cerebrovascular accident portrait

8/4/2019 Cerebrovascular Accident Portrait

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MINDANAO SANITARIUM AND HOSPITAL COLLEGE

BRGY. SAN MIGUEL, ILIGAN CITY

SCHOOL OF NURSING

ACUTE BIOLOGIC CRISIS REQUIREMENTS

PRESENTED TO

ROSELYN S. PACARDO, MAN,MM, RN, RM

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR NCM 106

MARY LYON FAJARDO BSN 4BKLUAI MAI FERNANDEZ BSN 4B

JUNE 21, 2011


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CEREBROVASCULAR ACCIDENT (STROKE)

A stroke is damage to part of the brain when its blood supply is suddenly reduced or stopped. A

stroke may also be called a cerebral vascular accident, or CVA. The part of the brain deprived of blood

dies and can no longer function. Blood is prevented from reaching brain tissue when a blood vessel

leading to the brain becomes blocked (ischemic) or bursts (hemorrhagic). The symptoms of a stroke

differ, depending on the part of the brain affected and the extent of the damage. Symptoms following a

stroke come on suddenly and may include: weakness, numbness, or tingling in the face, arm, or leg,

especially on one side of the body trouble walking, dizziness, loss of balance, or coordination inability to

speak or difficulty speaking or understanding, trouble seeing with one or both eyes, or double vision,

confusion or personality changes, difficulty with muscle movements, such as swallowing, moving arms

and legs, loss of bowel and bladder control, severe headache with no known cause, and loss of

consciousness.

Classification

Ischemic

In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the brain

tissue in that area. There are four reasons why this might happen:

1. Thrombosis (obstruction of a blood vessel by a blood clot forming locally)2. Embolism (obstruction due to an embolus from elsewhere in the body, see below),[2]3. Systemic hypoperfusion (general decrease in blood supply, e.g., in shock)[12]4. Venous thrombosis.[13]

Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-

40% of all ischemic strokes.[2][14]

There are various classification systems for acute ischemic stroke. The Oxford Community Stroke Project

classification (OCSP, also known as the Bamford or Oxford classification) relies primarily on the initial

symptoms; based on the extent of the symptoms, the stroke episode is classified as total anterior

circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) orposterior

circulation infarct (POCI). These four entities predict the extent of the stroke, the area of the brain

affected, the underlying cause, and the prognosis.[15][16]

The TOAST (Trial ofOrg 10172 in Acute Stroke

Treatment) classification is based on clinical symptoms as well as results of further investigations; on this

basis, a stroke is classified as being due to (1) thrombosis or embolism due toatherosclerosis of a large

artery, (2) embolism ofcardiac origin, (3) occlusion of a small blood vessel, (4) other determined cause,

(5) undetermined cause (two possible causes, no cause identified, or incomplete investigation).[2][17]

Hemorrhagic

Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is

made between intra-axial hemorrhage (blood inside the brain) andextra-axial hemorrhage (blood inside

the skull but outside the brain). Intra-axial hemorrhage is due to intraparenchymal

hemorrhage or intraventricular hemorrhage(blood in the ventricular system). The main types of extra-

axial hemorrhage are epidural hematoma (bleeding between the dura mater and the skull), subdural

hematoma (in the subdural space) and subarachnoid hemorrhage (between the arachnoid mater and pia

mater). Most of the hemorrhagic stroke syndromes have specific symptoms (e.g., headache, previous head

