Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
"Worst headache of my life". Disease/Dx? - ansSubarachnoid hemorrhage
2nd most common type of ischemic stroke - ansEmbolic stroke
3 phases of CVA or Stroke - ansPrevention
Event
Recovery
20-25% of strokes are due to - ansinactivity
87% of all strokes are? - ansischemic strokes
A patient has a SAH what are they now at risk for? What should you as a nurse pay attention to? -
ansVasospasms
Acute treatement of stroke patient arrives at ED - ansRAPID triage, lab work, Non-contrasted head CT,
NPO, treat hypertension if necessary. 3 HOURS for Iv tPA 8 hours for Arterial tPA
After a hemorrhagic stroke what happens - ansthe pressure in the brain rises resulting in an overall
decrease/reduction in blood flow to brain.
ICP increase
All potential causes of ICH stroke - anstrauma, anti-coagulants, cocaine, vascular malformations (AVM),
brain tumors
Cardiac causes of a stroke - ansA FIB
A- Flutter
cerebral ischemia - ansInadequate supply of blood to the brain
Also cerebral hemorrhage
Computed tomography angiography (cta) - ansComputed tomography angiography (CTA) uses an
injection of contrast material into your blood vessels and CT scanning to help diagnose and evaluate
blood vessel disease or related conditions, such as aneurysms or blockages.
CVA - anscerebrovascular accident (stroke)
Deficit progression of thrombotic stroke - ansbecome progressively worse and may wax and wain
patients have
Diagnositc Studies after stroke - ansCT
MRI
PET
angiogram
,Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
Doppler
Embolic Stroke (Ischemic) - ansa clot is formed in one place and then travels to occlude a blood vessel in
the brain
hemorrhagic stroke - ansoccurs when a blood vessel in the brain leaks or ruptures; also known as a brain
bleed. Blood leaks into surrounding brain tissue
how long after a SAH is a patient at risk for vasospasm - ans6-10 days
how to diagnose a Subarachnoid hemorrhage? - ansCTA (Computed tomography angiography)
Angiography
how to treat subarachnoid hemorrhage - anscoiling or clipping the anyeryms
How would you assess a stroke - ansNIH stroke scale
ABCS
Infarction - anssudden blockage of an artery, death to tissue
Lease common type of hemorrhagic stroke - ansintracerbral
Major risk factors of a stroke or cerebral vascular accident (CVA) - ansUNcontrolled hypertension
diabetes (DM)
Atril fibrulation or flutter
stress smoking obesity ETOH/ cocaine use
oral birth control use
AA race
management of intracerebral hemorrhage. (Main focus) - ansTreatment aimed at ICP control and
evaluation
Management phase of stroke, what are the modifiable risk factors for 90% of strokes? - ansDM, ETOH,
psychosocial factors,the ratio of apolipoprotein B to A1 (highCHOL and lipids), cardiac issues A-fib, A
flutter and valve disease
hypertension smokeing abdominal obesity diet, 20-25% of strokes are due to inactivity
Previous MI
medical mamagement of ischemic stroke - ansThrombolytic therapy (t-PA)
Most common cause of a hemorrhagic stroke - ansuncontrolled hypertension
most common type of ischemic stroke... - ansThrombotic Stoke
NIH stroke scale - ansA tool used to objectively quantify the impairment caused by a stroke
,Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
Composed of 11 items, each of which scores a specific ability between a 0 and 4.
For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score
is indicative of some level of impairment
Individual scores from each item are summed in order to calculate a patient's total NIHSS score.
Maximum score is 42, minimum is 0 :
0 = no stroke symptoms
1-4 = minor stroke symptoms
5-15 = moderate
16-20 = moderate to severe
21-42 = severe
Presence of blood in CSF - ansmay be a sign of hemorrhagic stroke - but, not diagnostic
prodromal strokes - ansministrokes ususally end up leading to a thrombotic stroke
Progressing stable stoke - ansTIA, transient ischemic attack
This can be included in a cerebral vascular accident
Side effect of t-PA - ansCerbral Hemorrage
SP. SAH tests and risks of test - ansLumber puncture
Presence of blood in CSF may be a sign of hemorrhagic stroke - but, not diagnostic
Contra indicaed in the precene of IICP >15
So CAT scan first b/c of herniation
Stoke Signs and Symptoms - ansOne sided weakness
Numbness/paralysis of face, arm, or leg
Blurred vision in one or both eyes
Difficulty speaking
Slurred speech
Facial drooping
Loss of balance/coordination
Severe headache
Stroke occurrence the physiology - ansa blood clot enters the cerebral circulation, blocking an artery and
causing the death of brain tissue.
