Medical surgical nursing important topic

1. CEREBROVASCULAR
ACCIDENT

2. CEREBROVASCULAR ACCIDENT/
STROKE
• Also called “brain attack”, cerebral infarction,
cerebral hemorrhage, ischemic stroke or stroke
• A stroke is caused by the interruption of the
blood supply to the brain, usually because a
blood vessel bursts or is blocked by a clot. This
cuts off the supply of oxygen and nutrients,
causing damage to the brain tissue.

3. DIRECT CAUSES:
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CEREBRAL THROMBOSIS
a blood clot or plaque blocks an artery that supplies
a vital
brain center
CEREBRAL HEMORRHAGE/ANEURYSM
an artery in the brain bursts, weakens the
aneurysm wall; severe rise in BP causing
hemorrhage and ischemia
CEREBRAL EMBOLISM
a blood clot breaks off from a thrombus elsewhere in
the body, lodges in a blood vessel in the brain and
shuts off blood supply to that part of the brain

4. TYPES:
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ISCHEMIC STROKE
Occurs when a clot or a mass clogs a blood vessel, cutting off the
blood flow to brain cells. The underlying condition for this type of
obstruction is the development of fatty deposits lining the vessel
walls. This condition is called atherosclerosis.
Almost 85% of strokes are ischemic
ATHEROSCLEROSIS
- “hardening of the arteries”
“athero” – gruel or paste
“sclerosis” – hardness
It’s the process in which deposits of fatty substances,
cholesterol, cellular waste products, calcium and other
substances build up in the inner lining of an artery. This
buildup is called plaque.

5. TYPES:
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HEMORRHAGIC STROKE
Results from a weakened vessel that ruptures and bleeds
into the surrounding brain. The blood accumulates and
compresses the surrounding brain tissue.
About 15% of all strokes but responsible for 30% of stroke
deaths
2 TYPES
SUBARACHNOID HEMORRHAGE (SAH)
occurs when a blood vessel on the surface of the brain ruptures and
bleeds into the space between the brain and the skull
INTRACEREBRAL HEMORRHAGE (ICH)
Occurs when a blood vessel bleeds into the tissue deep within the
brain.

6. POINTS TO CONSIDER
– 2,000,000 brain cells die every minute
during stroke, increasing risk of
permanent brain
damage, disability or death.
– Recognizing symptoms and acting fast
to get medical attention can save life
and limit
disabilities.

7. STAGES OF CVA
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Transient Ischemic Attack
sudden and short-lived attack
Is a "mini stroke" that occurs when a blood clot blocks an
artery for a
short time.
What is the difference between stroke and TIA?
There's no way to tell if symptoms of a stroke will lead to a TIA
or a major stroke. It's important to call 9-1-1 immediately for
any stroke symptoms.
Reversible ischemic neurologic deficit (RIND) similar to
TIA, but symptoms can last up to a week
Stroke in evolution (SIE)
Gradual worsening of symptoms of brain ischemia
Completed stroke (CS) – symptoms of stroke stable over
a
period and rehab can begin

8. Signs and Symptoms
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In embolism
Usually occurs without warning
Client often with history of cardiovascular disease
In thrombosis
Dizzy spells or sudden memory loss
No pain, and client may ignore symptoms
In cerebral hemorrhage
May have warning like dizziness and ringing in the ears
(tinnitus)
Violent headache, with nausea and vomiting
Sudden Onset CVA
Usually most severe
Loss of consciousness
Face becomes red
Breathing is noisy and strained

9. Signs and Symptoms
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Sudden Onset CVA
Usually most severe
Loss of consciousness
Face becomes red
Breathing is noisy and strained
Pulse is slow but full and
bounding
Elevated BP
May be in a deep coma

10. TIME IS CRTITICAL!
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The longer the time period that the person
remains unresponsive, the less likely it is that
the person will recover.
The first few days after onset is critical.
The responsive person may:
Show signs of memory loss or inconsistent
behavior
May be easily fatigued, lose bowel and
bladder control, or have poor balance

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RISK FACTORS:
Being over age 55
Having diabetes
Having a family history of stroke
MEDICAL STROKE RISK
Previous stroke
Previous episode of transient ischemic attack (TIA)
or mini- stroke
High cholesterol
High blood pressure
Heart disease

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RISK FACTORS:
LIFESTYLE STROKE RISK
Smoking
Being overweight
Drinking too much alcohol
You can control lifestyle risks by quitting smoking,
exercising regularly, watching what and how much
you eat and limiting alcohol consumption.

