Adults- Exam 3 Study Guide.docx - Nursing Hero (2024)

Stroke Risk Factors: -Age -Smoke -Alcohol -Diabetes -HTN -Obesity -African Americans higher risk NIH Stroke Rating scale -Higher score= higher degree of impairments -Helps to gauge degree of cerebral infarction -Done at established intervals to determine evolving status -Fleas give me a stroke oFace; droop, smile oLOC; alert? lethargic oEyes: when do they open? oArms/legs: can they move them, push, pull oSpeech: clear? Make sense? Impairments? Communication? -Fast oFace drooping oArm weakness oSpeech difficulty oTime to call 911- time is of the essence!!! Determines if they qualify for treatment -Circle of willis oGroup of arteries that are at the base of the brain oInternal carotids branch into smaller arteries Terms to know -Hemiparesis: weakness on one side of body -Hemiplegia: paralyzed on one side -Aphasia: difficulty with speech** left sided strokes oExpressive: understands but cant express oGlobal: cannot receive, understand or respond -Dysarthria: slurring -Dysphagia: difficulty swallowing -Apraxia: difficulty practicing movement, purposeful movement, imagined movement -Hemianopia: visual loss in ½ of visual field -Agnosia: unable to recognize familiar objects -Nystagmus: eye movement, repetitive uncontrolled movements in the eyes Transient Ischemic Attack -Warning signs that cause transient focal neurologic dysfunction resulting from a brief interruption in cerebral blood flow, possibly resulting from cerebral vasospasm or systemic arterial hypertension -Symptoms can last several minutes to several hours, but resolve on their own -May need carotid US and endarterectomy Stroke AKA "Brain Attack" -Sudden onset of acute neurologic deficit persisting for more than 24 hours and caused by interruptions of blood flow to brain oLeading cause of adult disability -Types: oIschemic (83%)- can be thrombus or embolus

Description: Thrombotic or embolic (aspirin for anti-platelet effect) 87% of all strokes Etiology: embolus from heart (AFIB cause) or lower circulation (DVT) 30% attributed to cardioembolic phenomenon Pathophysiology: Cerebral hemodynamic insult/infarction Blood flow reduced to level insufficient to maintain neuronal viability and ischemic injury occurs Focal stroke oPenumbra: area of hypo perfused tissue- surrounds core of ischemic cells oGoal is to salvage penumbra by returning blood flow oTemp neuro deficits as cerebral edema resides and penumbra re-perfused Cerebral edema occurs in 10-20% of patients Assessment and diagnosis: Neurologic abnormalities of different types of ischemic stroke locations National institutes of health stroke scale Diagnostics: First** Ct brain to R/O hemorrhage MRI next- wont show infarct for 8-12 hours EKG Echocardiogram Carotid US/US Duplex Medical Management Ischemic Stroke: Thrombolytic therapy (TPA)- Fibrinolytic Therapy oGOAL: restore blood flow to the brain oIV recombinant tissue plasminogen activator (r-TPA) oProtein involved in the breakdown of a clot oCan be risky 6% of people will have a intracranial hemorrhage oGiven IV; 0.9 mg.kg oMust be in ICU oContraindications: No recent surgery 3-4 hours of onset Anticoagulants No improvement of symptoms oComplications: IC hemorrhage Orolingual angioedema (Airway) Acute hypotension Systemic bleeding Airway protection and ventilatory assistance oDecline really quickly Antihypertensive therapy oCan make a stroke worse, high enough to keep cerebral fusion pressure Identification and treatment of complications oWatch for skin ulcers, aspiration pneumonia Nursing care after t-pa oICU

oBP management oMonitor for major/minor bleeding complications oAvoid invasive procedures immediately prior to and for 24 hours after administration oHemorrhagic (17%) Cerebral aneurysm Stress placed on poorly developed thin vessel wall Ballooning out of vessel occurs Becomes clinically significant when wall ruptures AVM Large, dilated vessel structure containing both arteries and veins Veins become engorged and rupture Can also be caused by TBI Subarachnoid hemorrhages Assessment and diagnosis oSigns and symptoms "Worst headache of my life" Brief loss of consciousness N/V Focal neurologic deficits Stiff neck oDiagnostic tests Computed tomography of head, cerebral angiogram Lumbar puncture Bloody cerebrospinal fluid SAH Management oMedical emergency oGoal is preservation of neurologic function oSupport vital functions oAirwaymanagement and ventilatory assistance oVentriculostomy to control intracranial pressure Rebleeding- complication oSurgical aneurysm clipping oSurgical AVM excision oEmbolization Silastic beads or glue Placement of one or more detachable balloons Platinum coils Complications oCerebtal vasospasm Constricting or narrowing of vessel when blood is surrounding arteries. This causes ischemia and infarction Prevention: hypertensive, hypervolemic, hemodilution therapy Nimodipine (CCB): relaxes vessels; can cause bradycardia, hypotension, dizziness Cerebral angioplasty oHyponatremia (due to hypervolemia) oHydrocephalus Intracerebral hemorrhages- highest fatality rate Description

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