MS CH 49 Nursing Care of Patients With Cerebrovascular Disorders
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Questions and Answers

What is the primary cause of long-term complications following a subarachnoid hemorrhage?

  • Peritoneal shunt malfunction
  • Ischemic stroke
  • Vasospasm (correct)
  • Intracerebral bleed
  • A blood vessel's diameter narrows due to which of the following?

  • Rehabilitation therapy
  • Vasospasm (correct)
  • Subarachnoid hemorrhage
  • Ischemic stroke
  • Where does vasospasm typically originate?

  • In the peritoneal cavity
  • In the cerebral spinal fluid
  • In the vessel giving rise to the aneurysm (correct)
  • In the respiratory tract
  • What potential consequence of vasospasm explains why its outcomes can be widespread?

    <p>It can spread to other vessels (D)</p> Signup and view all the answers

    Which type of long-term complication is similar to those of subarachnoid hemorrhage?

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

    What type of facility is a patient likely to be transferred to, if they can tolerate intensive therapy?

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

    A ventriculoperitoneal shunt drains cerebrospinal fluid into which cavity?

    <p>Peritoneal Cavity (C)</p> Signup and view all the answers

    When assessing a cerebrovascular disorder patient, what should be assessed before offering oral intake?

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

    Why might patients dismiss early symptoms of a subarachnoid hemorrhage?

    <p>The symptoms are mild and mimic a flulike illness. (A)</p> Signup and view all the answers

    What is a common subjective description of a headache experienced during a subarachnoid hemorrhage?

    <p>The worst headache experienced in one's life. (D)</p> Signup and view all the answers

    Which of the following best describes the variability in a patient's level of consciousness (LOC) after a subarachnoid hemorrhage?

    <p>Patients may lose consciousness or gradually become less responsive. (D)</p> Signup and view all the answers

    What is the primary reason for the decreased level of consciousness (LOC) observed in some patients after a subarachnoid hemorrhage?

    <p>Increased intracranial pressure and impaired cerebral blood flow. (B)</p> Signup and view all the answers

    What is the typical systolic blood pressure range that is managed in patients with subarachnoid hemorrhage?

    <p>120-160 mm Hg (D)</p> Signup and view all the answers

    Why is careful blood pressure monitoring essential in patients with subarachnoid hemorrhage?

    <p>To maintain a stable pressure to prevent aneurysm rupture or ischemia. (C)</p> Signup and view all the answers

    What is the definitive treatment for a cerebral aneurysm associated with a subarachnoid hemorrhage?

    <p>Performing a craniotomy to expose the aneurysm. (D)</p> Signup and view all the answers

    Besides correcting the cause, what is a critical aspect of care for patients with subarachnoid hemorrhage?

    <p>Preventing or managing complications and providing supportive care. (C)</p> Signup and view all the answers

    What should a nurse assess prior to administering anything by mouth to a patient with a suspected stroke?

    <p>Facial symmetry and swallowing ability (B)</p> Signup and view all the answers

    A patient with a suspected stroke coughs and has a gurgly voice after a swallow screen. What should the nurse do?

    <p>Keep the patient NPO until cleared by a physician or speech pathologist. (D)</p> Signup and view all the answers

    Which diagnostic test uses sound waves to identify narrowing of the carotid arteries?

    <p>Carotid Doppler testing (A)</p> Signup and view all the answers

    What is the primary focus of emergency care for a stroke patient while awaiting test results?

    <p>Providing supportive care by monitoring ABCs. (D)</p> Signup and view all the answers

    If a patient has an oxygen saturation of 90%, what should the nurse administer?

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

    What does the term 'aphasia' refer to?

    <p>Absence of speech (D)</p> Signup and view all the answers

    A patient has difficulty speaking after a stroke. Which term best describes their condition?

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

    Which of the following is NOT a typical visual deficit associated with stroke?

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

    Which healthcare professional is specifically trained to diagnose and treat communication problems?

    <p>Speech Pathologist (C)</p> Signup and view all the answers

    What is a recommended measure to facilitate communication when a patient has communication challenges?

    <p>Providing aids such as a picture board or pencil and paper (C)</p> Signup and view all the answers

    When communicating with a patient who is fatigued, what type of questions are most appropriate?

    <p>Questions that require short, concise answers (B)</p> Signup and view all the answers

    Why is it important to provide education to family members and significant others regarding the patient's communication problems?

    <p>To enable them to participate in the patient's care and communication. (A)</p> Signup and view all the answers

    What information is essential to provide to a patient and family upon discharge to home?

    <p>Information related to medications, treatments, and follow-up care that are needed for home care. (C)</p> Signup and view all the answers

    In the acute phase of illness, why is it advisable to give information in small amounts?

    <p>The patient might have difficulty processing large amounts of data due to their medical state. (B)</p> Signup and view all the answers

    What might result due to the fear patients and their families have about the patient's current condition?

    <p>Anxiety and distress, which can hinder the process of proper care. (C)</p> Signup and view all the answers

    When communicating with a patient, why should one avoid interrupting?

    <p>To allow them ample time for communication and be able to express their needs. (C)</p> Signup and view all the answers

    What percentage of strokes is classified as ischemic strokes?

    <p>87% (C)</p> Signup and view all the answers

    What is a transient ischemic attack (TIA)?

    <p>A temporary blockage of blood to the brain (A)</p> Signup and view all the answers

    What type of stroke occurs when a blood clot is formed in a vessel in the brain?

    <p>Thrombotic stroke (C)</p> Signup and view all the answers

    What common situation can lead to an embolic stroke?

    <p>A blood clot traveling from another part of the body (B)</p> Signup and view all the answers

    How long does a transient ischemic attack (TIA) typically last?

    <p>Minutes to hours (B)</p> Signup and view all the answers

    What is the main goal of treating a transient ischemic attack (TIA)?

    <p>To prevent a full stroke (D)</p> Signup and view all the answers

    In which arteries do thrombotic strokes most often occur?

    <p>Internal or common carotid arteries (C)</p> Signup and view all the answers

    What percentage of strokes are preceded by a transient ischemic attack (TIA)?

    <p>15% (B)</p> Signup and view all the answers

    What is the primary mechanism of action for tissue plasminogen activator (tPA) in the treatment of cerebrovascular disorders?

    <p>Dissolving existing blood clots. (D)</p> Signup and view all the answers

    A patient is prescribed aspirin following a TIA. Which of the following best describes the primary therapeutic goal in this context?

    <p>To reduce the risk of new clot formation by inhibiting platelet aggregation. (D)</p> Signup and view all the answers

    What is a critical factor regarding the administration of tissue plasminogen activator (tPA) for a patient experiencing a stroke?

    <p>It must be administered within 3 hours of symptom onset. (C)</p> Signup and view all the answers

    What is the most important monitoring parameter for a patient prescribed warfarin?

