VASCULAR

DISORDERS
STROKE
BRAIN ATTACK
Cerebrovascular Accident (CVA)
⚫ Central Nervous System
⚫ Occurs when :
1. Vessel in the brain ruptures and bleeds
2. Blockage in the blood supply
⚫ Prevents blood & oxygen from reaching the brain
⚫ Within minutes cells & tissues could die and damage
the brain.
⚫ Damaged part of the brain could affect body function
and part
⚫ Cryptogenic strokes have no known cause
⚫ Brain damage, long-term disability, death
TYPES OF STROKE

Arteries Artery in the

supplying blood Blood flow to the
brain breaks
to the brain brain is blocked
open or leaks
narrow / is temporarily
blood
blocked Transient
Ischemic Hemorrhagic
Ischemic
Stroke Stroke
Attack
TYPES OF STROKE
⚫ Most common type
⚫ Brain’s blood vessels become
narrowed or blocked, causing
ischemia
⚫ Causes:
✔ Fatty deposits build up
Blood supply to ✔ Blood clots
the brain ✔ Other debris that lodges in the
narrow / is blood vessels
blocked ✔ COVID-19 infection
Ischemic
Stroke
TYPES OF STROKE

1. Thrombotic - Forms in one of the

arteries supplying blood to the
brain.
2. Embolic - Forms in another part of
the body and moves through the
Blood supply to bloodstream to the brain
the brain ✔ Atrial fibrillation - blood clots to
narrow / is develop in the heart.
blocked
Ischemic
Stroke
TYPES OF STROKE

⚫ Ministroke
⚫ Caused by blood clot / debris
⚫ Temporarily decreases blood supply
to the brain ( < 5 mins)
⚫ Warning sign of a future stroke
Blood flow to the ⚫ Doesn’t cause permanent damage.
brain is blocked ⚫ ⭡ Risk of having a full-blown stroke
temporarily ⚫ Medical emergency
Transient
Ischemic
Attack
TYPES OF STROKE
⚫ Blood from ruptured artery creates
excess pressure in the skull and
swells the brain
⚫ Caused by High blood pressure
⚫ Related Factors:
✔ Anticoagulants
✔ Aneurysms Artery in the
✔ Trauma brain breaks
✔ Cerebral amyloid angiopathy open or leaks
blood
✔ Ischemic stroke
Hemorrhagic
✔ Arteriovenous malformation
Stroke
TYPES OF STROKE

1. Intracerebral - tissues
surrounding the brain fill with blood
after an artery bursts

2. Subarachnoid - bleeding in the

subarachnoid space Artery in the
✔ Main symptom - severe brain breaks
headache, possibly following a open or leaks
blood
popping or snapping feeling.
Hemorrhagic
Stroke
Signs & Symptoms
 Signs & Symptoms
● Numbness or weakness of ● Ataxia
the face ● Dysarthria
● Change in mental status
● Dysphagia
● Trouble speaking or
understanding speech ● Paresthesia
● Visual disturbances ● Expressive aphasia
● Homonymous hemianopsia ● Receptive aphasia
● Loss of peripheral vision
● Global aphasia
● Hemiparesis
● Hemiplegia
Signs & Symptoms
● WOMEN: MEN
● nausea or vomiting ● drooping on one side of the
● hallucination face or an uneven smile
● pain ● slurred speech, difficulty
● general weakness speaking, and trouble
● shortness of breath or trouble understanding other speech
breathing ● arm weakness or muscle
● fainting or losing weakness on one side of the
consciousness body
● seizures
● confusion, disorientation, or
lack of responsiveness
● sudden behavioral changes,
especially increased agitation
2 MAIN CAUSES OF STROKE
A. Blocked Artery
(ischemic stroke)

-Most common type of stroke.

