xxx
NUR245 Lecture Week Four Day Two –
Stroke, Venous Thromboembolism (VTE)
Stroke:
Pathophysiology:
- blood is supplied to the brain by internal carotid arteries + vertebral
arteries
- carotids oxygenate:
front, parietal, temporal, basal ganglia, thalamus and hypothalamus
*** brain requires continuous supply of blood to oxygenate the body ***
- blood flow = 750mL – 1L/min or 20% of cardiac output Factors
affecting blood flow include:
- systemic BP
- cardiac output
- blood viscosity
- collateral circulation development- increased intracranial pressure
Risk Factors:
*** these are the ONLY nonmodifiable and modifiable risk factors of CVAs ***
Nonmodifiable:
- age (risk doubles each decade >55 years old)
- gender (men = more common; women = more deaths)
- ethnicity (Black Americans 2x risk of stroke + death) - genetics (2 first-
degree relatives) Modifiable (90% of strokes):
- HTN
- heart disease
- DM
- smoking
- obesity
- sleep apnea
- metabolic syndrome
- sedentary lifestyle
- diet
- drug abuse
- PO contraceptive use
Transient Ischemic Attack, TIA:
- hx of TIA = increased risk of stroke
,xxx
What is it? transient (short) episode of neurological dysfunction d/t
ischemia (focal brain, spinal cord, retina) without acute infarction of
brain
- short-lived, symptoms last <1 hr
*** no way to predict outcome ***
1/3 = no other event
1/3 = more TIAs
1/3 = have CVA
Types of Stroke:
- classed by cause + underlying pathological findings
ischemic (thrombotic or embolic)
THROMBOTIC:
- clot formation (thrombosis) results in narrowing lumen of vessel (could be
d/t atherosclerosis, HLD), blocking arterial blood flow
- embolus = blood clot/fatty plaque (HLD) gets lodged in an artery,
blocking arterial blood flow
hemorrhagic (intracerebral or subarachnoid)
HEMORRHAGIC:
- burst blood vessel; blood seeps into and damages tissues until clotting
shuts off the leak *** picture of strokes ***
Ischemic Stroke:
- 87% of all CVAs
- caused by inadequate cerebral blood flow to brain d/t partial or
complete arterial occlusion - thrombotic or embolic Thrombotic Stroke:
60% of all strokes are thrombotic
common in people with preexisting atherosclerotic plaques
***RISK FACTORS:***
- HTN
- DM
- HLD
- atherosclerosisEmbolic Stroke:
- embolus lodges in and occludes a cerebral artery, l/t infarction + edema
to area (why? It’s no longer receiving oxygenated blood)
- originates when plaque breaks off from endocardium + enters circulation
***RISK FACTORS:***
- afib
- hx of MI
- infective endocarditis
, xxx
- rheumatic heart disease
- valvular heart prosthesis
- atrial septal defects (congenital)
- air + fat from long bone fractures (air, fat emboli)
WARNING SIGNS:
*** occurs rapidly ***
- headache, neurological deficits/AMS
***Ischemic Stroke Treatment***:
*** begins with managing AIRWAY, BREATHING, CIRCULATION ***
We have to know this
common sense; make sure they can breathe
- obtain baseline neuro assessment
- monitor for signs of increasing neurological deficit
REMEMBER: many patients worsen in the first 24-48 hours
*** elevated BP = common immediately following CVA
could be compensatory measure/protective response to maintain cerebral
perfusion
Drug Therapy:
*** do NOT delay in giving thrombolytic therapy!!! “TIME IS BRAIN”
Drug of choice: tPA (tissue plasminogen activator)
PURPOSE: strop the extension of stroke
- given IV, WEIGHT BASED MED
- closely monitor VS, neuro status q15 min
BP control is VITAL! SBP <185
- intraarterial infusion can be used when mechanical thrombectomy isn’t an
option
*** tPA must be given with 3-4.5 hours of symptom onset/last known well ***
CT in hand? Shows thrombotic stroke? Prepare to give tPA Following
Immediate Stabilization:
- antiplatelets (clopidogrel/Plavix, ASA)
- anticoagulants (warfarin, Eliquis, rivaroxaban)
- ***+statins = effective following ischemic stroke core measure; metric
must be met prior to d/c
Endovascular Therapy:
- stent retrievers (manages ischemic stroke)
catheter guides small stent into affected artery
