what is the definition of CVA
disruption of blood flow in the brain resulting in loss of function
how quickly must thrombolytic therapy be started when the patient has a CVA?
3 hrs or fewer to decrease brain damage
what are some causes of stroke?
- thrombus, emboli-ischemic
- hemmorhage, aneurysm, areteriovenous malformation.
what does ipsilateral and contralateral mean?
- ipsilateral- same side
- contralateral- opposite side
common s/sx of strokes.
- weakness of the face arm or leg
- on one side of the body(hemiparesis)
- impaired speech(dysarthia)
- loss of speech(aphagia)
- unsteady gait(ataxia)
- makes verbal substitutions(apraxia)
what is homymous hemianopsia?
temp or permanent loss of half of visual field.
what is agnosias?
inability to recognize familiar objects
if the frontal lobe has a lesion what are expected cognitive problems?
- -frontal lobe is responsible for learning capacity and memory
- -limited attention span
what is the DASH diet?
high fruit/vegetables, low fat dairy products and protein
what does the CT scan do when helping identify type stroke?
if it is ischemic or hemorrhagic
what does a EKG and carotid US do?
is its ischemic, emboli or thrombi
name some modifiable risk factors of ischemic stroke.
- -A fib
- peridontal disease
what are medical tx for ischemic stroke?
- if cardioembolic storke- warfarin with target INR 2-3
- ASA, plavix- reduce cerebral infarction
- statins- reduce coronary events and strokes
what is t-PA?
- -recombinant copy of thrombolytic substance made in the body.
- -must be done within 3 hours-revascularization after 3 hours leads to cerebral edema and hemorrhage
what is the dosage of t-PA? How is it given?
- -0.9 mg/kg
- -max is 90 mg-10% IV bolus in 1 minute than the rest given via IV infusion for 1 hr
what is the most common side effect of t-PA
bleeding( most common)
management of ischemic stroke without t-PA
- -osmotic diuretic(mannitol), lower ICP
- -elevate HOB, promote venous drainage
- -hemicraniectomy for increased ICP
- monitor BP and neurological less than 180/100, this reduces potential chance of bleeding
what are you monitoring for in the acute phase?
- -stiffness or flaccidity of neck
- -eye opening
nursing intervention r/t immobility
- -correct positioning
- -change position q2 hrs to prevent edema and bed sores
- -ROM 4-5 x a day
- -Pt ASAP
- -give bedpan once pattern observed
- -constipation tx with water and fiber
- - training program and have positive feedback to pt
nursing intervention r/t sensory
- 1st time approach unaffected side than next time approach from affected side
- - remind pt of other side
- -nutrition- may cause dribbling or pooling in mouth
- dysphagia- difficult to swallow
nursing intervention r/t communication
- - dont finish sentences for them
- be sensitive
- - speak slowly and use consisten language, one instruction at a time
what is hemorrhagic stroke?
bleeding in the brain tissue or subarachnoid space
what is more common ischemic or hemorrhaic stroke
what is AVM?
- -abnormality in emmbroynal phase
- - tangle of arteries and veins
- -absence of capillary bed leads to rupture
what is subarachnoid hemorrhage?
- -may be r/t AVM, htn, trauma
- most common cause is bleeding into circle of willis
- -dilation of the walls of a cerebral artery
- -unknown cause
before recieving t-PA pt should be assessed for NIHSS
score of over 22 is not eligible
what is the main surgical procedure for managing TIA
left side stroke
- affects right side
- altered intellectual ability
- slow, cautios behavior
right side stroke
- spatial perceptual deficits
- increased distraction
- impulse behavior