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Stroke

Stroke. Megan McClintock, MS, RN 11/4/11. Pathophysiology. Regulation of cerebral blood flow Atherosclerosis. Risk Factors. Non-modifiable Age Gender Ethnicity/Race Family history. Modifiable HTN Heart disease Smoking Alcohol Obesity Sleep apnea Diabetes Lack of exercise

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Stroke

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  1. Stroke Megan McClintock, MS, RN 11/4/11

  2. Pathophysiology • Regulation of cerebral blood flow • Atherosclerosis

  3. Risk Factors • Non-modifiable • Age • Gender • Ethnicity/Race • Family history • Modifiable • HTN • Heart disease • Smoking • Alcohol • Obesity • Sleep apnea • Diabetes • Lack of exercise • Poor diet • Drug abuse

  4. Types of Stroke • Ischemic • Thrombotic • Embolic • Treatment • Must know time of onset – tPa w/in 3-4.5 hours • ABCs • No seizure prophylaxis • No heparin, but may give ASA •  O2,  CO2 • Keep BP slightly high • Keep hydrated • No fever • Hemorrhagic • Intracerebral • Subarachnoid • Treatment • No anticoagulants or platelet inhibitors • Keep BP slightly high • Seizure prophylaxis • Surgical treatment • Nimotop

  5. Symptoms • Left versus right (see chart, pg 1465) • Motor • Communication • Affect • Intellect • Spatial-Perceptual • Elimination

  6. Diagnostic Studies • CT is most important • CT angiography • MRI • Transcranialdoppler • LP (may or may not) • LICOX monitoring

  7. Treatment • Prevention • Antiplatelet drugs for TIAs • ASA • Plavix • Warfarin • Surgery • Carotid endarterectomy • Transluminal angioplasty • Stenting • EC-IC bypass

  8. Interventions • Respiratory • Neuro

  9. Interventions • Cardiovascular • Musculoskeletal

  10. Interventions • Integument • GI

  11. Interventions • Urinary • Nutrition

  12. Interventions • Communication • Sensory-Perceptual

  13. Interventions • Coping • PT – mobility, ambulation, transfers, equipment • OT – ADLs, cognitive/perceptual eval and training • ST – speech, communication, cognition, eating

  14. Home Interventions • Musculoskeletal • Nutrition • Bowels • Bladder

  15. Home Interventions • Sensory/Perceptual • Affect • Coping • Sexual • Resources

  16. 1. A patient with right-sided paresthesias and hemiparesis is hospitalized and diagnosed with a thrombotic stroke. Over the next 72 hours, the nurse plans care with the knowledge that the patient 1. is ready for aggressive rehabilitation. 2. will show gradual improvement of the initial neurologic deficits. 3. may show signs of deteriorating neurologic function as cerebral edema increases. 4. should not be turned or exercised to prevent extension of the thrombus and increased neurologic deficits.

  17. 2. While performing health screening at a health fair, the nurse identifies which of the following individuals at greatest risk for experiencing a stroke? 1. A 46-year-old white female with hypertension and oral contraceptive use for 10 years 2. A 58-year-old white male salesman who has a total cholesterol level of 285 mg/dL 3. A 42-year-old African American female with diabetes mellitus who has smoked for 30 years 4. A 62-year-old African American male with hypertension who is 35 pounds overweight

  18. 3. A patient with a stroke has dysphagia. Before allowing the patient to eat, which of the following actions should the nurse take first? 1. Check the patient’s gag reflex. 2. Request a soft diet with no liquids. 3. Place the patient in high-Fowler’s position. 4. Test the patient’s ability to swallow with a small amount of water.

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