Stroke nursing process

Stroke (CVA) is the 3rd most common cause of death in US with nearly 144,000 deaths each year (NSA)2009a. The leading cause of serious long-term disability. Major public health problem in term of morbidity and mortality. Quality of life issues can not be appropriately evaluated.

1. Stroke – CerebroVascular Accident (CVA ) Nursing process Jamilah saad Alqahtani CNS,MSN,BSN,RGN,OR Specilaist

2. Objectives Students will be able to understand: Introduction Definition Perceptions Pathophyisology Signs and symptoms Risk factors Warning signs of stroke Mechanisms affect cerebral blood flow Types of stroke Diagnostic studies Treatment Nursing process Stroke-prevention guidelines Summary References jamilah saad Alqahtani 2

3. Outlines Introduction Definition Perceptions Pathophyisology Signs and symptoms Risk factors Warning signs of stroke Mechanisms affect cerebral blood flow Types of stroke Diagnostic studies Treatment Nursing process Stroke-prevention guidelines Summary References jamilah saad Alqahtani 3

4. Introduction Stroke (CVA) is the 3 rd most common cause of death in US with nearly 144,000 deaths each year (NSA)2009a. The leading cause of serious long-term disability. Major public health problem in term of morbidity and mortality. Quality of life issues can not be appropriately evaluated. jamilah saad Alqahtani 4

5. Definition Cerebrovascular accident (CVA) or stroke is a “brain attack” .it happens in the brain rather than the heart and causes sudden loss of brain function accompanied by neurological deficit. It is a medical emergency and immediate treatment is crucial for the best outcome just as it is for a heart attack (National Stroke Association [NSA],2009d). jamilah saad Alqahtani 5

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9. Pathology Causes the symptoms common neurological deficits are motor deficits of hemiplegia (paralysis of one side of the body on the side opposite of the brain lesion), hemiparesis (weakness of one side of the body), dysarthria (impairment of speech caused by muscles).emotional ability (loss of emotional control),inability to control behavior and inability to process multiple pieces of information are also common manifestations of stroke jamilah saad Alqahtani 9

10. Pathology . Sensory deficit include the visual deficit of double vision, decreased visual acuity and homonymous hemianopia , the loss of vision in half of the visual field on the same side of both eyes. Other possible sensory deficits include decreased sensation to touch, pressure, pain, heat, and clod. The client also may be confused and disoriented . jamilah saad Alqahtani 10

11. Intellectual deficits include memory impairment, poor judgment, short attention span, difficulty organizing thoughts, and inbility to reseaon or calculate. Emotional deficits include depression and decressed tolerance to stressors. Most pts experience initial bowel and bladder dysfunction. With early recognition of problem and use bowel and bladder retraining programs, however most clients regain continence of bowel and bladder . Pathology jamilah saad Alqahtani 11

12. Signs and symptoms Common symptoms include: Trouble walking, loss of balance and coordination. Speech problems. Dizziness. Numbness, weakness, or paralysis. Blurred, blackened, or  double vision . Sudden severe  headache . Confusion. Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue. A transient ischemic attack (TIA) may be a sign of an impending stroke - TIA is a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter period and do not leave noticeable permanent damage. jamilah saad Alqahtani 12

13. Risk factors Non-modifiable Gender Age Race Heredity Modifiable Sedentary Lifestyle Smoking Use of oral contraceptive HTN DM Obesity Stress Hyperlipidemia Drug abuse (specially of cocaine) Clients with more than one risk factor are at even greater risk. 1:20 people who have a TIA will have a stroke within 2days (NSA, 2009b) jamilah saad Alqahtani 13

14. Mechanisms affect cerebral blood flow Extra-cranial factors Systemic blood pressure (MAP) Cardiac output Viscosity of blood Intracranial factors Intracranial pressure 2. Atherosclerosis 3. Blood vessels jamilah saad Alqahtani 14

15. Types of stroke Ischemic Thrombotic Embolic 2. Hemorrhagic Intracerebral Subarachnoid jamilah saad Alqahtani 15

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17. Ischemic strokes Thrombotic stroke 60% -blood clot occludes blood vessel -2/3s associated with HTN,DM -30%-50% have prodromes ( earlys /s) TIAs -characteristics Men >women Occurs during/after sleep _symptoms peak over 72 hours _resolution takes up to 2 weeks Symptoms occur over several hours Permanent neurologic deficits -size of lesion -collateral circulation jamilah saad Alqahtani 17

18. Transient Ischemic Attack (TIA) Temporary focal loss of neurologic function lasting less than24 hours Warning sign of progressing disease Carotid involvement - Amaurosis fugax (transient loss of vision in one eye ) - hemiparesis Inbility to speak Vertebrobasilar - Tininitus -Vertigo blurred vision - hemiparesis jamilah saad Alqahtani 18

19. Embolic Stroke Embolus occludes cerebral artery Men > women Rapid onset Headache Recurrence is common unless cause of embolism is addressed Causes of embolic strokes are (A trial fibrillation, Rheumatic fever, Atherosclerotic plaques) jamilah saad Alqahtani 19

20. 2. Hemorrhage stroke Intracerebrial Hemorrhage Stroke -bleeding within the brain that lasts from minutes to days caused by ruptured vessel -women > men -Often occurs during activity without warning -causes(HTN, Brain tumors, trauma, thrombolytic drugs, ruptured aneurysms) -symptoms vary with area of bleed ( sever headache, nausea, vomiting, weakness on one side) -prognosis is poor jamilah saad Alqahtani 20

21. Subarachnoid Hemorrhage stroke Bleeding beneath the arachnoid and pia mater layers (cerebrospinal fluid-filled space) often related to HTN, aneurysms, trauma, congenital malformations( arteriovenous ), anticoagulants, sympathomimetics Women >men Ballooning vessels may cause prodrome …..often sudden with rapid neuro changes Sever Headache Prognosis----guarded -surgical interventions jamilah saad Alqahtani 21

22. Warning signs for stroke Mnemonic Mnemonic hint Action Stroke symptom F A S T Face Arms Speech Time Ask pt to smile Ask pt to raise both arms Ask pt to say a simple sentence e.g. the grass is green If any of these signs are present in a non hospitalized client, call 911 to transport the client to an acute facility One side of the face may droop. One arm and falls downward. The speech is slurred or garbled. Adapted from NATIONAL STROKE ASSOSIATION NSA (2010) jamilah saad Alqahtani 22

23. Diagnostic studies CT MRI Angiography Transcranial Doppler Lumbar puncture jamilah saad Alqahtani 23

24. Treatment Medical Surgical Pharmacological Diet Activity jamilah saad Alqahtani 24

25. Nursing process Nursing diagnosis Deficient knowledge related to home care. Impaired verbal communication related to neuromuscular impairment Unilateral neglect related to neuromuscular impairment jamilah saad Alqahtani 25

26. Assessment jamilah saad Alqahtani 26

27. Planning jamilah saad Alqahtani 27

28. Intervention jamilah saad Alqahtani 28

29. Evaluation jamilah saad Alqahtani 29

30. Stroke-prevention guidelines jamilah saad Alqahtani 30

31. Summary jamilah saad Alqahtani 31

32. References Medical-surgical nursing, white duncan baumle http://www.powershow.com/view/318c0-OWNhZ/Nursing_Management_Stroke_powerpoint_ppt_presentation http://www.medicalnewstoday.com/articles/7624.php jamilah saad Alqahtani 32