Week 4: Stroke

which are lifestyle modifications related to exercise that are benefits for patients with high blood pressure

select all that apply

• reduces water body, decreasing circulation blood volume

• decreases blood glucose and cholesterol levels, increasing sense of well-being

• reduce stress and lowers blood presure

• improves cardiac efficiency by increasing cardiac output and decreasing peripheral vascular resistance

the cause of primary (essential) hypertension

• kidney disease

• drugs

• pregancy

• unknown

Answer explanation

Primary HTN accounts for 90% to 95% of all cases of HTN

- related to:

-increase sodium intake

-being overweight

- diabetes mellitus

- excessive alcohol use

what are significant risk factors for primary (essential) hypertension?

select all that apply

• Dyslipidemia, family history of obesity, HTN

• Tobacco use

• Obesity

• Atherosclerosis

Answer explanation

risk factors are:

- high cholesterol

-DM

- men over 55 & wonen over 65

-family hx (heart disease, obesity, HTN)

- sedentary lifestyle

- obesity

- stress (high pressure job, financial worries, family problems, increase secretion of catecholamine)

- stimulants ( may contribute or aggravate HTN; caffeine [tea, coffee, chocolate], nicotine, & amphetamine)

- drugs

- nicotine ( smoking or chewing tobacco product)

- overstimulation

- caffeine (tea, coffee, chocolate)

- Nicotine is consumed by smoking or chewing tobacco products

what causes secondary HTN

• kidney disease

• arterial conditions

• drugs such as dexamethasone

• occasionally pregnancy

Answer explanation

caused by underlying risk factors such as:

- kidney disease

- arterial conditions

- some drugs: flurocortisone, methylprednisodone, prednisone, prednisolone

(corticosteroids)

- pregnancy

what are some lifestyle modifications for HTN

• weight restriction

• smoking cessation

• sodium and alcohol restriction

• relaxation technique

Answer explanation

Isotonic exercise such as walking, bicycling, and swimming help to reduce weight and promotes relaxation.

-relaxation therapy, biofeedback, behavior modification technique may also be used to reduce stress and lower Bp.

A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?

• ECG

• non contrast head CT

• chest x-ray

• 12 lead ECG

A client is admitted with a stroke (brain attack). Which tool does the nurse use to facilitate a focused neurologic assessment of the client?

• NIHSS

• Intracranial pressure monitor

• Mini-Mental Exam

• Glasgow Coma Scale

Mr. Howell, a 65-year-old male presents to the Emergency Department at 0800 with left sided weakness and slurred speech.  His wife states the symptoms started when he was eating breakfast at 0730.  A non-contrast CT of the head was completed which showed no hemorrhagic stroke.  The provider orders tPA (alteplase) administration. Mr. Howell weighs 198 pounds.

Administration Instructions:

The recommended treatment dose of Activase is 0.9 mg/kg (not to exceed 90 mg total treatment dose) infused over 60 minutes.

10% of the total treatment dose should be administered as an initial bolus over 1 minute

The remaining treatment dose should be infused intravenously over 60 minutes

What is the amount of the initial bolus?

A patient presents to the Emergency Department with facial droop and slurred speech.  What is the priority factor when considering fibrinolytic therapy?

• history of stroke

• time of onset of symptoms

• age 80 or above

• recent surgery

Signs of possible stroke include (Select all that apply)

• Face Drooping

• Arm Weakness

• Speech Difficulty

• Shuffling gait