Sudden loss of brain function resulting from a disruption of the normal blood supply to a part of the brain.
where there is mild ischemia & actual improvement between episodes & later progress to full-blown CVA. Vessels are narrowed or sometimes spasm & pt. has transient symptoms
Leading cause for adult long term disability
*Cause of death rank: 4th *Stroke is the leading cause for adult long term disability.
FAST stands for?
Our job as nurses -- educate people about S&S: Call "911;" Get help fast! (Face, Arm, Speech, Time)
term from American Stroke Association (ASA) to get lay public to recognize that, like a heart attack, best outcome will be achieved if person gets help quickly!
Treatment for hemorrhagic CVA
Management of hypertension with oral and IV agents to maintain systolic BP less than 160 mm Hg and seizure prophylaxis in acuter preiod
What causes an ischemic CVA
Caused by occlusion of a cerebral artery from either a thrombus (stationary clot) or embolus (moving clot)
Diagnosis of a TIA.
CT or MRI
Give signs & symptoms of a TIA
depends upon which blood vessels are involved. carotid system - affects vision, sensation, speaking vertebrobasilar - ears, eyes, ptosis,diploia, vertigo, tinnitus
Transient Ischemic attack
Sometimes referred to as a mini-stroke, temporary interruption in the blood supply to the brain.
difficulty in speaking - general term
inability to use or comprehend language either partially or completely (Wernicke's Aphasia) inability to understand spoken or written word, thus , can't follow commands, May use "jargon" or meaningless words not in context and they don't realize they're not making sense
(Broca's Aphasia) incorrect words are spoken pt. becomes very frustrated, becuae they hear the wrong words come out
difficulty in articulation & pronunciation (cause is loss of motor function of tongue & muscles of speech), A speech disorder characterized by difficulty speaking properly, due to paralysis of the muscles of speech.
repetition of word, phrase, action inappropriately
inability to name objects even through usage is understood
Oral motor muscles loose function, unable to speak with meaningfull utterances. DISORDER OF MOTOR PLANNING. LOSS OF LEARNED PURPOSEFUL MOVEMENTS.
-The inability to understand and interpret the significance of sensory input
loss of half of the visual field from damage to optic tract or occipital lobe most often occurs as a homonymous---blindness in same side of both eyes (eg Nasal field of Rt. eye & temporal field of left = LEFT HH). Client has to turn head toscan visual field these fibers cross at the optic chiasm--- *LEFT HH means that the injury is to the right optic tract *RIGHT HH means that injury is to left optic tract
loss of vision in the temporal half of both fields:"Tunnerl Vision"--due to an injury at the optic chiasm---involves only fibers that are crossing over to the opposite side
Resources utilized in transitioning a CVA client from hospital or rehab unit to home.
critical factor in discharge planning is pt's level of independance in performing ADLs
Discuss the importance of monitoring the Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and International Normalized Ratio (INR) as a part of the treatment plan for a CVA client.
CVA patients are on anticoagulants to prevent future strokes by preventing the formation of a thrombus in the first place. These valuses need to be checked to have a balance between clot prevention and bleeding due to lack of clotting factors
Partial Thromboplastin Time (PTT)
Measures intrinsic clotting time, used to monitor heparin terapy; APTT range for heparin therapy is 1.5 - 2.5 times the normal value
Prothrombin Time (PT)
A test used to evaluate the extrinisic pathway; also used to monitor coumadin (warfin) therapy.
International Normalized Ratio (INR)
INR; a more consistant measure of coagulation for coagulation studies regardless of thromboplastin reagent used. Accepted from World Health Organization; makes results not dependent upon reagent used.
Determine when to notify the physician of a CVA patient's elevated blood pressure.
