Regulation of cerebral blood flow Atherosclerosis

Non-modifiable

Modifiable

Age Gender Ethnicity/Race Family history

HTN Heart disease Smoking Alcohol Obesity Sleep apnea Diabetes Lack of exercise Poor diet Drug abuse

Ischemic

Thrombotic Embolic

Hemorrhagic

Intracerebral Subarachnoid

Treatment

Must know time of onset

Treatment

tPa w/in 3-4.5 hours ABCs No seizure prophylaxis No heparin, but may give ASA O2, CO2 Keep BP slightly high Keep hydrated No fever

No anticoagulants or

platelet inhibitors Keep BP slightly high Seizure prophylaxis Surgical treatment Nimotop

Left versus right (see chart, pg 1465) Motor Communication Affect Intellect Spatial-Perceptual Elimination

CT is most important CT angiography MRI Transcranial doppler LP (may or may not) LICOX monitoring

Prevention Antiplatelet drugs for TIAs

ASA Plavix Warfarin

Surgery

Carotid endarterectomy Transluminal angioplasty Stenting EC-IC bypass

Respiratory

Neuro

Cardiovascular

Musculoskeletal

Integument

GI

Urinary

Nutrition

Communication

Sensory-Perceptual

Coping

PT mobility, ambulation, transfers, equipment OT ADLs, cognitive/perceptual eval and training ST speech, communication, cognition, eating

Musculoskeletal Nutrition Bowels Bladder

Sensory/Perceptual Affect Coping Sexual

Resources

1. A patient with right-sided paresthesias and hemiparesis is hospitalized and diagnosed with a thrombotic stroke. Over the next 72 hours, the nurse plans care with the knowledge that the patient 1. is ready for aggressive rehabilitation. 2. will show gradual improvement of the initial neurologic deficits. 3. may show signs of deteriorating neurologic function as cerebral edema increases. 4. should not be turned or exercised to prevent extension of the thrombus and increased neurologic deficits.

2. While performing health screening at a health fair, the nurse identifies which of the following individuals at greatest risk for experiencing a stroke?

1. A 46-year-old white female with hypertension and oral contraceptive use for 10 years 2. A 58-year-old white male salesman who has a total cholesterol level of 285 mg/dL 3. A 42-year-old African American female with diabetes mellitus who has smoked for 30 years 4. A 62-year-old African American male with hypertension who is 35 pounds overweight

3. A patient with a stroke has dysphagia. Before allowing the patient to eat, which of the following actions should the nurse take first?

1. 2. 3. 4.

Check the patients gag reflex. Request a soft diet with no liquids. Place the patient in high-Fowlers position. Test the patients ability to swallow with a small amount of water.