MANAGEMENT OF STROKE Flashcards
Functional abnormality of the central nervous system that occurs when the blood supply to the brain is disrupted
Stroke
Medical Emergency
Stroke
Two type of Stroke
- Ischemic (87%)
- Hemorrhagic (13%)
Presence of vascular occlusion resulting to a significant hypoperfusion
Ischemic
Blood extravasates into the brain tissue or subarachnoid space
Hemorrhagic
Risk factors of Stroke
(HANDOS DRAGDEN FAMILY)
-Hypertension
- Atrial Fibrillation
- Not Physically Active
-Diabetes Mellitus
-Obesity
-Smoking
-Dyslipidemia
-Race
- Age >55 years old
- Gender
- Drug Addiction
- ETOH dependence
- Nutrition and Dietary Factors
Family History
Management of High Risk
-Provide Health Teaching on reduction strategies
- Facilitate consultation with physician
Low Risk Management
Health Promotion Activities
results from a sudden loss of functioning resulting from a disruption of blood supply to a part of the brain
Ischemic Stroke
Blood flow to an area of the brain stops due to an occlusion by a blood clot
Ischemic Stroke
Precipitating Factor of Thrombotic Stroke
-Hypertension
-Diabetes Mellitus
Pathophysiology of Thrombotic Stroke
Blood clot resulting from a blood vessel injury occludes arterial blood flow to specific areas of the brain
Incidence by Gender in Thrombotic Stroke
Men > Women
Onset of Manifestations of Thrombotic Stroke
Slow-onset
Precipitating Factor of Embolic Stroke
Atrial Fibrillation
Pathophysiology of Embolic Stroke
Blood clot circulates with blood and ultimately lodges in any of the cerebral artery causing disruption of blood flow
Incidence by gender
Men > Women
Onset of Manifestations of Embolic Stroke
Sudden-onset
An area of low CBF
Penumbra Region
Ischemic brain tissue that may be salvaged with timely interventions
Penumbra Region
Results from bleeding into the brain tissue itself or into the subarachnoid space or ventricles
Hemorrhagic Stroke
Precipitating Factor of Intracerebral
Hypertension
Pathophysiology of Intracerebral
Persistently elevated blood pressure causes the artery to rupture
Incidence by gender in Intracerebral
Women > Men
Onset of Manifestations in Intracerebral
Activity-related
Prognosis of Intracerebral
Poor- 50% of deaths occur within the first 48 hours
Precipitating Factor of Subarachnoid
- Aneurysms
- Head Trauma
- Cocaine Abuse
Pathophysiology of Subarachnoid
A dilated and weakened portion of an artery ruptures secondary to elevated blood pressure
Incidence by gender in Subarachnoid
Women > Men
Onset of Manifestations in Subarachnoid
Activity-related (Acute)
Prognosis in Subarachnoid
Worsens if with declining level of consciousness
Blood flow to an area of the brain stops due to rupture of the artery
Hemorrhagic Stroke
What is the early warning sign of hemorrhagic stroke?
-Headache
-Seizures are common
Motor Deficits in Stroke
-Hemiparesis
- Hemiplegia
- Ataxia
- Dysphagia
- Dysarthria
WEAKNESS of the face, arm, and leg on the same side
Hemiparesis
PARALYSIS of the face, arm, and leg on the same side
Hemiplegia
Staggering, unsteady gait
Unable to keep feet together; needs broad base to stand
Ataxia
Difficulty Swallowing
Dysphagia
-Difficulty forming words
-Occurs when the muscles used for speech are weakened or the patient has difficulty controlling them
-Nasal, slurred speech
Dysarthria
Sensation of numbness, tingling, or a “pins and needles” sensation
Difficulty with proprioception
Paresthesia
Inability to communicate
Aphasia
Inability to express self. Unable to form words that are understandable; may speak in single- word responses
Expressive Aphasia
Inability to understand language; Unable to comprehend the spoken word; can speak but may not make sense.
Receptive Aphasia
Combination of receptive and expressive aphasias
Global Aphasia
Nursing Care of Hemiparesis
-Place objects within the patient’s reach on the non- affected side
-Instruct the patient to exercise and increase strength on the affected side
Nursing Care of Hemiplegia
-Encourage the patient to provide ROM exercises to the affected side
-Provide immobilization as needed to affected side
-Maintain body alignment in functional position
-Exercise unaffected limb to increase mobility, strength, and use
Nursing Care of Ataxia
-Support patient during the initial ambulation phase
-Provide supportive devices for ambulation
-Instruct patient not to walk without assistance or supportive devices
Nursing Care of Dysphagia
- Test the patient’s pharyngeal reflexes before offering food or fluids
- Assist the patient with meals
- Place food on the unaffected side of the mouth
- Allow ample time to eat
Nursing Care of Dysarthria
-Provide the patient with alternative methods of communicating
-Allow patient sufficient time to respond to verbal communication
-Support patient and family to alleviate frustration related to difficulty communicating
Nursing Care of Paresthesia
-Instruct patient that sensation may be altered
-Provide range of motion to affected areas and apply corrective devices as needed
Nursing Care of Expressive Aphasia
-Encourage patient to repeat sounds of the alphabet
-Explore the patient’s ability to write as an alternative means of communication
Nursing Care of Receptive Aphasia
-Speak clearly and in an unhurried manner to assist the patient in forming the sounds
-Explore the patient’s ability to read as an alternative means of communication
Nursing Care of Global Aphasia
-Speak clearly and in simple sentences; use gestures or pictures when able
-Establish alternative means of communication
Nursing Care of Homonymous Hemianopsia
-Place object within intact field of vision
-Approach the patient from side of intact field of vision
-Instruct/remind patient to turn head in the direction of visual loss to compensate for loss of visual field
-Encourage the use of eyeglasses if available
-When educating patients, do so within patient’s intact visual field
-Unaware of persons or objects on side of visual loss
-Neglect of one side of the body
-Difficulty judging distances
Homonymous Hemianopsia
-Difficulty seeing at night
-Unaware of objects or the borders of objects
Loss of Peripheral Vision
Double Vision
Diplopia
