Podcast
Questions and Answers
Which of the following best describes a cerebrovascular accident (CVA)?
Which of the following best describes a cerebrovascular accident (CVA)?
- An infection of the brain causing encephalopathy
- A traumatic injury to the brain causing long-term deficits
- A chronic brain condition that affects memory over time
- A sudden interruption in blood flow to the brain (correct)
What percentage of strokes are ischemic in origin?
What percentage of strokes are ischemic in origin?
- 50%
- 87% (correct)
- 25%
- 13%
Which type of stroke is caused by bleeding into the brain tissue and is often associated with hypertension?
Which type of stroke is caused by bleeding into the brain tissue and is often associated with hypertension?
- Intracerebral hemorrhage (correct)
- Embolic
- Thrombotic
- Subarachnoid hemorrhage
Which of the following is a defining characteristic of a transient ischemic attack (TIA)?
Which of the following is a defining characteristic of a transient ischemic attack (TIA)?
Which of the following are considered types of ischemic strokes? (Select all that apply)
Which of the following are considered types of ischemic strokes? (Select all that apply)
Which of the following are modifiable risk factors for stroke? (Select all that apply)
Which of the following are modifiable risk factors for stroke? (Select all that apply)
Which assessment finding is most indicative of a right hemispheric stroke?
Which assessment finding is most indicative of a right hemispheric stroke?
A patient presents with sudden facial droop, arm weakness, and slurred speech. What is the most appropriate initial action?
A patient presents with sudden facial droop, arm weakness, and slurred speech. What is the most appropriate initial action?
Which scale is commonly used to assess stroke severity in the acute phase?
Which scale is commonly used to assess stroke severity in the acute phase?
Which of the following is considered a warning sign of stroke? (Select all that apply)
Which of the following is considered a warning sign of stroke? (Select all that apply)
What is the primary goal of early stroke imaging (CT scan)?
What is the primary goal of early stroke imaging (CT scan)?
A patient is diagnosed with an ischemic stroke. Which medication is most appropriate?
A patient is diagnosed with an ischemic stroke. Which medication is most appropriate?
Which of the following is not a contraindication to thrombolytic therapy in stroke patients?
Which of the following is not a contraindication to thrombolytic therapy in stroke patients?
Which nursing action is a priority when a patient receives tPA?
Which nursing action is a priority when a patient receives tPA?
A patient with a hemorrhagic stroke is being monitored in ICU. Which intervention is most appropriate?
A patient with a hemorrhagic stroke is being monitored in ICU. Which intervention is most appropriate?
Which of the following complications is a major concern following a subarachnoid hemorrhage (SAH)?
Which of the following complications is a major concern following a subarachnoid hemorrhage (SAH)?
A patient develops brain herniation following a hemorrhagic stroke. What is the priority assessment?
A patient develops brain herniation following a hemorrhagic stroke. What is the priority assessment?
Which of the following clinical signs is associated with increased intracranial pressure (ICP)? (Select all that apply)
Which of the following clinical signs is associated with increased intracranial pressure (ICP)? (Select all that apply)
What are potential complications of dysphagia post-stroke? (Select all that apply)
What are potential complications of dysphagia post-stroke? (Select all that apply)
A stroke patient is experiencing left-sided hemiplegia. What is the priority nursing diagnosis?
A stroke patient is experiencing left-sided hemiplegia. What is the priority nursing diagnosis?
What is the most appropriate action when feeding a stroke patient with suspected dysphagia?
What is the most appropriate action when feeding a stroke patient with suspected dysphagia?
Which of the following nursing actions reduces the risk of aspiration during meals? (Select all that apply)
Which of the following nursing actions reduces the risk of aspiration during meals? (Select all that apply)
A patient with expressive aphasia is trying to communicate. What is the best nursing response?
A patient with expressive aphasia is trying to communicate. What is the best nursing response?
Which approach helps maintain skin integrity in an immobile stroke patient?
Which approach helps maintain skin integrity in an immobile stroke patient?
Which of the following is the best way to prevent contractures in a stroke patient with hemiparesis?
Which of the following is the best way to prevent contractures in a stroke patient with hemiparesis?
What is the half-life of tissue plasminogen activator (tPA)?
What is the half-life of tissue plasminogen activator (tPA)?
Tenecteplase differs from tPA in which of the following ways? (Select all that apply)
Tenecteplase differs from tPA in which of the following ways? (Select all that apply)
Why is it essential to obtain a non-contrast CT scan before administering thrombolytics?
Why is it essential to obtain a non-contrast CT scan before administering thrombolytics?
A patient with a hemorrhagic stroke is most likely to need which intervention?
A patient with a hemorrhagic stroke is most likely to need which intervention?
