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Cerebrovascular Accident

A stroke occurs when blood flow to the brain is disrupted, depriving brain cells of oxygen and nutrients. It is a leading cause of disability. Risk factors include hypertension, diabetes, smoking, obesity, high cholesterol, and atrial fibrillation. Symptoms depend on the affected area of the brain and may include weakness, numbness, vision loss, impaired speech, and cognitive deficits. Diagnosis involves imaging tests like CT scans and MRI. Treatment focuses on rehabilitation and managing risk factors to prevent future strokes. Nursing care addresses impairments, promotes mobility and self-care, and provides education on prevention.

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Siwani rai
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260 views

Cerebrovascular Accident

A stroke occurs when blood flow to the brain is disrupted, depriving brain cells of oxygen and nutrients. It is a leading cause of disability. Risk factors include hypertension, diabetes, smoking, obesity, high cholesterol, and atrial fibrillation. Symptoms depend on the affected area of the brain and may include weakness, numbness, vision loss, impaired speech, and cognitive deficits. Diagnosis involves imaging tests like CT scans and MRI. Treatment focuses on rehabilitation and managing risk factors to prevent future strokes. Nursing care addresses impairments, promotes mobility and self-care, and provides education on prevention.

Uploaded by

Siwani rai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CEREBROVASCULAR

ACCIDENT

PRESENTED BY
SIWANI RAI
M.Sc.NURSING -I
INTRODUCTION
A stroke is caused by the disruption of blood flow to
the brain, resulting in death of brain cells
characterized by area specific focal neurological
deficits.
 In most cases, permanent disability results.
About 795,000 people of all ages are affected each
year.
 60,000 more women have strokes each year than
men.
Stroke is our nation's number four cause of death and
the leading cause of disability.
DEFINITION
A cerebrovascular accident (CVA), “brain
attack,” is a sudden loss of brain function
resulting from a disruption of the blood
supply to a part of the brain either by a
blockage or the rupture of a blood vessel.
ANATOMY AND PHYSIOLOGY
The brain is a large organ weighing
around 1.4 kg, which lies within the
cranial cavity.
It is a part of the Central Nervous System.
It is protected by the cranium and the
meninges- the dura mater , arachnoid
mater and innermost pia mater
LOBES OF BRAIN
Parts are:
1. Forebrain – Cerebrum
2. Midbrain – Diencephalon : Thalamus,
Hypothalamus
3. Hindbrain –
 Pons
 Medulla Oblangata
 Cerebellum
PARTS OF BRAIN
BLOOD SUPPLY OF BRAIN
CIRCULATION OF BRAIN
CEREBRAL CIRCULATION
Supplied by arrangement of arteries
called Circulus Arteriosus or Circle of
Willis.
Four large arteries – Two internal carotid
arteries and the two vertebral artieries

VENOUS DRAINAGE
 Cerebral Veins
FUNCTIONS OF BRAIN
FUNTIONS
THALAMUS
- Relays motor and sensory signals to the
cerebral cortex
- Regulates sleep , alertness and wakefulness
HYPOTHALAMUS
 Releases hormones to pituitary gland for
other hormone secretion
 Body temperature, thirst maintenance ,
emotional reactions etc.
FUNCTIONS
CEREBELLUM:
 Co-ordinates activities associated with
posture maintenance, balance and
equilibrium
 Damage to this results in clumsy, unco-
ordinated muscular movements ,
staggering gait
FUCNTIONS
MEDULLA OBLANGATA
 Transports signals between the spinal cord
and higher parts of brain
 Controls autonomic functions such as
heartbeat, respiration etc.
CLASSIFICATION OF STOKE
See chart
ETIOLOGY:
Large artery thrombosis.
Small penetrating artery thrombosis.
Cardiogenic emboli
Thrombosis
Cerebral Embolism
Ischemia
Vascular compression
Arterial spasm
RISK FACTORS
PATHOPHYSIOLOGY
The brain cannot store oxygen or glucose, so it relies on a constant supply of these nutrients

The disruption in the blood flow initiates a complex series of cellular metabolic events.
-Decreased cerebral blood flow

neurons are unable to maintain aerobic respiration

The mitochondria would need to switch to anaerobic respiration, which generates large
amounts of lactic acid

Causing a change in pH and rendering the neurons incapable of producing sufficient


quantities of ATP.

The membrane pumps that maintain electrolyte balances fail and the cells cease to function.

There is an area of brain tissue surrounding the damage, called the penumbra, which contains
brain cells that are "stunned" and can be revived if the brain is reperfused quickly.

The particular vessel or vessels involved determine the area of the brain affected and the
symptoms that result
CLINICAL MANIFESTATIONS
Motor Loss
Hemiplegia and Hemiparesis: Due to
lesion on the opposite hemisphere
Flaccid paralysis : Loss of deep tendon
reflexes followed by reappearances after
48 hours and abnormally increased
muscle tone
Ataxia: Impaired co-ordination of
voluntary muscles, cerebral dysfunction
like staggering gait, unsteady
HEMIPARESIS
HEMIPLEGIA
Perceptual disturbance and sensory loss

Visual-perceptual dysfunctions
(homonymous hemianopia)
Disturbances in visual-spatial relations
(frequently seen in patients with right
hemispheric damage).
Sensory losses: slight impairment of
touch or more severe with loss of
proprioception; difficulty in interrupting
visual, tactile, and auditory stimuli
HEMIANOPIA
LOSS OF PERIPHERAL VISIONS
Communication Loss
Dysarthria: Difficulty speaking. Neuronal
dysfuntion of Cranial Nevres – Trigeminal,
Facial , Glossopharyngeal etc.
Dysphagia: Facial muscle paralysis
Apraxia: Inability to perform previously
learned action
Expressive Aphasia : Unable to form
understandable words (cerebral dysfunction)
Receptive Aphasia : Unable to comprehend
spoken word, speaking without making sense
Impaired Cognitive and Psychological
Effects

