Stroke (CVA) is the 3rd most common cause of death in US with nearly 144,000 deaths each year (NSA)2009a. The leading cause of serious long-term disability. Major public health problem in term of morbidity and mortality. Quality of life issues can not be appropriately evaluated.

1. Stroke –
CerebroVascular
Accident (CVA )
Nursing process
Jamilah saad
Alqahtani
CNS,MSN,BSN,RG
N,OR Specilaist

2. Objectives
Students will be able to understand:
• Introduction
• Definition
• Perceptions
• Pathophyisology
• Signs and symptoms
• Risk factors
• Warning signs of stroke
• Mechanisms affect cerebral blood flow
• Types of stroke
• Diagnostic studies
• Treatment
• Nursing process
• Stroke-prevention guidelines
• Summary
• References jamilah saad Alqahtani 2

3. Outlines
• Introduction
• Definition
• Perceptions
• Pathophyisology
• Signs and symptoms
• Risk factors
• Warning signs of stroke
• Mechanisms affect cerebral blood flow
• Types of stroke
• Diagnostic studies
• Treatment
• Nursing process
• Stroke-prevention guidelines
• Summary
• References jamilah saad Alqahtani 3

4. Introduction
• Stroke (CVA) is the 3rd most common cause of
death in US with nearly 144,000 deaths each
year (NSA)2009a. The leading cause of serious
long-term disability. Major public health
problem in term of morbidity and mortality.
Quality of life issues can not be appropriately
evaluated.
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5. Definition
• Cerebrovascular accident (CVA) or stroke is a
“brain attack” .it happens in the brain rather
than the heart and causes sudden loss of brain
function accompanied by neurological deficit.
It is a medical emergency and immediate
treatment is crucial for the best outcome just
as it is for a heart attack (National Stroke
Association [NSA],2009d).
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9. Pathology
• Causes the symptoms common neurological
deficits are motor deficits of hemiplegia(paralysis
of one side of the body on the side opposite of
the brain lesion), hemiparesis(weakness of one
side of the body),dysarthria(impairment of
speech caused by muscles).emotional ability (loss
of emotional control),inability to control behavior
and inability to process multiple pieces of
information are also common manifestations of
stroke
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10. Pathology
• . Sensory deficit include the visual deficit of
double vision, decreased visual acuity and
homonymous hemianopia, the loss of vision in
half of the visual field on the same side of
both eyes. Other possible sensory deficits
include decreased sensation to touch,
pressure, pain, heat, and clod. The client also
may be confused and disoriented .
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11. • Intellectual deficits include memory impairment,
poor judgment, short attention span, difficulty
organizing thoughts, and inbility to reseaon or
calculate. Emotional deficits include depression
and decressed tolerance to stressors.
• Most pts experience initial bowel and bladder
dysfunction. With early recognition of problem
and use bowel and bladder retraining programs,
however most clients regain continence of bowel
and bladder .
Pathology
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12. Signs and symptoms
• Common symptoms include:
• Trouble walking, loss of balance and coordination.
• Speech problems.
• Dizziness.
• Numbness, weakness, or paralysis.
• Blurred, blackened, or double vision.
• Sudden severe headache.
• Confusion.
• Smaller strokes (or silent strokes), however, may not cause any
symptoms, but can still damage brain tissue.
• A transient ischemic attack (TIA) may be a sign of an impending
stroke - TIA is a temporary interruption in blood flow to part of the
brain. Symptoms of TIA are similar to stroke but last for a shorter
period and do not leave noticeable permanent damage.
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13. Risk factors
• Non-modifiable
1. Gender
2. Age
3. Race
4. Heredity
• Modifiable
1. Sedentary Lifestyle
2. Smoking
3. Use of oral contraceptive
4. HTN
5. DM
6. Obesity
7. Stress
8. Hyperlipidemia
9. Drug abuse (specially of cocaine)
Clients with more than one
risk factor are at even greater
risk.
1:20 people who have a TIA
