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Unit 8 Adult Health Nursing
1. Unit VIII- ADVANCE NURSING MANAGEMENT
OF NEUROVASCULAR DISEASES
Cerebral vascular accident
BY
SEHRISH NAZ
RN, Post RN, MSN
Lecturer, Institute of Nursing Sciences, Khyber Medical
University
Subject: Adult Health Nursing
2/8/2020 Post RN semester one 1
2. Objective
• Utilize Functional health pattern to identify patients
problems related to Cerebral vascular accident.
• Integrate pathophysiology and pharmacology concepts
of Cerebral vascular accident.
• Apply with support on Evidence-Based Nursing (EBN)
to provide to the clients with Cerebral vascular
accident.
• Discuss the holistic approach for nursing management
of the patient with Cerebral vascular accident.
• Develop a teaching plan for a client experiencing
disorders of the Cerebral vascular accident.
5. Case Study
Patient name: XYZ
Age: 60 years
Gender: Male
Chief Complains:
Sudden Loss of Consciousness since yesterday
Right side weakness----one day
Dysarthria(slurred speech)
He also complained of vomiting before LOC
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6. Cont..
Past Medical Hx : Known DM and HTN
Family history: Father had HTN
Socio-economic history: Middle class
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10. Treatment (Rx)
• Inj: Lasix 40mg OD
• Tab: Lowplat 75mg P/O OD
• Tab: Rovista 10mg P/O OD
• Tab: Ascard 150mg P/OOD
• Tab: Concor 5mg BD
• Inj: Rocephin 2gm IV OD
• Inj: Zantac 50mg IV BD
2/8/2020 10
11. Definition of Stroke
According to World Health Organization (WHO)
stroke is “a clinical syndrome consisting of rapidly
developing clinical signs of focal disturbance of
cerebral function, lasting more than 24 hours or
leading to death with no apparent cause other
than that of vascular origin”
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12. Types of Stroke
• Classification based on underlying
pathophysiologic findings
– Ischemic
• Thrombotic
• Embolic
– Hemorrhagic
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14. Ischemic Stroke
• Result of inadequate blood flow to brain due to
partial or complete occlusion of an artery
constitute 85% of all strokes
• Most patients with ischemic stroke do not have a
decreased level of consciousness in the first 24
hours
• Symptoms often worsen during first 72 hours
due to cerebral edema
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15. Hemorrhagic Stroke
• Account for approximately 15% of all
strokes
• Result from bleeding into the brain tissue
itself or into the subarachnoid space or
ventricles
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16. Transient Ischemic Attacks (TIA)
• Temporary focal loss of neurologic
function caused by ischemia (analogous to
angina in CAD)
• Most resolve within 3 hours
• May be due to micro-emboli that
temporarily block blood flow
• A warning sign of progressive
cerebrovascular disease
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23. Clinical Manifestations of Stroke
• Depends on the type of stroke and location of
the lesion
• Contra-lateral impairment
• Hemiparesis - weakness on one side of the
body - entire side; face, arm, or leg
• Numbness on one side
• Loss of vision in one visual field (transient
monocular blindness)
• Dysarthria (slurred speech)
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24. Cont.…
• Visual disturbances e.g. double vision, altered
visual perception
Aphasia - total loss of comprehension and use of
language
• Headache - dizziness, Vomiting
• Memory difficulties
• Behavioral or personality changes
• Swallowing
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26. Diagnostic Studies
• When symptoms of a stroke occur, diagnostic
studies are done to
– Confirm that it is a stroke
– Identify the likely cause of the stroke
• CT is the primary diagnostic test used after a
stroke
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30. Cont.…
Medically: TPA (intravenous tissue plasminogen
activator)
◦ AHA/ASA: Within 4.5 hours
◦ the earlier tPA is administered, the higher the
likelihood of a positive neurologic outcome
Endovascular: Intra-arterial mechanical thrombectomy
◦ For proximal large vessel occlusion of anterior
circulation (intracranial internal carotid, middle
cerebral, anterior cerebral)
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31. Cont.….
Antithrombotic treatment
◦ Aspirin 160 to 325 mg within 48 hours
High dose statin
◦ Atorvastatin 80mg
Anticoagulation: only in cardio embolic stroke
◦ IV not recommended during first 48h after acute
ischemic stroke
◦ Warfarin can be started for small or moderate-
sized infarct after 24 hours
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33. Nursing Management
Nursing Diagnoses
Impaired physical mobility R/t motor cortex
involvement as evidence by hemiplegia
Impaired verbal communication R/t Broca’s
area involvement as evidence by Dysarthria
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35. Nursing Management
Implementation
o provide passive exercise to the affected
area
– Prevent joint contractures and muscular atrophy
– In the acute phase, range-of-motion exercises and
positioning
– Pressure relief by position changes, special
mattresses
– Position patient affected side for only 30 minutes
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41. What should we do…
Aim to reduce the incidence and impact of
stroke
Advocate for prevention and public education
Provide professional education and training
Provide recovery resources for stroke survivors
and caregivers
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42. References:
Ismail A. Khatri & Wasay,M.(2011) Can We Stop
the Stroke Epidemic in Pakistan, Journal of the
College of Physicians and Surgeons Pakistan, Vol.
21 (4): 195-196
Sher,K. Shah,S. & Kumar,S. (2013) Etiologic
Patterns of Ischaemic Stroke in Young Adults,
Journal of the College of Physicians and Surgeons
Pakistan, Vol. 23 (7): 472-475
2/8/2020 42
43. References
• National Stroke Association. The Complete
Guide to Stroke. 2011. At:
http://www.stroke.org/site/DocServer/NSA_c
omplete_guide.pdf?docID=341.
• World Health Organization (2015) The Global
Burden of Disease. 2011 Update. Geneva,
Switzerland: retrieved at www.WHO.org.com
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Brain requires continuous supply of O2 and glucose for neurons to function
If blood flow is interrupted
Neurologic metabolism is altered in 30 seconds
Metabolism stops in 2 minutes
Cell death occurs in 5 minutes
Around the core area of ischemia is a border zone of reduced blood flow where ischemia is potentially reversible
If adequate blood flow can be restored early (<3 hours) and the ischemic flow can be interrupted
less brain damage and less neurologic function lost