13. Common STROKE symptoms…
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Weakness or paralysis
Numbness, tingling, decreased sensation
Vision changes
Speech problems
Swallowing difficulties or drooling
Loss of memory
Vertigo
Loss of balance and coordination
Personality changes
Mood changes (depression, apathy)
Drowsiness, lethargy, or loss of consciousness
Uncontrollable eye movements or eyelid
drooping

14. MAJOR EFFECT of STROKE
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HEMIPLEGIA – most common result of CVA
Paralysis of one side of the body
May affect other functions, such as hearing,
general sensation and circulation
The degree of impairment depends on the part
of the brain affected
Stages:
– Flaccid – numbness and weakness of affected
side
– Spastic – muscles contracted and tense,
movement hard
– Recovery – therapy and rehab methods
successful

15. MAJOR EFFECT of STROKE
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Aphasia and Dysphasia
Brain Damage – extent of brain damage determines
chances of recovery
Hemianopsia – blindness in half of the visual field of one
or both eyes
Pain – usually very little; injection of local anesthetic
provides temporary relief
Autonomic Disturbances
Such as perspiration or “goose flesh” above the level
of paralysis
May have dilated pupils, high or low BP or headache
Treated with atropine-like drugs

16. DIAGNOSIS
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Physical Examination
(neurological examination &
medical history)
Imaging (CT scan and MRI)

17. ISCHEMIC STROKE

18. HEMORRHAGIC STROKE

19. TRANSIENT ISCHEMIC ATTACK
(TIA)

21. ACT F.A.S.T
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F – FACE
Ask the person to smile. Does one side of the face
droop?
A – ARMS
Ask the person to raise both arms. Does one arm
drift downward?
S – SPEECH
Ask the person to repeat a simple sentence. Does
the speech sound slurred or strange?
T – TIME
Call 911 Immediately

22. ASSESSMENT
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Monitor for signs and symptoms
Symptoms will vary based on the area of the brain
that is not adequately supplied with oxygenated
blood
The left cerebral hemisphere is responsible for
language, mathematic skills and analytic thinking
The right cerebral hemisphere is responsible for
visual and spatial awareness and proprioception
Assess/Monitor Airway patency

23. ASSESSMENT
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Swallowing ability/aspiration risk
Level of consciousness
Neurological status
Motor, sensory and cognitive
functions
Glasgow Coma Scale score

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Ineffective tissue perfusion
(cerebral)
Disturbed sensory perception
Impaired physical mobility
Risk for injury
Self-care deficit
Impaired verbal communication
Impaired swallowing
NURSING DIAGNOSIS

25. NURSING CONSIDERATIONS
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Maintain patent airway
Monitor for changes in the client’s level of
consciousness
Institute seizure precautions.
Maintain anon-stimulating environment.
Assist with communication skills if the client’s
speech is impaired.
Assist with safe feeding.
Assess swallowing reflexes.
Thicken liquid to avoid aspiration.
Eat in an upright position and swallow with the head and neck
flexed
slightly forward.
Place food in the back of the mouth on the unaffected side.
Suction on standby.

26. NURSING CONSIDERATIONS
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Maintain skin integrity.
Encourage PROM every 2 hr to the affected
extremities and AROM every 2 hr to the unaffected
extremities.
Elevate the affected extremities to promote venous
return and to reduce swelling.
Maintain a safe environment to reduce the risks of
falls.
Scanning technique (turning head from side to side)
when eating and ambulating to compensate for
hemianopsia.
Provide care to prevent deep-vein thrombosis
(sequential compression stockings, frequent

27. THROMBOLYTIC THERAPY
–Anticoagulants: Sodium heparin, warfarin
(Coumadin)
–Antiplatelets: Ticlopidine (Ticlid),
clopidogrel (Plavix)
–Antiepileptic medications: Phenytoin
(Dilantin), gabapentin (Neurontin)

28. STROKE PREVENTION
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Get screened for high BP.
Have your cholesterol level checked.
LDL should be lower than 70 mg/dL.
Follow a low-fat diet.
Quit smoking!
Exercise!
Limit alcohol intake!

29. THAT’S it!
THANK YOU
FOR
LISTENING!