1. what is the definition of CVA
    disruption of blood flow in the brain resulting in loss of function
  2. how quickly must thrombolytic therapy be started when the patient has a CVA?
    3 hrs or fewer to decrease brain damage
  3. what are some causes of stroke?
    • thrombus, emboli-ischemic
    • hemmorhage, aneurysm, areteriovenous malformation.
  4. what does ipsilateral and contralateral mean?
    • ipsilateral- same side
    • contralateral- opposite side
  5. common s/sx of strokes.
    • numbness
    • weakness of the face arm or leg
    • on one side of the body(hemiparesis)
    • ALOC
    • impaired speech(dysarthia)
    • loss of speech(aphagia)
    • unsteady gait(ataxia)
    • makes verbal substitutions(apraxia)
  6. what is homymous hemianopsia?
    temp or permanent loss of half of visual field.
  7. what is agnosias?
    inability to recognize familiar objects
  8. if the frontal lobe has a lesion what are expected cognitive problems?
    • -frontal lobe is responsible for learning capacity and memory
    • -limited attention span
    • -comprehension
  9. what is the DASH diet?
    high fruit/vegetables, low fat dairy products and protein
  10. what does the CT scan do when helping identify type stroke?
    if it is ischemic or hemorrhagic
  11. what does a EKG and carotid US do?
    is its ischemic, emboli or thrombi
  12. name some modifiable risk factors of ischemic stroke.
    • -htn
    • -A fib
    • -obesity
    • -smoking
    • -diabetes-
    • peridontal disease
  13. 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
  14. 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
  15. 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
  16. what is the most common side effect of t-PA
    bleeding( most common)
  17. management of ischemic stroke without t-PA
    • -osmotic diuretic(mannitol), lower ICP
    • -elevate HOB, promote venous drainage
    • -hemicraniectomy for increased ICP
    • -intubation
    • monitor BP and neurological less than 180/100, this reduces potential chance of bleeding
  18. what are you monitoring for in the acute phase?
    • -LOC
    • -stiffness or flaccidity of neck
    • -eye opening
    • -PERLA
  19. 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
  20. 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
  21. nursing intervention r/t communication
    • - dont finish sentences for them
    • be sensitive
    • - speak slowly and use consisten language, one instruction at a time
  22. what is hemorrhagic stroke?
    bleeding in the brain tissue or subarachnoid space
  23. what is more common ischemic or hemorrhaic stroke
  24. what is AVM?
    • -abnormality in emmbroynal phase
    • - tangle of arteries and veins
    • -absence of capillary bed leads to rupture
  25. what is subarachnoid hemorrhage?
    • -may be r/t AVM, htn, trauma
    • most common cause is bleeding into circle of willis
  26. intracranial aneurysm?
    • -dilation of the walls of a cerebral artery
    • -unknown cause
  27. before recieving t-PA pt should be assessed for NIHSS
    score of over 22 is not eligible
  28. what is the main surgical procedure for managing TIA
    carotid endarectomy
  29. left side stroke
    • affects right side
    • aphasia
    • altered intellectual ability
    • slow, cautios behavior
  30. right side stroke
    • spatial perceptual deficits
    • increased distraction
    • impulse behavior
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