Cerebrovascular Accident

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Information about Cerebrovascular Accident
Health & Medicine

Published on November 24, 2008

Author: txnurse

Source: slideshare.net

Description

PowerPoint Presentation on Cerebrovascular Accident (CVA) or Stroke.

Presented by Maria G. Nelson and Imelda de los Santos

CVA or Stroke An interruption of blood supply to a vital center in the brain Also called “brain attack”, cerebral infarction, cerebral hemorrhage, ischemic stroke or stroke

An interruption of blood supply to a vital center in the brain

Also called “brain attack”, cerebral infarction, cerebral hemorrhage, ischemic stroke or stroke

The Human Brain

Stroke 101 Third leading cause of death in America, behind heart disease and cancer Kills 160,000 people each year Leading cause of adult disability About 750,000 strokes will occur this year, 500,000 of those strokes could be prevented Costs the nation $62.7 billion in direct and indirect costs

Third leading cause of death in America, behind heart disease and cancer

Kills 160,000 people each year

Leading cause of adult disability

About 750,000 strokes will occur this year, 500,000 of those strokes could be prevented

Costs the nation $62.7 billion in direct and indirect costs

Brain Attack

Direct Causes of Stroke Cerebral thrombosis – a blood clot or plaque blocks an artery that supplies a vital brain center Cerebral hemorrhage or aneurysm – an artery in the brain bursts, weakens the aneurysm wall; severe rise in BP causing hemorrhage and ischemia Cerebral embolism – a blood clot breaks off from a thrombus elsewhere in the body, lodges in a blood vessel in the brain and shuts off blood supply to that part of the brain

Cerebral thrombosis – a blood clot or plaque blocks an artery that supplies a vital brain center

Cerebral hemorrhage or aneurysm – an artery in the brain bursts, weakens the aneurysm wall; severe rise in BP causing hemorrhage and ischemia

Cerebral embolism – a blood clot breaks off from a thrombus elsewhere in the body, lodges in a blood vessel in the brain and shuts off blood supply to that part of the brain

Types of Stroke Ischemic stroke - when arteries are blocked by blood clots or by gradual build up of plaque and other fatty deposits. Almost 85% of strokes are ischemic. Hemorrhagic stroke – when a blood vessel in the brain breaks leaking blood into the brain. About 15% of all strokes but responsible for 30% of stroke deaths

Ischemic stroke - when arteries are blocked by blood clots or by gradual build up of plaque and other fatty deposits.

Almost 85% of strokes are ischemic.

Hemorrhagic stroke – when a blood vessel in the brain breaks leaking blood into the brain.

About 15% of all strokes but responsible for 30% of stroke deaths

Stroke

Points to Consider 2,000,000 brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death. Recognizing symptoms and acting fast to get medical attention can save life and limit disabilities.

2,000,000 brain cells die every minute during stroke, increasing risk of permanent brain damage, disability or death.

Recognizing symptoms and acting fast to get medical attention can save life and limit disabilities.

Stages of CVA Transient ischemic attack (TIA) – sudden and short-lived attack Reversible ischemic neurologic deficit (RIND) similar to TIA, but symptoms can last up to a week Stroke in evolution (SIE) - gradual worsening of symptoms of brain ischemia Completed stroke (CS) – symptoms of stroke stable over a period and rehab can begin

Transient ischemic attack (TIA) – sudden and short-lived attack

Reversible ischemic neurologic deficit (RIND) similar to TIA, but symptoms can last up to a week

Stroke in evolution (SIE) - gradual worsening of symptoms of brain ischemia

Completed stroke (CS) – symptoms of stroke stable over a period and rehab can begin

Signs and Symptoms In embolism Usually occurs without warning Client often with history of cardiovascular disease In thrombosis Dizzy spells or sudden memory loss No pain, and client may ignore symptoms In cerebral hemorrhage May have warning like dizziness and ringing in the ears (tinnitus) Violent headache, with nausea and vomiting

In embolism

Usually occurs without warning

Client often with history of cardiovascular disease

In thrombosis

Dizzy spells or sudden memory loss

No pain, and client may ignore symptoms

In cerebral hemorrhage

May have warning like dizziness and ringing in the ears (tinnitus)

Violent headache, with nausea and vomiting

Signs and Symptoms Sudden-onset CVA Usually most severe Loss of consciousness Face becomes red Breathing is noisy and strained Pulse is slow but full and bounding Elevated BP May be in a deep coma

Sudden-onset CVA

Usually most severe

Loss of consciousness

Face becomes red

Breathing is noisy and strained

Pulse is slow but full and bounding

Elevated BP

May be in a deep coma

Time is Critical! The longer the time period that the person remains unresponsive, the less likely it is that the person will recover. The first few days after onset is critical. The responsive person may: Show signs of memory loss or inconsistent behavior May be easily fatigued, lose bowel and bladder control, or have poor balance.

The longer the time period that the person remains unresponsive, the less likely it is that the person will recover.

The first few days after onset is critical.

The responsive person may:

Show signs of memory loss or inconsistent behavior

May be easily fatigued, lose bowel and bladder control, or have poor balance.