NUR245 Lecture Week Four Day Two –
Stroke, Venous Thromboembolism (VTE)
Stroke:
Pathophysiology:
- blood is supplied to the brain by internal carotid arteries + vertebral
arteries
- carotids oxygenate:
front, parietal, temporal, basal ganglia, thalamus and hypothalamus
*** brain requires continuous supply of blood to oxygenate the body ***
- blood flow = 750mL – 1L/min or 20% of cardiac output Factors
affecting blood flow include:
- systemic BP
- cardiac output
- blood viscosity
- collateral circulation development- increased intracranial pressure
Risk Factors:
*** these are the ONLY nonmodifiable and modifiable risk factors of CVAs ***
Nonmodifiable:
- age (risk doubles each decade >55 years old)
- gender (men = more common; women = more deaths)
- ethnicity (Black Americans 2x risk of stroke + death) - genetics (2 first-
degree relatives) Modifiable (90% of strokes):
- HTN
- heart disease
- DM
- smoking
- obesity
- sleep apnea
- metabolic syndrome
- sedentary lifestyle
- diet
- drug abuse
- PO contraceptive use
Transient Ischemic Attack, TIA:
- hx of TIA = increased risk of stroke
,xxx
What is it? transient (short) episode of neurological dysfunction d/t
ischemia (focal brain, spinal cord, retina) without acute infarction of
brain
- short-lived, symptoms last <1 hr
*** no way to predict outcome ***
1/3 = no other event
1/3 = more TIAs
1/3 = have CVA
Types of Stroke:
- classed by cause + underlying pathological findings
ischemic (thrombotic or embolic)
THROMBOTIC:
- clot formation (thrombosis) results in narrowing lumen of vessel (could be
d/t atherosclerosis, HLD), blocking arterial blood flow
- embolus = blood clot/fatty plaque (HLD) gets lodged in an artery,
blocking arterial blood flow
hemorrhagic (intracerebral or subarachnoid)
HEMORRHAGIC:
- burst blood vessel; blood seeps into and damages tissues until clotting
shuts off the leak *** picture of strokes ***
Ischemic Stroke:
- 87% of all CVAs
- caused by inadequate cerebral blood flow to brain d/t partial or
complete arterial occlusion - thrombotic or embolic Thrombotic Stroke:
60% of all strokes are thrombotic
common in people with preexisting atherosclerotic plaques
***RISK FACTORS:***
- HTN
- DM
- HLD
- atherosclerosisEmbolic Stroke:
- embolus lodges in and occludes a cerebral artery, l/t infarction + edema
to area (why? It’s no longer receiving oxygenated blood)
- originates when plaque breaks off from endocardium + enters circulation
***RISK FACTORS:***
- afib
- hx of MI
- infective endocarditis
, xxx
- rheumatic heart disease
- valvular heart prosthesis
- atrial septal defects (congenital)
- air + fat from long bone fractures (air, fat emboli)
WARNING SIGNS:
*** occurs rapidly ***
- headache, neurological deficits/AMS
***Ischemic Stroke Treatment***:
*** begins with managing AIRWAY, BREATHING, CIRCULATION ***
We have to know this
common sense; make sure they can breathe
- obtain baseline neuro assessment
- monitor for signs of increasing neurological deficit
REMEMBER: many patients worsen in the first 24-48 hours
*** elevated BP = common immediately following CVA
could be compensatory measure/protective response to maintain cerebral
perfusion
Drug Therapy:
*** do NOT delay in giving thrombolytic therapy!!! “TIME IS BRAIN”
Drug of choice: tPA (tissue plasminogen activator)
PURPOSE: strop the extension of stroke
- given IV, WEIGHT BASED MED
- closely monitor VS, neuro status q15 min
BP control is VITAL! SBP <185
- intraarterial infusion can be used when mechanical thrombectomy isn’t an
option
*** tPA must be given with 3-4.5 hours of symptom onset/last known well ***
CT in hand? Shows thrombotic stroke? Prepare to give tPA Following
Immediate Stabilization:
- antiplatelets (clopidogrel/Plavix, ASA)
- anticoagulants (warfarin, Eliquis, rivaroxaban)
- ***+statins = effective following ischemic stroke core measure; metric
must be met prior to d/c
Endovascular Therapy:
- stent retrievers (manages ischemic stroke)
catheter guides small stent into affected artery