When BP is 220/120 or greater
Nursing interventions for CVA client with visual/perceptual deficits
approach patient from non-affected side, break tasks into small steps, develop structure, amy use eye patch for diplopia (alternate eye patch q4hr)
Nursing interventions for CVA client with self-care deficits
good skin care, promote elimination by offereing bedpan or urinal every 2 hours
Describe signs of increasing intracranial pressure.
causes brain compression and reduced cerebral blood flow. *LOC - partial consciousness or unconsciousness *Change in VS - pressure on thalamus, hypothalamus, pons, medulla causing cushing's triad *ocular signs - compression of cranail nerve III, dialation of pupil on same side of injury, sluggish, ptosis of eyelid *decrease motor function - contralateral hemiparesis or hemiplegia *headache - continuous but gets orse *vomiting -
Define & discuss neglect/extinction and identify appropriate nursing interventions.
put brightly colored object on affected limb to help re-integrate affected side into body image *encourage pt. to touch affected side *teach pt. to visually check position of limb
caused by stroke on left side of brain, right hemiplegia, aphasis, impaired right/left discrimination, slow performance, cautious, aware of deficits, depression, anxiety, impaired comprehension related to language,math
caused by stroke on right side of brain, left hemiplegia, left side neglect, spatial-perceptual deficits, deny or minimize problems, rapid performance, short attention span, impulsive, impaired judgement, impaired time concepts, safety problem
Expected outcome for CVA
1. maintenance of life 2. prevention of further neurological damage 3. promotion of recovery 4. restoration of prior performance 5.adaptation to visual, spatial, language, momory problems 6. prevention of injury & complications from CVA
Contributing factors for CVA
nonmodifiable: *advance age above 65 *male *latino or african american *history of stroke Modifiable *HTN *A-fib *Diabetes *hypercholesterolemia *poor diet *obesity *diet *smoking *peripheral vasuclar disease (PVD)
Treatment for ischemic CVA
The use of tPA within the first 4.5 hours of onset of symptoms
What does frontal lobe control?
*motivation, emotions, social behavior *attention, judgement, problem solving, desicion-making *expressive language (Broca's area), motor function of speech *motor integration; voluntary movement
An aphasia associated with damage to the Broca's area of the brain, demonstrated by the impairment in producing understandable speech.
What does parietal lobe control?
*touch *awareness of spatial relations (body consciousness, 3-dimensional perception *singing, playing musical instruments, processin non-verbal cues (singing is primarily a right brain function & speech a left) *taste sensation *academic skills
What does temporal lobe control?
*memory *language comprehension *receptive language (Wernicke's Center) *interpretation of complex sounds, allows for processing of words into coherent thought & *recognition of printed words into ideas *learning, memory, understanding speech *musical awareness *sequencing skills
Speech Comprehension Center
What does the occipital lobe control?
Primary visual center receiving stimuli from retina, where fibers from other lobes all synapse allows for processing complex thoughts. An area at the back of each cerebral hemisphere that is the primary receiving area for visual information.
Difficult and defective speech due to a dysfunction of the muscles used for speech
situated on same side of stroke, example right cerebellum controls right side balance & motor coordination
circle of willis
A structure at the base of the brain that is formed by the joining of the carotid and basilar arteries.
watch for blood in urine, bleeding gums, bruising, use soft toothbrush
Patient teaching what to avoid when on anticogulants.
foods high in Vitamin K (antidote for coumadin) cranberry juice, grapefruit, kale, cabbage, broccoli, asparagus, lettuce, spinach, large doses of Vit C
When given coumadin what labs should be tested?
PT INR hold if
When given Heparin IV what labs should be tested?
PTT or APTT hold if
What medication is given to SAH patients to prevent vasospasm?
Calcium channel blockers (nimodipine/Nimotop) prevent spasm minimize cerebral damage. hold for HR less than 60
When can a vasospasm occur?
after clipping/coiling treatment for aneurysm
What is a MERCI retriver?
mechanical embolus removal in cerebral ischemia retriever: under xray guidance catheter travels up carotid artery to clot in brain, tiny corkscrew dislodges it and captured and pulled out with balloon out of the body
What is the surgical treatment for an aneurysm to prevent rebleeding?
clipping or coiling
How does coiling work?
coil placed in aneurysm to occlude blood from circulating through the aneurysm reducing risk of rupture.
Bleeding into the subarachnoid space into the cerebrospinal fluid- filled space between the arachoid and pia mater membrane on the surface of the brain, "Worst headache of my life"
Where do the majority of SAH occur?
in the circle of Willis, other causes trauma and cocaine abuse