AH: Module 2

What is the definition of a stroke?

A stroke, also known as a cerebrovascular accident (CVA), is an injury or death of brain tissue related to ischemia (insufficient blood flow/O₂) or hemorrhage (bleeding into brain tissue).

At what age is stroke more common?

Stroke is more common in individuals over 65 years of age but can occur at any age, including in children.

What is the function of the right hemisphere of the brain?

The right hemisphere functions in the present moment, thinks in pictures, learns kinesthetically through movement, and integrates sensory information.

What is the function of the left hemisphere of the brain?

The left hemisphere thinks linearly and methodically, focuses on past and future, organizes information, and is responsible for language and internal dialogue.

What is a thrombotic stroke?

A thrombotic stroke is caused by cerebral atherosclerosis where plaque narrows the artery, leading to a clot that blocks blood flow and results in ischemia of brain tissue.

What is an embolic stroke?

An embolic stroke occurs when an embolus, which is a blood clot or debris, travels to a cerebral artery and becomes lodged, blocking blood flow.

What is a hemorrhagic stroke?

A hemorrhagic stroke is caused by a ruptured blood vessel that allows blood to enter brain tissue, damaging surrounding tissue.

What are common causes of hemorrhagic stroke?

Common causes include a ruptured cerebral aneurysm and a ruptured arteriovenous malformation (AVM).

What is the classic manifestation of a hemorrhagic stroke?

The classic manifestation is a severe headache, often described as the 'worst headache of my life.'

What is a transient ischemic attack (TIA)?

A TIA is a temporary neurologic event that may be caused by vasospasm, hypotension, or small emboli, and serves as a warning sign of a future stroke.

What are the risk factors for stroke?

Risk factors include medical conditions like diabetes mellitus, hypertension, coronary artery disease, age over 65, smoking, and the use of oral contraceptives.

What is carotid artery disease?

Carotid artery disease involves plaque or stenosis in the carotid arteries, which can be assessed using diagnostic studies such as carotid Doppler and angiogram.

What is angioplasty and stenting?

Angioplasty and stenting involve inserting a balloon into a narrowed carotid artery, inflating it to compress plaque, and deploying a stent to keep the artery open.

What is carotid endarterectomy?

Carotid endarterectomy is a surgical procedure to remove plaque from the carotid artery, with a major risk being stroke.

What are the priority assessments after carotid procedures?

Priority assessments include monitoring for signs and symptoms of stroke, cardiovascular monitoring, bleeding assessment, airway assessment, and blood pressure management.

What medications are commonly used for long-term stroke prevention?

Common medications include antiplatelet therapy (such as clopidogrel and aspirin) and antilipemic therapy to reduce atherosclerotic plaque formation.

What is the NIH Stroke Scale (NIHSS)?

The NIH Stroke Scale (NIHSS) is a standardized stroke assessment tool frequently used in stroke centers.

What is the significance of assessing the Level of Consciousness (LOC) in stroke patients?

Assessing LOC helps determine responsiveness; hemorrhagic stroke patients are more likely to be unconscious due to increased intracranial pressure (ICP).

What commands can be used to assess a patient's ability to follow commands?

Ask the patient to open their eyes and squeeze their hands.

What does a patient's ability to follow commands demonstrate?

It demonstrates their ability to hear, understand speech, and shows motor function and strength of upper extremities.

What are common findings in pupillary assessment (PERRL) associated with increased ICP?

Findings include unilateral pupil dilation, fixed and dilated pupil, and sluggish light response.

What is contralateral hemiplegia/hemiparesis?

It is a condition where deficits occur on the side opposite the brain injury, e.g., left-brain stroke leads to right-sided weakness.

What does the Arm Drift Test indicate?

It indicates weakness if the patient's arm drifts downward or if there is hand pronation when palms are up and eyes are closed.

What is the typical gait observed in stroke patients?

The affected leg swings forward in a semicircle, and the affected arm is held flexed.

What is ptosis?

Ptosis is the drooping of the upper eyelid.

What is hemianesthesia?

