SlideShare a Scribd company logo
1 of 37
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Cerebrovascular Disorders
Functional abnormality of the CNS that occurs when
the blood supply to the brain is disrupted
Stroke is the primary cerebrovascular disorder and
the fifth leading cause of death in the United States
Stroke is the leading cause of serious long-term
disability in the United States
Financial impact is profound
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Risk Factors
 Nonmodifiable risk factors
o Age, gender, ethnicity
 Modifiable risk factors
o Hypertension is the primary risk factor
o Cardiovascular disease
o Elevated cholesterol or elevated hematocrit
o Obesity
o Diabetes
o Oral contraceptive use
o Smoking and drug and alcohol abuse
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Stroke
“Brain attack”
Sudden loss of function resulting from a disruption
of the blood supply to a part of the brain
Types of stroke:
o Ischemic
o Hemorrhagic
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Ischemic Stroke
Disruption of the blood supply caused by an
obstruction, usually a thrombus or embolism, that
causes infarction of brain tissue
Types
o Large artery thrombosis
o Small penetrating artery thrombosis
o Cardiogenic embolism
o Cryptogenic
o Other
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Pathophysiology
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Manifestations of Ischemic Stroke
Symptoms depend on the location and size of the
affected area
Numbness or weakness of face, arm, or leg,
especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance or
coordination
Sudden, severe headache
Perceptual disturbances
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Signs and symptoms
Hemiplegia
Hemiparesis
Dysarthria
Aphasia
o Expressive aphasia
o Receptive aphasia
Hemianopsia
Agnosia
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Comparison between right and left side
stroke
Left hemispheric stroke Right hemispheric stroke
 Paralysis or weakness on right side of
body
 Right visual field deficit
 Aphasia (expressive, receptive, or
global)
 Altered intellectual ability
 Slow, cautious behavior
 Paralysis or weakness on left
side of body
 Left visual field deficit
 Spatial-perceptual deficits
 Increased distractibility
 Impulsive behavior and poor
judgment
 Lack of awareness of deficits
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Transient Ischemic Attack (TIA)
Temporary neurologic deficit resulting from a
temporary impairment of blood flow
“Warning of an impending stroke”
Diagnostic workup is required to treat and prevent
irreversible deficits
Copyright © 2022 Wolters Kluwer · All Rights Reserved
prevention
Primary prevention is the best method to avoid
hemorrhagic and ischemic stroke through
management of modifiable risk factors including:-
o controlling hypertension
o consuming alcohol in moderation
o exercise
o no smoking
o and managing diabetes.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Preventive Treatment and Secondary
Prevention of TIA and Stroke
Carotid endarterectomy for carotid stenosis
Anticoagulant therapy for atrial fibrillation
Antiplatelet therapy
“Statins for atherosclerosis
Antihypertensive medications
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Carotid Endarterectomy
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Prompt diagnosis of stroke is very
important
 Any patient with neurologic deficits needs a careful history and a complete
physical and neurologic examination.
 The initial diagnostic test for a stroke is a noncontrast computed tomography
(CT) scan performed emergently to determine if the event is ischemic or
hemorrhagic (which determines treatment).
 Further diagnostic workup for ischemic stroke involves attempting to identify
the source of the thrombi or emboli.
 A 12-lead electrocardiogram
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Medical Management: Acute Phase of
Stroke
 Elevation of the head of the bed to promote venous drainage
and to lower increased ICP unless contraindicated
 Intubation with an endotracheal tube to establish a patent
airway, if necessary
 Continuous hemodynamic monitoring.
 Thrombolytic therapy if patient is a candidate for it
 Continuous neurologic assessment to determine if stroke is
recovering or complications develop.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Eligibility Criteria for t-PA Administration
 Age 18 years or older
 Clinical diagnosis of stroke
 Time of onset of stroke known and is 3 hours or less
 BP systolic ≤ 185; diastolic ≤ 110
 No seizure at onset of stroke
 Not taking warfarin (Coumadin) or heparin
 Prothrombin time ≤ 15 seconds or INR ≤ 1.7
 Platelet count ≥ 100,000
 Blood glucose level between 50 and 400 mg/dL
 No prior intracranial hemorrhage, neoplasm, arteriovenous malformation, or
aneurysm, No major surgical procedures within 14 day, No stroke or serious head
injury within 3 months
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Hemorrhagic Stroke
 Caused by bleeding into brain tissue, the ventricles, or
subarachnoid space
 May be caused by spontaneous rupture of small vessels
primarily related to hypertension; subarachnoid hemorrhage
caused by a ruptured aneurysm; or intracerebral hemorrhage
related to amyloid angiopathy, arterial venous malformations
(AVMs), intracranial aneurysms, or medications such as
anticoagulants
 Brain metabolism is disrupted by exposure to blood
 ICP increases caused by blood in the subarachnoid space
 Compression or secondary ischemia from reduced perfusion
and vasoconstriction causes injury to brain tissue
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Manifestations of Hemorrhagic Stroke
 Similar to ischemic stroke
 Severe headache
 Early and sudden changes in Level of Consciousness (LOC)
 Vomiting
 Bleeding
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Medical Management of Hemorrhagic
Stroke
Diagnosis: CT scan, cerebral angiography, lumbar
puncture if CT is negative and ICP is not elevated to
confirm subarachnoid hemorrhage
Care is primarily supportive
Bed rest with sedation
Oxygen
Treatment of vasospasm, increased ICP,
hypertension, potential seizures, and prevention of
further bleeding
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Stroke algorithm
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Stroke algorithm continued
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Management of Ischemic Stroke:
Acute Phase
 Ongoing, frequent monitoring of all systems, including vital
signs and neurologic assessment
 LOC
 Motor symptoms
 Speech
 Pupil changes
 I & O
 Blood pressure maintenance
 Bleeding
 Oxygen saturation
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Assessment of the Patient Recovering
from an Ischemic Stroke
After the acute phase:
o Mental status
o Sensation/perception
o Motor control
o Swallowing ability
o Nutritional and hydration status
o Skin integrity
o Activity tolerance
o Bowel and bladder function
