Exam 2

• A Stroke or Cerebral Vascular Injury is caused by a reduced cerebral blood flow that leads to brain cell death and functional disability.
• Ischemic stroke results from an occluded artery that deprives blood flow to a certain part of the brain.
• Hemorrhagic stroke is caused by a ruptured artery, resulting in bleeding in or around the brain.
• Transient Ischemic Attack (TIA) is a temporary blockage of blood supply to the brain.
• Ischemic strokes result from an "ischemic cascade" of pathologic metabolic events.
• Transient ischemic attack (TIA) has the same pathophysiologic mechanism as an ischemic cascade but symptoms are transient and do not cause permanent damage.
• Modifiable risk factors for a stroke are obesity, hypertension, diet, lack of exercise, sleep apnea, diabetes, smoking, dyslipidemia and atrial fibrillation.
• Non-modifiable risk factors for a stroke are family history, age, and race.
• If a patient has had a stroke one of the risk factors must be modified to prevent a recurrence.
• High sodium intake is associated with an increased risk of stroke. (think hypertension, a risk factor for stroke).
• Symptoms of a stroke are numbness or weakness in the face arm, or leg especially on one side of the body, confusion or change in mental state, expressive or receptive aphasia, slurred speech (dysarthria), difficulty swallowing (dysphasia), sudden and severe headache, Visual disturbances (Homonymous hemianopsia), difficulty walking, dizziness, loss of balance or coordination.
• NIHSS is a scale that measures 0-42 the severity of the deficits due to a stroke. It tests the level of consciousness, visual field motor, language, and body spatial neglect.
• The NIHSS score can predict which patients will have good outcomes from thrombolytic therapy. A score less than 15 indicates a better outcome.
• The Glasgow Coma Scale is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. A high number = good level of consciousness and a low number = poor level of consciousness.
• Ischemic strokes are managed with thrombolysis with recombinant tissue plasminogen activator (rTPA), which is given within 4.5 hours of symptom onset. This medication required ICU management and neuro checks every 15 minutes - 1 hour.
• If it has been passed the 4.5 hours of symptom onset, treatment is anticoagulants and antiplatelets.
• Hemorrhagic stroke requires treatment to reduce intracranial pressure, possibly including surgery. NO ANTICOAGULANTS and seizure precautions are necessary.
• When a patient has had a suspected stroke it is crucial to do a STAT CT scan.
• A patient who has suffered a stroke should be NPO especially if they have signs of dysphagia (difficulty swallowing) or dysarthria (slurred speech).
• If a patient is being monitored on rTPA you should be mindful of acute changes in mental status, hypertensive urgency (>180/120), bleeding, and intracranial bleeding.
• MRI requires a screening checklist, and need to determine allergies to contrast and/or presence of metal in the patient's body that are not MRI compatible.
• Right-sided Stroke symptoms are left-sided paresis/paralysis, left-sided sensory deficit, impulsive behavior, and visual deficits (hemianopsia).
• Left-sided stroke symptoms are right-sided paresis/paralysis, right-sided sensory deficit, dysphagia, dysarthria, visual difficulties (hemianoplasia), and cautious behavior.
• If a patient is experiencing dysphagia they must eat thick liquids and pureed foods, aspiration precautions, 1:1 supervision, medication must be crushed.
• Contusion: A soft tissue injury produced by blunt force
• Strain: An injury to a muscultendinous unit caused by overuse, overstretching, or excessive stress
• Sprain: An injury to the ligaments and supporting muscle fibers that surround the joint.
• Treatments for contusions, sprains, or strains include applying cold, compression bandages, elevating the affected leg, and immobilizing the leg.
• Pay close attention to the neurovascular status of the injured limb. (The 6 Ps)
• The 6 Ps include Pressure, Pain, Pallor, Poikilothermia, Paresthesia Paralysis, and Pulselessness. The above findings indicate compartment syndrome and should be reported immediately.
• Compartment Syndrome is when pressure builds up inside an enclosed space causing damage to tissues.
• To assess pain you use the pain scale/
• To assess poikilothermia, you use the back of your hand and note any warmth.
• Paresthesias are abnormal sensations such as numbness, prickling, or tingling.
• Pulselessness means there is no pulse present at the distal extremity.
• Paralysis is loss of muscle function due to injury to nerves that control muscles.
• Pallor is a pale color of the skin due to lack of oxygen
• An open fracture also called a compound fracture, is a fracture in which there is an open wound or break in the skin near the site of the broken bone. The bone is protruding and can be seen through the skin.
• A closed fracture is a break in the continuity of the bone that is not protruding through the skin and cannot be seen outside the body.
• Manifestations of a fracture are pain, loss of function, deformity, shortening, crepitus, swelling, and discoloration.