Cerebral Vascular Accident (Stroke)

Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle
Learning Objectives
 Define Stroke
 List the etiology of Stroke
 List the clinical manifestations of Stoke
 Explain the types of medication used in Stroke
 Able to identify nursing problem and plan nursing for these problems
 Explain the preventive measures for Stroke
Cerebral Vascular Accident

Definition:
A sudden loss of brain functions caused by death of
brain cells due to lack of blood supply to the brain.
Type of STROKE
2 major type of stroke
1. Ischemic stroke - caused by a blood clot that blocks or plugs a blood vessel in the brain.
2. Hemorrhage stroke - caused by a blood vessel that breaks and bleeds into the brain.
Other type
1. Transient Ischemic Attack (TIA) - blood supply to brain is briefly interrupted.

2. Cerebral Aneursym - dilation of the walls of the cerebral artery resulting from a weakness in the
arterial wall.
Cerebral Vascular Accident Pathophysiology
When blood flow to the brain is impaired, oxygen and important nutrients cannot be delivered.
↓
Deprived of Oxygen (O2), the nerve cell start to die
↓
The result is loss or Impairment of sensory – motor functions.
Etiology of Stroke
 Thrombus – blood clot form in the arteries that supply to brain. Clot usually forms in the area
damaged by the arthrosclerosis.
 Emboli – occur when blood clot or other particle (tumor, fat, bacteria, and air) lodge in arteries
leadingto brain.
 Hemorrhage – rupture of cerebral vessel which causes bleeding in to brain tissue. Causes such as
hypertension, rupture aneurysm or vascular malformation.
©Cassidy Rabong 2010 Prepared By: SN. CaR

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Other risk factor
 Advanced age
 History of previous stroke
 Hereditary
 Race
 Cigarette smoking
 Heart disease
 Diabetes
 Warning signs of history of stroke
 Lack of exercise
 Obesity
 Alcohol
 Consumption
 High cholesterol
Clinical Manifestations
1. The symptoms depend on the area of the brain that has been affected and the amount of brain
tissue damage.
2. Because of the sensory – motor pathways cross at the junction of medulla and spinal cord, the
impairment of the body is on the side of the body opposite the brain that is damaged.
3. Weakness or paralysis on one side of the body (the left or right side of the body)
4. Sensory deficit
5. Aphasia – impaired speaking, listening, writing, comprehending
6. Numbness or tingling in the leg, arm, or face
7. Weakness of face muscle, which can cause drooling
8. Blurred vision
9. Slurred speech
10. Dysphagia (difficulty in swallowing)
11. Urinary and bowel incontinent
12. Eyelid drooping
13. Drowsiness, loss of consciousness
14. Loss of balance and coordination
15. Difficulty breathing
16. Depression
17. Nuchal rigidity and pain on neck movement

CVA – Investigation
Investigation:
 Computed tomography (CT scan) – location and extent of necrotic brain tissue
 Magnetic resonance imaging (MRI) – same as CT scan
 Carotid Doppler Ultrasound
 Angiogram – reveals a narrowing of the carotid artery
 Blood test – complete blood count (CBC) or (FBC)
 Neurological examination
Treatment – CVA
Medication
 Thrombolytic therapy – to dissolve clot in the blood vessel e.g. Tissue Plasmonogen Activator
(t-PA) *(this treatment is not given to patient with stroke caused by cerebral hemorrhage)
 Anticoagulation – to prevent formation of blood clot e.g. Heparin and Aspirin
 Antihypertensive – to treat high blood pressure
 Osmotic Diuretic – to reduce ICP(Intra Cranial Pressure) e.g. Mannitol
 Anticonvulsant – for patient having recurrent seizures after stroke e.g. Valium
Surgery
 Carotid Endarterectomy – removed of plaque from the artery

