Stroke Certified Registered Nurse ACTUAL
QUESTIONS AND CORRECT ANSWERS
CBF/MAP/ICP Relationships - Correct answers✔CBF:
• Compromise occurs when MAP < 50 mm Hg.
• Compromise occurs even if ICP is normal.
• Brain ischemia is likely when MAP < 40 mm Hg.
• CP = MAP ([systolic - diastolic]/3 + diastolic) - ICP
• With increased ICP, consider keeping MAP > 90 mm Hg.
• Goal MAPs, ICPs, and CPPs should be set for each patient by the neurology and/or
neurosurgical team.
Neuroplasticity + Application for Stroke team: - Correct answers✔Neuroplasticity:
• L.e., brain plasticity; plasticity = remoldability
• Alterations in the brain in response to changes in thinking, learning, injury, or
- environment
• Changes can happen to both brain anatomy (physical) and physiology (functionality)
• Occurs on a continuum from cellular changes (learning) to cortical remapping (injury)
• Application for stroke treatment:
• Recovery of motor and sensory function can occur when healthy brain tissue adjacent to
damaged tissue is stimulated to take over the functions of the damaged tissue(s).
• Supports cost/benefit ratios for various therapy modalities (e.g., ST, OT, PT) as part of post-
stroke care
• Some studies show that progesterone injections (may increase neuroplasticity capabilities) post-
brain injury reduce morbidity and mortality.
,CSF Draining - Correct answers✔Via pressure line from inside cerebral ventricle (via
ventriculostomy)
• Raising the burette above the zero reference level may create expected pressures within the
brain.
• A 0-cm pressure level is used for maximal pressure unloading, and the pressure treated from the
CSF would be O.
• If a patient has higher CS pressures at a 0-cm pressure level, suspect complications such as
cerebral edema.
• A 10-cm pressure level above 0 will usually result in normal pressures (i.e., no CSF drainage
will occur).
• A 20-cm pressure level above the 0 reference level will usually result in an ICP of 20 mm Hg.
This pressure can have a "tamponade" effect on unsecured ruptured subarachnoid aneurysm
(may be useful when weaning from EVD).
Stroke: Reperfusion Syndrome - Correct answers✔Causes
Restoration of CBF from mechanical revascularization or from thrombolysis of a clot causing a
stroke; risk factors include HTN, dysautoregulation, and cytokine release.
S/S
Triad: severe ipsilateral headache, contralateral neuro deficits, seizure(s)
Dx tests
Clinical d; tests for risk: preop transcranial Doppler, acetazolamide SPECT scan
Nsg dx
Risk for ineffective cerebral tissue perfusion, risk for injury
Nsg tx
Bedrest, maintain airway, IV access, seizure precautions
Med tx
Prevention is key; studies are currently in progress for future "stroke cocktail" preparations:
control BP: consider doxycycline or other neuroprotective agents.
, Watch for
Cerebral hemorrhage
Diet
NO while acute
Contraindicated
HTN (Cleveland Clinic had study showing BP kept < 120/80 had best outcomes.)
Other
L.e., hyperperfusion syndrome
Stroke: General Care - Correct answers✔Goal: physiologic optimization
Interventions:
• Hypoxia prevention (supplement 02 if SpO2 < 94%)
• Hypertension management (stricter with tPA administration)
• Glucose control (controversial; treat if glucose > 185 mg/dL)
• Use NS or LR IV fluids instead of dextrose-containing IV fluids
• Temperature management/euthermia (treat fever > 99.5 F/37.5 C)
• Nutritional support
• Prevent complications:
• Associated stroke injuries (e.g., DVT, UTI, skin breakdown)
• Aspiration/aspiration pneumonia (perform dysphagia screening)
• DVT
o UTI
Stroke Chain of Survival - Correct answers✔Eight D's:
• Detection: identifying stroke onset
QUESTIONS AND CORRECT ANSWERS
CBF/MAP/ICP Relationships - Correct answers✔CBF:
• Compromise occurs when MAP < 50 mm Hg.
• Compromise occurs even if ICP is normal.
• Brain ischemia is likely when MAP < 40 mm Hg.
• CP = MAP ([systolic - diastolic]/3 + diastolic) - ICP
• With increased ICP, consider keeping MAP > 90 mm Hg.
• Goal MAPs, ICPs, and CPPs should be set for each patient by the neurology and/or
neurosurgical team.
Neuroplasticity + Application for Stroke team: - Correct answers✔Neuroplasticity:
• L.e., brain plasticity; plasticity = remoldability
• Alterations in the brain in response to changes in thinking, learning, injury, or
- environment
• Changes can happen to both brain anatomy (physical) and physiology (functionality)
• Occurs on a continuum from cellular changes (learning) to cortical remapping (injury)
• Application for stroke treatment:
• Recovery of motor and sensory function can occur when healthy brain tissue adjacent to
damaged tissue is stimulated to take over the functions of the damaged tissue(s).
• Supports cost/benefit ratios for various therapy modalities (e.g., ST, OT, PT) as part of post-
stroke care
• Some studies show that progesterone injections (may increase neuroplasticity capabilities) post-
brain injury reduce morbidity and mortality.
,CSF Draining - Correct answers✔Via pressure line from inside cerebral ventricle (via
ventriculostomy)
• Raising the burette above the zero reference level may create expected pressures within the
brain.
• A 0-cm pressure level is used for maximal pressure unloading, and the pressure treated from the
CSF would be O.
• If a patient has higher CS pressures at a 0-cm pressure level, suspect complications such as
cerebral edema.
• A 10-cm pressure level above 0 will usually result in normal pressures (i.e., no CSF drainage
will occur).
• A 20-cm pressure level above the 0 reference level will usually result in an ICP of 20 mm Hg.
This pressure can have a "tamponade" effect on unsecured ruptured subarachnoid aneurysm
(may be useful when weaning from EVD).
Stroke: Reperfusion Syndrome - Correct answers✔Causes
Restoration of CBF from mechanical revascularization or from thrombolysis of a clot causing a
stroke; risk factors include HTN, dysautoregulation, and cytokine release.
S/S
Triad: severe ipsilateral headache, contralateral neuro deficits, seizure(s)
Dx tests
Clinical d; tests for risk: preop transcranial Doppler, acetazolamide SPECT scan
Nsg dx
Risk for ineffective cerebral tissue perfusion, risk for injury
Nsg tx
Bedrest, maintain airway, IV access, seizure precautions
Med tx
Prevention is key; studies are currently in progress for future "stroke cocktail" preparations:
control BP: consider doxycycline or other neuroprotective agents.
, Watch for
Cerebral hemorrhage
Diet
NO while acute
Contraindicated
HTN (Cleveland Clinic had study showing BP kept < 120/80 had best outcomes.)
Other
L.e., hyperperfusion syndrome
Stroke: General Care - Correct answers✔Goal: physiologic optimization
Interventions:
• Hypoxia prevention (supplement 02 if SpO2 < 94%)
• Hypertension management (stricter with tPA administration)
• Glucose control (controversial; treat if glucose > 185 mg/dL)
• Use NS or LR IV fluids instead of dextrose-containing IV fluids
• Temperature management/euthermia (treat fever > 99.5 F/37.5 C)
• Nutritional support
• Prevent complications:
• Associated stroke injuries (e.g., DVT, UTI, skin breakdown)
• Aspiration/aspiration pneumonia (perform dysphagia screening)
• DVT
o UTI
Stroke Chain of Survival - Correct answers✔Eight D's:
• Detection: identifying stroke onset
