Professional Documents
Culture Documents
• Expressive aphasia: Struggles to find the right words, and may put
incorrect strings of words together (“word salad”)
• Double vision
• Visual disturbances like blurry vision, hallucinations, or even
blindness
• Don’t do the action because they can mimic you, but you want to
see if they understand what you are asking them.
** Injury to the brain’s right hemisphere can cause left neglect. The
condition is also known as left side neglect. “Left neglect” is a term
describing a deficit in awareness that occurs following an injury to the
brain’s right side. Because of the injury, the brain has difficulty paying
attention to items falling into the left hemisphere.**
• FACE: Ask the person to smile, is one side of the face drooping?
• Arms: Ask the person to raise their arms. Is one arm weak?
• Speech: Ask the person to speck. Is their speech slurred?
(Dysarthria)
• Time: call 911 right away at the first sign of a stroke. (brain cells
need perfusion so that they don’t die) (can help decide what type
of stroke: sudden onset is always ischemic stroke)
STROKE PREVENTION:
Non-modifiable:
• Age (older than 55 years)
• African American
• Males (estrogen has protective factors)
• Previous stroke
• Cardiovascular disease (general) like A-fib and carotid stenosis
• Diabetes (unmanaged diabetes)
• Sleep apnea (fluctuation in 02)
• Smoking, drugs(cocaine, meth, injected heroin) and alcohol
• Periodontal disease
Preventive Treatment and Secondary Prevention:-
• Health promotion measures, healthy lifestyle, smoking cessation,
exercise, healthy diet and weight
• Antiplatelet therapy
• Stains: put on if you had a stroke regardless since they are high
risk
• Antihypertensive medication (*hypertension #1 risk factor so are
they complaint with their med)
Ischemic Stroke
Disorder etiology:
• Thrombotic: A clot
• Embolic: A clot that has moved
Clinical Manifestations:-
• When pt doesn’t qualify for t-PA then they surgical remove the
clot.
• They go through femoral to brain to remove clot (not available at
all hospitals)
Acute Phase:
Mnemonic to remember:-
• Ambulate and assist out of bed as soon as possible with PT/OT (get
BP before getting up because orthostatic hypotension is very
common with them)
Hemorrhagic Stroke:
Causes:-
• #1 risk is hypertension: rupture of small vessels primarily related
to hypertension.
CEREBRAL VASOSPASM:-
**Secondary injury that subarachnoid hemorrhages are at risk for. Peak
is usually around days 7-10 post bleed. (monitor for 21. Days for
vasospasm)**
CPP=MAP-ICP
• reference range for CPP is 70 to 100 mmHg (goal>60)
• A CPP less than 50 mmHg results in permanent neurologic damage
EARLY:-
• Decrease in LOC
LATE:
• Cushing triad: bradycardia, widening pulse pressure, irregular
respiration
• Vital sign: decrease or erratic HR & RR, widening pulse pressure and
worsening respiratory pattern, including Cheyne breathing and
respiratory arrest.
Assessment of pt. with increased ICP:-
Brain Herniations:-
• Decerebrate (worse): pinch them and arm and legs go out (leads to
brain death)
• Decorticate: spinal reflex (abnormal posturing where the pt. is
stiff with bent arms in towards the body, clenched fists and legs
out straight.)
• Decorticate -> Decerebrate-> BRAIN DEATH