Ischemic Stroke - created from Mind Map

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Pathophysiology (Elias & Giraldo, 2018

Types (Lewis, 2014)

Risk Factors (Heart & Stroke Foundation, 2018)

Main Causes (The Internet Stroke Center, 2018).

Treatment & Management

Prevention (Pandian, et al, 2018)

Nursing Consideration (RNAO, 2011)

Diagnostic Test (NIH, 2018)

Clinical Manifestations (Lewis,2014)

Post-stroke (Heart & Stroke Foundation, 2018)

Inadequate blood flow in a artery - compensated for by collateral system. I.e. carotid & vertebral arteries via anastomoses at circle of willis. However, normal variations of circle of willis, other vessels, & atherosclerosis can interfere with collateral flow, increasing blockage, leading to ischemia.

Mechanisms

Edema & Microvascular

Inflammatory mediators

Severe edema leads to Intracranial pressure

IL-IB, Tumor necrosis factor alpha

Embolic

Thrombotic

Clot lodge

Single event, s/s develop quickly usually some improvement, recurrence common without aggressive treatment of underlying disease.

Onset

Lack of relationship to activity, sudden

TIA occur in different distribution

Maximal Deficits

Occurs anytime day or night

Seizures more likely associated

Plaque formation

Progressive, s/s develop slow, usually some improvement, recurrence in 20-25% of survivor

Onset

often during or after sleep

TIA frequent & occurs in same distribution

Progress to minutes to hours

Can increase and decrease in cycle

Associated seizures rare

Modifiable

Nonmodifible

Hypertension

Diabetes

Smoking

Cholesterol- LDL

Age

African & South Asian Heritage

Personal Circumstances

Sex

Family & Medical history

Indigenous Heritage

Risk increased with age especially >65

More likely to have hypertension, diabetes which can both cause stroke

Lack of access to health services & social services

lack of access to safe drinking water

lack of access to healthy food

Risk increased for women after menopause

Risk increased if relative experiences heart disease, stroke or TIA. Also, women who had pre-eclampsia during pregnancy are at increased risk

More likely to have hypertension & diabetes than general population which can both cause stroke

Blood clots in the heart

Aterosclerosis

Other causes (The Internet Stroke Center, 2018).

Myocardial Infraction

heart valve abnormalities

Irregular heartbeat (i.e. partial fibrillation)

Heart Failure

Arteries narrow, blood cells collect & form blood clots

Blood can block the artery where they are formed (Thrombosis)

Drugs

Injury to neck blood vessels

Blood clotting disordes

Medications (Lewis, 2014)

Surgical Intervention

Advance Technology (Brewer, Horgan & hickey, 2013)

Oral anticoagulation

Anti platelet drugs

Warfarin used for clients with AF

Clopidogrel (Plavix)

Aspirin is most frequently used

Combined aspirin & dipyridamole (Aggrenox)

Vital Stim

Virtual reality & gaming

Armeo spring

Robotic & Computer-assisted therapy

SeMG biofeedback

LIte Gait & Balance Master, lokomat

Population-based approaches

Individual-based approaches

Combo of approaches

Secondary Prevention

Primary Prevention

Tobacco control: WHO's Framework Convention on Tobacco Control (FCTC)

Prevention strategies related to nutrition focus on price/ product regulation

Prevention strategies targeted active transport (bicycles), built environment & schools

Polypills: affordable combination therapy.

medications combined for cardiovascular prevention. Comprise of a stain, aspirin & a least one antihypertensive agent

mHealth: the use of phones to provide patients & healthcare workers with support to improve health

Salt reduction

Task shifting & sharing

Reorganization of tasks to improve access & minimize costs

Tobacco cessation, healthy diet & regular physical activity

Smoking cessation

Reduction of salt intake (<5 g/day). Adequate intake of fruits & vegetables (at least 400 g/day)

Regular physical activity: 30 minutes/day

Availability of aspirin, statin & antihypertensivesfor people 10-year risk of developing cardiovascular disease >30%

Plan

Assessment

Interventation

Evaluation

Neurological

Vital signs (R,BP, O2 stat, temp, pain

Mental Health

Puplis

LOC/orientation

Speech/Language

Motor

Strengh

Balance & coodination

Pronator drift

depression

isolation

Brain Test

Blood Test

Heart Test

CT Scan

MRI

CTA & MRA

Carotid Ultrasound

Carotid Angiography

Used after a stroke is suspected

Detects changes in brain tissues and damage.

Gives doctors more information about the site of a blood clot or flow

Shows whether plaque has narrowed or blocked arteries

Doppler ultrasound

It is a special test used with carotid ultrasound - it shows the speed & direction of blood flow.

Uses dye to help doctors to see the artery visibly on x-ray

Glucose test

PT & PTT test

Low glucose levels may cause symptoms similar to stroke

Platelet count

Tests abnormal platelet levels that may be a sign of bleeding disorder or thrombotic disorder

EKG

ECG

Uses sound waves to create pictures of heart. Can detect possible blood clot inside the heart & problems with aorta.

Measures steady or irregular heart rhythms and records the strength & timing of electrical signals pass through the heart

Signs

Symptoms

Embolic

Thrombotic

severe neurological deficits

pure motor hemiplegia

pure sensory stroke

isolated mortar/sensory stroke

decreased in vascular function

Embolic

Thrombotic

headache may/may not be present

20% asymptomatic

contralateral leg + face weakness

leg ataxia

Patients' needs

Resources

Services

Support in:

Practical

Emotion

Physical/ADL

Social

Psychological

Books/Fact sheet

Programs/Recommendation

"Your Stroke Journey"

Family Guide to Pediatric Stroke

Heart & Stroke Risk Assessment

TIA Fact SHeet

Post-Stroke checklist

Living with stroke

Heart & Stroke community of Survivors

Taking Action in Community & Long term Stroke care

Stroke in young Adults

Taking charge of your stroke recovery

Therapy

Medical Management

Rehabilitation

Swallowing

Respiratory

Recreational

Speech-Language-cognitive

physical