ch58 Stroke

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ch58 Stroke
2011-02-21 15:18:14
Medical Surgical Nursing Mosby Chapter

Chapter 58 Stroke
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  1. Circle of Willis
  2. Two types of stroke:
    Ischemic & hemorrhagic
  3. Ischemic stroke:
    Inadequate blood flow to the brain; occlusion of an artery. 80% of all strokes are ischemic.
  4. Ischemic strokes are divided into 2 subcategories:
    Thrombotic & Embolotic
  5. Thrombotic stroke:
    Plaque buildup (thrombosis) narrows artery; injury to arterial wall near plaques results in formation of blood clot which further blocks the artery. Common cause: HTN. 60% of strokes are thrombotic.
  6. Embolotic stroke:
    Embolus (floating plaque or other solid substance in bloodstream) lodges in a cerebral artery resulting in infarction and edema. 24% of strokes are embolotic.
  7. Lacunar stroke:
    Small artery occlusion, infarction of brain tissue. Cavity formation at site of cell death.
  8. Hemorrhagic stroke:
    Rupture of artery with bleeding into the brain tissue. 15% of strokes are hemorrhagic. Described as "worst headache of my life."
  9. The 3 major types of stroke:
  10. The most important diagnostic tool to evaluate for stroke is:
    • CT without contrast
    • - Obtain within 25 minutes of arrival at ER
    • - Radiologist to read within 45 minutes of arrival
    • - Indicates size & location of lesion
    • - Differentiates between ischemic and hemorrhagic stroke
  11. Ischemic stroke: Fibrinolytic therapy with tissue plasminogen activator (tPA) is indicated when:
    • - Ischemic stroke is <3 hours old
    • - CT appears normal with no signs of hemorrhage anywhere in body
    • - No bleeding history or head trauma in past 3 months
    • - No major surgery within 14 days
  12. CT Angiography (CTA) detects:
    Intracranial and extracranial vascular occlusive disease. It is the "gold standard" for imaging the carotid arteries.
  13. MRI detects:
    Extent of brain injury (has greater specificity than CT).
  14. Risk factors for stroke:
    • Hypertension
    • Diabetes mellitus
    • Obesity
    • High serum lipids
    • Cardiac dysfunction
  15. On-scene assessment test for stroke: FAST
    • Face
    • - Ask person to smile.
    • - Does one side of face droop?
    • Arm
    • - Ask person to raise both arms; can s/he?
    • - Does one arm drift downward?
    • Speech
    • - Ask person to repeat a simple sentence.
    • - Are words slurred?
    • - Can s/he repeat sentence correctly?
    • Time
    • - If person shows any of these symptoms, call 911.
    • - Time is Tissue!
  16. Transient ischemic attack (TIA):
    1) Define.
    2) Duration.
    3) Classic sign.
    • 1) Temporary loss of brain function d/t ischemia.
    • 2) Usually resolves within 3 hours (15 min. to <24 hours).
    • 3) Classic sign is vision loss in one eye with no pain or warning.
  17. Immediate assessment of a stroke patient at the ER includes:
    • - Assess ABCs, vitals
    • - Provide O2 via NC
    • - IV access
    • - Obtain blood sugar sample (hypoglycemia can mimic stroke)
    • - 12-lead EKG
    • - Neuro screening assessment (Glascow)
    • - Alert stroke team: Neurologist, radiologist, CT tech
    • Most important: Check onset of symptoms!
    • (Time is Tissue)
  18. Ongoing monitoring of a stroke patient includes:
    • - Vital signs
    • - Neurologic status & LOC (Glascow coma scale)
    • - Motor & sensory function
    • - Pupil size & reactivity
    • - SaO2
    • - Cardiac rhythm
  19. The incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with the administration of:
    Daily low-dose aspirin
  20. The medication used to treat a subarachnoid hemorrhage is:
    Nimodipine, a calcium channel blocker, inhibits vasospasm of a hemorrhaging artery.
  21. To reduce the risk of stroke-induced seizures, this medication is administered prophylactically:
    phenytoid (Dilantin)
  22. A right-sided brain stroke with homonymous hemianopsia results in vision loss of the ______ (right/left) field.
    • Left.
    • Homonymous hemianopsia results in visual field loss of the field contralateral to the stroke location.