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CEREBROVASCULAR


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CEREBROVASCULARACCIDENT/STROKE

• Also called “brain attack ”, cerebral infarction,cerebral e!orra"e, isce!ic stro#e or stro#e

• A stro#e is ca$sed b% te interr$&tion of te

blood s$&&l% to te brain, $s$all% beca$se ablood 'essel b$rsts or is bloc#ed b% a clot( Tisc$ts o) te s$&&l% of o*%"en and n$trients,ca$sin" da!a"e to te brain tiss$e(


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DIRECT CAUSES:

• CEREBRAL THROMBOSIS – a blood clot or &la+$e bloc#s an arter% tat s$&&lies

a 'ital brain center

•

CEREBRAL HEMORRHAGE/ANEURYSM – an arter% in te brain b$rsts, ea#ens te

ane$r%s! all- se'ere rise in B. ca$sin"e!orra"e and isce!ia

• CEREBRAL EMBOLISM – a blood clot brea#s o) fro! a tro!b$s elseere in

te bod%, lod"es in a blood 'essel in te brain ands$ts o) blood s$&&l% to tat &art of te brain


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TYPES:• ISCHEMIC STROKE

– Occ$rs en a clot or a !ass clo"s a blood 'essel, c$ttin" o) teblood /o to brain cells( Te $nderl%in" condition for tis t%&e ofobstr$ction is te de'elo&!ent of fatt% de&osits linin" te 'essel alls(

Tis condition is called atherosclerosis.

– Al!ost 012 of stro#es are isce!ic

ATHEROSCLEROSIS

- “ardenin" of te arteries”

- “athero” – gruel or paste

- “sclerosis” – hardness

- It3s te &rocess in ic de&osits of fatt% s$bstances,colesterol, cell$lar aste &rod$cts, calci$! and oter s$bstances b$ild $& in te inner linin" of an arter%( Tisb$ild$& is called plaque


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4att% de&osits can ca$se to t%&es ofobstr$ction5

! CEREBRAL THROMBOSIS

" CEREBRAL EMBOLISM


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TYPES:

• HEMORRHAGIC STROKE – Res$lts fro! a ea#ened 'essel tat r$&t$res and bleeds

into te s$rro$ndin" brain( Te blood acc$!$lates andco!&resses te s$rro$ndin" brain tiss$e(

–

Abo$t 612 of all stro#es b$t res&onsible for 782 ofstro#e deats

2 TYPES SUBARACHNOID HEMORRHAGE #SAH$

occ$rs en a blood 'essel on te s$rface of te brain r$&t$resand bleeds into te s&ace beteen te brain and te s#$ll

INTRACEREBRAL HEMORRHAGE #ICH$Occ$rs en a blood 'essel bleeds into te tiss$e dee& itin te

brain(


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POINTS TO CONSIDER

– 9,888,888 brain cells die e'er% !in$ted$rin" stro#e, increasin" ris# of

&er!anent brain da!a"e, disabilit% ordeat(

– Reco"ni:in" s%!&to!s and actin" fast

to "et !edical attention can sa'e lifeand li!it disabilities(


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STAGES O% CVA

T&a'()e'* I(+,e)+ A**a+. • s$dden and sort;li'ed attac#

• Is a

•

What is the diference between stroke and TIA?• Tere=s no a% to tell if s%!&to!s of a stro#e ill lead to a TIA or a !a>or stro#e( It=s i!&ortant to call ?;6;6 i!!ediatel%for an% stro#e s%!&to!s(

Ree&()0le )(+,e)+ 'eu&1l12)+ 3e4+)* #RIND$

si!ilar to TIA, b$t s%!&to!s can last $& to a ee#S*&1.e )' e1lu*)1' #SIE$

• @rad$al orsenin" of s%!&to!s of brain isce!ia

C1ple*e3 (*&1.e #CS$ s%!&to!s of stro#e stableo'er a &eriod and reab can be"in


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S)2'( a'3 S5p*1(

I' e01l)(• Us$all% occ$rs ito$t arnin"

• Client often it istor% of cardio'asc$lar disease

I' *,&101()(• Di::% s&ells or s$dden !e!or% loss• No &ain, and client !a% i"nore s%!&to!s

I' +e&e0&al ,e1&&,a2e• a% a'e arnin" li#e di::iness and rin"in" in te ears tinnit$s

•

Violent eadace, it na$sea and 'o!itin"Su33e' O'(e* CVA

• Us$all% !ost se'ere

• Loss of conscio$sness

• 4ace beco!es red

•

Breatin" is nois% and strained


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S)2'( a'3 S5p*1(

Su33e' O'(e* CVA• Us$all% !ost se'ere

• Loss of conscio$sness

•

4ace beco!es red• Breatin" is nois% and strained

• .$lse is slo b$t f$ll and bo$ndin"

• Ele'ated B.

• a% be in a dee& co!a


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TIME IS CRTITICAL6

– Te lon"er te ti!e &eriod tat te &ersonre!ains $nres&onsi'e, te less li#el% it istat te &erson ill reco'er(

–

Te rst fe da%s after onset is critical( – Te res&onsi'e &erson !a%5

• So si"ns of !e!or% loss orinconsistent bea'ior

• a% be easil% fati"$ed, lose boel andbladder control, or a'e &oor balance


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• RISK %ACTORS:• Bein" o'er a"e 11

• Bein" an African;A!erican

• Fa'in" diabetes

• Fa'in" a fa!il% istor% of stro#e

–MEDICAL STROE RIS • .re'io$s stro#e

• .re'io$s e&isode of transient isce!ic attac#

TIA or !ini;stro#e• Fi" colesterol

• Fi" blood &ress$re

• Feart disease


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• RISK %ACTORS:

