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2013-03-28 22:40:01

Cerebrovascular Accident and Transient Ischemic Attack
Show Answers:

  1. What's a TIA?
    Neuroologic dysfunction that lasts for only a few minutes (7-14)
  2. What's a CVA?
    Stroke, blood flow impeded to the brain which causes oxygenation deprivation to cerebral tissues.
  3. How do you get a TIA?
    high cholesterol
  4. How do you get a CVA?
    • Thrombus-plaque or clot
    • Embolis-moving clot from carotid artery or heart
    • Hypertensive or intracerebral hemorrhage
  5. S/S of a carotid and cerebral artery TIA
    • blind in one eye
    • hemiplegia (one side paralyzed)
    • hemianesthesias (one side decreased sensation)
    • speech disturbance
    • confusion
  6. S/S of vertebro basilar artery TIA
    • dizzy
    • diplopia
    • numbness
    • visual defects in 1 or both fields
    • dysarthria
  7. First sign of a CVA
    altered level of consciousness
  8. What will I see as a nurse that will initiate a "code stroke" call?
    • slurred speech
    • droopy face
    • change in extremity strength
  9. What are the changes in VS that confirm a stroke?
    • Cushing Reflex:
    • Elevated BP
    • Widened pulse pressure
    • Bradycardia
  10. Normal ICP
  11. Ischemic neurons vs necrossed
    If ischemic....they can be saved. dead
  12. aphasia
    disturbance in language:

    • Cant read:
    • write
    • speak
    • listen
    • comprehend
    • understand
  13. Brocas area
    • expressive language
    • pt can understand, but cant talk
  14. Wernickes area
    receptive language

    patient cant understand what you are saying
  15. dysphaSia
    difficulty speaking
  16. dysarthia
    defects in articulation
  17. alexia
    brain damage causing a patient to not be able to read
  18. anomia
    difficulty in selecting appropriate words-particularly nouns
  19. agraphia
    disturbance in ability to write
  20. apraxia
    • inability to perform previously learned purposeful motor acts
    • (wants a drink of water, picks up a pitcher and glass, then stops)
  21. agnosia
    • failure to recognize familiar objects by the senses
    • (close eyes, put keys in hand, dont know what it is)
  22. Homonymous Hemianopsia
    damage to the occipital area leading to blindness of 1/2 of the body....and is the opposite side of the damaged brain
  23. diplopia
    double vision
  24. Bi-temporal Hemianopsia
    partial blindness when the vision is missing in the outer half of both visual fields
  25. dysphaGia
    difficulty swallowing
  26. Nursing interventions for the client with aphasia
    speech therapy
  27. Nursing interventions for the stroke client with visual/perceptual problems
  28. When do you notify the physician of a CVA pt. elevated blood pressure?
  29. How do you have a CVA patient sit correctly?
    • HOB 30 degrees
    • head slightly flexed
    • shoulders relaxed
    • knees flexed

    To maximize ventilation potential
  30. Describe signs of ICP
    • Behavior change
    • Decreased LOC
    • Headache
    • weakness/numbness/eye movement problems
    • seizures
    • vomiting
  31. Cardio signs of ICP
    • hypertension
    • tachy
    • carotid bruit
  32. Urinary signs of ICP
    • frequency
    • urgency
    • incontinence
  33. Examples of behavior changes in a person with ICP
    • emotional
    • lethargic
    • apathy
    • combativeness
  34. What is unilateral neglect?
    related to visual field and a loss of one side of the body, (dont use it)