- Brain's blood vessels become
narrowed or blocked due to fatty
deposits
2 MAIN CAUSES OF STROKE
B. Burst blood vessels
(hemorrhagic stroke)
UNCONTROLLABLE
RISK FACTORS
❏ Age
❏ Family History
❏ Race
❏ Gender
❏ Prior Stroke, TIA or Heart
Attack
CONTROLLABLE RISK
FACTORS
❏ High Blood Pressure
❏ Smoking
❏ Diabetes
❏ Diet
❏ Physical Inactivity
❏ Obesity
❏ Sickle Cell Disease
(Sickle Cell Anemia)
OTHER RISK FACTORS
❏ Socioeconomic Factors
❏ Low income
❏ Inaccessibility to healthcare
facilities
❏ Alcohol Abuse
❏ Drug Abuse
❏ Sleep Habits
FACTORS RELATED TO
HEMORRHAGIC
❏
STROKE
Uncontrolled high blood pressure
❏ Overtreatment with anticoagulants
❏ Bulges at weak spots in your blood
vessel walls (aneurysms)
❏ Trauma
❏ Protein deposits in blood vessel walls
that lead to weakness in the vessel
wall (cerebral amyloid angiopathy)
❏ Ischemic stroke leading to hemorrhage
Diagnosis
❖ A physical exam
❖ Blood tests
❖ Computerized tomography (CT) scan
❖ Magnetic resonance imaging (MRI)
❖ Carotid ultrasound
❖ Cerebral angiogram
❖ Echocardiogram
❖ Positron Emission Tomography (PET) scan.
❖ Lumbar puncture
❖ Transcranial Doppler ultrasonography
❖ Electroencephalography (EEG)
❖ Skull x-ray
MANAGEME
NTS &
NURSING
INTERVENT
IONS
Medical Management Surgical
Management
⚫ Recombinant tissue
⚫ Carotid
plasminogen activator
⚫ Increased ICP endarterectomy
⚫ Endotracheal Tube ⚫ Hemicraniectomy
⚫ Hemodynamic
monitoring
⚫ Neurologic assessment
 Mobility and Preventing
Deformities
Positioning
● Prevent contractures
● Relieve pressure
● Maintain good body alignment
● Prevent compressive neuropathies
Prevent flexion and adduction
● Apply Splint at night (affected extremity)
● Place Pillow on axilla (affected shoulder)
Elevate affected arm
● Prevent edema and fibrosis
Position hands in slight supine
Change position every 2 hours
● Place patient in prone for 15-30 minutes several times a day
Exercise Program
Provide full range of motion
● Four or five times a day
● Maintains joint mobility
● Regain motor control
● Prevent contractures in paralyzed extremity
● Prevent further deterioration of neuromuscular system
● Enhance circulation
Observe signs of pulmonary embolus or excessive cardiac
workload
● Check for shortness of breath, chest pain, cyanosis, and
increased pulse rate
Supervise and support patient
● Plan short periods of exercise
 Preparing for Ambulation
Start an active rehabilitation
program
● When consciousness returns and
when bleeding is gone
● When indicated
Teach patient to maintain
balance
Begin walking when standing
balance is achieved
● Use parallel bars and wheelchair
● Keep period short and frequent
 Enhancing Self-care
Encourage personal hygiene
● Select suitable self-care activities
Set realistic goals
● Add a new task daily
Carry out self-care activities on unaffected
side
● Make sure patient does not neglect affected
side
Assist with dressing activities
● Keep environment uncluttered and
organized
Provide encouragement and emotional
support
● Prevent fatigue and discouragement
 Managing Sensory-Perceptual
Difficulties
Approach on the side where visual
perception is intact
● Place all visual stimuli on this side
Teach patient to turn and look in
the direction of the defective visual
field
Increase lighting in the room
Provide eyeglasses to improve
vision
Place extremities where patient can
see them
● For patient with hemianopsia of the
other side of the body
 Assisting with Nutrition
Observe for:
● Paroxysms of coughing
● Food dribbling out or pooling
on one side of the mouth
● Food retained for long periods
● Nasal regurgitation when
swallowing liquids
Have patient sit upright when
eating and drinking
 Assisting with Nutrition (cont.)
Assist in teaching alternate
swallowing techniques
● Advise patient to take smaller boluses
of food
● Provide food easier to swallow
Prepare for GI feedings through a
tube, if indicated
● Elevate the head of bed during
feedings
● Check tube position before feeding
● Ensure cuffs of tracheostomy tube is
inflated (if applicable)
● Monitor and report excessive residual
feeding
 Bowel and Bladder Control
Perform intermittent sterile
catheterization
● During the period of loss sphincter control
Analyze voiding pattern
Offer urinal or bedpan on patient’s
voiding schedule
Assist male patient to an upright position
when voiding
Provide high-fiber diet and adequate
fluid intake, unless contraindicated
● Establish a regular time for toileting
 Improving Thought Processes
Reinforce structured training
program using:
● Cognitive, perceptual retraining
● Visual imagery, reality
orientation
● Cueing procedures
Support patient by:
● Observe performance and
progress
● Give positive feedback
● Convey an attitude of confidence
and hopefulness
 Improving Communication
Reinforce individually tailored program
Jointly establish goals
Make the atmosphere conducive to communication
● Remaining sensitive to patient’s reactions and needs
● Responding in appropriate manner
● Treat the patient as an adult
Provide strong emotional support and understanding
● Avoid completing patient’s sentences
Be consistent in schedule, routines, and repetitions
● Written schedule, checklists, and audio tapes may help with memory and
concentration
Maintain patient’s attention when talking
● Speak slowly
● Give one instruction at a time
● Allow the patient time to process
Talk to aphasic patients when providing care to provide social contact.
 Improving Communication

Frequently assess skin for

signs of breakdown

Regular turning and

positioning every 2 hours
minimally

Keep skin clean and dry

 Improving Family Coping
Provide counseling and support to the
family
Involve others in patient’s care
● Teach stress management techniques
● Maintenance of personal health for family
coping
Give information on the expected
outcomes of the stroke
● Counsel to avoid doing things for the
patient that he/she can do
Develop attainable goals for the patient
at home
Encourage everyone to approach the
patient with a supportive and optimistic
attitude
● Focusing on abilities that remain
● Emotional ability usually improves with
Health Teaching
Points
Teach patient to resume as much self care as
possible;
Coordinate care provided by numerous health care
professionals
Advise family that patient may easily:
⚫ Get tired
⚫ Become irritable and upset
⚫ Show less interest.
CREDITS: This presentation template was created by Slidesgo,
Make a referral for home speech therapy
including icons by Flaticon and infographics & images by Freepik
⚫ Encourage family involvement.
⚫ Provide family with practical instructions between
speech therapy sessions.
Health Teaching
Points
Encourage patient to attend community-based stroke
clubs to give a feeling of belonging and fellowship to
others.
Encourage patient to continue with hobbies,
recreational and leisure interests, and contact with
friends to prevent social isolation.
Encourage family to support patient and give positive
CREDITS: This presentation template was created by Slidesgo,
reinforcement.
including icons by Flaticon and infographics & images by Freepik

Remind spouse and family to attend to personal

health and wellbeing.
 Complications
If cerebral oxygenation is still inadequate
⚫ Tissue ischemia
⚫ Cardiac dysrhythmias
Prevent
ion
THANK
YOU!
REFERENCES:
✔ [Link]
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_accident
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✔ [Link]
350119
✔ [Link]
✔ [Link]