Cerebrovascular Disorders CH 46
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Questions and Answers

Which intervention is most effective in enhancing a hemiplegic patient's communication during care activities?

  • Using complex medical jargon when explaining procedures
  • Relying solely on written instructions for communication
  • Avoiding discussions to minimize frustration
  • Incorporating gestures while speaking to the patient (correct)

How should family members be advised to cope with the slow rehabilitation process of a hemiplegic patient?

  • Neglect their own emotional needs during the process
  • Expect rapid improvements to avoid disappointment
  • Recognize that rehabilitation may take many months and be gradual (correct)
  • Focus solely on the patient's physical recovery

What self-care strategy is recommended to maintain skin integrity in immobilized patients?

  • Leave the skin uncovered to promote air circulation
  • Implement a turning schedule every two hours (correct)
  • Change position every four hours
  • Keep skin moist and oily at all times

Which of the following strategies can help address sexual dysfunction in stroke patients?

<p>Educating patients and partners on alternative sexual expressions (A)</p> Signup and view all the answers

What is an important family coping mechanism for supporting a hemiplegic patient at home?

<p>Create attainable goals with the rehabilitation team for at-home care (D)</p> Signup and view all the answers

Which population is reported to have a higher incidence of cerebrovascular disorders?

<p>Pacific Islanders (B)</p> Signup and view all the answers

What is the purpose of the NIH Stroke Scale?

<p>To evaluate neurologic function (A)</p> Signup and view all the answers

Which of the following is a key symptom of an ischemic stroke?

<p>Numbness or weakness on one side of the body (C)</p> Signup and view all the answers

Which measure is not part of the stroke performance measures?

<p>Discharge on pain medication (B)</p> Signup and view all the answers

During which step of the 7 D's is the patient brought to a stroke center?

<p>Delivery (B)</p> Signup and view all the answers

What does the term 'ischemic penumbra' refer to?

<p>The area surrounding a stroke that may recover with intervention (C)</p> Signup and view all the answers

Which medication is commonly initiated for patients discharged following an ischemic stroke?

<p>Antithrombotic therapy (B)</p> Signup and view all the answers

Which potential cause of ischemic stroke is categorized as cryptogenic?

<p>No known cause (A)</p> Signup and view all the answers

What approach should be taken when managing shoulder pain for a patient with limited external rotation?

<p>Place a pillow in the axilla. (A)</p> Signup and view all the answers

How should a nurse assist a patient with decreased vision to enhance their visual perception?

<p>Present visual stimuli on the unaffected side. (B)</p> Signup and view all the answers

What strategy should be employed to improve communication with a patient?

<p>Ensure consistent routine and speak slowly. (A)</p> Signup and view all the answers

What is important when teaching self-care strategies to patients who can start sitting up?

<p>Incorporate activities like combing hair and bathing. (D)</p> Signup and view all the answers

Which method can enhance a patient's memory and concentration?

<p>Offering a written copy of their daily schedule. (D)</p> Signup and view all the answers

How can a nurse effectively support a patient's thought processes?

<p>Use supportive and positive feedback techniques. (A)</p> Signup and view all the answers

What adjustment should be made in the environment to assist patients with sensory-perceptual difficulties?

<p>Increase natural or artificial lighting in the room. (B)</p> Signup and view all the answers

What is a recommended approach when dealing with patients' reactions and needs during communication?

<p>Be sensitive and responsive to their needs. (C)</p> Signup and view all the answers

Flashcards

High-fiber diet for preventing issues

A high-fiber diet and adequate fluid intake (2-3 liters a day) for toileting and digestion, especially when there are no contraindications.

Shoulder pain care during PT

Place a pillow under the arm (axilla) if external rotation is limited. Avoid lifting or pulling the affected arm or shoulder.

Patient hygiene promotion

Encourage personal hygiene (hair combing, teeth brushing, shaving, bathing, eating) as soon as the patient can sit up.

Vision difficulty strategies

Approach patients with decreased vision from the side where vision is intact. Put visual aids like clocks and calendars there too.

