Term
| an interruption of blood flow to part of the brain |
|
Definition
|
|
Term
| without normal blood flow, the affected areais deprived of _ and cell death begins to occur in as little as _ |
|
Definition
|
|
Term
| a CVA is commnly referred to as |
|
Definition
|
|
Term
| nonmodifiable risk factors of CVA |
|
Definition
| age, race, gender, heredity, having had a previous TIA or CVA, fibromuscular disease and patent foramen ovale |
|
|
Term
|
Definition
| men,, african americans, people 51 to 74 years ofa age and those with a family history of CVA |
|
|
Term
| causes of strokes among the young include |
|
Definition
| drug abuse, use of birth control pills in combinarion with smoking, congenital heart conditions, mitral valve prolaps, atrial fibrillation, infections endocarditis, sickle cell anemia, rheumatic fever, leukemia |
|
|
Term
| a common denominator of many of the risk factors is |
|
Definition
|
|
Term
| transient episode of neurological dysfunction caused by focal brain, spinal cord, retinal ischemia, without acute infarction |
|
Definition
| transient ischemic attack |
|
|
Term
| it is believed that at least _ of blood flow to an area must be blocked before signs and symptoms of a TIA appear |
|
Definition
|
|
Term
| TIAs are important warning signs for the individual who could potentially experience a _ in the future |
|
Definition
|
|
Term
| a temporary onset of stroke symptoms without permanent damage |
|
Definition
|
|
Term
| it is recommended that a patient experiencing a TIA receve a full medical evaluation within |
|
Definition
|
|
Term
|
Definition
|
|
Term
| _ percent of patients have a stroke within 3 months |
|
Definition
|
|
Term
| one tool used to assess the risk of stroke after TIA is the |
|
Definition
|
|
Term
| For the ABCD score points are assigned based on |
|
Definition
| age, blood pressure on the first evaljuation, clinical symptoms and duration of symptoms and diagnosis of diabetes |
|
|
Term
| the ABCD score can range from |
|
Definition
| 0 to 7 (the greater the score, the more increased the risk of stroke is within 2 days) |
|
|
Term
| with TIA neurologic sings and sympoms resolve with no |
|
Definition
|
|
Term
| common signs and symptoms of TIA |
|
Definition
| dizziness, momentary confusion, loss of speech, loss of balance, tinnitus, visual disturbances, pitosis,dysarthria, dysphagia, drooping mouth, weakness and tingling or numbness on one side of the body |
|
|
Term
| confirmation of TIA requries |
|
Definition
| brain imaging studies (preferably MRI) |
|
|
Term
| treatment of TIA depends on the |
|
Definition
|
|
Term
| the common causes of tia are thought to be |
|
Definition
| carotid aretery disease, large or small artery disease from atherosclerosis, and atrial fibrillation |
|
|
Term
| treatmeant of atherosclerotic disease r/t tia depends on the location of the narrowed vessel and |
|
Definition
|
|
Term
| the american strok association recmmends intial treatment fo artherosclerosis r/t tia with _ to decrease platelet clumping |
|
Definition
| acetylsalicylic acid(aspirin) alone or in combination of acetylsalicylic acid and extended release dipyridamole(aggrenox), or a comination of acetylsalicylic and with clopidogrel bisulfate |
|
|
Term
| In atrial fibrillation, _ are believed to form which later are released from the heart and travel to the arteries of the _ to cause tia or stroke |
|
Definition
| microscopic emboli, brain |
|
|
Term
| the only options for patients exhibiting cardioembolic TIA used to be : |
|
Definition
|
|
Term
| the dosage for warfarin therpay is based on the |
|
Definition
|
|
Term
| for therapeutic anticoagulation, the PT is usually kept in a therapeutif range of _ and the INR kept at |
|
Definition
| 1.5 TO 2.0 times the normal, 2.0 to 3.0 |
|
|
Term
| the effect of unfractionated heparin therpay is monitored with the |
|
Definition
| activated partial throboplastin time (aPTT) |
|
|
Term
| _ are also indicated for stroke prevention in nonvalvular atrial fibrillation |