will have a stroke within
2days (NSA, 2009b)
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14. Mechanisms affect
cerebral blood flow
• Extra-cranial
factors
1. Systemic blood
pressure (MAP)
2. Cardiac output
3. Viscosity of blood
• Intracranial factors
1. Intracranial pressure
2. Atherosclerosis
3. Blood vessels
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15. Types of stroke
1. Ischemic
• Thrombotic
• Embolic
2. Hemorrhagic
• Intracerebral
• Subarachnoid
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17. 1. Ischemic strokes
• Thrombotic stroke 60%
-blood clot occludes blood vessel
-2/3s associated with HTN,DM
-30%-50% have prodromes (earlys/s) TIAs
-characteristics
 Men >women
 Occurs during/after sleep
_symptoms peak over 72 hours
_resolution takes up to 2 weeks
 Symptoms occur over several hours
 Permanent neurologic deficits
-size of lesion
-collateral circulation
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18. Transient Ischemic
Attack (TIA)
• Temporary focal loss of neurologic function lasting less
than24 hours
• Warning sign of progressing disease
• Carotid involvement
-Amaurosis fugax (transient loss of vision in one eye )
-hemiparesis
Inbility to speak
• Vertebrobasilar
-Tininitus
-Vertigo blurred vision
-hemiparesis
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19. Embolic Stroke
• Embolus occludes cerebral artery
• Men > women
• Rapid onset
• Headache
• Recurrence is common unless cause of embolism
is addressed
• Causes of embolic strokes are (A trial fibrillation,
Rheumatic fever, Atherosclerotic plaques)
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20. 2. Hemorrhage stroke
• Intracerebrial Hemorrhage Stroke
-bleeding within the brain that lasts from minutes to days
caused by ruptured vessel
-women > men
-Often occurs during activity without warning
-causes(HTN, Brain tumors, trauma, thrombolytic drugs,
ruptured aneurysms)
-symptoms vary with area of bleed ( sever headache,
nausea, vomiting, weakness on one side)
-prognosis is poor
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21. Subarachnoid
Hemorrhage stroke
• Bleeding beneath the arachnoid and pia mater layers
(cerebrospinal fluid-filled space) often related to HTN,
aneurysms, trauma, congenital
malformations(arteriovenous), anticoagulants,
sympathomimetics
• Women >men
• Ballooning vessels may cause prodrome…..often
sudden with rapid neuro changes
• Sever Headache
• Prognosis----guarded
-surgical interventions
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22. Warning signs for stroke
Mn
emo
nic
Mnemoni
c hint
Action Stroke symptom
F
A
S
T
Face
Arms
Speech
Time
Ask pt to smile
Ask pt to raise both arms
Ask pt to say a simple sentence e.g.
the grass is green
If any of these signs are present in
a non hospitalized client, call 911 to
transport the client to an acute
facility
One side of the face may droop.
One arm and falls downward.
The speech is slurred or garbled.
Adapted from NATIONAL STROKE ASSOSIATION NSA (2010)
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23. Diagnostic studies
• CT
• MRI
• Angiography
• Transcranial Doppler
• Lumbar puncture
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24. Treatment
• Medical
• Surgical
• Pharmacological
• Diet
• Activity
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25. Nursing process
• Nursing diagnosis
1. Deficient knowledge related to home care.
2. Impaired verbal communication related to
neuromuscular impairment
3. Unilateral neglect related to neuromuscular
impairment
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26. Assessment
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27. Planning
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28. Intervention
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29. Evaluation
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30. Stroke-prevention guidelines
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31. Summary
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32. References
• Medical-surgical nursing, white duncan
baumle
• http://www.powershow.com/view/318c0-
OWNhZ/Nursing_Management_Stroke_power
point_ppt_presentation
• http://www.medicalnewstoday.com/articles/7
624.php
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