Why is atrial fibrillation a risk factor for stroke?
Clot formation
If going through an ischemic stroke why do we not want to lower the BP?
Decrease perfusion
What are the two types of stroke and what are their sources?
Thrombotic - plaque ruptures and thrombus occludes vessel
Embolic - A-fib, MI, Valvular diseases
TIA
Reversible or Irreversible?
Resolves within?
Sign of impending?
Reversible
24 hours
CVA
What are the clinical presentations of a TIA?
Amaurosis Fugas (losing vision in one eye)
Weakness
Aphasia
Diplopia
Vertigo
Syncope
Reflex Asymmetry
Be sure to not confuse a TIA with what other diagnosis?
Migraine
Partial Seizure
Subdural Hematoma
Brain Tumor
Cardiac Syncope
Hypoglycemia
Encephalitis
A small area of infarct the blocks a penetrating blood vessel is?
Lacunar Stroke
Can be asymptomatic and lead to dementia
Hemorrhagic Stroke
Prognosis?
Risk factors?
Very poor
Hypertension, Aneurysms, Trauma, Tumor, AVM
This problem has a sudden onset, severe headache, N&V, decrease LOC and elevated BP
Intracerebral Bleed
This problem has a decrease in LOC, N&V, focal neuro deficits and is usually coined the "worst headache of my life"
Subarachnoid Hemorrhage
How to care for a stroke?
ABC's
Know time of onset
Vitals
Seizure precautions
The most important assessment for a stroke is
LEVEL OF CONSCIOUSNESS!
tPA must be initated within _________ hours
3-4.5
tPA is contraindicated with ___________
Those people are given a _______ hour window.
80y/o+ who are on anticoagulants, diabetics or had previous stroke
3 hour
Once tPA is initiated, the nurse must monitor closely for
Bleeding
What is the best diagnostic test for a stroke?
Non-Contrast CT
Treatment of Ischemic Stroke
Heparin Drip
Antiplatelets
Coumadin for A-Fib (Target INR: 2-3)
Carotid Endarterectomy
Carotid Stenting
MERCI Retriever
A speech deficit usually results from a ________ CVA
Left
What is difference between non-fluent and fluent aphasia?
Non-fluent - slow, can't get words out
Fluent - freely speaking but not making sense
What is the difference between Broca's area and Wernicke's area?
Broca - Expressive aphasia
EX: "Son ... University ... Smart ... Boy ... Good ... Good ..."
Wernicke - Receptive aphasia
EX: "I called my mother on the television and did not understand the door."
What is homonymous hemianopsia?
Loss of one side of visual fields in both eyes
Right Side CVA presentations
Left side paralysis
Fall Risk
Spatial perceptual deficits
Denial
Impulsive
Impaired judgment
Left Side CVA presentations
Right side paralysis
Language deficit
Slow/cautious behavior
Aware of deficits
Depression
Impaired comprehension
Damage to which part of the brain is responsible for expressive aphasia?
B) Broca's Area
Which of teh following patients is at higher risks for falls?
C) Right brain CVA
John Smith is an 85y/o male who began experiencing right sided weakness and difficulty speaking 30 minutes ago. His BP is 160/90. He is not on anticoagulants. Which of the following are true:
C) He needs a CT and thorough history to determine eligibility for tPA
