Cerebrovascular Disorders Ischemic vs. Hemorrhagic Stroke

Stroke (Brain Attack) What are the Implications? Sudden disruption in the normal blood supply to the brain fka: Cerebrovascular Accident (CVA) Medical emergency Immediate treatment required Third most common cause of death in US Primary cause of adult disability Why is disrupted blood supply a concern? What are the Implications?

Stroke Risk Factors History: History: TIA ASCVD HTN Dysrhythmia (Atrial Fib) ECG changes Rheumatic heart disease Diabetes Mellitus Gout History: Cardiac enlargement Hyperlipidemia Lack of exercise Hormonal contraceptive use Drug abuse Smoking Family history of stroke Sickle cell disease

Classifications Transient Ischemic Attack (TIA) Progressive Complete Least severe Temporary Complete return to normal functioning Progressive Begins with slight neurologic deficit and worsens over a day or two Complete Most severe Causes maximum neurologic deficits at onset

To remember important points of TIA T: Transient episode that clears in 12-24 hrs I: Warning sign of Impending stroke A: Aspirin and Anticoagulants to minimize risk of thrombosis

Types of Strokes Compare and contrast the two types of strokes Identify the three major causes of stroke in order of incidence Ischemic Caused by occlusion of a cerebral artery Hemorrhagic Ruptured sacular aneurysm Ruptured atreriovenous malformation (AVM) Hypertension

Pathophysiology Of Ischemic Stroke Create a flow-chart concept map of the Pathophysiology of an Ischemic Stroke.

Pathophysiology of Hemorrhagic Stroke What do you need to know to be able to discuss the pathophysiology of a Hemorrhagic Stroke?

Stroke: Assessments Accurate History Activity when stroke began Ischemic: sleep Hemorrhagic: activity Progression of Sx Objective assessment: Loss of consciousness, dizziness, seizure Level of Consciousness Current LOC Presence of deficits Medical History Head trauma HTN Heart disease Anemia Obesity Headache Current meds Anticoagulants ASA Vasodilators Illegal drugs

Assessment What will physical findings depend upon? How will data be gathered if patient is unable to give history information?

Diagnostics Why should contrast not be used for the CT? Noncontrast CT 12 Lead ECG Carotid ultrasound Cerebral angiography Trancranial doppler studies Transthoracic or transesophageal echo MRI Xenon enhanced CT SPECT Which of these are considered the standard diagnostics? Why should contrast not be used for the CT? What is the role of the nurse in these diagnostics?

Collaborative Problems/Potential Problems Ischemic ↓cerebral blood flow due to ↑ ICP Inadequate oxygen to the brain Pneumonia Hemorrhagic Vasospasms Seizures Hydrocephalus Rebleeding Hyponatremia

Ischemic Stroke: Medical Management Secondary prevention Thrombolytic therapy Maintenance of cerebral perfusion Managing potential complications Surgical prevention What measures will be included for these interventions?

Ischemic Stroke: Nursing Interventions (Recovery) Improve mobility and prevent joint deformity Prevent shoulder pain Enhance self-care Manage sensory-perceptual difficulties Assist with nutrition Attaining bowel and bladder control Improving thought processes Improving communication Maintaining skin integrity Improving family coping Helping patient cope with sexual dysfunction

Hemorrhagic Stroke: Nursing Interventions Optimizing cerebral tissue perfusion Relieving sensory deprivation and anxiety Monitoring and managing potential complications

Stroke: Impaired Verbal Communication Occurs in dominant hemisphere/majority in left hemisphere Dysarthria due to loss of motor function Aphasia caused by cerebral hemisphere damage Expressive (Broca’s or motor) aphasia Receptive (Wernicke’s or sensory) aphasia Discuss how impaired verbal communication impacts the patient/client, the family and the caregiver.

Impaired Communication Compare and Contrast the different types of aphasia. How would your plan of care differ in regards to the type of aphasia experienced?

Left Frontal Stroke

Left Frontal Stroke (underside)

Right Sided Stroke

Right Sided Stroke