    <p>Monitoring international normalized ratio(INR) until therapeutic, and then monthly. (B)</p> Signup and view all the answers

    Why would a patient with a stroke be considered for surgery?

    <p>To stabilize them after a stroke or if they have warning signs. (C)</p> Signup and view all the answers

    If a patient experiences weakness on the left side of their body following the cerebral infarct, where is the most likely location of the brain lesion?

    <p>In the right side of the brain, contralateral to the weakness. (C)</p> Signup and view all the answers

    What is the primary concern with Simvastatin and other statin drugs mentioned when they are administered?

    <p>Monitoring for muscle pain or weakness. (C)</p> Signup and view all the answers

    A patient is taking clopidogrel. What key adverse effect should the nurse monitor for?

    <p>Bruising, change in level of consciousness, and prolonged bleeding time. (D)</p> Signup and view all the answers

    What is the surgical procedure called that involves removing an occlusion from the carotid artery?

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

    During which procedure is a carotid stent typically placed?

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

    Which of the following best describes hemiplegia?

    <p>Paralysis on one side of the body (B)</p> Signup and view all the answers

    What is the function of the balloon during a carotid stent procedure?

    <p>It is inflated to push plaque outward and open the artery. (B)</p> Signup and view all the answers

    What is the purpose of a stent after a balloon inflates to open a carotid artery?

    <p>To keep the artery open for improved blood flow (C)</p> Signup and view all the answers

    The primary underlying cause of cerebrovascular disorders is:

    <p>Inadequate supply of blood and oxygen to brain cells (C)</p> Signup and view all the answers

    Following a stroke, which term best describes the condition where a patient experiences difficulty with coordination or balance?

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

    A patient who experienced a stroke begins to experience double vision. Which of the following terms best describes the patient's condition?

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

    An intracerebral hemorrhage occurs within which area?

    <p>The deeper tissues of the brain. (C)</p> Signup and view all the answers

    Which of the following best differentiates a thrombotic stroke from an embolic stroke?

    <p>A thrombotic stroke results from a clot forming in a brain vessel. (A)</p> Signup and view all the answers

    What is the most common cause of intracerebral hemorrhage?

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

    What is the term for the area of the brain surrounding an ischemic stroke where some tissue is still viable but at risk?

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

    Why may intracerebral hemorrhages sometimes go undetected initially?

    <p>The bleeding occurs slowly and may not cause immediate dramatic symptoms. (C)</p> Signup and view all the answers

    Which of the following terms best describes the type of stroke that occurs when a cerebral blood vessel ruptures?

    <p>Hemorrhagic stroke (C)</p> Signup and view all the answers

    What surgical intervention involves the removal of plaque from the lining of an artery to improve blood flow?

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

    What is a primary blood pressure management goal for patients with a history of intracerebral hemorrhage?

    <p>Systolic pressure below 120 mm Hg and diastolic below 80 mm Hg. (B)</p> Signup and view all the answers

    What is critical for teaching patients and families to recognize?

    <p>The warning signs of a stroke and the need to activate EMS. (D)</p> Signup and view all the answers

    A patient is experiencing weakness on the right side of their body after suffering a stroke. Which of the following best indicates the location of the stroke?

    <p>Left side of the brain (A)</p> Signup and view all the answers

    What is the best way to manage an acute stroke quickly?

    <p>Activating the EMS to facilitate prompt medical care. (C)</p> Signup and view all the answers

    What is not a typical consequence of long-term untreated intracerebral hemorrhages?

    <p>Decreased blood pressure. (B)</p> Signup and view all the answers

    What does maintaining blood pressure below 120/80 mm Hg aim to achieve in patients with intracerebral hemorrhage?

    <p>Reduce the chance of further bleeding. (D)</p> Signup and view all the answers

    Why is a temperature greater than 99.6°F treated in patients who have experienced a stroke?

    <p>It is associated with poorer outcomes following a stroke. (B)</p> Signup and view all the answers

    Which type of intravenous (IV) fluid is preferred for stroke patients to prevent hyperglycemia?

    <p>Normal saline solution (D)</p> Signup and view all the answers

    What is the primary action of thrombolytic agents in treating ischemic stroke?

    <p>They convert plasminogen to plasmin to dissolve clots. (A)</p> Signup and view all the answers

    What is the recommended timeframe in which a stroke team should assess a patient upon arrival at the hospital?

    <p>Within the first 15 minutes of arrival. (B)</p> Signup and view all the answers

    If a patient awakens after a night’s sleep to discover they have stroke symptoms, why are they typically not candidates for thrombolytic therapy?

    <p>Their symptom onset time cannot be accurately determined. (D)</p> Signup and view all the answers

    Within what timeframe after a stroke patient's arrival should the healthcare provider make a decision regarding thrombolytic therapy?

    <p>Within 1 hour of arrival. (C)</p> Signup and view all the answers

    Why might stroke patients be at risk of developing increased intracranial pressure (ICP)?

    <p>As a direct result of brain tissue damage from the stroke. (C)</p> Signup and view all the answers

    What is the significance of the phrase 'Time lost is brain lost' in the context of stroke care?

    <p>It stresses that the faster a stroke patient receives treatment, the more brain function can be preserved (B)</p> Signup and view all the answers

    Which medication class is designed to dissolve existing blood clots in the context of cerebrovascular disorders?

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

    A patient is prescribed aspirin following a TIA. What should the nurse prioritize monitoring in relation to this medication?

    <p>Signs of bleeding or bruising (B)</p> Signup and view all the answers

    What is the primary purpose of antiplatelet medications like clopidogrel in the context of stroke prevention?

    <p>To prevent the formation of new blood clots (A)</p> Signup and view all the answers

    A patient is prescribed simvastatin after experiencing a stroke. What should the nurse instruct the patient to report immediately?

    <p>Muscle pain or weakness (D)</p> Signup and view all the answers

    What is a crucial consideration regarding the timeframe for administering tissue plasminogen activator (tPA) for stroke patients?

    <p>It must be administered within 3 hours of symptom onset (B)</p> Signup and view all the answers

    A patient is taking warfarin after a stroke. Which lab test is most crucial for nurses to monitor?

    <p>International normalized ratio (INR) (D)</p> Signup and view all the answers

    What is the rationale for considering surgery in patients who have had a stroke?

    <p>For patients with warning signs of a stroke or those stable after a stroke (D)</p> Signup and view all the answers

    If a patient experiences paralysis on the right side of their body due to a stroke, where is the most likely location of the brain lesion?

    <p>The left side of the brain (A)</p> Signup and view all the answers

    In the immediate post-stroke period, when should antihypertensive medications be administered?

    <p>If systolic blood pressure exceeds 220 mm Hg or diastolic exceeds 120 mm Hg. (C)</p> Signup and view all the answers

    What is the primary rationale for allowing permissive hypertension in the acute phase of stroke treatment?

