SCRN study guide: hyperacute care
ABCD score - correct answer-A: age B: blood C: clinical features D: Duration of TIA
symptoms
ABCD2 score - correct answer-A simple assessment called the ABCD2 score (ie, ABCD
squared, for Age, Blood pressure, Clinical features, Duration of symptoms, and Diabetes)
may be used to identify patients at high risk of ischemic stroke in the first seven days after
TIA. The ABCD2 score is tallied as follows:
●Age (≥60 years = 1 point)
●Blood pressure elevation when first assessed after TIA (systolic ≥140 mmHg or diastolic
≥90 mmHg = 1 point)
●Clinical features (unilateral weakness = 2 points; isolated speech disturbance = 1 point;
other = 0 points)
●Duration of TIA symptoms (≥60 minutes = 2 points; 10 to 59 minutes = 1 point; <10 minutes
= 0 points)
●Diabetes (present = 1 point)
Score 6 to 7: High two-day stroke risk
Score 4 to 5: Moderate two-day stroke risk
Score 0 to 3: Low two-day stroke risk
Anterior Circulation Stroke: Lacunar syndromes (Dysarthria-clumsy hand syndrome) -
correct answer-• Dysarthria
• Dysphagia
• Contralateral tongue and facial weakness and paresis
• Clumsiness of the contralateral arm and hand
Anterior Circulation Stroke: Lacunar syndromes (Homolateral ataxia and crural paresis) -
correct answer-• Paresis of the contralateral leg and side of the face
• Prominent ataxia of the contralateral leg and arm
Anterior Circulation Stroke: Lacunar syndromes (Isolated motor/sensory stroke) - correct
answer-• Paralysis and sensory loss of the contralateral leg, arm, and face
• No visual loss or cognitive impairment
Anterior Circulation Stroke: Lacunar syndromes (pure motor) - correct answer-• Contralateral
- Usually affects the face and upper and lower extremities equally
, • Also associated with dysarthria
• No sensory or visual loss
• No cognitive impairment
Anterior Circulation Stroke: Lacunar syndromes (pure sensory) - correct answer-•
Contralateral loss of all sensory modalities - Equally affects the face and upper and lower
extremities
• No motor signs, dysarthria, visual loss, or cognitive impairment
Anterior Circulation Stroke: Left hemisphere (ie, dominant) - correct answer-• Right
hemiparesis - Variable involvement of face and upper and lower extremity
• Right-sided sensory loss in a pattern similar to that of the motor deficit - Usually involves all
modalities, decreased stereognosis, and graphesthesia
• Right homonymous hemianopia
• Dysarthria
• Aphasia, fluent and nonfluent
• Alexia
• Agraphia
• Acalculia
• Apraxia
Anterior Circulation Stroke: Right hemisphere (ie, nondominant) - correct answer-• Left
hemiparesis - Same pattern as on right
• Left-sided sensory loss - Similar pattern that of the motor deficit
• Left homonymous hemianopia - Same pattern as on right
• Dysarthria
• Neglect of the left side of environment
• Anosognosia
• Asomatognosia
• Loss of prosody of speech
• Flat affect
Blood Glucose goals ischemic stroke - correct answer-It is important to check blood glucose
regularly after acute stroke to detect transient hyperglycemia, but more crucially to detect
persistent hyperglycemia, when the patient's blood glucose level remains high 48 hours after
stroke. Nurses should consider patients with persistent hyperglycemia to be at increased rise
of diabetes. Delayed hyperglycemia, which occurs a few days after an acute stroke, is also
associated with increased risk of diabetes.
Blood pressure goals ischemic stroke - correct answer-Special considerations apply to blood
pressure control in patients with acute ischemic stroke who are eligible for thrombolytic
therapy. Before lytic therapy is started, treatment is recommended so that systolic blood
pressure is ≤185 mmHg and diastolic blood pressure is ≤110 mmHg. The blood pressure
should be stabilized and maintained at or below 180/105 mmHg for at least 24 hours after
thrombolytic treatment.
For patients with ischemic stroke who are not treated with thrombolytic therapy, most
consensus guidelines recommend that blood pressure not be treated acutely unless the
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