Mwami Schools of Nursing and Midwifery

MWAMI SCHOOLS OF NURSING AND MIDWIFERY
COURSE: MEDICINE & MEDICAL NURSING
TOPIC: CEREBRAL VASCULAR ACCIDENT(CVA)/STROKE
BY: BALDWIN HAMOONGA
5TH YEAR NURSING STUDENT (RU)
SUPERVISOR: MR.J NYERENDA
04/04/2020 [email protected] 1
GENERAL OBJECTIVE
 By the end of this lesson, 2nd year RNs should be able to demonstrate
an understanding about cerebral vascular accident(CVA) stroke and be
able to manage a patient with it.
SPECIFIC OBJECTIVES
 By the end of this lesson, 2nd years RNs should be able to;
 Define cerebral vascular accident(CVA)/ stroke.
 Discuss the incidence of CVA

SPECIFIC OBJECTIVES CONT’
 Outline the predisposing of CVA
 State the causes of CVA
 Discuss the types of CVA
 Explain the signs and symptoms of CVA
 Mention the investigations in making the diagnosis of CVA
 Discuss the management of CVA
INTRODUCTION
Cerebral vascular accident (CVA) or stroke, it is any functional

abnormality of the central nervous system that occurs when the normal
blood supply to the brain is disrupted. stroke is one of the highest cause
of death around the world, nearly 2M People globally suffer from
stroke.
DEFINATION OF CVA/STROKE
• Stroke/Cerebral Vascular Accident(CVA) is a clinical syndrome that

occurs when blood supply to parts of the brain is disrupted causing
brain cells to die (Rosemary S, 2002)
INCIDENCE
• AGE: higher in people above 65 years old, those who survive, 50% to
70% will function independently and 15% to 30% will live with
permanent disability.
• SEX: more common in men than women.
PREDISPOSING FACTORS
NON-MODIFIABLE
AGE
 Above 65 years.
GENDER
 More in men than women

RACE
 African American
PREDISPOSING FACTORS CONT’
FAMILY HISTORY
 Hereditary
MODIFIABLE
Hypertension
 Can cause rapture of brain blood vessels leading to hemorrhagic stroke
Heart diseases
 heart diseases such as coronary heart disease or heart attack can cause
stroke by depositing of blood clot which can block the brain blood
vessels.
Smoking &Excessive alcohol consumption
 can cause atrial fibrillation (irregular heart beat) which can cause clots
which can block the brain blood vessels.
Obesity
 Excessive fats can lead to poor blood circulation.
Sleep apnea
 Reduced oxygen supply to the brain hence hypertension which can
cause brain blood vessels rapture
Oral contraceptives
 By raising blood pressure and making blood hypercoagulable.
CAUSES OF STROKE/CVA
Ischemia
 Due to Loss of blood supply to the brain
Hemorrhage
 Bleeding in the brain could be due to head injury or blood vessel

rapture.
TYPES OF STROKE
 Strokes are classified as ischemic or hemorrhagic based on the cause

findings.
1.ISCHEMIC STROKE
 An ischemic stroke results from inadequate blood flow to the brain

from partial or complete occlusion of an artery. These accounts for
approximately 80% of all strokes. Ischemic stroke is further divided
into thrombotic and embolic.
TYPES OF STROKE CONT’
A. Thrombotic stroke
 It occurs from injury to a blood vessel walls and formation of a blood

clot. The lumen of the blood vessels becomes narrowed and if it
becomes occluded, infarction occurs. The occlusion readily occurs on
the narrowed arteries. Two third of thrombotic stroke are associated
with hypertension or diabetic mellitus.
B. Embolic stroke
 This type of stroke occurs when a blood clot or a piece of

atherosclerotic plaque (cholesterol and calcium deposits on the wall of
the inside of the heart or artery) breaks loose, travels through the
bloodstream and lodges in the arteries in the brain.
(Rosemary S, 2002)
2. HEMORRHAGIC STROKE
• is when blood from an artery begins bleeding into the brain. This
happens when a weakened blood vessel bursts and bleeds into the
surrounding brain, Pressure from the leaked blood damages brains
cells, and, as a result, the damaged area is unable to function
properly. High blood pressure and trauma are two leading causes.
TYPES OF STROKE
SIGNS & SYMPTOMS
• VISUAL FIELD DEFICITS
• Homonymous hemianopia (loss of half of the visual field)
• Unaware of person or objects on the side of visual loss
• Neglect of one side of the body
• Difficulty judging distance
SIGNS & SYMPTOMS CONT’
Loss of peripheral vision
 Difficulties seeing at night
 Unaware of objects or the borders of objects
 Diplopia (Double vision)
MOTOR DEFICITS
Hemiparesis
 Weakness of the face, arm, and leg non the same side (due to a lesion
in the opposite hemisphere)
Hemiplegia
 Paralysis of the leg non the same side (due to a lesion in the opposite)
Ataxia
 Defective muscular co-ordination, unsteady gait unable to keep feet

together; needs to broad base to stand.
Dysarthria
 Difficulties in forming words
Dysphagia
 Difficulties in swallowing.
SENSORY DEFICIT
Paresthesia
 Numbness and tingling of extremities.
 Occurs on the side opposite the lesion.
VERBAL DEFICIT
Expressive aphasia
 Unable to form words that are understandable; may be able to speak in

single-word responses.
Receptive aphasia
 Unable to comprehend the spoken word; can speak but may not make
sense.
Global (mixed) aphasia
 Combination of both receptive and expressive aphasia
COGNITIVE DEFICIT
 Short and long term memory loss
 Decreased attention span
 Impaired ability to concentrate
 Poor abstract reasoning