    <p>To encourage blood flow through collateral vessels to salvage brain tissue. (B)</p> Signup and view all the answers

    Which of these is NOT identified as a risk factor for developing a deep vein thrombosis (DVT) in stroke patients?

    <p>The use of anticoagulant medications. (B)</p> Signup and view all the answers

    What is the immediate priority when a stroke patient vomits?

    <p>Turn the patient to the side. (D)</p> Signup and view all the answers

    What should be assessed prior to initiating oral feedings in a patient recovering from a stroke?

    <p>The patient’s level of alertness and swallowing ability. (C)</p> Signup and view all the answers

    Why are stroke patients prone to respiratory complications?

    <p>Because of a decreased level of consciousness and impaired swallowing ability, leading to aspiration. (A)</p> Signup and view all the answers

    Following the acute phase of stroke treatment, what do physical, occupational, and speech therapy consultations focus on?

    <p>Evaluating the patient’s functional status and making treatment recommendations. (D)</p> Signup and view all the answers

    Which of the following is a primary non-drug method of preventing deep vein thrombosis (DVT)?

    <p>Sequential compression devices and elastic stockings. (C)</p> Signup and view all the answers

    What is the primary underlying cause of an intracerebral hemorrhage?

    <p>Uncontrolled hypertension leading to arterial rupture. (C)</p> Signup and view all the answers

    How might multiple, minor intracerebral hemorrhages manifest in a patient before major neurological deficits occur?

    <p>With minimal or no detectable neurological deficits initially. (D)</p> Signup and view all the answers

    What is the recommended blood pressure management goal for patients with a history of intracerebral hemorrhage to prevent recurrence?

    <p>Maintain systolic less than 120 mm Hg and diastolic less than 80 mm Hg. (C)</p> Signup and view all the answers

    Why is it essential to teach patients and their families to recognize the signs and symptoms of a stroke?

    <p>To accelerate timely activation of emergency medical services (EMS). (B)</p> Signup and view all the answers

    What does the term 'intracerebral' indicate in the context of an intracerebral hemorrhage?

    <p>Bleeding occurring within the brain tissue. (C)</p> Signup and view all the answers

    What is the most significant difference between an intracerebral hemorrhage and an embolic stroke based on the etiology?

    <p>Intracerebral hemorrhage is typically caused by internal vessel issues, while embolic strokes result from a blood clot traveling to the brain. (A)</p> Signup and view all the answers

    Which of the following statements best describes the progression of deficits associated with multiple minor intracerebral bleeds?

    <p>The deficits may be masked initially, but eventually accumulate to cause major issues. (D)</p> Signup and view all the answers

    If a patient with an intracerebral hemorrhage has fluctuating blood pressure readings, what intervention is most critical in the short term?

    <p>Administer an anti-hypertensive with appropriate monitoring and aim for a systolic of less than 120. (D)</p> Signup and view all the answers

    Which of the following best describes the relationship between blood supply and brain cell survival following a stroke?

    <p>Brain cells rely on a constant supply of oxygen and glucose, and some cells in the penumbra can be revived if the brain is reperfused quickly. (C)</p> Signup and view all the answers

    In the context of a stroke, what does the term 'penumbra' refer to?

    <p>Brain cells that are 'stunned' and potentially viable if blood flow is restored quickly. (D)</p> Signup and view all the answers

    A patient presents with stroke symptoms, and diagnostic tests are underway. Which aspect of care takes priority?

    <p>Monitoring for symptom fluctuation or progression. (A)</p> Signup and view all the answers

    What is the significance of the duration of ischemia in determining the outcomes of a stroke?

    <p>Extended periods of ischemia typically result in permanent neurological deficits. (C)</p> Signup and view all the answers

    Which of the following is a key characteristic differentiating hemorrhagic stroke from an ischemic stroke?

    <p>Hemorrhagic strokes involve bleeding in the brain, while ischemic strokes involve a lack of blood flow. (B)</p> Signup and view all the answers

    Which clinical finding is LEAST likely to be observed in a patient experiencing an acute ischemic stroke?

    <p>Bilateral deficits in motor function observed immediately after the event (D)</p> Signup and view all the answers

    Why is it important to identify a transient ischemic attack (TIA) as a possible warning sign for a more serious type of stroke?

    <p>TIAs are often the first clear indication that there may be an underlying issue that places the individual at risk of experiencing a more serious stroke. (B)</p> Signup and view all the answers

    Which population group has the highest incidence of stroke?

    <p>People with lower levels of education, lower socioeconomic status, and those in the southeastern United States. (B)</p> Signup and view all the answers

    A patient with an ischemic stroke presents with a sudden onset of right-sided weakness and facial droop. Which area of the brain is MOST likely affected?

    <p>Left cerebral hemisphere (A)</p> Signup and view all the answers

    A nurse is performing a dysphagia screen. Which finding would cause a nurse the MOST concern?

    <p>Patient has a weak cough with a change in voice quality after swallowing (A)</p> Signup and view all the answers

    According to the provided content, what is the primary reason for cerebral dysfunction in stroke patients?

    <p>Inadequate supply of oxygen and glucose to neurons in the brain. (B)</p> Signup and view all the answers

    A patient with suspected stroke has completed an initial CT scan. Which diagnostic procedure would be the MOST appropriate NEXT step?

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

    Which clinical manifestation is MOST indicative of a cerebellar issue after a stroke?

    <p>Poor balance and a staggering gait. (B)</p> Signup and view all the answers

    A patient is admitted with right-sided hemiplegia and is scheduled for a comprehensive stroke assessment. What is the MOST essential parameter to monitor during the initial assessment period?

    <p>Patient’s level of consciousness (C)</p> Signup and view all the answers

    A patient with a suspected stroke presents with new onset weakness on the left side of the body. Which of the following assessments is MOST critical to complete before the patient is allowed any PO intake?

    <p>An assessment for dysphagia (A)</p> Signup and view all the answers

    An ED nurse utilizes the NIHSS to determine the patient’s neurologic deficit level. What does it evaluate?

    <p>Severity of the patient’s stroke (A)</p> Signup and view all the answers

    Why might a patient with a subarachnoid hemorrhage initially present with symptoms that are mistaken for a flulike illness?

    <p>Mild headache, vomiting, and disorientation are common early symptoms that can be attributed to other illnesses. (D)</p> Signup and view all the answers

    In the context of subarachnoid hemorrhage, what is the primary reason for maintaining a systolic blood pressure between 120 and 160 mm Hg?

    <p>To balance the risk of aneurysm rerupture at high pressures and cerebral ischemia at low pressures. (A)</p> Signup and view all the answers

    What is the immediate goal of surgical management for a patient with a subarachnoid hemorrhage due to an aneurysm?

    <p>To directly treat the underlying cause by exposing and addressing the aneurysm. (D)</p> Signup and view all the answers

    What is the significance of a patient holding their head and moaning or crying in pain during a subarachnoid hemorrhage?

