This document discusses strokes, including types like ischemic and hemorrhagic strokes. It notes that strokes are the 5th leading cause of death in the US, with 795,000 people suffering strokes annually. Risk factors include hypertension, smoking, heart disease, and diabetes. Nursing interventions focus on monitoring vital signs, administering tPA if indicated, preventing complications like aspiration, and providing rehabilitation through physical, occupational and speech therapies to address deficits in mobility, communication and cognition.

1. CEREBROVASCULAR ACCIDENT (CVA) or
STROKE
Transient Ischemic Attack (TIA)
NSG 2640

2. OBJECTIVES
 Review and discuss types of stroke
 Identify causes of stroke
 Review and discuss nursing
interventions for prevention,
treatment of acute and post-acute
stroke
 Identify complications of stroke and
interventions for long-term treatment

3. CEREBROVASCULAR
ACCIDENT (CVA)
 Condition that involves the blood
vessels that supply blood to the brain
 Without adequate supply of oxygen,
nerve cells of the brain can't work
and may die within minutes.
 Condition in which decrease blood
flow to a localized area of the brain
causes neurologic deficits
 Cell death may occur after 5 minutes

4. Stroke is the fifth leading cause of death in the United
States
795,000 people in the United States suffer a stroke each
year (About 610,000 of these are first or new strokes)
1 in 4 strokes are people who have had a previous stroke
Risk of having a first stroke is nearly twice as high for
blacks as for whites, and blacks have the highest rate of
death due to stroke.
In 2018, 1 in every 6 deaths from cardiovascular disease
was due to stroke.
Four million Americans who have survived a stroke are
living with impairments and 15% to 30% are permanently
disabled
Stroke-related costs in the United States came to
nearly $46 billion between 2014 and 2015
https://www.cdc.gov/stroke/facts.htm

5. On average, someone in the U.S. has a
stroke every 40 seconds.
On average, someone dies of a stoke
every 3.59 minutes in the U.S. There are
about 401 deaths from stroke each day,
based on 2017 data.
Stroke risk increases with age, but strokes
can—and do—occur at any age.
In 2009, 34% of people hospitalized for
stroke were less than 65 years old.
https://www.cdc.gov/stroke/facts.htm
https://professional.heart.org/en/science-news/heart-disease-and-
stroke-statistics-2020-update

7. STROKE RISK
FACTORS
 Smoking
 High blood pressure
 Cigarette smoking
 Rhythm changes (atrial fibrillation or flutter)
 Coronary artery disease/High Cholesterol
 Oral contraceptives
 Diabetes
 Obesity/Lack of exercise
 Heavy use of alcohol or drugs (Cocaine)
 Family Hx
 Age
 Previous hx of TIA

8. STROKE
PREVENTION
 Healthy Diet
 Healthy Weight
 Physical Activity
 No Smoking
 Limited Alcohol

10. ISCHEMIC STROKE
• Occurs because of blood
clots or narrowing of
blood vessels
• Approximately 87% of all
strokes
HEMORRHAGIC STROKE
• Occurs when a blood vessel in the brain
breaks leaking blood into the brain.
• Account for 13% of all strokes
• Responsible for 30% of all stroke deaths.
Most fatal type of stroke

11. Transient Ischemic Attack
(TIA)
 “Mini-stroke”
 Temporary decrease in blood flow
occurs (ischemia)
 Patient exhibits stroke-like symptoms
due to transient hypoxia but cells do
not die
 Ischemia resolves and function
returns to “normal” condition over a
24-hour period
 A warning sign (precursor) to
thrombotic CVA

14. NURSING
DIAGNOSES:
 Ineffective Cerebral Tissue Perfusion
 Impaired Physical Mobility
 Impaired Verbal Communication
 Disturbed Sensory Perception
 Ineffective Coping
 Self-Care Deficit
 Risk for Impaired Swallowing
 Activity Intolerance
 Risk for Unilateral Neglect
 Deficient Knowledge