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Collaborative Problems and Potential
Complications of the Patient Recovering from
an Ischemic Stroke
Decreased cerebral blood flow
Inadequate oxygen delivery to brain
Pneumonia
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
Improving mobility and preventing joint deformities
o Prevent shoulder abduction
o Position the hands and fingers
o Change positions—every 2 hours
o Establish an exercise program
 Passive or active ROM four or five times day
o Prepare for ambulation
 Assist patient out of bed as soon as possible
Preventing shoulder pain
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
 Enhancing self-care
o Use of assistive devices such as Raised toilet seat, Long-handled bath sponge)
o Ensure the patient does not neglect the affected side.
o Return of functional ability is important to the patient recovering after a stroke.
o clothing is preferably a size larger than that normally worn.
o the nurse can take steps to keep the environment organized and uncluttered.
o The clothing is placed on the affected side.
o Using a large mirror while dressing .
o Support and encouragement are provided to prevent the patient from becoming
overly fatigued and discouraged.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
 Adjusting to physical changes
 Assisting with nutrition
o Consult with speech therapy or nutritional services
o Have patient sit upright, preferably out of bed, to eat
o Chin tuck or swallowing method
o Use of thickened liquids or pureed diet
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
 Managing Sensory-Perceptual Difficulties
o All visual stimuli (clock, calendar, and television) should be placed on
affected side.
o make eye contact with the patient and draw his or her attention to the
affected side.
o stand at a position that encourages the patient to move to visualize who is in
the room.
o Increasing the natural or artificial lighting in the room and providing
eyeglasses are important in increasing vision.
o It is important for the nurse to constantly remind the patient of the other side
of the body, to maintain alignment of the extremities if possible, to place the
extremities where the patient can see them.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke #3
 managing dysphagia
o Advise to take smaller boluses of food, and taught about which
foods are easier to swallow.
o The patient may initially be started on a thick liquid or puréed
diet because these foods are easier to swallow than thin liquids.
o Having the patient sit upright, preferably out of bed in a chair,
and instructing him or her to tuck the chin toward the chest as
he or she swallows, will help prevent aspiration.
o The diet may be advanced as the patient becomes more
proficient at swallowing.
o If the patient cannot resume oral intake, a gastrointestinal
feeding tube will be placed for ongoing tube feedings.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
 Attaining Bowel And Bladder Control
o intermittent catheterization with sterile technique is carried
out.
o The voiding pattern is analyzed and the urinal or bedpan
offered on this pattern or schedule.
o The upright posture and standing position are helpful for
male patients during this aspect of rehabilitation.
o Unless contraindicated, a high-fiber diet and adequate fluid
intake (2 to 3 L per day)
o Bedpain should be provided and a regular time established
(usually after breakfast) for toileting.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
 Improving Communication
o Face the patient and establish eye contact.
o Speak in a normal manner and tone.
o Use short phrases and pause between phrases to allow the
patient
o time to understand what is being said.
o Limit conversation to practical and concrete matters.
o Use gestures, pictures, and objects.
o Be consistent in using the same words and gestures each
time you give instructions or ask a question.
o Keep extraneous noises and sounds to a minimum..
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient
Recovering from an Ischemic Stroke
Maintaining Skin Integrity
o A regular turning and positioning schedule must be followed.
o Pressure-relieving devices may be employed but do not replace
regular turning and positioning.
o The turning schedule (at least every 2 hours)
o When the patient is positioned or turned, care must be used to
minimize shear and friction forces, which cause damage to
tissues and predispose the skin to breakdown.
o The patient’s skin must be kept clean and dry;
o gentle massage of healthy (nonreddened) skin and adequate
nutrition are other factors that help to maintain normal skin and
tissue integrity.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Assessment of the Patient with a
Hemorrhagic Stroke
Complete and ongoing neurologic assessment; use
neurologic flow chart
Altered LOC
Sluggish pupillary reaction
Motor and sensory dysfunction
Cranial nerve deficits
Speech difficulties and visual disturbance
Headache and nuchal rigidity
Other neurologic deficits
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Collaborative Problems and Potential
Complications of the Patient with a
Hemorrhagic Stroke
Vasospasm
Seizures
Hydrocephalus
Rebleeding
Hyponatremia
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Planning and Goals for the Patient with a
Hemorrhagic Stroke
Goals may include:
o Improved cerebral tissue perfusion
o Relief of anxiety
o The absence of complications
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions for the Patient with
a Hemorrhagic Stroke
 Optimizing cerebral tissue perfusion; implementing aneurysm
precautions
o Provide a nonstimulating environment, prevent increases
in ICP, prevent further bleeding
o Absolute bed rest with HOB 30 degrees
o Avoid all activity that may increase ICP or BP; Valsalva
maneuver, acute flexion or rotation of neck or head
o Stool softener and mild laxatives
o Nonstimulating, nonstressful environment; dim lighting,
no reading, no TV, no radio
o Visitors are restricted
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions of the Patient with
a Hemorrhagic Stroke
Relieving anxiety
o Keep sensory stimulation to a minimum for
aneurysm precautions
o Realty orientation
Monitoring and managing potential complications
o Seizure precautions
Patient and family education
o strategies to regain and promote self-care and
rehabilitation
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Home Care and Education for the Patient
Recovering from a Stroke
 Prevention of subsequent strokes, health promotion, and
follow-up care; refer to Chart 62-6
 Prevention of and signs and symptoms of complications
 Medication education
 Safety measures
 Adaptive strategies and use of assistive devices for ADLs
 Nutrition: diet, swallowing techniques, tube feeding
administration
 Elimination: bowel and bladder programs, catheter use
 Exercise and activities, recreation and diversion
 Socialization, support groups, and community resources

