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62 Cards in this Set
- Front
- Back
CVA is characterized by?
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A gradual or rapid, non- convulsive onset of neurologic deficits related directly or indirectly to a deficiency of the cerebral blood supply.
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CVA is the leading cause of?
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Long term disability
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What is the #1 risk factor for CVA?
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HTN
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What are some risk factors for CVA?
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- Age
- Cardiac disorders - Diabetes - Smoking - Alcohol - Blood lipid abnormalities - Obesity - Family history - Drug abuse - Birth control pill > 30 and smokes |
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What are the two types of CVA?
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- Ischemic injury: blockage of a vessel
- Hemorrhagic: rupture of a vessel |
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Transient Ischemic Attack (TIA) is?
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Episodes of reversible neurologic deficits that appear for moments, or hours then disappears
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S/S of TIA
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- Visual loss or blurring
- Motor weakness or numbing - Speech difficulties or slurring - Vertigo |
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What is the significance of a TIA?
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- Signals the existance of significant cerebrovascular disease
- Serves as a warning of potential danger |
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What are the two types of ischemic CVA?
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- Thrombosis
- Embolus |
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What is the difference between TIA and CVA?
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- TIA: Ischemia occurs without infarction
- CVA: Infarction and cell death occur |
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Thrombosis CVA is often due to?
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Atherosclerosis
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What are the charateristics of thrombosis CVA?
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- tends to develop while asleep or within one hour of rising
- step like progression of symptoms, "Stroke in Evolution" |
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What are possible clinical findings of thrombosis CVA?
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- Bruits in neck from blood going around obstructions
- other evidence of atherosclerotic disease (angina, PVD) |
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What are lacunar infarcts?
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Thrombotic CVA's affecting the smaller penetrating arteries. The affected areas slough off leaving a small cavity or lake in the brain tissue.
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Thombosis vs Embolism
The extent of damage is often less severe in which? |
Embolism
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What can alot of lacunar infarcts cause?
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Dementia
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True or False
Recovery is more rapid in an embolism CVA? |
True
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Embolism CVAs are associated with what? why?
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- Heart disease becuase clots or vegetations break off from heart and travel to cerebral circulation
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Characteristics of an Embolism CVA are?
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- Symptoms develop rapidly and are unrelated to activity
- No warning or may be preceded by headache |
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Possible clinical findings for Embolism CVAs are?
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- Bruit heard over the heart
- History of heart disease or thrombophlebitis |
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The two hemorrhagic types of CVAs are?
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- Intracerebral hemorrhage
- Subarachnoid hemorrhage |
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Hemorrhage CVAs usually have the most _____ effects and _____ recovery.
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Residual
Slow |
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What type of CVA is the most common cause of death?
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Hemorrhage
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Intracerebral hemorrhage is?
Where does it bleed? |
- Rupture of an artheriosclerotic vessel in the presence of hypertension
- Bleeding into brain tissue itself |
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Intracerebral hemorrhage is usually seen in what population?
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Older
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Subarachnoid hemorrhage is?
Where does it bleed? |
- Rupture of a cerebral aneurysm or arterio-venous malformation
- Bleeding into the subarachnoid space. |
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Subarachnoid hemorrhage is usually seen in what population?
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Younger
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Hemorrhage CVAs characteristics are?
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- Develops abruptly with a severe headache
- Occurs during active waking hours |
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What kind of CVA would most likely be found in a person stating, " worst of headache of my life"?
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Subarachnoid hemorrhage
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Clinical findings of hemorrhage CVAs include?
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- Nuchal rigidity (stiff neck)
- Bloody cerebrospinal fluid - May see vomiting, photophobia, seizures |
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Cerebral edema is a result of?peaks at?
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- Result of injury to brain tissue which sets inflammatory process in motion
- Peaks at about 2-4 days after injury |
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What are the goals of treatment for cerebral edema?
