1. Understanding Medical Surgical Nursing, 4th Edition Nursing Care of Patients with Cerebrovascular Disorders Chapter 49

2. Understanding Medical Surgical Nursing, 4th Edition Transient Ischemic Attack Temporary Impairment of Cerebral Circulation Deprives Brain of Glucose and Oxygen Symptoms Resolve One-third of Patients have Stroke within 5 Years

3. Understanding Medical Surgical Nursing, 4th Edition Cerebrovascular Accident (Stroke) Pathophysiology Inadequate Blood Flow to Brain Infarction of Brain Tissue Permanent Damage if Not Reversed Neurological Deficits

4. Understanding Medical Surgical Nursing, 4th Edition Etiology Ischemic Deficient Blood Supply Thrombotic Embolic Hemorrhagic Subarachnoid Intracerebral

5. Understanding Medical Surgical Nursing, 4th Edition Risk Factors Modifiable Hypertension Smoking Diabetes Mellitus Cardiovascular Disease Atrial Fibrillation Carotid Stenosis Tia Sickle Cell Anemia Dyslipidemia Non-Modifiable Age Gender Heredity Prior Stroke or Heart Attack

6. Understanding Medical Surgical Nursing, 4th Edition Warning Signs Sudden Numbness or Weakness Sudden Confusion Sudden Change in Vision Sudden Trouble Walking/Dizziness Sudden Severe Headache CALL 911!

7. Understanding Medical Surgical Nursing, 4th Edition F.A.S.T. Face Arms Speech Time – Call 911

8. Understanding Medical Surgical Nursing, 4th Edition Acute Signs and Symptoms Depend on Area of Brain Affected One-Sided Weakness/Paralysis Dysphagia Sensory Loss Mental Status Changes Visual Disturbance Speech Disturbance

9. Understanding Medical Surgical Nursing, 4th Edition Opposite Side Affected

10. Understanding Medical Surgical Nursing, 4th Edition One-Sided Weakness

11. Understanding Medical Surgical Nursing, 4th Edition Visual Disturbances

12. Understanding Medical Surgical Nursing, 4th Edition Diagnosis CT Scan EKG CBC, Electrolytes, Glucose Metabolic Panel PT, INR NIH Stroke Scale Carotid Doppler Cerebral Angiogram

13. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Thrombolytic Therapy Airway Management Control of Hypertension, Fever, Glucose Seizure Prevention

14. Understanding Medical Surgical Nursing, 4th Edition Thrombolytic Therapy Dissolves Clot Three Hour Time Window May Reverse Symptoms TIME LOST IS BRAIN LOST!

15. Understanding Medical Surgical Nursing, 4th Edition Post-Emergent Interventions Treat Cause of Stroke Physical, Occupational, Speech Therapy Antiplatelet Agent Anticoagulant Agent Antihyperlipidemic Agent Antidysrhythmic Agent Maintain Patent Airway

16. Understanding Medical Surgical Nursing, 4th Edition Stroke Prevention Control Weight Hypertension Cholesterol Smoking Cessation Aspirin or Warfarin Early Recognition and Treatment

17. Understanding Medical Surgical Nursing, 4th Edition Surgical Intervention Carotid Endarterectomy Balloon Angioplasty with Stent

18. Understanding Medical Surgical Nursing, 4th Edition Long-Term Effects Impaired Motor Function Impaired Sensation Dysphagia Aphasia Emotional Lability Impaired Judgment Unilateral Neglect

19. Understanding Medical Surgical Nursing, 4th Edition Cerebral Aneurysm/ Subarachnoid Hemorrhage Aneurysm Weakness in Artery Wall Subarachnoid Hemorrhage Aneurysm AV Malformation Head Trauma

20. Understanding Medical Surgical Nursing, 4th Edition Arteriovenous Malformation

21. Understanding Medical Surgical Nursing, 4th Edition Signs and Symptoms Severe Headache Photophobia Vomiting Disorientation IICP Changes in LOC Seizures Nuchal Rigidity Pupil Changes Motor Dysfunction

22. Understanding Medical Surgical Nursing, 4th Edition Diagnosis CT Scan Cerebral Angiogram

23. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions Craniotomy Clamp Wrap Remove

24. Understanding Medical Surgical Nursing, 4th Edition Therapeutic Interventions (cont’d) Nonsurgical Thrombose Aneurysm Monitoring Blood Pressure Control

25. Understanding Medical Surgical Nursing, 4th Edition Complications Rebleed Hydrocephalus Vasospasm Others Similar to Stroke