– LI!ESTYLE STROE RIS • S!o#in"

• Bein" o'erei"t• Drin#in" too !$c alcool

• Go$ can control lifest%le ris#s b% +$ittin"s!o#in", e*ercisin" re"$larl%, atcin" at

and o !$c %o$ eat and li!itin" alcoolcons$!&tion(


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C11' STROKE (5p*1(7

Hea#ness or &aral%sisN$!bness, tin"lin", decreased sensation

Vision can"es

S&eec &roble!s

Salloin" dic$lties or droolin"Loss of !e!or%

Verti"o s&innin" sensation

Loss of balance and coordination

.ersonalit% can"es

ood can"es de&ression, a&at%

Drosiness, letar"%, or loss of conscio$sness

Uncontrollable e%e !o'e!ents or e%elid droo&in"


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AJOR E44ECT of STROKE

– HEMIPLEGIA 8 !ost co!!on res$lt of CVA• .aral%sis of one side of te bod%

• a% a)ect oter f$nctions, s$c as earin","eneral sensation and circ$lation

• Te de"ree of i!&air!ent de&ends on te &art ofte brain a)ected

• S*a2e(:

–%la++)3 n$!bness and ea#ness of a)ected side

–Spa(*)+ !$scles contracted and tense, !o'e!entard

–Re+1e&5 tera&% and reab !etods s$ccessf$l


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AJOR E44ECT of STROKE

• A&asia and D%s&asia• Brain Da!a"e e*tent of brain da!a"e deter!ines

cances of reco'er%

• He"ia#o$sia blindness in alf of te 'is$al eld of

one or bot e%es• .ain $s$all% 'er% little- in>ection of local anestetic

&ro'ides te!&orar% relief

• A$tono!ic Dist$rbances

–

S$c as &ers&iration or “"oose /es” abo'e tele'el of &aral%sis

– a% a'e dilated &$&ils, i" or lo B. or eadace

– Treated it atro&ine;li#e dr$"s


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DIA@NOSIS

• .%sical E*a!ination ne$rolo"icale*a!ination !edical istor%

• I!a"in" CT scan and RI


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ISCHEMIC STROKE


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HEMORRHAGIC STROKE


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TRANSIENT ISCHEMIC ATTACK#TIA$


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ACT %AST

% 8 %ACE• As# te &erson to s!ile( Does one side of te

face droo&M

A 8 ARMS• As# te &erson to raise bot ar!s( Does one

ar! drift donardM

S 8 SPEECH• As# te &erson to re&eat a si!&le sentence(

Does te s&eec so$nd sl$rred or stran"eM

T 8 TIME• Call ?66 I!!ediatel%


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ASSESSMENT – onitor for si"ns and s%!&to!s – S%!&to!s ill 'ar% based on te area of te

brain tat is not ade+$atel% s$&&lied ito*%"enated blood

– Te left cerebral e!is&ere is res&onsible forlan"$a"e, !ate!atic s#ills and anal%tictin#in"

– Te ri"t cerebral e!is&ere is res&onsible for'is$al and s&atial aareness and&ro&rioce&tion

– Assessonitor Aira% &atenc%


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ASSESSMENT

– Salloin" abilit%as&iration ris# – Le'el of conscio$sness

– Ne$rolo"ical stat$s

–otor, sensor% and co"niti'e f$nctions

– @las"o Co!a Scale score


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NURSING DIAGNOSIS

– Ine)ecti'e tiss$e &erf$sion cerebral

–Dist$rbed sensor% &erce&tion

– I!&aired &%sical !obilit%

–Ris# for in>$r%

–Self;care decit

– I!&aired 'erbal co!!$nication

– I!&aired salloin"


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NURSINGCONSIDERATIONS

aintain &atent aira%

onitor for can"es in te client3s le'el ofconscio$sness

Instit$te sei:$re &reca$tions(

aintain a non;sti!$latin" en'iron!ent(Assist it co!!$nication s#ills if te client3s s&eec

is i!&aired(

Assist it safe feedin"(•

Assess salloin" re/e*es(• Tic#en li+$id to a'oid as&iration(

• Eat in an $&ri"t &osition and sallo it te ead and nec#/e*ed sli"tl% forard(

• .lace food in te bac# of te !o$t on te $na)ected side(

•

S$ction on standb%(


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NURSINGCONSIDERATIONS

– aintain s#in inte"rit%(

– Enco$ra"e .RO e'er% 9 r to te a)ected e*tre!itiesand ARO e'er% 9 r to te $na)ected e*tre!ities(

– Ele'ate te a)ected e*tre!ities to &ro!ote 'eno$sret$rn and to red$ce sellin"(

– aintain a safe en'iron!ent to red$ce te ris#s offalls(

– Scannin" tecni+$e t$rnin" ead fro! side to sideen eatin" and a!b$latin" to co!&ensate for

e!iano&sia(

– .ro'ide care to &re'ent dee&;'ein tro!bosisse+$ential co!&ression stoc#in"s, fre+$ent &ositioncan"es, !obili:ation


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THROMBOLYTIC THERAPY

–A'*)+1a2ula'*(5 Sodi$! e&arin,arfarin Co$!adin

–A'*)pla*ele*(: Ticlo&idine Ticlid,

clo&ido"rel .la'i*

–A'*)ep)lep*)+ e3)+a*)1'(5.en%toin Dilantin, "aba&entin

Ne$rontin


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STROKE PREVENTION

–@et screened for i" B.( –Fa'e %o$r colesterol le'el

cec#ed( LDL so$ld be loer tan

8 !"dL( –4ollo a lo;fat diet(

–P$it s!o#in"Q

–E*erciseQ

–Li!it alcool inta#eQ


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THAT9S )*6

THANK YOU %ORLISTENING6

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