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Chapter 67- Cerebrovascular Disorders

Terms in this set (21)

Cerebrovascular Disorders
Functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted
Stroke is the primary cerebrovascular disorder and the fifth leading cause of death in the United States
Stroke is the leading cause of serious long-term disability in the United States
Financial impact is profound
Agnosia
is failure to recognize familiar objects perceived by the senses.
Aphasia
is an inability to express oneself or to understand language.
Apraxia
is an inability to perform previously learned purposeful motor acts on a voluntary basis.
Ataxia
is an impaired ability to coordinate movement, often seen as a staggering gait or postural imbalance
Prevention
Refer to Chart 67-2
Nonmodifiable risk factors
Age (older than 55 years), male gender, African Americans
Modifiable risk factors
Hypertension is the primary risk factor
Cardiovascular disease
Elevated cholesterol or elevated hematocrit
Obesity
Diabetes
Oral contraceptive use
Smoking and drug and alcohol abuse
Stroke
Brain attack"
Sudden loss of function resulting from a disruption of the blood supply to a part of the brain
Types of stroke: refer to Table 67-1
Ischemic (87%)
Hemorrhagic (13%)
Ischemic Stroke
Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism, that causes infarction of brain tissue
Types
Large artery thrombosis
Small penetrating artery thrombosis
Cardiogenic embolism
Cryptogenic
Other
Manifestations of Ischemic Stroke
Symptoms depend on the location and size of the affected area
Numbness or weakness of face, arm, or leg, especially on one side
Confusion or change in mental status
Trouble speaking or understanding speech
Difficulty in walking, dizziness, or loss of balance or coordination
Sudden, severe headache
Perceptual disturbances
Transient Ischemic Attack (TIA)
Temporary neurologic deficit resulting from a temporary impairment of blood flow
"Warning of an impending stroke"
Diagnostic workup is required to treat and prevent irreversible deficits
Medical Management
Prevention: control of hypertension
Diagnosis: CT scan, cerebral angiography, lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage
Care is primarily supportive
Bed rest with sedation
Oxygen
Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding
Preventive Treatment and Secondary Prevention
Health maintenance measures including a healthy lifestyle, not smoking, exercise, healthy diet and weight
Carotid endarterectomy for carotid stenosis
Anticoagulant therapy for atrial fibrillation
Antiplatelet therapy
"Statins"
Antihypertensive medications
Medical Management: Acute Phase of Stroke
Prompt diagnosis and treatment: refer to Table 67-4
Assessment of stroke: NIHSS assessment tool
Thrombolytic therapy
Criteria for tPA: refer to Chart 67-3
IV dosage and administration
Patient monitoring
Side effects: potential bleeding
Elevate head of bed (HOB) unless contraindicated
Maintain airway and ventilation
Continuous hemodynamic monitoring and neurologic assessment
Hemorrhagic Stroke
Caused by bleeding into brain tissue, the ventricles, or subarachnoid space
May be caused by spontaneous rupture of small vessels primarily related to hypertension; subarachnoid hemorrhage caused by a ruptured aneurysm; or intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations (AVMs), intracranial aneurysms, or medications such as anticoagulants
Brain metabolism is disrupted by exposure to blood
ICP increases caused by blood in the subarachnoid space
Compression or secondary ischemia from reduced perfusion and vasoconstriction causes injury to brain tissue
Manifestations of Hemorrhagic Stroke
Similar to ischemic stroke
Severe headache
Early and sudden changes in LOC
Vomiting
Bleeding
Nursing Process: The Patient Recovering From an Ischemic Stroke—Assessment
Acute phase:
Ongoing, frequent monitoring of all systems, including vital signs and neurologic assessment
LOC
motor symptoms
speech
pupil changes
I & O
blood pressure maintenance
Bleeding
oxygen saturation
Nursing Care Post Acute Phase
After the acute phase:
Mental status
Sensation/perception
Motor control
Swallowing ability
Nutritional and hydration status
Skin integrity
Activity tolerance
Bowel and bladder function
Improving Mobility and Preventing Joint Deformities
Turn and position in correct alignment every 2 hours
Use of splints
Passive or active ROM four or five times day
Positioning of hands and fingers
Prevention of flexion contractures
Prevention of shoulder abduction
Do not lift by flaccid shoulder
Measures to prevent and treat shoulder problems
Nursing Process: The Patient With a Hemorrhagic Stroke—Assessment
Complete and ongoing neurologic assessment; use neurologic flow chart
Altered LOC
Sluggish pupillary reaction
Motor and sensory dysfunction
Cranial nerve deficits
Speech difficulties and visual disturbance
Headache and nuchal rigidity
Other neurologic deficits
Aneurysm Precautions
Provide a nonstimulating environment, prevent increases in ICP, prevent further bleeding:
Absolute bed rest with HOB 30 degrees
Avoid all activity that may increase ICP or BP; Valsalva maneuver, acute flexion or rotation of neck or head
Stool softener and mild laxatives
Nonstimulating, nonstressful environment; dim lighting, no reading, no TV, no radio
Visitors are restricted
Home Care and Education for the Patient Recovering from a Stroke
Prevention of subsequent strokes, health promotion, and follow-up care; refer to Chart 67-6
Prevention of and signs and symptoms of complications
Medication education
Safety measures
Adaptive strategies and use of assistive devices for ADLs
Nutrition: diet, swallowing techniques, tube feeding administration
Elimination: bowel and bladder programs, catheter use
Exercise and activities, recreation and diversion
Socialization, support groups, and community resources
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