Stroke PDF

STROKE Medicalemergency Eitherlackof bloodflowto brain or bleed into brain 5th leading cause ofdeath cursaltmodifiableres...

STROKE Medicalemergency Eitherlackof bloodflowto brain or bleed into brain 5th leading cause ofdeath cursaltmodifiableres 1 i iii womenmorelikelytodie Heartd isease DysrhythmiasafibMI cardiomyopathy Theseptsare on anticoags topreventstroke BlackpopulationhighestriskHispanic NativeAmericanAsianpopulations risk Familyhistory Inflammatoryconditionssicklecellanemia lipids clottingdisorders Metabolicsyndrome Atherosclerosis Birth control w smoking smokerswhotakebirthcontrol shouldtake nonhormone birth control can No infarctioncell tissuedeath Resolveswithin an hour risk forfutureTIA stroke Ischemic Stroke Clot in brain flow no blood E ibt fta Ifti.EEus jiiestcommon stroke Blood clot forms in brain and does not Priority Airway me sumptomsstarted Donotfeedif LOCditaspiration come from anywhere else NPOuntilswallow assessment Usuallyassociated w HTN DMbecause both checkBpÉismÉitmion perishing accelerate atherosclerosis Thrombotic Embolic stroke 2ndmostcommon stroke a.at Elaine.ieoasamentiiaisiiii iii iii.im ineaiii iiaY.ii a Ischemiccouldturnintohemorrhagic so in split of usually lodges vessels assess frequently  High recurrencebecauseclotcamefromsomewhereelse Notusually atherosclerosisusuallyabrupt no warningsigns a titrnagic stroke not always an option it cannotgettodot uaaem titillatingiiiiie.EE g t i ii iin titiiiiiiiiiiiiiiiiiiii iii ii.EE 6 Stopimmediately if any bleedinganywhere CarotidEndarterectomyTakeoutplaquehighris Transluminal AngioplastyStentingBalloon or 7 Monitor vs closely ICPneurodeterioration CangetlocalizedtPa if weknowwhereclotis 15 ha PÉEdon't'd suigeri.is goonaspir Instead of 3 this cando within ahours Hemorrhagic Stroke Bleeding intobraintissue abruptonset Poorprognosis HTN is mostcommoncause Eventually leads to hematoma bloodpooling within brain E inteei.io Intracerebralhemorrhagecaused byrupturedvessel iEi Efrhagicstroke No alteplaseanticoagulants Subarachnoid hemorrhage Bleeding intoCSF antiplateletsbloodthinners riskbleeding Usually caused by cerebral aneurysm rupture risk seizures need seizure silentkiller because mostpeople unawarethey have precautions a cerebralaneurysm S l hhtatoma in head through burr hole For patient w aneurysmwho is at risk for hemorrhagicstroke clipend of aneurysm coil inserted wewantclot to formtoprevent rupture 2 io t.mn Iontrmas iintjsk ii whenlast normal was mti carotidartery i t IschemicTIA Nothingshows up ECG  Hemorrhagic Can see blood Tele to look for afib 3 If ischemic Transcranialdopplerto monitor for Give Alteplase if we can spasm of brain vaso ifnotkeepBPhigh removeclot w stent If hemorrhagic Burrhole todrainblood keep BPlow stroke Assessment BE fast E.EE a i.s Balance Eyes gas nagicstrokeoqiÉÉ ini iiia a Speech Encephalopathy checkelectrolytes Lipidpanel Timeterribleheadache Headache usually associated w hemorrhagic A A tumorcanalsolooklikestroke wewouldseethis ontheCTscan stroke on Left side of n Rightside of Brain Right sided deficits Left sided deficits Slow performance cautious Rapid performance shortattention span Aware of deficits Impulsive safety problems Depressionanxiety Impairedjudgement Impaired comprehensionrelated to Deniesminimizesproblemsdeficits language math Impairedtimeconcepts OtherDeficits g trouble swallowing Aphasia Inabilityto understand orexpressspeech Expressive aphasiaInability to produce language Receptive aphasia cannot comprehend language Total global aphasiaTotal inability toproduce or comprehend language work and speech is slurred era int iIii iiaiiii mai int Y fE.in iity to recognize object bysight ApraxiaInhability tocarry out sequential movement HomonymousHemianopsiaVisualdeficitthebrain'sinabilityto see Braindoesnot comprehend anything on leftright side Strokeon right side of brain canonly see on rightside theylosesighton leftside Elimalantate urgencyincontinenceretentionconstipation frequency  InpatientPost Stroke Nursing Management 2 Respiratorysystem Isiiedtassessmenffnsafionotk.at all systems veryhigh risk for respcomplications ascore symptoms worseprognosis Monitor airway pts may need patients viastatsgassess Ytitute pitima ingestion Change in baselineSTAT CT aspiration pneumonia to look for MCP ASP ry higheven if nutrition 3 Cardiovascularsystem is enteral canstillc ought hrowup BP rules riskfordysphagia afterstroke HemorrhagicstrokekeepBP low NPOwhile lethargic Ischemic strokeKeepBP high eat in chairnotbed Low BP could harm ischemicCVA Mayneedthickliquids or pureebuttry ptbuttoohighcouldbecomehemorrhagic toavoidthis because it's gross Monitor for abnormal heartrhythms Mouthcare before afterwards pocketing risk orthostatic hypotension placefood onunaffectedside Highrisk for DVTclots opt should swallowtwice IschemicstrokeGoes on heparinlovenox Monitor lung sounds clopggital HemorrhagicstrokeNEVERONANTI Early ambulationROMimportant 4 Musculoskeletal system 5 Gastrointestinal System Ptsmayhave limb ataxia riskconstipationmostpts Uncoordinated movements on stool softener ROMassessment exercisesimportant Maynotbeable to sit upbear Positionextremities they can'tmove downto have a BM One extremityhigherthanotherdependent Enemas notgiven because it BP Bowel training good for thesepts 54 Padalt riskbreakdown prominences risk subluxation dislocation inextremities they can't move Neverpull on extremities riskfalls rollingankles 6 Gastrourinary system Takepts tobathroomevery 2hrs to t.NET itIn is a priority trainbladder to pee on a schedule Pt lethargic NPO aspirationrisk Ptswho are nonverbal ifthey are tosilverware plates can make it Alterations restlessassumetheyneed to pee easier toeat 8 Communication 9 Sensory frustrating HomonymousHemianopsiaTell Pt Talkto pt not family to turn head Yes or no questions Eventually brain compensates but Normaltone volume simple choicesgivepttimetorespond fallatdroÉp keepeye moist Fatigue anxiety can dcommunication Goal Get patient todo ADLS in any way they can 1 1f.it ainProblems ask.im ttiis Ifftoning Loss of function Maintain bodyfunction adequate nutrition Avoidcomplications of stroke I I ting 9,5711 impairedelimination 4571 groups Depression anxiety etc common RIhaqbiltftipf.o.st.ec community reintegration good Immediately startingrehab is best toworkvolunteeretc Mostptsrecover 6 mo max benefits seen iii.intiiiemenisii iiiiactions Voluntary muscle movements is latestage of recovery Balance training should be doneearly someptsendup wheelchairbound  PIE.EE 11 ptoms Stat CT w o contrast Lariseeangmony ischemic iiiiit Iiii.it symptoms within 45 hr BP 185105 To I Intel iffinPhaethon