Frontal lobe damage: Learning capacity,


memory, or other higher cortical intellectual
functions may be impaired. Such dysfunction
may be reflected in a limited attention span,
difficulties in comprehension, forgetfulness, and
lack of motivation.
Depression, other psychological problems:
emotional lability, hostility, frustration,
resentment, and lack of cooperation.
OTHER MANIFESTATIONS
Numbness or weakness of the face

Change in mental status


WARNING SIGNS OF STROKE
Complications

Tissue Ischemia : Inadequate blood


supply to brain , decreased cerbral blood
flow.

Cardiac dysrhythmias : Heart


compensates for the decreased cerebral
blood flow
ASSESSMENT AND DIAGNOSTIC
FINDINGS
PET SCAN
MRI
CERABRAL ANGIOGRAPHY
LUMBAR PUNCTURE
TRANCRANIAL DOPPLER USG
EEG
SKULL X-RAY
ECG AND ECHOCARDIOGRAPHY
LAB STUDIES
CT SCAN : Structural abnormalities , edema, ischemia, infarctions (after 8-12 hrs ), hemorrhage- immediately apparent.
MRI: Shows areas of infarction, hemorrhage, AV malformations,
areas of ischemia
LUMBAR PUNCTURE: Clear CSF- Thrombosis,embolism.If Hemorrhage – elevated pressure and bloody CSF, elevated protein in thrombosis
CEREBRAL –ANGIOGRAPHY: Determines specific cause of stroke like hemorrhage, sites of occlusion , position
PET- SCAN: Data on metabolism and
bio-chemical changes of organs
CAROTID ULTRASOUND
SKULL X-RAY: Shift of pineal gland, calcifcation of internal carotid
artery , aneurysm wall
NEUROLOGICAL ASSESSMENT
OTHER TESTS:
ECG AND ECHOCARDIOGRAPHY :
Rules out cardiac origin as source of
embolus , cardiac diseases- valvulitis ,
endocarditis
Laboratory studies: CBC, Clotting
Studies
MEDICAL MANAGEMENT
Recombinant tissue plasminogen
activator
Increased ICP
Endotracheal Tube
Hemodynamic Monitoring
Neurologuc Assessment
PHARMACOLOGICAL
MANAGEMENT

Anticoagulants- Warfarin (10mg/day 1st 2 days then


3-9mg/day) , Apixaban( 5mg BD, 2.5 mg BD)
Platelet Inhibiting Drugs- Aspirn
(325mg-650mg/day)
Antihypertensives – Thiazide Diuretics eg.
Chlorthiazide(25mg-30mg) BD, Beta- blockers e.g.
Atenolol( 50mg/day)
Hypolipidemic Agents- Lovastatin(10-80MG /day)
Anti-convulasants – Phenytion (20mg/kg/day)
Anti-pyretics- PCM (1000mg/day)
SURGICAL MANAGEMENT
Carotid Endarterectomy: Removal of
arthersoclerotic plaque or thrombus from
carotid artery .
Hemicraniectomy: To reduce ICP
CRANIOTOMY
NURSING MANAGEMENT
Nursing Assessment: History
collection , Physical examination ,GCS,
bleeding, neurological assessment, vital
signs etc.
Level of consciousness, involuntary-
voluntary movements, bleeding, MSE,
Neck stiffness, speech , Sensory
perceptions, temperature
NURSING DIAGNOSIS
1. Impaired physical mobility related to
hemiparesis, loss of balance etc.
2. Acute Pain related to hemiplegia and
disuse
3. Deficit self-care related to paraplegia
4. Disturbed Sensory Perception related to
altered sensory reception.
NURSING DIAGNOSIS
1. Impaired urinary elimination related to
flaccid bladder
2. Impaired verbal communication related
to brain damage
3. Risk for impaired skin integrity related
to immobility , hemiparesis
4. Interrupted family process related to
caregiving burden , terminal illness
NURSING INTERVENTIONS
Positioning
Prevent Edema
ROM
Personal Hygiene
Manage Sensory Difficulties
Speech Therapy
Bowel and bladder functioning
establishment
Enhancing Self Care
Managing Sensory-Perceptual Difficulties
Assisting with Nutrition
Improving Thought Processes
Improving Communication
Maintaining Skin Integrity
Improving Family Coping
PREVENTION
Primary prevention of stroke remains the
best approach.
Healthy lifestyle
DASH diet.
Stroke risk screenings.
Education.
Low-dose aspirin
ASSIGNMENT
DASH DIET
SUMMARY
INTRODCUTION
DEFINITION
ANATOMY PHYSIOLOGY
ETIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
DIAGNOSIS AND ASSESSMENT
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
NURSING MANAGEMENT
CONCLUSION
BIBLIOGRAPHY
Williams. S. Linda, Hopper D.Paula.
Understanding Medical Surgical
Nursing.Fifth Edition.New Delhi:Jaypee
Brothers Medical Publications; 2015.Page
No.
Madhavi S. Sharma K. Suresh. Bruner and
Suddharth’s Textbook of Medical Surgical
Nursing. Second Impression South Asian
Edition.Haryana:Wolters Kluwer India Pvt.
Limited;2019.Page No. 424-30.

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