Which labs should the nurse monitor before starting tPA? (Select all that apply)
Which labs should the nurse monitor before starting tPA? (Select all that apply)
What is the nurse's role during stroke rehabilitation?
What is the nurse's role during stroke rehabilitation?
A patient is recovering from a left hemispheric stroke. What is a likely deficit?
A patient is recovering from a left hemispheric stroke. What is a likely deficit?
What education is most important for a patient going home post-stroke? (Select all that apply)
What education is most important for a patient going home post-stroke? (Select all that apply)
A home health nurse assesses a stroke survivor's home. Which hazards should be removed? (Select all that apply)
A home health nurse assesses a stroke survivor's home. Which hazards should be removed? (Select all that apply)
A patient with hemianopia can benefit from which nursing intervention?
A patient with hemianopia can benefit from which nursing intervention?
During rehabilitation, the nurse encourages a stroke patient with right-sided hemiparesis to use the affected arm in activities. This approach promotes:
During rehabilitation, the nurse encourages a stroke patient with right-sided hemiparesis to use the affected arm in activities. This approach promotes:
A patient recovering from a stroke becomes frustrated while speaking. The best nursing action is to:
A patient recovering from a stroke becomes frustrated while speaking. The best nursing action is to:
A patient with left hemispheric stroke is impulsive and unaware of deficits. The nurse should:
A patient with left hemispheric stroke is impulsive and unaware of deficits. The nurse should:
Which statement by a family member of a stroke patient indicates a need for more teaching?
Which statement by a family member of a stroke patient indicates a need for more teaching?
The nurse is teaching a patient with a history of TIA about stroke prevention. Which instruction is most important?
The nurse is teaching a patient with a history of TIA about stroke prevention. Which instruction is most important?
Which neurological assessment finding requires immediate action in a post-stroke patient?
Which neurological assessment finding requires immediate action in a post-stroke patient?
A patient with a stroke has dysphasia and is at high risk for aspiration. Which intervention should the nurse implement first?
A patient with a stroke has dysphasia and is at high risk for aspiration. Which intervention should the nurse implement first?
The nurse suspects a stroke when the patient suddenly shows facial droop, slurred speech, and arm drift. What's the next priority step?
The nurse suspects a stroke when the patient suddenly shows facial droop, slurred speech, and arm drift. What's the next priority step?
Which finding is most important to report before administering thrombolytics to a stroke patient?
Which finding is most important to report before administering thrombolytics to a stroke patient?
Which dietary recommendation is most appropriate for a stroke survivor at risk of recurrent stroke?
Which dietary recommendation is most appropriate for a stroke survivor at risk of recurrent stroke?
Flashcards
Cerebrovascular Accident (CVA)
Cerebrovascular Accident (CVA)
A sudden interruption in blood flow to the brain, resulting in tissue ischemia and potential cell death.
Ischemic Stroke Prevalence
Ischemic Stroke Prevalence
Approximately 87% of all strokes are ischemic, often caused by thrombosis or embolism.
Intracerebral Hemorrhage
Intracerebral Hemorrhage
Bleeding within the brain tissue, often linked to high blood pressure.
Transient Ischemic Attack (TIA)
Transient Ischemic Attack (TIA)
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Types of Ischemic Strokes
Types of Ischemic Strokes
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Modifiable Stroke Risk Factors
Modifiable Stroke Risk Factors
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Right Hemispheric Stroke Deficit
Right Hemispheric Stroke Deficit
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Initial Action for Stroke Symptoms
Initial Action for Stroke Symptoms
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Stroke Severity Assessment
Stroke Severity Assessment
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Warning Signs of Stroke
Warning Signs of Stroke
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Primary Goal of Early Stroke Imaging
Primary Goal of Early Stroke Imaging
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Preferred Medication for Acute Ischemic Stroke
Preferred Medication for Acute Ischemic Stroke
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Priority Nursing Action with tPA
Priority Nursing Action with tPA
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Priority Intervention for Hemorrhagic Stroke
Priority Intervention for Hemorrhagic Stroke
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Dietary Recommendation post-stroke
Dietary Recommendation post-stroke
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Study Notes
Cerebrovascular Accident (CVA)
- CVA, or stroke, involves a sudden interruption of blood flow to the brain
- This results in tissue ischemia and potential cell death
- Approximately 87% of all strokes are ischemic
- Ischemic strokes are typically due to thrombosis or embolism blocking cerebral arteries
