Cerebrovascular Accident

Question 1

Definition

Answer 1

refers to a lack of functioning of the Central Nervous System as a result of disruption of the blood flow to the brain.

Blood rich in oxygen can NOT reach brain cells and they begin to die.

This can be caused by a blockage or bleeding.

Question 2

Types of Strokes

Answer 2

Ischemic
Hemorrhagic
Transient ischemic attack (TIA)

Question 3

Ischemic stroke

Answer 3

This can be as a result of a blockage like a blood clot or stenosis (narrow) of blood vessels resulting in a lack of blood flow to affected area

1. Large artery thrombotic strokes
   
   • caused by atherosclerotic plaques
2. Small penetrating artery thrombotic strokes
   
   • more than one areas affects
3. Cardiogenic strokes
   
   • caused by dysrhythmias - usually atrial fibrillation
4. Cryptogenic
   - no know origin
5. Other
   - substance abuse
   - dissection of the carotid artery

Question 4

Embolism

Answer 4

A clot has left a part of the body and travelled to the brain, which stops blood flow

Question 5

Thrombosis

Answer 5

Clot forms within the artery wall within the neck or brain… seen in patients with hyperlipidemia or atherosclerosis.

Question 6

Hemorrhagic stroke

Answer 6

This happens when there is bleeding in the brain due to a ruptured blood vessel which leads to no blood to perfuse the brain cells and excessive swelling from the leakage of blood in the brain.

Causes: brain aneurysm bursts, uncontrolled hypertension, old age (vessels are NOT as resilient)

Question 7

Types of hemorrhagic strokes

Answer 7

 Intracerebral hemorrhage

 Subarachnoid hemorrhage

 Cerebral aneurysm

 Atriovenous malformation

Question 8

What arteries supply the brain with blood?

Answer 8

Carotid and vertebral

Question 9

Right hemisphere

Answer 9

Creativity

• Paralysis or weakness on the lefts side
• Left visual field deficit
• Spatial perceptual deficits
• Short attention span
• Impulsive behavior
• Lack of awareness deficits

Question 10

Left hemisphere

Answer 10

Logical

• Paralysis or weakness on the Right side
• Right visual field deficits
• Aphasia
• Altered intellectual ability
• Slow cautious behavior

Question 11

Pathophysiology

Answer 11

1. Blood flow decreases to less than 25 mg per 100 mg per minute
2. Aerobic switches to anaerobic producing lactic acid
3. Lactic acid lowers the bloods pH making it acidic
4. ATP ( adenosine triphosphate) levels decrease significantly slows the process of depolarization.
5. Electrolyte pump which maintains electrolyte balance fail and this leads to cell death

Question 12

Clinical manifestations

Answer 12

Confusion

Numbness or weakness

Difficulty speaking or understanding speech

Visually disturbances

Dizziness

Difficulty walking, loss of balance and coordination

Motor loss

• Hemiplegia
  
  • Flaccid paralysis
  • Loss/decrease of reflexes
  • spastic (increase in tone)
• Hemiparesis

Communication loss

• Dysarthria
• Dysphagia: impaired speech
• Aphasia: loss of speech
• Apraxia: inability to perform previous learned action

Perceptual loss
- Visual perceptual loss

Question 13

Circle of Willis

Answer 13

Where most strokes occurs

Question 14

Nursing diagnosis

Answer 14

Impaired physical mobility
Acute pain –painful shoulder
Self care deficit
Disturbed sensory perception
Urinary /bowel incontinence
Disturbed thought process
Risk for altered skin integrity
Interrupted family processes
Sexual dysfunction