26. Understanding Medical Surgical Nursing, 4th Edition Ventriculoperitoneal Shunt

27. Understanding Medical Surgical Nursing, 4th Edition Nursing Process: Assessment LOC Restlessness Dizziness Vision Changes Pupil Changes Vital Signs Pain SpO2 Paresthesias Weakness Paralysis Seizures Respiratory Status Swallowing

28. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses: Cerebrovascular Disorder Ineffective Cerebral Tissue Perfusion Ineffective Airway Clearance Risk for Injury Impaired Physical Mobility Imbalanced Nutrition

29. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses (cont’d) Disturbed Sensory Perception Risk for Impaired Skin Integrity Incontinence Self-Care Deficit Impaired Verbal Communication

30. Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses (cont’d) Acute or Chronic Confusion Risk for Falls Deficient Knowledge Risk for Caregiver Role Strain

31. Understanding Medical Surgical Nursing, 4th Edition Ineffective Cerebral Tissue Perfusion Monitor Neurological Status Vital Signs SpO2 Blood Glucose Coagulation Studies Medication Effects Report Changes Keep HOB up 20 to 30 Degrees Monitor Medication Effects

32. Understanding Medical Surgical Nursing, 4th Edition Ineffective Airway Clearance Monitor Lung Sounds, Cough, Respirations Position to Maintain Open Airway Encourage to Cough and Deep Breathe Suction PRN

33. Understanding Medical Surgical Nursing, 4th Edition Risk for Injury Monitor Neuro Status and Report Changes Monitor for Hemorrhage Administer Anticonvulsant as Ordered Implement Seizure Precautions Assist with Transfers and Ambulation

34. Understanding Medical Surgical Nursing, 4th Edition Impaired Physical Mobility Refer to PT, OT Consider Constraint Therapy Maintain Good Body Alignment Perform ROM Exercises Mobilize: Chair or Ambulate Turn q 2 Hours

35. Understanding Medical Surgical Nursing, 4th Edition Imbalanced Nutrition Keep NPO Until Swallowing Evaluated Perform Dysphagia Screen Try Sip of Water Request ST Swallowing Evaluation Implement Aspiration Precautions Consider Tube Feeding if Necessary

36. Understanding Medical Surgical Nursing, 4th Edition Disturbed Sensory Perception Assess for Sensory Deficits Teach Patient to Scan Environment Protect Skin

37. Understanding Medical Surgical Nursing, 4th Edition Risk for Impaired Skin Integrity Monitor Skin for Breakdown Keep Perineal Area Clean and Dry Use Barrier Cream PRN Turn Patient every 2 Hours Use Lift Sheet to Reposition Consider Pressure-Reducing Mattress

38. Understanding Medical Surgical Nursing, 4th Edition Incontinence Monitor for Incontinence Determine Usual Elimination Patterns Provide Assistance with Toileting Schedule Respond Quickly to Requests for Help

39. Understanding Medical Surgical Nursing, 4th Edition Self-Care Deficit Assess Ability to Perform ADLs Encourage Independence Place Objects in Reach Provide Assistive Devices Assist to Learn Use of Non-Dominant Side Involve and Educate Family

40. Understanding Medical Surgical Nursing, 4th Edition Impaired Verbal Communication Assess Verbal Ability Consult Speech Pathologist Answer Call Light in Person Listen Patiently Provide Communication Aids Keep Communication Appropriate Don’t Assume Patient Does Not Understand

41. Understanding Medical Surgical Nursing, 4th Edition Picture Board

42. Understanding Medical Surgical Nursing, 4th Edition Acute or Chronic Confusion Monitor Changes in Thought Processes Place Calendars, Clocks in Environment Reduce Stressors Maintain Patient’s Usual Routines Communicate Slowly and Clearly Involve Family

43. Understanding Medical Surgical Nursing, 4th Edition Risk for Falls Perform Fall Risk Assessment Instruct to Ask for Help to Get Up Keep Call Light Within Reach Provide Frequent Toileting Avoid Restraints

44. Understanding Medical Surgical Nursing, 4th Edition Deficient Knowledge Explain What Happened to Patient Explain Tests and Procedures Orient Patient and Family to Setting Provide Instruction for Care at Home Evaluate Need for Home Nursing

45. Understanding Medical Surgical Nursing, 4th Edition Risk for Caregiver Role Strain Assess Impact of Patient’s Needs on Caregiver Assist Caregiver to Identify Resources Consult Social Worker or Case Manager Consider Skilled Nursing Facility PRN