11411 Pathophysiology Regulation of cerebral blood flow Atherosclerosis Risk Factors Nonmodifiable Age Gender EthnicityRace Family history Modifiable HTN Heart disease Smoking Alcohol ID: 931062
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Slide1
Stroke
Megan McClintock, MS, RN11/4/11
Slide2Pathophysiology
Regulation of cerebral blood flowAtherosclerosis
Slide3Risk Factors
Non-modifiableAgeGender
Ethnicity/Race
Family history
Modifiable
HTN
Heart
disease
Smoking
Alcohol
Obesity
Sleep apnea
Diabetes
Lack of exercise
Poor diet
Drug abuse
Slide4Types of Stroke
IschemicThrombotic
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, CO2Keep BP slightly highKeep hydratedNo fever
Hemorrhagic
Intracerebral
Subarachnoid
Treatment
No anticoagulants or platelet inhibitors
Keep BP slightly high
Seizure prophylaxis
Surgical treatment
Nimotop
Slide5Symptoms
Left versus right (see chart, pg 1465)MotorCommunication
Affect
Intellect
Spatial-Perceptual
Elimination
Slide6Diagnostic Studies
CT is most importantCT angiographyMRI
Transcranial
doppler
LP (may or may not)
LICOX monitoring
Slide7Treatment
PreventionAntiplatelet drugs for TIAs
ASA
Plavix
Warfarin
Surgery
Carotid
endarterectomy
Transluminal
angioplastyStentingEC-IC bypass
Slide8Interventions
RespiratoryNeuro
Slide9Interventions
CardiovascularMusculoskeletal
Slide10Interventions
IntegumentGI
Slide11Interventions
UrinaryNutrition
Slide12Interventions
CommunicationSensory-Perceptual
Slide13Interventions
CopingPT – mobility, ambulation, transfers, equipment
OT – ADLs, cognitive/perceptual
eval
and training
ST – speech, communication, cognition, eating
Slide14Home Interventions
MusculoskeletalNutrition
Bowels
Bladder
Slide15Home Interventions
Sensory/PerceptualAffect
Coping
Sexual
Resources
Slide161. 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.
Slide172. 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
Slide183. 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.