More Related Content

Similar to 9- stroke hemorrhagic and ischemic 9.pptx

Cerebrovascular Acc Dr.T
Cerebrovascular Acc Dr.TCerebrovascular Acc Dr.T
Cerebrovascular Acc Dr.Tmycomic
 
Seminar on haemorrhage
Seminar on haemorrhageSeminar on haemorrhage
Seminar on haemorrhageSimran Dhiman
 
Stroke cerebrovascular accident
Stroke cerebrovascular accidentStroke cerebrovascular accident
Stroke cerebrovascular accidentHIRANGER
 
What are the signs of stroke and what should you do
What are the signs of stroke and what should you doWhat are the signs of stroke and what should you do
What are the signs of stroke and what should you doBiocon
 
38824331 care-of-clients-with-problems-in-oxygenation-part-2
38824331 care-of-clients-with-problems-in-oxygenation-part-238824331 care-of-clients-with-problems-in-oxygenation-part-2
38824331 care-of-clients-with-problems-in-oxygenation-part-2Nursing Path
 
Cerebrovascular accident oct 2017
Cerebrovascular accident oct 2017Cerebrovascular accident oct 2017
Cerebrovascular accident oct 2017Kemi Dele-Ijagbulu
 
Cerebrovascular Diseases
Cerebrovascular DiseasesCerebrovascular Diseases
Cerebrovascular Diseasesmycomic
 
Colorectal cancer
Colorectal cancerColorectal cancer
Colorectal cancerSumreen4
 
SHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdf
SHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdfSHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdf
SHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdfDolisha Warbi
 
MANAGEMENT OF STROKE
MANAGEMENT OF STROKEMANAGEMENT OF STROKE
MANAGEMENT OF STROKEtahav kershio
 
Ppt chapter29 hf1
Ppt chapter29 hf1Ppt chapter29 hf1
Ppt chapter29 hf1golden41
 
Cerebrovascular accident
Cerebrovascular accidentCerebrovascular accident
Cerebrovascular accidentbijayaDhakal4
 

Similar to 9- stroke hemorrhagic and ischemic 9.pptx (20)

Mark O
Mark OMark O
Mark O
 
Cerebrovascular Acc Dr.T
Cerebrovascular Acc Dr.TCerebrovascular Acc Dr.T
Cerebrovascular Acc Dr.T
 
Seminar on haemorrhage
Seminar on haemorrhageSeminar on haemorrhage
Seminar on haemorrhage
 
Cva stroke
Cva  strokeCva  stroke
Cva stroke
 
Stroke cerebrovascular accident
Stroke cerebrovascular accidentStroke cerebrovascular accident
Stroke cerebrovascular accident
 
What are the signs of stroke and what should you do
What are the signs of stroke and what should you doWhat are the signs of stroke and what should you do
What are the signs of stroke and what should you do
 
38824331 care-of-clients-with-problems-in-oxygenation-part-2
38824331 care-of-clients-with-problems-in-oxygenation-part-238824331 care-of-clients-with-problems-in-oxygenation-part-2
38824331 care-of-clients-with-problems-in-oxygenation-part-2
 
Stroke Awareness
Stroke AwarenessStroke Awareness
Stroke Awareness
 
20. CVA.pptx
20. CVA.pptx20. CVA.pptx
20. CVA.pptx
 
Stroke CVa.pptx
Stroke CVa.pptxStroke CVa.pptx
Stroke CVa.pptx
 
Strokes
StrokesStrokes
Strokes
 
Cerebrovascular accident oct 2017
Cerebrovascular accident oct 2017Cerebrovascular accident oct 2017
Cerebrovascular accident oct 2017
 
Cerebrovascular Diseases
Cerebrovascular DiseasesCerebrovascular Diseases
Cerebrovascular Diseases
 