|
Definition
| Rivaroxaban(Xerelto) and dibigatran(Pradaxa) |
|
|
Term
| _ are recommended for patients iwth elevated lips or coronary artery disease or when evidence exists that the TIA is related to atherosclerosis |
|
Definition
|
|
Term
| the most common procdures for stroke prevention are |
|
Definition
| carotid endarterectom and trasluminal angioplasty |
|
|
Term
| the surgical removal of plaques in the artery to permit improved blood flow |
|
Definition
|
|
Term
| patients who are at high risk for surgical intervention because of other health problems may benefit from |
|
Definition
|
|
Term
| improves blood flow by dilating the narrowed artery with a balloon that is inserted into the artery |
|
Definition
|
|
Term
| an abrupt impariment of brain function resulting in a set of neurologic signs and symptoms caused by imparied blood flow to the brain and that last more than 24 hours |
|
Definition
|
|
Term
| when symptoms progress over hours or days the condition is descrbed as |
|
Definition
|
|
Term
| when the neurologic deficits do not change for _ the stroke is said to be _ |
|
Definition
|
|
Term
| two main classifications of stroke are |
|
Definition
|
|
Term
| a blood vessel in the brain ruptures and bleeding into the brain occurs, as a result, ICP may increase, disrupting normal cerebral function |
|
Definition
|
|
Term
| intracerebral stroke is associated with |
|
Definition
| trauma, uncontrolled hypertension and aneurysms |
|
|
Term
| when hemorrhage occurs within the spaces of the brian the terms _ are used to describe the location |
|
Definition
| subdural, subarachnoid, ventricular |
|
|
Term
| hemorrhagic strokes are often |
|
Definition
|
|
Term
| occurs between the arachnoid and pia mater layers of the brain covering |
|
Definition
|
|
Term
| subarachnoid hemorrhage may be caused by |
|
Definition
| congenital malformations of blodd vessels in the brain or ruputure of an aneurysm |
|
|
Term
| ischemic stroke is caused by the obstruction of ablood vessel by an |
|
Definition
| aterhosclerotic plaque, a blood clot, a combination of the tow, or other debris released into the vessel that impedes blood flow to an aerea of the brain |
|
|
Term
| Ishemic strokes account for 87% of all strokes including |
|
Definition
| embolic and thrombotic strokes |
|
|
Term
| the clot or plaque fragment is traveling through a blood vesssel from an area outside of the brain until it lodges in a cerebral artery |
|
Definition
|
|
Term
| _ are cardiovascular conditions that may lead to the development of lcots that become emboli |
|
Definition
| mitral valve sentosis, atrial fibrillaiton, myocardial infarction |
|
|
Term
| develops when an obstructionforms in a blood vessel fo the brain |
|
Definition
|
|
Term
| produces most of the throbotic stroks |
|
Definition
|
|
Term
| patients may experience strok inevolution in which symptoms worsen during approximately |
|
Definition
|
|
Term
| as the obstrcution r/t throbotic stroke progresses, neurologic impaiment |
|
Definition
|
|
Term
| patients who have thrombotic strokes may habe a history of |
|
Definition
|
|
Term
| results form the occlusion of the small penetrating arteris deep within the brain |
|
Definition
|
|
Term
| defined as an empty space, the result of tissu death from a occlusive process in the small arteries of the brain |
|
Definition
|
|
Term
| frisk factors for lacunar stroke sinclude |
|
Definition
| advanced age, chronic hypertension, smoking and diabetes mellitus |
|
|
Term
| symptoms of a hemorrhagic stroke geenrlaly occurr suddenly and may includ |
|
Definition
| sever headache that the patient describes as "the worst headache of my life" |
|
|
Term
| other symptoms of stroke are |
|
Definition
| stiff neck, loss of consciousness, vomiting and seizures |
|
|
Term
| one of or more of these symptoms may be present with embolic stroke |
|
Definition
| one sided weakness, numbness, visual problems, ocnfusion and memory lapses, ehadache, dysphagia and language problems |
