CVA Stroke power point presentation 12

According to World Health Organization (WHO) stroke is “a clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin”

1. UNIT II- Neuro-NursingUNIT II- Neuro-Nursing
TOPIC: TOPIC: Cerebro-Vascular Accident (CVA) Cerebro-Vascular Accident (CVA)
(Stroke, Brain Attack) (Stroke, Brain Attack)
(Brunner and Suddarth Chapter 61)(Brunner and Suddarth Chapter 61)) )
BYBY
SEHRISH NAZ SEHRISH NAZ
RN, Post RN, MSNRN, Post RN, MSN
Assistant ProfessorAssistant Professor
Subject: Adult Health Nursing II
Institute of Nursing Sciences, Khyber Medical University

2. Definition of StrokeDefinition of Stroke
According to World Health Organization (WHO)
stroke is “a clinical syndrome consisting of rapidly
developing clinical signs of focal disturbance of
cerebral function, lasting more than 24 hours or
leading to death with no apparent cause other than
that of vascular origin”
(WHO. 2017)
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3. Types of StrokeTypes of Stroke
Classification based on underlying
pathophysiologic findings
◦Ischemic
Thrombotic
Embolic
◦Hemorrhagic
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4. Major Types of StrokeMajor Types of Stroke
Fig. 56-310/03/24 4

5. Ischemic StrokeIschemic Stroke
Result of inadequate blood flow to brain due to
partial or complete occlusion of an artery
Constitute 85% of all strokes
Most patients with ischemic stroke do not have
a decreased level of consciousness in the first
24 hours
Symptoms often worsen during first 72 hours
d/t cerebral edema
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6. Hemorrhagic StrokeHemorrhagic Stroke
Account for approximately 15% of all
strokes
Result from bleeding into the brain tissue
itself or into the subarachnoid space or
ventricles
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7. Transient Ischemic Attacks (TIA)Transient Ischemic Attacks (TIA)
Temporary focal loss of neurologic function
caused by ischemia (analogous to angina in CAD)
Most resolve within 3 hours
May be due to micro-emboli that temporarily
block blood flow
A warning sign of progressive cerebrovascular
disease
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8. Etiology and PathophysiologyEtiology and Pathophysiology
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9. Risk FactorsRisk Factors
NonmodifiableNonmodifiable
Age
Gender
Race
(African
Americans)
Heredity
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10. Risk FactorsRisk Factors
ModifiableModifiable
Hypertension
Obesity
Oral
contraceptive use
Physical inactivity
Smoking
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Asymptomatic
carotid stenosis
Diabetes mellitus
Heart disease, atrial
fibrillation
Heavy alcohol
consumption
Hyperlipidemia

11. Clinical Manifestations of StrokeClinical Manifestations of Stroke
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12. Clinical Manifestations of Right-Brain and Left-Brain Clinical Manifestations of Right-Brain and Left-Brain
StrokeStroke
Fig. 56-610/03/24 12

13. Diagnostic StudiesDiagnostic Studies
History
Physical examination
CT
MRI
Other tests as needed
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14. Medical Management (Ischemic)Medical Management (Ischemic)
Medically: TPA (intravenous tissue plasminogen activator)
◦American heart association: Within 4.5 hours
◦The earlier TPA is administered, the higher the likelihood of a
positive neurologic outcomes
Antithrombotic treatment
◦Aspirin 160 to 325 mg within 48 hours
High dose statin
◦Atorvastatin 80mg
Anticoagulation: only in cardio embolic stroke
◦IV not recommended during first 48h after acute ischemic stroke
◦Warfarin can be started for small or moderate-sized infarct after 24
hours
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15. Surgical Management Surgical Management
Occasionally, emergency surgery may be needed to remove any blood
from the brain and repair any burst blood vessels.
This is usually done using a surgical procedure known as a
craniotomy. During a craniotomy, a section of the skull is removed
to allow the surgeon access to the source of the bleeding.
If a stroke is caused by a blockage in a carotid artery in the neck—
which supplies blood to the brain—doctors may perform what's
known as a carotid endarterectomy.
In this procedure, surgeons remove the buildup of plaque, a hard, waxy
substance that contains cholesterol, fat, and calcium.
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16. Nursing ManagementNursing Management

Nursing Assessment
◦Clinical manifestations
◦Risk factors
◦Complications
Nursing Diagnoses
Impaired physical mobility R/t motor cortex
involvement as evidence by hemiplegia
Impaired verbal communication R/t Broca’s area
involvement as evidence by Dysarthria
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17. Nursing ManagementNursing Management
Planning Planning
Goals
◦Attain maximum physical functioning
◦Attain maximum self-care abilities and
skills
◦Maximize communication abilities
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18. Nursing ManagementNursing Management
Nursing ImplementationNursing Implementation
o provide passive exercise to the affected
area
◦Prevent joint contractures and muscular atrophy
◦In the acute phase, range-of-motion exercises
and positioning
◦Pressure relief by position changes, special
mattresses
◦Position patient affected side for only 30 minutes
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19. Nursing ManagementNursing Management
Nursing ImplementationNursing Implementation
Communication
◦Assess ability to speak and understand
◦Speak slowly and calmly, using simple words
or sentences
◦Provide time to express self
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20. Stroke Prevention GuidelinesStroke Prevention Guidelines
1.Know your blood pressure. Have it
checked at least annually. If it is elevated,
work with your healthcare professional
to control it.
2.Find out if you have atrial fibrillation
(Afib) – a type of irregular heartbeat. If
you have it, work with your healthcare
professional to manage it.
3.If you smoke, stop.
© 2011 National Stroke Association
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21. Cont.…Cont.…
7. Include exercise in your daily routine
8. Enjoy a lower sodium (salt) and lower
fat diet
9.If you have circulation problems, work
with your healthcare professional to
improve your circulation.
10.If you experience any stroke symptoms,
call 1122 immediately. Every minute
matters!
© 2011 National Stroke Association
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22. Types of Stroke RehabilitationTypes of Stroke Rehabilitation
Physical therapy (PT)
–Walking, range of movement
Occupational therapy (OT)
–Taking care of one’s self
Speech language therapy
–Communication skills, swallowing, cognition
Recreational therapy
–Cooking, gardening
© 2011 National Stroke Association
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23. Complications of strokeComplications of stroke
Brain edema
Pneumonia
Urinary tract infection (UTI) and/or bladder control problems
Seizures
Clinical depression
Pressure ulcers
Limb contracture
Spasticity, or muscle contractions that create tightness and
stiffness
Shoulder pain
Deep venous thrombosis (DVT)
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24. Thank you
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