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Communication with decreased mental abilities

Speak slowly, give one instruction at a time, gain attention. Use consistent language, utilize a communication board (pictures for needs).

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Thought process support

Offer supportive environment, positive feedback, and confidence to improve thought processes.

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Memory and concentration aids

Use schedules, personal info folders, checklists, and audio tapes for improving memory and concentration.

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Environment for communication

Create a supportive, calming atmosphere tailored to individual needs and reactions to promote communication.

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Skin Integrity Care

Maintaining healthy skin by preventing pressure sores, friction, and dryness.

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Aphasia Patient Care

Communicate actively with aphasia patients during care activities.

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Family Coping in Stroke Rehab

Educate the family about the length and possible slow progress of stroke rehabilitation.

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Home Care Modifications

Adapt home environments to assist stroke patients with daily living activities (e.g., bathing, eating).

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Sexual Dysfunction in Stroke

Assess and address the impact of a stroke on the patient's and partner's sexuality.

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Stroke Incidence

Stroke occurs more frequently in older men and is more common among African Americans, Asians, and Pacific Islanders. The Southeast US has a higher incidence, known as the 'stroke belt'.

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NIH Stroke Scale

A standardized assessment used to evaluate the severity of a stroke, focusing on neurological function.

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Ischemic Stroke

A type of stroke caused by a blocked blood vessel, depriving brain tissues of oxygen and nutrients. It can be further classified into different causes like large-artery thrombosis, small-artery thrombosis, cardiogenic embolic, cryptogenic, and others.

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Hemorrhagic Stroke

A type of stroke caused by a ruptured blood vessel, leading to bleeding in the brain.

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Ischemic Penumbra

The brain tissue surrounding the area of cell death (core infarct) in an ischemic stroke. Blood flow is reduced in the penumbra, making it vulnerable but potentially salvageable with timely intervention.

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7 D's of Stroke Care

A framework for optimizing stroke care, emphasizing rapid detection, dispatch, delivery, door assessment, data collection, decision-making, and drug administration.

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tPA Therapy

Tissue plasminogen activator (tPA) is a medication used to dissolve blood clots in ischemic stroke patients. It's a time-sensitive treatment and requires careful evaluation of risks and benefits.

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Stroke Education

Providing patients with essential information about stroke, including risk factors, prevention strategies, and post-stroke management, enhancing their understanding and empowering them to make informed decisions.

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Study Notes

Cerebrovascular Disorders CH 46

  • Incidence is higher in older men, African Americans, Asians, and Pacific Islanders, particularly in the Southeast US "stroke belt"
  • Review stroke performance measures are a key assessment component.

Stroke Performance Measures

  • NIH Stroke scale is assessed
  • Ischemic and Hemorrhagic strokes are considered
  • Discharge and antithrombotic therapies, anticoagulation (A-Fib), thrombolytic therapy, and cholesterol-reducing medications are assessed.
  • Antithrombotic medications are administered by the end of day 2 in the hospital.
  • Stroke education is assessed, including rehabilitation.

7 D's

  • Assess for detection of stroke symptoms
  • Dispatch (911) is a critical step
  • Delivery of the patient to the stroke center
  • Door-time assessment at the hospital
  • Data is collected (CT, neuro exams, tPA potential exclusions)
  • Decision-making (pt is candidate for tPA if appropriate)
  • Drug (tPA) administration, monitoring

Types of Strokes

  • Ischemic: Cell death at the occlusion site. Surrounding tissue affected is ischemic penumbra
  • Causes: Large artery, small penetrating artery thrombosis, cardiogenic embolic, cryptogenic, or other
  • Main presenting symptoms: numbness/weakness on one side of the body, slurred speech, or difficulty with word finding or comprehension.
  • Hemorrhagic:
  • Causes: Intracerebral hemorrhage, subarachnoid hemorrhage, cerebral aneurysm, arteriovenous malformation
  • Main presenting symptoms: Exploding (sudden onset) headache, decreased level of consciousness (LOC), vomiting, visual changes, seizures

TIA (Transient Ischemic Attack)

  • Warning signs (temporary, less than 24 hrs): blurred vision, diplopia, blindness, tunnel vision, weakness, ataxia, numbness, vertigo, aphasia, dysarthria.
  • Diagnostics: CT scan (with and without contrast), MRI (magnetic resonance imaging), MRA (Magnetic resonance angiography), carotid ultrasound, transcranial Doppler (TCD), cerebral angiography.

