Cerebral

Vascular
Accident
Or

Stroke

Discussion
by:
Dominguez, John
Michael S.
Bachelor of Science
Major in Nursing

DEFINITION:

STROKE is also referred as:

DEFINITION:
Disruption of the
cerebral circulation
that results in
motor and sensory
deficits.

CAUSES:

Cerebral Arteriosclerosis
Syphilis
Trauma
Hypertension
Thrombosis
Embolism
Hemorrhage
Vasospasm

PATHOPHYSIOLOGY
:

Precipitating
Factors
Predisposing
Factors
Precipitating
Factor
Predisposing
Factors
Smoking

Age
Older
Older Age
Male
Male
Black heritage
Black heritage
Hereditary
Hereditary

Vasospas
m

Smoking
Substance Abuse
Substance Abuse
Obesity
Obesity
Sedentary Lifestyle
Sedentary Lifestyle
Heavy Alcoholism
Heavy Alcoholism
Oral Contraceptive Use
Oral Contraceptive Use

Embolus
that
dislodge

PATHOPHYSIOLOGY
:

Increas
e
oxygen
demand

Decrease
oxygen
supply in
the blood

Inadequate
blood
perfusion

PATHOPHYSIOLOGY
:

Disruption of
cerebral blood flow

Cerebral
anoxia

PATHOPHYSIOLOGY
:

Cell injury and

death
Cerebrovascular
Accident

ASSESSMEN
T:

KEY STROKE
ASSESSMENT
FINDINGS

Change in LOC
Paresthesia
Aphasia
Paralysis
Weakness

ASSESSMEN
T:

OTHER
ASSESSMENT
FINDINGS

Syncope
Headache
Seizures
Labile emotional
responses

Diagnostic
Test:

DIAGNOSTIC TEST
FINDINGS
CT scan:

Intracranial
bleeding, infarct, or shift of
midline structures
EEG: Focal slowing in area of
lesion
MRI: Intracranial bleeding,
infarct, or shift of midline
structures

Medical Management:

MEDICAL
MANAGEMENT
Diet:

Low sodium, increased

potassium
IV Therapy: Saline lock

Oxygen Therapy
Intubation & Mechanical
ventilation
GI Decompression: NGT
Position: Semi-Fowlers

Medical Management:

MEDICAL
MANAGEMENT
Activity:

CBR, A/PROM, &

Isometric Exercises
Monitoring: V/S, I&O, ECG,
ICP Neurovital Signs
Labs: Na, K, Glucose, ABG
Analysis

Nutritional Support: TPN

Indwelling Urinary

Medical Management:

MEDICAL
MANAGEMENT
Analgesic: Codeine (Paveral)
Diuretics: Mannitol

(Osmitrol), Furosemide (Lasix)

Antacids: Mg & Al HO2
(Maalox), Al HO2 gel
(AlternaGEL)

Anticonvulsant:
Phenytoin (Dilantin)

Medical Management:

MEDICAL
MANAGEMENT
Histamine Antagonists:
Cimetidine (Tagamot),
Ranitidine (Zantac)

Antihypertensive:
Diazoxide (Hyperstat)

Pulse Oximetry
Physical Therapy
Anticoagulants: Warfarin

Nursing Intervention:

NURSING
INTERVENTION
Maintain Patients Diet
Administer IVF
Administer Oxygen
Provide suction & turning
Encourage coughing &
deep breathing
Assess neurovascular,

Nursing Intervention:

NURSING
INTERVENTION
Maintain position, patency
& low suction of the NGT
Keep patient om semifowler position
Monitor V/S, I&O. pulse
oximetry
Administer TPN
Administer medications as

Nursing Intervention:

NURSING
INTERVENTION
Maintain a quiet environment
Assess for receptive and
expressive aphasia
Protect client from falls &
injury
Apply anti-embolism stockings
Maintain seizure precautions
Provide PROM
Turn & position patient q 2h

Nursing Intervention:

NURSING
INTERVENTION
Refer to a government
services on stroke patients.
Individualized Home Care
Instructions:
Identify ways to reduce stress
Recognize S/S of seizure
Minimize environmental stress
Reinforce established means of
communication; Teach scanning

Complications:

COMPLICATIONS

Cerebral Edema
Vasospasm
Pneumonia
Increased ICP
Problems from immobility
Thrombophlebitis
Pulmonary Embolism
Osteoporosis
Urinary Stasis

Surgical Intervention:

POSSIBLE SURGICAL
INTERVENTIONS
Carotid endarectomy
Craniotomy for evaluation of a
clot or for superior temporal
artery middle cerebral artery
anastomosis

DEFINITION
:

A stroke can result in behavioral

changes. These changes can vary
and are based on the strokes
severity and the part of the brain
in which the stroke takes place.

CLASSIFICATION

The largest portion of the brain

the cerebral cortexhas two
hemispheres. 1. The right
hemisphere of the brain controls
nonverbal communication,
emotions and spatial orientation
or sense of body position.
2. The left hemisphere of the
brain controls the right side of the
body, is the brains language
center and also is largely
responsible for analytical thinking.

RIGHT BRAIN STROKE

Affects the Left Side of the Body.

Trouble knowing how far or near an object is to the
body.
Neglect of left side of the body, or not able to see
things to the left of the body.
Poor decision making.
Lack of insight into the changes in ability since the
stroke.
Leading to safety concerns.
Impulsiveness.
Short attention span.
Slowed learning of new things.
Facial weakness.
Unclear speech.
Problems swallowing.

