BRAIN ATTACKS
                      AKA: CVA’s
INTRODUCTION / DEFINITION
•Other terms:
  –Stroke
  –Cerebral Vascular Acci...
CLASSIFICATIONS / CATEGORIES (continued)
•Ischemic
   –Blood supply to part of the brain is suddenly interrupted by:
     ...
•Manifestations
  –Depend upon location and size of cerebral vessel involve
  –Sudden onset with disappearance within minu...
EMBOLIC CVA’s
•Definition
•Pathophysiology
  –Most frequent site: bifurcation of vessels (carotid and middle
  cerebral ar...
•Seizures
     •Hemiplegia
     •S/Sx of increased intracranial pressure
     •LOC (loss of consciousness)

TYPICAL SIGNS/...
•Right Brain Injury
   –Left hemiplegia
   –Difficulty with spatial-perceptual tasks:
     •Distance
     •Size
     •Posi...
•Lumbar puncture (if no danger of ↑ ICP)
•Blood studies
•EEG

MANAGEMENT OF CLIENTS
WITH BRAIN ATTACKS
•Assessment
•Treatm...
•Maintain airway
•Frequent neuro-checks, vital signs and general assessment
•Observe for signs of progression of thrombosi...
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Cerebrovascular Accident Student outline

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Cerebrovascular Accident Student outline

