CEREBROVASCULAR ACCIDENT(STROKE)

1. Mr. HIREN GEHLOTH
JG COLLEGE OF NURSING

6. An Ischemic stroke, also known as
a cerebrovascular accident (CVA), or “Brain
Attack” is a sudden loss of function resulting
from disruption of the blood supply to a part
of brain.

7. Definition of intracerebral
haemorrhage:
A focal collection of blood
within the brain parenchyma or
ventricular system that is not
caused by trauma.
Definition of ischemic stroke:
An episode of neurological dysfunction
caused by focal cerebral, spinal, or retinal infarction.

9. TYPES OF STROKE
1. TRANSIENT ISCHEMIC ATTACK:
TIA OR Mini stroke is short term stroke that lasts
for less than 24 hours. The oxygen supply to the
brain is quickly restored and symptoms
disappeared.
A transient stroke need prompt medical attention
because it indicate the a serious risk of a major
stroke.
TIAs occurs before almost 30% of ischemic
strokes.

10. TYPES OF STROKE
An ischemic stroke
occurs when the supply of blood to one or
more regions of the brain is suddenly cut off
or interrupted.
It is similar to a heart attack,
but it occurs in the brain and causes a lack
of oxygen to millions of neurons and other
brain cells fed by the blocked artery.

11. Blockages that cause ischemic strokes stem from three conditions:
 a clot develops within a blood vessel of the brain and grows
large enough to impair blood flow, called thrombosis
 a clot moves from another part of the body (such as the heart
or a diseased artery in the chest or neck) into a narrower
artery in the neck or brain, called embolism
 an artery in the brain or neck narrows, called stenosis.

12. When an artery in the
brain bursts, blood gushes into or
around the brain, damaging the
surrounding tissue. This is called a
hemorrhagic stroke.

14. There are three types of hemorrhagic stroke,
depending on where the bleeding occurs:
 a subarachnoid hemorrhage
 a parenchymal or intracerebral hemorrhage
involves bleeding directly into the brain
tissue
 an intraventricular hemorrhage involves
bleeding into or around the ventricles,
 Cerebral aneurysm
 AVM(Arteriovenous malformation)

15. AVMs

16. Ischemia
Energy failure
Cell injury and death
Glutamate
Cell membranes and proteins breakdown
Formation of free radicals
Protein production decrease
Intracellular calcium increased
Ion imbalance
Acidosis
Depolarization
ISCHEMIC CASCADE

17. CLINICAL MANIFESTATION

18. F—Face: Ask the person to smile. Does one side of the face
droop?
A—Arms: Ask the person to raise both arms. Does one arm
drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is the
speech slurred or strange?
T—Time: If you see any of these signs, call emergency
response team right away.

19. Visual Field Loss
• Hemianopsia (Loss of half of the visual field)
• Loss of peripheral vision
• Diplopia
Motor deficit
• Hemiparesis
• Hemiplegia
• Ataxia
• Dysarthria
• Dysphagia

20. Sensory Deficit
• Paresthesia (occurs on the opposite the lesion)
Verbal Deficit
• Aphasia (Impaired speech
• Expressive aphasia( Inability to express one self),
Receptive aphasia (Inability to understand the language),
Global (Mixed)
Cognitive Deficit
• Short and Long tem Memory loss
• Decrease attention span
• Impaired ability to concentrate
• Poor abstract reasoning
• Altered judgement

21. Emotional Deficit
• Loss of self control
• Emotional lability
• Decrease tolerance to stressful situation
• Depression
• Withdrawal
• Fear, hostility, and anger
• Feelings of isolation

23. DIAGNOSTIC EVALUATION
• CT SCAN
• MRI
• CATHETER BASED ANGIOGRAPHY
• NIHSS SCALE
• FAST
• GCS
• ECHOCARDIOGRAM
• CAROTID ULTRASOUND
• BLOOD INVESTIGATIONS

24. MANAGEMENT OF CVA
• Ischemic Stroke:
(1)Tissue Plasminogen activator: Within 3 hour The Golden Period
It works by binding to fibrin and converting plasminogen to plasmin,
which stimulate the fibrinolysis of clot.(STK, Alteplase)
(1)Anti Coagulant Medication: Heparin and LMWH
(2)Anti Platelet: Aspirin (If Anti Coagulant is contraindicated)
(3)Anti Coagulant: Specific Caumadin/warfarin for the arterial fibrillation
to prevent cardioembolic stroke.

25. Surgical Management:

26. • Hemorrhagic Stroke:
(1) Coagulant: If the cause of hemorrhage is anti-coagulant medicine.
e.g Vitamin K.
(2) Anti Seizure Drug.
(3) Anticoagulant- only and only LMWH if the patient is bed ridden for 4-5
days, to prevent the Deep Vein Thrombosis.
(4) Anti hyperglycemic drug.
(5) Acetaminophen/Analgesics : For pain and fever.

27. Surgical Management:
SURGICAL CLIPPING ENDOVASCULAR COILING

28. THERAPY FOR PATIENTS WITH ISCHEMIC STROKE
NOT RECEIVING TISSUE PLASMINOGEN ACTIVATOR
• Not all patients are candidates for t-PA therapy. In Some cases other treatment may
include anticoagulant administration.
• Maintenance of ICP
• Maintaining the partial pressure of PaCO2 with slightly lower range.
• Providing supplemental oxygen if oxygen saturation is below 92%.
• Elevation of the head of the bed to 25 to 30 degrees to assist the patient in handling oral
secretions and decrease intracranial pressure.
• Possible hemicraniactomy for increased ICP from brain edema in a very large stroke.
• Intubation with an endotracheal tube to establish a patent airway; if necessary.
• Continuous hemodynamic monitoring.
• Frequent neurologic assessment.

30. NURSING DIAGNOSIS
1. Impaired physical immobility related to hemiparesis, loss of balance and
coordination, spasticity, and brain injury
2. Acute pain related to hemiplegia
3. Self care deficits related to stroke sequelae.
4. Impaired physical comfort related to altered sensory reception,
transmission, and/or integration.
5. Impaired swallowing
6. Impaired urinary elimination related to flaccid bladder, confusion, or
difficulty in communicating.
7. Constipation related to change in mental status or difficulty
communicating
8. Impaired verbal communication related to hemiparesis, hemiplegia, or
decreased mobility,
9. Interrupted family processes related to catastrophic illness and care giving
burdens.