Hemianesthesia is the loss of sensation on one side of the body, often occurring after a stroke.

What is homonymous hemianopsia?

Homonymous hemianopsia is the loss of the right or left visual field in both eyes, often leaving the patient unaware of the deficit.

What does unilateral neglect indicate?

Unilateral neglect indicates that the patient ignores one side of their body or environment, increasing injury risk.

What is agnosia?

Agnosia is the inability to recognize objects through sight, touch, or sound.

What is expressive aphasia (Broca's aphasia)?

Expressive aphasia is characterized by difficulty speaking, finding words, and may result in gibberish or no speech despite understanding language.

What defines receptive aphasia (Wernicke's aphasia)?

Receptive aphasia is characterized by an inability to understand spoken language, leading to impaired speech comprehension.

What is global aphasia?

Global aphasia is the most severe form of aphasia where the patient cannot understand speech or express needs.

What is the purpose of thrombolytic therapy (tPA)?

Thrombolytic therapy is used to dissolve existing clots in stroke patients.

What is the time window for administering tPA?

tPA should ideally be administered within 3-4.5 hours of symptom onset.

What is mechanical thrombectomy?

Mechanical thrombectomy is a procedure to physically remove a clot from a cerebral artery using a catheter.

What initial priorities are included in stroke management?

Initial priorities include airway assessment, vital signs, IV access, blood work, medical history, physical examination, and neurologic assessment.

What is the role of the Stroke Protocol Team?

The Stroke Protocol Team includes Emergency Department, Neurology, Radiology, and ICU/Neuro ICU to ensure coordinated care.

What are the primary antiplatelet medications used after a stroke?

Aspirin and Clopidogrel.

What is the risk associated with combining antiplatelet medications?

Increased bleeding risk.

What is the purpose of anticoagulants in patients with atrial fibrillation?

To prevent embolic stroke.

What factors should be evaluated when considering anticoagulants for stroke patients?

Risks versus benefits, including the risk of frequent falls.

What is a common discharge medication for stroke patients?

Statins, used to treat underlying atherosclerosis.

Which blood pressure medications are commonly used after a stroke?

Metoprolol and Nicardipine.

What should be checked before administering Metoprolol?

Blood pressure and apical pulse.

What is the purpose of IV fluids in stroke patients?

To prevent dehydration and hemoconcentration, and to reduce clot formation.

What type of care do hemorrhagic stroke patients often require?

ICU care.

How are ischemic stroke patients typically managed?

In a dedicated stroke unit, unless they are unstable or critically ill.

What are common deficits associated with left-brain strokes?

Right-sided deficits.

What are common deficits associated with right-brain strokes?

Left-sided deficits.

What is expressive aphasia?

The inability to speak well.

What is receptive aphasia?

The inability to understand speech.

What imaging study is obtained first to rule out hemorrhage before administering tPA?

CT scan.

What is the benefit of earlier thrombolytic therapy?

It leads to better outcomes.

What is a major source of embolic stroke?

Atrial fibrillation.

What screenings do stroke patients require before discharge?

Dysphagia screening, DVT prophylaxis, rehab evaluation, smoking cessation education, and antithrombotic therapy.

What is the purpose of rehabilitation after a stroke?

To maximize recovery through a multidisciplinary process.

What characterizes subacute rehabilitation?

Occurs in a nursing home with approximately 1-2 hours of therapy daily.

What characterizes acute rehabilitation?

Occurs in a rehabilitation center with approximately 3-5 hours of therapy daily, including PT, OT, and Speech Therapy.

Who specializes in rehabilitation medicine?

A physiatrist.

What does a physical therapist assist with?

Ambulation, gross motor movement, and mobility training.

What does an occupational therapist assist with?

Fine motor skills, eye-hand coordination, eating, dressing, and activities of daily living (ADLs).

What does a speech-language pathologist evaluate?

Swallowing safety, aspiration risk, and communication deficits.

What is the Functional Independence Measure (FIM)?

A functional assessment tool that determines what a patient can and cannot do.

