CEREBROVASCULA

R
CEREBROVASCULAR ACCIDENT/STROKE
• Also called “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.
DIRECT CAUSES:
• CEREBRAL THROMBOSIS
– a blood 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
TYPES:
• ISCHEMIC STROKE
– Occurs when a 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.
TYPES:
• HEMORRHAGIC STROKE
– Results from a 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.
– 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.

POINTS TO CONSIDER
 STAGES OF CVA
Transient Ischemic 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
 Signs and Symptoms
In embolism
• 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
 Signs and Symptoms
Sudden Onset 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
TIME IS CRTITICAL!
– The longer 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
• RISK FACTORS:
• Being over age 55
• Being an African-American
• 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
• RISK FACTORS:

– LIFESTYLE STROKE RISK

• 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.
Common STROKE symptoms…
Weakness or paralysis
Numbness, tingling, decreased sensation
Vision changes
Speech problems
Swallowing difficulties or drooling
Loss of memory
Vertigo (spinning sensation)
Loss of balance and coordination
Personality changes
Mood changes (depression, apathy)
Drowsiness, lethargy, or loss of consciousness
Uncontrollable eye movements or eyelid drooping
 MAJOR EFFECT of STROKE
– 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
 MAJOR EFFECT of STROKE
• 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
 DIAGNOSIS
• Physical Examination (neurological
examination & medical history)
• Imaging (CT scan and MRI)
ISCHEMIC STROKE
HEMORRHAGIC STROKE
TRANSIENT ISCHEMIC ATTACK (TIA)
 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
 ASSESSMENT
– Monitor for signs and 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
 ASSESSMENT
– Swallowing ability/aspiration risk
– Level of consciousness
– Neurological status
– Motor, sensory and cognitive functions
– Glasgow Coma Scale score
– Ineffective tissue perfusion (cerebral)
– Disturbed sensory perception
– Impaired physical mobility
– Risk for injury
– Self-care deficit
– Impaired verbal communication
– Impaired swallowing

NURSING DIAGNOSIS
 NURSING CONSIDERATIONS
Maintain patent airway
Monitor for changes in the client’s level of
consciousness
Institute seizure precautions.
Maintain a non-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.
 NURSING CONSIDERATIONS
– Maintain skin integrity.
– 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 position changes,
mobilization)
 THROMBOLYTIC THERAPY
–Anticoagulants: Sodium heparin, warfarin
(Coumadin)
–Antiplatelets: Ticlopidine (Ticlid), clopidogrel
(Plavix)
–Antiepileptic medications: Phenytoin
(Dilantin), gabapentin (Neurontin)
 STROKE PREVENTION
– Get screened for 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!
 THAT’S it!
THANK YOU FOR
LISTENING! 
POISONING
 Poison
• Any substance that is harmful to
the body
• When ingested, inhaled, injected,
or absorbed through the skin
• Does not include adverse
reactions to medications taken
correctly
 Classification
• Intentional poisoning: A person
taking or giving a substance with the
intention of causing harm, e.g.
Suicide and Assault
• Unintentional poisoning: If the person
taking or giving a substance did not
mean to cause harm, e.g. For
recreational such as in an “Overdose”
or Accidentally taken by a toddler
• “Undetermined”: When the distinction
between intentional and unintentional
is unclear
U.S. Occurrence
Pesticide Poisoning in the
Philippines
<10%
71.3%
Insecticides