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- reduce edema
- prevent penumbra from infarcting |
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What are factors that determine the nature and extent of neurological defects with a CVA?
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- Size of area involved
- Location of brain injury - Adequacy of collateral circulation - How quickly the person gets to the ER |
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What are the nursing management for acute care of a patient with CVA?
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- Patent airway (HOB up)
- Adequate O2 - Keep neck in good alignment to improve venous drainage - F & E balance - Frequent V/S, neuro checks - Seizure precautions - Monitor ICP - Baseline assessment |
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What is the purpose of diagnostic testing in CVA?
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- Distinguishes between vascular pathology and generalized conditions
- Determines location of injury and type of CVA |
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What test is done first and can tell if CVA is ischemic or hemorrhage?
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CT scan
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What are the general medical management measure done for CVA?
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- Hyperosmotic diuretics
- Anticonvulsants - Antipyretics - Measurement of ICP - Measurement of partial pressure of brain tissue oxygen (PbO2) |
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What are the medical management measures specific to ischemia CVA?
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- Platelet aggregation inhibitors
- Anticoagulants - Thrombolytic therapy (tPA) - Control BP - Oxygen - Prevent progression of occulsive cerebrovascular disease |
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Where do you want to keep the BP for an ischemic CVA?
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Normal to high normal level
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True or False
For a patient to recieve thrombolytic therapy they have to reach a certain critieria. |
True
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What is the dosage of Aspirin that would indicate it is being used as a platelet aggregation inhibitor?
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81 or 325 mg/ day
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What are medical management measure specific to hemorrhagic CVA?
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- Antihypertensive drugs
- Calcium channel blockers (for vasospasms) - Decrease activity level - Avoid straining |
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What functions does the frontal lobe have?
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- motor function of opposite sode of body
- intellectual activites - mature judegement - social inhibition - motor speech center |
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What functions does the parietal lobe have?
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- body image
- sensory impulses from other side of body |
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What functions does the temporal lobe have?
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- hearing
- taste - smell - short term memory - sensory speech area |
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What functions does the occipital lobe have?
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- visual stimuli
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What part of the brain controls vital functions?
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Hypothalamus
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What part of the brain controls rhythmic breathing?
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Pons
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What is dysarthria?
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Disturbance in the muscular control of speech, resulting in poor articulation.
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What is aphasia?
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Lost or diminshed ability to use or understand language
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What is expressive aphasia?
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Lost or diminished ability to use speech or written word (Broca's area)
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If a patient is having expressive aphasia what lobe has been damaged?
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Frontal
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What is receptive aphasia?
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Lost or diminished ability to decode or understand auditory and/ or written words (Wernicke's area)
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If a patient is having receptive aphasia what lobe has been damaged?
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Usually left temporal lobe but can also be right
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What is diplopia?
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Double vision
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What is homonymous hemianopsia?
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Defective vision or loss of vision in one half of each visual field
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What is agnosia?
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Inability to recognize sensory stimuli by sound, touch, sight, or taste.
- Does not know what an object is but knows how to use it |
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What is apraxia?
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Inability to perform skilled and purposeful movements on command
- Knows what the object is and how it is use but can not use it correctly |
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What is seen in a left sided injury with emotional lability?
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- Depressed
- Apathetic - Cautious |
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What is seen in a right sided injury with emotional lability?
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- Cheerful
- Euphoric - Impulsive |
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What are manifestations of right brain damage from a stroke?
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- Paralyzed left side
- Left sided neglect - Spatial perceptual deficits - Tends to deny or minimize problems - Rapid performance - Short attention span - Impulsive (could be a safety problem) - Impaired judgement - Impaired time concepts |
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What are manifestations of left brain damage from a stroke?
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- Paralyzed right side
- Impaired speech/ language aphasias - Impaired R/L discrimination - Slow performance, cautious - Aware of deficits, depression, anxiety - Impaired comprehension related to language, math |