Stroke Pathophysiology and Risk Factors
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What should be the primary goal of nursing care for a patient after a stroke once they have stabilized?

  • To prioritize medication management
  • To preserve life at all costs
  • To focus solely on communication rehabilitation
  • To minimize complications and improve physical function (correct)

Which of the following is NOT a common nursing goal for a stroke patient?

  • Maintain effective personal and family coping
  • Maximize communication abilities
  • Maintain stable body functions
  • Achieve complete independence immediately (correct)

During the acute phase after a stroke, which respiratory problem is a patient particularly at risk for?

  • Atelectasis (correct)
  • Pneumothorax
  • Influenza
  • Chronic obstructive pulmonary disease (COPD)

Which of the following measures helps maintain optimal function of the musculoskeletal system in stroke patients?

<p>Frequent passive range of motion exercises (A)</p> Signup and view all the answers

What is the most common bowel problem encountered by stroke patients?

<p>Constipation (D)</p> Signup and view all the answers

What is the priority for managing the urinary system in stroke patients?

<p>Promoting normal bladder function (D)</p> Signup and view all the answers

In the first 24 hours after a stroke, what should be assessed regarding the patient's swallowing ability?

<p>The risks of aspiration and nutritional needs (A)</p> Signup and view all the answers

What is a key role of healthcare professionals to reduce the incidence of stroke?

<p>Educating patients about modifiable risk factors (C)</p> Signup and view all the answers

What is the primary goal during the acute phase of care for ischemic stroke patients?

<p>Preserve life and prevent further brain damage (D)</p> Signup and view all the answers

Which of the following is a common treatment for preventing further strokes in patients who have experienced a TIA?

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

What is the significance of the time of onset in the evaluation of a patient with ischemic stroke?

<p>It is crucial for administering tPA treatment. (B)</p> Signup and view all the answers

What surgical interventions may be performed for a patient with TIAs caused by carotid disease?

<p>Carotid endarterectomy and angioplasty (C)</p> Signup and view all the answers

During acute care for hemorrhagic stroke, which therapy is used to manage hypertension and prevent seizures?

<p>Drug therapy (D)</p> Signup and view all the answers

What is an important aspect of managing fluid and electrolyte balance in stroke patients?

<p>Ensuring adequate hydration to promote perfusion (A)</p> Signup and view all the answers

Which diagnostic procedure is necessary to evaluate the presence of intracranial pressure in a stroke patient?

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

What is homonymous hemianopsia commonly associated with after a stroke?

<p>Blindness in the same half of each visual field (D)</p> Signup and view all the answers

What type of drug therapy would be administered to reduce the incidence of cerebral vasospasms in hemorrhagic stroke patients?

<p>Vasodilators (A)</p> Signup and view all the answers

What is crucial for maximizing a patient's abilities during stroke rehabilitation?

<p>A team approach involving various rehabilitation specialists (A)</p> Signup and view all the answers

During the acute phase of stroke recovery, which functions should rehabilitation initially emphasize?

<p>Musculoskeletal functions like eating and walking (A)</p> Signup and view all the answers

What is a general preventive measure at risk for stroke patients to avoid thrombus or embolus formation?

<p>Regulating diet and alcohol consumption (B)</p> Signup and view all the answers

During which phase does treatment shift towards rehabilitation?

<p>Acute phase (A)</p> Signup and view all the answers

What dietary adjustment may be necessary for a stroke patient?

<p>Adjusting the diet for the patient’s ability to swallow solids and fluids (A)</p> Signup and view all the answers

What type of deficits might a patient with a stroke on the right side of the brain typically experience?

<p>Difficulty judging position, distance, and rate of movement (B)</p> Signup and view all the answers

What is a common emotional challenge faced by stroke patients?

<p>Coping with various sensory and functional losses (C)</p> Signup and view all the answers

Which risk factor is considered the most significant modifiable risk factor for stroke prevention?

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

What is a transient ischemic attack (TIA)?

<p>A temporary episode of neurologic dysfunction without acute infarction lasting less than one hour (B)</p> Signup and view all the answers

Which type of professional is typically involved in assessing and planning care for communication deficits in stroke patients?

