Apply knowledge regarding: patho-physiology, disease process, clinical manifestations, specific diagnostic and therapeutic interventions (diagnostic tests and examinations) of Cerebrovascular disease. Assess, relate and apply the scientific process of nursing, provision and facilitation of nursing care. Evaluate, analyse and solve problems in familiar and unfamiliar context in the Comprehensive Health Care system. Understand the relationship between social, cultural and economic factors that may impact significantly on the health status of clients / patients and groups.

1. 4/17/2018 Compiled by C Settley 1

2. • Apply knowledge regarding: patho-physiology,
disease process, clinical manifestations, specific
diagnostic and therapeutic interventions
(diagnostic tests and examinations) of
Cerebrovascular disease.
• Assess, relate and apply the scientific process of
nursing, provision and facilitation of nursing care.
• Evaluate, analyse and solve problems in familiar
and unfamiliar context in the Comprehensive
Health Care system.
• Understand the relationship between social,
cultural and economic factors that may impact
significantly on the health status of clients /
patients and groups.
4/17/2018 Compiled by C Settley 2

3. • Definition
– Damage to the brain from interruption of its
blood supply.
4/17/2018 Compiled by C Settley 3

4. • According to the World Health
Organization, the disease is responsible
for 6.2 million deaths each year.
• It kills more people each year compared to
AIDS, tuberculosis and malaria put
together.
• It can happen to anyone at any age,
affecting its survivors and also family and
community.
4/17/2018 Compiled by C Settley 4

5. • However, 80% of strokes could be
prevented.
• Up to 50% of survivors would require
some form of institutionalised care or
suffered severe permanent impairment.
• There is a need for new therapies or
strategies that can improve the outcome
for Cerebrovascular Disease patients.
4/17/2018 Compiled by C Settley 5

6. • Atherosclerosis, a condition in which
high cholesterol and arterial inflammation
in the brain cause the cholesterol to build
up into a thick, waxy plaque that can
obstruct the flow of blood to
the brain, causing ischemic
stroke or transient ischemic
attack, or dementia.
4/17/2018 Compiled by C Settley 6

7. • Blood clots may also form in an already-
narrow artery, creating a thrombus; when the
entire artery becomes blocked, this is called a
thrombotic stroke. Usually accompanied
with plaque.
• In addition, a clot may break off from
somewhere else in the body and travel up to
the brain and block a smaller artery there;
this is called an embolism, and it causes an
embolic stroke.
4/17/2018 Compiled by C Settley 7

8. 4/17/2018 Compiled by C Settley 8

9. 4/17/2018 Compiled by C Settley 9

10. • Certain drugs and medical condition
(e.g., carotid dissection, or a tear in the
lining of the carotid artery) can increase a
person’s risk of ischemic stroke, especially
in people under the age of 40 who do not
necessarily have plaque build-up.
• Haemorrhage
4/17/2018 Compiled by C Settley 10

11. Carotid artery disease
• Narrowing of the
blood vessels in the
neck that carry blood
from the heart to the
brain.
4/17/2018 Compiled by C Settley 11

12. • Age
– Being older increases the likelihood of
developing the disease.
• Gender
– Females less prone due to protective effect of
estrogen.
– After menopause the risk is equal.
4/17/2018 Compiled by C Settley 12

13. • Genetics
– Family history.
– Inherited factors such as hyperlipidemia.
• Personality factors
– A-type personality: the work alcoholic, driven
perfectionist type is more at risk than the
relaxed B-type personality individual.
4/17/2018 Compiled by C Settley 13

14. • Stress factors
– Increased cardiac output increases myocardial oxygen
demand and myocardial workload.
– Mobilisation of fat from the fat stores to provide energy in
response to stress also contributes to atherosclerosis.
– Stress tends to affects the clotting ability of the blood.
• Existing diseases
– Hypertension due to increased force of the blood against
the artery walls.
– Diabetes as it narrows or block the blood vessels in the
brain or neck, cutting off the blood supply, stopping oxygen
from getting to the brain and causing a stroke.
4/17/2018 Compiled by C Settley 14

15. • Diet
– Obesity
– Blood fat levels
– High lipid levels
• Lipid metabolism
– Abnormalities increases the risk for obvious
reasons.
4/17/2018 Compiled by C Settley 15

16. • Gout
– Metabolic abnormalities disrupts enzyme
systems.
– Elevates lipid levels.
• Smoking
– Causes damage to the endothelium
– Increases clotting
– Makes platelets more ‘sticky’
– Therefore increases coagulability
4/17/2018 Compiled by C Settley 16

17. • Occupation
– If an individual follows a sedentary lifestyle
and occupation, fats taken in the diet are not
used for energy and may instead be
deposited as atherosclerotic plaques in the
arteries.
4/17/2018 Compiled by C Settley 17

18. • Other:
• smoking.
• diet.
• high blood cholesterol.
• lack of exercise.
• being overweight and obese.
• excessive alcohol consumption.
4/17/2018 Compiled by C Settley 18

19. • The common pathway of ischaemic stroke is lack of sufficient
blood flow to perfuse cerebral tissue, due to narrowed or
blocked arteries leading to or within the brain.
• Ischaemic strokes can be broadly subdivided into thrombotic
and embolic strokes.
• Narrowing is commonly the result of atherosclerosis – the
occurrence of fatty plaques lining the blood vessels. As the
plaques grow in size, the blood vessel becomes narrowed
and the blood flow to the area beyond is reduced.
• Damaged areas of an atherosclerotic plaque can cause a
blood clot to form, which blocks the blood vessel – a
thrombotic stroke.
4/17/2018 Compiled by C Settley 19

20. • Neurological dysfunction
• Hemiplegia
• Sensory deficits
• Visual disturbances
• Aphasia (inability to talk/communicate)
• Impaired coordination
• Confusion
• Cardiorespiratory collapse due to brain hypoxia
and raised intracranial pressure
4/17/2018 Compiled by C Settley 20

21. • Usually confirmed by CAT scan
• Carotid angiography done to pinpoint
blockages within intracranial blood vessels
4/17/2018 Compiled by C Settley 21

22. • Largely supportive
• Airway, breathing and circulation must be
maintained
• Fluid, electrolyte balances
• Blood glucose levels
• Prevention of aspiration and pneumonia
4/17/2018 Compiled by C Settley 22

23. • Anticoagulation
– To prevent thrombosis
– Heparin should be given intravenously
• Thrombolytic therapy
– Attempt to dissolve blood clots
– Therapy must be commenced within 3 hours of
onset of symptoms in order for it to be effective
4/17/2018 Compiled by C Settley 23

24. • Carotid endarterectomy
– To relieve obstruction of the carotid artery
– Greater than 30% are not suitable as the risks
outweigh the benefits
• Antihypertensive therapy
– Rapid reduction of high blood pressure is not
advocated
– It may reduce cerebral perfusion
4/17/2018 Compiled by C Settley 24

25. • Neurological deterioration
• Possible pneumonia
• Deep vein thrombosis
• Urinary tract infection due to immobility
• Severe disability or vegetative state from
which the patient seldom recovers
4/17/2018 Compiled by C Settley 25

26. • Diet
• Lifestyle
• Weight reduction
• Smoking
• Physical activity
4/17/2018 Compiled by C Settley 26

27. Reference list
• https://villa-medica.com/cell-therapy-for-
stroke/
4/17/2018 Compiled by C Settley 27