|
|
Term
| language problems r/t embolic stroke may bbe in the form of |
|
Definition
| difficultiy understanding, difficulty speaking or both |
|
|
Term
| the signs and symptoms may be the same as those of an embolic stroke except the symptoms may develop mroe |
|
Definition
|
|
Term
| long term effects of stroke that merit further dicussion are |
|
Definition
| aphasia, dysarthria, dysphagia, dyspraxia, hemiplegia, senosry impariment, unilateral neglect, homonymous hemianopsia, personaliyt change, emotional labiltiy, impaired cognition and bladder dysfunction |
|
|
Term
| the speech center is located in the |
|
Definition
|
|
Term
| in left handed persons the speeche center is sometimes located in the |
|
Definition
|
|
Term
| a defect in the use of language: speech, reading, writing, or word comprehension |
|
Definition
|
|
Term
|
Definition
|
|
Term
| difficulty understanding spoken or written words |
|
Definition
|
|
Term
| difficulty speaking and writing |
|
Definition
|
|
Term
| aphasia can also be classified as |
|
Definition
|
|
Term
| patient soudns normal but makes little sense |
|
Definition
|
|
Term
| patient has difficulty initiating speech |
|
Definition
|
|
Term
| sometimes used when speech is impaired to the point that the person ahs almost no ability to communicate |
|
Definition
|
|
Term
| the inability to speak clearly. |
|
Definition
|
|
Term
| cause by nerologic damage that prevents normal control of muscles used in speech |
|
Definition
|
|
Term
| patients with dysarthria are also likely to have |
|
Definition
|
|
Term
| the partial inability to initiate coordinated voluntary motor acts |
|
Definition
|
|
Term
| the person who has apraxia can move the affected parts but cannot perfomr specific purposeful actions such as |
|
Definition
|
|
Term
| defined as paralysis of one side of the body |
|
Definition
|
|
Term
| the affected side of hemiplegia is _ form the side of the brain in which the stroke occured |
|
Definition
|
|
Term
| himplegia is characterized firs by _ and then by _ |
|
Definition
|
|
Term
| patient does not recognize one side of their body as belonging to them |
|
Definition
|
|
Term
| unilateral neglect is most common with _ and results in failure to attend to _ of the body |
|
Definition
| right hemisphere, left side |
|
|
Term
| a perceptual problem that involve loss of one side of the field of vision |
|
Definition
|
|
Term
| translates to a half blinded field of vision that cocurs on the same side in both eyes |
|
Definition
|
|
Term
| procedures ordered to diagnose stroke |
|
Definition
| blood studies, ECG, CT, MRI, carotid ultrasound studies, cerbrall and carotid angiography, EEG, positron emission tomography, single- photon emission |
|
|
Term
| blood studies and the ECG are done to identify the prescence of risk factors for stroke such as |
|
Definition
| abnormal clotting, hperlipidemia, atrial fibrlations |
|
|
Term
| If subarachnoid hemorrhage is supspected and the CT scan is negative for blood a _ may be performed to obtain CSF |
|
Definition
|
|
Term
| grossly bloody CSF during lumbar puncture indicates _ rather than ischemic stroke |
|
Definition
|
|
Term
| antiocoagulants ar contraindicated after |
|
Definition
|
|
Term
| a lumbar puncture is not done if increased _ is suspected |
|
Definition
|
|
Term
| the patient with sever motor impairment is at risk for |
|
Definition
| constipations, dehydration, contractures, urinary ttract infections, thrombophlebitis, pressure injuries andpneumonia |
|
|
Term
| sensory losses put the patient at riks for |
|
Definition
| traumatic and thermal injuries |
|
|
Term
| swallowing difficulties place the patient at risk for pulmonary complications such as |
|
Definition
| choking, aspiration and pneumonia |
|
|
Term
| after a stroke some patients experience a dsiabling pain called |
|
Definition
| central post stroke pain (CPSP) |
|
|
Term
| symptoms that occur after with right sided brain damage, affecting the left side of the body |