<p>Speech therapist (A)</p> Signup and view all the answers

What type of stroke results from inadequate blood flow to the brain due to an occluded artery?

<p>Ischemic stroke (A)</p> Signup and view all the answers

What aspect of stroke rehabilitation is often highlighted as being mutually set by all team members?

<p>Goals of rehabilitation (D)</p> Signup and view all the answers

Which of the following statements is true regarding thrombotic strokes?

<p>They occur due to injury to a blood vessel wall and clot formation. (D)</p> Signup and view all the answers

What nursing measure is focused on promoting urinary continence in stroke patients?

<p>Comprehensive bowel management program (D)</p> Signup and view all the answers

Which factor can significantly contribute to the stress experienced by patients during a stroke event?

<p>The suddenness and extreme nature of the event (A)</p> Signup and view all the answers

Which diagnostic study is effective in assessing blood flow to the brain during a suspected stroke?

<p>CT angiography or MRI angiography of the brain (D)</p> Signup and view all the answers

What is a common motor deficit that may occur after a stroke?

<p>Impairment of mobility (B)</p> Signup and view all the answers

Which of the following best describes the prognosis for intracerebral hemorrhage?

<p>Prognosis is poor due to ongoing bleeding and brain damage (C)</p> Signup and view all the answers

Which diagnostic tool is primarily used to distinguish between ischemic and hemorrhagic stroke?

<p>MRI or noncontrast CT scan (C)</p> Signup and view all the answers

What is a key goal of preventive therapy for stroke?

<p>Managing modifiable risk factors (B)</p> Signup and view all the answers

Which symptom is NOT commonly associated with motor deficits after a stroke?

<p>Impaired spatial navigation (A)</p> Signup and view all the answers

What characterizes subarachnoid hemorrhage?

<p>Bleeding into the cerebrospinal fluid-filled space (D)</p> Signup and view all the answers

Which of the following statements regarding a right-sided stroke is true?

<p>It may cause unilateral neglect (D)</p> Signup and view all the answers

What should be assessed to confirm a diagnosis of stroke?

<p>MRI or noncontrast CT scan results (C)</p> Signup and view all the answers

What emotional change might a patient experience after a stroke?

<p>Difficulty controlling emotions (C)</p> Signup and view all the answers

Which of the following is typically NOT a cause of subarachnoid hemorrhage?

<p>Chronic hypertension (C)</p> Signup and view all the answers

Nursing interventions for stroke patients do not include monitoring the respiratory system as it is not a priority.

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

Nursing goals for stroke patients include maintaining a stable level of consciousness and maximizing communication abilities.

<p>True (A)</p> Signup and view all the answers

Administering IV infusions to stroke patients is only done to provide medications and has no role in maintaining fluid and electrolyte balance.

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

Nurses are responsible for assessing swallowing ability within the first 48 hours after a stroke.

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

Promoting normal bladder function in stroke patients can include avoiding the use of indwelling catheters.

<p>True (A)</p> Signup and view all the answers

Antiplatelet drugs are used to prevent thrombus or embolus formation in patients at risk for stroke.

<p>True (A)</p> Signup and view all the answers

Managing airway, breathing, circulation, and intracranial pressure is only crucial in patients who have experienced a hemorrhagic stroke.

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

Platelet inhibitors and anticoagulants are given to stabilize patients after they have had a stroke.

<p>True (A)</p> Signup and view all the answers

A nurse should prioritize monitoring for increasing neurological deficits in patients who have had an ischemic stroke.

<p>True (A)</p> Signup and view all the answers

Recombinant tissue plasminogen activator (tPA) must be administrated within 6 hours of stroke onset.

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

Fluid and electrolyte balance is less important during the acute care of stroke patients.

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

Surgical interventions are only considered for patients with ischemic strokes, not for hemorrhagic strokes.

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

Elevated blood pressure after a stroke is always harmful and should be treated immediately.

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

Careful control of fluid balance in stroke patients can help decrease the likelihood of subsequent brain injury.

<p>True (A)</p> Signup and view all the answers

The selection of surgical procedures for hemorrhagic strokes is based solely on the patient's age.

