals of therapy c stroke pt
    • First- initiate p physical conditioning regimen designed to regain pre-stroke levels of activity
    • Second- prevent recurrent stroke and cardiovascular events
    • Third- improve aerobic fitness
Card Set:
2011-10-07 02:47:15
neuro muscularskeletal

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