This document discusses cerebrovascular accidents (CVAs), also known as strokes. It defines a stroke as the rapidly developing loss of brain function due to a disturbance in blood supply to the brain caused by a blockage or hemorrhage. Risk factors include hypertension, smoking, diabetes, heart disease, and heredity. Strokes are classified as ischemic, resulting from a blockage, or hemorrhagic, resulting from a bleeding event in the brain. Signs and symptoms depend on the area of brain affected but may include weakness, numbness, vision issues, and altered mental status. Treatment involves restoring blood flow through thrombolysis or angioplasty for ischemic strokes and neurosurgery for hemorrhag

1. CEREBROVASCULAR ACCIDENT (CVA)
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2. STROKE
 It is the rapidly developing loss of brain function(s)
due to disturbance in the blood supply to the brain.
This can be due to ischemia (lack of blood flow)
caused by blockage (thrombosis, arterial embolism),
or a hemorrhage (leakage of blood).
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3. DEFINITION OF CVA
 World Health Organization( 1970) is a "neurological
deficit of cerebrovascular cause that persists beyond
24 hours or is interrupted by death within 24 hours".
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4. EPIDEMIOLOGY
 10% of deaths worldwide
 95% of strokes occur in people age 45 and older, and
two-thirds of strokes occur in those over the age of
65.
 Men are 25% more likely to suffer strokes than
women
 60% of deaths from stroke occur in women
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5. ETIOLOGY OF CVA
 Thrombotic Stroke---Large vessel disease
Small vessel disease
 Embolic stroke ---- blockage of an artery by an arterial
embolus
 atrial fibrillation
 deep vein thrombosis
 ventricular septal defect
 Pulmonary embolism
 Venous thrombosis
 Hypertension
 Bleeding disorders
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6. RISK FACTORS FOR STROKE
 Hypertension
 Smoking
 Diabetes Mellitus
 Carotid artery disease
 Heart disease
 Blood disorders
 Alcohol
 Sex
 Heredity
 stress
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7. CLASSIFICATION OF CVA
 Ischemic Stroke--In an ischemic stroke, blood supply
to part of the brain is decreased, leading to
dysfunction of the brain tissue in that area.
 REASONS FOR CVA
 Thrombosis
 Embolism
 Systemic hypo perfusion
 Venous thrombosis
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8. PATHOPHYSIOLOGY OF ISCHEMIC STROKE
 loss of blood supply to part of the brain
Brain tissue ceases to function if deprived of
oxygen
Irreversible injury to brain tissue
death of the tissue, i.e., infarction
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9. CLASSIFICATION OF CVA
 Hemorrhagic stroke
 intra-axial hemorrhage(blood inside the brain)
 extra-axial hemorrhage(blood inside the skull but
outside the brain).
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10. PATHOPHYSIOLGY OF HEMORRHAGIC STROKE
tissue injury
compression of tissue from an expanding hematoma
loss of blood supply to affected tissue
Infarction
blood released by brain hemorrhage appears to have
direct toxic effects on brain tissue
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12. SIGNS AND SYMPTOMS
 numbness
 reduction in sensory or vibratory sensation
 Hemiplegia
 altered smell, taste, hearing, or vision (total or partial)
 drooping of eyelid (ptosis) and weakness of ocular
muscles
 decreased reflexes: gag, swallow, pupil reactivity to
light
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13. SIGNS AND SYMPTOMS
 decreased sensation and muscle weakness of the
face
 balance problems and nystagmus
 altered breathing and heart rate
 weakness in sternocleidomastoid muscle with
inability to turn head to one side
 weakness in tongue (inability to protrude and/or
move from side to side)
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14. ASSOCIATED SYMPTOMS
 Loss of consciousness
 headache, and vomiting.
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15. STROKE WARNING SIGNS
 Sudden numbness of face, arm, leg
 Sudden confusion
 Sudden trouble, seeing in both eyes
 Sudden trouble in walking, dizziness
 Sudden severe headache, with no cause.
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16. DIAGNOSING STROKE
 Clinical Assessment
 CT scan
 MRI
 EEG
 Doppler Ultrasound
 Carotid angiography
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17. WHAT IS TIA?
 Transient Ischemic Attack is a mini-stroke caused by
a temporarily blocked blood vessel.
 TIA leaves no permanent brain damage.
 10% of cases TIA comes before Stroke.
 It is a warning sign for Major Stroke.
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18. TREATMENT OF STROKE
 Ischemic stroke– thrombolysis (aspirin, clopidogrel,
tissue plasminogen activator )
 Mechanical thrombectomy: It is method that have
been demonstrated effective at restoring blood flow
in patients who were unable to receive thrombolytic
drugs.
 Angioplasty and stenting
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19. TREATMENT OF STROKE
 Hemorrhagic Stroke: Neurosurgical management
done.
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20. PROGNOSIS
 Disability affects 75% of stroke survivors
 30 to 50% of stroke survivors suffer post stroke
depression
 10% of all stroke patients develop seizures
 Cognitive deficits --
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21. NURSING MANAGEMENT
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22. NURSING MANAGEMENT
 Initial management during acute phase.
 Maintenance of body fuctions.
 Psychological needs.
 Rehabilitation within the hospital
 Discharge planning.
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23. NURSING DIAGNOSIS
 Ineffective airway related to unconsciouness.
 Altered tissue perfusion related to ischemia.
 Risk of injury related to seizure activity.
 Constipation related to cerebral injury.
 Altered nutrition related to inability to take food.
 Impaired skin integrity related to immobility.
 Disturbed sleep pattern related to cerebral injury.
 Self-care deficit related to loss of consciousness.
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24. REHABILITATION AFTER STROKE
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25. CARE AND REHABILITATION
 It is the process by which patients with disabling
strokes undergo treatment to help them return to
normal life as much as possible by regaining and
relearning the skills of everyday living.
 It also aims to help the survivor understand and
adapt to difficulties, prevent secondary complications
and educate family members to play a supporting
role.
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26. REHABILITATION
 Physical therapy
 Occupational therapy
 Home care services
 Speech and language therapy
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