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EXAM 3:Cerebrovascular Accident (Stroke) - CHP 59 Lewis Chapter 23 Lewis,…
EXAM 3:Cerebrovascular Accident (Stroke) - CHP 59 Lewis Chapter 23 Lewis
Pathophysiology:
used to describe stroke.
Ischemic
- Inadequate blood flow to the brain from partial or complete occlusion of an artery.
Thrombotic Stroke
:
Occurs from injury to a blood vessel wall and formation of blood clot
Embolic Stroke:
embolus or blood clot or other debris circulating in the blood. When it reaches an artery in the brain that is too narrow to pass through it lodges.
Hemorrhagic
-
bleeding into the brain tissue itself or into the subarachnoid space or ventricles.
-Hypertension is the most common cause
-Prognosis is poor with 30 day mortality rate and 40%-80% recovery.
Intracerebral
- bleeding within the brain caused by a rupture of a vessel
Subarachnoid
- occurs when there is intracranial bleeding into the cerebrospinal fluid(CSF)-filled space between the arachnoid and pia mater membranes on the surface of the brain.
Blood is supplied to the brain by two main arteries:
Internal carotid arteries
-Vertebral arteries
Risk Factors
:
Nonmodfiable:
-Age
-Gender
-Ethnicity
-Race
-Family History
Heredity
Modifiable:
:
-Hypertension
-Heart Disease
-Diabetes
-Smoking
-Obesity
-Sleep Apnea
-Metabolic Syndrome
-Lack of Physical Exercise
-Poor Diet
-Drug and Alcohol Abuse
TIA(Transient Ischemic Attack)
:
A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but WITHOUT acute infarction of the brain.
Nurse Management:
Assessment:
-Description of the current illness with attention to initial symptoms especially onset and duration, nature and challenges
-Current medications
-History of risk factors or other illnesses, such as hypertension
-History of having a similar symptoms previously
-Family history of stroke, aneurysm, or cardio disease
-History of having had similar symptoms previously
Diagnoses
:
-Decreased intracranial adaptive capacity
-Impaired communication
-Difficulty coping
-Risk for aspiration
-Impaired physical mobility
-Risk for injury
Planning:
-maintain stable or improved level of consciousness
-attain maxiumum physical functioning
-attain maximum self-care abilities and skills
-maintain stable body functions
-maximize communication abilities
-maintain adequate nutrition
-avoid complications of stroke
-maintain effective personal family coping
Implementation
:
-Health Promotion
-Acute Care, management of respiratory is priority. Neurologic assessments are ongoing, including NIHSS, mental status, pupillary response, and extremity movement and strength.
Clinical Manifestations
Motor Function:
-mobility
-respiratory function
-Swallowing and speech
-gag reflex
-Self Care abilities
Communication:
Aphasia/Dyshasia - refers to the impaired ability to communicate
Expressive - inability to produce language
Global - total inability to communicate
Receptive - loss of comprehension
Dysarthria - affects the mechanics of speech. Impairment may be pronunciation, articulation, and phonation.
Affect
: Patient may have difficulty controlling emotions.
Intellectual Function
: May impair both memory and judgement.
Left Brain Stroke Patient - Often more cautious in making judgement. EXAMPLE: would move slowly and cautiously from wheelchair.
Right Brain Stroke - tends to be impulsive and move quickly. EXAMPLE: they would rise quickly from wheelchair without locking the wheels or raising the footrests.
Sensory Perceptual Problems:
2nd Category: Occurs when patient neglects all input from affected side. Worsens with homonymous hemianopsia, in which blindness occurs in the same half of the visual fields of both eyes.
3rd Category:
Agnosia
, the inability to recognize an object by sight, touch, or hearing.
1st Category: Damage to the parietal lobe causes to have incorrect perception of self and illness
4th Category:
Apraxia
, the inability to carry out learned sequential movements on command.
Motor Deficits
:
-Akinesia, loss skilled voluntary movement
-Changes in muscle tone
Interprofessional Care Acute Stroke
Preventative Therapy
:
-Healthy Diety
-Weight control
-Regular Exercise
-No Smoking
-Limiting alcohol consumption
-BP Management
-Routine health assessments
Preventative Drug Therapy:
-Antiplatelet drugs are given for prevention, whom had TIAS
-Aspirin 81mg
END OF CHAPTER QUESTIONS
Type of Stroke
Type of Stroke
Type of Ischemic Stroke
Type of Ischemic Stroke
Type of Hemorrhagic Stroke
Type of Hemorrhagic Stroke