What imaging studies help determine stroke size and rehabilitation potential?

CT and MRI scans.

What begins once a stroke patient becomes medically stable?

Discharge planning.

What is a key goal in promoting independence for stroke patients?

To maximize independence with activities of daily living (ADLs).

What should be done to assist patients with unilateral neglect during meals?

Remind them to scan the neglected side and encourage turning their head toward the affected side.

What is the purpose of adaptive eating equipment?

To assist stroke patients in eating independently.

What is hand-over-hand feeding?

A technique where the occupational therapist guides the patient's hand from the plate to their mouth.

What is the purpose of swallow evaluations performed by a speech-language pathologist?

To evaluate swallowing ability and aspiration risk.

What is a common feeding method used immediately after a stroke?

NG tube feeding.

What are some swallowing precautions for stroke patients?

Thickened liquids, sitting upright, slight forward head tilt, and placing food on the unaffected side.

What is a J-tube used for?

To extend into the jejunum and may reduce aspiration risk.

What adaptive devices can assist with bathing and hygiene?

Electric toothbrushes, tub benches, shower chairs, and long-handled sponges.

What is the nursing diagnosis related to self-care deficits in bathing?

Self-Care Deficit: Bathing/Hygiene.

What adaptive equipment can assist with dressing?

Long-handled reachers, Velcro clothing, elastic shoelaces, and dressing sticks.

What is the recommended order for dressing a stroke patient?

Dress the affected side first and undress the unaffected side first.

What should be done to manage urinary elimination after a stroke?

Remove indwelling catheters as soon as possible and consider intermittent catheterization.

What are some methods to prevent constipation in stroke patients?

Increased fluids, stool softeners, and bulk laxatives.

What is a common sign of fecal impaction?

Diarrhea may indicate stool leaking around the impaction.

What role does physical therapy play in stroke rehabilitation?

Ambulation, bracing, mobility training, and strengthening.

What are some mobility equipment options for stroke patients?

Mechanical lifts, walking slings, parallel bars, and transfer belts.

What is the importance of maintaining hand positioning in stroke patients?

To prevent severe hand contractures and moisture accumulation.

What complications can arise in the shoulder and hip after a stroke?

Shoulder subluxation and dislocation may occur.

What is a potential consequence of a dislocated arm?

May require sling or wheelchair arm support.

What is the purpose of de-rotation boots?

They are used to assist with lateral hip rotation that interferes with walking.

What are trochanter rolls used for?

They help in managing lateral hip rotation to improve walking stability.

What causes foot drop?

A plantar-flexed foot that leads to tripping and interferes with ambulation.

What should be monitored in stroke patients taking antihypertensives?

Blood pressure and symptoms of dizziness when raising them slowly.

What are some methods for DVT prevention?

TED hose, SCDs, foot pumps, heparin, and enoxaparin.

How should you approach a patient with homonymous hemianopsia?

Approach from the unaffected side and point out objects on the affected side.

What should be taught to patients with homonymous hemianopsia before discharge?

To scan their environment and encourage turning their head toward the affected side.

What safety risks should be considered for patients with homonymous hemianopsia?

Door frames, curbs, stairs, and obstacles, especially with right-brain strokes due to spatial perception deficits.

What are the general principles for communication rehabilitation?

Follow the SLP plan, allow adequate response time, and use simple one-step commands.

What are some alternative communication methods for patients?

Thumbs-up/thumbs-down responses, communication boards, and electronic speaking devices.

What is the primary cause of peptic ulcers?

H. pylori infection and NSAID use.

What is a characteristic pain pattern for duodenal ulcers?

Burning epigastric pain that commonly awakens the patient at night.

What is a chronic complication of gastric ulcers?

Pyloric scarring leading to gastric outlet obstruction syndrome.

What are the common findings in gastric ulcers?

Epigastric pain after meals, vomiting, and reduced nutritional intake.

What are stress ulcers and their characteristics?

Ulcers that develop rapidly during hospitalization, often leading to sudden GI bleeding.