Professional Documents
Culture Documents
with Cerebrovascular
Disorders
Cerebrovascular Disorders
$53.6 Functional abnormality of the CNS that
occurs when the blood supply is disrupted
Diabetes
Other
Pathophysiology
Manifestations of Ischemic
Stroke
Symptoms depend upon the location and size of
the affected area
Numbness or weakness of face, arm, or leg,
especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance
or coordination
Sudden, severe headache
Perceptual disturbances
See Tables 62-2 and 62-3
Types of Paralysis
Abnormal Visual Fields
Cerebrovascular Terms
Hemiplegia
Hemiparesis
Dysarthria
Hemianopsia
Transient Ischemic Attack
(TIA)
Temporary neurologic deficit
resulting from a temporary
impairment of blood flow
Severe headache
Vomiting
Medical Management
Prevention: control of hypertension
Diagnosis: CT scan, cerebral angiography, and
lumbar puncture if CT is negative and ICP is not
elevated to confirm subarachnoid hemorrhage
Care is primarily supportive
Bed rest with sedation
Oxygen
Treatment of vasospasm, increased ICP,
hypertension, potential seizures, and
prevention of further bleeding
Intracranial Aneurysms
Nursing Process—Assessing the
Patient Recovering From an
Ischemic Stroke
Acute phase
Ongoing/frequent monitoring of all systems
including vital signs and neurologic
assessment: LOC and motor, speech, and eye
symptoms
Monitor for potential complications including
musculoskeletal problems, swallowing
difficulties, respiratory problems, and signs and
symptoms of increased ICP and meningeal
irritation
After the stroke is complete
Focus on patient function; self-care ability,
Nursing Process—Diagnosis of
the Patient Recovering From an
Ischemic Stroke
Impaired physical mobility
Acute pain
Self-care deficits
Impaired swallowing
Urinary incontinence
Nursing Process—Diagnosis of
the Patient Recovering From an
Ischemic Stroke (cont.)
Disturbed thought processes
Sexual dysfunction
Collaborative Problems/Potential
Complications
Decreased cerebral blood flow
Pneumonia
Nursing Process—Planning
Patient Recovery After an
Ischemic Stroke
Major goals include:
Improved mobility
Avoidance of shoulder pain
Achievement of self-care
Relief of sensory and perceptual
deprivation
Prevention of aspiration
Continence of bowel and bladder
Nursing Process—Planning
Patient Recovery After an
Ischemic Stroke (cont.)
Major goals include (cont):
Improved thought processes
Achievement of a form of
communication
Maintenance of skin integrity
Restoration of family functioning
Improved sexual function
Absence of complications
Interventions
Focus on the whole person
Anxiety
Collaborative Problems/Potential
Complications
Vasospasm
Seizures
Hydrocephalus
Rebleeding
Hyponatremia
Nursing Process—Planning Care
of the Patient With a
Hemorrhagic Stroke/Cerebral
Aneurysm
Goals may include:
Improved cerebral tissue perfusion
Relief of sensory and perceptual
deprivation
Relief of anxiety
Absence of complications
Aneurysm Precautions
Absolute bed rest
Providenonstimulating, nonstressful
environment: dim lighting, no reading,
no TV, and no radio
Prevent constipation
Restrict visitors
Interventions
Relieve sensory deprivation and anxiety
Keep sensory stimulation to a minimum for
aneurysm precautions
Implement reality orientation
Provide patient and family teaching
Provide support and reassurance
Implement seizure precautions
Implement strategies to regain and
promote self-care and rehabilitation
Home Care and Teaching for the
Patient Recovering From a
Stroke
Prevention of subsequent strokes, health
promotion, and implementation of follow-
up care
Prevention of and signs and symptoms of
complications
Medication teaching
Safety measures
Adaptive strategies and use of assistive
devices for ADLs
Home Care and Teaching for the
Patient Recovering From a
Stroke (cont.)
Nutrition: diet, swallowing techniques,
and tube feeding administration
Elimination: bowel and bladder programs
and catheter use
Exercise and activities: recreation and
diversion
Socialization, support groups, and
community resources
See Chart 62-6