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- 2. CEREBROVASCULAR ACCIDENT/ STROKE • Alsocalled “brain attack”, cerebral infarction, cerebral hemorrhage, ischemic stroke or stroke • A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.
- 3. DIRECT CAUSES: • – • – • – CEREBRAL THROMBOSIS ablood clot or plaque blocks an artery that supplies a vital brain center CEREBRAL HEMORRHAGE/ANEURYSM an artery in the brain bursts, weakens the aneurysm wall; severe rise in BP causing hemorrhage and ischemia CEREBRAL EMBOLISM a blood clot breaks off from a thrombus elsewhere in the body, lodges in a blood vessel in the brain and shuts off blood supply to that part of the brain
- 4. TYPES: • – – - - - ISCHEMIC STROKE Occurs whena clot or a mass clogs a blood vessel, cutting off the blood flow to brain cells. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis. Almost 85% of strokes are ischemic ATHEROSCLEROSIS - “hardening of the arteries” “athero” – gruel or paste “sclerosis” – hardness It’s the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.
- 5. TYPES: • – – HEMORRHAGIC STROKE Results froma weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. About 15% of all strokes but responsible for 30% of stroke deaths 2 TYPES SUBARACHNOID HEMORRHAGE (SAH) occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull INTRACEREBRAL HEMORRHAGE (ICH) Occurs when a blood vessel bleeds into the tissue deep within the brain.
- 6. POINTS TO CONSIDER –2,000,000 brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death. – Recognizing symptoms and acting fast to get medical attention can save life and limit disabilities.
- 7. STAGES OF CVA • • • • • TransientIschemic Attack sudden and short-lived attack Is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. What is the difference between stroke and TIA? There's no way to tell if symptoms of a stroke will lead to a TIA or a major stroke. It's important to call 9-1-1 immediately for any stroke symptoms. Reversible ischemic neurologic deficit (RIND) similar to TIA, but symptoms can last up to a week Stroke in evolution (SIE) Gradual worsening of symptoms of brain ischemia Completed stroke (CS) – symptoms of stroke stable over a period and rehab can begin
- 8. Signs and Symptoms • • • • • • • • • • Inembolism Usually occurs without warning Client often with history of cardiovascular disease In thrombosis Dizzy spells or sudden memory loss No pain, and client may ignore symptoms In cerebral hemorrhage May have warning like dizziness and ringing in the ears (tinnitus) Violent headache, with nausea and vomiting Sudden Onset CVA Usually most severe Loss of consciousness Face becomes red Breathing is noisy and strained
- 9. Signs and Symptoms • • • • • • • SuddenOnset CVA Usually most severe Loss of consciousness Face becomes red Breathing is noisy and strained Pulse is slow but full and bounding Elevated BP May be in a deep coma
- 10. TIME IS CRTITICAL! – – – • • Thelonger the time period that the person remains unresponsive, the less likely it is that the person will recover. The first few days after onset is critical. The responsive person may: Show signs of memory loss or inconsistent behavior May be easily fatigued, lose bowel and bladder control, or have poor balance
- 11. • • • • – • • • • • RISK FACTORS: Being overage 55 Having diabetes Having a family history of stroke MEDICAL STROKE RISK Previous stroke Previous episode of transient ischemic attack (TIA) or mini- stroke High cholesterol High blood pressure Heart disease
- 12. • – • • • • RISK FACTORS: LIFESTYLE STROKERISK Smoking Being overweight Drinking too much alcohol You can control lifestyle risks by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.
- 13. Common STROKE symptoms… Weaknessor paralysis Numbness, tingling, decreased sensation Vision changes Speech problems Swallowing difficulties or drooling Loss of memory Vertigo Loss of balance and coordination Personality changes Mood changes (depression, apathy) Drowsiness, lethargy, or loss of consciousness Uncontrollable eye movements or eyelid drooping
- 14. MAJOR EFFECT ofSTROKE – • • • • HEMIPLEGIA – most common result of CVA Paralysis of one side of the body May affect other functions, such as hearing, general sensation and circulation The degree of impairment depends on the part of the brain affected Stages: – Flaccid – numbness and weakness of affected side – Spastic – muscles contracted and tense, movement hard – Recovery – therapy and rehab methods successful
- 15. MAJOR EFFECT ofSTROKE • • • • • – – – Aphasia and Dysphasia Brain Damage – extent of brain damage determines chances of recovery Hemianopsia – blindness in half of the visual field of one or both eyes Pain – usually very little; injection of local anesthetic provides temporary relief Autonomic Disturbances Such as perspiration or “goose flesh” above the level of paralysis May have dilated pupils, high or low BP or headache Treated with atropine-like drugs
- 16. DIAGNOSIS • • Physical Examination (neurological examination& medical history) Imaging (CT scan and MRI)
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- 21. ACT F.A.S.T • • • • F –FACE Ask the person to smile. Does one side of the face droop? A – ARMS Ask the person to raise both arms. Does one arm drift downward? S – SPEECH Ask the person to repeat a simple sentence. Does the speech sound slurred or strange? T – TIME Call 911 Immediately
- 22. ASSESSMENT – – – – – Monitor for signsand symptoms Symptoms will vary based on the area of the brain that is not adequately supplied with oxygenated blood The left cerebral hemisphere is responsible for language, mathematic skills and analytic thinking The right cerebral hemisphere is responsible for visual and spatial awareness and proprioception Assess/Monitor Airway patency
- 23. ASSESSMENT – – – – – Swallowing ability/aspiration risk Levelof consciousness Neurological status Motor, sensory and cognitive functions Glasgow Coma Scale score
- 24. – – – – – – – Ineffective tissue perfusion (cerebral) Disturbedsensory perception Impaired physical mobility Risk for injury Self-care deficit Impaired verbal communication Impaired swallowing NURSING DIAGNOSIS
- 25. NURSING CONSIDERATIONS • • • • • Maintain patentairway Monitor for changes in the client’s level of consciousness Institute seizure precautions. Maintain anon-stimulating environment. Assist with communication skills if the client’s speech is impaired. Assist with safe feeding. Assess swallowing reflexes. Thicken liquid to avoid aspiration. Eat in an upright position and swallow with the head and neck flexed slightly forward. Place food in the back of the mouth on the unaffected side. Suction on standby.
- 26. NURSING CONSIDERATIONS – – – – – – Maintain skinintegrity. Encourage PROM every 2 hr to the affected extremities and AROM every 2 hr to the unaffected extremities. Elevate the affected extremities to promote venous return and to reduce swelling. Maintain a safe environment to reduce the risks of falls. Scanning technique (turning head from side to side) when eating and ambulating to compensate for hemianopsia. Provide care to prevent deep-vein thrombosis (sequential compression stockings, frequent
- 27. THROMBOLYTIC THERAPY –Anticoagulants: Sodiumheparin, warfarin (Coumadin) –Antiplatelets: Ticlopidine (Ticlid), clopidogrel (Plavix) –Antiepileptic medications: Phenytoin (Dilantin), gabapentin (Neurontin)
- 28. STROKE PREVENTION – – – – – – Get screenedfor high BP. Have your cholesterol level checked. LDL should be lower than 70 mg/dL. Follow a low-fat diet. Quit smoking! Exercise! Limit alcohol intake!
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