15. NURSING
INTERVENTIONS
 Monitor Vital Signs
 Neuro Checks – around the clock
Cranial nerves-pupillary response
 NIH Stroke Scale
 Blood pressure meds
 Monitor for Increased ICP
 increased BP, decreased hr, decreased
resp, N/V, decreased LOC
 Airway – issues with swallowing –
suction at the bedside

16. TPA
TISSUE
PLASMINOGEN
ACTIVATOR
 May administer tPA
 Monitor for bleeding if tPA given
 Monitor for EKG changes
 Avoid Unnecessary venipunctures if
tPA given
 Avoid IM injections if tPA given

17. NURSING
INTERVENTIONS
POST-ACUTE:
 Bowel/bladder function – bedpan, foley
 Skin & Limb Integrity: Neglect
syndrome (Unilateral neglect),
alignment and ROM exercises
 Diet – evaluate by speech therapy
 Bowel/bladder function – bedpan, foley
 Assist with communication difficulties
 Patient Education
 Fall/Injury prevention
 Family Education
 Multidisciplinary Approach

20. MOTOR
DEFICITS
 Hemiplegia
 Paralysis of one side of the body
 Hemiparesis
 Weakness of one side of the body.
 Flaccidity
 Absence of muscle tone (hypotonia).
 Spasticity
 Increased muscle tone (hypertonia)

21. SENSORY-PERCEPTUAL DEFICITS
 Hemianopia
 blindness in vision in one half of the visual field due to damage of the
optic pathway in the brain.
This is how a street
scene looks with
normal vision
This is how the same
scene looks with
right hemianopia

22. COMMUNICATION
DEFICITS
APHASIA - language deficits (expressive,
receptive or mixed)
EXPRESSIVE – comprehends speech but
cannot respond back with speech
(BROCA’s area)
RECEPTIVE – unable to comprehend
speech (WERNICKE’s area)
MIXED – combination of expressive &
receptive
GLOBAL – complete inability to
understand or produce speech

24. COMMUNICATION
DEFICITS
 Dysarthria – unable to speak d/t weak
muscles (hard to understand)
 Apraxia – can’t perform voluntary
movements even though muscle function is
normal
 Agraphia – loss of ability to write
 Alexia – loss of ability to read (don’t
understand or see the words)
 Agnosia – doesn’t understand sensations or
recognize known objects or people

25. COGNITIVE
DEFICITS
 A change in the level of consciousness
 Mild confusion to coma.
 Intellectual change
 Memory loss, decreased attention span,
poor judgment, inability to think
abstractly
 Behavioral
 Emotionally labile (laugh ,cry,
inappropriately)
 Loss of Self Control
 Swearing, refusing to wear clothing
 Decreased tolerance for stress
 Resulting in anger or depression
(Smeltzer,Bare, Hinkle, & Cheever, 2010)

26. DYSPHAGIA
Difficulty swallowing
 Dysphagia screen
 Swallow evaluation
 May result in choking,
drooling, ***Aspiration***
(Smeltzer,Bare, Hinkle, & Cheever, 2010)

27. ASPIRATION
PRECAUTIONS
 Careful when feeding clients
 may have to add a thickening agent to
liquids
 Think safety
 Position in upright sitting position with neck
slightly flexed (chin to chest)
 Order soft or pureed food
 Teach or feed client by putting food behind teeth
on the unaffected side of mouth
 Feed slowly. One bite at a time.
 Check pockets of mouth
(Smeltzer,Bare, Hinkle, & Cheever, 2010)

28. THERAPIES
 Physical Therapy
 Prevent contractures and
improve muscle strength
and coordination
 Occupational Therapy
 Provide assistive devices
and a plan for regaining lost
motor skills that greatly
improve quality of life after
a stroke
 Speech Therapy
 For communication &
swallowing disorders