Cerebrovascular Disorder

1. CEREBROVASCULAR DISORDERSCEREBROVASCULAR DISORDERS
functional ability of the central nervous system that occurs when the functional ability of the central nervous system that occurs when the
normal blood supply to the brain is disrupted.normal blood supply to the brain is disrupted.

2. 2 MAIN CATEGORIES:2 MAIN CATEGORIES:
Ischemic stroke – Ischemic stroke – vascular occlusion and vascular occlusion and
significant hypoperfusion occur significant hypoperfusion occur
Hemorrhagic stroke – Hemorrhagic stroke – there is there is
extravasations of blood into the brain or extravasations of blood into the brain or
subarachnoid spacesubarachnoid space

3. ISCHEMIC STROKEISCHEMIC STROKE
““brain attack”brain attack”
sudden loss of functional resulting from disruption of the blood supply to the sudden loss of functional resulting from disruption of the blood supply to the
part of the brain.part of the brain.

4. 5 DIFFERENT TYPES:5 DIFFERENT TYPES:
Large artery thrombotic strokesLarge artery thrombotic strokes
– – caused by atherosclerotic plaques in the largecaused by atherosclerotic plaques in the large
blood vessels of the brain. blood vessels of the brain.
Small penetrating artery thrombotic strokesSmall penetrating artery thrombotic strokes
– – affect one or more vessels and are the mostaffect one or more vessels and are the most
common type of ischemic stroke. common type of ischemic stroke.
Cardiogenic embolic strokesCardiogenic embolic strokes
– – associated with cardiac dysrhythmias, associated with cardiac dysrhythmias,
usually atrial fibrillation usually atrial fibrillation
Cryptogenic strokesCryptogenic strokes
– – no known cause no known cause
Strokes from other causesStrokes from other causes

5. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Cell injury and deathCell injury and death
↓↓
Intracellular calcium increasedIntracellular calcium increased
↓↓
Cell membranes and proteins break downCell membranes and proteins break down
↓↓
Formation of free radicalsFormation of free radicals
↓↓
Protein production decreasedProtein production decreased
↓↓
GlutamateGlutamate
↓↓
DepolarizationDepolarization
↓↓
Ion imbalanceIon imbalance
↓↓
AcidosisAcidosis
↓↓
Energy failureEnergy failure

6. This is how blood flows through a This is how blood flows through a healthy vesselhealthy vessel. .
Ischemic strokeIschemic stroke can happen when a blood vessel is can happen when a blood vessel is
narrowed due to the build-up of fatty deposits on the walls narrowed due to the build-up of fatty deposits on the walls
of the vessel. This can cause blood to collect and clot. of the vessel. This can cause blood to collect and clot.
Embolic StrokeEmbolic Stroke, a type of ischemic stroke, happens when , a type of ischemic stroke, happens when
a wandering blood clot from another part of the body gets a wandering blood clot from another part of the body gets
stuck in a vessel leading to or in the brain. Such clots often stuck in a vessel leading to or in the brain. Such clots often
come from diseased areas of the heart. come from diseased areas of the heart.
Hemorrhagic StrokeHemorrhagic Stroke happens when a weakened vessel in happens when a weakened vessel in
the brain bursts, flooding the area with blood. The brain the brain bursts, flooding the area with blood. The brain
cells die because bloodcells die because blood

7. Numbness or weakness of the face, arm Numbness or weakness of the face, arm
or leg, especially on one side of the body or leg, especially on one side of the body
Confusion or change in mental status Confusion or change in mental status
Trouble speaking or understanding Trouble speaking or understanding
speech speech
Difficulty walking, dizziness or loss of Difficulty walking, dizziness or loss of
balance or coordination balance or coordination
Sudden severe headache Sudden severe headache
SIGNS and SYMPTOMSSIGNS and SYMPTOMS

8. NEUROLOGIC DEFICITSNEUROLOGIC DEFICITS
Visual Field Deficits Visual Field Deficits
Motor DeficitsMotor Deficits
Sensory DeficitsSensory Deficits
Verbal DeficitsVerbal Deficits
Cognitive DeficitsCognitive Deficits
Emotional DeficitsEmotional Deficits