Colorectal cancer
Colorectal cancerColorectal cancer
Colorectal cancer
 
SHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdf
SHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdfSHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdf
SHOCK/TYPES OF SHOCK AND ITS MANAGEMENT.pdf
 
coronary artery disease
coronary artery diseasecoronary artery disease
coronary artery disease
 
MANAGEMENT OF STROKE
MANAGEMENT OF STROKEMANAGEMENT OF STROKE
MANAGEMENT OF STROKE
 
Ppt chapter29 hf1
Ppt chapter29 hf1Ppt chapter29 hf1
Ppt chapter29 hf1
 
Cerebrovascular accident
Cerebrovascular accidentCerebrovascular accident
Cerebrovascular accident
 
Cmanagement patient with coronary blood desorder
Cmanagement patient with coronary blood desorderCmanagement patient with coronary blood desorder
Cmanagement patient with coronary blood desorder
 

More from AbdallahAlasal1

ACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptx
ACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptxACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptx
ACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptxAbdallahAlasal1
 
11-Environmental ';l';l';l';l';Cleaning.ppt
11-Environmental ';l';l';l';l';Cleaning.ppt11-Environmental ';l';l';l';l';Cleaning.ppt
11-Environmental ';l';l';l';l';Cleaning.pptAbdallahAlasal1
 
Pra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptx
Pra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptxPra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptx
Pra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptxAbdallahAlasal1
 
مقدمة في العلاج الطبيعي للإصابات الرياضية.pptx
مقدمة في العلاج الطبيعي للإصابات الرياضية.pptxمقدمة في العلاج الطبيعي للإصابات الرياضية.pptx
مقدمة في العلاج الطبيعي للإصابات الرياضية.pptxAbdallahAlasal1
 
Lower gastrointestinal disorders 2- week 12.ppt
Lower gastrointestinal disorders 2- week 12.pptLower gastrointestinal disorders 2- week 12.ppt
Lower gastrointestinal disorders 2- week 12.pptAbdallahAlasal1
 
Methods and Principle of sterilization (Filtration).pptx
Methods and Principle of sterilization (Filtration).pptxMethods and Principle of sterilization (Filtration).pptx
Methods and Principle of sterilization (Filtration).pptxAbdallahAlasal1
 
3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx
3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx
3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptxAbdallahAlasal1
 
digestion of كطمكطك"طكطكarbohydrates.ppt
digestion of كطمكطك"طكطكarbohydrates.pptdigestion of كطمكطك"طكطكarbohydrates.ppt
digestion of كطمكطك"طكطكarbohydrates.pptAbdallahAlasal1
 
Protein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptx
Protein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptxProtein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptx
Protein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptxAbdallahAlasal1
 
4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx
4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx
4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptxAbdallahAlasal1
 
lect. 1 mental health and mental illness (2).ppt
lect. 1 mental health and mental illness (2).pptlect. 1 mental health and mental illness (2).ppt
lect. 1 mental health and mental illness (2).pptAbdallahAlasal1
 
1-introduction to reproductive health .pptx
1-introduction to reproductive health .pptx1-introduction to reproductive health .pptx
1-introduction to reproductive health .pptxAbdallahAlasal1
 
Chaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptx
Chaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptxChaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptx
Chaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptxAbdallahAlasal1
 
week 9 Assessment and Management of Patients with Hypertension- crisis.ppt
week 9 Assessment and Management of Patients with Hypertension- crisis.pptweek 9 Assessment and Management of Patients with Hypertension- crisis.ppt
week 9 Assessment and Management of Patients with Hypertension- crisis.pptAbdallahAlasal1
 
9- Introduction to Virology and Prions.pptx
9- Introduction to Virology and Prions.pptx9- Introduction to Virology and Prions.pptx
9- Introduction to Virology and Prions.pptxAbdallahAlasal1
 
9 - sexual transmitted disease modified.pptx
9 - sexual transmitted disease modified.pptx9 - sexual transmitted disease modified.pptx
9 - sexual transmitted disease modified.pptxAbdallahAlasal1
 
4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx
4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx
4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptxAbdallahAlasal1
 
4- Bacterial Stainكمنكمنكمنطكمطكنمing.pptx
4- Bacterial  Stainكمنكمنكمنطكمطكنمing.pptx4- Bacterial  Stainكمنكمنكمنطكمطكنمing.pptx
4- Bacterial Stainكمنكمنكمنطكمطكنمing.pptxAbdallahAlasal1
 
10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx
10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx
10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptxAbdallahAlasal1
 
5- Normal lkjkljjlkjlkjMicrobial Flora.pptx
5- Normal lkjkljjlkjlkjMicrobial Flora.pptx5- Normal lkjkljjlkjlkjMicrobial Flora.pptx
5- Normal lkjkljjlkjlkjMicrobial Flora.pptxAbdallahAlasal1
 

More from AbdallahAlasal1 (20)

ACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptx
ACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptxACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptx
ACST 24.,/.,/,/,/.,,?</,/,/,/,/,2 lecture11.pptx
 
