NR: Stroke (4) Exam Questions With 100% Complete Solutions Scored A+

NR: Stroke (4) Exam Questions With
100% Complete Solutions Scored A+

Stroke is the ___ leading cause of death - ANSWER-5th



Only about ___ of stroke survivors get outpatient care in the US - ANSWER-1/3



Stroke - definition - ANSWER-Sudden loss of neurological function due to *interruption
of blood supply* to the brain



Stroke - 2 main types and frequencies - ANSWER-- *Ischemic Stroke* (87%):
BLOCKAGE (obstruction) of a vessel due to atherosclerosis; 2 types - thrombotic or
embolic

- *Hemorrhagic Stroke* (13)%): RUPTURED blood vessel; common sources: HTN,
aneurysm, AVM; 2 types - intracerebral or subarachnoid



Ischemic stroke - 2 types - ANSWER-- *Thrombotic* (80%) = primary clot

- *Embolic* (20%) = ineffective heart function (atrial fibrillation), heart valves,
atherosclerotic vessels, internal carotid dissection (due to trauma or genetics)



Ischemic stroke - pathophysiology (4) - ANSWER-1. Cessation of blood flow

2. O2 and glucose deprivation

3. Triggers ischemic cascade

4. Ischemic core neurons die within minutes --> cerebral infarction



Penumbra - defintion - ANSWER-- The fragile area surrounding the ischemic core
(where infarction occurs and neurons die)

,- Still salvageable and is the target of treatment / recovery



Hemorrhagic stroke - common causes of ruptured blood vessel (3) - ANSWER-1. HTN

2. Aneurysm

3. Arterial venous malformation (AVM) - congenital defect at junction of arterial and
venous junction that may leak or break



Hemorrhagic stroke - 2 types - ANSWER-- Intracerebral hemorrhage (ICH) (10%)

- Subarachnoid hemorrhage (SAH) (3%)



Hemorrhagic stroke - pathophysiology (4) - ANSWER-1. *Loss of blood supply distally*
--> same events as with an ischemic stroke

- Cessation of blood flow

- O2 and glucose deprivation

- Triggers ischemic cascade

- Ischemic core neurons die within minutes --> cerebral infarction

PLUS:

2. *Direct toxic effect* to tissue

3. *Tissue compression*

4. *Swelling*



CVA vs. TIA - ANSWER-- Neurological deficits must persist for *at least 24 hours* to be
considered a CVA

- A transient ischemic attack (TIA / "mini-stroke") results in similar deficits but *resolves
within 24 hours*; usually *no permanent brain damage, however increased risk of
stroke*

- TIA involves a temporary blockage of blood flow to the brain

,- About 15% of strokes are preceded by a TIA



Mortality based on stroke type - ANSWER-- Risk is *time dependent*

- Initial risk: 4x higher in hemorrhagic stroke

- After 1 week: 2.5x higher risk

- After 3 weeks: 1.5x higher risk

- By 3 months: NO difference b/t stroke types and mortality



Stroke - modifiable risk factors (*know 7*) - ANSWER-1. HTN

2. High cholesterol

3. Smoking

4. DM

5. Diet / nutrition

6. Inactivity

7. Obesity

- 1-7 are considered "Life's Simple 7" key health factors tracked by AHA

---

8. Heart disease

9. Peripheral artery disease

10. Atrial fibrillation (--> metabolic stroke)



Stroke - NON-modifiable risk factors (6) - ANSWER-1. Age (>60)

2. Sex (F > M)

3. Family hx / genetics

4. Prior hx of CVA, TIA or heart attack

, 5. Race (Black, Hispanic, Alaskan Native), Geography (South Eastern US)

6. Sickle cell anemia



Stroke - early warning signs (5) - ANSWER-All are *SUDDEN ONSET* "red flags"

1. *Numbness or weakness of the face, arm, or leg* especially on ONE side of the body
e.g. face drooping, one arm hanging down

2. *Confusion, trouble speaking, or understanding* e.g. slurred speech

3. *Vision changes / loss* - trouble seeing in one or both eyes

4. Trouble *walking, dizziness, lack of balance or coordination*

5. Severe *HA* with no known cause



BEFAST:

- Balance, HA, dizziness

- Eyes: vision, blurriness

- Face: 1 side drooping, numb

- Arms or legs weak and numb

- Speech difficulty, confusion

(Time to call 911)



Stroke - levels of care (6) - ANSWER-1. ED

2. ICU

3. Acute

4. Inpatient rehab facility (IRF) / 5. Subacute rehab - SNF or TCU

6. Outpatient, home health or community based settings