Stroke
- also called brain attack
- neurologic deficits resulting from sudden decreases in blood flow to localized area of brain
- more common in males than females
- preventable, most commonly caused by CAD
- can be sudden onset or gradual
Risk factors
- African American and Hispanics
- HTN poses greatest risk
- heart disease, afib
- DM causes vascular damage
- sleep apnea increases BP
- hyperlipidemia contribute to CAD
- smoking
- sickle cell disease increases occlusion risk
- substance abuse, such as cocaine, ampetamines, pot, heroin
- living in stroke belt which is south eastern states have highest stoke mortality rate
- FH
- Male
- obesity, sedentary lifestyle
Ischemic Stroke
- result from blockage or stenosis of cerebral artery that decreases or stops blood flow
- classified as transient, thrombotic, or embolic
Transient Ischemic Attack (TIA)
- mini stroke
- warning signals of thrombotic stroke
- sudden onset with manifestations disappear within mins or hours
- manifestations include contralateral weakness or numbness, aphasia, visual disturance
Thrombotic stroke
- caused my large occlusion
- occur mostly during resting or sleeping
- usually affects only 1 region of brain
- occurs rapidly, progresses slowly and worsens over next 1-2 days (stroke in evolution)
- when maximum neurological deficit has been reached (about 3 days), its called completed stroke and the brain tissue that is damaged is usually edematous and necrotic
Embolic stroke
- traveling blood clot occludes vessel and brain affected becomes ischemic
- seen in younger people while awake and active
- usually caused by emboli leaving heart during afib
- sudden onset with immediate deficits
- where emboli was, the vessel walls are weaken increasing risk of hemorrhagic strokes
Hemorrhagic stroke
- intracranial hemorrhage occuring when blod vessel ruptures
- occurs often with HTN
- occurs suddenly when person is active
- most fatal
- can be intracerebral hemorrhage or subarachinoid hemorrhage
- rapid onset
- vomiting, headache, seizures, hemiplegia, altered LOC
What happens if left side of brain is affected?
The left hand side of the brain is responsible for language, Not only talking but also understanding, reading and writing so speech will be affected in this case.
- Paralyzed right side
- Impaired speech/language aphasias
- Impaired right/left discrimination
- Slow performance, cautious
- Aware of deficits;depression, anxiety
- Impaired comprehension related to languange/math
What happens if right side of brain is affected?
The right hand side of the brain is responsible for our perceptual skills such as making sense of what we see, hear and touch. The right hand side of the brain is also responsible for our spatial skills such as judging size, speed, distance or position in space.
- Left-side neglect
- Tends to deny or minimize problems
- Rapid performance, short attention span
- Impulsive, safety problems
- Impaired judgment
- Impaired time concepts
- Paralyzed left side
What are the 2 main causes of a brain attack?
- A blockage. This is called an ischemic brain attack, This happens when a clot blocks an artery that carries blood to the brain
- A bleed. This is when a blood vessel bursts causing internal bleeding into the brain
- Other factors which can contribute to these causes include: Smoking, alcohol, diet and exercise.
S/S of brain attack
- Paralysis/hemiparesis
- Neglect
- Weakness
- Dizziness
- Visual deficits or loss
- Slurred/indistinct speech
- Inability to understand speech
- Unilateral sensory defect (numbness/tingling)
- Mental status change/loss of consciousness
- Very severe headache
- swallowing and sleep alteration
Sensory Perceptual deficits: Propriorception Hemianaopia Agnosia Apraxia Neglect Syndrome
P: bodies sense of position
H: loss of half of visual field in one of both eyes
Ag: inability to recognize one o rmore subjects that were previously familiar
Ap: inability to carry out motor pattern
NS: client ignores/forgets affected side
Cognitive and Behavioral changes
- mild confusion to coma
- emotional liability (laughing or crying inappropriately)
- loss of self control (cussing)
- decreased tolerance for stress
- memory loss, decreased attention span, poor judgement, inability to think abstractly
Communication disorders: Aphasia Expressive Aphasia Receptive Aphasia Mixed of Global Aphasia Dysarthria
-caused by damage in left hemisphere
A: inability to use or understand language
EA: can understand what is being said, but cant respond verbally (Brocas Aphasia)
RA: cannot understand spoken words with inappropriate speech (Wernickes Aphasia)
MGA: language dysfunction in both understanding and expression
D: disturbance in muscular control of speech
Hemiplegia
Hemiparesis
Flaccidity
Spasticity
H: paralysis of one side of body
H: weakness of one side of body
F: absence of muscle tone
S: increased muscle tone with weakness
Stroke diagnostics
- CT
- MRI
- Angiography
- DSA (an angio into the brain but bone is subtracted from image)
- Carotid duplex scan
- Transcranial Doppler studies
Cincinnati Pre-hospital Stroke Scale
- Face Droop
- Pronator drift
- Slurred/inappropriate speech
Pharamcolic thereapies for prevention
- antiplatelet used to treat TIAs or those that had previous stroke
- plavix
- baby asa
Pharmacologic therapies for acute stroke
- anticoagulants for ischemic stroke such as warfarin, heparin and lovenox (don’t dissolve clot, just prevent further formation)
- fibrinolytics to dissolve clot, has to be given within 3 hours (TPA)
- drugs used to treat HTN
- corticosteroids to treat cerebral edema (dexamethsone)
- diuretics for IICP
- anticonvulsants or barbiturates for IICP causing seizures
Sugeries for Stroke
- Carotid endarterectomy
- extracranial intracranial bypass
- carotid angioplasty to treat cerebral stenosis
Cushings triad for IICP
-Increased BP, decreased pulse and decreased respiration’s
Nursing Diagnosis for Brain attack
- ineffective tissue perfusion: cerebral
- impaired physical mobility
- self-care deficit
- impaired verbal communication
- impaired urinary elimination and risk for constipation
- impaired swallowing
