question

describe thrombotic stoke

answer

slow onset clot forms on unstable atherosclerotic plaque with cerebral arteries or branches

question

describe embolic stroke

answer

cloth forms elsewhere and travels to brain lodging within vessel and obstructing vessel

question

how will CT look for a patient with ischemic stoke

answer

normal

question

Describe intraceebral hemorrhage

answer

"bleeding into brain" clot forms within skull, displaces brain, increases ICP, creating ischemia and or infarction bleeding in brain caused by rupture of vessel

question

causes of intracerebral hemorrhage

answer

HTN!!!!!!! vascular malformations, coagulation disorders anticoagulant and thrombolytic drugs, trauma brain tumors ruptured aneurysms

question

s/s of intracerebral hemorrhage

answer

HA N/V decreased LOC HTN!!!!!!!

question

causes of subarachnoid hemorrhage

answer

aneurysm

question

s/s sub arachnoid hemorrhage

answer

neuro deficits, N/V, SZ, neck rigidity, vasospasm

question

mortality rates for someone with intracerebral hemorrhage

answer

poor prognosis 40-80% mortality rate in 30 days

question

priority nursing concern for patient with stroke

answer

patent airway

question

dysphagia

answer

difficulty swallowing

question

left sided injury s/s

answer

language deficits, aphasia, dysphasia, dysarthria, impaired memory, cautious

question

right sided injury s/s

answer

impulsive and quick in decisions. complications with perception of self and illness

question

agnosia

answer

inability to recognize objects by sight touch or hearing

question

apraxia

answer

inability to carry out sequential movements on command

question

Dx test for Stroke

answer

CT w/o contrast CT angiography MRI/MRA angiography transcranial doppler lumbar puncture

question

sx interventions for stroke

answer

carotid endartectomy transluminal angioplasty with stenting extra cranial-intracranial bypass

question

if LDL greater than __________ then give statins at DC

answer

100

question

the BP must be below _________ before tPA therapy

answer

185/110

question

neuro assessment tool

answer

national institute of heath stroke scale "NIHSS"

question

nursing interventions to control increased ICP

answer

avoid neck flexion HOB at 30 degrees minimal stimulation control hyperthermia mannitol and lasix

question

how can be tx/prevent contractures

answer

PT/OT position with splints prevention of DVT secondary to contractors

question

nursing interventions for unilateral neglect

answer

injury prevention!!!! promotion of bilateral exercises: passive or active ROM minimize time laying on affected side to 30 mins approach unaffected side first, gradually move place personal item on unaffected side first, gradually move

question

t/f flaccidity several weeks after stroke has poor functional prognosis

answer

t

question

when are spacticity and exaggerated reflexes expected in relation to a stroke

answer

first 48 hours

question

t/f it is good for the stroke patient to lean to the affected side while sitting or laying

answer

f you should work to avoid leaning to affected side

question

t/f after a stroke keep the head of bed elevated

answer

t prevents patient from chocking on tongue

question

what ethic group is at greater risk for strokes

answer

african americans

question

what is the single most important modifiable risk factor for stroke

answer

HTN

question

what is a TIA

answer

neurologic d/f caused by ischemia but without acute infraction of brain

question

clinical symptoms last less than __________ for TIA

answer

1 hr

question

t/f TIA may progress to stroke

answer

t

question

what heart conditions predispose you to strokes

answer

Fib, MI, rheumatic herat dz, valve prosthesis, atrial septal defects

question

"silent killer"

answer

cerebral aneurysm

question

those with aneurysm are at risk for ____________

answer

vasospasm keep in ICU for 14 days if high risk for vasospasm

question

initially patients with a stroke muscle tone will be ______________, and then it will process to ________________

answer

hyporeflexia hypereflexia

question

what is done for stroke patients. (put in order)

answer

admin O2 complete neuro check CT scan TPA

question

usually for stroke patients the hip rotates _______

answer

externally

question

aphasia

answer

language deficit. inability to communicate

question

dysphasia

answer

difficulty communicating

question

brocas aphasia

answer

non fluent aphasia short phrases the make sense but are produced with great effort omits words aware of their difficulties and become frustrated understands speech of other fairly well

question

wernickes aphasia

answer

fluent aphasia may speak in long sentences that have no meaning uses unnecessary words makes up words often unaware of their confusing speech

question

brocas aphasia

answer

expressive aphasia

question

wernickers aphasia

answer

receptive aphasia

question

before tPA therapy typically _________________ is given IV to bring down BP

answer

hydralazine

question

dysarthria

answer

"slurred speech" involves impaired movement of muscles used for speech

question

s/s of dysphagia

answer

coughing during or right after eating or drinking wet or gurgle sounding voice during or after eating or drink extra effort or time need to chew or swallow recurring pneumonia chest congestion after eating weight loss or dehydration from not being able to eat enough

question

d/c plavix ________ days prior to sx

answer

10-14

question

Patients with a fib should go on what drug to prevent stroke

answer

anticoagulants: warfarin, rivaroxaban (xarelto)

question

to prevent stroke...take what meds

answer

anitplatelet, statin

question

ways to reduce ICP

answer

avoid hip flexion preventing hyperthermia pain management avoidance of hypervolemia management of constipation

question

before admin tPA therapy what should the RN do

answer

insert urinary catheter nasogastric tube multiple IVs

question

t/f use of anticoagulants such as heparin are usually indicated initially after a stroke

answer

f b/c risk for intracerebral hemorrhage however, after the patient has stabilized anticoagulants may be considered

question

main therapy for someone with hemorrhagic stroke

answer

management of HTN (below 160)

question

t/f anticoagulant and anitplatlets are both CI for patients with hemorrhagic stroke

answer

t

question

t/f after a stroke the patient is at risk for venous thromboembolism

answer

t

question

nursing interventions to optimize musculoskeletal fx

answer

trochanter roll at hip tp prevent external rotation hand cones to prevent contractors arm supports with slings and lap boards to prevent shoulder displacement posterior leg splints, foot boards, high top shoes hand splints to reduce spasticity

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