CEREBROVASCULA
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
- Its 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.
Fatty deposits can cause two types of
obstruction:
1. CEREBRAL THROMBOSIS
2. CEREBRAL EMBOLISM
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
ASSESSMEN
T
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 clients level of
consciousness
Institute seizure precautions.
Maintain a non-stimulating environment.
Assist with communication skills if the clients 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
MaintainCONSIDERATIONS
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!
THATS it!
THANK YOU FOR
LISTENING!
