Clinical Preparation: Preclinical Research

Patient: G. S Age: 87 y/o M F

Diagnosis: Transient ischemic attack Other Health Care problem: Asthma

• Etiology: A TIA results from a temporary blockage of the blood supply to the brain. The carotid artery
in the front of the neck is a major supply of blood to the brain. A build-up of plaque and hardening of this
artery can slow or stop blood flow. Reasons for the blockage may include:
• Atherosclerosis of carotid and vertebral women; noninfectious necrotizing vasculitis
arteries (primary cause); drugs; irradiation; local trauma
• Embolic sources - Valvular disease, • Sympathomimetic drugs (eg, cocaine)
ventricular thrombus, and thrombus formation due • Mass lesions (eg, tumors, subdural
to atrial fibrillation hematomas) - Less frequently cause transient
• Arterial dissection symptoms and more often result in progressive
• Arteritis - Inflammation of the arteries persistent symptoms
occurring primarily in elderly persons, especially
• Pathophysiology:
The transient ischemic attack (TIA) is characterized by a temporary reduction or cessation of cerebral blood
flow in a specific neurovascular distribution that is due to low flow through a partially occluded vessel, an
acute thromboembolic event, or stenosis of a small penetrating vessel.
• Signs & Symptoms: Symptoms begin suddenly, last only a short time (from a few minutes to 1 to 2
hours), and disappear completely. They may occur again at a later time. A TIA is different than a stroke.
However, the symptoms of TIA are the same as a stroke and include the sudden development of:
• Muscle weakness of the face, arm, or • Personality, mood, or emotional
leg (usually only on one side of the body) changes
• Numbness or tingling on one side of • Confusion or loss of memory
the body • Difficulty swallowing
• Trouble speaking or understanding • Difficulty writing or reading
others who are speaking • Lack of coordination and balance,
• Problems with eyesight (double clumsiness, or trouble walking
vision, loss of all or part of vision) • Abnormal sensation of movement
• Changes in sensation, involving (vertigo) or dizziness
touch, pain, temperature, pressure, hearing, • Lack of control over the bladder or
and taste bowels
• Change in alertness (sleepiness, less • Inability to recognize or identify
responsive, unconscious, or coma) sensory stimuli (agnosia)
• Possible complications
• Death of brain cells due to too little • Injury that occurs from falls
blood flow to the brain • Stroke
• Paralysis or loss of muscle
movement.
• Medical treatment:
• The goal is to prevent a stroke from occurring.If you have had a TIA within the last 48
hours.
• .Underlying disorders such as high blood pressure, heart disease, diabetes, and blood
disorders, should be treated appropriately.
• Blood thinners, such as aspirin, may be prescribed to reduce blood clotting. Others
include dipyridamole, clopidogrel, Aggrenox or heparin, Coumadin,or other similar medications.
Treatment may be continued for an indefinite time period.
• Surgery (carotid endarterectomy) may be appropriate for some people who have clogged
neck arteries.
• Nursing care required by priority:

• Ensure patent airway and IV access • Initial neurological vital signs (Q4H)
• Temperature (treat >38°C, as fever may contribute • O2 saturation
to further brain injury or indicate complication such• Blood sugar (treat hypo and hyperglycemia)
as pneumonia)
• •
BP (treat >220 systolic or >120 diastolic cautiously
in first 48hrs; aim for reduction by 10-15% unless •
otherwise indicated by medical conditions)
• Heart rhythm (to assess for atrial fibrillation) •
• Swallowing screen (if fails keep NPO until full
swallowing assessment)
Health teaching about measures to prevent stroke.
Provide psychosocial support and offer assistance
to the pt. and family.
Plan for discharge, possible need for rehabilitation
and coordinate with other interdisciplinary team.