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89 Cards in this Set
- Front
- Back
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numbness or weakness of the face, arm, or leg, especially on one side of the body Usually plateus at 6 months |
Ischemic stroke |
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Exploding headache Decreased level of consciousness Plateaus at 18 months or so |
Hemorrhagic stroke
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Right side stroke (football player) |
distracted easily
poor spatial perception lack of judgemen/impulsive doesn't believe anything is wrong L side affected (motor and vision) |
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Left side (dorks) |
cautious and careful altered intellectual ability either cant express themselves or understand you or both R side affected (motor and vision) |
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hemiparesis |
weakness on one side want to strengthen UNAFFECTED side |
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hemiplegia |
paralysis on one side want to ROM exercise on affected side immobilization to affected side maintain body alignment Exercise unaffected as well |
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ataxia |
staggering need broad base to stand cane, walker, do not walk w/o assistance or supportive device |
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parasthesia |
sensation of numbness, tingling, or pins and needles sensation, diff. with proprioception (cant feel where there body part is or what its doing) Provide ROM and corrective devices to area and educate pt that they have altered sensation |
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what are stroke pt. cognitive deficits? |
short/long term mem loss decreased attention span impaired ability to concentrate poor abstract reasoning altered judgment |
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RN can do what for cognitive deficits? |
reorient verb and auditory familar objects noncomplicated language show and tell decrease distraction when educating repeat and reinforce instructions often |
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expressive aphasia |
may say single words encourage alphabet sound repitition write |
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receptive aphasia |
doesn't mean they can speak clearly read speak clear and simple use gestures |
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loss of self control (impulsive) emotional lability (mixed emotions) decreased stress tolerance depressed withdrawn fear, hositility, anger isolated feeling |
encourage group activities provide stimulation control stressful situations if possible safe place encourage expression |
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what do you do if your stroke pt has an outburst |
support them during the outburst talk to family that the outburst are dt disease process |
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early stage pt is flaccid/loss of deep tendon reflexes then pt recovers after 48 hr reflexes return however muscles have increased tone on affected side |
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dysathria |
dt paralysis |
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dysphasia = aphasia |
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inability to perform familiar actions inability to express correct words, may want to say chicken and say pool |
apraxia
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careful w/ apraxia vs ataxia |
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inability to remember familiar objects perceived by one or more of the senses |
agnosias |
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limited attention span, forgetfulness, decreased learning, lack of motivation, easily frustrated |
frontal lobe affected |
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Initial assessment of a stroke patient focuses on what |
airway patency then cardiac then neuro |
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TIA typically last less than |
1 hour |
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sudden loss of motor, vision, sensory, and vision |
TIA |
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The stroke pt should receive a CT within |
25 minutes of arrival |
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They may also get |
an ECG and carotid ultrasound test CT angiography CT perfusion, MRI, transcranial doppler, transthoracic transesopheagel echocardiography, xenon enhand CT scan, single photon emission computed tomograpy scan |
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high in fruits/veges, low in Na, mod in low fat dairy, low in protein and animal fat legumes and nuts are good |
DASH diet
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modifiable risk factors |
a. fib hyperlypidemia weight diet HTN sedentary lifestyle diabetes smoking sleep apnea alcohol asymptomatic carotid stenosis periodontal disease |
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caused by a.fib |
given warfarin |
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monitor INR ratio with a.fib treatment |
2-3 target ratio |
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dabigatran (Pradaxa) |
new anticoagulant can be used for stroke if caused by a. fib |
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rivaroxaban (Xarelto) |
new anticoagulant can be used for stroke if caused by a.fib |
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What if anticoagulants are contraindicated for your patient? |
They will be given aspirin (81-325 mg aspirin) |
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aspirin or extended-release dipyridamole plus aspirin (Aggrenox) |
TIA from embolic or thombotic cause |
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Why would stroke patient receive statins after a stroke? |
reduce heart events and strokes particularly for pt. with Diabetes |
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simvastatin (Zocor) |
post stoke episode managment |
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antihypertensive meds ACE inhibitors and thiazide diuretics |
regulate BP |
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tiny corkscrew, one uses suction, stents |
treatment approved by FDA |
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TPA |
give w/in 3 hrs of stroke 60 min of arrival IV (2 one for TPA and one for fluids) |
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TPA dose |
.9mg/kg Max of 90mg 10% IV push for 1 min 90% IV for 1 hour |
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qualifications for TPA platelets INR age BP 14 days 3 months 21 days 48 hours 6 left |
platelets >100,000 INR >1.7 prothrombin < or equal to 15 age > or equal to 18 BP <or equal 185 S < or equal to 110 D No major surgery w/in 14d No brain surgeries, head trauma, or stroke w/in 3 months no GI bleeds/urinary bleeds w/in 21d no heparin w/in 48 hr not taking warfarin no seizure with onset of stroke time of stroke is known no prior intracranial hemorrhage, neoplasm, arteriovenous malformation, or aneurysm no minor stroke or rapidly resolving |
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Try to get CT w/in |
25 minutes of arrival |
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before getting tPA pt assessed with what scale |
NIHSS 0=normal 42=severe |
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VS in ICU maintain BP at |
every 15 min first 2 hours every 30 min for the next 6 hours every 1 hr for 24 hours systolic < 180 diastolic <105 |
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TPA side effects |
24 hr delay in catheter urine and intra arterial placement and NG tubes bleeding |
