VASCULAR DISTURBANCES (MODULE C) Blanket on hip – promote normal gait

Knees and thigh should not be flexed – venous return

CEREBROVASCULAR ACCIDENT (CVA) Unilateral neglect – move affected part with unaffected part
-stroke; brain attack; counterpart of MI
- interruption of blood supply to the brain, causing temporary or 1 MOTOR DEFICITS
loss of movements, thoughts, speech or sensation. Ataxia – ambulation devices; provide safety
Dysarthria – gestures; ample time to respond
Predisposing factors: Psychological – emotional support
Hereditary ( familial predisposition) Dysphagia – chew properly and on unaffected side
Age ( increase age – increase risk) – 55 y.o. - Sit upright when eating or out of bed
Gender - NGT
- Tuck chin to chest – swallowing; prev. aspiration
Types:
>Large Artery Thrombotic stroke 2 VERBAL DEFICITS
>Small Penetrating Artery thrombosis Aphasia – loss/ineffective speech
- lacunar stroke; most common 3 types:
>Cardiogenic Embolic stroke >Sensory/Receptive/Wernicke’s/Fluent
- assoc. with atrial fibrillation >Motor/Expressive/Broca’s/Non-Fluent
>Cryptogenic stroke >Global
- no known cause
>Other causes: migraine, drug use, coagulopathies Interventions:
Use simple sentences
Precipitating factors: Encourage gestures and pictures
HPN, DM, Smoking, Atrial fibrillation, obesity, hyperlipidemia, Alternative means
increase alcohol consumption, stressful lifestyle Talk slowly and clearly
Ample time to respond
Atherosclerotic plaque Enc. to repeat alphabet sound esp on broca’s
Be consistent and repeat if necessary
*Thrombotic – slow, progressive ( LAT and SMA)
Embolic – sudden 3 VISUAL DEFICITS
**Homonymous Hemianopsia
HEMORRHAGIC STROKE  Left Homonymous Hemianopsia

Precipitating factor :  Right Homonymous Hemianopsia

Uncontrolled HPN
Arteriovenous malformation – rupture of vessel >Approach on unaffected side
Intracranial aneurysm – bleeding (rupture) >Provide safety
Intracranial neoplasm >Allow to scan room
Onset: sudden, rapid
**Aplopia – consistent placing of things in same place
Manifestations: >Explain location
>motor deficits – dysarthria; hemiparesis/plegia; ataxia(staggering,
unsteady gait) **Horner’s Syndrome – paralysis of sympathetic nerve
>”frozen” shoulder - Ptosis / sinking of eyeballs
>Subluxation of shoulder - Constriction of pupils
>Painful shoulder – hand dystrophy
- Tearing
>Addduction of arm with internal rotation. Flexion of elbow, wrist
>Explain location of things
and fingers
>Proper lighting
>External rotation of leg at hip joint, flexion at knee and plantar
flexion and supination of ankle.
4 SENSORY DEFICITS
>shortened heel cord
**Paresthesia – numbness/tingling sensation of affected
>speech difficulties and visual disturbances
extremities.
>Don’t use affected areas as dominant limb.
Interventions: >ROM – affected area.
>pillow below the axilla (side-lying position)
>free palm – relieve pressure 5 EMOTIONAL DEFICITS
For flaccid paralysis: ~depression ~mood swings
>”dorsal wrist splint” – spastic upper extreme. ~hostility ~loss of self-control
> passive ROM – affected ~anger ~decrease tolerance to stimuli
Active ROM – unaffected ~fear
4-5x daily >Encourage verbalization of feelings
>turn to sides q 2h >Participate in group activities
>15-30mins in prone
>less amount of time in affected area – decreased sensation
DX TESTS:
o Carotid Ultrasound
Pillow on head
 o CT Scan  Congenital conditions
o Cerebral Angiography  Trauma
o PET Scan  Infection
o MRI  Inflammation
o ECG  Increase turbulence in a section of a vessel
 HPN
MANAGEMENT  Smoking

MED: Pathophysio:
Goal : To allow brain to recover from initial insult Vasospasm - > ischemia
To restore cerebral blood flow Subarachnoid hemorrhage - > blood in CSF
To provide complications and tissue damage.
S/S: N/V – increased ICP
1. Maintain patent airway Visual disturbances
2. Reperfusion and hemodilution with volume expanders. COMPLI : Hydrocephalus
3. Thrombolytic therapy Cerebral Vasospasm
4. Antihypertensive therapy Seizures
5. Diuretic therapy Rebleeding in 1st 7-14days
6. Calcium channel blockers
7. Anticoagulant therapy DX TESTS:
8. Stool softeners o Lumbar Tap – presence of blood in subarachnoid space;
except for increase ICP
SURG: Craniotomy o Angiography – definitive exam
o Skull X-rays
>>Nuchal Rigidity – sign of altered cerebral tissue perfusion o CT-Scan
o Hunt-Hess Scale -bleeding
TRANSIENT ISCHEMIC ATTACK
“Silent Stroke” – can go unnoticed TX:
>lasts 5-20 mins MED:
>temporary disruption of blood supply >Antifibrinolytic agent – Epsilon Aminocaproic acid
>mini-stroke – copies s/s of stroke >Increase ICP – Dexamethasone
>warning stroke >Prophylactic anticonvulsant

DX TESTS: SURG:
o Auscultation of Carotid Artery Balloon Therapy
o CT Scan – Rule out stroke Gamma knife
o Transesophageal Echocardiography (TEEC)
NG:
MGT: Prevent occurrence of stroke Glasgow Coma Scale
Monitoring changes in ICP
>TIA caused by Atrial Fibrillation Monitor for focal neurologic deficits
-> Anticoagulant Therapy

>Exercise 10 mins everyday.

>Determine risk factors

SURG : Carotid Endarterectomy

Cerebral Angioplasty

INTRACRANIAL ANEURYSM
>a thin-walled outpouching or dilation of an artery of the brain
>develop usually at Circle of Willis and Internal Carotid Artery

>> Berry
Saccular – saccular outpouching
Fusiform - outpouching of vessel
Dissecting – intimal layer

>Usually aymptomatic until

-- compress surrounding tissue or cranial nerve
-- rupture and cause the classical symptoms of subarachnoid
hemorrhage
ETIOLOGY:
 Atherosclerosis MYELOMALACIA
 Genetics >softening or infarction of spinal cord from spinal artery occlusion
>poor prognosis
>little or no return of normal fxn Vascular malformation
>”transverse myelitis” Bleeding d/o

MANIF: MANIF:
INITIAL : Areflexia >immediately happens after spinal injury; depends on size of
Flaccid limbs hemorrhage
Motor paralysis >motor deficits
Sensory loss below level of lesion
Paralysis of bladder and bowel sphincters DX TESTS:
X-Ray
TX: Spinal Angiograph
>Symptomatic care of probs rxlting from cord lesion Spinal CT-Scans
>Tx of ds that caused vascular lesion MRI

NG: TX:
>Provide pain relief >Immediate surgery to relieve cord compression
>Maintain body fxns >Ligating the feeding vessels
>Preventing complications of immobility >Excising the entire malformation
>Intensive rehab for 12-48 hrs after onset of manifestations
NG:
>Provide pain relief
>Maintain body fxn
>Prevent compli of immobility
>Intensive rehab 12-14hrs pc onset of manif

HEMATOMYELIA
>hemorrhage into substance of spinal cord

Cause : Trauma