NSB231 Lecture Notes - Lecture 3: Transient Ischemic Attack, Calcium Channel Blocker, Stroke

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Week 3 Stroke, Hypertension & PVD Lecture
Hypertension
National health survey
140/90 mmHg defined
Primary and secondary
Implication- chronic stress on the heart and vessels
RASS important regulating blood volume
Secondary Hypertension
Elevated BP with a specific cause
Interventions (NHRA 2016)
Calcium channel blockers
ACE
Diuretics
Manage associated conditions
Lifestyle modifications
Monitor BP
Stroke (Stroke Foundation)
Occurs when there is ischemia or haemorrhage into the brain that results in death of brain
cells
Loss of function varies according to location and extent of brain tissue
Physical, cognitive, emotional impact of patient.
Stroke Prevention
Healthy diet
Weight control
Exercise
No smoking
Limit alcohol
Routine health assessment
Transient Ischemic Attack (TIA)
Mini stroke happens when blood supply to brain is interrupted for a short time
Last less than an hour
1/3 will progress to ischemic stroke
Signs and symptoms
-weakens, numbness
-difficult speaking
-dizziness, loss of balance
-loss of visions, blurred vision
Types of Strokes
1. Ischemic (blockage)
i. Thrombotic
-injury to blood vessel wall and formation of a clot
-progressive, asymptomatic
ii. Embolic
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-moving clot that lodges into an artery
-sudden symptoms and onset
1. Haemorrhagic (rupture)
-sudden onset
-high mortality
-change intercranial pressure
FAST
F- one side of the face drooping
A- arm or leg weakness
S- speech difficulty
T- time of occurrence (IMPORTANT)
Diagnostic Studies
Confirm that it is a stroke
Identify the likely cause of the stroke
Noncontract CT scan and MRI
-indicate the size and location of lesion
-differentiate between ischemic and haemorrhagic stroke
Other studies
-CTA or MRA
-cerebral angiography
-Transcranial Doppler ultrasonography
Surgical Therapy for TIA/Stroke
Carotid endarterectomy
Stenting
Transluminal angioplasty
Extracranial-intracranial bypass
Postoperative care is important
Neurovascular assessment
BP management
Assessment of stent occlusion
Minimize complications at insertion site
Acute Care for Ischemic Stroke
Goals
-preserving life
Preventing further brain damage
Reducing disability
The time of onset of symptoms is critical information
Beings with managing
1. Airway
2. Breathing
3. Circulation
Baseline neurologic assessment
-monitor closely for ICP, neuro deficit
Elevated BP is common
Carefully work to control fluid and electrolyte balance
Mange ICP
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Document Summary

Week 3 stroke, hypertension & pvd lecture. Hypertension: national health survey, 140/90 mmhg defined, primary and secondary, rass important regulating blood volume. Implication- chronic stress on the heart and vessels. Secondary hypertension: elevated bp with a specific cause. Interventions (nhra 2016: calcium channel blockers, ace, diuretics, manage associated conditions, monitor bp. Stroke (stroke foundation: occurs when there is ischemia or haemorrhage into the brain that results in death of brain cells. Loss of function varies according to location and extent of brain tissue: physical, cognitive, emotional impact of patient. Stroke prevention: healthy diet, weight control, exercise, no smoking. Last less than an hour: mini stroke happens when blood supply to brain is interrupted for a short time, 1/3 will progress to ischemic stroke. Injury to blood vessel wall and formation of a clot. Diagnostic studies: confirm that it is a stroke, noncontract ct scan and mri. Differentiate between ischemic and haemorrhagic stroke: other studies.

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