Learning Guide Online
Module 9: Neurosensory Disorders: Stroke
Marnie Quick, RN, MSN, CNRN
Utilizing the Lewis textbook, the notes, other required references and your critical
thinking to answer the following:
1.
Why is the term ‘Brain Attack” used for a stroke?
2.
State the risk factors for stroke, which are modifiable? What is the single most
modifiable risk?
3.
Utilizing Lewis 1451 Fig. 56-13 and 1504 Fig 58-1, identify the blood supply in
the brain:
a. Internal carotid arteries
b. Vertebral and basilar arteries
c. Cerebral arteries- anterior, middle, and posterior
d. Communicating arteries- anterior and posterior
e. Circle of Willis- what is the purpose of the Circle of Willis?
4.
Lack of blood supply to the brain causes what series of events to occur? What
effect does collateral circulation have?
5.
Describe the terms and their symptoms:
a. TIA
b. RIND
c. CVA
6.
Explain the basic differences between ischemic and hemorrhagic strokes. Which
is usually comatose? Which has a poorer prognosis?
7.
Fill in the following regarding ischemic and hemorrhagic strokes:
Type of stroke
Ischemic:
Thrombotic
Ischemic:
Embolic
Hemorrhagic:
Intracranial
Hemorrhage (ICH)
Hemorrhagic:
Pathophysiology
Medical Treatment
Subarachnoid
Hemorrhage (SAH)
8.
What diagnostic tests are utilized for an individual experiencing a stroke?
9.
Cardiac rhythm disorders, especially atrial fibrillation can lead to what type of
stroke?
10.
Which type of stroke is more common?
11.
What is the time limit for tPA? Why must hemorrhage be ruled out first?
12.
How are cerebral aneurysms graded? Which is worse?
13.
Describe the major complications of cerebral aneurysms.
a. Rebleed
b. Vasospasms
c. Hydrocephalus
14.
Describe treatment utilized for vasospasms post cerebral aneurysm clipping.
15.
Why is Aminacproic acid (Amicar) used with cerebral aneurysms and what are
the complications of using?
16.
What are ‘aneurysms precautions’?
17.
Why do headache, nuchal rigidity and photophobia occur with subarachnoid
bleeds?
18.
How does an A-V malformation interfere with cerebral perfusion?
19.
What does a gamma knife do to an A-V malformation?
20.
What surgical procedures are done for aneurysm and A-V malformation?
21.
Severity of loss of brain function varies according to what?
22.
Differentiate the symptoms seen in a stroke that affects the:
Right internal carotid
(Right brain damage or
right stroke/CVA)
Left internal carotid
(Left brain damage or
left stroke/CVA)
23.
What would you expect to see different in a stroke affecting the middle cerebral
arteries from a stroke that affects the internal carotids?
24. Fill out the following regarding typical stroke deficits.
Stroke Deficit
Describe the
How assess?
deficit
Motor Function:
1. Mobility/movement
2. Facial motor
3. Eye movements
4. Swallow/gag reflex
5. Self-care
Sensory function:
1. Superficial sensation
2. Proprioception
3. Vision (homonymous
hemianopia)
Communication ability:
1. Expressive aphasia
2. Receptive aphasia
3. Mixed aphasia
4. Dysarthia
Affect and Intellectual
Function:
1. LOC changes
2. Emotional liability
3. Loss of self control
4. Intellectual changes
Spatial-Perceptual:
1. Neglect Syndrome
2. Agnosia
Nursing care of
pt with deficit
3. Apraxia
Elimination:
1. Bowel
2. Bladder
25.
What determines which of the above deficits will occur in an individual with a
stroke?
26.
What is ‘pronator drift’, how and why do you test for it in the stroke patient?
27.
Draw a picture of the brain and visual fields showing homonymous hemianopia.
Which side can the patient not be able to see toward- paralyzed or
nonparalyzed side? What should you teach client to do to compensate for
deficit?
28.
Describe the National Institute of Health (NIH) scale used for stroke patients?
29.
What is the time frame that a thrombolic agent can be given to a stroke
patient? What does it do? What diagnostic test is utilized prior to giving? Why?
30.
What are the warning signs of a stroke? Your neighbor asks you if all the
American Heart Association ‘Warning signs’ (Lewis 1515 Table 58-7) need to be
occurring to indicate a stroke, your response would be---
31.
In dressing your stroke patient, which arm is placed in the sleeve first, the
paralyzed (affected) or nonparalyzed? Why might an arm sling be needed?
32.
What are the guidelines for communicating with a stroke patient with aphasia?
33.
Should you discourage your stroke patient, who is beginning to regain his
speech, from swearing? Explain why/why not?
34.
Why would a stroke patient be ordered a ‘swallow eval’? What do you do if the
speech therapist says your patient has’ failed’ the test?
35.
What are the safety concerns when caring for the stroke patient?
36.
Explain the major problems and nursing care for an individual with a stroke in
both the acute and rehabilitative phases.