This document discusses cerebrovascular disorders such as stroke. It begins by defining cerebrovascular disorders as any functional abnormality of the central nervous system caused by disrupted blood supply to the brain. Stroke is the primary cerebrovascular disorder. The document then covers the anatomy of the nervous system, definitions of stroke, risk factors, types of stroke (ischemic and hemorrhagic), clinical manifestations, diagnostic findings, and management approaches including medical, surgical, and nursing considerations.
cerebrovascular accident, commonly known as stroke is one of the most common health problems of the world. in the developing world, its increasing incidence is a matter of concern among the health workers across the globe. thus adequate knowledge about this medical condition is a must to deal with it effectively.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from sudden excessive discharge from cerebral neurons.
cerebrovascular accident, commonly known as stroke is one of the most common health problems of the world. in the developing world, its increasing incidence is a matter of concern among the health workers across the globe. thus adequate knowledge about this medical condition is a must to deal with it effectively.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity (or a combination of these) resulting from sudden excessive discharge from cerebral neurons.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
Encephalitis is a rare yet serious disease that can be life-threatening.
Encephalitis is an inflammation of the brain tissue.
The most common cause is viral infections.
In rare cases it can be caused by bacteria or even fungi.
Encephalitis is an inflammation of the brain tissue.
Primary encephalitis- It occurs when a virus directly infects the brain and spinal cord.
Secondary encephalitis- It occurs when an infection starts elsewhere in the body and then travels to your brain.
Older adults
Children under the age of 1 year
People with weak immune systems
Primary (infectious) encephalitis
Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
Childhood viruses, including measles and mumps
Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis
Secondary encephalitis: could be caused by a complication of a viral infection.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
Encephalitis is a rare yet serious disease that can be life-threatening.
Encephalitis is an inflammation of the brain tissue.
The most common cause is viral infections.
In rare cases it can be caused by bacteria or even fungi.
Encephalitis is an inflammation of the brain tissue.
Primary encephalitis- It occurs when a virus directly infects the brain and spinal cord.
Secondary encephalitis- It occurs when an infection starts elsewhere in the body and then travels to your brain.
Older adults
Children under the age of 1 year
People with weak immune systems
Primary (infectious) encephalitis
Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
Childhood viruses, including measles and mumps
Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis
Secondary encephalitis: could be caused by a complication of a viral infection.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
I am presently working in Columbia asia hospitals, Bangalore.
My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology, Endoscopic and minimally invasive Neurosurgery, Endoscopic spine surgery.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Psychosocial care of coronavirus disease 2019Nursing Path
The novel Coronavirus (nCoV) epidemic in 2019 -2020 has recently emerged. The route of transmission is not totally known, although it is known that it can spread from person to person, and local health care systems may be ill-equipped to handle a large-scale outbreak.
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A mental health disorder characterised by feelings of worry, anxiety or fear that are strong enough to interfere with one's daily activities.
The term "anxiety disorder" refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD), panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias.
Selection and organization of learning experienceNursing Path
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Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing.
Swine influenza is an infection caused by any one of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) is any strain of the influenza family of viruses that is endemic in pigs
Abortion is the ending of pregnancy by removing an embryo or fetus before it can survive outside the uterus. An abortion that occurs spontaneously is also known as a miscarriage.
The enterobacteriaceae basic properties.ppsx xNursing Path
The Enterobacteriaceae are a large family of Gram-negative bacteria that includes, along with many harmless symbionts, many of the more familiar pathogens, such as Salmonella, Escherichia coli, Yersinia pestis, Klebsiella, and Shigella.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
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Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
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An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
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2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2. INTRODUCTION
• Cerebrovascular disorders” is any functional
abnormality of the central nervous system
(CNS) that occurs when the normal blood
supply to the brain is disrupted. Stroke is the
primary Cerebrovascular disorder in the
United States and in the world. stroke is still
the third leading cause of death.
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3. ANATOMY & PHYSIOLOGY OF
NERVOUS SYSTEM
The nervous system is divided into two parts:
• Central nervous system
• Peripheral nervous system
• ARTERIES: Two internal carotid arteries, Two
vertebral arteries
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4. DEFINITION
• A stroke, or Cerebrovascular accident (CVA),
occurs when blood supply to part of the brain
is disrupted, causing brain cells to die.
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5. INCIDENCE
• AGE : The percentage is higher for people age
65 and older. Of those who survive, 50% to
70% will be functioning independent and 15%
to 30% will live with permanent disability.
• SEX : Stroke is more common in men than in
women.
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6. RACE
• African american have a higher incidence of strokes than whites.
• This high incidence may be related to increase rate of hypertension,
diabetes mellitus and sickle cell anemia in african americans.