Common Stroke Symptoms Weakness or paralysis Numbness, tingling, decreased sensation Vision changes Speech problems Swallowing difficulties or drooling Loss of memory Vertigo (spinning sensation) Loss of balance and coordination Personality changes Mood changes (depression, apathy) Drowsiness, lethargy, or loss of consciousness Uncontrollable eye movements or eyelid drooping

Weakness or paralysis

Numbness, tingling, decreased sensation

Vision changes

Speech problems

Swallowing difficulties or drooling

Loss of memory

Vertigo (spinning sensation)

Loss of balance and coordination

Personality changes

Mood changes (depression, apathy)

Drowsiness, lethargy, or loss of consciousness

Uncontrollable eye movements or eyelid drooping

Act F.A.S.T . F = Face Ask the person to smile. Does one side of the face droop? A = Arms Ask the person to raise both arms. Does one arm drift downward? S = Speech Ask the person to repeat a simple sentence. Does the speech sound slurred or strange? T = Time Call 911 immediately!

F = Face Ask the person to smile. Does one side of the face droop?

A = Arms Ask the person to raise both arms. Does one arm drift downward?

S = Speech Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?

T = Time Call 911 immediately!

Risk Factors Being over age 55 Being an African-American Having diabetes Having a family history of stroke

Being over age 55

Being an African-American

Having diabetes

Having a family history of stroke

Medical Stroke Risks Previous stroke Previous episode of transient ischemic attack (TIA) or mini-stroke High cholesterol High blood pressure Heart disease Atrial fibrillation and carotid artery disease

Previous stroke

Previous episode of transient ischemic attack (TIA) or mini-stroke

High cholesterol

High blood pressure

Heart disease

Atrial fibrillation and carotid

artery disease

Lifestyle Stroke Risks Smoking Being overweight Drinking too much alcohol You can control lifestyle risks by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.

Smoking

Being overweight

Drinking too much alcohol

You can control lifestyle risks by quitting smoking, exercising regularly, watching what and how much you eat and limiting alcohol consumption.

Major Effects of Stroke Hemiplegia - most common result of CVA Paralysis of one side of the body May affect other functions, such as hearing, general sensation and circulation The degree of impairment depends on the part of the brain affected Stages: Flaccid – numbness and weakness of affected side Spastic – muscles contracted and tense, movement hard Recovery – therapy and rehab methods successful

Hemiplegia - most common result of CVA

Paralysis of one side of the body

May affect other functions, such as hearing, general sensation and circulation

The degree of impairment depends on the part of the brain affected

Stages:

Flaccid – numbness and weakness of affected side

Spastic – muscles contracted and tense, movement hard

Recovery – therapy and rehab methods successful

Aphasia and Dysphasia Brain Damage – extent of brain damage determines chances of recovery Hemianopsia – blindness in half of the visual field of one or both eyes Pain – usually very little; injection of local anesthetic provides temporary relief Autonomic Disturbances Such as perspiration or “goose flesh” above the level of paralysis May have dilated pupils, high or low BP or headache Treated with atropine-like drugs Personality Changes – either functional or organic

Aphasia and Dysphasia

Brain Damage – extent of brain damage determines chances of recovery

Hemianopsia – blindness in half of the visual field of one or both eyes

Pain – usually very little; injection of local anesthetic provides temporary relief

Autonomic Disturbances

Such as perspiration or “goose flesh” above the level of paralysis

May have dilated pupils, high or low BP or headache

Treated with atropine-like drugs

Personality Changes – either functional or organic

Diagnostic Procedures Magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging, computed axial tomography (CAT) scan Used to identify edema, ischemia and necrosis Magnetic resonance angiography (MRA) or cerebral angiography To identify presence of cerebral hemorrhage, abnormal vessel structures, vessel ruptures, and regional perfusion of blood flow in the brain Lumbar puncture Used to assess presence of blood in the CSF Carotid endarterectomy Performed to open the artery by removing atherosclerotic plaque Interventional radiology Performed to treat cerebral aneurysm

Magnetic resonance imaging (MRI) and/or computed tomography (CT) imaging, computed axial tomography (CAT) scan

Used to identify edema, ischemia and necrosis

Magnetic resonance angiography (MRA) or cerebral angiography

To identify presence of cerebral hemorrhage, abnormal vessel structures, vessel ruptures, and regional perfusion of blood flow in the brain

Lumbar puncture

Used to assess presence of blood in the CSF

Carotid endarterectomy

Performed to open the artery by removing atherosclerotic plaque

Interventional radiology

Performed to treat cerebral aneurysm

Assessments Monitor for signs and symptoms Symptoms will vary based on the area of the brain that is not adequately supplied with oxygenated blood The left cerebral hemisphere is responsible for language, mathematic skills and analytic thinking The right cerebral hemisphere is responsible for visual and spatial awareness and proprioception Assess/Monitor Airway patency Swallowing ability/aspiration risk Level of consciousness Neurological status Motor, sensory and cognitive functions Glasgow Coma Scale score

