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    Cerebrovascular Accident CVA

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    fleurgab35

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    Cerebrovascular Accident CVA

    Uploaded by

    fleurgab35
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    9 views40 pages

    Cerebrovascular Accident CVA

    Uploaded by

    fleurgab35

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 40

    NEURO SESSION 5 :

    STROKES (2 TYPES)

    JOBELLE A. LOMIBAO
    CAHS- UPANG
    Learning Objectives

    ◼ 1. Explain and differentiate 2 types of stroke.


    ◼ 2. Illustrate pathophysiology of
    cerebrovascular disorders.
    ◼ 3. Discuss management medical and surgical
    management of stroke.
    Cerebrovascular disorders
    > umbrella term that refers to a
    functional abnormality of the CNS
    that occurs when the normal blood
    supply to the brain is disrupted
    Transient Ischemic Attack

    - is a transient or temporary
    episode of neurologic
    dysfunction caused by decreased
    blood supply to the brain
    2 major categories of strokes

    1. Ischemic stroke
    2. Hemorrhagic stroke
    Ischemic stroke

    ◼ sudden loss of function resulting


    from disruption of blood supply to a
    part of the brain caused by
    obstruction of cerebral BV.
    ◼ diminishes oxygen supply in brain
    tissues
    ◼ urgent health care issue similar to a
    heart attack
    5 types of ischemic stroke
    1. Large artery thrombotic strokes
    2. Small penetrating artery thrombotic
    strokes
    3. Cardiogenic embolic strokes
    4. Cryptogenic strokes
    5. Others
    Pathophysiology
    Obstruction of a blood vessel
    ↓
    Cerebral bld. flow disruption (<25mL/100g bld./min)
    ↓
    Neurons unable to maintain aerobic respiration
    ↓
    Mitochondria switch to anaerobic respiration
    ↓
    Membranes begin to fail & cells cease to function;
    ↓
    DEATH
    Risk Factors
    Non-modifiable Risk Modifiable Risk Factors
    Factors
    • Age • Hypertension
    • Atrial fibrillation
    • Gender
    • Hyperlipidemia
    • Race • Diabetes mellitus
    •Asymptomatic carotid stenosis
    • Obesity
    •Lifestyle
    •Arteriosclerosis/atherosclerosis
    Non-modifiable VS Modifiable
    Diagnostic tests

    ◼ Computed tomography
    ◼ Magnetic Resonance Imaging
    ◼ Lumbar puncture
    ◼ Cerebral Angiography
    ◼ Electroencephalogram (EEG)
    ◼ Carotid ultrasound
    A B
    A B
    Clinical Manifestations
    1. Numbness or weakness of the face, arm,
    or leg especially on one side of the body
    2. Confusion or change in mental status
    3. Trouble speaking or understanding
    speech
    4. Visual disturbances
    5. Difficulty walking, dizziness, or loss of
    balance & coordination
    6. Sudden severe headache
    MOTOR LOSS
    ◼ Lesion in the upper motor
    neuron & loss of voluntary
    control over motor movements
    ◼ Because the upper motor
    neurons decussate (cross), a
    disturbance of voluntary motor
    control on one side of the body
    may reflect damage to the
    upper motor neurons on the
    opposite side of the brain.
    ◼ Hemiplegia
    ◼ Hemiparesis
    COMMUNICATION LOSS

    ◼ Aphasia
    ◼ Dysphasia
    ◼ Dysarthria
    ◼ Apraxia- loss of motor function
    PERCEPTUAL DISTURBANCES/
    SENSORY LOSS

    ◼ Homonymous hemianopsia
    ◼ Impairment of touch, loss of
    proprioception, difficulty in
    interpreting visual, tactile &
    auditory stimuli
    ◼ Agnosia
    Clips
    COGNITIVE IMPAIRMENT &
    PSYCHOLOGICAL EFFECTS
    ◼ Impairment in learning capacity, memory
    & higher intellectual functions
    ▪ Limited attention span, difficulties in
    comprehension, forgetfulness & lack of
    motivation
    ◼ Depression, emotional lability, hostility,
    frustration, resentment, lack of
    cooperation
    Comparison of left & right
    hemispheric strokes
    Left Hemispheric Stroke Right Hemispheric Stroke
    •Paralysis or weakness • Paralysis or weakness on
    on right side of body the left side of body
    •Right visual field deficit •Left visual field deficit
    •Spatial perceptual deficits
    •Aphasia (expressive, • Increased distractibility
    receptive, global) • Impulsive behavior & poor
    •Altered intellectual judgment
    ability • Lack of awareness of
    •Slow, cautious behavior deficits
    PREVENTION

    ◼ Primary
    prevention
    ◼ Healthy
    lifestyle,
    daily
    exercise,
    DASH diets
    Pharmacotherapy

    ◼ Anticoagulant
    1. warfarin (Coumadin); cardioembolic strokes

    ◼ Platelet-inhibiting medications
    1. Aspirin (ASA)
    2. Dipyridamole (Persantine)
    3. Clopidogrel (Plavix)
    4. Ticlopidine (Ticlid)
    Clips
    Thrombolytic therapy

    ◼ Thrombolytic agents- used to treat ischemic


    stroke by dissolving the blood clot that is
    blocking blood flow to the brain. (Recombinant
    t-Pa or tissue plasminogen activator)
    ◼ Rapid diagnosis of stroke & initiation of
    thrombolytic therapy (within 3 hours) in patients
    with ischemic stroke leads to a decrease in the
    size of the stroke & an overall improvement in
    functional outcome after 3 months
    ◼ Bleeding- most common side effect
    Surgery
    ◼ Carotid
    endarterectomy;
    ✔ Removal of an
    atherosclerotic
    plaque or
    thrombus
    Management
    ◼ Complete physical & neurologic examination
    ◼ Initial assessment focuses on airway patency
    ◼ Elevation of the head of the bed
    ◼ Intubation with an ET tube
    ◼ Administration of supplemental oxygen
    ◼ Continuous hemodynamic monitoring
    ◼ Neurologic assessment
    ◼ Provide restful & quiet environment
    ◼ STROKE REHABILITATION
    Neurologic Deficit Nursing Interventions
    Homonymous Place objects /approach within intact field of vision; Instruct
    hemianopsia the patient to turn head in the direction of visual loss

    Hemiparesis Place objects within the patient’s reach on the non-affected


    side; exercise & increase strength on the unaffected side

    Hemiplegia Encourage patient to provide ROM exercises to affected side,


    maintain body alignment in functional position

    Ataxia Support patient during the initial ambulation phase; provide


    supportive device in ambulation (walker, cane)

    Dysarthria Provide the patient with alternative method of


    communicating; allow patient sufficient time to respond to
    verbal communication

    Dysphagia Test the pt.’s pharyngeal reflexes before offering foods or


    fluids; place the food on the unaffected side of the mouth;
    allow ample time to eat
    Neurologic Deficit Nursing Implications

    Expressive aphasia (same as dysarthria)

    Receptive aphasia Speak slowly & clearly to assist patient in forming sounds

    Global (mixed) Speak clearly & in simple sentences; use gestures & pictures
    when able

    Cognitive deficits Reorient patient to time, place & situation frequently


    Provide familiar objects (family photographs, favorite
    objects)

    Emotional deficits Support patient during uncontrollable outbursts,


    Provide safe environment, discuss with the family that the
    outbursts are due to the disease process
    Encourage patient to express feelings & frustrations related
    to disease process
    40

    Thanks!
    Any questions?

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