Health & Illness Exam 3

Stroke

when blood flow to part of the brain is interrupted

Ischemic Stroke

most common 80% of strokes, occurs when a blood vessel supplying the brain becomes blocked.

Hemorrhagic Stroke

about 20% of all strokes, occurs when a blood vessel ruptures and bleeding happens in the brain.

Thrombotic Stroke

a type of ischemic stroke, caused by a blood clot that forms inside the artery

Embolic Stroke

a type of ischemic stroke, caused by a clot that travels from another part of the body

Causes of hemorrhagic stroke

Ruptured aneurysm, AV malformation, severe hypertension, trauma, cocaine use

Transient Ischemic Attack (TIA)

a temporary stroke-like event caused by brief loss of blood flow to the brain.

5% risk of stroke within 48 hours and 10–20% risk within 90 days after …

Transient Ischemic Attack (TIA)

Risk Factors for Stroke:

Hypertension(leading causes), age and genetics, female, previous stroke or TIA, smoking, cocaine use, heavy alcohol intake, oral contraceptives, diabetes, A1C goal of < 7%, BG <120, CAD, atrial fibrillation, sickle cell disease, high cholesterol, poor diet, obesity, physical inactivity

The recommendation for lifestyle prevention of stroke:

exercise for 30 minutes daily

Stroke Signs and Symptoms

numbness or weakness, confusion, trouble speaking, trouble understanding speech, vision problems, difficulty walking, dizziness, loss of balance, severe sudden headache

ABCs of Heart Health (Stroke Prevention)

A – Aspirin when appropriate

B – Blood pressure control

C – Cholesterol management

S – Smoking cessation

Cincinnati Prehospital Stroke Scale

used by EMS to identify stroke. Signs: facial droop, arm drift, slurred speech.

Cincinnati Prehospital Stroke Scale Interpretation:

1 sign present → 72% chance of stroke, All 3 signs → 85% chance of stroke

Stroke Assessment in the Emergency Department

Neurological assessment, labs, ECG, imaging: CT, MRI

Why must a CT scan be done first?

To determine if the stroke ischemic or hemorrhagic. A CT has to be normal before tPA is given.

Stroke Treatment Timeline

CT scan → 25 minutes tPA given → within 60 minutes

Thrombolytic Therapy (tPA): Alteplase (tPA)

Breaks up the clot causing ischemic stroke.

Eligibility for Alteplase (tPA)

Stroke causing neurological deficit, symptoms started less than 4.5 hours ago, age ≥18

Who Cannot Receive tPA:

Recent head trauma, stroke within the last three months, evidence of bleeding, platelets < 100,000, BG < 50 BP > 185/110, hx of brain hemorrhage, recent surgery, recent heart attack, GI bleeding

Medications used to manage BP in Stroke:

Labetalol, Nicardipine, Hydralazine, Enalapril

True or False: After giving tPA, no anticoagulants or antiplatelets should be given for 24 hours

True

Increased Intracranial Pressure (ICP)

There is too much pressure in the brain, which can damage brain tissue. Stroke can cause swelling in the brain.

Causes of increased intracranial pressure

edema, hemorrhage, hematoma

The leading cause of death in stroke patients is

Increased Intracranial Pressure (ICP)

Signs of Increased ICP:

Restlessness, confusion, headache, nausea and vomiting, pupillary changes, photophobia, seizures, severe hypertension, widened pulse pressure, decreased HR/RR, cushing’s reflex

True or False: Cushing’s Reflex indicates brainstem herniation

True

The most important nursing intervention for ICP

Patient positioning

Right Brain Stroke

affects spatial awareness and visual perception

Right Brain Stroke Sx:

impulsive behavior, personality changes, poor awareness of deficits, disorientation

Left Brain Stroke

affects language, math, analytical thinking

Left Brain Stroke Sx:

Aphasia (language problems)

Expressive aphasia (Broca):

patient understands, but cannot speak clearly

Receptive aphasia (Wernicke):

patient speaks, but speech makes no sense

Mixed aphasia:

patient has difficulty understanding and speaking

Global aphasia:

patient has severe impairment of language

Hypotonia

Flaccid muscles and weak tone

Hypertonia

Spastic muscles and contractures

Neglect Syndrome

Common with right brain stroke, when patient ignores the left side of the body.

Homonymous hemianopsia

Loss of half the visual field in both eyes, patient must turn head side to side to see fully.

True or False: Always perform a swallow study before feeding a stroke patient. This prevents aspiration.