 Altered judgement
EMOTIONAL DEFICIT
 Loss of self-control
 Emotional lnstability
 Deceased tolerance to stressful situation
 Depression
• Withdrawals
• Fear, hostility and anger
• Feelings of isolation
(Rosemary S, 2002)
MANAGEMENT
GOALS
 Minimize volume of brain reversibly damaged
 Prevent complications
 Rehabilitation
 Reduce risk of occurrence.
MANAGEMENT CONT’
INVESTIGATIONS
CT SCAN
 Create images of the brain, detection of bleeding.
COMPUTED TOMOGRAPHY (CT)
 Brain scan- creates high images; tumors, sinus blockage, bleeding.
LUMBAR PUNCTURE
 Blood found in CSF indicate cerebral bleeding.

MANAGEMENT CONT’
CEREBRAL ANGIOGRAM
 images of blood vessels.
PHARMACOTHERAPY
Heparin
Action
 anticoagulant prevents clotting.
MANAGEMENT CONT’
Dose
 5000 units SC q8-12 hourly(prophylaxis)
 80 units/kg IV bolus, THEN continue infusion of 18 units/kg/hour.
Side effects
 Thrombocytopenia , Bleeding (gums, nose, mouth etc)
Caution
 Only given in ischemic type of stroke patients

MANAGEMENT CONT’
Aspirin
Action
 Blood thinner prevents clotting.
Dose
 500mg-1g tds.
MANAGEMENT CONT’
Side effects
 Easily bleeding
 Tinnitus
 Nausea
 Caution
 Only given in ischemic type of stroke patients
(Bradberry, 2002).
MANAGEMENT CONT’
SURGICAL MANAGEMENT
ISCHEMIC STROKE
Endovascular intervention
 Angioplasty and stenting- a mechanism of clot disruption/clot

extraction.
Intracranial hemorrhage
 Surgical evacuation of hematoma (craniotomy)

MANAGEMENT CONT’
Intraventricular hemorrhage /hydrocephalus
 External Ventricular drainage
NURSING MANAGEMENT
Airway
 Keep the mouth clean free of foreign bodies & dentures.
 Prevent tongue fall, can use tongue depressor
 Elective tracheostomy should be performed after 2 weeks for

MANAGEMENT CONT’
 prolonged coma or pulmonary complications.
Observations
 Check vital signs quarter hourly (BP, respirations, pulse)
 Use of a Glasgow coma scale (used to assess the level of conscious)
 It has three parameters; eye opening(E), verbal response(V), motor

response(M)
 Check for oxygen saturation using a pulse oximeter 4/1 hourly.

MANAGEMENT CONT’
 Monitor blood glucose levels using a glucometer to prevent

hypoglycemia and hyperglycemia.
Prevent Muscle atrophy
 Do passive muscle exercises
 Call a physiotherapist for daily patient exercises.
MANAGEMENT CONT’
Electrolyte balance
 Fluids such as normal saline should be administered IV in case of

hypovolemia.
 Typically, 3 liters per day is given
Oxygen therapy
 Administer oxygen as necessary if the patient is hypoxic, use nasal

tubing or mask, sometimes the patient might have to be intubated if
MANAGEMENT CONT’
-unable to breath on his/her own.
Nutrition
 The patient might lose conscious or be paralyzed, feed the patient if

possible orally, if unconscious dextrose IV can be given or NGT
feeding has to be done.
MANAGEMENT CONT’
Elimination
 The patient might not be able to visit the toilet due to loss of
consciousness or paralyzed, nurses should offer bedpan if conscious.
 Catheterization has to be done and wearing the patient dippers in their

unconscious state. The elimination process has to be checked hourly
and be documented in order to rule out constipation.
MANAGEMENT CONT’
Psychological care
 If the patient is able to get the voice, talk to the patient about the
condition and other things to avoid depression.
 Talk to the family members that we are doing everything possible to

the best interest of the patient.
 Encourage family support be shown to the patient.
MANAGEMENT CONT’
Medication
 Give prescribed drugs as ordered and make sure to look out for any
improvement for drug efficacy, monitor for drug side effects for
possible drug change if undesired results are seen.
Blood pressure management
 Blood pressure should be kept in the normal ranges (systolic 120-139,

diastolic (80-89 mmhg) as hypertension or hypotension can worsen -
MANAGEMENT CONT’
 -the condition, fluids and blood pressure drugs should be used for
regulations.
Prevention of bed sores
 Do decubitus sore care
 Hourly turning of the patient
 Bed making routinely
 Change the soiled beddings frequently