9. Visual DeficitsVisual Deficits
 Homonymous HemianopsiaHomonymous Hemianopsia – loss of half of the visual field – loss of half of the visual field
 Manifestations: Manifestations:
 Unaware of persons or objects on side of visual loss.. Unaware of persons or objects on side of visual loss..
 Neglect of one side of the body. Neglect of one side of the body.
 Difficulty judging distances. Difficulty judging distances.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Place objects within intact field of vision. Place objects within intact field of vision.
 Approach the patient from side of intact field of vision. Approach the patient from side of intact field of vision.
 Instruct/ remind the patient to turn head in the direction of visual loss of compensate for loss of Instruct/ remind the patient to turn head in the direction of visual loss of compensate for loss of
visual field. visual field.
 Encourage the use of eyeglasses if available. Encourage the use of eyeglasses if available.
 When teaching the patient, do so within patient’s intact visual field. When teaching the patient, do so within patient’s intact visual field.
 Loss of peripheral visionLoss of peripheral vision
 Manifestation: Manifestation:
 Difficulty seeing at night. Difficulty seeing at night.
 Unaware of objects or the borders of objects. Unaware of objects or the borders of objects.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Place objects in center of patient’s intact visual field. Place objects in center of patient’s intact visual field.
 Encourage the use of a cane or other object to identify objects in the periphery of the visual field. Encourage the use of a cane or other object to identify objects in the periphery of the visual field.
 Driving ability will need to evaluated. Driving ability will need to evaluated.
 Diplopia Diplopia
 Manifestation:Manifestation:
 Double vision. Double vision.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Explain to the patient the location of an object when placing it near the patient. Explain to the patient the location of an object when placing it near the patient.
 Consistently place patient care items in the same location. Consistently place patient care items in the same location.

10. Motor DeficitsMotor Deficits
 Hemiparesis Hemiparesis
 Manifestation:Manifestation:
 Weakness of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere) Weakness of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere)
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Place objects within the patient’s reach on the non affected side. Place objects within the patient’s reach on the non affected side.
 Maintain body alignment in functional position. Maintain body alignment in functional position.
 Exercise unaffected limb to increase mobility, strength, and use. Exercise unaffected limb to increase mobility, strength, and use.
 Ataxia Ataxia
 Manifestation:Manifestation:
 Staggering, unsteady gait. Staggering, unsteady gait.
 Unable to keep feet together; need a broad base to stand. Unable to keep feet together; need a broad base to stand.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Support patient during the initial ambulation phase. Support patient during the initial ambulation phase.
 Provide supportive device for ambulation (walker, cane) Provide supportive device for ambulation (walker, cane)
 Instruct the patient not to walk without assistance or supportive device. Instruct the patient not to walk without assistance or supportive device.
 Dysarthria Dysarthria
 Manifestation:Manifestation:
 Difficulty in forming words Difficulty in forming words
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Provide the patient with alternative methods of communicating. Provide the patient with alternative methods of communicating.
 Allow the patient sufficient time to respond to verbal communications. Allow the patient sufficient time to respond to verbal communications.
 Support patient and family to alleviate frustration related to difficulty in communicating. Support patient and family to alleviate frustration related to difficulty in communicating.
 Dysphagia Dysphagia
 Manifestation:Manifestation:
 Difficulty in swallowing Difficulty in swallowing
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Test the patient’s pharyngeal reflexes before offering food and fluids. Test the patient’s pharyngeal reflexes before offering food and fluids.
 Assist the patient with meals. Assist the patient with meals.
 Place food on the unaffected side of the mouth. Place food on the unaffected side of the mouth.
 Allow ample time to eat. Allow ample time to eat.

11. Sensory DeficitsSensory Deficits
ParesthesiaParesthesia
(occurs on the side opposite the lesion) (occurs on the side opposite the lesion)
Manifestation:Manifestation:
Numbness and tingling of extremity. Numbness and tingling of extremity.
Difficulty with proprioception Difficulty with proprioception
Nursing Implications/ Patient Teaching Nursing Implications/ Patient Teaching
Applications:Applications:
Instruct patient that sensation may be altered. Instruct patient that sensation may be altered.
Provide range of motion to affected areas and Provide range of motion to affected areas and
apply corrective devices as needed. apply corrective devices as needed.

