Nursing Management in Cerebrovascular Accident (Stroke), Study Guides, Projects, Research of Nursing

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Nursing Management in CVA

(Cerebrovascular Accident

(Stroke)

Dr Shokoh Varaei Associate professor of TUMS

• A cerebrovascular accident (CVA), an ischemic stroke or “brain attack,” is a sudden loss of brain function resulting from a disruption of the blood supply to a part of the brain.

CLASSES OF STROKE

• Hemorrhagic strokes : caused by ruptured blood vessels, such as: Intracerebral hemorrhage Subarachnoid hemorrhage

Risk Factors

• Nonmodifiable
• Advanced age (older than 55 years)
• Gender (Male)
• Race (African American)
• Modifiable
• Hypertension
• Atrial fibrillation
• Hyperlipidemia
• Obesity
• Smoking
• Diabetes
• Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis, prosthetic heart valves)
• Periodontal disease

Causes

• Large artery thrombosis

( atherosclerotic plaques).

• Small penetrating artery thrombosis.

(most common type)

• Cardiogenic emboli (usually AF).

Clinical Manifestations

• Numbness or weakness of the face.
• Change in mental status.
• Trouble speaking or understanding speech.
• Visual disturbances.

Clinical Manifestations

• Dysarthria (difficulty speaking)

Expressive aphasia

Receptive aphasia

Global aphasia

or aphasia (loss of speech)

• Apraxia (inability to perform a previously

learned action

Impaired Cognitive and Psychological

Effects

• Frontal lobe damage: Learning capacity, memory, or

other higher cortical intellectual functions may be

impaired.

• Depression, other psychological problems: emotional

lability, and lack of cooperation.

Prevention of stroke

Prevention of stroke.

• Healthy lifestyle.
• DASH diet. ( Dietary Approaches to Stop Hypertension)
• Stroke risk screenings.
• Education.
• Low-dose aspirin.

Assessment and Diagnostic Findings

• CT scan.
• PET scan.
• MRI.
• Cerebral angiography.
• Lumbar puncture.
• Transcranial Doppler ultrasonography.
• EEG.
• Skull x-ray.
• ECG and echocardiography.
• Laboratory studies to rule out systemic causes:

Medical Management

• Patients who have experienced TIA or stroke should have medical management for secondary prevention.
• Recombinant tissue plasminogen activator (rtpa)
• Increased ICP (diuretics, Paco2 at 30-35mmHg, avoid hypoxia).
• Endotracheal Tube
• Hemodynamic monitoring.
• Neurologic assessment

Management of cerebral venous

thrombosis

• The treatment of CVT:
• Anticoagulation with low molecular weight heparin ( LMWH ) to prevent propagation of the thrombus and emboli.
• If anticoagulation is contraindicated, or if the patient does not respond to anticoagulation, thrombolysis or thrombectomy can be considered.

Surgical Management

• Surgical management may include prevention and relief from increased ICP.
• Carotid endarterectomy. (removal of atherosclerotic plaque or thrombus)
• Hemicraniectomy.