    <p>It is a typical response to severe headache caused by the rupture of an aneurysm. (B)</p> Signup and view all the answers

    Why is sensitivity to light important in the assessment of a patient with a suspected subarachnoid hemorrhage?

    <p>It is a common finding in subarachnoid hemorrhage that is an important assessment finding. (D)</p> Signup and view all the answers

    A patient with a subarachnoid hemorrhage is admitted to the ICU. What is the typical purpose of an arterial line in this context?

    <p>To continuously monitor blood pressure and facilitate blood sampling. (C)</p> Signup and view all the answers

    What is the significance of monitoring central venous pressure in patients with subarachnoid hemorrhage?

    <p>To manage fluid balance and right ventricular function, which could reflect in cerebral perfusion. (D)</p> Signup and view all the answers

    In managing a patient with a subarachnoid hemorrhage, if the systolic blood pressure goes outside of the 120 - 160 mm Hg range, what is most important?

    <p>To adjust the prescribed medications to bring the blood pressure back to within the target range without delay. (A)</p> Signup and view all the answers

    If a patient experiences vasospasm extending beyond the initial vessel, what is the primary characteristic that determines the extent of the damage?

    <p>The number of cerebral vessels impacted by the vasospasm. (D)</p> Signup and view all the answers

    In the context of cerebrovascular disorders, what is the relationship between interventions given to patients that have had a stroke of any sort?

    <p>Rehabilitation and long-term care are generally the same for aneurysm, intracerebral bleeds, and ischemic strokes. (D)</p> Signup and view all the answers

    When a patient with a cerebrovascular disorder is being discharged to a rehabilitation center, what prerequisite condition must generally be met?

    <p>The patient must be able to tolerate intensive therapy. (D)</p> Signup and view all the answers

    Following a ventriculoperitoneal shunt procedure, what is the anatomical structure that receives the drained cerebrospinal fluid?

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

    If a nurse notes a change in vital signs, respiratory function, or neurologic status in a patient, what is the most appropriate immediate action?

    <p>Promptly report the changes (C)</p> Signup and view all the answers

    In the immediate care of a patient suspected of any kind of cerebrovascular event, which assessment takes precedence before offering any oral intake?

    <p>Swallowing ability. (A)</p> Signup and view all the answers

    A patient is undergoing assessment for a cerebrovascular event and the health care provider notes a change in breath sounds. What is the most relevant action to take?

    <p>Report the change promptly to the physician. (B)</p> Signup and view all the answers

    What is the correct order for assessing a patient with a suspected stroke in relation to oral intake?

    <p>Assess swallowing ability, then pain level, then respiratory function. (C)</p> Signup and view all the answers

    Which intervention is most directly aimed at addressing a patient's risk for falls due to confusion?

    <p>Instructing the patient and family to call for assistance before getting up. (B)</p> Signup and view all the answers

    A patient struggles to articulate words correctly and uses the wrong order. Besides consulting a speech pathologist, which nursing action should be prioritized?

    <p>Establishing a baseline for verbal communication difficulties. (C)</p> Signup and view all the answers

    What is the primary goal of assisting a patient with a dominant side deficit to use their non-dominant side?

    <p>To reduce discouragement associated with slow progress. (B)</p> Signup and view all the answers

    Which nursing action is LEAST likely to be effective in preventing falls in a patient with impaired mobility due to a cerebrovascular event?

    <p>Administering medication to prevent muscle spasms. (B)</p> Signup and view all the answers

    A patient exhibits dysarthria following a stroke. What specific approach should be implemented to help the patient achieve effective communication?

    <p>Providing a supportive environment and allowing the patient time to communicate. (B)</p> Signup and view all the answers

    Which outcome best demonstrates that a patient's communication goals are being met following a stroke causing language deficits?

    <p>The patient can express needs and desires effectively, avoiding frustration. (A)</p> Signup and view all the answers

    When a patient displays aphasia secondary to a stroke, what specific action should caregivers prioritize to foster effective communication?

    <p>Seeking aid from a speech pathologist and using clear, simple language. (A)</p> Signup and view all the answers

    What is the main objective of providing education to the family about a patient’s condition and recovery plan?

    <p>To enable family members to assist the patient effectively in rehabilitation. (D)</p> Signup and view all the answers

    Which of the following is NOT explicitly mentioned as a risk factor for cerebrovascular disorders?

    <p>Elevated homocysteine levels (A)</p> Signup and view all the answers

    According to the information provided, what is the critical action to take when a patient experiences sudden, severe headache with no known cause?

    <p>Activate emergency medical services immediately (B)</p> Signup and view all the answers

    A patient presents with sudden onset of dizziness, loss of balance, and difficulty walking. Based on the information provided, what should be the immediate concern?

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

    Which symptom is specifically described as potentially affecting 'one or both eyes' according to the American Stroke Association, requiring immediate EMS activation?

    <p>Visual Disturbance (C)</p> Signup and view all the answers

    Which of the following is considered a modifiable risk factor for cerebrovascular disorders, based on the provided information?

    <p>High total cholesterol (B)</p> Signup and view all the answers

    Which of the following is the most critical initial action when caring for a patient with a suspected stroke upon arrival at the hospital?

    <p>Evaluating the patient within the first 15 minutes of arrival. (D)</p> Signup and view all the answers

    A patient who had a stroke the day prior had a temperature of 100.4°F. What is the primary intervention that should be considered based on the provided text?

    <p>Treating the elevation in temperature to prevent poorer outcomes. (B)</p> Signup and view all the answers

    If a patient is a candidate for intravenous fluids after a stroke, which type of solution is most appropriate to use?

    <p>Normal saline solution. (B)</p> Signup and view all the answers

    What is the primary mechanism by which thrombolytic agents like tPA help in the treatment of ischemic stroke?

    <p>Promoting the conversion of plasminogen to plasmin to dissolve clots. (A)</p> Signup and view all the answers

    Within what time frame does the healthcare provider (HCP) make a decision regarding thrombolytic therapy for a stroke patient after the patient's arrival at the healthcare facility?

    <p>Within 1 hour of arrival. (B)</p> Signup and view all the answers

    A patient suspected of having a stroke went to bed at 10 PM and woke up at 6 AM with stroke symptoms. Why does this impact their eligibility for thrombolytic therapy?

    <p>Their sleep may mask the true onset of the stroke, making it appear longer than it actually was. (D)</p> Signup and view all the answers

    A stroke patient receives tissue plasminogen activator (tPA) and responds positively. What best describes the potential outcome?

    <p>The patient may be discharged in one to two days with no lasting effects. (C)</p> Signup and view all the answers

    What is the significance of the phrase 'Time lost is brain lost' in the context of stroke management?

    <p>It highlights the direct correlation between time to a treatment and the amount of neurological damage. (C)</p> Signup and view all the answers

    What is the most accurate description of the progression of vasospasm following a subarachnoid hemorrhage?