True

Psychosocial Assessment for Stroke

Emotional reaction, body image, ability to perform ADLs, financial concerns, occupation, family support

Stroke Prevention Procedures

Carotid endarterectomy, carotid artery stenting, AV malformation treatment: coils, balloons

Discharge Planning

Patients may leave the hospital after 2–3 days, depending on the condition. Disposition depends on NIHSS score: 0–5 → Home

Stroke recovery often requires:

Physical therapy, occupational therapy, speech therapy, and cognitive therapy

The goal for stroke recovery at rehabilitation centers

Maximize functional ability and independence.

Ischemic Stroke Medications

tPA (alteplase), Aspirin, Clopidogrel (Plavix), Labetalol, Lisinopril

Hemorrhagic Stroke Medications

Calcium channel blockers

Which finding indicates Cushing’s reflex?

Hypertension, bradycardia

What is the time window for tPA?

4.5 hours

TIA symptoms usually resolve within:

1 hour

Right brain stroke patients are often:

Impulsive

Left brain stroke patients are often:

Frustrated

Which stroke occurs during sleep?

Thrombotic

What is cellular regulation?

Everything a cell does to maintain homeostasis and respond to its environment.

What is mitosis?

Cell division → one cell becomes two identical cells.

What is hyperplasia?

Increase in the number of cells.

What is neoplasia?

Abnormal, uncontrolled new cell growth → tumor formation.

What is carcinogenesis (oncogenesis)?

The process of cancer formation.

What is a carcinogen?

Anything that causes cancer (smoking, radiation, chemicals).

Difference between benign and malignant?

Benign = not cancer; Malignant = cancer (can spread)

What is thrombocytopenia?

Low platelets → bleeding risk

What is neutropenia?

Low neutrophils → infection risk

What is a primary tumor?

Where the cancer starts

What is a metastatic tumor?

Cancer that has spread to another location

What is a solid tumor?

A mass (ex: breast, lung)

What are hematologic cancers?

Blood cancers → leukemia, lymphoma

What is grading?

How abnormal the cells look; high grade = more aggressive

What is staging?

How far cancer has spread

Which staging is most accurate?

Pathologic staging

Where do most cancers come from?

External factors (80%) Smoking, radiation, diet

Examples of cancer-causing lifestyle factors?

Processed meat, alcohol, smoking

What is primary prevention?

Prevent cancer before it starts

What is secondary prevention?

Early detection

What is tertiary prevention?

Focuses on managing disease after diagnosis

What are the CAUTION warning signs of cancer?

Change in bowel/bladder, a sore that won’t heal, unusual bleeding, thick lump, indigestion, obvious mole change, nagging cough

Which cells are most at risk for cancer?

Cells that divide rapidly: bone marrow, skin, GI tract, breast ducts, lung lining

What systems does cancer affect?

Immune, blood, GI, nervous, heart/lungs, and emotional health

What is bone marrow suppression?

↓ WBC → infection, ↓ RBC → anemia, ↓ platelets → bleeding

What is cachexia?

Severe weight loss and wasting

What is anorexia (in cancer)?

Loss of appetite

What is peripheral neuropathy?

Tingling, pain, nerve damage

Main cancer treatments?

surgery, radiation, chemotherapy, immunotherapy, targeted therapy, hormonal therapy

How does radiation work?

Kills cancer in a specific area

Common radiation side effects?

Fatigue, skin burns, taste changes

How does chemotherapy work?

Kills fast-growing cells (both cancer + normal)

Why does chemo cause side effects?

It also damages normal fast-dividing cells

Common chemo side effects?

Bone marrow suppression, nausea/vomiting, mucositis, hair loss, neuropathy, chemo brain

Fever in chemo patient means what?

EMERGENCY (infection)

What is nadir?

Lowest WBC point → highest infection risk

What is ANC?

Absolute neutrophil count → infection risk

When is ANC dangerous?

<500 = severe infection risk

Platelet levels for bleeding risk?

<50,000 → bleeding; <20,000 → spontaneous bleeding

What is leukemia?

Cancer of blood and bone marrow → affects WBCs

Main problem in leukemia?

Cells don’t mature → crowd out normal cells

What does leukemia cause?

Infection, anemia, bleeding

What is lymphoma?

Cancer of lymphatic system (lymph nodes, spleen)

Hodgkin’s lymphoma key feature?

Reed-Sternberg cells

What is multiple myeloma?

Cancer of plasma cells → weak bones, anemia, kidney issues

What is a bone marrow transplant?

Replacing damaged marrow with healthy stem cells