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STROKE, Screen Shot 2020-06-15 at 4.04.21 PM, Fig 57.4 Manifestation of Rt…
STROKE
Pathophysiology
:
Stroke is also called CVA (cerebral vascular attack)
Transient ischemic attack (TIA) can be a warning sign of an impending stroke.
Stroke = occurs in brain when there is either an inadequate blood flow (ischemia) or when bleeding (hemorrhage) into the brain
It happens when there is a loss of blood circulation to part of the brain.
Signs & Symptoms:
Neurologic deficits, headache, nausea, vomiting, decreased LOC, HTN, dysphagia, dysarthria, impaired urinary/bowel excretion
FAST: Face drooping, Arm weakness, slurred speech or speech difficulties
Blurred vision, loss of balance, leg weakness
Medications:
Antiplatelets (Aspirin), Anticoagulants
Ticlopidine, Clopidogrel (Plavix), Dipyridamole
Statins to lower cholesterol
Related Disorders:
Vascular Disease - history
Cerebral Vasculature
HTN, Heart Disease, Diabetes
Obesity, Sleep Apnea
Metabolic Syndrome, Sickle cell disease
Migraines, Inflammatory conditions
Blood clotting disorders
Contraceptives
Priority Nursing Assessment:
Post stroke: Motor deficits:
impaired swallowing and speech, gag reflex, ADL
Akinesia - loss of skilled voluntary mvnt
initial Hyporeflexia - depressed reflexes, progress to Hyperreflexia
Changes in LOC and vital signs
Changes in coagulation studies and lab values
Independent Nursing Intervention:
Teach FAST, warning signs of stroke:
Face drooping
Arm weakness
Speech difficulties
Time -very critical, note time of first sign
Teach risks and Encourage cessation of smoking
Teach and Encourage Limit Alcohol Consumption to reduce HTN and further reduce chances of stroke
Encourage exercising to reduce risk of stroke, Light to Moderate exercise 40 mins 3 to 4 days a week
Teach and Encourage a healthy diet, to reduce sodium intake, and to follow a diet low in saturate fats and high in fruits and veggies
Encourage pt to continue to see PCP for follow-ups and further testing
Encourage pt to reduce sodium intake
Collaborative Nursing Intervention:
Physical Therapist: to help the pt regain and retrain muscular/neuro strength; Some pts have flaccid stages, muscle spasms, a weaken/paralyzed side of the body
Speech Therapist: to help pt with any speech disorders that may have developed
Dr Orders: CT Scan, CT Angiography, MRI perfusion & diffusion imaging, MRA, Carotid angiography, Transcranial Doppler ultrasonography, chest xray, EKG
Dr Orders: Cardiac Markers (troponin, Creatine kinase-MB), Coagulation studies (pt, ptt), CBC w/ platelets, Lipid panel, renal & hepatic studies, electrolyte panel w/ blood glucose
Nutritionist: to educate pt on healthy diet choices
Delegated Tasks:
UAP: assist pt with self-care/bathing/using restroom, report any changes in vitals and LOC, record urine intake/output, assist with positioning and turning,
2 TYPES OF STROKES:
Ischemic Stroke
Inadequate blood flow to brain from partial or complete occlusion of artery usually caused by a blood clot
Embolic or Thrombotic strokes
Common in pt w/ high cholesterol, atherosclerosis, or diabetes
Decreased LOC is sometimes not shown in the first 24 hours; Symptoms progress in the first 72 hours
Embolic Strokes: when an embolus lodges and occludes a cerebral artery; Severe manifestations occur suddenly and rapidly;
Medications: Fibrinolytic = tPA
Anticoagulants and antiplatelets after pt is stabilized
Hemorrhagic Stroke
Bleeding into brain tissue or into subarachnoid space/ventricles
Intracerebral Hemorrhage: bleeding w/in brain caused by rupture of a vessel; Prognosis is poor; HTN most common cause
Sudden onset of symptoms w/ progression from minutes to hours
Manifestations: neurologic deficits, headache, nausea, vomiting, decreased LOC, HTN
Manifestation of severe hemorrhage: abnormal body posturing, coma, hemiplegia, fixed & dilated pupils
Subarachnoid Hemorrhage: Intracranial bleeding into CSF; Often caused by cerebral Aneurysm but other causes can be cocaine use, trauma to the head
Cerebral aneurysm = Silent Killer ; most do not have warning signs/symptoms
LOC ranges from alert to comatose depending on bleeding range
stiff neck, seizures, focal neurologic deficits
Medications: Calcium channel blocker = Nimodipine to treat cerebral vasospasms
Fig 57.4 Manifestation of Rt-brain & Lt-brain stroke
Reference:
CNE, M. M., Jeffrey Kwong, D., Roberts, D., Hagler, D., & Dnp, C. R. (2019). Ch47, Lewis's medical-surgical nursing E-book: Assessment and management of clinical problems (11th ed.). Elsevier Health Sciences.
