Podcast
Questions and Answers
Which intervention is most effective in enhancing a hemiplegic patient's communication during care activities?
Which intervention is most effective in enhancing a hemiplegic patient's communication during care activities?
How should family members be advised to cope with the slow rehabilitation process of a hemiplegic patient?
How should family members be advised to cope with the slow rehabilitation process of a hemiplegic patient?
What self-care strategy is recommended to maintain skin integrity in immobilized patients?
What self-care strategy is recommended to maintain skin integrity in immobilized patients?
Which of the following strategies can help address sexual dysfunction in stroke patients?
Which of the following strategies can help address sexual dysfunction in stroke patients?
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What is an important family coping mechanism for supporting a hemiplegic patient at home?
What is an important family coping mechanism for supporting a hemiplegic patient at home?
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Which population is reported to have a higher incidence of cerebrovascular disorders?
Which population is reported to have a higher incidence of cerebrovascular disorders?
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What is the purpose of the NIH Stroke Scale?
What is the purpose of the NIH Stroke Scale?
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Which of the following is a key symptom of an ischemic stroke?
Which of the following is a key symptom of an ischemic stroke?
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Which measure is not part of the stroke performance measures?
Which measure is not part of the stroke performance measures?
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During which step of the 7 D's is the patient brought to a stroke center?
During which step of the 7 D's is the patient brought to a stroke center?
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What does the term 'ischemic penumbra' refer to?
What does the term 'ischemic penumbra' refer to?
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Which medication is commonly initiated for patients discharged following an ischemic stroke?
Which medication is commonly initiated for patients discharged following an ischemic stroke?
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Which potential cause of ischemic stroke is categorized as cryptogenic?
Which potential cause of ischemic stroke is categorized as cryptogenic?
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What approach should be taken when managing shoulder pain for a patient with limited external rotation?
What approach should be taken when managing shoulder pain for a patient with limited external rotation?
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How should a nurse assist a patient with decreased vision to enhance their visual perception?
How should a nurse assist a patient with decreased vision to enhance their visual perception?
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What strategy should be employed to improve communication with a patient?
What strategy should be employed to improve communication with a patient?
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What is important when teaching self-care strategies to patients who can start sitting up?
What is important when teaching self-care strategies to patients who can start sitting up?
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Which method can enhance a patient's memory and concentration?
Which method can enhance a patient's memory and concentration?
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How can a nurse effectively support a patient's thought processes?
How can a nurse effectively support a patient's thought processes?
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What adjustment should be made in the environment to assist patients with sensory-perceptual difficulties?
What adjustment should be made in the environment to assist patients with sensory-perceptual difficulties?
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What is a recommended approach when dealing with patients' reactions and needs during communication?
What is a recommended approach when dealing with patients' reactions and needs during communication?
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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.
