2_Cerebral Vascular Accident

2_Cerebral Vascular Accident

1. Pathophysiology

   • Interruption of blood flow to the brain
     • Types of Stroke
       • Permanent loss of brain cells
         • Ishemic
           • Thrombotic
             • thrombosis or narrowing of blood vessel
             • most common
           • Embolic
             • embolus occuldes cerebral artery
             • 2nd most common
         • Hemorrhagic
           • Intracerebral
             • bleeding in brain caused by ruptured vessel
             • htn is risk factor
           • Subrarachnoid
             • bleeding in cerebrospinal fluid
       • Temporarily reduced brain function
         • TIA
           • "Mini-Stoke" when cerebral artery is temporarily blocked

2. Clinical Manifestations

   • motor function
     • akinesia
     • dysphagia
     • dyspnea
   • Heart and Stroke Foundation: Signs of Stroke: http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.9231987/k.E4A7/Help_us_share_the_FAST_signs_of_stroke.htm
   • communication
     • aphasia
       • receptive
       • expressive
   • Affect
     • exagerated/unpredictable emotions
   • memory & judgement impaired

3. Diagnostic Studies

   • CT Scan; MRI; Cerebral Angiography; Cerebral Flow Measures; ECG; Chest X-Ray; Echocardiograph; ABGs; RBC and Hb Count

4. Collaborative Care

   • Nursing Management
     • Assessment
       • History
         • medications
         • risk factors
         • family history
         • other illnesses
         • symptoms
       • Neurological
         • LOC
           • Canadian Neurological Scale
         • motor abilities
         • cranial nerve function
         • sensation
         • proprioception
         • cerebellar function
         • deep tendon reflexes
       • Immediate
         • cardiovascular & respiratory status
     • Planning
       • Goals
         • maintain stable or improved LOC
         • attain maximum physical functioning
         • attain maximum self-care abilities & skills
         • maintain stable body functions
         • maximize communication abilities
         • maintain adequate nutrition
         • avoid complications
         • maintain effective personal & family coping
     • Implementation
       • Health Promotion
       • Nutrition
       • Communication
       • Sensory- Perceptual
       • Sexual function
       • Affect
       • Care Provider
         • Coping
           • facilitator of personal recovery
             • helping
             • comforting
             • teaching
             • working with risk taking
         • doing
         • providing
         • educating
       • Multisystem monitoring
     • Evaluation
       • Achievement of Goals
   • Drug Therapy
     • Ischemic
       • Thrombolytics
         • Recombinant tissue plasminogen activator (tPA)
     • Hemorrhagic
       • Management of HTN
         • ACEi ; ARBs ; BetaBlockers ; Diruetics ; Ca-channel blockers
     • TIA & Prevention
       • anticoagulants
         • Heparin
         • Warfarin
       • antiplatelets
         • Aspirin
         • Plavix
         • Persantine
   • Rehabilitation
     • Kirkevold's 4 Therapeutic Functions in Rehabilative Nursing Care
       • understand implication of stroke
       • provide emotional support
       • attain best possible state for therapy
       • assimilate skills into meaningful self care, or social activities
         • Community Reintegration
   • Surgical Therapy
     • Ischemic
       • MERCI retriever
     • Hemorrhagic
       • clipping aneurysms
       • coiling aneurysms
     • TIA & Prevention
       • carotid endarterectomy
       • transluminal angioplasty
       • cranial artery bypass

5. Risk Factors

   • Non Modifiable: Age, gender, ethnicity, family hx, heredity, low birth weight
     • risk of stroke increases with age
     • women more at risk than men due to longer life expectancy than men
     • family hx of TIA or stroke
     • 55+ years old
   • Modifiable: anything that can be potentially altered
     • Asymptomatic carotid stenosis
     • DM
     • Heart disease (including atrial fibrillation)
     • Alcohol abuse and illicit drug use
     • Obesity
     • Dyslipedemia and sickle cell disease
     • HTN
       • Most important modifiable risk factor
     • Trauma
       • 1.6x more likely to have CVA
         • because of hypercoagulable state post injury, which increases risk of DVT
     • Lifstyle
       • delay onset by 14 years

6. Statistics

   • 400, 000+ are living with long-term stroke disability
   • in 2012, 13, 000 died from Stroke
   • in 2011, 46, 500 hospitalized with stroke

7. Living with Stroke

   • Issues with physical recovery
     • dysphasia; dysphasia; unilateral weakness; incontinence; sensory/visual perceptual disturbances
   • Personal Experience
     • Overwhelming catastrophy
     • detached from body as a whole
     • Jill Bolte Taylor: My Stroke of Insight: https://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight?language=en
   • New challenges
     • developing new coping mechanism
     • Emotional Recovery
       • uncertainty; hope; loss of control; anger
     • Social Recovery
       • changing roles; isolation; reflections previous life

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