Key words It is an acute disruption (reduction/ absence) of blood supply to a territory of the brain, resulting in neurologic signs & symptoms. This interruption of blood supply may be related to: ischemia, hemorrhage, or embolism. Strokes are considered a medical emergency. The 2nd leading cause of death in Gaza Strip, and a leading cause adult disability Up to 80 percent of all strokes are preventable through risk factor management

Women and Stroke Stroke kills more than twice as many American women every year as breast cancer More women than men die from stroke and risk is higher for women due to higher life expectancy Women suffer greater disability after stroke then men Women ages 45 to 54 are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge

Types of CVA Ischemic: 85% TIA Thrombotic: Embolic Hemorrhagic 15%: ICH SAH

Ischemic = Clot (makes up approximately 87 percent of all strokes) Hemorrhagic = Bleed - Bleeding around brain - Bleeding into brain Thrombotic 87

Risk Factors Non modifiable: age and sex Modifiable: HTN Atherosclerosis Hyperlipidemia DM Cocaine use Atrial fibrillation Smoking Use of oral contraceptives Obesity Hypercoagulability Cerebral aneurysm Arteriovenous malformation (AV)

Diagnostic Procedures and Nursing Interventions History and complete physical and neurologic examination Noncontrast CT scan 12-lead ECG and carotid ultrasound CT angiography or MRI and angiography Transcranial Doppler flow studies Transthoracic or transesophageal echocardiography (MRA) or cerebral angiography is used to identify the presence of cerebral hemorrhage, abnormal vessel structures, vessel ruptures,……….. LP is used to assess for presence of blood in the CSF.

Therapeutic Procedures and Nursing Interventions Carotid endarterectomy is performed to open the artery by removing atherosclerotic plaque. Interventional radiology is performed to treat cerebral aneurysms.

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. Aphasia (language use or comprehension difficulty) Alexia (reading difficulty) Agraphia (writing difficulty) Right hemiplegia or hemiparesis Slow, cautious behavior Depression and quick frustration Visual changes, such as hemianopsia

Clinical picture Rt cerebral hemisphere is responsible for visual and spatial awareness and proprioception. Unawareness of deficits (neglect syndrome, overestimation of abilities) Loss of depth perception Disorientation Impulse-control difficulty Poor judgment Left hemiplegia or hemiparesis Visual changes, such as hemianopsia

Stroke symptoms Sudden and severe headache Trouble seeing in one or both eyes Sudden dizziness, Trouble walking Sudden confusion Trouble speaking Sudden numbness or weakness of face, arm or leg

Assess/Monitor Airway patency Swallowing ability/aspiration risk Level of consciousness Neurological status Motor function Sensory function Cognitive function Glasgow Coma Scale score

NANDA Nursing Diagnoses Ineffective tissue perfusion (cerebral) Disturbed sensory perception Impaired physical mobility Acute pain Unilateral neglect Risk for injury Self-care deficit Impaired verbal communication

NANDA Nursing Diagnoses Impaired swallowing Impaired urinary elimination Impaired verbal communication Disturbed thought processes Risk for impaired skin integrity Interrupted family processes Sexual dysfunction

Nursing Interventions Maintain a patent airway. Monitor for changes in the client’s LOC ( ICP). Elevate the client’s head to ICP and to promote venous drainage. Avoid extreme flexion/ extension (maintain the head in the midline neutral position, and elevate the head of the bed to 30°). Keep seizure precautions. Maintain a calm environment. Assist with communication skills if the client’s speech is impaired.

Nursing Interventions Assist with safe feeding. Assess swallowing reflexes: swallowing, gag, and cough before feeding. The client’s liquids may need to be thickened to avoid aspiration. Have the client 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. Maintain a distraction-free environment during meals.

Nursing Interventions Maintain skin integrity. Reposition the client frequently and use padding. Monitor bony prominences, paying particular attention to the affected extremities. Encourage passive ROM every 2 hr to the affected extremities and active ROM 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 risk of falls. Instruct the client to use a scanning technique (turning head from side to side) when eating and ambulating to compensate for hemianopsia. Provide care to prevent DVT

Nursing Interventions Administer medications as prescribed. Thrombolytic therapy restores cerebral blood flow. It must be administered within hours of the onset of symptoms. It is contraindicated for treatment of hemorrhagic stroke and for clients with an increased risk of bleeding. Rule out hemorrhagic stroke with an MRI prior to initiation of thrombolytic therapy. Anticoagulants: heparin, Coumadin Antiplatelets

Nursing Interventions Antiepileptic medications: Phenytoin (Dilantin), gabapentin (Neurontin) Provide assistance with activities of daily living (ADLs) as needed. Initiate referrals to social services (rehabilitation services) and Physical/ Occupational Therapy (adaptive equipment needs in the home).

Complications and Nursing Implications Dysphagia and aspiration – Suction as needed. Preassess the client’s swallowing abilities. Unilateral neglect – loss of awareness of the side affected by the CVA. This poses great risk for injury and inadequate self care. Instruct the client to dress the affected side first. Teach the client to care for both sides.

Be stroke smart Recognize —S troke symptoms Reduce — Stroke risk Respond — At the first sign of stroke, CALL 101 IMMEDIATELY

Stroke Strikes FAST You Should, Too. Call F = FACE: Ask the person to smile. A = ARM: Ask the person to raise both arms. S = SPEECH: Ask the person to speak a simple sentence. T = TIME: If you observe any of these signs, call immediately © 2011 National Stroke Association