  1. 1. BRAIN ATTACKS AKA: CVA’s INTRODUCTION / DEFINITION •Other terms: –Stroke –Cerebral Vascular Accident •Definition: –Condition in which neurological deficits result from decreased blood flow to the brain •Incidence: –3rd Leading cause of death in North America –600,000 (approx.) CVA victims per year –At least 80% of CVA victims survive –Many survivors are left with functional impairments. CLASSIFICATIONS / CATEGORIES •Two basic categories –Occlusion –Hemorrhage •More specific causes –Arterial spasm –Compression –Thrombosis –Embolism –Lacunar stroke •More specific causes (cont.) –Hemorrhage may occur: •Outside the dura mater •Beneath the dura mater •In the subarachnoid space •Within the brain substance (ICH) (intracerebral hemorrhage)
  2. 2. CLASSIFICATIONS / CATEGORIES (continued) •Ischemic –Blood supply to part of the brain is suddenly interrupted by: •Thrombus •Embolus •TIA’s (transient ischemic attack) •Hemorrhagic –Blood vessel breaks and spills blood into the brain RISK FACTORS •TIA’s •Hypertension •Diabetes mellitus •Substance abuse •Atherosclerosis •Obesity •Sedentary life-style •Hyperlipidemia •Atrial fibrillation •Oral contraceptives •Cigarette smoking ISCHEMIC CVA’s TIA’s •Localized cerebral ischemia which causes temporary neurological deficits •Considered to be a warning signal for ischemic CVA’s •Causes: –Inflammatory artery disorders –Sickle cell anemia –Atherosclerotic changes in cerebral vessels –Thrombosis –Emboli –Subclavian Steal Syndrome
  3. 3. •Manifestations –Depend upon location and size of cerebral vessel involve –Sudden onset with disappearance within minutes, hours or a couple of days –Contra-lateral numbness or weakness of hand, forearm, corner of mouth (middle cerebral artery) –Aphasia –Visual disturbances such as blurring (posterior cerebral artery) THROMBOTIC CVA’s •Definition –Occlusion of a large cerebral vessel by a thrombus •Target Population –Often seen in older people who are resting or sleeping •Patho –Clots tend to form in: •Large arteries that bifurcate and . . . •Narrowed lumens as a result of atherosclerotic plaque –Common locations: •Internal carotid artery •Vertebral arteries •Junction of vertebral and basilar arteries •Lacunar strokes –Thrombotic strokes which affect smaller cerebral vessels and leave small cavities or “lakes” •Manitestations –Occur rapidly but usually progress slowly –May start as TIA and worsen (“stroke-in-evolution”) –Maximum neurological damage usually reached in 3 days (“completed stroke”) –Affected area is edematous & may become necrotic
  4. 4. EMBOLIC CVA’s •Definition •Pathophysiology –Most frequent site: bifurcation of vessels (carotid and middle cerebral arteries) –Most embolic CVA’s originate from thrombi in the left chamber of the heart during atrial fibrillation. –Other sources of emboli •Target Population HEMORRHAGIC CVA’s •Defined as “intracranial hemorrhage” •Occur when cerebral blood vessel ruptures •RISK FACTORS –Sustained increase in BP –Intracranial aneurysms –Trauma –Erosion of blood vessels by tumors –Arterio-venous malformations –Anticoagulant therapy –Blood disorders •Pathophysiology –Blood vessel ruptures and blood enters tissues, cerebral ventricles or subarachnoid space. This leads to . . . •Compression of adjacent tissues causing . . . •Blood vessel spasms and cerebral edema –Blood in ventricles or subarachnoid space irritates meninges & brain tissue causing . . . •Inflammatory reaction and . . •Impairing absorption and circulation of CSF •Prognosis •Manifestations –Onset of S/Sx is rapid unless bleed is a slow leak. –Depend upon location of hemorrhage •Vomiting •Headache
  5. 5. •Seizures •Hemiplegia •S/Sx of increased intracranial pressure •LOC (loss of consciousness) TYPICAL SIGNS/SYMPTOMS OF CVA’s •Focal –Weakness –Paralysis –Sensory loss –Language disorders •Broca’s •Wernicke’s –Reflex changes –Visual changes •Generalized –Headache –Vomiting –Confusion / Disorientation –Seizures –Coma –↑ BP –Memory impairment & other mental changes –Fever –Cardiac abnormalities –Nuchal rigidity –Sclerosis of peripheral vessels & retinal vessels •Left Brain Injury –Right hemiplegia –Dysphasia / aphasia / agraphia –Frequently understand more than they can speak or write. –Behavioral style •Slow •Cautious •Disorganized •Anxious
  6. 6. •Right Brain Injury –Left hemiplegia –Difficulty with spatial-perceptual tasks: •Distance •Size •Position •Rate of movement •Form •Relationship of parts to the whole –Impaired time perception –Errors are inconsistent –Behavioral style •Quick •Impulsive •Often unaware of deficits •Perform unsafe activities ONE-SIDED NEGLECT •Deficit of: –Looking –Listening –Touching –Searching •May have visual field cuts •Clinical Manifestations –Eat food only on one side of the plate. –Ignore person who approaches impaired side. –Fail to attend to one side of the body. •Put makeup on one side of the face only. DIAGNOSIS •CT •MRI •Arteriography of cerebral vessels •PET (positron emission tomography) •Doppler (transcranial ultrasound)
  7. 7. •Lumbar puncture (if no danger of ↑ ICP) •Blood studies •EEG MANAGEMENT OF CLIENTS WITH BRAIN ATTACKS •Assessment •Treatment –Medications –Surgery –Physical Therapy –Occupational Therapy –Speech Therapy –Education –Home Care •Diagnostic Tests •History •Head-to-Toe •Treatment depends on severity, nature and extent of damage. •Treatment is directed toward: –Preserving life. –Minimizing residual deficits. –Reducing ICP (intracranial pressure). –Preventing extension of manifestations. –Preventing recurrence of brain attack. •Aspirin •Plavix (clopidrogrel) •Persantine (dipyridamole) •Trental (pentoxifylline) •Ticlid (ticlopidine) •Anticoagulation therapy •Thrombolytic therapy •Carotid endarectomy •Extracranial-intracranial bypass
  8. 8. •Maintain airway •Frequent neuro-checks, vital signs and general assessment •Observe for signs of progression of thrombosis or hemorrhage –LOC changes –Increased loss of motor or sensory function –Progressive aphasia –Increased respiratory difficulty •Ensure F&E balance •Maintain proper positioning & alignment •Maintain adequate elimination •Prevent constipation / impaction •Involve significant others in plan of care •Provide restful, quiet environment •Administer meds as ordered •If eyelids remain open protect the eye: –Sterile saline (no preservatives) –Artificial tears –Patch •Mouth care •Prevent intellectual regression –Reorient –Talk with client –Post date, nurse’s name –Place clock where client can easily see it BE SURE TO REVIEW CRANIAL NERVES (number, name, symptoms of deficits, assessment and nursing measures) A & P of the NEUROLOGICAL SYSTEM QUESTIONS???

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