• African americans also have a higher incidence of smoking and
obesity than white, which are two other risk factors for stroke.
• African american are twice as likely to die from a strokes as white.
COUNTRY :
• An estimated 700,000 person in the united states and 50,000 in
canada suffer a stroke annually.
• Stroke is the third most commen cause of the death in the united
states and canada, behind cancer and heart disease.
• In canada about 16,000 die from stroke each year, while in united
states there are over 160,000 deaths from strokes.
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7. ETIOLOGY
Nonmodifiable risk factors :
• Age : more than 65 yr
• Gender : More in men than women
• Race : African American
• Family history : Heredity
Modifiable risk factors :
• Hypertension
• Heart disease
• Smoking
30/04/2015 www.drjayeshpatidar.blogspot.com 7
11. TYPES OF STROKE
Strokes are classified as ischemic or hemorrhagic
based on the underlying pathophysiologic
findings.
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12. Ischemic stroke
• An ischemic stroke result from inadequate
blood flow to the brain from partial or
complete occlusion of an artery. These
account for approximately 80% of all strokes.
Ischemic stroke are further divided into
thrombotic and embolic.
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13. Thrombotic stroke
• A thrombotic stroke occurs from injury to a blood
vessels wall and formation of a blood clot. The
lumen of the blood vessel becomes narrowed
and if it becomes occluded, infarction occur.
Thrombosis develops readily where
atherosclerotic plaques have already narrowed
blood vessels. Thrombotic stroke, which is the
result of thrombosis or narrowed blood vessel, is
the most common cause of stroke. Two third of
thrombotic strokes are associated with
hypertension or diabetes mellitus
30/04/2015 www.drjayeshpatidar.blogspot.com 13
14. Embolic stroke
• Another type of stroke may occur when a
blood clot or a piece of atherosclerotic plaque
(cholesterol and calcium deposits on the wall
of the inside of the heart or artery) breaks
loose, travels through the bloodstream and
lodges in an artery in the brain. When blood
flow stops, brain cells do not receive the
oxygen and glucose they require to function
and a stroke occurs. This type of stroke is
referred to as an embolic stroke.
30/04/2015 www.drjayeshpatidar.blogspot.com 14
15. CLINICAL MANIFESTATIONS
• Visual Field Deficits :
Homonymous hemianopsia (loss of half of the visual field)
- Unaware of persons or objects on side of visual loss
- Neglect of one side of the body
- Difficulty judging distances
Loss of peripheral vision
-Difficulty seeing at night
- Unaware of objects or the borders of objects
Diplopia
-Double vision
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16. Motor Deficits
Hemiparesis
• Weakness of the face, arm, and leg non the same side (due to a
lesion in the opposite hemisphere)
Hemiplegia
• Paralysis of the face, arm, and leg on the same side (due to a lesion
in the opposite hemisphere)
Ataxia
• Defective muscular co-ordination, unsteady gait Unable to keep
feet together; needs a broad base to stand
Dysarthria
• Difficulty in forming words
Dysphagia
• Difficulty in swallowing
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17. Sensory Deficits
Paresthesia (occurs on the side opposite the
lesion)
• Numbness and tingling of Extremity
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18. Verbal Deficits
Expressive aphasia
• Unable to form words that are understandable;
may be able to speak in single-word responses
Receptive aphasia
• Unable to comprehend the spoken word; can
speak but may not make sense
Global (mixed) aphasia
• Combination of both receptive and expressive
aphasia
30/04/2015 www.drjayeshpatidar.blogspot.com 18
19. Cognitive Deficits
• Short- and long-term memory loss
• Decreased attention span
• Impaired ability to concentrate
• Poor abstract reasoning
• Altered judgment
Emotional Deficits
• Loss of self-control
• Emotional lability
• Decreased tolerance to stressful situations
• Depression
• Withdrawal
• Fear, hostility, and anger
• Feelings of isolation
30/04/2015 www.drjayeshpatidar.blogspot.com 19
20. ASSESSMENT AND DIAGNOSTIC FINDING
HEALTH HISTORY :
• Past health history : Hypertension, previous stroke,
aneurysm, cardiac disease (including recent myocardial
infraction), dysrhythmias, heart failure, valvular disease,
infective endocarditis, hyperlipidemia, polycythemia,
diabetes
• Family history : Hypertension, diabetes, stroke, coronary
artery disease.