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

Flashcards

Stroke Core Measures

Standards set by The Joint Commission to improve outcomes after a stroke.

Post-Stroke Care Focus (12-24 hrs)

Shifting from life-saving measures to minimizing disability and maximizing a patient's functions.

Stroke Nursing Goals

Maintaining consciousness, achieving maximum physical/self-care/communication/nutrition; preventing complications; and supporting family/patient coping.

Stroke Risk Reduction

Nursing role in promoting health and educating patients about reducing modifiable stroke risk factors.

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Acute Stroke Respiratory Care

Prioritizing respiratory health during the initial phase (e.g., monitoring for atelectasis, obstruction, aspiration).

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Neurological Monitoring post-stroke

Closely tracking brain function to spot any changes related to stroke progression, increased intracranial pressure, vasospasm, or recovery.

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Stroke Bowel Problem

Constipation is the most common bowel issue for stroke patients.

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Stroke Bladder Problem

Poor bladder control (incontinence) is the primary urinary challenge for stroke patients.

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Health Promotion for Stroke Prevention

Strategies to reduce stroke risk through healthy lifestyle choices like diet, exercise, and avoiding smoking.

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TIA Treatment focus

Antiplatelet drugs are the main treatment to prevent further stroke after TIA (mini-stroke).

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Surgical Interventions for TIAs

Carotid endarterectomy, angioplasty, and stenting to treat TIAs related to carotid artery disease.

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Acute Ischemic Stroke Goals

Preserving life, preventing further brain injury, and minimizing disability during acute ischemic stroke.

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Acute Stroke: ABCs

Managing airway, breathing, and circulation is the initial priority.

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tPA Administration

Recombinant tissue plasminogen activator (tPA) should be given intravenously within 3-4.5 hours of stroke onset.

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Hemorrhagic Stroke Goals

The same ABCs (airway, breathing, and circulation) and intracranial pressure management as for ischemic stroke.

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Hemorrhagic Stroke Treatment

Surgical interventions like aneurysm clipping or coiling, and hematoma evacuation are common treatments.

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Rehabilitative Stroke Care

Treatment approaches change during the rehabilitation from acute to recovery.

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Stroke Prevention Focus

Controlling blood pressure, limiting alcohol, and routine health assessments help prevent stroke.

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Hemorrhagic Stroke

A type of stroke caused by bleeding within the brain tissue, subarachnoid space, or ventricles.

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Intracerebral Hemorrhage

Bleeding within the brain tissue itself, often caused by a ruptured blood vessel.

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Subarachnoid Hemorrhage

Bleeding into the space between the arachnoid and pia mater membranes, often caused by an aneurysm rupture.

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Stroke Prognosis

Outcome prediction for a stroke, related to the amount of brain tissue deprived of blood.

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Stroke Manifestations

Symptoms of a stroke depend on the affected brain area.

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Motor Deficits in Stroke

Problems with movement, breathing, swallowing, and other bodily functions due to brain damage.

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Emotional Changes in Stroke

Difficulty controlling emotions, often stemming from brain damage.

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Cognitive Impairments in Stroke

Problems with memory, judgement, and other cognitive functions.

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Spatial-Perceptual Problems in Stroke

Difficulties with spatial awareness, perception, and coordination, often associated with right-side brain strokes.

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Stroke Diagnostic Studies

Tests like MRI or CT scan are used to confirm a stroke, identify cause, and assess severity.

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Homonymous Hemianopsia

Blindness in the same half of both visual fields. This is a common complication after a stroke.

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Stroke Patient Disregard

Patients with homonymous hemianopsia may ignore objects in their blind field, unaware of the visual deficit.

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Stroke Stress

A stroke is a stressful event for the patient, family, and caregivers.

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Stroke Rehabilitation Goals

Rehabilitation goals are collaboratively set by the patient, family, nurses, and other team members.

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Stroke Rehabilitation Focus (Initial)

Initial rehabilitation focuses on basic functions like eating, toileting, and walking.

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Stroke Diet Considerations

A dietitian assesses the patient's needs, ensuring adequate calories and appropriate food consistency for safe swallowing.

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Stroke Bowel Management

A bowel management program helps address constipation or incontinence, common complications after stroke.