|
Definition
| paralyzed left side, left sided neglect, spatial perceptual defiicts, tends to deny or minimize problems, rapid performance, short attention span, impulsive, saftey hazard, imparied judgment impaired time conepts |
|
|
Term
| symptoms that occur after left sided brain damage affecting the right side |
|
Definition
| paralyzed on the right side, impaired speech/language aphasia, impaired right/left discrimination, slow perfomrance, causious, aware of deficits, deprresion, anxiety, impared comprehensio r/t to language, math |
|
|
Term
| locations of brain lesion r/t receptive aphasia |
|
Definition
|
|
Term
| location of brain lesion for expressive aphasia |
|
Definition
|
|
Term
| location of brain lesion for dysarthria |
|
Definition
|
|
Term
| characteristics of receptive aphasia |
|
Definition
| unable to comprhend spoken or written words |
|
|
Term
| characteristics of expressive aphasia |
|
Definition
| difficulty speaking or writing |
|
|
Term
| characterisics of dysarthria |
|
Definition
| apeaks slowly with great effort, words prolonged, hard to understand |
|
|
Term
| the acute phase of stroke begins with the onset of signs and symptoms and continues until the patients _ stabilize |
|
Definition
| vital signs, particularily blood pressure and neurologic condition |
|
|
Term
| the acute phase of stroke usually lasts |
|
Definition
|
|
Term
| managemnt of chronic conditions such as _ must continue during the acute phase of storke |
|
Definition
| diabetes mellitus, heart diseas, arthritis and gastrointestinal disturbances |
|
|
Term
| major focus ares for medical managment interventions that are directed at minimaizing complications |
|
Definition
| hypertension, oxygenations, hyperthermia, hyperglycemia, arrhythmias |
|
|
Term
| it is very important to monitor stroke patients and report any changes in |
|
Definition
| vital signs, oxygenation, temperature or glucose levels |
|
|
Term
| the majority of paitents admitted with an acute stroke have _ during and immediately after a stroke |
|
Definition
|
|
Term
| even without treatment blodo pressure naturally begins to decfrease within _ and gradually falls for _ |
|
Definition
|
|
Term
| in patients experiencing a hemorrhagic stroke, blood pressure control wil be maintianed mcuh _ and hypertensio will be avoided to reduce the risk of more bleeding into the |
|
Definition
|
|
Term
| _ of any degree has now been shown to extend the area of damage and potentially worsen the outcome after stroke |
|
Definition
|
|
Term
| fever can be adequately managed with medications such as |
|
Definition
|
|
Term
| _ during the acute phase of a stroke may represent the bodhy's stress response to stroke |
|
Definition
|
|
Term
| current reommendations require treating hyperglycemia with insulin if the serum glucose is found to be more than |
|
Definition
|
|
Term
| in the first 2 days, blood glucose should be measured every _ in patients who have received thrombolytic therapy and every _ in other patients |
|
Definition
|
|
Term
| may be given to dissolve clots in patients with acute ischemic strokes |
|
Definition
| tissue plasminogen activator |
|
|
Term
| to be give IV t-PA should be initiated within _ from the onest of stroke symptoms |
|
Definition
|
|
Term
| selection criteria for t-pa are also very strict because this medication is associated with an increased risk of _ in patients who have received it |
|
Definition
|
|
Term
| inclusion critera for IV recombant tissue plasminogen activator |
|
Definition
- age 18 years or older
- diagnosis of ischeic stroke causing measurable neurologic deficit
- clinical diagnosis of stroke with a NIHSS score less than 22
- time of onset of stroke is known and is 3 hours or less
|
|
|
Term
| Exclusion criteria for t-PA |
|
Definition
- significant head trauma or prior stroke in previous 3 months
- sympomts suggest a subarachnoid hemorrhag
- history of previou sintracranial hemorrhag
- intracranial neoplasm, arteriovenous malformation or aneurysm
