1. Nursing Care of Patients with Cerebrovascular Disorders
The Nervous System
Nursing Care of Patients with Cerebrovascular Disorders

2. Transient Ischemic Attack
Temporary impairment of cerebral circulation, deprives brain of glucose and oxygen, may last mins to hrs, resolve/24
24-29% have Stroke within 5 Years
May be a forewarning for CVA
S/S: depends on area of brain affected, visual/speech difficulty, weakness/paralysis

3. Cerebrovascular Accident (Stroke)
Pathophysiology
Inadequate blood flow to brain, destroys brain tissue, permanent damage if not reversed
Ischemic- death of brain tissue
Thrombotic- circulation or Embolic-obstruction
Hemorrhagic- rupture of a vessel, bleeding into the brain

4. Risk Factors Modifiable Non-Modifiable Hypertension Smoking
Diabetes Mellitus
Atherosclerosis
Atrial Fibrillation
Obesity
Hypercholesterolemia
TIA
Alcohol, Drugs
Non-Modifiable
Age
Gender
Prior Stroke or Heart Attack
Heredity

5. Warning Signs CALL 911! Sudden Numbness or Weakness Sudden Confusion
Sudden Change in Vision
Sudden Trouble Walking / Dizziness
Sudden Severe Headache
CALL 911!

6. Acute Signs & Symptoms Depend on Area of Brain Affected
Change in LOC, numbness, weakness
Visual/ language disturbance
One-Sided Weakness / Paralysis
Dysphagia
HA, N/V, resp compromise

7. Opposite Side Affected

8. Visual Disturbances

9. Cincinnati Pre-Hospital Stroke Scale
Have Patient Smile
Have Patient Hold Arms out Straight and Close Eyes
Ask Patient to Repeat a Phrase
CT, MRI, Angiogram, NIH stroke scale, PT, PTT, electrolytes, CBC

10. Therapeutic Interventions
Thrombolytic Therapy
Must be given within 3 hours to be effective to reverse stroke s/s TIME IS BRAIN!
Treat cause of stroke
Airway Management
Control of Hypertension
Seizure Prevention
Anticoagulants and antiplatelets

11. Surgical Intervention
Carotid Endarterectomy- carotid artery is opened and plaque removed
Balloon Angioplasty

12. Long Term Effects Impaired Motor Function Impaired Sensation Aphasia
Emotional Lability
Impaired Judgment
Unilateral Neglect
Homonymous Hemianopsia

13. Cerebral Aneurysm/Subarachnoid Hemorrhage
Weakness in Artery Wall, result of trauma, disease, or congential
Subarachnoid Hemorrhage
AV Malformation
Head Trauma

14. Arteriovenous Malformation

15. S/S of Hemorrhage Severe Headache Photophobia Vomiting Disorientation
IICP
Dx: CT scan, cerebral angiogram
Changes in LOC
Seizures
Nuchal Rigidity
Pupil Changes
Motor Dysfunction

16. Therapeutic Interventions
Craniotomy
Clamp
Wrap
Remove

17. Therapeutic Interventions cont’d
Nonsurgical
Thrombose Aneurysm
Monitoring
Blood Pressure Control

18. Complications
Rebleed
Hydrocephalus
Vasospasm
Others Similar to Stroke

19. Ventriculoperitoneal Shunt

20. Nursing Process: Assessment
LOC
Restlessness
Dizziness
Vision Changes
Pupils
Vital Signs
Pain
SaO2
Paresthesias
Weakness
Paralysis
Seizures
Respiratory Status
Swallowing

21. Nursing Diagnoses: Cerebrovascular Disorder
Ineffective Cerebral Tissue Perfusion
Ineffective Airway Clearance
Risk for Injury
Impaired Physical Mobility
Imbalanced Nutrition
Disturbed Sensory perception
Risk for Impaired Skin integrity

22. Nursing Diagnoses Cont’d
Incontinence
Self-Care Deficit
Impaired Verbal Communication
Disturbed Thought Processes
Deficit Knowledge
Risk for Caregiver Role Strain

23. Ineffective Cerebral Tissue Perfusion
Monitor Neurological Status
Monitor Vital Signs
Monitor Coagulation Studies
Monitor Medication Effects
Report Changes

24. Ineffective Airway Clearance
Monitor Lung Sounds, Cough, Respirations
Position to Maintain Open Airway
Encourage to Cough and Deep Breathe
Suction PRN

25. Risk for Injury Monitor Neuro Status and Report Changes
Administer Anticonvulsant as Ordered
Implement Seizure Precautions
Offer Toileting on Schedule

26. Impaired Physical Mobility
Refer to PT, OT
Maintain Good Body Alignment
Perform ROM Exercises
Mobilize – Chair or Ambulate
Turn q 2 Hours

27. 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

28. Disturbed Sensory Perception
Assess for Sensory Deficits
Teach Patient to Scan Environment
Protect Skin

29. Risk for Impaired Skin Integrity
Monitor Skin for Breakdown
Keep Perineal Area Clean and Dry
Use Barrier Cream PRN
Turn Patient q2 Hours
Use Lift Sheet to Reposition
Consider Pressure-Reducing Mattress

30. Incontinence Monitor for Incontinence
Determine Usual Elimination Patterns
Provide Assistance with Toileting Schedule
Respond Quickly to Requests for Help

31. 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

32. 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

33. Picture Board

34. Disturbed Thought Processes
Monitor Changes in Thought Processes
Place Calendars, Clocks in Environment
Reduce Stressors
Maintain Patient’s Usual Routines
Communicate Slowly and Clearly
Involve Family

35. 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

36. 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