Transcript Stroke - mydsn.net

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Regulation of cerebral blood flow
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Atherosclerosis
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Non-modifiable
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Age
Gender
Ethnicity/Race
Family history
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Modifiable
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HTN
Heart disease
Smoking
Alcohol
Obesity
Sleep apnea
Diabetes
Lack of exercise
Poor diet
Drug abuse
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Ischemic
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Treatment
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› Thrombotic
› Embolic
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› Must know time of onset –
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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
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platelet inhibitors
Keep BP slightly high
Seizure prophylaxis
Surgical treatment
Nimotop
Left versus right (see chart, pg 1465)
 Motor
 Communication
 Affect
 Intellect
 Spatial-Perceptual
 Elimination
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CT is most important
 CT angiography
 MRI
 Transcranial doppler
 LP (may or may not)
 LICOX monitoring
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Prevention
 Antiplatelet drugs for TIAs
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› ASA
› Plavix
› Warfarin
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Surgery
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Carotid endarterectomy
Transluminal angioplasty
Stenting
EC-IC bypass
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Respiratory
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Neuro
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Cardiovascular
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Musculoskeletal
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Integument
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GI
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Urinary
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Nutrition
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Communication
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Sensory-Perceptual
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Coping
PT – mobility, ambulation, transfers,
equipment
 OT – ADLs, cognitive/perceptual eval
and training
 ST – speech, communication, cognition,
eating
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Musculoskeletal
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Nutrition
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Bowels
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Bladder
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Sensory/Perceptual
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Affect
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Coping
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Sexual
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Resources
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.
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
3. A patient with a stroke has dysphagia. Before allowing the
patient to eat, which of the following actions should the nurse
take first?
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Check the patient’s gag reflex.
Request a soft diet with no liquids.
Place the patient in high-Fowler’s position.
Test the patient’s ability to swallow with a small amount of
water.