- Intracerebral hemorrhages are caused by bleeding within the brain tissue
- Intracerebral hemorrhages are frequently linked to high blood pressure
- Transient Ischemic Attack (TIA) is a "mini-stroke"
- TIA involves a temporary blockage of blood flow to the brain without permanent tissue damage
- Ischemic stroke types include embolic, thrombotic, and small vessel disease
- Hemorrhagic strokes include intracerebral and subarachnoid hemorrhages
- Modifiable risk factors for stroke include hypertension, smoking, and diabetes
- Age and gender are non-modifiable risk factors
Stroke Assessment and Initial Actions
- Right hemispheric strokes typically cause left-sided motor deficits
- Prompt recognition and activation of stroke protocols is critical to preserve brain function
- The NIH Stroke Scale (NIHSS) evaluates the severity of neurological deficits in stroke patients
- Sudden confusion, vision changes, and headache are hallmark signs and warning signs of stroke
Treatment and Management of Strokes
- Early stroke imaging helps differentiate between hemorrhagic and ischemic stroke to guide treatment
- tPA (tissue plasminogen activator) is the preferred thrombolytic used in acute ischemic stroke
- tPA is most effective when given within the therapeutic window
- Early presentation (less than 3 hours) is a criterion for receiving tPA
- Recent GI bleeding, platelet count < 100,000, and major surgery within the past 14 days are contraindications with thrombolytic therapy
- Monitoring for bleeding is the priority nursing action when a patient receives tPA
Hemorrhagic Strokes Interventions
- Hemorrhagic stroke patients are at risk of increased ICP due to bleeding into the brain
- Monitoring for signs of increased ICP is most appropriate
- Vasospasm is a serious complication of subarachnoid hemorrhage (SAH)
- Vasospasm can lead to delayed cerebral ischemia
- The priority assessment for brain herniation following a hemorrhagic stroke is pupillary response
- Changes in pupillary response can indicate increased ICP or herniation, requiring immediate action
- Cushing's triad (bradycardia, widened pulse pressure, and irregular respirations) is a classic sign of increased ICP
Post Stroke Potential Complications
- Dysphagia can lead to poor intake, aspiration, and dehydration.
- Provide early intervention in these cases.
- Hemiplegia causes immobility, increasing risk for complications such as pressure injuries and DVTs
Nursing Care and Safety
- A speech-language pathologist evaluates swallowing and helps prevent aspiration
- Proper positioning, slow feeding, and checking for reflexes are key to preventing aspiration
- Alternative communication methods help patients with expressive aphasia communicate their needs
- Regular repositioning and nutrition are essential to prevent pressure injuries in immobile patients
- Passive ROM helps maintain joint flexibility and prevent muscle contractures
Pharmacology and Surgical Management
- tPA has a very short half-life of 4 minutes, allowing for quick onset and clearance
- Tenecteplase has a longer half-life, is given as a single bolus, and is not yet FDA-approved for stroke use
- It is essential to obtain a non-contrast CT scan before administering thrombolytics to rule out hemorrhagic stroke
- Hemorrhagic stroke is a contraindication for thrombolytic therapy
- Surgical decompression may be necessary to relieve pressure from the hemorrhage
- Monitor PT/PTT, INR, and CBC before starting tPA
- Coagulation and platelet status are essential to assess bleeding risk before thrombolytic therapy
Stroke Rehabilitation and Patient Education
- Rehabilitation includes promoting independence and assisting with daily living activities (ADLs)
- A left-sided stroke often results in right-sided weakness and language problems
- Education should include risk reduction, recognition of symptoms, and follow-up care
- Home safety modifications are crucial for stroke patients with mobility issues because fall risks involve throw rugs, dim lighting, cluttered walkways, and unsecured cords
- Placing objects within the intact visual field helps the patient navigate the environment safely with hemianopia
- Encouraging use of the affected side supports neuroplasticity and helps the brain form new pathways for movement
- Patience and support reduce anxiety and help patients regain confidence in communication
- Right-sided brain damage often results in impulsivity; supervision and safety measures are crucial to prevent injury
Family Teaching Points
- Stroke patients often have cognitive or memory issues
- Medications should be given on a schedule, not as remembered
Stroke/TIA Prevention
- Antiplatelet therapy (e.g., aspirin or clopidogrel) is key in reducing the risk of ischemic stroke following a TIA
Immediate Actions in Post-Stroke Patients
- New onset of unequal pupils may indicate increased ICP or brain herniation, a medical emergency
- A speech-language pathologist should assess swallowing ability before oral intake to prevent aspiration
- The priority is to alert the provider and prepare for diagnostic imaging ASAP in stroke care.
- Time is critical
Dietary and Pre-tPA Considerations
- Uncontrolled hypertension increases the risk of intracranial bleeding
- Blood pressure must be controlled before tPA
- Stroke prevention includes a heart-healthy diet to manage blood pressure and cholesterol levels
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