10.2%
Herbicides

10.9%
Not Known
79.5%
 *Top Poisons
(Those 19 Years and Below)
1. Methamphetamine
2. Multiple drugs
3. Mixed pesticide
4. Ethanol
5. Isoniazid
6. Marijuana
7. Salicylic Acid (Salicylates)
8. Malathion (Organophosphates)
9. Paracetamol (Acetaminophen)
10.Caustic Substances
 Data Needed
• Phone Number
• Address
• Evaluation of Severity
• Weight and Age
• Route of Exposure
• Time of Exposure
• Past Medical History
• Type of Exposure
• Amount of Exposure
• Informant’s Relationship to Victim
 Types of Exposure
• Acute: Exposure < 24 hours
 Single: a single or continuous exposure
(e.g. carbon monoxide)
 Repeated: multiple interrupted exposures
where there may be accumulation (e.g.
aspirin overdose)
• Chronic: > 24 hours or long-term exposure,
for weeks or months (e.g. lead poisoning)
• Acute “on chronic”: Acute exposure against a
background of chronic exposure to the same
agent (e.g. organophosphorus pesticide
exposure on a chronically exposed child)
• “Hit and run”: Acute exposure leading to
delayed effects once the toxicant is gone
(e.g. thalidomide exposure during gestation
leading to phocomelia)
 Acute Poisoning
• Pharmaceuticals: sedatives, analgesics,
contraceptives, cardiovascular drugs
• Household products: bleaches,
detergents, solvents, kerosene
• Cosmetics: perfumes, shampoo, nail
products
• Substances of abuse: alcohol, tobacco,
illicit drugs
• Pesticides: insecticides, rodenticides,
herbicides
• Plants and mushrooms: berries, seeds,
leaves
• Seafood Poisoning: paralytic shellfish
poisoning, fish poisoning
• Venomous bites and stings: snake,
scorpions, bees, jellyfishes, spiders
 Chronic Poisoning
• Metals
Lead
Mercury
• Pesticides in food or fields
Organophosphates
Carbamates
Warfarins
Organochlorines: Persistent
Organic Pollutants (POPs), has
potential developmental
neurobehavioral and endocrine
effects, e. g. DDT
 Prevention
1. Primary: to prevent occurrence
a) Discard old prescriptions
b) Have only few tablets per bottle at a
time
c) Use child-proof packaging
d) Keep medicines in high locked cabinets
e) Keep potentially dangerous substances
properly labeled and stored in places not
easily accessible to toddlers
2. Secondary: to lessen injury after exposure
a) Create poison control centers
 Is your home poison proof?

Remove the risk. Put poisons away. Straight away.