TIA Nursing Care

  • Teaching on hypertension, diabetes, anticoagulants, lifestyle changes

Risk Factors for Stroke

  • Non-modifiable: Age, gender (male), family history, race (African-American), history of heart attack, history of migraine, prior stroke, sickle cell.
  • Modifiable: Hypertension, dyslipidemia, cardiovascular disease, diabetes, clotting disorders, sleep apnea, substance abuse, obesity, sedentary lifestyle, oral contraceptives, and alcohol use.

Clinical Manifestations

  • Assess left and right hemispheric strokes focusing on paralysis/weakness, visual field deficits, aphasia, altered cognitive ability, slow behavior, left-sided paralysis/weakness, or other spatial-perceptual deficits.
  • Other possible symptoms include: increased distractibility, impulsive behavior, poor judgment, lack of awareness of deficits, difficulty with language use, dysarthria, apraxia, agraphia, hemiplegia, hemiparesis, ataxia, agnosia, diplopia, hyper/hypotonia, unilateral neglect, or unilateral visual field deficits (hemianopsia), dysphagia, or emotional lability.

Assessments/Diagnostics

  • Conduct baseline assessments (CBC, PT/PTT, INR).
  • Rule out hemorrhagic stroke using CT scan.
  • Conduct toxicology screens.
  • Use MRI, MRA, carotid ultrasound, TCD, or cerebral angiography for additional diagnostics.

Interventions

  • Improving cerebral perfusion: embolization, clipping of aneurysms, carotid stent, frequent neuro checks, carotid endarterectomy, and quiet environment with HOB elevated
  • Ischemic interventions: tPA (tissue plasminogen activator) to dissolve clots if time allows and no contraindications. Manage BP, monitor for bleeding, and assess for re-bleeding.
  • Drug therapy: tPA, blood pressure management, anticoagulants, antiseizure medications, stool softeners, and pain control
  • Improve mobility/prevent deformities
  • Positioning, turning every 2 hrs, splinting, and OOB (out of bed).

Bowel and Bladder Control

  • Provide adequate fluid intake and establish toileting routine.

Preventing Shoulder Pain

  • Use pillows for support.
  • Avoid lifting patients by their flaccid shoulders.

Enhancing Self-Care

  • Provide personal hygiene assistance.

Managing Sensory-Perceptual Difficulties

  • Encourage the patient to turn their head.
  • Position yourself to encourage patient to turn or move or to visualize the surroundings
  • Incorporate increasing lighting and eyeglasses.

Improving Thought Processes

  • Be supportive and empathetic as well as optimistic
  • Make sure schedules are clear and consistent.

Maintaining Skin Integrity

  • Turning schedule
  • Minimize shear and friction
  • Skin care

Improving Family Coping

  • Explain that recovery will take time and will be slow
  • Maintain caregiver support and optimism.

Coping with Sexual Dysfunction

  • Begin a dialogue with the patient and/or their partner.
  • In-depth assessments.
  • Relevant information
  • Education,
  • Reassurance,
  • Adjustment of medications

Promoting Home Care

  • Make modifications to the home environment (shower, long-handled tools etc)

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Description

This quiz focuses on cerebrovascular disorders, particularly stroke, and includes key performance measures and assessment protocols. It highlights incidence rates, the NIH Stroke Scale, types of stroke, and the critical '7 D's' for effective stroke management. Prepare to understand the intricacies of stroke detection, treatment, and rehabilitation.

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