    • Tell pt to:
    • scan things from left to right-see everything
    • position bed in room so I come at them from unaffected side
    • put things in visual field of unaffected side...gradually moving things to affected side
    • work on reintegration of the whole body
  35. What is neglect syndrome?
    Dont acknowledge the affected side of the body. Like it doesnt even exist
  36. disuse syndrome
    a wasting of a body part due to it not being used
  37. What meds are given to a person who has had a stroke?
    • antiplatelets....aspirin 81mg
    • Ticlid
    • Plavis
    • dipyridamole
  38. What kind of stroke patient gets coumadin?
    one with a-fib
  39. BP medication that is effective for pt. who have had a stroke
    • statins
    • Simvastatin
    • Lovastatin
  40. Interventions for a CVA pt at risk for airway obstruction
    • clear airway-TCDB or suction
    • encourage slow deep breathing
    • HOB at 30 degrees with ....etc
    • IS to prevent atelectasis
    • NPO till swallow eval is done to prevent aspiration
  41. Interventions to assist the CVA pt to achieve urinary and bowel continence
    • bladder retraining
    • kegels
    • interval training
    • positive reinforcement for making it to the toilet
  42. What are important concepts related to patient teaching and stroke prevention:
    • Call 911 if:
    • sudden numbness/weakness/paralysis...especially on one side of body
    • slurred speech
    • sudden confusion/or trouble understanding
    • trouble walking/dizzy/loss of balance
    • sudden severe headache
  43. What should be included in a home environment assessment for the CVA pt?
    • assistive devices-utensils
    • pillows to prop up pt so dont slump
    • railings-stairs/bathroom
    • good lighting
    • things placed in sight
    • no skid surfaces-remove rugs
  44. Describe resources the might be utilized in transitioning a CVA client from hospital or rehabilitation unit to home
    • Home health aid
    • bus or car service
  45. Frontal lobe
    • motor
    • speech
    • emotion
    • cognitive fxn
  46. Where is brocas?
    frontal lobe
  47. Where is the brain damage if you see a change in personality?
    frontal lobe
  48. parietal lobe
    receives and interprets sensory stimuli
  49. What part of the brain tells you if you are hot, cold or in pain?
    parietal lobe
  50. Occipital lobe
    interprets visual stimuli
  51. Temporal lobe
    • hearing
    • speech reception
    • taste
    • smell
  52. What part of the brain has Wernikes?
    Temporal lobe
  53. What part of the brain controls long term memory?
    Temporal Lobe
  54. What does the cerebellum do?
    • coordinates muscle tone and fxn
    • integrates proprioception and maintains balance and coordination
  55. What makes up the brain stem?
    • Thalamus
    • Hypothalamus
    • Midbrain
    • Pons and Medulla
    • Reticular activation system
  56. Thalamus
    major receiving and communication center for sensory input
  57. hypothalamus
    • thermoregulation
    • supervises the ANS
  58. Midbrain
    relays impulses from the cerebellum to the cerebrum
  59. Pons and Medulla
    Repiration and VS
  60. Reticular Activation system
    controls wakefulness and arousal
  61. What happens when you have thick blood?
    High HCT
    it is harder to get blood up to the brain
  62. 3 metabolic factors important to regulation of ICP
    • CO2
    • H+
    • 02
  63. 3 areas Glascow coma scale checks:
    • eyes opening
    • motor response-obey commands?
    • verbal response-tell to do something, do it
  64. Person who has had a CVA should start PT when?
    Immediately....I can do without a doctors order with ROM exercises
  65. Golden test for CVA
    CT scan....needs to be done within 30 minutes and labs need to be done within 45 min
  66. Prior to do a CT scan what do you need to find out?
    if the pt is allergice to seafood or iodine....use contrast
  67. Treatment of thrombus CVA
    • clot buster within 6 hours of onset of symptoms
    • heparin to prevent further thrombi
  68. Treatment of hemorrhagic CVA
    control ICP and prevent further bleeding
  69. Treatment of ICP
    • intubation
    • hyperventilation
    • admin of 02
    • IV mannitol and lasix
  70. Measures to prevent or control ICP
    • HOB at 30
    • prevent hyperextension, flexion or rotation of head
    • prevent emotional upset
    • prevent valsalva maneuver
    • prevent constipation
    • prevent sudden arousal from sleep
  71. A person who has ICP....their CO2 should be kept under
  72. The reason why rehab therapy is effective is cuz of Bobath principles.  What are they?
    • you can relearn things even after the brain is damaged cuz:
    • level of excitability of nerve cells is changeable
    • when neural conncections are impaired, there is a degeneration of inhibition that allow previously unused connections to be utilized
    • collateral sprouting
  73. What does it mean when you say the excitability of nerve cells is changeable?
    if a cell dies, remaining cells can produce a better response to the lower input received from fewer cells
  74. What is collateral sprouting?
    when previously unconnected axons attached to dendrites of cells deprived of input cuz of cell deaths, provide new input
  75. What does medicare type D cover?
    medications up to $2800, then the pt pays 100% of drug charges
  76. What is capitation?
    accepting a fixed amount of money per enrolled person per enrollment period (1 year) and agreeing to provide certain healh care services to all plan members with no additional billing