    <p>It begins in the vessel of the aneurysm but may extend to other vessels. (A)</p> Signup and view all the answers

    In the context of long-term care after a cerebrovascular event, what is a primary shared characteristic of patients with an aneurysm, intracerebral bleed, and ischemic stroke?

    <p>The need for rehabilitation and long-term care is likely to be similar. (D)</p> Signup and view all the answers

    During assessment of a patient with a cerebrovascular disorder, which finding would necessitate the MOST immediate reporting?

    <p>A change in neurological status such as increased confusion or decreased motor function. (D)</p> Signup and view all the answers

    What is the primary implication of vasospasm in the context of subarachnoid hemorrhage?

    <p>Leading to a narrowing of blood vessels and potential ischemia. (B)</p> Signup and view all the answers

    A patient with a cerebrovascular disorder is observed to have changes in vital signs, respiratory status and a worsening level of consciousness. Which of the following options is the priority in this situation?

    <p>Notifying the healthcare provider immediately. (D)</p> Signup and view all the answers

    A patient exhibits a sudden onset of diplopia and paresthesias. According to the provided information, which nursing diagnosis would be most appropriate to consider?

    <p>Ineffective cerebral tissue perfusion related to interruption of blood supply (A)</p> Signup and view all the answers

    When a patient shows signs of decreased cerebral tissue perfusion, how frequently should the nurse initially monitor their neurologic status?

    <p>Every 30 minutes (D)</p> Signup and view all the answers

    Following a subarachnoid hemorrhage (SAH), a patient progresses to rehabilitation. Besides physical recovery, which aspect should also be a focus for the care team?

    <p>Emotional and psychological support for the patient and their family. (B)</p> Signup and view all the answers

    A ventriculoperitoneal shunt is placed to drain cerebrospinal fluid. Where is the fluid being drained to?

    <p>Into the peritoneal cavity. (B)</p> Signup and view all the answers

    Which of the following expected outcomes indicates improved cerebral tissue perfusion, as outlined in the plan of care?

    <p>Absence of dizziness and syncope (D)</p> Signup and view all the answers

    What action should a nurse prioritize when assessing a patient with a cerebrovascular disorder before offering oral intake?

    <p>Evaluating patient's swallowing ability for dysphagia. (A)</p> Signup and view all the answers

    A patient with a stroke is taking warfarin. Which laboratory test is most critical for the nurse to monitor?

    <p>International Normalized Ratio/Prothrombin Time (INR/PT) (A)</p> Signup and view all the answers

    Which of the following best describes the phenomenon of emotional lability observed after a stroke?

    <p>Rapid and unpredictable mood swings, such as from deep sadness to euphoria, often unrelated to the patient's circumstances. (D)</p> Signup and view all the answers

    What constitutes an important change in vital signs for a patient with potential cerebral tissue perfusion issues?

    <p>A body temperature of 100.1°F (D)</p> Signup and view all the answers

    Why is it crucial to avoid raising your voice when a patient with aphasia is having difficulty understanding?

    <p>Aphasia is a communication impairment, not a problem with their hearing capabilities. (D)</p> Signup and view all the answers

    Which of the following neurological assessment findings suggests worsening cerebral tissue perfusion?

    <p>Change in visual fields (B)</p> Signup and view all the answers

    What is a relevant intervention, mentioned in the text, which may aid a patient in regaining communication skills after experiencing a stroke?

    <p>Speech therapy to address their communication deficits. (D)</p> Signup and view all the answers

    What is the rationale for initially assessing vital signs every 30 minutes in a patient suspected of having a stroke?

    <p>To identify trends that can lead to decreased tissue perfusion or recurrent stroke (B)</p> Signup and view all the answers

    What is the term used to describe the condition of double vision?

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

    Which nursing intervention is most beneficial to assist family members in comprehending a patient's symptoms of emotional lability after a stroke?

    <p>Explaining to the family that the patient’s emotional responses may not align with their feelings due to stroke damage. (C)</p> Signup and view all the answers

    Beyond the acute phase of a stroke, what are some considered long-term complications a patient might be at risk for?

    <p>Pneumonia, deep venous thrombosis, and pressure ulcers. (B)</p> Signup and view all the answers

    A patient is being discharged home and needs further assistance. What is a preventative measure the caregivers should be educated on to support the patient's recovery?

    <p>Early recognition and prevention of complications such as pneumonia or pressure ulcers. (A)</p> Signup and view all the answers

    What is the likely next step in care for a patient being discharged to rehabilitation after a stroke, according to the text?

    <p>The patient will be transferred from an acute setting to a skilled nursing facility with rehabilitation needs. (A)</p> Signup and view all the answers

    Where could a family find more resources about stroke and its effects?

    <p>The National Stroke Association or The American Stroke Association. (A)</p> Signup and view all the answers

    What is one potential benefit of implementing a comprehensive stroke unit?

    <p>Reduced length of hospital stay (C)</p> Signup and view all the answers

    What should be done if a patient is found to be unable to take in adequate oral calories?

    <p>Consider inserting a feeding tube (B)</p> Signup and view all the answers

    In the context of stroke recovery, which intervention is essential when a patient has visual and sensory perception deficits?

    <p>Teach the patient to scan their environment (C)</p> Signup and view all the answers

    What is the role of advance directives in the management of patients requiring a feeding tube?

    <p>To be consulted before placing the feeding tube (D)</p> Signup and view all the answers

    What is a potential outcome of identifying specific sensory deficits in stroke patients?

    <p>Creation of a focused plan of care (C)</p> Signup and view all the answers

    What is an expected outcome from effective management of disturbed sensory perception in stroke patients?

    <p>The patient will adapt to sensory-perceptual deficits (A)</p> Signup and view all the answers

    Which of the following is NOT a component of comprehensive stroke care delivery?

    <p>Reduction of patient education efforts (D)</p> Signup and view all the answers

    What is the significance of monitoring calorie intake in stroke patients?

    <p>To ensure sufficient nutrition is maintained (B)</p> Signup and view all the answers

    Flashcards

    Transient Ischemic Attack (TIA)

    A temporary blockage of blood supply to the brain causing temporary neurological impairment. It lasts minutes to hours and the patient recovers completely.

    Thrombotic Stroke

    A blood clot that forms within the brain, blocking blood flow.

    Embolic Stroke

    A blood clot that forms elsewhere in the body and travels to the brain, blocking blood flow.

    Stroke

    A cerebrovascular accident (CVA); a permanent blockage of blood flow to the brain, causing damage.

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    Ischemic Stroke

    It occurs when blood supply to the brain is blocked or slowed, leading to damage.

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    Hemorrhagic Stroke

    A brain bleed due to a ruptured blood vessel, causing damage.

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    Risk Factors for Stroke

    Factors that increase the risk of developing a stroke.

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    TIA and its relation to stroke

    The event that leads to a stroke is often preceded by a TIA.

