Cerebrovascular

Accident

Brain Attack
Stroke
Third leading cause of
death
30% of stroke
survivors return to
productive lives within
1 year
Approximately
750,000 Americans
have a stroke each
year
Risk Factors for
CVA
Most
common in
men
African
Americans
Ages 51 to
74 years
Family
history
Hypertensio
n
Atheroscler
osis

Diabetes
mellitus
Atrial
fibrillation
Valvular
heart
disease
Migraine
headaches
Cigarette
smoking
Obesity
High fat
diet
Drug abuse

Types of Strokes
Transient Ischemic
Attacks
Ischemic
Hemorrhagic
Transient Ischemic
Attack
Temporary neurologic
deficits caused by
impaired cerebral
blood flow
Considered a warning
sign
Characterized by
focal neurological
deficits, typically
lasting minutes to
hours in duration
When symptoms
persist more than 24
hours but then
disappear, the patient
is said to have
Reversible Ischemic
Neurologic Deficits

Transient Ischemic
Attack
Clinical
Manifestations
of a TIA
Dizziness
Momentary
confusion
Difficulty
with
speech
Visual
disturbanc
es
Weakness
of
paralysis
on one side
of the
body
Ptosis
Tinnitus

Diagnosis of TIA
Health History
Clinical
Presentation
Brain imaging MRI
/ CT
Cerebral
angiography
Carotid Doppler
Testing
Treatment of
TIA
Aimed at cause
Hypertension
management
Decrease platelet
aggregation
Ticlid (ticlopidine)
Plavix (clopidogrel)
Aspirin
Coumadin (warfarin)
For carotid stenosis
>70% - endarterectomy
Ischemic Strokes
Thrombotic or embolic
Obstruction in blood
flow from a clot,
atherosclerotic plague
or a combination of the
two
Account for 80% of
strokes
Thrombotic
atherosclerotic plagues
Embolic atrial fib;
valve stenosis; MI
Hemorrhagic
Strokes
Account for 20% of
strokes
Rupture of blood
vessel with bleeding
into brain tissue
Intracerebral
associated with
trauma, HTN,
aneurysms
Subarachnoid
hemorrhage, subdural
hemorrhage or
ventricular
hemorrhage
PCP, crack, cocaine,
amphetamines and
heroin have been
associated with
hemorrhagic stroke

Hemorrhagic
Strokes
Signs &
Symptoms of a
Stroke
Can be permanent or
resolve in time
Can vary depending
on type and location
Symptoms of
Cerebrovascular
Accident according
to Artery
Hemip
aresis
Dysph
agia
Visual
Chang
es
Altered
LOC
Atax
ia
Carotid X X X X
Middle
Cerebr
al
X X X X
Vertebr
o-
basilar
X X
Comparison of
Right-sided and
Left-sided Stroke
Signs &
Symptoms of a
Stroke
Aphasia
Expressive
Receptive
Global
Dysarthria
Dysphagia
Dyspraxia

Hemiplegia
Altered
sensation
Unilateral
neglect
Homonymous
hemianopsia
Emotional
lability
Impaired
judgement
Incontinence

Treatment of
Client with a CVA
Oxygenati
on
Ischemic
strokes
tPA
Blood
pressure
managemen
t
Osmotic
diuretic
such as
mannitol

Steroids
Anitconvul
sants
Anticoagul
ants in
embolitic
strokes
IV fluids
Surgical
interventio
n for
embolitic
strokes


Nursing Care of
Client with CVA
Neurological checks
Monitor respiratory
status oxygen, turn and
reposition, nebulizers,
suctioning, deep
breathing exercises if
capable
Seizure precautions
Safety precautions
Fluid volume balance
Proper care of tube
feedings / TPN

Nursing Care of
Client with CVA
Homonymous
Hemianopsia in
acute phase, position
so that approached
on the unaffected
side
Position affected
side carefully, check
placement and
safety
Re-orient client

Aphasia use gestures,
simple, clear
statements; yes/no
questions; allow time
for responses
Proper skin care
Range of motion
Catheter care
Support and
reassurance

Nursing Care of
Client with CVA
Rehabilitation
Phase
Goal is to maximize
functional ability and
compensate for
losses
Interdisciplinary
approach
Promote
independence in
ADLs use assistive
devices

For homonymous
hemianopsia place
items on affected
side to challenge
client and teach
them to scan
Speech therapy
Toileting schedule
Physical and
occupational therapy

Rehabilitation
Phase
Thank you