RIGHT BRAIN STROKE

The right half (hemisphere) of the brain controls

the movement of the left side of the body.
A person with a right brain stroke may not be able
to move the left side of the body (hemiplegia).
May be very weak in the left arm or leg
(hemiparesis).
The right half of the brain controls judging
distance, size, speed, and position. This may
cause a person with a right brain stroke to
misjudge distances leading to falls.
The person may not be able to control the hand to
pick up an object.
Survivors of right-brain strokes often have
problems making good decisions.

RIGHT BRAIN STROKE

These patients often become impulsive.

Persons with right brain stroke are often unaware of the changes
that have happened to them.
They believe they can do the same tasks as they did before the
stroke.
People with right brain strokes may also have left-sided neglect.
Due to visual field changes, left-sided neglect causes the person to
forget or ignore objects or people on the left side.
Some people with right brain strokes will have issues with shortterm memory. Although the person may be able to tell you about
an event that happened 20 years ago, they may not be able to tell
you whom they spoke with that morning or what they had for
breakfast.
Trouble speaking or understanding words said or written (aphasia ).
Slow, careful movements. Not able to see things on the right
side of the body. Facial weakness, unclear speech, or problems
with swallowing.

RIGHT BRAIN STROKE

Damage to this side of the brain can cause a range of

problems in a persons emotions and behavior.
A stroke survivor with right-brain injury may be unaware of
his or her impairment and be certain that he or she can
perform the same tasks as before the stroke.
This individual also may experience emotional lability.
Poor judgment.
Short attention span.
Short-term memory loss.
Spatial-perceptual difficulties involved in right-brain injuries
are overlooked.
Uncooperative.
Confused.
Overly dependent.
Motivated.

RIGHT BRAIN STROKE

For stroke survivors with

right-brain injury, it is
important to:
Keep a safe environment. All items that have the potential
to be dangerous (e.g., poisons, cleaning chemicals and
sharp objects) should be kept in a safe place.
Remember to scan (turn your head from side to side) in
order to see what would usually be ignored on the affected
side.
Acknowledge the affected part of your body as still a part of
you. Remember the affected side of your body by touching
it or rubbing it.
Dont try to handle all activities alone. Ask for help if you
are in a situation where you may become injured or
confused.

RIGHT BRAIN STROKE

Encourage caregivers to be sensitive to your visual and
sensory difficulties. For instance, make sure that caregivers
place items that you may need on your right side if you
cannot perceive things on your left side.
Minimize environmental clutter and distractions. Too much
visual or auditory stimulation in your environment may be
dangerous and may add to your confusion. Calm and quiet
surroundings can help you focus on a given task.
Help prevent injuries that may result from your inability to
determine depth and distance. Make sure that pointed
edges on things such as furniture and doorways are clearly
marked.
Stroke survivors with right-brain injuries frequently have
speech and communication problems. Many of these
individuals have a hard time pronouncing speech sounds
properly because of the weakness or lack of control in the
muscles of the mouth and face. In addition, survivors may
have difficulty interacting normally because of problems
with their thinking skills.

LEFT BRAIN STROKE

The left half (hemisphere) of the brain controls the right side
of the body.
A person with a left brain stroke may not be able to move
the right side of the body (hemiplegia).
May be very weak in the right arm or leg (hemiparesis).
The left half of the brain controls speech and language for
most people.
Someone who has had a left brain stroke may also have
trouble speaking or understanding what is being said to
them (aphasia.)
Persons with left brain stroke often are slow and careful. It
may take many verbal cues and a lot of extra time to get
something done.
Persons with left brain stroke may now have trouble
remembering or learning new things.

LEFT BRAIN STROKE

Left-brain stroke survivors may experience

personality changes.
Communication problems.
Paralysis on the right side.
Survivors with left-brain damageunlike
those with right-brain damagetend to
behave in a cautious, compulsive, or
disorganized way and are easily frustrated.
People with left-brain injury may be slow to
take action or to respond to questions.

LEFT BRAIN STROKE

For stroke survivors with

left-brain injury, it is
important to:
Develop strategies permitting the survivor to function at a
comfortable pace. The organization of daily routines and
schedules needs to be done with care.
Recognize and address fatigue. Fatigue can be a roadblock
to recovery. Encourage the survivor to ask for help or to
delegate duties.
Be patient. Do not try to rush the survivor into a response
to your questions or comments. Resist the temptation to
answer for him or her.
Unless you are aware that the survivor has a hearing
problem, speak in a normal voice.

LEFT BRAIN STROKE

For stroke survivors with

left-brain injury, it is
important
to:feedback to the survivor in the form
Give immediate and frequent
of words or by non-verbal gestures.
State questions so that the survivor can give a yes or no
answer.
Keep comments simple.

1. Give 5 nursing
interventions on CVA.
2. Give 2 causes of CVA.
3. Give 5 complications of
CVA.
4. Give the 4 things to do
when stroke happens
and explain.
5. Give 5 sign and
symptoms of CVA.

6. What is the definition of

Cerebrovascular Accident?
7. What are the 4 predisposing
factors of CVA?
8. What is the proper diet for
CVA patients?

9. What is the preferred position

of the patient when not
contraindicated?

10. Give 2 medications to be

prescribed & administered and
give examples for each
medication given.