CerebrovasculCerebrovascular Accidentsar Accidents

Rochee P. Benito, RNRochee P. Benito, RN

“Brain Attack”

• “Stroke”• Third leading cause

of death• 30% of stroke

survivors return to productive lives within 1 year

• Approximately 750,000 Americans have a stroke each year

Risk Factors for CVA

• Most common in men

• African Americans

• Ages 51 to 74 years

• Family history

• Hypertension

• Atherosclerosis

• Diabetes mellitus

• Atrial fibrillation

• Valvular heart disease

• Migraine headaches

• Cigarette smoking

• Obesity• High fat diet• Drug abuse

Types of Strokes

• Transient Ischemic Attacks

• Ischemic• Hemorrhagic

Transient Ischemic Attack

• Temporary neurologic deficits caused by impaired cerebral blood flow

• Considered a warning sign

• Characterized by focal neurological deficits, typically lasting minutes to hours in duration

• When symptoms persist more than 24 hours but then disappear, the patient is said to have Reversible Ischemic Neurologic Deficits

Transient Ischemic Attack

Clinical Manifestations

of a TIA• Dizziness• Momentar

y confusion

• Difficulty with speech

• Visual disturbances

• Weakness of paralysis on one side of the body

• Ptosis• Tinnitus

Diagnosis of TIA

• Health History• Clinical

Presentation• Brain imaging –

MRI / CT• Cerebral

angiography• Carotid Doppler

Testing

Treatment of TIA

• Aimed at cause• Hypertension

management• Decrease platelet

aggregation– Ticlid (ticlopidine)– Plavix (clopidogrel)– Aspirin

• Coumadin (warfarin)• For carotid stenosis

>70% - endarterectomy

Ischemic Strokes

• Thrombotic or embolic• Obstruction in blood

flow from a clot, atherosclerotic plague or a combination of the two

• Account for 80% of strokes

• Thrombotic –atherosclerotic plagues

• Embolic – atrial fib; valve stenosis; MI

Hemorrhagic Strokes

• Account for 20% of strokes

• Rupture of blood vessel with bleeding into brain tissue

• Intracerebral – associated with trauma, HTN, aneurysms

• Subarachnoid hemorrhage, subdural hemorrhage or ventricular hemorrhage

• PCP, crack, cocaine, amphetamines and heroin have been associated with hemorrhagic stroke

Hemorrhagic Strokes

Signs & Symptoms of a

Stroke

•Can be permanent or resolve in time

•Can vary depending on type and location

Symptoms of Cerebrovascular

Accident according to

ArteryHemiparesis

Dysphagia

Visual Chang

es

Altered LOC

Ataxia

Carotid X X X X

Middle Cerebral

X X X X

Vertebro-basilar

X X

Comparison of Right-sided and

Left-sided Stroke

Signs & Symptoms of a

Stroke• Aphasia

– Expressive– Receptive– Global

• Dysarthria• Dysphagia• Dyspraxia

• Hemiplegia• Altered

sensation• Unilateral

neglect• Homonymou

s hemianopsia

• Emotional lability

• Impaired judgement

• Incontinence

Treatment of Client with a

CVA• Oxygenati

on• Ischemic

strokes – tPA

• Blood pressure management

• Osmotic diuretic such as mannitol

• Steroids• Anitconvul

sants• Anticoagu

lants in embolitic strokes

• IV fluids• Surgical

intervention for embolitic strokes

Nursing Care of Client with CVA

• Neurological checks • Monitor respiratory status

–oxygen, turn and reposition, nebulizers, suctioning, deep breathing exercises if capable

• Seizure precautions• Safety precautions• Fluid volume balance• Proper care of tube

feedings / TPN

Nursing Care of Client with CVA• Homonymous

Hemianopsia – in acute phase, position so that approached on the unaffected side

• Position affected side carefully, check placement and safety

• Re-orient client

• Aphasia – use gestures, simple, clear statements; yes/no questions; allow time for responses

• Proper skin care• Range of motion• Catheter care• Support and

reassurance

Nursing Care of Client with CVA

Rehabilitation Phase

•Goal is to maximize functional ability and compensate for losses

•Interdisciplinary approach

•Promote independence in ADLs – use assistive devices

•For homonymous hemianopsia – place items on affected side to challenge client and teach them to scan

• Speech therapy• Toileting schedule• Physical and

occupational therapy

Rehabilitation Phase

Thank you