Ischemic stroke

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Ischemic stroke by Mind Map: Ischemic stroke

1. Types

1.1. Large artery thrombotic strokes

1.1.1. Caused by

1.1.1.1. atherosclerotic plaques

1.1.2. S/S

1.1.2.1. ischemia and infarction

1.2. small penetrating artery thrombotic strokes (lacunar strokes)

1.3. cardiogenic embolic strokes

1.3.1. associated with

1.3.1.1. cardiac dysrhythmias

1.3.1.2. atrial fibrillation

1.3.1.3. valvular heart disease

1.3.1.4. thrombi in left ventricle

1.4. cryptogenic strokes

1.4.1. have no known cause

1.5. other

2. Definition

2.1. a type of stroke that occurs when the flow of blood to the brain is blocked

3. Risk factors

3.1. modifiable

3.1.1. HTN

3.1.2. DM

3.1.3. Hyperlipidemia

3.1.4. Obesity

3.1.5. Smoking

3.1.6. Poor diet

3.1.7. Lack of physical activity

3.2. non-modifiable

3.2.1. Age 👴(older than 55)

3.2.2. Male

3.2.3. Family Hx

3.2.4. African American

3.2.5. Latino

4. Commons signs and symptoms

4.1. Depends

4.1.1. Location

4.1.2. Size

4.1.3. collateral blood flow

4.2. General S/S

4.2.1. Numbness/Weakness

4.2.2. Changes in mental status (confusion)

4.2.3. Trouble speaking

4.2.4. Visual disturbances

4.2.5. Dizziness, loss of balance/coordination

4.2.6. Sudden severe headache

5. Diagnostics

5.1. CT scan

5.1.1. within 25 min to determine type of stroke

5.2. MRI

5.3. MR angiography of brain & neck vessels

5.4. Rule out / Assess for other complications

5.4.1. 12-lead EKG

5.4.2. carotid ultrasound

5.4.3. CT angiography

5.5. Transcranial Doppler flow

5.6. transthoracic/transesophageal echocardiography

6. Expected treatments

6.1. Thrombolytic Therapy

6.1.1. Dissolves clot

6.1.2. Goal is administer to within 60min of admission to ED

6.1.3. Side effects

6.1.3.1. Bleeding

6.2. Endovascular Therapy

6.2.1. Criteria

6.2.1.1. 18yrs or older

6.2.1.2. NIHSS score greater than 6

6.2.1.3. ASPECT score greater than 6

6.2.1.4. receving IV t-Pa within 4.5 hrs of onset

6.2.1.5. Causative occlusion

6.2.1.6. Prestroke status of no deficits

6.3. Anticoagulant administration

6.3.1. Heparin

6.3.2. LMWH

6.3.3. Warfarin

6.3.3.1. INR between 2-3

6.3.4. Newer antigcoagulants

6.3.4.1. dabigatran

6.3.4.2. apixban

6.3.4.3. edoxaban

6.3.4.4. rivaroxban

6.3.5. IF contraindicated

6.3.5.1. Aspirin

7. Common nursing diagnosis

7.1. Impaired physical mobility

7.2. Acute pain

7.3. Risk for impaired skin integrity

7.4. Risk for Impaired Swallowing

7.5. Risk for Injury

7.6. Impaired Verbal Communication

7.7. Disturbed Sensory Perception

8. Interprofessional team members

8.1. neurologist

8.2. neuroradiologist

8.3. radiology department

8.4. laboratory technicians

8.5. pharmacy

8.6. Provider

8.7. speech pathologist

9. ischemic cascade

9.1. Happens when blood flow is ⬇️ 25 mL/ 100g blood per min

9.2. Anaerobic respiration occurs

9.3. ⬆️lactic acid

9.4. ⬇️ pH

9.5. ⬇️ATP

10. Prevention

10.1. Diet

10.1.1. Fruits & veggies

10.1.2. DASH Diet

10.1.3. low-fat dairy products

10.1.4. low animal protein

10.1.5. Mediterranean diet

10.2. Weight control / regular exercise

10.3. Annual Check for at high risk pt.

10.4. Smoking cessation programs

11. Nursing Interventions

11.1. Improving mobility & preventing joint

11.1.1. Proper body alingment

11.1.2. Splint affected extremity at night

11.1.3. distal joints higer than proxmial jonits

11.1.3.1. Preventing edema and fibrosis of joints

11.1.4. Range of motion

11.1.4.1. 4-5x/day

11.1.5. Bed exercises

11.1.6. Frequnet postion changes

11.1.6.1. should be positioned in prone 15-30 mins a day

11.1.7. monitor for orthostatic hypotension as when pt. resumes activity

11.2. Enhancing self care

11.2.1. preform self-care activities on the unaffected side

11.2.1.1. BUT make sure pt. doesn't neglect affected side

11.2.2. if possible add a new skill every day

11.2.3. Clothing a size larger

11.2.4. Velcro clothing

11.2.5. Ensure environment is organized and clutter free

11.2.6. change in front of a large mirror

11.3. Assist pt. adjust to changes

11.3.1. place stimili on pt.'s unaffected side

11.3.1.1. Call bell light, clocks, TV. etc

11.3.2. teach pt. to turn towards stimuli

11.3.3. increase room lighting

11.3.4. encourage eyeglasses

11.4. Nutrition

11.4.1. Swallow assessment w/ speech therapy

11.4.2. smaller boluses of food

11.4.3. thick/ pureed diet

11.4.4. position up right

11.4.5. Teach pt. to "Tuck chin towards chest when swallowing"

11.5. Bowel & Bladder control

11.5.1. Intermittent cath

11.5.2. high fiber diet

11.5.3. fluid intake (2-3L/day)

11.5.4. establish schedule for toileting

11.6. Improving communication

11.6.1. Avoid complete pt.'s thought/sentences

11.6.2. communication board w/ pictures

11.6.3. speak slowly

11.6.4. alter the environment to make it communication friendly

11.6.5. collaborate with speech therapist

12. New vocab

12.1. Dysarthria

12.1.1. Weakness in the muscles used for speech

12.2. Aphasia

12.2.1. inability to understand/express language

12.2.1.1. Expressive

12.2.1.2. Receptive

12.2.1.3. Mixed?

12.2.1.4. Global

12.3. HEMI

12.3.1. -plegia

12.3.1.1. paralysis

12.3.2. --paresis

12.3.2.1. weakness

12.4. Homonymous hemianopsia

12.4.1. loss of half of vision