- recent intracranial surgery
- elevated blood presure: systolic greater than 185 or diastolic gretera than 110
- active internal bleeding
- blood glucose less than 50 mg/dL or more than 400 mg dL
|
|
|
Term
| relative exclusion criteria for t-PA |
|
Definition
- only a minor or rapidly resolving stroke
- seizure at onset of stroke
- major surgery or serious trauma within previous 14 days
- recent gastrointestinal or urinary tract hemorrhage
|
|
|
Term
| relative exclusion criteria for t-PA |
|
Definition
- only a minor or rapidly resolving stroke
- seizure at onset of stroke
- major surgery or serious trauma within previous 14 days
- recent gastrointestinal or urinary tract hemorrhage
|
|
|
Term
| Criteria for extenign intravenous rt=PA treatment 3 to 4.5 hours from symptom onset |
|
Definition
- Patient 80 years of age or older
- patient does not have a history of both diabetes and stroke
- patient is not taking warfarin or any other anticoagulant regardless of inr/coagulation results
- NIHSS is 25 or more
- Written informed consent must be obtained from patient and or familly for IV rt-pa within the 3 to 4.5 hours window
|
|
|
Term
| Criteria for extenign intravenous rt=PA treatment 3 to 4.5 hours from symptom onset |
|
Definition
- Patient 80 years of age or older
- patient does not have a history of both diabetes and stroke
- patient is not taking warfarin or any other anticoagulant regardless of inr/coagulation results
- NIHSS is 25 or more
- Written informed consent must be obtained from patient and or familly for IV rt-pa within the 3 to 4.5 hours window
|
|
|
Term
| cerebral edema is sometimes treated with |
|
Definition
| osmotic diuretics such as mannitol and with hyperventilation |
|
|
Term
| _ may be ordered to prevent sapsms in cerebral blood vessels after subarachnoid hemorrhage |
|
Definition
|
|
Term
|
Definition
|
|
Term
| anticonvulsants that may be ordered if the patient has seizures |
|
Definition
|
|
Term
| heparin and heparinoid drugs are no longer used as a first line treatment with a TIA or an acute ischemic stroke unless a _ is suspected |
|
Definition
|
|
Term
| when appropriate, heparin is given IV followed by |
|
Definition
|
|
Term
| drugs given to prevent strokes caused by thrombi are |
|
Definition
| acetylsalicylic acid, clopidogrel, extendended release dipyridamole |
|
|
Term
| decisions about surgery are based on the patient's |
|
Definition
| age, ICP and the location of hemorrhage |
|
|
Term
| IV fluids are usually administered for the stroke patient in the |
|
Definition
|
|
Term
| intermittent catheterizaion is done every _ as ordered |
|
Definition
|
|
Term
| the most important aspects of care during the acute phase of a stroke are assessment and stabilization of the patient to prevent further brain injury, this phase is sometimes referred to as |
|
Definition
|
|
Term
| a toool used to assess patients hwo have experienced a storke |
|
Definition
|
|
Term
| provides a method to guide systematic assessment of neurologic deficits often associated with an acute stroke |
|
Definition
|
|
Term
| the NIHSS examination addresses |
|
Definition
| motor funciton, visual fields, ataxia, speech, language, cognitition, and motor and sensory abnomalities |
|
|
Term
| to ensure adequate oxygneation, maintain the patient's body aligmnet and elevate the head of the bed |
|
Definition
|
|
Term
| increasing ICP may affect the respiratory center in the brain, causing |
|
Definition
|
|
Term
| if the patient exhibits signs of increased ICP elevate the head of the bed _ |
|
Definition
| 30 degrees and notify the physician |
|
|
Term
| the most frequent cause of death after stroke |
|
Definition
|
|
Term
| _ may be discouraged in the acute phase after a hemorrhagic stroke because it tends ot increase ICP |
|
Definition
|
|
Term
| sensory perceptual problems in the stroke patient may include |
|
Definition
| visual disturbances, sensory deprivation, or overload and impaired tactile sensation |