Monitor for signs and symptoms

Symptoms will vary based on the area of the brain that is not adequately supplied with oxygenated blood

The left cerebral hemisphere is responsible for language, mathematic skills and analytic thinking

The right cerebral hemisphere is responsible for visual and spatial awareness and proprioception

Assess/Monitor

Airway patency

Swallowing ability/aspiration risk

Level of consciousness

Neurological status

Motor, sensory and cognitive functions

Glasgow Coma Scale score

Nursing Diagnoses Ineffective tissue perfusion (cerebral) Disturbed sensory perception Impaired physical mobility Risk for injury Self-care deficit Impaired verbal communication Impaired swallowing

Ineffective tissue perfusion (cerebral)

Disturbed sensory perception

Impaired physical mobility

Risk for injury

Self-care deficit

Impaired verbal communication

Impaired swallowing

Nursing Considerations Maintain patent airway. Monitor for changes in the client’s level of consciousness (increased intracranial pressure sign). Elevate the client’s head to reduce ICP and to promote venous drainage. Avoid extreme flexion or extension, maintain the head in a midline neutral position and elevate the head of bed to 30 degrees. Institute seizure precautions.

Maintain patent airway.

Monitor for changes in the client’s level of consciousness (increased intracranial pressure sign).

Elevate the client’s head to reduce ICP and to promote venous drainage. Avoid extreme flexion or extension, maintain the head in a midline neutral position and elevate the head of bed to 30 degrees.

Institute seizure precautions.

Maintain a non-stimulating environment. Assist with communication skills if the client’s speech is impaired. Assist with safe feeding. Assess swallowing reflexes. Thicken liquid to avoid aspiration. Eat in an upright position and swallow with the head and neck flexed slightly forward. Place food in the back of the mouth on the unaffected side. Suction on standby.

Maintain a non-stimulating environment.

Assist with communication skills if the client’s speech is impaired.

Assist with safe feeding.

Assess swallowing reflexes.

Thicken liquid to avoid aspiration.

Eat in an upright position and swallow with the head and neck flexed slightly forward.

Place food in the back of the mouth on the unaffected side.

Suction on standby.

Maintain skin integrity. Encourage PROM every 2 hr to the affected extremities and AROM every 2 hr to the unaffected extremities. Elevate the affected extremities to promote venous return and to reduce swelling. Maintain a safe environment to reduce the risks of falls. Scanning technique (turning head from side to side) when eating and ambulating to compensate for hemianopsia.

Maintain skin integrity.

Encourage PROM every 2 hr to the affected extremities and AROM every 2 hr to the unaffected extremities.

Elevate the affected extremities to promote venous return and to reduce swelling.

Maintain a safe environment to reduce the risks of falls.

Scanning technique (turning head from side to side) when eating and ambulating to compensate for hemianopsia.

Provide care to prevent deep-vein thrombosis (sequential compression stockings, frequent position changes, mobilization). Administer medications as prescribed. Systemic or catheter directed thrombolytic therapy restores cerebral blood flow. It must be administered within hours of the onset of symptoms. It is contraindicated for treatment of hemorrhagic stroke and for clients with an increased risk of bleeding. Rule out hemorrhagic stroke with an MRI prior to initiation of thrombolytic therapy.

Provide care to prevent deep-vein thrombosis (sequential compression stockings, frequent position changes, mobilization).

Administer medications as prescribed.

Systemic or catheter directed thrombolytic therapy restores cerebral blood flow. It must be administered within hours of the onset of symptoms. It is contraindicated for treatment of hemorrhagic stroke and for clients with an increased risk of bleeding. Rule out hemorrhagic stroke with an MRI prior to initiation of thrombolytic therapy.

Thrombolytic Therapy Anticoagulants: Sodium heparin, warfarin (Coumadin) Antiplatelets: Ticlopidine (Ticlid), clopidogrel (Plavix) Antiepileptic medications: Phenytoin (Dilantin), gabapentin (Neurontin)

Anticoagulants: Sodium heparin, warfarin (Coumadin)

Antiplatelets: Ticlopidine (Ticlid), clopidogrel (Plavix)

Antiepileptic medications: Phenytoin (Dilantin), gabapentin (Neurontin)

Stroke Prevention Get screened for high BP. Have your cholesterol level checked. LDL should be lower than 70 mg/dL. Follow a low-fat diet. Quit smoking! Exercise! Limit alcohol intake!

Get screened for high BP.

Have your cholesterol level checked. LDL should be lower than 70 mg/dL.

Follow a low-fat diet.

Quit smoking!

Exercise!

Limit alcohol intake!

Stroke Resources www.strokeassociation.org www.americanstroke.org www.stroke.org www.strokecenter.org www.ced.gov www.ahajournals.org Thanks Batch 17 and Ms. Shiela for being a great audience!!! Margi & Imeeh

www.strokeassociation.org

www.americanstroke.org

www.stroke.org

www.strokecenter.org

www.ced.gov

www.ahajournals.org

Thanks Batch 17 and Ms. Shiela for being a great audience!!!

Margi & Imeeh

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