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    Swallow (Dysphagia) Screening

    A quick test to check if a patient can safely swallow without choking or aspirating.

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    Dysphasia

    A condition in which a patient has difficulty speaking or forming words.

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    Aphasia

    A condition in which a patient is unable to speak or has complete loss of speech.

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    Homonymous Hemianopsia

    A condition in which a patient's vision is partially or completely lost in one or both eyes, affecting the same side of each eye.

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    Bitemporal Hemianopsia

    A condition in which a patient's vision is partially or completely lost in both eyes, affecting the outer half of each eye.

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    Stenosis

    A painless condition in which a blood vessel is narrowed or clogged, restricting blood flow.

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    Carotid Doppler Testing

    A test that uses sound waves to visualize blood flow through the carotid arteries, which supply blood to the brain.

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    Carotid Angiography

    A procedure that is used to create images of the blood vessels in the neck and brain, providing detailed information about blockages and blood flow.

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    Thrombosis

    A blood clot that forms within a blood vessel, blocking the flow of blood.

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    Embolism

    A blood clot that travels from one part of the body to another, blocking a blood vessel.

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    Thrombolytic

    A medication that helps to dissolve existing blood clots.

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    Antiplatelet

    A medication that prevents the formation of new blood clots.

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    Anticoagulant

    A medication that prevents new clots from forming and slows down the time it takes for existing clots to form.

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    Statin

    A medication that lowers cholesterol levels in the blood.

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    Subarachnoid Hemorrhage: Early Signs

    A small leak of blood from an aneurysm that can cause a mild headache, vomiting, or disorientation. This is usually misdiagnosed as a flu-like illness by the patient.

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    Subarachnoid Hemorrhage - Hallmark Symptom

    The most common symptom is a sudden onset of a severe headache, described as 'the worst headache of my life'.

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    Photophobia in Subarachnoid Hemorrhage

    The patient may be very sensitive to light, making it difficult to examine their pupils.

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    Subarachnoid Hemorrhage - LOC

    Subarachnoid hemorrhage can cause a decrease in level of consciousness (LOC) due to increased intracranial pressure (ICP) and impaired cerebral blood flow.

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    Subarachnoid Hemorrhage - Seizures

    Patients may experience seizures due to the disruption caused by the hemorrhage in the brain.

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    Subarachnoid Hemorrhage - Blood Pressure Management

    The primary goal of treatment is to control blood pressure within a specific range to prevent rerupture or ischemia.

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    Subarachnoid Hemorrhage - Surgical Management

    This involves surgically accessing the aneurysm and repairing it.

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    Subarachnoid Hemorrhage - Treatment Focus

    There is no cure for subarachnoid hemorrhage. Treatment focuses on addressing the cause, preventing complications, and providing supportive care.

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    Speech-Language Pathologist

    A speech-language pathologist specializes in communication disorders, including aphasia.

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    Communication Strategies for Aphasia

    Use visuals and clear, concise language to communicate with patients who have aphasia.

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    Reducing Anxiety Post-Stroke

    Providing clear information about the stroke, tests, and procedures can help reduce anxiety in the patient and family.

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    Information Delivery for Stroke Patients

    Presenting information in small amounts and repeatedly can help with comprehension.

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    Reassuring the Patient and Family

    Assuring the patient and family that appropriate care is being provided can reduce anxiety.

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    Family Education in Aphasia Care

    Educating family members about communication difficulties and interventions allows them to participate actively in the patient's care.

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    Discharge Planning for Stroke Patients

    Ensure that the patient and family have the information they need for medications, treatments, and follow-up care at home.

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    Vasospasm

    A narrowing of a blood vessel, often caused by a spasm in the smooth muscle of the vessel wall.

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    Vasospasm and Subarachnoid Hemorrhage

    This condition is a major long-term complication of subarachnoid hemorrhage, leading to reduced blood flow to the brain.

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    Ischemia and Infarction

    Ischemia, a condition where there is insufficient blood flow, and infarction, a condition where tissue dies due to lack of blood supply.

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    Rehabilitation

    The process of helping patients recover from an illness or injury. In the context of cerebrovascular disorders, it focuses on restoring lost function.

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    Ventriculoperitoneal Shunt

    A surgical procedure where excess cerebrospinal fluid (CSF) is drained from the brain and redirected into the peritoneal cavity.

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    Peritoneal Cavity

    It's located within the abdominal cavity and serves as the destination for CSF in a ventriculoperitoneal shunt.

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    Key Vital Signs and Assessments

    These include vital signs, laboratory values, respiratory function, and neurologic status.

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    Prompt Reporting of Changes

    Rapidly reporting any changes in these vital signs and assessments to the medical team is crucial for timely intervention.

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    TIA's Relationship to Stroke

    A TIA often serves as a warning sign of a possible impending stroke.

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    Intracerebral Hemorrhage

    A type of stroke where bleeding occurs in the deeper tissues of the brain, often caused by uncontrolled high blood pressure.

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    Thrombolytic Therapy

    A type of therapy used for ischemic stroke that dissolves blood clots causing the blockage, restoring blood flow to the brain.

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    Thrombolytic Agent

    A medication that breaks down blood clots by converting plasminogen into plasmin, which is the enzyme that dissolves clots.

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    Time to Treatment

    The amount of time between symptom onset and the start of treatment. It's critical for effective recovery.

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    Increased Intracranial Pressure (ICP)

    An increase in pressure inside the skull, commonly occurring after a stroke. It can further damage the brain.

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    Stroke Team

    A team of medical professionals dedicated to assessing and treating stroke patients, often within a specific time window.

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    Permissive Hypertension

    Keeping the blood pressure slightly elevated (but not excessively high) to help blood flow through collateral vessels in the brain and reach the affected area after a stroke.

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    Sequential Compression Devices

    A device used to compress and release pressure on the legs, helping to prevent blood clots (DVT) in patients confined to bed.

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    Thrombolytic Drugs

    Medications that help dissolve blood clots.

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    Antiplatelet Medications

    Medications used to prevent the formation of new blood clots.

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    Anticoagulant Medications

    Medications that prevent new blood clots from forming and slow down the formation of existing clots.

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    Carotid Endarterectomy

    A surgical procedure to remove a blockage from a carotid artery, improving blood flow to the brain.

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    Stent

    A tiny metal or polymer tube inserted into a narrowed artery to keep it open and improve blood flow.

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    Carotid Angioplasty

    A procedure where a catheter is inserted into a carotid artery, a balloon inflates to open the blockage, and a stent is placed to keep it open.

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    Hemiplegia

    Paralysis of one side of the body, often caused by a stroke.

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    Cerebrovascular Accident (CVA)

    A condition caused by insufficient blood flow to the brain, often due to a blockage in a carotid artery.

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    Thrombolytic Medication

    A medication that helps dissolve existing blood clots. It is often used in cases of ischemic stroke when there is a time-sensitive need to restore blood flow and prevent further damage to the brain.

