Adult Health 1 - Stroke

TIA

Caused by ischemia

Symptoms typically occur less than an hour

No brain or tissue damage results

Typically a precursor to a stroke

Tinnitus/vertigo

Blurred vision, diplopia, ptosis

Dysarthria and dysphagia

Ataxia, numbness/weakness of limbs

Seizure symptoms

B: Balance

E: Eyes

F: Facial drooping

A: Arm weakness

S: Slurred speech

T: Time

Infarction occurs (cell/tissue death)

Ischemic Stroke

Inadequate blood flow to the brain from partial or complete occlusion of an artery

More common than hemorrhagic

2 Types of Ischemic Strokes

Thrombotic

Embolic

Thrombotic

Most common form of ischemic stroke

Narrowed blood vessel or formation of a blood clot from injury

Develops slowly

Often preceded by TIAs

May see improvements before recurrence

Often occurs during sleep at night

More common in men

Oldest median age

Embolic stroke

Occlusion of cerebral artery from a clot that travels from another part of body

Sudden onset

TIA uncommon

Most likely to occur during activity

Often a single event

More common in men

Hemorrhagic Stoke

Bleeding into the brain tissue itself or into the subarachnoid space or ventricles causing a severe sudden headache

2 Kinds of Hemorrhagic Strokes

Intracerebral

Subarachnoid

Intracerebral

More common in women

Subarachnoid

More common in women

Youngest median age

Risk factors for stroke

HTN & CVD (#1)

Diabetic

A fib (increases stoke chance by 25%, and 5x more likely than someone else)

Smoking

Obesity

Alcohol use

Poor diet

Age (chances double at 55)

History of TIA's

Sleep apnea

Ethnicity (blacks are 50% more likely than caucasians)

Gender (more common in males, but more females die from strokes than males)

Lack of exercise

Right Sided Brain Damage s/s

Paralyzed Left side: hemiplegia

Left sided neglect

Spatial-perceptual deficits

Tends to deny or minimize problems

Rapid performance

Short attention span

Impulsive, safety problems

Impaired judgment

Impaired time concepts

Left sided brain damage s/s

Paralyzed right side: hemiplegia

Impaired speech/language

Impaired right/left discrimination

Slow performance, cautious

Aware of deficits: depression, anxiety

Impaired comprehension related to language and math

Broca's-nonfluent Aphasia

• Damage to frontal lobe of brain

• Often speak in short phrases that make sense but take great effort

• Often omit small words (e.g., is, and, the)

• May say, "Walk dog," meaning, "I will take the dog for a walk," or "Book 2 table," for "There are 2 books on the table"

• Typically understands others' speech

• Often aware of their difficulties and can become easily frustrated

Global-severe Nonfluent Aphasia

• Results from damage to extensive portions of language areas of brain

• Have severe communication difficulties

• May be limited in ability to speak or understand language

Wernicke's Fluent

Long & nonsensical

• Results from damage to extensive portions of language areas of brain

• Have severe communication difficulties

• May be limited in ability to speak or understand language

Other kinds of Aphasia

• Results from damage to different language areas in brain

• Some may have trouble repeating words and sentences, even though they can speak and understand the meaning of the word or sentence

• May have trouble naming objects, even though they know what the object is and what its use is

Communicating with a Patient with Aphasia

1. Decrease environmental stimuli that may be distracting and disrupting to communication efforts.

2. Treat the patient as an adult.

3. Speak with normal volume and tone.

4. Present a single thought or idea at a time.

5. Keep questions simple or ask questions that can be answered with "yes" or "no."

6. Let the person speak. Do not interrupt. Allow time for the person to complete thoughts.

7. Make use of gestures as an alternative form of communication. Encourage this by saying, "Show me . . . ." or "Point to what you want."

8. Do not pretend to understand the person if you do not. Calmly say you do not understand. Encourage the use of nonverbal communication or ask the person to write out what they want.

9. Give the patient time to process information and generate a response before repeating a question or statement.

10. Allow body contact (e.g., clasp of a hand, touching) as much as possible. Realize that touching may be the only way the patient can express feelings.

11. Organize the patient's day by preparing and following a schedule (the more familiar the routine, the easier it will be).

12. Do not push communication if the person is tired or upset. Aphasia worsens with fatigue and anxiety.

13. Teach communication techniques to caregivers and family members.

Immediate Nursing Interventions for Stroke Patients

Get all of this done within 10 minutes:

ABCs & VS

O2 is less than 90%

Figure out last well time - when did symptoms start

Obtain IV access, labs

BG, treat if indicated

Is patient taking anticoagulants?

Full neuro assessment

Call stroke code/stroke team

Order emergent CT without contrast or MRI

Door to Needle Time within 60 Minutes

Door to physician less than 10 minutes

Door to stroke team less than 15 minutes

Door to CT/MRI initiation less than 25 minutes

Door to CT/MRI interpretation less than 45 minutes

Door to needle less than 60 minutes

Stroke Team Assessment

Review's history

Establish time of symptom onset or last known normal

Perform thorough neurologic exam

NIH Stroke Scale Scoring

Less than 5: no stroke

5-15: moderate

15-20: moderate to severe

21-42: severe stroke

CT Contrast & TPA NC

Noncontrast CT & NO TPA: Hemorrhagic

Contrast CT & TPA: Ischemic

*Can use TPA if within 3-4.5 hours of stroke onset

Don't give TPA if patient is on anticoagulants

Don't give anticoagulants for the following 24-48 hours

Anticoagulants

Interfere with coagulation cascade preventing the formation of blood clots

Platelet Inhibitors

Prevent platelets from sticking together to form clots

BP and Stroke NC

Stroke chances decrease by 50% when SBP is maintained below 140