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EXAM 3 CELEBRAL VASCULAR ACCIDENT
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EXAM 3 CELEBRAL VASCULAR ACCIDENT QUESTIONS AND ANSWERS
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EXAM 3 CELEBRAL VASCULAR ACCIDENTExam 3
Cerebral Vascular Accident
Incidence of Stroke
o ~ 780,000 strokes/year
~540,000 1st time strokes
~240,000 recurrent strokes
rd
o 3 leading cause of death in US
160,000 deaths per year
o If you survive 1st stroke – 9x more likely to suffer 2nd stroke
o One death every 37 seconds from cardiovascular disease or
stroke each day
o 2008 cost burden = $448 billion
o Hemorrhagic strokes are the most lethal
Non-modifiable Risk Factors
o Men > women
o Age
o African-American > Hispanic or Asian/Pacific Islander >
Caucasians
o Family history
o Previous Stroke or TIA
o Sickle Cell Anemia
Modifiable Risk Factors
o Smoking
o ETOH
o Obesity
Walking, non-strenuous activity
o High cholesterol
Statin based medication, educate about statins and effects
on liver
Low fat, low sodium diet (heart healthy)
Folic acid, vitamin D
o Hypertension
o Diabetes
o Atrial Fibrillation
Signs and Symptoms of TIA
o Blurred vision
o Caused by lack of blood flow/oxygen
o Headache
o Any neurological changes = need to seek medical attention
,
Ischemic vs. Hemorrhagic
o Ischemic
Thrombotic
Embolic
o Hemorrhagic
Intracerebral
Subarachnoid
Clinical Manifestations
o Headache
o Dependent on area affected
o Weakness/paralysis
o Speech
o Sensation
o Visual
o Decreased LOC
o Cognitive
Review of Terminology
o Aphasia – loss of speech
Expressive – unable to form words
Receptive – speaks but makes no sense
o Dysarthria – difficulty speaking
o Dysphagia – difficulty swallowing
Do not eat or drink until we know they can swallow (at risk
for aspiration)
Need to be NPO
When did they last have something to eat/drink?
o Ataxia – unsteady gait
o Hemiparesis – weakness of face, leg on same side.
o Hemiplegia – paralysis of the face, leg on same side.
o Parethesia – numbness and tingling.
Perceptual Disturbances
, o Homonymous Hemianopia
o
Homonymous Hemianopsia
o Right eye visual field, left hemisphere
Common Symptoms
o Unsure of footing while walking and may trip or stumble.
o Often startled by moving objects or people appearing suddenly.
Maximize other senses such as hearing (announce or knock
when coming in the room)
If they cannot see out of their right eye, place food on tray
to the left
Be aware of coffee (hot) and utensils (sharp) – safety
first!!!! Put it on the side they can see
o May have bruises on shoulder or arm from colliding with door-
frames.
o Has withdrawn from most reading.
o Frequently spills drinks when eating.
o Unsteady Balance in walking or Fear in walking through
unfamiliar areas.
o Uneasiness, anxiety or even panic attacks in crowded area.
o Withdrawal from going to stores or other crowded areas.
o Gets around well at home, but avoids outside activities.
Should have a home safety assessment
o Patient may deny the above problems that caregivers observe.
o Right Hemispheric o Left Hemispheric
o Left Hemiplegia o Right Hemiplegia
o Left neglect from visual o Aphasia or Impaired
o Field impairments language ability
o Short-term memory o Impaired right/left d
o Impulsive/Dangerous behavior style o Slow and cautious b
frequent instruction
, o Impaired judgment o Difficulty learning ne
o Impaired time concepts o Depression
Initial Evaluation
o Note time of onset of symptoms
Last time they ate/drank
When did the symptoms start??!!!!
Take them to imaging
o Imaging will determine ischemic vs.
hemorrhagic
Ischemic strokes – TPA is a blood thinner, but there is
a time window!!!
Never give TPA to a patient experiencing a
hemorrhagic stroke!!!!!
o Rapid transport
Should not be driving themselves!!
o Assess ABCs and glucose
o Use of stroke scale
Cincinnati
NIH
o Monitor Neuro status
Diligent and frequent neuro checks
o EKG
Could be in a fib (likely an ischemic based stroke)
o Patient history
Get a good set of vital signs!
280/110 is very rough on blood vessels (likely a
hemorrhagic stroke)
Stroke Scales
o Cincinnati Scale
Facial Droop
Arm Drift
Speech
o NIH Scale score from 0 to 42.
o A score of more than approximately 25 indicates a large stroke
Diagnostic Studies
o CT Scan
o MRI/MRA
o Carotid Dopplers
o TTE/TEE
o C-spine if any trauma suspected
o Labs
Blood thinners
PT/PTT/INR
Platelets
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