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    Statin Medication

    A medication used to reduce cholesterol levels in the blood. By lowering cholesterol levels, these medications help to prevent atherosclerosis, a condition that can lead to a narrowed blood vessel and an increased risk of stroke.

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    What is a Transient Ischemic Attack (TIA)?

    A temporary blockage of blood supply to the brain causing temporary neurological impairment.

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    What is a Hemorrhagic Stroke?

    A type of stroke that happens when a blood vessel in the brain ruptures, causing bleeding.

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    What is a Thrombotic Stroke?

    A type of stroke caused by a blood clot that forms in a blood vessel within the brain, blocking blood flow.

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    What is an Embolic Stroke?

    A type of stroke caused by a blood clot that forms elsewhere in the body and travels to the brain, blocking blood flow.

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    What is an Ischemic Stroke?

    A type of stroke that happens when blood supply to the brain is blocked or slowed, leading to damage.

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    What is the Penumbra?

    The healthy tissue surrounding the damaged area in the brain after a stroke.

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    What is a Cerebral Hemorrhage?

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

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    What is Intracerebral Hemorrhage?

    A type of cerebral hemorrhage where the bleeding occurs within the deeper tissues of the brain.

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    Cerebrovascular Stenosis

    A condition where a blood vessel in the brain is narrowed or blocked, often caused by a buildup of plaque, leading to decreased blood flow and potential damage to brain tissues.

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    Angioplasty

    A procedure where a balloon is inflated and a stent is placed inside a narrowed or blocked blood vessel to improve blood flow.

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    What is a motor disturbance symptom of a stroke?

    Sudden weakness or paralysis, often affecting one side of the body, is a common symptom of ischemic stroke. This occurs due to the disruption of blood flow to the brain, causing damage to the affected area.

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    Can motor disturbances occur on both sides of the body?

    If a stroke affects the brainstem or vertebrobasilar artery, weakness or paralysis may occur on both sides of the body.

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    What does dysphagia mean?

    Difficulty swallowing, also known as dysphagia, can be a symptom of stroke. This happens when the stroke affects the muscles responsible for swallowing.

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    What is ataxia?

    Ataxia, characterized by poor balance and unsteady gait, can occur after a stroke. This is often linked to damage to the cerebellum or coordination issues caused by weakness or paralysis.

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    What is the NIHSS?

    The National Institutes of Health Stroke Scale (NIHSS) is a standardized tool used to measure the severity of a stroke. It helps assess the impact of the stroke on different neurological functions.

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    What blood tests are typically performed after a stroke?

    A complete blood count (CBC), blood glucose level, metabolic panel, and other tests are often performed in the emergency department after a suspected stroke to assess the patient's overall health and identify contributing factors.

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    Why are patients placed on a cardiac monitor and pulse oximeter after a stroke?

    Cardiac monitoring and pulse oximetry are crucial after a stroke. These tools continuously monitor heart rhythm and oxygen saturation levels, providing vital information about the patient's condition.

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    What is an ECG used for after a stroke?

    An ECG (electrocardiogram) is done after a stroke to check for atrial fibrillation, a heart rhythm irregularity that increases the risk of stroke.

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    Penumbra

    The tissue surrounding the damaged area in the brain after a stroke, still potentially salvageable with quick treatment.

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    Cerebral Hemorrhage

    The overarching category of stroke caused by a ruptured blood vessel within the brain, leading to bleeding.

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    What are the five signs or symptoms that require immediate medical attention?

    Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body; Sudden confusion or trouble speaking or understanding; Sudden trouble seeing in one or both eyes; Sudden trouble walking, dizziness, loss of balance, or coordination; Sudden severe headache with no known cause.

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    What is Cerebrovascular Stenosis?

    A condition where a blood vessel in the brain is narrowed or blocked, often caused by a buildup of plaque, leading to decreased blood flow and potential damage to brain tissues.

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    What is Angioplasty?

    A procedure where a balloon is inflated and a stent is placed inside a narrowed or blocked blood vessel to improve blood flow.

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    What is emotional lability?

    Emotional lability is a common after-stroke symptom. It involves rapid shifts in mood and emotional responses, like sudden crying or laughing inappropriately.

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    What is a common complication after a stroke?

    A common complication after stroke is pneumonia. This is due to weakness and difficulty swallowing, leading to aspiration of food or fluids into the lungs.

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    What is a cerebral aneurysm?

    A cerebral aneurysm is a weak, bulging area in a blood vessel in the brain. It can rupture and cause a subarachnoid hemorrhage, a type of stroke.

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    What is a subarachnoid hemorrhage?

    A subarachnoid hemorrhage is a type of stroke caused by bleeding into the space between the brain and the outer layer of the membranes covering the brain.

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    What is a hallmark symptom of a subarachnoid hemorrhage?

    A subarachnoid hemorrhage often presents with a sudden, severe headache, often described as 'the worst headache of my life.'

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    What is photophobia?

    A patient with a subarachnoid hemorrhage may experience photophobia, which is sensitivity to light.

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    Explain emotional lability after a stroke.

    A stroke can lead to emotional lability, which is marked by abrupt changes in mood and emotional responses.

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    What is a DVT?

    Deep vein thrombosis (DVT) can be a complication after a stroke. This is due to immobility, leading to blood clots in the legs.

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    What is vasospasm and its significance in subarachnoid hemorrhage?

    Vasospasm is a narrowing of blood vessels, often caused by a spasm in the vessel wall. It's a major long-term complication of subarachnoid hemorrhage, leading to reduced blood flow to the brain.

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    What is a ventriculoperitoneal shunt?

    A ventriculoperitoneal shunt is a surgical procedure used to drain excess cerebrospinal fluid (CSF) from the brain into the peritoneal cavity.

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    What is the purpose of stroke rehabilitation?

    Rehabilitation aims to help stroke patients recover lost functions and improve their overall well-being.

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    What's the most common long-term complication of subarachnoid hemorrhage?

    The most common complication of a subarachnoid hemorrhage is vasospasm. It may lead to reduced blood flow to the brain and cause damage to brain tissue.

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    What is the peritoneal cavity?

    The peritoneal cavity is the space within the abdomen where excess cerebrospinal fluid is directed in a ventriculoperitoneal shunt.

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    Why are changes in vital signs important to track after a stroke?

    Promptly reporting any changes in vital signs, laboratory values, respiratory function, or neurologic status to the medical team is crucial for timely intervention and optimal patient care.

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    What's the importance of discharge planning for stroke patients?

    Discharge planning for stroke patients involves ensuring they and their families have the information they need for medication, treatments, and follow-up care at home.

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    How can vasospasm impact the brain?

    The ischemia or infarction caused by vasospasm can be widespread and devastating, resulting in damage to brain tissue and potential neurological deficits.

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    Decreased Cerebral Tissue Perfusion

    Reduced blood flow to the brain, leading to symptoms like decreased consciousness, dizziness, and vision changes.