injury).
http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Stroke#cite_note-11http://en.wikipedia.org/wiki/Stroke#cite_note-11http://en.wikipedia.org/wiki/Stroke#cite_note-11http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosishttp://en.wikipedia.org/wiki/Stroke#cite_note-Stam2005-12http://en.wikipedia.org/wiki/Stroke#cite_note-Stam2005-12http://en.wikipedia.org/wiki/Stroke#cite_note-Stam2005-12http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Total_anterior_circulation_infarcthttp://en.wikipedia.org/wiki/Total_anterior_circulation_infarcthttp://en.wikipedia.org/wiki/Partial_anterior_circulation_infarcthttp://en.wikipedia.org/wiki/Lacunar_infarcthttp://en.wikipedia.org/wiki/Posterior_circulation_infarcthttp://en.wikipedia.org/wiki/Posterior_circulation_infarcthttp://en.wikipedia.org/wiki/Stroke#cite_note-14http://en.wikipedia.org/wiki/Stroke#cite_note-14http://en.wikipedia.org/wiki/Stroke#cite_note-14http://en.wikipedia.org/wiki/Danaparoidhttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Intra-axial_hemorrhagehttp://en.wikipedia.org/wiki/Extra-axial_hemorrhagehttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/Intraventricular_hemorrhagehttp://en.wikipedia.org/wiki/Epidural_hematomahttp://en.wikipedia.org/wiki/Dura_materhttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Subdural_spacehttp://en.wikipedia.org/wiki/Subarachnoid_hemorrhagehttp://en.wikipedia.org/wiki/Arachnoid_materhttp://en.wikipedia.org/wiki/Pia_materhttp://en.wikipedia.org/wiki/Pia_materhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Head_injuryhttp://en.wikipedia.org/wiki/Head_injuryhttp://en.wikipedia.org/wiki/Head_injuryhttp://en.wikipedia.org/wiki/Head_injuryhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Pia_materhttp://en.wikipedia.org/wiki/Pia_materhttp://en.wikipedia.org/wiki/Arachnoid_materhttp://en.wikipedia.org/wiki/Subarachnoid_hemorrhagehttp://en.wikipedia.org/wiki/Subdural_spacehttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Dura_materhttp://en.wikipedia.org/wiki/Epidural_hematomahttp://en.wikipedia.org/wiki/Intraventricular_hemorrhagehttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/Intraparenchymal_hemorrhagehttp://en.wikipedia.org/wiki/Extra-axial_hemorrhagehttp://en.wikipedia.org/wiki/Intra-axial_hemorrhagehttp://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Hearthttp://en.wikipedia.org/wiki/Atherosclerosishttp://en.wikipedia.org/wiki/Danaparoidhttp://en.wikipedia.org/wiki/Stroke#cite_note-14http://en.wikipedia.org/wiki/Stroke#cite_note-14http://en.wikipedia.org/wiki/Posterior_circulation_infarcthttp://en.wikipedia.org/wiki/Posterior_circulation_infarcthttp://en.wikipedia.org/wiki/Lacunar_infarcthttp://en.wikipedia.org/wiki/Partial_anterior_circulation_infarcthttp://en.wikipedia.org/wiki/Total_anterior_circulation_infarcthttp://en.wikipedia.org/wiki/Total_anterior_circulation_infarcthttp://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1http://en.wikipedia.org/wiki/Stroke#cite_note-Stam2005-12http://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosishttp://en.wikipedia.org/wiki/Stroke#cite_note-11http://en.wikipedia.org/wiki/Shock_(circulatory)http://en.wikipedia.org/wiki/Stroke#cite_note-Donnan-1


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Pathophysiology


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Diagnostic tests

CT scan without contrast: determine hemorrhage, tumors, aneurysms, ischemia, edema,tissue necrosis, shifting in intracranial contents Arteriography of cerebral vessels: reveals abnormal vessel structures, vasospasm,

stenosis of arteries

MRI: detect shifting of brain tissues resulting from hemorrhage or edema Positron emission tomography (PET), single-photon emission computed tomography

(SPECT): examine cerebral blood flow distribution and metabolic activity of brain

Management and Nursing care

Medical management is directed at early diagnosis and early identification Maintain cerebral oxygenation and cerebral blood flow Maintain patent airway and turn patient to side if unconscious Elevate head and neck should not be flexed Hypertension may be reduced with vasodilators and calcium channel blockers Thrombolytic agents are given to dissolve the clot

Intracerebral hemorrhage should be ruled out first

Must be given within 3 hours of onset of manifestations

E.g. streptokinase, urokinase and tissue plasminogen activator (alteplase)

Antiplatelet and anticoagulants are given to prevent clot formationHeparin and warfarinAspirin, clopidogrel (Plavix), ticlodipine (Ticlid) or dipyridamole (Persantine)

Corticosteroids to treat cerebral edema, diuretics to reduce increased intracranialpressure and anticonvulsants to prevent seizures

Hyperthermia is treated immediately Temperature elevations lead to increased cerebralmetabolic needs which in turn cause cerebral

edemawhich can lead to further ischemia

Antipyretics are used

Causing the client to shiver should be avoided

Aspiration precaution is doneOral food and fluids are generally withheld for 24-48 hours

Tube feeding is done

Prevent valsalva maneuver Maneuver increases ICP

Straining stool, excessive coughing, vomiting, liftingand use of the arms to change position

should beavoided

Mild laxatives and stool softeners are often prescribed

Compensate for perceptual difficulties For clients with visual deficits

Approach the client from the unaffected side

Place articles on the unaffected side

Teach client to turn the head from side to side to see entire visual field

Eye patch over one eye in clients with diplopia is helpful

Assist and support client Prevent injury and falls


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Promote self-care and prevent skin breakdown

Prevent complications Physical therapy to prevent contractures and to improve muscle strength and coordination

Encourage bed exercise

Facilitate ROM and isometric exercises or Do not force extremities beyond the point ofinitiating pain and spasm or Always support the joint and move the extremity smoothly

Allow client to work on balance and proprioception skills

cerebrovascular accident portrait

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