Case Study on CVA

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Patient Diagnosis A cerebrovascular accident (CVA), which is more commonly known as a stroke, occurs when there is an interruption of blood flow to the brain. The brain requires 20% of the bodys total circulation of blood.. The blood enters the brain from two carotid arteries in the neck, which branch off into multiple arteries that supply each specific area of the brain with oxygen. If the blood flow in any of these arteries is interrupted for longer than a few seconds, brain cells die and cause permanent damage. The results depend on the area of the brain affected, the extent of the damage and the cause of the stroke. Signs and Symptoms The first mentioned sign of the onset of a CVA that affected Mr. M is dysphasia, which is the inability to speak. It is also sometimes termed expressive aphasia. The headaches that he had been experiencing also could have suggested to Mr. M. that a CVA was imminent, but a headache could be caused my many other things. On the day after admission Mr. M. shows that most common sign of CVA which is hemiplagia or hemiparalysis. He now has no motor coordination or sensation on his right side. This is caused by the blockage of blood to the left side of his brain which controls the right side of his body. His drowsiness can also be associated with this because of the brains deprivation of oxygen. Other Signs and Symptoms Some other symptoms that can be seen in a CVA patients are changes in vision. They can have a decrease in visual acuity, experience diplopia, or go blind all together. Another change that can be seen is a change in reception. This is called receptive aphasia. This can be the alteration of the ability to follow verbal direction, or written direction. Weakness or change in level of consciousness can be seen because of the lack of oxygen in certain parts of the brain. Common Tests to Diagnosis An easy non invasive test that will assess the signs and symptoms of a stroke is a physical examination and a full neurological assessment. Most common test ordered to confirm a stroke is a head CT. This will show a clot or other blockage in the flow of blood. A doppler study can be ordered to see if the cause of the symptoms is stenosis of the carotid arteries. Another test that could be seen is an ECG. This is usually ordered if a cardiac embolus is suspected. Predisposing Factors Males have a higher incidence of cva than women. Smoking, as in almost any other disease increases the chances of the development of this disease. Hypertention, Diabetes Mellitus, and Heart Disease significantly increases the chance of CVA. Chances also double with each decade after age 35. The most common cause is of this disease is atherosclerosis. This is a condition in which fatty deposits and blood platelets collect on the wall of the arteries, forming plaque. Over time the plaques begin to block blood flow, leading to a CVA. Laboratory Data From the labs that were drawn, most of the values were within normal range. Sodium, potassium, WBC, and Hgb were all in normal range. Glucose reading was at 122 was slightly elevated from the normal 80-120 range but not high enough to be diagnosed with diabetes. Hematocrit at 36% is also low from the normal range of 40-54%. Vital Signs Temperature of 99.0 and pulse of 88 are both within normal range. A blood pressure

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of 180/110 raises a concern. This is very high and is definately a reportable finding, especially because he has a history of hypertention. Respirations of 22 is just above the normal range of 12-20 respirations per minute and is therefore a reportable finding. This could be caused by acute pain that could be currently experienced by Mr. M. Nursing Interventions With CVA patients there are many nursing interventions that should be applied for safety reasons. For example, side rails should always be up, the patient should always be assisted in transfers, and all necessary items should be placed in arms reach so the patient does not have to leave his bed. As always the patient should also be acquainted with the call bell. Pain level should also be assessed along with the numbness and tingling, making sure there is no spread. Because this is a disease affecting the brain level of consciousness should be monitored frequently, along with motor function. The ability to swallow should be monitored and so should weight and hydration because of the occurrence in the inability to swallow. Vision loss could also be a result of the CVA so that should also be closely monitored. Speech assessment is another necessity. Because of the heparin drip PTT lab values should be closely monitored as well as other precautions that are associated with heparin such as padded side rails. As with all other patients vital signs should be monitored, meds should be administered as ordered and all labs should be monitored. Drug Action and Nursing Implications The heparin drip was ordered to prevent the clot in the brain from becoming larger occluding the blood supply. As a result bleeding precautions should be observed. Also because of the destructive abilities of this drug it should be placed on a pump not free flowing gravity. PTT should be drawn if this drug given again. ASA 81mg was also ordered to be started after the heparin is discontinued. This is ordered as a thrombolytic to prevent the formation of another clot. Essentially this does the same job as the heparin but obviously it is not as potent. Patient Teachings There are many teachings necessary for safety, treatment and prevention of a stroke. Because Mr. M has a history of a high blood pressure he should be monitoring this very closely and the education of low sodium diet should be implied. Another major teaching is exercise, to regain control of his affected side and maintain range of motion. The patient should also be told to see his doctor frequently for checkups and he should ask for referrals to therapists such as a physical therapist, a occupational therapist, and a speech therapist. Instruction in the use of a cane or walker may be necessary if one is prescribed for Mr. M. The family should be taught safety precautions for the home such as handrails on all stairs, no throw rugs where slippage can occur, and adaptive devices for showering and toileting. Proper skin care is always a necessary teaching for any patient. If the patient had a history of smoking he should be encouraged to cease because there is an increased chance of occurrence in smokers.