 Angiography – surgery to repair aneurysm and vascular malformation (that causes cerebral
bleeding)
Rehabilitation
 Rehabilitation includes physical therapy, speech therapy, and occupational therapy
Nursing management
1. Intial assessment
 Level of consciousness – unconscious/drowsy/conscious * GCS Chart
 Papillary response to light – normal/dilated/constrict, equal size, any reaction to light
 Movement of extremities – able move with normal strength/weak/no movement
 Speech – normal/slurred/mumbling/no sound
 Sensation – normal sensation/only reacting to pain stimuli
 Swallowing reflexes
 (Use Glasgow Coma Scale (GCS) )
2. Assess vital signs
 Blood pressure – hypotension/hypertension
 Breathing pattern – normal/dyspea (difficulty of breathing)
 Pulse – tachycardia, bradycardia + pounding pulse rate = cerebral edema

 Body temperature
3. Maintain pattern airway

 O2(Oxygen)
 Suction prn (per needed)
 Position: lateral, semi prone with head slight elevated/fowler’s position
 If poor ventilation – intubations and mechanical ventilation
4. Maintain optimum nutritional status
 Maintain accurate intake/output chart
 Feeding – position patient upright, soft diet, small and frequent diet
 Regular mouth care
 Intravenous (I/V) therapy
 Enteral feeding
 Refer dietician
5. Maintain good hygiene
 Assist in activity daily living (ADL) such as mouth care, eye care, bathing, elimination and etc
 Positioning of patient to prevent pressure sore, pain, contracture, and respiratory problem
6. Promote rehabilitation and independent
 Encourage use of unaffected arm to bathe, brush, teeth, comb hair, dress and eat
 Early ambulation – assist to walk with walking frame, tripod etc
 Promote bed exercises
 Regular physiotherapy, speech therapy and occupational therapy
7. Facilitate communication
 Reduce the rate of speech
 Give them time to talk and let them enough time to respond
 Speak in a normal tone of voice
 Use simple phrases. Repeat a statement when necessary
 Try alternate methods of communication such as writing, sign language
Cerebral Vascular Accident
Support and advice to patient and family on discharge home
 Remind family members to encourage self – care help. Must not encourage dependent, as
physical function may continue to improve for up to 3 months.
 Continue with physiotherapyeven after discharge
 Advice family where to buy equipments and disposable items that is required before discharge
 Some modifications to the house may be necessary order for the patient to be able to use a
wheelchair or walker. If patient can ambulate with walking stick, raised toilet seat etc can be use.
 Refer to the National Stroke Association of Malaysia (NASAM)
 Must be complaint with taking medication to prevent another stroke from occurring – anti
platelet, antihypertensive
 Encourage patient to stop smoking, increase exercises activity, control diet
 Regular chekup of blood pressure and cholesterol level

Nursing Diagnosis
 Altered cerebral tissue perfusion

 Impaired swallowing
 Impaired physical mobility
 Impaired verbal communication
 Self – care deficit
 Altered urinary elimination: incontinence
 Risk for trauma: falls, burns, and lacerations
 Risk for aspiration
 Ineffective individual coping


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Talking About Health, Disease, Treatment, Prevention, and Knowledge in Healthy Lifestyle

Cerebral Vascular Accident

2 major type of stroke

1. Transient Ischemic Attack (TIA) - blood supply to brain is briefly interrupted.

Cerebral Vascular Accident Pathophysiology

©Cassidy Rabong 2010 Prepared By: SN. CaR

Other risk factor

©Cassidy Rabong 2010 Prepared By: SN. CaR

 Carotid Endarterectomy – removed of plaque from the artery

 Rehabilitation includes physical therapy, speech therapy, and occupational therapy

 Pulse – tachycardia, bradycardia + pounding pulse rate = cerebral edema

3. Maintain pattern airway

Cerebral Vascular Accident

Support and advice to patient and family on discharge home

©Cassidy Rabong 2010 Prepared By: SN. CaR

 Altered cerebral tissue perfusion

©Cassidy Rabong 2010 Prepared By: SN. CaR

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