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CEREBROVASCULAR DISEASE (RISK FACTORS (Age, Gender, Genetics, Personal…

- - - - • These are episodes of temporary neurological dysfunction due to ischaemia.
      - The onset of the attack is rapid, followed by complete spontaneous resolution.
      - Attack lasts less than 24 hours and most of TIAs resolve with 30 minutes.
    - - This type of stroke is usually due to atherosclerotic occlusion.
      - This type of stroke makes approximately 40% of all cerebrovascular disease accidents (CVA)
      - The onset of stroke is gradual, occurring over hours or even days, preceded by TIAs
    - - Embolic Embolic stroke may be caused by blood clots, atheromatous material that has broken off from the arterial wall.
      - stroke makes approximately 30% of the CVAs.
      - Embolic stroke are abrupt in onset and are typically not preceded by TIAs
  - - - Intracerebral bleeding is responsible for about 10% of all strokes.
      - The onset of stroke is abrupt and often occurs immediately after some event that caused the patient’s blood pressure to increase.
    - - This is the bleeding into the subarachnoid space, is a relatively uncommon but devastating type of cerebrovascular accident.
    - - This often the result of trauma to the head where blood vessels are ruptured and bleed into extradural space.
      - Important point for a nurse to remember is that extradural bleeding is associated with a phenomenon known as the lucid interval.
    - - Many subdural haemorrhages are also due to trauma and present in the same way as an extradural bleed.
      - Spontaneous subdural bleeding may occur especially in the elderly.
      - Causes include bleeding and rapture of small blood vessels in the arachnoid mater due to hypertension.
- - - - This therapy is given to prevent progressive thrombosis or recurrent emboli.
      - Give Heparin intravenously
      - Monitor clotting factors as anticoagulant can cause intracranial bleeding.
    - - This may be used to attempt dissolving of blood clots.
      - Therapy must be commenced within 3hours of the onset.
      - Intracranial haemorrhage is the potential complication
    - - This is carried out to patients with mild stroke or frequent TIAs to relieve obstruction of the carotid artery.
      - Patient with cerebral ischemia or carotid obstruction greater than 30% are not suitable for surgery.
    - - Lowering blood pressure may significantly reduce cerebral perfusion.
      - Patient with high blood pressure must be on antihypertensive therapy.
  - - - NURSING GOALS Re-establish mobility as soon as possible
      - INTERVATIONS
        
        Provide walking assistance e.g walking stick or walking frame
        
        Rails in the toilet or bathroom may be needed to enable the patient to be independent.
        
        Daily activities like dressing, eating and eliminating should be re-established
    - - NURSING GOALS
        
        Patient and family understand and accept the condition
        
        Patient accepts the residual deficit and actively participates in the rehabilitation programme
      - INTERVANTIONS
        
        Assess prior knowledge and level of understanding.
        
        Arrange medical practitioner to talk to the patient and family about the condition.
        
        Maintain supportive role throughout
        
        Provide information on rehabilitation programme and community facilities that can provide on-going support.