11-Environmental ';l';l';l';l';Cleaning.ppt
11-Environmental ';l';l';l';l';Cleaning.ppt11-Environmental ';l';l';l';l';Cleaning.ppt
11-Environmental ';l';l';l';l';Cleaning.ppt
 
Pra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptx
Pra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptxPra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptx
Pra;lk;lk;k;llk;lkjjk;';k';k'ctical Guide.pptx
 
مقدمة في العلاج الطبيعي للإصابات الرياضية.pptx
مقدمة في العلاج الطبيعي للإصابات الرياضية.pptxمقدمة في العلاج الطبيعي للإصابات الرياضية.pptx
مقدمة في العلاج الطبيعي للإصابات الرياضية.pptx
 
Lower gastrointestinal disorders 2- week 12.ppt
Lower gastrointestinal disorders 2- week 12.pptLower gastrointestinal disorders 2- week 12.ppt
Lower gastrointestinal disorders 2- week 12.ppt
 
Methods and Principle of sterilization (Filtration).pptx
Methods and Principle of sterilization (Filtration).pptxMethods and Principle of sterilization (Filtration).pptx
Methods and Principle of sterilization (Filtration).pptx
 
3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx
3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx
3 ethics in psyc;lm;l;lm;lmiuoyiuyiuhiatry.pptx
 
digestion of كطمكطك"طكطكarbohydrates.ppt
digestion of كطمكطك"طكطكarbohydrates.pptdigestion of كطمكطك"طكطكarbohydrates.ppt
digestion of كطمكطك"طكطكarbohydrates.ppt
 
Protein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptx
Protein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptxProtein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptx
Protein chemis;lk;lj;lkjtry_Lecture 1 and 2.pptx
 
4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx
4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx
4_Autonomic_nervous_system_and_control_of_visceral_functions_lect.pptx
 
lect. 1 mental health and mental illness (2).ppt
lect. 1 mental health and mental illness (2).pptlect. 1 mental health and mental illness (2).ppt
lect. 1 mental health and mental illness (2).ppt
 
1-introduction to reproductive health .pptx
1-introduction to reproductive health .pptx1-introduction to reproductive health .pptx
1-introduction to reproductive health .pptx
 
Chaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptx
Chaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptxChaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptx
Chaptl;k;lkl;k;lkk;lk;lk;lk;lk;lkl;ker 6.pptx
 
week 9 Assessment and Management of Patients with Hypertension- crisis.ppt
week 9 Assessment and Management of Patients with Hypertension- crisis.pptweek 9 Assessment and Management of Patients with Hypertension- crisis.ppt
week 9 Assessment and Management of Patients with Hypertension- crisis.ppt
 
9- Introduction to Virology and Prions.pptx
9- Introduction to Virology and Prions.pptx9- Introduction to Virology and Prions.pptx
9- Introduction to Virology and Prions.pptx
 
9 - sexual transmitted disease modified.pptx
9 - sexual transmitted disease modified.pptx9 - sexual transmitted disease modified.pptx
9 - sexual transmitted disease modified.pptx
 
4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx
4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx
4 - Anten';l';l';l';\][]\[\][\][\][]\atal care.pptx
 
4- Bacterial Stainكمنكمنكمنطكمطكنمing.pptx
4- Bacterial  Stainكمنكمنكمنطكمطكنمing.pptx4- Bacterial  Stainكمنكمنكمنطكمطكنمing.pptx
4- Bacterial Stainكمنكمنكمنطكمطكنمing.pptx
 
10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx
10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx
10 - menop;kp;lk;lkkll;k'polp[o;lkause.pptx
 
5- Normal lkjkljjlkjlkjMicrobial Flora.pptx
5- Normal lkjkljjlkjlkjMicrobial Flora.pptx5- Normal lkjkljjlkjlkjMicrobial Flora.pptx
5- Normal lkjkljjlkjlkjMicrobial Flora.pptx
 

Recently uploaded

NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...
NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...
NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...Amil baba
 
100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...
100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...
100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...drjose256
 
How do microorganisms contribute to food flavour development .pptx
How do microorganisms contribute to food flavour development .pptxHow do microorganisms contribute to food flavour development .pptx
How do microorganisms contribute to food flavour development .pptxfoodresearch
 
Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...
Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...
Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...vanyaj843
 
5 Ways Sea Moss Can Improve Thyroid Function
5 Ways Sea Moss Can Improve Thyroid Function5 Ways Sea Moss Can Improve Thyroid Function
5 Ways Sea Moss Can Improve Thyroid FunctionJoy Ecc
 
Drug Regulatory Authority of Pakistan (DRAP).pptx
Drug Regulatory Authority of Pakistan (DRAP).pptxDrug Regulatory Authority of Pakistan (DRAP).pptx
Drug Regulatory Authority of Pakistan (DRAP).pptxShafaatHussain20
 
Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...
Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...
Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...zoyat9250
 
Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...
Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...
Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...jiyav969
 
496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf
496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf
496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdfGilbertChia4
 
Meal Kit Delivery Service Market: Competitive Analysis and Market Positioning
Meal Kit Delivery Service Market: Competitive Analysis and Market PositioningMeal Kit Delivery Service Market: Competitive Analysis and Market Positioning
Meal Kit Delivery Service Market: Competitive Analysis and Market PositioningAishwaryaDoiphode3
 
Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...
Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...
Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...GilbertObanil2
 
Elo Cakes | Premium Cake Shop | Order Now
Elo Cakes | Premium Cake Shop | Order NowElo Cakes | Premium Cake Shop | Order Now
Elo Cakes | Premium Cake Shop | Order NowElo Cakes
 
Toko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra Sidoarjo
Toko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra SidoarjoToko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra Sidoarjo
Toko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra Sidoarjoadet6151
 

Recently uploaded (13)

NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...
NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...
NO1 Qari Amil Baba Bangali Baba | Aamil baba Taweez Online Kala Jadu kala jad...
 