• Medications : Use of oral contraceptives, use of
antihypertensive and anticoagulant therapy
• Nutritional history : Anorexia, nausea, vomiting,dysphagia,
altered sensation of taste and smell
• Cognitive perceptual history : Numbness, tingling of one
side of body, loss of memory, altered in speech, pain,
headache, visual disturbance
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21. PHYSICAL ASSESSMENT
• Glasgow coma scale
• NIH stroke scale
• COGNITIVE FUNCTION :-
• Orientation :
Speech :-aphasia & other problems
– Fluent aphasia (motor/Borka’s) – inability to express
self
– Non-fluent aphasia ( sensory / wernicke’s) – inability
to understand the spoken language.
– Global aphasia – inability to speak or understand
spoken language.
– Other aphasia syndromes – amnesia, conduction.
30/04/2015 www.drjayeshpatidar.blogspot.com 21
22. • Other alterations include :
– Confabulation – fluent , nonsensical speech
– Preservation – continuation of thought process
with inability to change rain of though without
direction or repetition.
• MOTOR FUNCTION :
-Voluntary movement
-Reflexive movement : Biceps, Triceps, Patellar,
Achilles, Planter:
30/04/2015 www.drjayeshpatidar.blogspot.com 22
27. MANAGEMENT :
MEDICAL MANAGEMENT :
• Platelet-inhibiting medications : Aspirin, dipyridamole
[Persantine], clopidogrel [Plavix], and ticlopidine [Ticlid]).
Currently the most cost-effective antiplatelet regimen is
aspirin 50 mg/d and dipyridamole 400 mg/d.
• Thrombolytic therapy : Recombinant t-PA is a genetically
engineered form of t PA, a thrombolytic substance made
naturally by the body. The minimum dose is 0.9 mg/kg; the
maximum dose is 90 mg.
30/04/2015 www.drjayeshpatidar.blogspot.com 27
28. Eligibility Criteria for t-PA
Administration
• Age 18 years or older
• Clinical diagnosis of stroke with NIH stroke scale score
under 22
• Time of onset of stroke known and is 3 hours or less
• BP systolic ≤ 185; diastolic ≤ 110
• Not a minor stroke or rapidly resolving stroke
• No seizure at onset of stroke
• Not taking warfarin (Coumadin)
• Prothrombin time ≤ 15 seconds or INR ≤ 1.7
• Not receiving heparin during the past 48 hours with
elevated partial thromboplastin time.
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29. • Platelet count ≥ 100,000
• Blood glucose level between 50 and 400 mg/dL
• No acute myocardial infarction
• No prior intracranial hemorrhage, neoplasm,
arteriovenous, malformation, or aneurysm
• No major surgical procedures within 14 days
• No stroke or serious head injury within 3 months
• No gastrointestinal or urinary bleeding within last
21 days
• Not lactating or postpartum within last 30 days
30/04/2015 www.drjayeshpatidar.blogspot.com 29
30. Surgical management
• Carotid endarterectomy : Removal of an
atherosclerotic plaque or thrombus from the carotid
artery to prevent stroke in patients with occlusive
disease of the extracranial cerebral arteries. This
surgery is indicated for patients with symptoms of
TIA or mild stroke found to be due to severe (70% to
99%) carotid artery stenosis or moderate (50% to
69%) stenosis with other significant risk factors.
30/04/2015 www.drjayeshpatidar.blogspot.com 30
31. NURSING MANAGEMENT
ASSESSMENT
• Assess the level of consciousness or responsiveness as
evidenced by movement, resistance to changes of
position, and response to stimulation; orientation to time,
place, and person
• Presence or absence of voluntary or involuntary
movements of the extremities; muscle tone; body
posture; and position of the head
• Stiffness or flaccidity of the neck
• Eye opening, comparative size of pupils and pupillary
reactions to light, and ocular position
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32. • Color of the face and extremities; temperature and
moisture of the skin
• Quality and rates of pulse and respiration; arterial
blood gas values as indicated, body temperature,
and arterial pressure
• Ability to speak
• Volume of fluids ingested or administered; volume
of urine excreted each 24 hours
• Presence of bleeding
• Maintenance of blood pressure within the desired
parameters
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33. NURSING DIAGNOSES
• Impaired physical mobility related to hemiparesis, loss
of balance and coordination, spasticity, and brain
injury
• Acute pain related to hemiplegia and disuse of
extrimity
• Self-care deficits (hygiene, toileting, grooming, and
feeding) related to stroke
• Disturbed sensory perception related to altered
sensory reception, transmission, and/or integration
• Impaired swallowing
• Incontinence related to flaccid bladder, detrusor
instability, confusion, or difficulty in communicating
30/04/2015 www.drjayeshpatidar.blogspot.com 33
34. • Disturbed thought processes related to brain
damage, confusion, or inability to follow
instructions
• Impaired verbal communication related to
brain damage
• Risk for impaired skin integrity related to
