Cerebrovascular Accidents
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Transcript of Cerebrovascular Accidents
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CerebrovasculCerebrovascular Accidentsar Accidents
Rochee P. Benito, RNRochee P. Benito, RN
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“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
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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
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Types of Strokes
• Transient Ischemic Attacks
• Ischemic• Hemorrhagic
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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
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• When symptoms persist more than 24 hours but then disappear, the patient is said to have Reversible Ischemic Neurologic Deficits
Transient Ischemic Attack
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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
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Diagnosis of TIA
• Health History• Clinical
Presentation• Brain imaging –
MRI / CT• Cerebral
angiography• Carotid Doppler
Testing
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Treatment of TIA
• Aimed at cause• Hypertension
management• Decrease platelet
aggregation– Ticlid (ticlopidine)– Plavix (clopidogrel)– Aspirin
• Coumadin (warfarin)• For carotid stenosis
>70% - endarterectomy
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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
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Hemorrhagic Strokes
• Account for 20% of strokes
• Rupture of blood vessel with bleeding into brain tissue
• Intracerebral – associated with trauma, HTN, aneurysms
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• Subarachnoid hemorrhage, subdural hemorrhage or ventricular hemorrhage
• PCP, crack, cocaine, amphetamines and heroin have been associated with hemorrhagic stroke
Hemorrhagic Strokes
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Signs & Symptoms of a
Stroke
•Can be permanent or resolve in time
•Can vary depending on type and location
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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
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Comparison of Right-sided and
Left-sided Stroke
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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
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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
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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
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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
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• 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
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Rehabilitation Phase
•Goal is to maximize functional ability and compensate for losses
•Interdisciplinary approach
•Promote independence in ADLs – use assistive devices
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•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
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Thank you