CEREBROVASCULAR ACCIDENT (STROKE)

CEREBROVASCULAR ACCIDENT (STROKE)

Overview

A stroke occurs when the blood supply to the parts of brain is interrupted or reduced depriving brain tissue of oxygen and nutrients. Brain cells begin to die early action can minimize brain   damage and potential complications.

DEFINITION OF CEREBROVASCULAR ACCIDENT (STROKE)

 Stroke is a condition in which the neurologic deficit results from decreased blood flow to a localized area of the brain. It interrupts or diminishes oxygen supply, causing serious damage or necrosis in brain tissues.

TYPES OF STROKE

1. ISCHEMIC STROKE: Blood supply to a part of the Brian is suddenly interrupted due to a THROMBUA, EMBOLUS, and SYSTEMIC OR METABOLIC DISEASE.

2. HEMORRHAGIC STROKE: This occurs when a blood vessel breaks open, spilling blood into spaces surrounding neurons.

3. TRANSIENT ISCHEMIC ATTACH (TIA): Brief episode, less than 24hours of neurological dysfunction, it's a warning for impending stroke. Neurological Dysfunction is present for minutes to hours but no permanent neurological deficit remains.

4. NEUROMUSCULAR DEFICITS: These are due to damage of motor neurons of the pyramidal tracts.

5. RIGHT AND LEFT STROKE: Damage to either the left or right side of the brain will result in paralysis of either the right or left side of the body (HEMIPLEGIA) OR vice versa

CAUSES OR RISK FACTORS

1. Hypertension

2. Diabetes Mellitus

3. Heart disease

4. Obesity

5. Smoking

6. Atherosclerosis

7. High Serum Triglyceride level

8. Oral Contraceptives.

9. Aging

10. Family History Of Cerebrovascular disease.

Note: Stroke is commoner in males than in female.

PATHOPHYSIOLOGY

In stroke, there is reduced blood and oxygen supply to a particular area of the brain this could result from obstruction or rupturing of the tiny blood vessels. The impaired brain tissue perfusion will result in speech defect, dysphagia, visual problems, sensory losses such as touch and auditory stimuli, impaired mental activity if the frontal lobes is affected e.g reduced comprehension forgetfulness, loss of control of the external sphincter resulting in incontinence. Depending on the side that is affected.

Note: HEMIPLEGIA is one of the most common symptoms. Left HEMIPLEGIA results from effect on the right side of the Brain.

 CLINICAL MANIFESTATIONS

It depends on the affected artery thorn

1. Hemiplegia/paralysis

2. Sensory Defects e.g loss of tactile and auditory stimuli.

3. Aphasia (speech defect)

4. Unilateral neglect of paralyzed side.

5. Bladder impairment (Urinary incontinence)

6. Respiratory impairment

7. Cranial nerve impairment

8. Dysphagia, impaired tongue movement

9. Dyslexia(Reading problem)

10. Dysgrahia(inability to write).

DIAGNOSTIC EVALUATION

1. MRI to evaluate lesion location and size

2. EEG will detect reduced electrical activity in an area of infarction.

3. Cerebra Angiography details shows disruption or displacement of the cerebra circulation by occlusion or haemorrhagic.

4. Lumber puncture.

Medical Management

Medical Management of stroke commonly includes the following;

i.                    Physical Rehabilitation

ii.                 Pharmacotherapy which includes

iii.               Anticonvulsant e.g Phenobarbital.

iv.               Corticosteroids e.g dexamethasone.

v.                  Diuretics e.g Lasix

vi.               Aspirin and Antihypertensives e.g Vasoprin

vii.             Anticoagulant e.g Warfarin e.t.c

Surgery: depending on the CVA cause and extent. The patient may also undergo surgery example Craniotomy.

NURSING MANAGEMENT

Admission: ensure air way pattern and suction as order if patient is in coma.

Observation: monitor vital signs routinely especially blood pressure.

Physical care: Encourage range of motion exercises to help maintain strength/contractures. Active and passive exercises increase venous return and decreases the risk of thrombophlebitis.

Nutrition/diet: Provide balanced diet and assist the patient with eating if necessary.

Mobility: Assist patient with hemiplegia movement by standing on the affected side. Teach patient how to use walker, cane or wheelchair as appropriate.

Educate: Educate the patient and family about how to help the patient to maintain the optimal level of functioning.

Advice on discharge

NURSING DIAGNOSIS

1. Ineffective air way clearance related to altered level of consciousness

2. Impaired physical mobility related to the function of neurological damage

3. Ineffective cerebra tissue perfusion related to interruption of blood flow, occlusion, disorder haemorrhage, cerebral oedema

COMPLICATIONS

i.                    Cerebral swelling (edema)

ii.                 Increased intracranial pressure (ICP)

iii.               Intracerebral hemorrhage

iv.               Seizures

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