hemiparesis/ hemiplegia, or decreased
mobility
• Interrupted family processes related to
catastrophic illness and caregiving burdens
• Sexual dysfunction related to neurologic
deficits or fear of failure
30/04/2015 www.drjayeshpatidar.blogspot.com 34
35. Hemorrhagic strokes
• Hemorrhagic strokes account for 15% of
cerebrovascular disorders and are primarily
caused by an intracranial or subarachnoid
hemorrhage
• Hemorrhagic strokes are caused by bleeding into
the brain tissue, the ventricles, or the
subarachnoid space. Primary intracerebral
hemorrhage from a spontaneous rupture of small
vessels accounts for approximately 80% of
hemorrhagic strokes and is primarily caused by
uncontrolled hypertension
30/04/2015 www.drjayeshpatidar.blogspot.com 35
36. Pathophysiology
Etiological factors
•
•
presses on nearby cranial nerves or brain tissue
•
•
•
causing subarachnoid hemorrhage
•
•
increase in ICP resulting from the sudden entry of blood into the subarachnoid
space,
•
•
injures brain tissue; or by secondary ischemia of the brain resulting from the
reduced perfusion pressure
30/04/2015 www.drjayeshpatidar.blogspot.com 36
37. TYPE OF HEMORRHAGE
• INTRACEREBRAL HEMORRHAGE
An intracerebral haemorrhage, or bleeding into the brain
substance, is most common in patients with hypertension and
cerebral atherosclerosis because degenerative changes from
these diseases cause rupture of the vessel.
30/04/2015 www.drjayeshpatidar.blogspot.com 37
38. • INTRACRANIAL (CEREBRAL) ANEURYSM
An intracranial (cerebral) aneurysm is a dilation
of the walls of a cerebral artery that develops
as a result of weakness in the arterial wall.
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39. • SUBARACHNOID HEMORRHAGE :
• A subarachnoid hemorrhage (hemorrhage into
the subarachnoid space) may occur as a result
trauma, or hypertension.
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40. CLINICAL MANIFESTATIONS
• Severe headache
• Loss of consciousness
• Rigidity of the back and neck (nuchal rigidity)
• Pain in spine due to meningeal irritation
• Visual disturbance (visual loss, diplopia,
ptosis)
• Dizziness
• Hemiparesis
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41. ASSESSMENT AND DIAGNOSTIC
FINDING :
DIAGNOSTIC EVALUATION :
• CT Scan : To determine the size and location of the
hematoma as well as presence or absence of ventricular
blood.
• Cerebral angiography : To confirm the diagnosis of an
aneurysm or AVM.
• Lumber puncture
PREVENTION:
• Control hypertension.
• Stop smoking.
• Stop to take alcohol.
• Avoid to take high cholesterol diet
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42. SURGICAL MANAGEMENT
• Craniotomy : Many patients with a primary
intracerebral hemorrhage are not treated
surgically. However, surgical evacuation is
strongly recommended for the patient with a
cerebellar hemorrhage if the diameter
exceeds 3 cm. Surgical evacuation is most
frequently accomplished via a craniotomy.
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43. Extracranial-intracranial arterial bypass :
An extracranial-intracranial arterial bypass may be performed to
establish collateral blood supply to allow surgery on the
aneurysm. Alternatively, an extracranial method may be used,
whereby the carotid artery is gradually occluded in the neck
to reduce pressure within the blood vessel.
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45. NURSING DIAGNOSIS :
• Ineffective cerebral tissue perfusion related to
bleeding
• Disturbed sensory perception related to
medically imposed restrictions (aneurysm
precautions)
• Anxiety related to illness and/or medically
imposed restrictions (aneurysm precaution)
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46. HOME CARE
• Discuss measures to prevent subsequent strokes.
• Identify signs and symptoms of specific
complications.
• Identify potential complications and discuss
measures to prevent them (blood clots, aspiration,
pneumonia, urinary tract infection, fecal impaction,
skin breakdown, contracture).
• Identify psychosocial consequences of stroke and
appropriate interventions.
• Identify safety measures to prevent falls.
• State names, doses, indications, and side effects of
medications.
•
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47. • Demonstrate adaptive techniques for accomplishing
ADLs.
• Demonstrate swallowing techniques (for patients with
dysphagia).
• Demonstrate care of enteric feeding tube, if applicable.
• Demonstrate home exercises, use of splints or
orthotics, proper positioning, and need for frequent
repositioning.
• Describe procedures for maintaining skin integrity.
• Demonstrate indwelling catheter care, if applicable.
Describe a bowel and bladder elimination program as
appropriate.
• Identify appropriate recreational or diversional
activities, support groups, and community resources.
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