MANAGEMENT CONT’
IEC
 Educate patient and family to notify the staffs immediately of

neurological changes.
 Instruct patient to ask for help when changing position, make sure
position doesn’t hinder blood flow
COMPLICATIONS
• Cerebral oedema
• Aspiration pneumonia
• Hypertension
• Hypoglycemia
• Pressure sores
• Constipation
• Deep vein thrombosis
• Epileptic seizure
(Behrouz, 2019)
SUMMARY
• Stroke/CVA is a clinical syndrome that occurs when blood supply to
parts of the brain is disrupted causing brain cells to die. There are two
main causes of stroke we discussed today namely; hemorrhagic and
ischemic, we have looked at the signs and symptoms, the
investigations carried out to diagnose stroke, the management which is
in three forms; surgical, pharmacotherapy and nursing management.
We further discussed the complications of stroke.
EVALUATION
• What is cerebral vascular accident(CVA)/ stroke.
• How is the incidence of Cerebral Vascular Accident?
• What are the predisposing of Cerebral Vascular Accident?
• What are the causes of Cerebral Vascular Accident?
• What are the types of Cerebral Vascular Accident?
• What are the signs and symptoms of Cerebral Vascular Accident?
• What are the investigations in making the diagnosis of Cerebral
Vascular Accident?
• what is the management of Cerebral Vascular Accident?
ASSIGNMENT
Write briefly in your note books explaining how the listed complications
can come about.
REFERENCES
Behrouz, Reza et all (2019). complications of acute stoke. Spring

Publishers, New York, America
Bradberry JC, Fragan SC, (2002) stroke: pharmacotherapy, fifth edition.

McGraw-Hill publication division, New York, America.
http://www.utoledo.edu /policies/utmc/nursingstandards/S19.pdf
Retrieved on 27/02/2020.
Rosemary S, (2002) understanding stroke. McGraw-Hill, America


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MWAMI SCHOOLS OF NURSING AND MIDWIFERY

COURSE: MEDICINE & MEDICAL NURSING

TOPIC: CEREBRAL VASCULAR ACCIDENT(CVA)/STROKE

BY: BALDWIN HAMOONGA

5TH YEAR NURSING STUDENT (RU)

SUPERVISOR: MR.J NYERENDA

 Define cerebral vascular accident(CVA)/ stroke.

 Discuss the incidence of CVA

 Outline the predisposing of CVA

 State the causes of CVA

 Discuss the types of CVA

 Explain the signs and symptoms of CVA

 Mention the investigations in making the diagnosis of CVA

 Discuss the management of CVA

Cerebral vascular accident (CVA) or stroke, it is any functional

• Stroke/Cerebral Vascular Accident(CVA) is a clinical syndrome that

 More in men than women

 Can cause rapture of brain blood vessels leading to hemorrhagic stroke

Smoking &Excessive alcohol consumption

 By raising blood pressure and making blood hypercoagulable.

 Due to Loss of blood supply to the brain

 Bleeding in the brain could be due to head injury or blood vessel

 Strokes are classified as ischemic or hemorrhagic based on the cause

 An ischemic stroke results from inadequate blood flow to the brain

 It occurs from injury to a blood vessel walls and formation of a blood

 This type of stroke occurs when a blood clot or a piece of

• VISUAL FIELD DEFICITS

• Homonymous hemianopia (loss of half of the visual field)

• Unaware of person or objects on the side of visual loss

• Neglect of one side of the body

• Difficulty judging distance

Loss of peripheral vision

 Difficulties seeing at night

 Unaware of objects or the borders of objects

 Diplopia (Double vision)

 Defective muscular co-ordination, unsteady gait unable to keep feet

 Difficulties in forming words

 Numbness and tingling of extremities.

 Occurs on the side opposite the lesion.

 Unable to form words that are understandable; may be able to speak in

Global (mixed) aphasia

 Combination of both receptive and expressive aphasia

 Short and long term memory loss

 Decreased attention span

 Impaired ability to concentrate

 Poor abstract reasoning

 Deceased tolerance to stressful situation

• Fear, hostility and anger

 Minimize volume of brain reversibly damaged

 Reduce risk of occurrence.

 Create images of the brain, detection of bleeding.

COMPUTED TOMOGRAPHY (CT)

 Brain scan- creates high images; tumors, sinus blockage, bleeding.

 Blood found in CSF indicate cerebral bleeding.

 images of blood vessels.

 anticoagulant prevents clotting.

 5000 units SC q8-12 hourly(prophylaxis)

 80 units/kg IV bolus, THEN continue infusion of 18 units/kg/hour.