12. Verbal DeficitsVerbal Deficits
 Expressive aphasiaExpressive aphasia
 Manifestation:Manifestation:
 Unable to form words that are understandable; may be able to speak in single-Unable to form words that are understandable; may be able to speak in single-
word responses. word responses.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Encourage patient to repeat sounds of the alphabet. Encourage patient to repeat sounds of the alphabet.
 Explore the patient’s ability to write as an alternative means of communication. Explore the patient’s ability to write as an alternative means of communication.
 Receptive aphasiaReceptive aphasia
 Manifestation:Manifestation:
 Unable to comprehend the spoken word; can speak but may not make sense. Unable to comprehend the spoken word; can speak but may not make sense.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Speak slowly and clearly to assist the patient in forming the sounds. Speak slowly and clearly to assist the patient in forming the sounds.
 Explore the patient’s ability to read as an alternative means of communication. Explore the patient’s ability to read as an alternative means of communication.
 Global (mixed) aphasiaGlobal (mixed) aphasia
 Manifestation:Manifestation:
 Combination of both receptive and expressive aphasia. Combination of both receptive and expressive aphasia.
 Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
 Speak clearly and in simple sentences; use gestures or pictures when able. Speak clearly and in simple sentences; use gestures or pictures when able.
 When alternative means of communication. When alternative means of communication.

13. Cognitive deficitsCognitive deficits
Manifestation:Manifestation:
Short and long term memory loss. Short and long term memory loss.
Decreased attention span. Decreased attention span.
Impaired ability to concentrate. Impaired ability to concentrate.
Poor abstract reasoning. Poor abstract reasoning.
Altered judgement. Altered judgement.
Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
Reorient patient to time, place, and situation, frequently. Reorient patient to time, place, and situation, frequently.
Use verbal and auditory cues to orient patient. Use verbal and auditory cues to orient patient.
Provide familiar objects (family photographs, favorite objects) Provide familiar objects (family photographs, favorite objects)
Use non complicated language. Use non complicated language.
Match visual tasks with a verbal cue; holding a toothbrush, simulate Match visual tasks with a verbal cue; holding a toothbrush, simulate
brushing of teeth while saying , “ I would like you to brush your teeth now” brushing of teeth while saying , “ I would like you to brush your teeth now”
Minimize distracting noises and views when teaching the patient. Minimize distracting noises and views when teaching the patient.
Repeat and reinforce instructions frequently. Repeat and reinforce instructions frequently.

14. Emotional DeficitsEmotional Deficits
Manifestation:Manifestation:
Loss of self-control Loss of self-control
Emotional ability Emotional ability
Decreased tolerance to stressful situations Decreased tolerance to stressful situations
Depression Depression
Withdrawal Withdrawal
Fear, hostility, and anger Fear, hostility, and anger
Feelings of isolation. Feelings of isolation.
Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications:
Support patient during uncontrollable outburst. Support patient during uncontrollable outburst.
Discuss with the patient and family that the outburst are due to the disease Discuss with the patient and family that the outburst are due to the disease
process. process.
Encourage patient to participate in group activity. Encourage patient to participate in group activity.
Provide stimulation for the patient. Provide stimulation for the patient.
Control stressful situations, if possible. Control stressful situations, if possible.
Provide a safe environment. Provide a safe environment.
Encourage patient to express feelings and frustrations related to disease process. Encourage patient to express feelings and frustrations related to disease process.

15. COMPARISON OF LEFT AND COMPARISON OF LEFT AND
RIGHT HEMISPHERE RIGHT HEMISPHERE
STROKESSTROKES
LEFT HEMISPHERE LEFT HEMISPHERE
Paralysis or weakness on right side of the bodyParalysis or weakness on right side of the body
Right visual field defectsRight visual field defects
AphasiaAphasia
Altered intellectual abilityAltered intellectual ability
Slow, cautious behaviorSlow, cautious behavior
RIGHT HEMISPHERERIGHT HEMISPHERE
Paralysis or weakness on left side of the bodyParalysis or weakness on left side of the body
Left visual field defectsLeft visual field defects
Spatial-perceptual deficitsSpatial-perceptual deficits
Increased distractibilityIncreased distractibility
Impulsive behavior and poor judgementImpulsive behavior and poor judgement
Lack of awareness of deficitsLack of awareness of deficits

16. ASSESSMENT:ASSESSMENT:
Transient Ischemic Attack Transient Ischemic Attack
(TIA)(TIA) – is a neurologic – is a neurologic
deficit lasting less than 24 deficit lasting less than 24
hours, with most hours, with most
episodes resolving in less episodes resolving in less
than 1 hour.than 1 hour.
sudden loss of motor, sudden loss of motor,
sensory, or visual sensory, or visual
function function
They occur when a blood They occur when a blood
clot blocks a vessel for a clot blocks a vessel for a
short period of time short period of time
may serve as a warning may serve as a warning
of impending stroke of impending stroke