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factors associated with symptomatic intracranial bleeding |
over 70 BS over 300 NIHSS over 20 edema or mass effect on CT |
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IV heparin or low molecular weight heparin |
Pt that cant receive TPA |
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After a stroke we want to maintain PaCO2 |
at 30-35 |
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Other treatments for stroke NON TPA |
O2 if oxygen below 92 HOB 25-30 intubation if neccessary hemodynamic monitoring craniectomy if edema frequent neuro |
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antihypertensive meds may be held unless |
systolic > 220 or diastolic >180 |
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sizures, bleeding, bradycardia, decreases CO, decreased CPP |
monitor in stroke pt. indicates complications |
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Airway |
we want increased cerebral blood flow risk for aspiration pneumonia |
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adequate O2 for stroke pt begins w/ |
pulmonary care maintenance of patent airway O2 as needed |
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CEA is for |
severe (70-99%) stenosis of carotid or mild (50-69% w/other risk factors |
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neck discomfort and wound expansion swelling, feel pressure in the neck difficulty breathing |
incision hematoma call dr. and report may have to reopen at bedside |
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Post CEA risk highest in firs 48 hours can cause hematoma or hyperperfusion syndrome |
hypertension BP freq report deviations assess neuro |
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post CEA usually resolves in 24-48 hours try to r/o MI |
hypotension give fluids adm. low dose phenylephrine monitor BP serial ECG |
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post CEA unilateral headache |
hyperperfusion syndrome sit upright or stand up call dr |
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post CEA risk w/old age and HTN... |
hemorrhage monitor neuro report changes immediately |
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pt has sudden neuro deficits weakness on one side of body post CEA |
suspect thrombus, prepare for repeat CEA |
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post CEA assess |
facial 7 vagus 10 spinal accessory 11 hypoglossal 12 |
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eccessive edema can obstruct airway so... |
have emergency supplies including trache needs ready monitor distal pulses usually discharged day after CEA |
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Why would a stroke pt have pain |
shoulder gives them pain from stretching |
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why would stroke pt hve consitpation |
change in mentaql status difficulty communicatin |
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Mobility, pain, comfort, self care, swallow, pee, poop, brain, talking, skin, family, sex are all affected by stroke |
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arms and legs arm tends to adduct and rotate internally elbow and wrist tend to flex affected leg tends to roll out at hip and bend at knee and foot at ankle extend (foot drop) |
splints may prevent flexing while sleeping |
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shoulder and arm while patient is in bed pillow under arm arm in slightly bent (neutral) position, elbow higher than shoulder, wrist higher than elbow |
helps shoulder pain prevents adduction prevents edema and joint hardening helps improve ROM and arm control |
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fingers fingers should barely be bent hands slightly upward (palms up) if flaccid a splint can be used if upward extremity is spastic do NOT USE HAND ROLLS bc it? |
stimulates grasp reflex
use dorsal wrist splint instead so palm is free of pressure |
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Botulinum toxin type A |
injected intramuscularly into wrist and finger temporary only last 2-4 months |
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stretching, splinting |
spaciscity treatment |
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baclofen (Lioresal) |
oral used for muscle spascity post ischemic stroke |
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Changing position post ischemic stroke |
turn Q2 (if sensation impaired, limit time on affected side) pillow b/w legs if on side lying upper thigh should not be flexed acutely |
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Prone position and the post ischemic stroke pt |
15-30 min several times a day put small pillow or support under pelvis extending from belly button to upper third of thigh promotes normal gait and prevents knees and hip contractutres, also helps with lungs and deformities of shoulders and knees |
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Exercising after a stroke |
should do so daily passive ROM on affected extremity 4-5x/d put unaffected leg under affected one to help move/turn start quad and glut exercises early 5x/d for 10 minutes at a time |
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what do you do if muscle tenses even more |
do more frequent excercises |
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SOB, chest pain, cyanosis, increasing pulse during excercise |
PE stop excercise give O2 call dr |
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preparing for walking post isch stroke |
get pt out of bed ASAP educate on balance can use tilt table to assist use folding wheelchair w/hand brakes parrallel bars usually ready to walk when have balanced stance adj. can can be used |
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prevent shoulder pain |
never lift the pt under affected shoulder never use overhead pulleys position arm on table or w/ pillows while seated sling w/ambulation clasp palms forward raise touch, stroke, rub, look at hands push heel of hand firmly down on surface |
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pharm therapy for shoulder pain |
analgesics and corticosteroid injections or botulism type A |
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shoulder strapping, electrical stimulation, heat or ice, soft tissue management |
for shoulder pain |
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Amitriptyline (Elavil) |
for post stroke pain |
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pt can't tolerate amitriptyline (elavil) for pain |
can give lamotrigine (Lamictral) and pregablin (Lyrica) |
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self care starts when? |
as soon as pt can sit up |
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What can a pt do with one hand? |
comb hair brush teeth shave w/electric razor bath eat |
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small towel for drying, boxed tissue |
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nutrition |
swallow test w/in 24 hours of adm thick liquid or pureed diet sit upright chin flex if enteral make sure tracheostomy tube is inflated before feeding if pt has one and give slowly |
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bladder of pt post stroke |
sometimes pt have urinary inc and so intermettent cath w/sterile tech. can return if not suspect bilateral brain damage analyze void pattern and offer urinal/bedpan on reg schedule |
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bowel post stroke |
unless contraindicated a high fiber diet and adequate fluid intake (2-3 L/day) usually after breakfast and a regular time |
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Sex is profoundly affected by stroke |
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