Clinical Quick Reference Monthly / CVA Quick Take
MULTIPLE CHOICE TOPIC REVIEW CVA/STROKE
According to the NIH, strokes (also known as cerebrovascular accidents) can be broadly classified as ischemic or hemorrhagic.
Acute strokes can result in a loss of circulation, nutrients, and oxygen to brain regions. This contributes to neuronal damage and subsequent neurological deficits.
Early treatment, rehab programs, and lifestyle changes can increase a patient’s chances of meaningful recovery.
tPA
tPA or “Tissue plasminogen activator” (tPA) is one of the essential components of the dissolution of blood clots. Examples include: alteplase, reteplase, and tenecteplase.
Its primary function includes catalyzing the conversion of plasminogen to plasmin, the primary enzyme involved in dissolving blood clots.
Indications for the use of tPA include ischemic stroke (most common) in patients presenting to treating facility within 3 hours (4.5 hours in certain, eligible patients) after symptom onset, MI if no delay of more than 1 to 2 hours before percutaneous transluminal coronary angioplasty, pulmonary embolism in massive pulmonary embolisms, causing severe instability due to high pressure on the heart, and thrombolysis (e.g., deep vein thrombosis). [1]
Ginny
Ginny Lee is a 61 yr old female with PMH of hypertension, T2D (type 2 diabetes) and is admitted with a new diagnosis of stroke.
1.) Routine oral hygiene is an important component of Ginny’s care. Which of the following nursing measures is not appropriate when providing oral hygiene?
A. Use a soft bristled toothbrush to clean Ginny’s mouth and teeth.
B. Keep a portable suction machine at the bedside.
C. Use a tongue blade to open Ginny’s mouth due to the effects of her stroke.
D. None of the above.
2.) Ginny’s husband asks you why his wife did not receive tPA after her hemorrhagic stroke. What should you speak with him about?
A. tPA is not given to patients with a history of diabetes.
B. Refer him to discuss the matter with the primary care provider.
C. tPA dissolves clots and could cause more bleeding in Ginny’s head.
D. Inform Ginny’s husband that she did not arrive in time for the medication to be used.
3.) Five days after her stroke, Ginny is to begin a trial of oral fluids and feedings. Before feeding Ginny, what should you do first?
A. Order a soft diet for Ginny.
B. Check Ginny’s gag reflex.
C. Check to see if Ginny can swallow small amounts of crushed ice prior to starting.
D. Raise the head of the bed to a comfortable position for Ginny to eat.
4.)A PCA is assisting Ginny, who has right-sided paralysis. Which action indicates the need for further instruction?
A. Placing call light within reach after care.
B. Providing PROM to the right extremities during a bed bath.
C. Elevating the foot of the bed to reduce edema.
D. Pulling Ginny up under the right shoulder when transferring her to a chair.
Answers are posted at the end of this article.
[1] Tissue Plasminogen Activator. Talha N. Jilani; Abdul H. Siddiqui. (February 27, 2022.)
https://www.ncbi.nlm.nih.gov/books/NBK507917/
Answers:
1-c; 2-c; 3-b; 4-d
Clinical Quick Reference Monthly is a study resource and is not intended to be used as medical advice. Always consult and follow the advice of your institution and/or medical provider.