NMNC 4410 – Evidence-Based Practice | University of New Mexico | Exam 3: Practice
Questions and Answers
Interprofessional care for ischemic stroke? (5) - time of onset of symptoms is critical
information!!
- monitor closely for signs of increasing neuro deficit and increased ICP
- BP Goal: SBP <220; DBP <120 (lower if on fibrinolytic therapy)
- control F&E balance
- manage ICP
Drug therapy for ischemic stroke? (2) tPA
- must be administered w/in 3 to 4 1/2 hours of onset of clinical signs of ischemic stroke.
- pts may be treated w/ anticoagulants and platelet inhibitors after they have stabilized.
Endovascular therapy
- stent retrievers: where we can go in and remove the clot.
- Solitaire FR: sending catheter in and taking clot out w/ it.
- ENROUTE: using carotid artery to suck out the remnants of a clot.
Contraindications for tPA? (9) - current intracranial hemorrhage
- s/s of subarachnoid hemorrhage
- active internal bleeding
- recent (w/in last 3 months) intracranial or intraspinal surgery, stroke, or serious head trauma
- computed tomography confirmation of multilobular infarction
- intracranial neoplasm, aneurysm, or arteriovenous malformation
- bleeding disorders
- current anticoagulant therapy
,- elevated BP (SBP >185 or DBP >110)
Drug therapy for hemorrhagic stroke? (2)
Drugs that are contraindicated? (2) - management of HTN is main focus: oral and IV agents
used to maintain BP in normal to high normal range (systolic between 140-160).
- seizure prophylaxis is situation specific.
- anticoagulants and platelet inhibitors are CONTRAINDICATED!
Surgical therapy for hemorrhagic stroke? (4) - resection
- clipping of aneurysm: placing clip on aneurysm to block blood flow and prevent rupture, stays
in place for life.
- evacuation of hematomas
- coil: used to occlude an aneurysm, clot forms around coil and seals off false lumen fully
reestablishing blood flow.
Hyperdynamic therapy for stroke? (3)
What drug can treat vasospasm? - increase MAP by really aggressive fluid resuscitation
- increase cerebral perfusion
- crystalloid or colloid solutions to help increase cerebral perfusion and keep arteries open
- vasospasm can be treated w/ calcium channel blocker nimodipine.
National Institutes of Health (NIH) Stroke Scale? (5) - certification required of nurses working
on stroke units
- recertify every 2 years
- may not adequately assess severity of posterior brain strokes
, - done when the pt first presents
- the higher the score, the worse the stroke is
Vision problems that may result from stroke? (4) - diplopia
- loss of corneal reflex --> inability to close eyelids
- ptosis: drooping eyelid
- homonymous hemianopsia leading to unilateral neglect: pt only sees half of their visual field,
they ignore the other side of their body.
Phases of a seizure? (4) - prodromal phase: slight sensation or behavior changes, may feel
euphoria.
- aural phase: sensory warning that seizure is about to happen.
- ictal phase: from beginning to end of the seizure.
- postictal phase: the recovery period after the seizure.
Typical absence seizure? (4)
Atypical absence seizure? (5) typic absence seizure:
- usually occurs only in children
- typical symptom is staring spell resembling "daydreaming"
- lasts only a few seconds
- EEG demonstrates pattern unique to this seizure (spike and wave pattern)
atypical absence seizure:
- staring spell w/ other manifestations
- eye blinking
- jerking movement of the lips
Questions and Answers
Interprofessional care for ischemic stroke? (5) - time of onset of symptoms is critical
information!!
- monitor closely for signs of increasing neuro deficit and increased ICP
- BP Goal: SBP <220; DBP <120 (lower if on fibrinolytic therapy)
- control F&E balance
- manage ICP
Drug therapy for ischemic stroke? (2) tPA
- must be administered w/in 3 to 4 1/2 hours of onset of clinical signs of ischemic stroke.
- pts may be treated w/ anticoagulants and platelet inhibitors after they have stabilized.
Endovascular therapy
- stent retrievers: where we can go in and remove the clot.
- Solitaire FR: sending catheter in and taking clot out w/ it.
- ENROUTE: using carotid artery to suck out the remnants of a clot.
Contraindications for tPA? (9) - current intracranial hemorrhage
- s/s of subarachnoid hemorrhage
- active internal bleeding
- recent (w/in last 3 months) intracranial or intraspinal surgery, stroke, or serious head trauma
- computed tomography confirmation of multilobular infarction
- intracranial neoplasm, aneurysm, or arteriovenous malformation
- bleeding disorders
- current anticoagulant therapy
,- elevated BP (SBP >185 or DBP >110)
Drug therapy for hemorrhagic stroke? (2)
Drugs that are contraindicated? (2) - management of HTN is main focus: oral and IV agents
used to maintain BP in normal to high normal range (systolic between 140-160).
- seizure prophylaxis is situation specific.
- anticoagulants and platelet inhibitors are CONTRAINDICATED!
Surgical therapy for hemorrhagic stroke? (4) - resection
- clipping of aneurysm: placing clip on aneurysm to block blood flow and prevent rupture, stays
in place for life.
- evacuation of hematomas
- coil: used to occlude an aneurysm, clot forms around coil and seals off false lumen fully
reestablishing blood flow.
Hyperdynamic therapy for stroke? (3)
What drug can treat vasospasm? - increase MAP by really aggressive fluid resuscitation
- increase cerebral perfusion
- crystalloid or colloid solutions to help increase cerebral perfusion and keep arteries open
- vasospasm can be treated w/ calcium channel blocker nimodipine.
National Institutes of Health (NIH) Stroke Scale? (5) - certification required of nurses working
on stroke units
- recertify every 2 years
- may not adequately assess severity of posterior brain strokes
, - done when the pt first presents
- the higher the score, the worse the stroke is
Vision problems that may result from stroke? (4) - diplopia
- loss of corneal reflex --> inability to close eyelids
- ptosis: drooping eyelid
- homonymous hemianopsia leading to unilateral neglect: pt only sees half of their visual field,
they ignore the other side of their body.
Phases of a seizure? (4) - prodromal phase: slight sensation or behavior changes, may feel
euphoria.
- aural phase: sensory warning that seizure is about to happen.
- ictal phase: from beginning to end of the seizure.
- postictal phase: the recovery period after the seizure.
Typical absence seizure? (4)
Atypical absence seizure? (5) typic absence seizure:
- usually occurs only in children
- typical symptom is staring spell resembling "daydreaming"
- lasts only a few seconds
- EEG demonstrates pattern unique to this seizure (spike and wave pattern)
atypical absence seizure:
- staring spell w/ other manifestations
- eye blinking
- jerking movement of the lips