17. Courtesy of Intermountain Medical Imaging, Courtesy of Intermountain Medical Imaging,
Boise, Idaho. Boise, Idaho.
Figure 1 shows an angiogram (a type of X-ray) Figure 1 shows an angiogram (a type of X-ray)
of a normal neck artery (carotid artery) with of a normal neck artery (carotid artery) with
smooth walls. Figure 2 shows a narrowed smooth walls. Figure 2 shows a narrowed
carotid artery with ulcerated plaque (the surface carotid artery with ulcerated plaque (the surface
of the plaque is irregular and broken) that is the of the plaque is irregular and broken) that is the
source of clots. The clots travel to the brain and source of clots. The clots travel to the brain and
cause TIA symptoms.cause TIA symptoms.
Angiogram of a transient ischemic attack (TIA)Angiogram of a transient ischemic attack (TIA)

18. MEDICAL MANAGEMENTMEDICAL MANAGEMENT ::
GoalGoal
preserve healthy brain tissue surrounding the preserve healthy brain tissue surrounding the
blockage. This can be accomplished by removing blockage. This can be accomplished by removing
the blockage and restoring blood flow to the area, or the blockage and restoring blood flow to the area, or
by protecting the surrounding tissue.by protecting the surrounding tissue.
warfarin sodiumwarfarin sodium – cardioembolitic stroke – cardioembolitic stroke
aspirinaspirin – if warfarin is contraindicated – if warfarin is contraindicated
platelet- inhibiting medicationplatelet- inhibiting medication – decrease the – decrease the
incidence of cerebral perfusion incidence of cerebral perfusion
3-hydroxy-2-methyl-glutaryl-coenzyme A 3-hydroxy-2-methyl-glutaryl-coenzyme A
reductase inhibitors-reductase inhibitors- to reduce coronary events to reduce coronary events
and strokes and strokes
THROMBOLYTIC THERAPYTHROMBOLYTIC THERAPY – dissolving the blood – dissolving the blood
clot that is blocking blood flow to the brainclot that is blocking blood flow to the brain
RECOMBINANT t-PARECOMBINANT t-PA- works by binding to fibrin - works by binding to fibrin
and converting plasminogen to plasminand converting plasminogen to plasmin

19. Angiogram 3D reconstruction showing area of Angiogram 3D reconstruction showing area of
intracranial arterial blockageintracranial arterial blockage

20. CONTRAINDICATIONS:CONTRAINDICATIONS:
 symptom onset greater than 3 hrs. before admission symptom onset greater than 3 hrs. before admission
 anticoagulated patient anticoagulated patient
 patient with any type of intracranial pathology patient with any type of intracranial pathology
 Criteria for t-PA administrationCriteria for t-PA administration
 18 years or older 18 years or older
 clinical diagnosed ischemic stroke clinical diagnosed ischemic stroke
 time of onset of stroke known and is 3 hours or less time of onset of stroke known and is 3 hours or less
 systolic BP <185 mm Hg; diastolic < 110 mm Hg systolic BP <185 mm Hg; diastolic < 110 mm Hg
 not a minor stroke or rapidly resolving stroke not a minor stroke or rapidly resolving stroke
 no seizures at onset of stroke no seizures at onset of stroke
 not taking warfarin (COUMADIN) not taking warfarin (COUMADIN)
 prothrombin time <15 seconds or INR < 1.7 prothrombin time <15 seconds or INR < 1.7
 not receiving heparin during the past 48 hours with elevated partial thromboplastin not receiving heparin during the past 48 hours with elevated partial thromboplastin
time time
 platelet count >100,000/mm3 platelet count >100,000/mm3
 no prior intracranial hemorrhage, neoplasm, arteriovenosus malformation or no prior intracranial hemorrhage, neoplasm, arteriovenosus malformation or
aneurysm aneurysm
 no major surgical procedures within 14 days no major surgical procedures within 14 days
 no stroke, serious head injury or intracranial surgery within 3 months no stroke, serious head injury or intracranial surgery within 3 months
 no gastrointestinal or urinary bleeding within 21 days no gastrointestinal or urinary bleeding within 21 days