Inadequate supply of blood to the brain (cerebral ischemia) or cerebra hemorrhage with in the brain
, Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
subarachnoid hemorrhage (SAH) - ansbleeding within the subarachnoid space, an area between brain
and thin tissues that cover the brain; usually caused by a ruptured brain aneurysm or AVM (arteriovenous
malformation)
Bleeding in the cerebral spinal space
Due to rupture of aneurysm
Symptom of thrombotic stroke - ansPatients may have noted 5-30 minute long prodromal "mini strokes"
prior to larger event
The two types of strokes are - ansischemic and hemorrhagic
thrombotic - ansan occlusive stroke typically caused by atherosclerosis or hardened arterial walls
65% of strokes. A blood clot is formed in the brain vessel itself
TIA - anstransient ischemic attack; mini stroke; blood vessel is blocked, but is quickly reopened.
Progressing Stable stroke
Types of Hemorrhagic Stroke - ansintracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)
Usual occurance of embolic stroke - ansgenerally presesnts during the day when the patient is active.
Begins abruptly...over seconds
Maximal deficits seen EARLY in the course of the stroke
What are the different types of ischemic strokes? - ansthrombotic and embolic
What kind of stroke occurs in ones sleep (most commonly) - ansThrombotic stroke generally begins in the
morning or during sleep. Wakes with deficits.
more than half had TIAs previously
when a patient is at higher risk for a stroke what are the priorities (Acute treatment) - ansEDUCATE
When to use t-PA what type of stroke - ansischeic strokes
When would one use a doppler to diagnose a stroke - ansto rule out carotid artery disease for those
presenting with TIA after CVA has been ruled out
Why do ischemic strokes occur - answhen there is inadequate blood supply to a region of the brain for
enough time to cause cell death (infarction)
"Worst headache of my life". Disease/Dx? - ansSubarachnoid hemorrhage
2nd most common type of ischemic stroke - ansEmbolic stroke
(CVA) John Gates is a 59-year-
old male -Answered
"Worst headache of my life". Disease/Dx? - ansSubarachnoid hemorrhage
2nd most common type of ischemic stroke - ansEmbolic stroke
3 phases of CVA or Stroke - ansPrevention
Event
Recovery
20-25% of strokes are due to - ansinactivity
87% of all strokes are? - ansischemic strokes
A patient has a SAH what are they now at risk for? What should you as a nurse pay attention to? -
ansVasospasms
Acute treatement of stroke patient arrives at ED - ansRAPID triage, lab work, Non-contrasted head CT,
NPO, treat hypertension if necessary. 3 HOURS for Iv tPA 8 hours for Arterial tPA
After a hemorrhagic stroke what happens - ansthe pressure in the brain rises resulting in an overall
decrease/reduction in blood flow to brain.
ICP increase
All potential causes of ICH stroke - anstrauma, anti-coagulants, cocaine, vascular malformations (AVM),
brain tumors
Cardiac causes of a stroke - ansA FIB
A- Flutter
cerebral ischemia - ansInadequate supply of blood to the brain
Also cerebral hemorrhage
Computed tomography angiography (cta) - ansComputed tomography angiography (CTA) uses an
injection of contrast material into your blood vessels and CT scanning to help diagnose and evaluate
blood vessel disease or related conditions, such as aneurysms or blockages.