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Stroke Urinary Management

Nursing interventions aim to promote urinary continence and prevent accidents.

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Perceptual Deficits (Stroke)

Right-sided brain stroke patients may struggle with judging position, distance, and movement.

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Stroke Losses

Stroke patients may experience various losses, including sensory, intellectual, communicative, and social.

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Stroke Cause: Blood Flow Interruption

A stroke happens when the brain doesn't get enough blood. This can be from a blockage (ischemia) or bleeding (hemorrhage) in the brain's blood vessels, leading to brain cell death.

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Stroke's Two Main Blood Supply Routes

The brain gets blood from two pairs of arteries: the internal carotid arteries (front of the brain) and the vertebral arteries (back of the brain).

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What is Atherosclerosis?

Atherosclerosis is like hardening and thickening of the arteries. It's a major cause of ischemic stroke because it can cause blood clots to form and block blood flow.

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Stroke Risk Factor: Hypertension

High blood pressure (hypertension) is the biggest modifiable risk factor for stroke. It increases the pressure on blood vessels and can make them weak and prone to bursting.

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What is a TIA?

A TIA (Transient Ischemic Attack) is a mini-stroke. It's a temporary blockage in the brain causing symptoms like weakness, numbness, or speech problems, but they usually disappear within an hour.

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Post-Stroke Care Shift

After a stroke stabilizes (12-24 hours), care shifts from life-saving to minimizing disability and maximizing function.

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Respiratory Care in Acute Stroke

During the acute phase, respiratory care is a priority, including monitoring for atelectasis, airway obstruction, and aspiration pneumonia.

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Musculoskeletal Care in Stroke

Measures are taken to prevent joint contractures and muscle atrophy to maintain optimal musculoskeletal function.

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Stroke Prevention: Lifestyle

Keeping a healthy weight, exercising regularly, eating a healthy diet, not smoking, and limiting alcohol intake can help prevent stroke.

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TIA: Mini-Stroke

A Transient Ischemic Attack (TIA) is a temporary blockage of blood flow to the brain, causing symptoms like weakness or speech problems.

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tPA: Stroke Treatment

Recombinant tissue plasminogen activator (tPA) is a drug that can break up blood clots and restore blood flow in the brain, but must be given within 3-4.5 hours of stroke onset.

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Acute Stroke Goals

The goals for acute stroke care are to save the patient's life, prevent further brain damage, and reduce disability.

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What is Hemorrhagic Stroke?

A hemorrhagic stroke happens when a blood vessel in the brain ruptures and bleeds, damaging surrounding brain tissue.

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Rehabilitation After Stroke

Rehabilitation focuses on helping stroke survivors regain lost functions and skills, such as walking, talking, or using their hands.

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Carotid Endarterectomy

Carotid endarterectomy is a surgery to remove plaque buildup from the carotid artery, preventing blood clots.

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Stroke Monitoring: Signs of Worsening

Nurses closely monitor patients for signs of worsening neurologic function, such as decreasing consciousness or increasing weakness, indicating potential complications.

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Study Notes

Stroke Pathophysiology

  • The brain needs a constant blood supply of oxygen and glucose for neurons to function.
  • A stroke occurs when the blood supply to the brain is interrupted, either due to ischemia (reduced blood flow) or hemorrhage (bleeding).
  • Interruption of blood supply results in brain cell death.
  • Two major artery pairs supply blood to the brain: internal carotid arteries (anterior circulation) and vertebral arteries (posterior circulation).
  • Factors affecting blood flow include systemic blood pressure, cardiac output, and blood viscosity.
  • Atherosclerosis (hardening and thickening of arteries) is a primary cause of ischemic stroke. It leads to thrombus formation and emboli.

Stroke Risk Factors

  • Prevention is the most effective way to reduce stroke burden.
  • Non-modifiable risk factors include age, gender, race, and heredity.
  • Hypertension is the most important modifiable risk factor.
  • Other modifiable risk factors include high serum cholesterol, smoking, excessive alcohol consumption, obesity, physical inactivity, poor diet, cardiac abnormalities, and drug use.