21. Dosage and administrationDosage and administration: dosage for t-PA is 0.9 : dosage for t-PA is 0.9
mg./kg., with a maximum dose of 90 mg. Ten percent of mg./kg., with a maximum dose of 90 mg. Ten percent of
the calculated dose is administered as an IV bolus over 1 the calculated dose is administered as an IV bolus over 1
minute. The remaining dose (90%) is administered by IV minute. The remaining dose (90%) is administered by IV
over 1 hour via an infusion pump.over 1 hour via an infusion pump.
Side effectSide effect: intracranial bleeding: intracranial bleeding
Other treatmentOther treatment: anticoagulant administration (IV): anticoagulant administration (IV)
Elevation of head of the bed to promote venous drainage Elevation of head of the bed to promote venous drainage
and to lower increased ICP.and to lower increased ICP.
Intubation with an endotracheal tube to establish a patent Intubation with an endotracheal tube to establish a patent
airway, if necessaryairway, if necessary
CAROTID ENDATERECTOMYCAROTID ENDATERECTOMY – removal of – removal of
atherosclerotic plaque or thrombus from the carotid artery atherosclerotic plaque or thrombus from the carotid artery
to prevent stroke in patients with occlusive disease of the to prevent stroke in patients with occlusive disease of the
extracranial cerebral arteries.extracranial cerebral arteries.
IndicationsIndications: TIA or mild stroke: TIA or mild stroke
CAROTID STENTINGCAROTID STENTING – less invasive procedure that is – less invasive procedure that is
used for severe stenosisused for severe stenosis
ComplicationComplication: stroke, cranial nerve injuries, infection or : stroke, cranial nerve injuries, infection or
hematomas and carotid artery disruptionhematomas and carotid artery disruption

22. NURSING INTERVENTIONSNURSING INTERVENTIONS ::
Improve mobility and preventing joint deformitiesImprove mobility and preventing joint deformities
 because flexor muscles are stronger than extensor muscles, a posterior splint is because flexor muscles are stronger than extensor muscles, a posterior splint is
applied at night to the affected extremity may prevent flexion and maintain applied at night to the affected extremity may prevent flexion and maintain
correct positioning during sleep correct positioning during sleep
 preventing shoulder adduction – a pillow is placed in the axilla when there is preventing shoulder adduction – a pillow is placed in the axilla when there is
limited external rotation limited external rotation
 the arm is placed in a neutral position, with distal joints positioned higher than the arm is placed in a neutral position, with distal joints positioned higher than
the more proximal joints the more proximal joints
 helps to prevent edema and resultant fibrosis helps to prevent edema and resultant fibrosis
 positioning the hand and fingers – volar resting splint can be used to support the positioning the hand and fingers – volar resting splint can be used to support the
wrist and hand in a functional position wrist and hand in a functional position
 changing position – should be changed every 2 hours changing position – should be changed every 2 hours
 to place patient in side-lying position pillow is placed between the legs before to place patient in side-lying position pillow is placed between the legs before
the patient is turned the patient is turned
 to promote venous return and prevent edema, the upper thigh should be acutely to promote venous return and prevent edema, the upper thigh should be acutely
flexed flexed
 if possible, the patient is placed in a prone position for 15-30 minutes several if possible, the patient is placed in a prone position for 15-30 minutes several
times a day times a day
 establishing an exercise program – to prevent venous stasis establishing an exercise program – to prevent venous stasis
 performed at least five times daily for 10 minutes at a time. performed at least five times daily for 10 minutes at a time.
 Preparing for ambulation – patient is ready to walk as soon as standing is Preparing for ambulation – patient is ready to walk as soon as standing is
achieved. achieved.

23. Preventing shoulder painPreventing shoulder pain
the nurse should never lift the patient the nurse should never lift the patient
by the flaccid shoulder or pull on the by the flaccid shoulder or pull on the
affected arm or shoulder affected arm or shoulder
range-of-motion exercise range-of-motion exercise
antiseizure medication lamotrigine antiseizure medication lamotrigine
(Lamictal) (Lamictal)