100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...
100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...
100^%)( FORDSBURG))(*((+27838792658))*))௹ )Abortion Pills for Sale in Benoni,...
 
How do microorganisms contribute to food flavour development .pptx
How do microorganisms contribute to food flavour development .pptxHow do microorganisms contribute to food flavour development .pptx
How do microorganisms contribute to food flavour development .pptx
 
Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...
Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...
Vip ℂall Girls Nirman Vihar Phone No 9999965857 High Profile ℂall Girl Delhi ...
 
5 Ways Sea Moss Can Improve Thyroid Function
5 Ways Sea Moss Can Improve Thyroid Function5 Ways Sea Moss Can Improve Thyroid Function
5 Ways Sea Moss Can Improve Thyroid Function
 
Drug Regulatory Authority of Pakistan (DRAP).pptx
Drug Regulatory Authority of Pakistan (DRAP).pptxDrug Regulatory Authority of Pakistan (DRAP).pptx
Drug Regulatory Authority of Pakistan (DRAP).pptx
 
Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...
Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...
Vip ℂall Girls Kotla Mubarakpur Phone No 9999965857 High Profile ℂall Girl De...
 
Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...
Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...
Vip ℂall Girls Ajmeri Gate Phone No 9999965857 High Profile ℂall Girl Delhi N...
 
496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf
496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf
496838544-Boy-in-the-Striped-Pajamas-Questions-With-Answers (1).pdf
 
Meal Kit Delivery Service Market: Competitive Analysis and Market Positioning
Meal Kit Delivery Service Market: Competitive Analysis and Market PositioningMeal Kit Delivery Service Market: Competitive Analysis and Market Positioning
Meal Kit Delivery Service Market: Competitive Analysis and Market Positioning
 
Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...
Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...
Assessing the COOKING SKILLS Development of Grade 11 Cookery Students in Cari...
 
Elo Cakes | Premium Cake Shop | Order Now
Elo Cakes | Premium Cake Shop | Order NowElo Cakes | Premium Cake Shop | Order Now
Elo Cakes | Premium Cake Shop | Order Now
 
Toko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra Sidoarjo
Toko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra SidoarjoToko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra Sidoarjo
Toko Jual Viagra Asli Di Sidoarjo 081229400522 Obat Kuat Viagra Sidoarjo
 