• Discard old
prescriptions •Keep potentially dangerous
• Have only few substances properly labeled
tablets per
bottle at a time
•Keep medicines in high •Use child-proof packaging
locked cabinets
•Keep potentially dangerous substances
properly labeled and stored in places not
easily accessible to toddlers
Exposure to Lead in Children
 Initial Medical Care
• Initial attention should be on life
support, primarily on
cardiorespiratory care
• Shock, arrhythmias and convulsions
must be dealt with urgently and as
in the case of any critically ill
• When the patient’s condition is
stable, the specific treatment or
antidote can be given
 Preventing Absorption
• Emesis: Syrup of Ipecac, 15-30 ml followed by water
results in vomiting in > 95% less than 5 yr
 Contraindications:
1) When there is significant risk of aspiration
2) A comatose or convulsing patient
3) Ingestion of strong acids or bases
 About 8-30% recovery of ingested substance
• Lavage: Warm saline or warm tap water
 Complication is esophageal perforation
 Used to remove fragments of tablets & capsules
• Charcoal: Activated charcoal most effective and safest
to prevent absorption given as water slurry, 15-30 gm
in a child and 30-100 gm in adolescent; repeat 20 gm q
2 hr until charcoal in stool
• Cathartic: Sorbitol max 1 gm/kg, MgSO4 max 250
mg/kg, sodium citrate max 250 mg/kg, or phosphosoda
max 250 mg/kg
 Used to hasten emptying of GIT
Requiring Simultaneous Antagonist
and Life Support
• Carbon Monoxide
 Oxygen 100% ASAP to reduce
concentration of CO in the blood
 Those with high toxin levels may need
hyperbaric oxygen therapy
• Opiates
 Naloxone minimum of 0.4 mg to any
patient irregardless of age or weight
 If unresponsive, up to 2.0 mg given IV
rapidly to larger children and adolescents
and may be repeated as needed
 Newborns to 6-month-old infants should
be given a dose of 10-100 g/kg
• Cyanide
 Oxygen immediately then antidote
 Antidote kit:
1) Amyl nitrite inhalers broken under nose
for 30 sec/min while sodium nitrite
solution being readied
2) Sodium nitrite 3% solution 0.33 ml/kg
(10 mg/kg) to maximum 10 ml/patient
with normal hemoglobin
3) Sodium thiosulfate 25% solution given
next at 1.65 ml/kg to maximum of whole
ampule
 Hydroxocobalamine-thiosulfate mixture in
doses of 4-10 g, an alternative
 These antidotes produce methemoglobin
that help remove cyanide by competition
for the cytochrome
• Substances Causing Methemoglobinemia
(Aniline Dyes, Nitrobenzene, Azo
Compounds & Nitrites)
Unresponsive to oxygen
If there is at least 20%
methemoglobinemia, patient’s drop of
blood will be relatively brown when
dried on filter paper
Methylene blue at 0.1-0.2 ml/kg (1-2
mg/kg)/dose of 1% solution is
therapeutic
Exchange transfusion may be needed
if two doses failed
• Cholinergic Agents (Organophosphates &
Carbamates)
 Manifestations are salivation, lacrimation,
urination, defecation and fasciculations
 Atropine 0.05 mg/kg to maximum initial
dose of 2-5 mg to be given while patient
decontaminated with soap and water
 If unresponsive, repeated doses of
atropine may be necessary
 Pralidoxime, a cholinesterase
regenerator, may be given when
cholinesterase level falls to 25% of
normal or lower, at a dose of 25-50
mg/kg over 30 min IV every 8-12 hr in
young children to maximum of 1 g/dose
in older children
Everything is poison,
there is poison
in everything.
Only the dose makes a
thing not a poison.
--Paracelsus, Father of Toxicology
HUMAN AGEING
INTRODUCTION
Ageing (British English) or aging (American English) is
the accumulation of changes in a person over time.
Ageing in humans refers to a multidimensional process
of physical, psychological, and social change. Some
dimensions of ageing grow and expand over
time, while others decline.
AIMS AND OBJECTIVES
Ageing is the single greatest challenge our society is
facing today. Recent breakthroughs have
demonstrated that it is possible to combine a long life
with the absence of age-related disease.
 THEORIES OF AGEING
 Biological Theories
 Wear and tear theory
 Cellular theory
 Auto-immune theory
 Genetic mutation theory
 Free radical theory
 Psychosocial Theories
 Disengagement theory
 Activity theory
 Continuity theory
 Social exchange and support
 Gero-transcendence
 Socio-emotional selectivity
SUCESSFUL AGEING
The concept of successful ageing can be traced back to
the 1950s, and was popularised in the 1980s.
Successful ageing consists of three components.
1.Low probability of disease or disability.
2.High cognitive and physical function capacity.
3.Active engagement with life.
NORMAL CHANGES DURING AGEING
PREMATURE AGEING DISEASE: PROGERIA
Progeria (Hutchinson-Gilford
Progeria
Syndrome, HGPS, Progeria
syndrome) is an extremely rare
genetic disease wherein
symptoms resembling aspects of
aging are manifested at a very
early age.
The disorder has a very
low incident rate,
occurring
in an estimated 1 per
8 million live births. It is
a genetic condition
that occurs as a new
mutation, and is rarely
 MOLECULAR ASPECTS OF AGEING
Telomere shortening during human ageing:

Changes in mitochondria with ageing

CAUSES OF AGEING
CONTROL OF AGEING
ANTI-OXIDANTS
ENDOGENOUS
EXOGENOUS
COSMETIC UV-PROTECTION
CONCLUSION
 From these above discussions we can conclude
that:
 We all change physically, as we grow older.
 Steps can be taken to help prevent illness and
injury, and which help maximize the older
person's independence, if problems do occur.
 There is no need for most people to fear getting
older.
 ACKNOWLEDGEMENT
We would like to thank our professors for their innovative
suggestions and their help with the given project.
 REFERENCES
• http://en.wikipedia.org/wiki/Ageing
• “An introduction to biological aging theory”- Theodore C.
Goldsmith
• “Telomere shortening and ageing”-H. Jiang, Z. Ju, K.L.
Rudolph