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    NIH Stroke Scale (NIHSS)

    A neurological assessment tool measuring stroke severity, helping track progress and make informed decisions.

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    What is the benefit of a comprehensive stroke unit?

    A comprehensive stroke unit is associated with reduced length of stay, lower mortality, and improved functional outcomes for stroke patients.

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    How do you address Disturbed Sensory Perception in stroke patients?

    Assist occupational therapists in assessing for visual, spatial, and sensory deficits to create a plan to address them.

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    Study Notes

    Nursing Care of Patients With Cerebrovascular Disorders

    • Learning Outcomes: Describe causes, risk factors, and pathophysiology of transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke; identify emergency interventions for these conditions; plan therapeutic measures; identify outcomes for stroke victims; and plan nursing care for patients with cerebrovascular disorders.

    Key Terms

    • Aphasia: Loss of language ability.
    • Ataxia: Loss of muscle coordination.
    • Diplopia: Double vision.
    • Dysphasia: Difficulty with speech.
    • Embolic: Caused by an embolus (a clot or other matter) that travels and blocks blood flow.
    • Embolism: The blockage of a blood vessel by an embolus.
    • Endarterectomy: Surgical removal of plaque from an artery.
    • Hemorrhagic: Related to bleeding.
    • Intracerebral: Within the cerebrum (part of the brain).
    • Ischemic: Related to lack of blood flow.
    • Penumbra: Region of brain tissue surrounding the area of damage; potentially salvageable.
    • Thrombolytic: Clot-dissolving.
    • Thrombosis: The formation of a blood clot inside a blood vessel.
    • Unilateral neglect: Inability to recognize or attend to the side of the body opposite the affected side.
    • Stroke: Cerebrovascular accident

    Transient Ischemic Attack (TIA)

    • A temporary blockage of blood to the brain, causing temporary neurologic impairment.
    • Risk factors and symptoms are the same as for stroke.
    • Urgent evaluation is needed to prevent a full stroke.
    • Treatment focuses on minimizing risk factors, such as controlling hypertension, cholesterol, or other cardiovascular disease risk factors.

    Stroke (Cerebrovascular Accident)

    • Disruption of blood flow to the brain, resulting in brain cell death.
    • Permanent disability is often the result.
    • Most common causes are thrombotic or embolic stroke.
    • Risk factors include age, gender, high blood pressure, diabetes, high cholesterol, atrial fibrillation, cardiovascular disease, dyslipidemia, cigarette smoking, obesity, excessive alcohol intake, poor diet (high sodium, high fat, low potassium), physical inactivity, pregnancy, oral contraceptives, hormone replacement therapy, high triglycerides, history of migraines, and a thick waist. Children with sickle cell disease and cardiac anomalies are also at risk. Increased risk in persons with lower levels of education, lower socioeconomic status, and those living in the southeastern United States.

    Pathophysiology of Stroke

    • Brain cells require constant oxygen and glucose; if the supply is interrupted, they die.
    • The penumbra region surrounding the damage contains "stunned" cells that survive if blood flow is restored quickly.
    • Symptoms depend on the affected area and the duration of ischemia.

    Ischemic Stroke

    • Blood supply to the brain is blocked or significantly slowed.
    • Two main types: thrombotic (occlusion builds in an artery) and embolic (clot forms elsewhere and travels).

    Hemorrhagic Stroke

    • Rupture of a cerebral blood vessel, allowing blood to leak into brain tissue.
    • Two main types: subarachnoid hemorrhage (bleeding between the brain and the tissues that cover it) and intracerebral hemorrhage (bleeding within the brain tissue).

    Warning signs of stroke

    • Use the FAST acronym for quick recognition:
    • F Face drooping
    • A Arms weakness
    • S Speech difficulty
    • T Time to call emergency services
    • Sudden numbness or weakness of face, arm, or leg (especially on one side); sudden confusion; trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance, or coordination; sudden severe headache with no known cause.

    Diagnostic Tests

    • CT scan (computed tomography): Essential to differentiate ischemic from hemorrhagic stroke.
    • Electrocardiogram (ECG): Checks for atrial fibrillation.
    • Echocardiogram: evaluates the heart for abnormalities.
    • Stroke Scale (NIHSS): quantifies the severity of a stroke for standardized measurements
    • Carotid Doppler: Uses ultrasound to detect carotid artery stenosis.
    • Carotid angiography: (If needed) allows visualization to determine the extent of blockage.

    Therapeutic Measures

    • Thrombolytic therapy (tPA): Clot-busting medication for ischemic stroke; must be administered within 4.5 hours of symptom onset.
    • Blood pressure control: Crucial for stroke patients, especially those receiving tPA. Blood pressure should be typically kept below 185/110 mm Hg.
    • Medications: For long-term management, blood pressure control medications (e.g., beta-blockers, calcium channel blockers), cholesterol-lowering drugs (statins), anticoagulants, and antiplatelet medications (e.g., aspirin, clopidogrel) may be necessary.

    Complications

    • Rebleeding: A serious complication of cerebral aneurysm (which is a sac formed in a blood vessel) and bleeding from it.
    • Vasospasm: narrowing of a blood vessel, commonly a consequence of subarachnoid hemorrhage
    • Hydrocephalus: Excessive accumulation of cerebrospinal fluid in the brain.
    • Emotional lability: rapid shifts in mood
    • Impaired Judgement or Safety: Common in strokes with right-side brain damage.
    • Unilateral neglect: Inability to recognize or attend to the side of the body opposite the affected side.
    • Aspiration pneumonia: A common complication resulting from the impaired swallowing ability (dysphagia) that occurs after a stroke.
    • Skin breakdown: Pressure injuries related to immobility and incontinence.
    • Urinary/bowel incontinence: Loss of bladder and/or bowel control.

    Nursing Care Plan

    (Existing information updated with new details)

    • Monitoring neurologic status: Frequent, ongoing neurologic assessments are essential to note changes.
    • Supporting swallowing: Thorough dysphagia screening to ensure safe feeding practices. Implementation of interventions to manage dysphagia to prevent aspiration.
    • Maintaining fluid balance: Prevent dehydration and ensure adequate hydration.
    • Maintaining safety: Prevent falls. Implement fall precautions such as ensuring clear pathways, bedside assistance, and appropriate assistive devices.
    • Promoting self-care: Assist with ADLs; encourage independence.
    • Managing skin integrity: Protect from pressure injuries. Use pressure-reducing mattresses and/or frequent repositioning.
    • Supporting family and caregivers: Provide education, emotional support, and resources to family and caregivers.
    • Communication: Establish clear and effective communication strategies with patients who have aphasia or dysphasia.

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    Test your knowledge on the long-term complications following a subarachnoid hemorrhage. This quiz covers topics such as vasospasm, patient assessment, and treatment facilities. Enhance your understanding of this critical medical condition.

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