Types of Stroke

Ischemic Stroke

  • Transient ischemic attack (TIA): temporary neurological dysfunction caused by reduced blood flow, without permanent brain damage. Symptoms usually last less than an hour.
  • Ischemic stroke: inadequate blood flow to a part of the brain, caused by either thrombotic (clot formation in the blood vessel) or embolic (traveling clot) strokes.
  • A thrombotic stroke's extent depends on the onset speed, lesion size, and presence of collateral circulation.
  • Embolic strokes result in infarction (tissue death) and edema in the affected area, with symptoms often appearing quickly.

Hemorrhagic Stroke

  • Hemorrhagic stroke occurs from bleeding into the brain tissue itself or the subarachnoid space or ventricles.
  • Bleeding can be caused by a ruptured blood vessel (intracerebral hemorrhage) or blood vessel in the surface of the brain (subarachnoid hemorrhage).

Clinical Manifestations of Stroke

  • Stroke manifestations depend on the affected area of the brain.
  • Affected areas can involve motor function, bladder/bowel function, cognitive function, spatial perception, personality, sensation, swallowing, and communication.
  • Stroke can also cause aphasia, dysphasia, dysphagia, and dysarthria (problems with speech).
  • Emotional control and memory/judgment may be affected.

Diagnostic Studies for Stroke

  • Diagnostic tests confirm stroke by ruling out other brain conditions (e.g., subdural hematoma).
  • MRI and non-contrast CT scans are important diagnostic tools to show the size and location of brain lesions, distinguishing between ischemic and hemorrhagic stroke.

Interprofessional Care for Stroke

Preventive Therapy

  • Managing modifiable risk factors (healthy diet, weight control, regular exercise, no smoking, and controlling hypertension) reduces the risk of stroke.
  • Antiplatelet drugs are commonly used to prevent further stroke in patients with TIA.
  • Surgical interventions might include carotid endarterectomy, transluminal angioplasty, and stenting for patients with carotid disease.

Acute Ischemic Stroke Care

  • Goals focus on life preservation, prevention of further brain damage, and reducing disability.
  • Initial care involves managing airway, breathing, and circulation (ABC). Monitor blood pressure carefully as it may be a protective response for cerebral perfusion.
  • Baseline neurologic assessment, and monitoring for increasing neurological deficits and increased intracranial pressure (ICP) are crucial.
  • Fluid and electrolyte balance must be carefully controlled.
  • Administer recombinant tissue plasminogen activator (tPA) within 3-4.5 hours of stroke onset.
  • Platelet inhibitors and anticoagulants may be given to prevent further clot formation.

Acute Hemorrhagic Stroke Care

  • Goals including managing ABC and intracranial pressure, are similar to ischemic stroke care.

Rehabilitative Care for Stroke

  • Treatment strategies evolve as the patient progresses from the acute to rehabilitation phase, focusing on lessening disability and achieving optimal function.
  • The Joint Commission has established stroke core measures to guide improvements.
  • Rehabilitation efforts maximize the patient's functional abilities, focusing on self-care, communication, and coping skills.
  • Speech therapists assist with communication issues, and dieticians manage appropriate nutritional intake.

Nursing Management for Stroke

  • Comprehensive nursing care promotes stable/improved consciousness, maximal self-care skills, optimal function, and effective coping strategies for the patient and family.
  • Focus on preventing complications like deep vein thrombosis (DVT), promoting skin integrity, ensuring adequate nutrition, and addressing communication and perceptual deficits.
  • Address bowel and bladder function and potential perceptual problems.
  • Implement a bowel management program to address constipation or incontinence and maintain urinary continence.

Ambulatory Care

  • Stroke patients transition from acute care to other settings like home or rehab facilities.
  • Ongoing rehab maximizes abilities with a team approach encompassing patients, families, and healthcare professionals.
  • Rehabilitation goals, including eating, toileting, walking, and progressive activities, are mutually set in collaboration.
  • Ongoing assessment for caloric intake and swallowing ability is key.

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Description

This quiz covers the essential aspects of stroke pathophysiology, including the brain's blood supply needs and the consequences of interrupted blood flow. It also delves into the risk factors associated with stroke, distinguishing between modifiable and non-modifiable elements. Test your knowledge on these critical health themes.

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