|
|
Term
| among the visual disturbances of stroke are |
|
Definition
| diplopia, los of the corneal reflex, ptosis, homonymous hemianopsia and inability to close the elids on the affected side |
|
|
Term
|
Definition
|
|
Term
| drooping of the upper eyelid |
|
Definition
|
|
Term
| patients who have homymous hemianopsia see only _ of the field of vision |
|
Definition
|
|
Term
| unilateral neglect is most common in patients iwht _ damage |
|
Definition
|
|
Term
|
Definition
| national institues of health stroke scale |
|
|
Term
| essential to reduce the risk of sensory deprivaiton or overload |
|
Definition
|
|
Term
| if rt-PA is administered for ischemic stroke the patient must b emonitored closely for hemorrhage for |
|
Definition
|
|
Term
| the most common location of hemmorhage associated with rt-PA therapy |
|
Definition
|
|
Term
| signs of intracranial hemorrhage include |
|
Definition
| change in LOC, elevation in blood pressure, deterioration in motor function, new headache, nausea and vomiting |
|
|
Term
| treatment of the bleeding r/t intracranial hemorrhage requries |
|
Definition
|
|
Term
| common after large cerebra infarctions, especially in younger patients |
|
Definition
|
|
Term
| early signs of increased ICP include |
|
Definition
| deterioration in LOC and motor function, headache, visual disturbances, change in repsiratory pattern, changes in blood preasur and HR |
|
|
Term
| keep the head of the bed elevated at _ to maintain the alignment of the head with the rest of the body |
|
Definition
|
|
Term
| medical interventions for cerebral edema |
|
Definition
| diuretic and barbiturate drugs, hyperventilaiton, surgery |
|
|
Term
| lab studies useful in indicating fluid balance |
|
Definition
| urine specific gravity, serum electrolytes, hematocrit |
|
|
Term
| factors that place the stroke patient at risk for deficient fluid volume include |
|
Definition
| age, dysphagia, drug therapy with diuretics and immobility |
|
|
Term
| deficient fluid volume contributes to |
|
Definition
| constipation, skin dryness, urinary tract infections, and renal calculi, |
|
|
Term
| signs of deficient fluid volume are |
|
Definition
| thready pulse, tachycardia, low blodo pressure, low urin output, concentrated urin, dry mucous membranes, and sometimes confusion |
|
|
Term
| factors that may lead to inadequatenutrition include |
|
Definition
| dysphagia, paralysis, difficulty chewing and depression |
|
|
Term
| the patient who is malnourished is at risk for |
|
Definition
| skin breakdown and infection |
|
|
Term
| aggressive treatment of dysphagia is delayed until the |
|
Definition
|
|
Term
| dyspagia often resolves _ after the first few months of recovery |
|
Definition
|
|
Term
| fever is treated aggressively most often with |
|
Definition
|
|
Term
| after a stroke patients may suffer |
|
Definition
| functional losses, alterations in sensation and perception and impaired communication |
|
|
Term
| neglect associated with right brain strokes may also be manifested as |
|
Definition
|
|
Term
| the potential for skin breakdown in impaired mobility is great because of |
|
Definition
| motro impairment, altered consciousness or sensation, poor nutrional status and incontinecne |
|
|
Term
| measures to maintain skin integrity include |
|
Definition
| cleanliness, pressure relief, and good hydration and nutrition |
|
|
Term
| when skin is dry as it often is in older patients it is important to |
|
Definition
| reduce bathing frequency, use soap sparingly and apply lotions to retian skin moisture |
|
|
Term
| skin breakdown can occur at vulnerable pressure points after just _ in one position |
|
Definition
|
|
Term
| an example of unhealthy coping is the patient who denies having problems with _ and refuses to call for help when _ |
|
Definition
| vision or balance, getting out of bed |
|
|
Term
| the general goals of treatment in the rehabilitation phase are to |
|
Definition
| teach ways to compensate for losses |
|
|
