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Post on 06-May-2015



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2. 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. 3. 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 4. 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 ischemicATHEROSCLEROSIS - 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. 5. 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 deaths2 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. 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 7. 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 ischemiaCompleted stroke (CS) symptoms of stroke stable over a period and rehab can begin 8. Signs and Symptoms In embolism Usually occurs without warning Client often with history of cardiovascular diseaseIn thrombosis Dizzy spells or sudden memory loss No pain, and client may ignore symptomsIn cerebralhemorrhage May have warning like dizziness and ringing in the ears (tinnitus) Violent headache, with nausea and vomitingSudden Onset CVA Usually most severe Loss of consciousness Face becomes red Breathing is noisy and strained 9. 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 10. 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 11. 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 ministroke High cholesterol High blood pressure Heart disease 12. 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. 13. 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 14. 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 15. 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 16. DIAGNOSIS Physical Examination (neurological examination & medical history) Imaging (CT scan and MRI) 17. ISCHEMIC STROKE 18. HEMORRHAGIC STROKE 19. TRANSIENT ISCHEMIC ATTACK (TIA) 20. 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 21. 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 22. ASSESSMENT Swallowing ability/aspiration risk Level of consciousness Neurological status Motor, sensory and cognitive functions Glasgow Coma Scale score 23. Ineffective tissue perfusion (cerebral) Disturbed sensory perception Impaired physical mobility Risk for injury Self-care deficit Impaired verbal communication Impaired swallowingNURSING DIAGNOSIS 24. 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. 25. 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) 26. THROMBOLYTIC THERAPY Anticoagulants: Sodium heparin, warfarin (Coumadin)Antiplatelets: Ticlopidine (Ticlid), clopidogrel (Plavix)Antiepileptic medications: Phenytoin (Dilantin), gabapentin (Neurontin) 27. 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! 28. THATS it! THANK YOU FOR LISTENING!