A stroke occurs when the blood supply to part of the brain is disrupted, depriving brain tissue of oxygen and nutrients. There are two main types of strokes: ischemic, caused by blockage of a blood vessel, and hemorrhagic, caused by a blood vessel rupture. Risk factors include age, gender, race, hypertension, atrial fibrillation, diabetes, and smoking. Symptoms vary depending on the affected brain region but may include weakness, confusion, trouble speaking, and visual issues. Diagnosis involves imaging tests and lab work. Treatment focuses on restoring blood flow acutely and long-term rehabilitation. Lifestyle changes and medication can help prevent strokes.

1. Stroke
BY ,
P. ABIRAJAN
B.SC (N) – II YEAR
CON - PIMS

3. Definition
A cerebrovascular accident (CVA), an
ischemic stroke or “brain attack,” is a sudden
loss of brain function resulting from a
disruption of the blood supply to a part of the
brain.
It is a functional abnormality of
the central nervous system.

4. The result is an interruption in the blood
supply to the brain, causing temporary or
permanent loss of movement, thought,
memory, speech, or sensation.

5. Classification
Strokes can be divided into two classifications
 Ischemic stroke
 Hemorrhagic stroke

6. • Ischemic stroke :This is the loss of function in
the brain as a result of a disrupted blood
supply
• Hemorrhagic stroke. Hemorrhagic strokes are
caused by bleeding into the brain tissue, the
ventricles, or the subarachnoid space.

7. Risk Factors
The following are the nonmodifiable and
modifiable risk factors of Cerebrovascular
accident
Nonmodifiable
• Advanced age (older than 55 years)
• Gender (Male)
• Race (African American)

8. Modifiable
• Hypertension
• Atrial fibrillation
• Hyperlipidemia
• Obesity
• Smoking
• Diabetes
• Asymptomatic carotid stenosis and valvular heart
disease (eg, endocarditis, prosthetic heart valves)
• Periodontal disease

10. Pathophysiology
Etiology factors
Pressures on nearby cranial nerves or brain tissue
Causing subarachnoid hemorrhage
Increase in ICP resulting from the sudden entry of blood into subarachnoid space
Injuries brain tissue ; or by secondary ischemia of the brain resulting from the
reduced perfusion pressure

11. Clinical Manifestations
• Numbness or weakness of the face
• Change in mental status
• Trouble speaking or understanding speech
• Visual disturbances
• Loss of peripheral vision
• Confusion
• Hemiparesis
• Hemiplegia
• Dysphagia
• Dysarthria
• Depression, other psychological problems like emotional
lability, lack of cooperation.

12. Diagnostic Evaluation
• Complete Medical History
• Physical Examination
• CT Scan
• MRI Scan
• Cerebral angiography
• Lumbar puncture
• Skull x-ray
• ECG and echocardiography
• Laboratory studies to rule out systemic causes: CBC,
platelet and clotting studies, VDRL/RPR, erythrocyte
sedimentation rate (ESR), chemistries (glucose,sodium)

13. Management
Medical Management
- Recombinant tissue plasminogen activator
- Increased ICP
- Endotracheal Tube
- Hemodynamic monitoring
- Neurologic assessment

14. Surgical Management
- Carotid endarterectomy
- Hemicraniectomy

15. Nursing Management
After the stroke is complete, management focuses on
the prompt initiation of rehabilitation for any deficits.

16. Nursing Assessment
During the acute phase,
• Change in level of consciousness or responsiveness.
• Presence or absence of voluntary or involuntary
movements of extremities.
• Stiffness or flaccidity of the neck.
• Eye opening, comparative size of pupils, and pupillary
reaction to light.
• Color of the face and extremities; temperature and
moisture of the skin.
• Ability to speak.
• Presence of bleeding.
• Maintenance of blood pressure.

17. During the postacute phase,
• Mental status
• Sensation and perception
• Motor control
• Continue focusing nursing assessment on
impairment of function in patient’s daily
activities.

18. Nursing Diagnosis
• Impaired physical mobility related to hemiparesis, loss of balance and
coordination, spasticity, and brain injury.
• Acute pain related to hemiplegia and disuse.
• Deficient self-care related to stroke sequelae.
• Disturbed sensory perception related to altered sensory reception,
transmission, and/or integration.
• Impaired urinary elimination related to flaccid bladder, detrusor
instability, confusion, or difficulty in communicating.
• Disturbed thought processes related to brain damage.
• Impaired verbal communication related to brain damage.
• Risk for impaired skin integrity related to hemiparesis or hemiplegia and
decreased mobility.
• Interrupted family processes related to catastrophic illness and caregiving
burdens.
• Sexual dysfunction related to neurologic deficits or fear of failure.

19. Complications
If cerebral oxygenation is still inadequate;
complications may occur.
- Tissue ischemia. If cerebral blood flow is
inadequate, the amount of oxygen supplied to
the brain is decreased, and tissue ischemia will
result.
- Cardiac dysrhythmias. The heart
compensates for the decreased cerebral blood
flow, and with too much pumping, dysrhythmias
may occur.

20. Prevention

21. • Healthy lifestyle:Leading a healthy lifestyle which includes not
smoking, maintaining a healthy weight, following a healthy diet,
and daily exercise can reduce the risk of having a stroke by about
one half.
• DASH diet : The DASH (Dietary Approaches to Stop Hypertension)
diet is high in fruits and vegetables, moderate in low-fat dairy
products, and low in animal protein and can lower the risk of
stroke.
• Stroke risk screenings : Stroke risk screenings are an ideal
opportunity to lower stroke risk by identifying people or groups of
people who are at high risk for stroke.
• Education : Patients and the community must be educated about
recognition and prevention of stroke.
• Low-dose aspirin : Research findings suggest that low-dose aspirin
may lower the risk of stroke in women who are at risk.