Stroke

Megan McClintock, MS, RN11/4/11

Pathophysiology

Regulation of cerebral blood flow

Atherosclerosis

Risk Factors

Non-modifiable› Age› Gender› Ethnicity/Race› Family history

Modifiable› HTN› Heart disease› Smoking› Alcohol› Obesity› Sleep apnea› Diabetes› Lack of exercise› Poor diet› Drug abuse

Types of Stroke Ischemic

› Thrombotic› 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, CO2› Keep BP slightly high› Keep hydrated› No fever

Hemorrhagic› Intracerebral› Subarachnoid

Treatment› No anticoagulants or

platelet inhibitors› Keep BP slightly high› Seizure prophylaxis› Surgical treatment› Nimotop

Symptoms

Left versus right (see chart, pg 1465) Motor Communication Affect Intellect Spatial-Perceptual Elimination

Diagnostic Studies

CT is most important CT angiography MRI Transcranial doppler LP (may or may not) LICOX monitoring

Treatment

Prevention Antiplatelet drugs for TIAs

› ASA› Plavix› Warfarin

Surgery› Carotid endarterectomy› Transluminal angioplasty› Stenting› EC-IC bypass

Interventions

Respiratory

Neuro

Interventions

Cardiovascular

Musculoskeletal

Interventions

Integument

GI

Interventions

Urinary

Nutrition

Interventions

Communication

Sensory-Perceptual

Interventions

Coping

PT – mobility, ambulation, transfers, equipment

OT – ADLs, cognitive/perceptual eval and training

ST – speech, communication, cognition, eating

Home Interventions

Musculoskeletal

Nutrition

Bowels

Bladder

Home Interventions

Sensory/Perceptual

Affect

Coping

Sexual

Resources

1. 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.

2. 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

3. 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.