24. Assistive devices to enhance self-care strokeAssistive devices to enhance self-care stroke
eating devices – nonskid to stabilize plates eating devices – nonskid to stabilize plates
plate guards to prevent food from being pushed off plate guards to prevent food from being pushed off
plate plate
wide-grip utensils to accommodate a weak graspwide-grip utensils to accommodate a weak grasp
bathing and grooming devices bathing and grooming devices
- Long-handled bath sponge- Long-handled bath sponge
grab bars, nonskid mats, hand-held shower heads grab bars, nonskid mats, hand-held shower heads
electric razors with head at 90 degrees to handle electric razors with head at 90 degrees to handle
shower and tub seats, stationary or on wheel shower and tub seats, stationary or on wheel
toileting aids toileting aids
raised toilet seat raised toilet seat
grab bars next to toilet grab bars next to toilet
dressing aids dressing aids
Velcro closures Velcro closures
elastic shoelaces elastic shoelaces
long-handled shoe horn long-handled shoe horn
mobility aids mobility aids
canes, walkers, wheelchairs canes, walkers, wheelchairs
transfer devices such as transfer boards and belts transfer devices such as transfer boards and belts

25. HEMORRHAGIC STROKEHEMORRHAGIC STROKE
15% to 20% of cerebrovascular disorders and are primarily caused by intracranial or 15% to 20% of cerebrovascular disorders and are primarily caused by intracranial or
subarachnoid hemorrhage. subarachnoid hemorrhage.
caused by bleeding into the brain tissue, the ventricles or the subarachnoid space. caused by bleeding into the brain tissue, the ventricles or the subarachnoid space.
primary intracerebral hemorrhage from a spontaneous rupture of small vessels primary intracerebral hemorrhage from a spontaneous rupture of small vessels
accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by
uncontrolled hypertension. uncontrolled hypertension.
secondary intracerebral hemorrhage is associated with arteriovenous secondary intracerebral hemorrhage is associated with arteriovenous
malformations(AVMs),an intracranial aneurysms, intracranial neoplasms or certain malformations(AVMs),an intracranial aneurysms, intracranial neoplasms or certain
medications(anticoagulants, amphetamines) medications(anticoagulants, amphetamines)
43% at 30 days-high mortality rate reported 43% at 30 days-high mortality rate reported

26. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
symptoms are produced when a primary symptoms are produced when a primary
hemorrhage, aneurysm, or AVM presses hemorrhage, aneurysm, or AVM presses
on nearby cranial nerves or brain tissue on nearby cranial nerves or brain tissue
or more dramatically when an aneurysm or more dramatically when an aneurysm
or AVM ruptures, causing subarachnoid or AVM ruptures, causing subarachnoid
hemorrhagehemorrhage

27. CLINICAL CLINICAL
MANIFESTATIONSMANIFESTATIONS
severe headache- conscious severe headache- conscious
patient most commonly patient most commonly
reports reports
present with a wide variety of present with a wide variety of
neurologic deficits, similar to neurologic deficits, similar to
the patient with ischemic the patient with ischemic
Stroke. Stroke.
comprehensive assessment comprehensive assessment
reveals the extent of the reveals the extent of the
neurologic deficits neurologic deficits
many of the same motor, many of the same motor,
sensory, cranial nerve, sensory, cranial nerve,
cognitive and other functions cognitive and other functions
that are disrupted after that are disrupted after
ischemic stroke are also ischemic stroke are also
altered after hemorrhagic altered after hemorrhagic
stroke. stroke.

28. COMPLICATIONSCOMPLICATIONS
Based on assessment data, potential Based on assessment data, potential
complications may develop include the ff,complications may develop include the ff,
vasospasm vasospasm
seizures seizures
hydrocephalus hydrocephalus
rebleeding rebleeding
hyponatremia hyponatremia

29. MEDICAL MEDICAL
MANAGEMENTMANAGEMENT
GOALS GOALS
allow the brain to recover from the initial result allow the brain to recover from the initial result
(bleeding)(bleeding)
to prevent or minimize the risk for rebleedingto prevent or minimize the risk for rebleeding
prevent or treat complications prevent or treat complications
primarily supportive and consists of bed rest with primarily supportive and consists of bed rest with
sedation sedation
management of vasospasms management of vasospasms
surgical or medical treatment surgical or medical treatment
Analgesics (codeine, acetaminophen) Analgesics (codeine, acetaminophen)
- for head and neck pain- for head and neck pain

30. NURSING NURSING
INTERVENTIONSINTERVENTIONS
Optimizing Cerebral Tissue Perfusion Optimizing Cerebral Tissue Perfusion
Relieving Sensory Deprivation and Relieving Sensory Deprivation and
Anxiety Anxiety
Monitoring and Managing Potential Monitoring and Managing Potential
Complications Complications
Promoting Home and Community Based Promoting Home and Community Based
Care Care

31. tHe EnD