CVA - anscerebrovascular accident (stroke)
Deficit progression of thrombotic stroke - ansbecome progressively worse and may wax and wain
patients have
Diagnositc Studies after stroke - ansCT
MRI
PET
angiogram
,Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
Doppler
Embolic Stroke (Ischemic) - ansa clot is formed in one place and then travels to occlude a blood vessel in
the brain
hemorrhagic stroke - ansoccurs when a blood vessel in the brain leaks or ruptures; also known as a brain
bleed. Blood leaks into surrounding brain tissue
how long after a SAH is a patient at risk for vasospasm - ans6-10 days
how to diagnose a Subarachnoid hemorrhage? - ansCTA (Computed tomography angiography)
Angiography
how to treat subarachnoid hemorrhage - anscoiling or clipping the anyeryms
How would you assess a stroke - ansNIH stroke scale
ABCS
Infarction - anssudden blockage of an artery, death to tissue
Lease common type of hemorrhagic stroke - ansintracerbral
Major risk factors of a stroke or cerebral vascular accident (CVA) - ansUNcontrolled hypertension
diabetes (DM)
Atril fibrulation or flutter
stress smoking obesity ETOH/ cocaine use
oral birth control use
AA race
management of intracerebral hemorrhage. (Main focus) - ansTreatment aimed at ICP control and
evaluation
Management phase of stroke, what are the modifiable risk factors for 90% of strokes? - ansDM, ETOH,
psychosocial factors,the ratio of apolipoprotein B to A1 (highCHOL and lipids), cardiac issues A-fib, A
flutter and valve disease
hypertension smokeing abdominal obesity diet, 20-25% of strokes are due to inactivity
Previous MI
medical mamagement of ischemic stroke - ansThrombolytic therapy (t-PA)
Most common cause of a hemorrhagic stroke - ansuncontrolled hypertension
most common type of ischemic stroke... - ansThrombotic Stoke
NIH stroke scale - ansA tool used to objectively quantify the impairment caused by a stroke
,Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
Composed of 11 items, each of which scores a specific ability between a 0 and 4.
For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score
is indicative of some level of impairment
Individual scores from each item are summed in order to calculate a patient's total NIHSS score.
Maximum score is 42, minimum is 0 :
0 = no stroke symptoms
1-4 = minor stroke symptoms
5-15 = moderate
16-20 = moderate to severe
21-42 = severe
Presence of blood in CSF - ansmay be a sign of hemorrhagic stroke - but, not diagnostic
prodromal strokes - ansministrokes ususally end up leading to a thrombotic stroke
Progressing stable stoke - ansTIA, transient ischemic attack
This can be included in a cerebral vascular accident
Side effect of t-PA - ansCerbral Hemorrage
SP. SAH tests and risks of test - ansLumber puncture
Presence of blood in CSF may be a sign of hemorrhagic stroke - but, not diagnostic
Contra indicaed in the precene of IICP >15
So CAT scan first b/c of herniation
Stoke Signs and Symptoms - ansOne sided weakness
Numbness/paralysis of face, arm, or leg
Blurred vision in one or both eyes
Difficulty speaking
Slurred speech
Facial drooping
Loss of balance/coordination
Severe headache
Stroke occurrence the physiology - ansa blood clot enters the cerebral circulation, blocking an artery and
causing the death of brain tissue.
Inadequate supply of blood to the brain (cerebral ischemia) or cerebra hemorrhage with in the brain
, Cerebral Vascular Accident
(CVA) John Gates is a 59-year-
old male -Answered
subarachnoid hemorrhage (SAH) - ansbleeding within the subarachnoid space, an area between brain
and thin tissues that cover the brain; usually caused by a ruptured brain aneurysm or AVM (arteriovenous
malformation)
Bleeding in the cerebral spinal space
Due to rupture of aneurysm
Symptom of thrombotic stroke - ansPatients may have noted 5-30 minute long prodromal "mini strokes"
prior to larger event
The two types of strokes are - ansischemic and hemorrhagic
thrombotic - ansan occlusive stroke typically caused by atherosclerosis or hardened arterial walls
65% of strokes. A blood clot is formed in the brain vessel itself
TIA - anstransient ischemic attack; mini stroke; blood vessel is blocked, but is quickly reopened.
Progressing Stable stroke
Types of Hemorrhagic Stroke - ansintracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)
Usual occurance of embolic stroke - ansgenerally presesnts during the day when the patient is active.
Begins abruptly...over seconds
Maximal deficits seen EARLY in the course of the stroke
What are the different types of ischemic strokes? - ansthrombotic and embolic
What kind of stroke occurs in ones sleep (most commonly) - ansThrombotic stroke generally begins in the
morning or during sleep. Wakes with deficits.
more than half had TIAs previously
when a patient is at higher risk for a stroke what are the priorities (Acute treatment) - ansEDUCATE
When to use t-PA what type of stroke - ansischeic strokes
When would one use a doppler to diagnose a stroke - ansto rule out carotid artery disease for those
presenting with TIA after CVA has been ruled out
Why do ischemic strokes occur - answhen there is inadequate blood supply to a region of the brain for
enough time to cause cell death (infarction)
"Worst headache of my life". Disease/Dx? - ansSubarachnoid hemorrhage
2nd most common type of ischemic stroke - ansEmbolic stroke