9- stroke hemorrhagic and ischemic 9.pptx

  • 1. Copyright © 2022 Wolters Kluwer · All Rights Reserved Cerebrovascular Disorders Functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted Stroke is the primary cerebrovascular disorder and the fifth leading cause of death in the United States Stroke is the leading cause of serious long-term disability in the United States Financial impact is profound
  • 2. Copyright © 2022 Wolters Kluwer · All Rights Reserved Risk Factors  Nonmodifiable risk factors o Age, gender, ethnicity  Modifiable risk factors o Hypertension is the primary risk factor o Cardiovascular disease o Elevated cholesterol or elevated hematocrit o Obesity o Diabetes o Oral contraceptive use o Smoking and drug and alcohol abuse
  • 3. Copyright © 2022 Wolters Kluwer · All Rights Reserved Stroke “Brain attack” Sudden loss of function resulting from a disruption of the blood supply to a part of the brain Types of stroke: o Ischemic o Hemorrhagic
  • 4. Copyright © 2022 Wolters Kluwer · All Rights Reserved Ischemic Stroke Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of brain tissue Types o Large artery thrombosis o Small penetrating artery thrombosis o Cardiogenic embolism o Cryptogenic o Other
  • 5. Copyright © 2022 Wolters Kluwer · All Rights Reserved Pathophysiology
  • 6. Copyright © 2022 Wolters Kluwer · All Rights Reserved Manifestations of Ischemic Stroke Symptoms depend on the location and size of the affected area Numbness or weakness of face, arm, or leg, especially on one side Confusion or change in mental status Trouble speaking or understanding speech Difficulty in walking, dizziness, or loss of balance or coordination Sudden, severe headache Perceptual disturbances
  • 7. Copyright © 2022 Wolters Kluwer · All Rights Reserved Signs and symptoms Hemiplegia Hemiparesis Dysarthria Aphasia o Expressive aphasia o Receptive aphasia Hemianopsia Agnosia
  • 8. Copyright © 2022 Wolters Kluwer · All Rights Reserved Comparison between right and left side stroke Left hemispheric stroke Right hemispheric stroke  Paralysis or weakness on right side of body  Right visual field deficit  Aphasia (expressive, receptive, or global)  Altered intellectual ability  Slow, cautious behavior  Paralysis or weakness on left side of body  Left visual field deficit  Spatial-perceptual deficits  Increased distractibility  Impulsive behavior and poor judgment  Lack of awareness of deficits
  • 9. Copyright © 2022 Wolters Kluwer · All Rights Reserved Transient Ischemic Attack (TIA) Temporary neurologic deficit resulting from a temporary impairment of blood flow “Warning of an impending stroke” Diagnostic workup is required to treat and prevent irreversible deficits
  • 10. Copyright © 2022 Wolters Kluwer · All Rights Reserved prevention Primary prevention is the best method to avoid hemorrhagic and ischemic stroke through management of modifiable risk factors including:- o controlling hypertension o consuming alcohol in moderation o exercise o no smoking o and managing diabetes.
  • 11. Copyright © 2022 Wolters Kluwer · All Rights Reserved Preventive Treatment and Secondary Prevention of TIA and Stroke Carotid endarterectomy for carotid stenosis Anticoagulant therapy for atrial fibrillation Antiplatelet therapy “Statins for atherosclerosis Antihypertensive medications
  • 12. Copyright © 2022 Wolters Kluwer · All Rights Reserved Carotid Endarterectomy
  • 13. Copyright © 2022 Wolters Kluwer · All Rights Reserved Prompt diagnosis of stroke is very important  Any patient with neurologic deficits needs a careful history and a complete physical and neurologic examination.  The initial diagnostic test for a stroke is a noncontrast computed tomography (CT) scan performed emergently to determine if the event is ischemic or hemorrhagic (which determines treatment).  Further diagnostic workup for ischemic stroke involves attempting to identify the source of the thrombi or emboli.  A 12-lead electrocardiogram
  • 14. Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical Management: Acute Phase of Stroke  Elevation of the head of the bed to promote venous drainage and to lower increased ICP unless contraindicated  Intubation with an endotracheal tube to establish a patent airway, if necessary  Continuous hemodynamic monitoring.  Thrombolytic therapy if patient is a candidate for it  Continuous neurologic assessment to determine if stroke is recovering or complications develop.
  • 15. Copyright © 2022 Wolters Kluwer · All Rights Reserved Eligibility Criteria for t-PA Administration  Age 18 years or older  Clinical diagnosis of stroke  Time of onset of stroke known and is 3 hours or less  BP systolic ≤ 185; diastolic ≤ 110  No seizure at onset of stroke  Not taking warfarin (Coumadin) or heparin  Prothrombin time ≤ 15 seconds or INR ≤ 1.7  Platelet count ≥ 100,000  Blood glucose level between 50 and 400 mg/dL  No prior intracranial hemorrhage, neoplasm, arteriovenous malformation, or aneurysm, No major surgical procedures within 14 day, No stroke or serious head injury within 3 months
  • 16. Copyright © 2022 Wolters Kluwer · All Rights Reserved Hemorrhagic Stroke  Caused by bleeding into brain tissue, the ventricles, or subarachnoid space  May be caused by spontaneous rupture of small vessels primarily related to hypertension; subarachnoid hemorrhage caused by a ruptured aneurysm; or intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations (AVMs), intracranial aneurysms, or medications such as anticoagulants  Brain metabolism is disrupted by exposure to blood  ICP increases caused by blood in the subarachnoid space  Compression or secondary ischemia from reduced perfusion and vasoconstriction causes injury to brain tissue
  • 17. Copyright © 2022 Wolters Kluwer · All Rights Reserved Manifestations of Hemorrhagic Stroke  Similar to ischemic stroke  Severe headache  Early and sudden changes in Level of Consciousness (LOC)  Vomiting  Bleeding
  • 18. Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical Management of Hemorrhagic Stroke Diagnosis: CT scan, cerebral angiography, lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage Care is primarily supportive Bed rest with sedation Oxygen Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding
  • 19. Copyright © 2022 Wolters Kluwer · All Rights Reserved Stroke algorithm
  • 20. Copyright © 2022 Wolters Kluwer · All Rights Reserved Stroke algorithm continued
  • 21. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management of Ischemic Stroke: Acute Phase  Ongoing, frequent monitoring of all systems, including vital signs and neurologic assessment  LOC  Motor symptoms  Speech  Pupil changes  I & O  Blood pressure maintenance  Bleeding  Oxygen saturation
  • 22. Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of the Patient Recovering from an Ischemic Stroke After the acute phase: o Mental status o Sensation/perception o Motor control o Swallowing ability o Nutritional and hydration status o Skin integrity o Activity tolerance o Bowel and bladder function
