Summary
Summary NRSG 3320 Exam 3 Study Guide
- Course
- NRSG 3320
- Institution
- Northeastern University
This is a comprehensive and detailed study guide on Exam 3 for NRSG 3320. ***An Essential Study Resource!! All for YOU!!
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EXAM 3 - REVIEWModule 9 - Cerebrovascular Disorders
Functional abnormality of the CNS that occurs when the blood supply to the brain is
disrupted
Stroke is the primary cerebrovascular disorder and the fifth leading cause of death in the
United States
Stroke is the leading cause of serious long-term disability in the United States
Financial impact is profound
Agnosia - Failure to recognize familiar objects perceived by the senses
Aphasia - is an inability to express oneself or to understand language.
Apraxia - is an inability to perform previously learned purposeful motor acts on a voluntarily
Ataxia - is an impaired ability to coordinate movement, often seen as a staggering gait or
postural imbalance
Prevention
Nonmodifiable risk factors
◦ Age (older than 55 years), male, gender, African Americans
Modifiable risk factors
◦ Hypertension is the primary risk factor
◦ Cardiovascular disease: esp. Afib and/or carotid stenosis
◦ Elevated cholesterol or elevated hematocrit
◦ Obesity
◦ Diabetes
◦ Oral contraceptive use
◦ Smoking and drug and alcohol abuse
◦ Sedentary lifestyle
◦ Sleep apnea
Question
Is the following statement true or false?
Ischemic stroke account for 80% to 85% of strokes, and hemorrhagic stroke accounts for 15% to
20%
Answer
True - ischemic stroke account for 80% to 85% of strokes, while hemorrhagic stroke accounts for
15% to 20%
◦
Stroke - “Brain attack”
Sudden loss of function resulting from a disruption of the blood supply to a part of the brain
Type of stroke Causes Main Presenting Functional Recovery
, Symptoms
Ischemic (~ • Large or small • Numbness or Usually plateaus at 6
87%) artery thrombosis weakness of months
• Cardiogenic the face, arm,
embolic leg, especially
• Cryptogenic (no on one side of
known cause) the body
• Other
Hemorrhagic • Intracerebral • “Exploding Slower, usually plateaus at
(~ 13%) hemorrhage headache” about 18 months
• Subarachnoid • Decreased
hemorrhage LOC
• Cerebral aneurysm
• Arteriovenous
malformation
Manifestations of Ischemic Stroke
Symptoms depend on the location and size of the affected area
o Numbness or weakness of face, arm, or leg, especially on one side
o Confusion or change in mental status
o Trouble speaking or understanding speech
o Difficulty in walking, dizziness, or loss of balance or coordination
o Sudden, severe headache
o Perceptual disturbances
◦ FAST – Face irregularities, Arm irregularities, speech irregularities, time to call
Terms
◦ Hemiplegia: paralysis of one side of the body.
◦ Hemiparesis: unilateral paresis, is weakness of one entire side of the body (hemi- means
"half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body.
◦ Dysarthria: difficult or unclear articulation of speech that is otherwise linguistically
normal.
◦ Aphasia: is an inability to express oneself or to understand language.
◦ expressive aphasia: also known as Broca's aphasia, is characterized by partial loss of the
ability to produce language (spoken, manual, or written), although comprehension
generally remains intact. A person with expressive aphasia will exhibit effortful speech
◦ receptive aphasia: Wernicke's aphasia, also known as receptive aphasia, sensory
aphasia, or posterior aphasia, is a type of aphasia in which individuals have difficulty
understanding written and spoken language.
, ◦ Hemianopsia: a decreased vision or blindness (anopsia) in half the visual field, usually
on one side of the vertical midline
◦ Agnosia: inability to interpret sensations and hence to recognize things, typically as a
result of brain damage
Transient Ischemic Attack (TIA)
◦ Temporary neurologic deficit resulting from a temporary impairment of blood flow
◦ “Warning of an impending stroke”
◦ May see drooping on one side of the face
◦ Diagnostic workup is required to treat and prevent irreversible deficits
Medical Management
◦ Prevention: control of hypertension
◦ Diagnosis: CT scan (1st intervention), cerebral angiography, lumbar puncture if CT is
negative and ICP is not elevated to confirm subarachnoid hemorrhage
◦ Care is primarily supportive
◦ Bed rest with sedation
◦ Oxygen
◦ Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention
of further bleeding
Preventive Treatment and Secondary Prevention
◦ Health maintenance measures including a healthy lifestyle, not smoking, exercise,
healthy diet and weight
◦ Carotid endarterectomy for carotid stenosis
◦ Anticoagulant therapy for atrial fibrillation
◦ Antiplatelet therapy
◦ “Statins”
◦ Antihypertensive medications
◦ Carotid Endarterectomy
Medical Management: Acute Phase of Stroke
◦ Prompt diagnosis and treatment
◦ Assessment of stroke: NIHSS assessment tool
◦ Thrombolytic therapy
◦ Criteria for TPA
Over 18 years old INR: less than 1.7 second
Must be diagnosed with ischemic stroke (CAT scan to No heparin in 58 hours
diagnose)
3 hours from onset of symptoms No neoplasm
, BP less than 185/ 110 No aneurisms
no seizures No bleeding issue in the last 21 days
No comadin No surgical procedure in 14 days
PT: less than 15 second No stroke/ head injury in past 3 months
No ICP issue
o IV dosage and administration
◦ Patient monitoring
◦ Side effects: potential bleeding
◦ Elevate head of bed (HOB) unless contraindicated
◦ Maintain airway and ventilation
◦ Continuous hemodynamic monitoring and neurologic assessment
Hemorrhagic Stroke
◦ Caused by bleeding into brain tissue, the ventricles, or subarachnoid space
◦ May be caused by spontaneous rupture of small vessels primarily related to
hypertension; subarachnoid hemorrhage caused by a ruptured aneurysm; or
intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations
(AVMs), intracranial aneurysms, or medications such as anticoagulants
◦ Brain metabolism is disrupted by exposure to blood
◦ ICP increases caused by blood in the subarachnoid space
◦ Compression or secondary ischemia from reduced perfusion and vasoconstriction causes
injury to brain tissue
Manifestations
◦ Similar to ischemic stroke
◦ Severe headache
◦ Early and sudden changes in LOC – level of consciousness
◦ Vomiting
◦ Bleeding
Nursing Process: The Patient Recovering From an Ischemic Stroke—Assessment
Acute phase:
◦ Ongoing, frequent monitoring of all systems, including vital signs and neurologic
assessment
◦ LOC
◦ motor symptoms
◦ speech
◦ pupil changes one bigger than the other
◦ I&O
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