CVA Flashcards
the three things that cause someone to have a CVA
thrombus, embolism, hemorrhage
when is it called an ischemic stroke
when its caused by a thrombus or embolism
CVA
Is a sudden circulatory impairment of one or more blood vessels that supply the brain.
Can result in destruction of brain cells (Infarction).
Caused by sudden or gradual interruption of blood supply to the brain following a thrombus, embolism, or hemorrhage.
risk factors for CVA
Hypertension, atherosclerosis, arteriosclerosis, Diabetes
Cardiac disease like valvular disease, chronic atrial fibrillation, myocardial infarction.
Obesity, smoking, inactivity, stress and taking oral contraceptives.
statistics for COPD
Third most common cause of death in US.
Most common cause of permanent neurological disability in adults.
Affects men more than women. Incidence increases with age.
Stroke rate 50% higher in African American men and 130% higher in African American women than Caucasian.
Death rate has decreased since the 1970s because of improved health habits.
classification of an ischemic stroke
Ischemic Stroke:
a. Thrombus caused by atherosclerosis,
arteritis, or hypercoaguability of the
blood.
b. Embolism caused by atrial fibrillation,
valvular disease, and endocarditis.
classification of an hemorrhagic stroke
Hemorrhagic Stroke:
a. Hypertensive intracerebral hemorrhage
into brain tissue from rupture of small
blood vessel.
b. Ruptured aneurysm or arteriovenous malformation.
c. Hypocoaguability of blood from blood dyscrasias.
pathophysiology of CVA’s
Any condition that alters brain perfusion can lead to cerebral hypoxia.
Prolonged hypoxia leads to infarction and permanent damage.
Cerebral edema accompanies hypoxia and worsens initial deficits.
Symptoms vary based on location and extent of injury.
stages of thrombotic CVA
transient ischemic attack (TIAS)
Stroke in evolution
Completed Stroke
Transient ischemic attack (TIAS)
Transient ischemic attack (TIAs) a. Warning sign of impending CVA. b. Brief period of neurological deficit lasting to no more than 24 hours. c. Complete recovery of symptoms.
stroke in evolution
a. Progressive development of stroke
symptoms over a period of hours to days.
completed stroke
Neurological deficit remains unchanged
for 2 to 3 day period.
common side effects of a CVA involving the right side of the brain
Hemiplegia or hemiparesis on left side of body.
Spatial-perceptual deficits.
May not recognize hemiplegic part and has neglect or ignores it.
Quick, impulsive behavior so safety risk.
Performance memory deficits. Left visual field deficits.
Indifference to disability.
CVA involving the left side of the brain
Paralysis or hemiparesis of right side of body.
Speech-language deficits if left brain dominant. Wernicke’s and Broca’s area on left hemisphere so can have aphasia.
Behavior style- slow, cautious
Memory deficits with language.
Right visual field deficits.
Distress and depression r/t disability.
other problems from CVA’s
Dysphagia Agnosia Apraxia Dysarthia Hemianopsia
agnosia
—Inability to recognize sensory input.
apraxia
—Inability to carry out previously learned motor skills with no weakness or sensory, cognitive, or coordination impairment.
dysarthia
—Slurred speech because of motor impairment.
Bowel and bladder incontinence.
Hemianopsia
—Loss of vision toward hemiplegic side.
stroke in the brainstem
Coordination problems.
Problems with swallowing, eye movement, and sometimes paralysis.
Some changes in levels of consciousness.
stroke in the cerebellum
Problems with coordination, balance and eye movement.
diagnostics tests for CVA
CT Scan which is highly sensitive to blood. Need to do it quickly to r/o hemorrhagic CVA.
MRI to look at extent of ischemic stroke.
Carotid ultrasound.
Cerebral angiography.
Transcranial doppler imaging
EEG
Cardiovascular workup like ECG, Echocardiogram and telemetry
medical management of CVA
Goal—maintain cerebral circulation to prevent ischemia of cerebral tissue.
B/P in an acute stroke is lowered slowly since thought to be a protective mechanism in an ischemic stroke.
Initially may be patient on bed rest with head of bed down for adequate circulation. HOB is elevated if the patient has a large ischemic stroke or hemorrhagic infarct to decrease ICP from edema.
medical management of CVA continued
IV fluids to maintain circulatory volume and adequate B/P. May be restricted if large amount of cerebral edema is present.
Patients with ischemic strokes may be given anticoagulants, vasodilators, and thrombolytics to prevent further damage. Antihypertensives are used if indicated. Remaining care consists of support of vital functions and prompt rehabilitation.
Patients with hemorrhagic strokes are on complete bedrest with meticulous monitoring. May need surgery to stop bleed.
New Solitaire procedure to evacuate thrombus
new therapies used for patients with strokes
Constraint-induced movement therapy (CIMT)- emphasizes use of disabled limb by constraining unaffected limb. Force patient to try to use disabled limb. Encourages Brain Plasticity which makes it possible for another part of the brain to take up the functions of the injured p[art of the brain.
Neuroprotection by preventing secondary brain injury by decreasing inflammation and blocking toxic chemicals created by dying brain cells.
Implantation of neural stem cells to see if they can replace cells that have died.
nursing care for a patient with CVA
Assessment of history of symptoms, co-existing health problems, subjective symptoms, focal deficits, generalized objective symptoms, communication deficits, perceptual deficits, mental status changes, sensory & motor deficits, potential nutritional problems, bowel & bladder alterations, symptoms of ICP.
how long should someone be positioned on their effected side after a CVA
20-30 minutes . NO MORE