  • 23. Copyright © 2022 Wolters Kluwer · All Rights Reserved Collaborative Problems and Potential Complications of the Patient Recovering from an Ischemic Stroke Decreased cerebral blood flow Inadequate oxygen delivery to brain Pneumonia
  • 24. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke Improving mobility and preventing joint deformities o Prevent shoulder abduction o Position the hands and fingers o Change positions—every 2 hours o Establish an exercise program  Passive or active ROM four or five times day o Prepare for ambulation  Assist patient out of bed as soon as possible Preventing shoulder pain
  • 25. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke  Enhancing self-care o Use of assistive devices such as Raised toilet seat, Long-handled bath sponge) o Ensure the patient does not neglect the affected side. o Return of functional ability is important to the patient recovering after a stroke. o clothing is preferably a size larger than that normally worn. o the nurse can take steps to keep the environment organized and uncluttered. o The clothing is placed on the affected side. o Using a large mirror while dressing . o Support and encouragement are provided to prevent the patient from becoming overly fatigued and discouraged.
  • 26. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke  Adjusting to physical changes  Assisting with nutrition o Consult with speech therapy or nutritional services o Have patient sit upright, preferably out of bed, to eat o Chin tuck or swallowing method o Use of thickened liquids or pureed diet
  • 27. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke  Managing Sensory-Perceptual Difficulties o All visual stimuli (clock, calendar, and television) should be placed on affected side. o make eye contact with the patient and draw his or her attention to the affected side. o stand at a position that encourages the patient to move to visualize who is in the room. o Increasing the natural or artificial lighting in the room and providing eyeglasses are important in increasing vision. o It is important for the nurse to constantly remind the patient of the other side of the body, to maintain alignment of the extremities if possible, to place the extremities where the patient can see them.
  • 28. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke #3  managing dysphagia o Advise to take smaller boluses of food, and taught about which foods are easier to swallow. o The patient may initially be started on a thick liquid or puréed diet because these foods are easier to swallow than thin liquids. o Having the patient sit upright, preferably out of bed in a chair, and instructing him or her to tuck the chin toward the chest as he or she swallows, will help prevent aspiration. o The diet may be advanced as the patient becomes more proficient at swallowing. o If the patient cannot resume oral intake, a gastrointestinal feeding tube will be placed for ongoing tube feedings.
  • 29. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke  Attaining Bowel And Bladder Control o intermittent catheterization with sterile technique is carried out. o The voiding pattern is analyzed and the urinal or bedpan offered on this pattern or schedule. o The upright posture and standing position are helpful for male patients during this aspect of rehabilitation. o Unless contraindicated, a high-fiber diet and adequate fluid intake (2 to 3 L per day) o Bedpain should be provided and a regular time established (usually after breakfast) for toileting.
  • 30. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke  Improving Communication o Face the patient and establish eye contact. o Speak in a normal manner and tone. o Use short phrases and pause between phrases to allow the patient o time to understand what is being said. o Limit conversation to practical and concrete matters. o Use gestures, pictures, and objects. o Be consistent in using the same words and gestures each time you give instructions or ask a question. o Keep extraneous noises and sounds to a minimum..
  • 31. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Recovering from an Ischemic Stroke Maintaining Skin Integrity o A regular turning and positioning schedule must be followed. o Pressure-relieving devices may be employed but do not replace regular turning and positioning. o The turning schedule (at least every 2 hours) o When the patient is positioned or turned, care must be used to minimize shear and friction forces, which cause damage to tissues and predispose the skin to breakdown. o The patient’s skin must be kept clean and dry; o gentle massage of healthy (nonreddened) skin and adequate nutrition are other factors that help to maintain normal skin and tissue integrity.
  • 32. Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of the Patient with a Hemorrhagic Stroke Complete and ongoing neurologic assessment; use neurologic flow chart Altered LOC Sluggish pupillary reaction Motor and sensory dysfunction Cranial nerve deficits Speech difficulties and visual disturbance Headache and nuchal rigidity Other neurologic deficits
  • 33. Copyright © 2022 Wolters Kluwer · All Rights Reserved Collaborative Problems and Potential Complications of the Patient with a Hemorrhagic Stroke Vasospasm Seizures Hydrocephalus Rebleeding Hyponatremia
  • 34. Copyright © 2022 Wolters Kluwer · All Rights Reserved Planning and Goals for the Patient with a Hemorrhagic Stroke Goals may include: o Improved cerebral tissue perfusion o Relief of anxiety o The absence of complications
  • 35. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient with a Hemorrhagic Stroke  Optimizing cerebral tissue perfusion; implementing aneurysm precautions o Provide a nonstimulating environment, prevent increases in ICP, prevent further bleeding o Absolute bed rest with HOB 30 degrees o Avoid all activity that may increase ICP or BP; Valsalva maneuver, acute flexion or rotation of neck or head o Stool softener and mild laxatives o Nonstimulating, nonstressful environment; dim lighting, no reading, no TV, no radio o Visitors are restricted
  • 36. Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions of the Patient with a Hemorrhagic Stroke Relieving anxiety o Keep sensory stimulation to a minimum for aneurysm precautions o Realty orientation Monitoring and managing potential complications o Seizure precautions Patient and family education o strategies to regain and promote self-care and rehabilitation
  • 37. Copyright © 2022 Wolters Kluwer · All Rights Reserved Home Care and Education for the Patient Recovering from a Stroke  Prevention of subsequent strokes, health promotion, and follow-up care; refer to Chart 62-6  Prevention of and signs and symptoms of complications  Medication education  Safety measures  Adaptive strategies and use of assistive devices for ADLs  Nutrition: diet, swallowing techniques, tube feeding administration  Elimination: bowel and bladder programs, catheter use  Exercise and activities, recreation and diversion  Socialization, support groups, and community resources