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Cerebrovascular Disorders
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Cerebrovascular Disorders
Functional abnormality of the CNS Occurs: normal blood supply to
brain is disrupted
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Stroke: Stats & Incidence Primary cerebrovascular disorder; third leading cause
of death in the U.S.
Leading cause of serious long-term disability in the U.S.
700,000 strokes (U.S.); 500,000: new strokes; 200,000: recurrent
3/4 occur in people over age 65; risk doubles each decade after age 65
25% survive initial stroke: die within 1st yr.
Can occur at any age; ¼ occur under age 65
Financial impact: 57 million (ADA, 2005)
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Major Stroke Categories
Ischemic (85%) Embolic or
thrombotic Hemorrhagic
(15%)
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Risk Factors Nonmodifiable risk factors
Age (over 55), male gender, African American race
Modifiable risk factors: see Chart 62-1 Hypertension: the primary risk factor-Controlling HTN is
key to preventing stroke Cardiovascular disease: asymptomatic carotid stenosis,
valvular heart disease; a-fib Elevated cholesterol or elevated hematocrit Obesity Diabetes Oral contraceptive use Smoking, drug and alcohol abuse
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Ischemic Stroke
Cerebrovascular accident (CVA) or “brain attack”
Sudden loss of function resulting from disruption of the blood supply to a part of the brain.
Subdivided in 5 different types based on cause
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Types of Ischemic Strokes Large artery thrombotic stroke
Atherosclerotic plaque Thrombus formation & occlusion =
ischemia & infarction Small penetrating artery thrombotic
stroke Cardiogenic embolic strokes Cryptogenic strokes Other
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Anatomy of Cerebral Circulation
Blood is supplied to the brain by two major pairs of arteries Internal carotid arteries (ant. Circulation) Vertebral arteries (post. Circulation)
Carotid arteries branch to supply most of the Frontal, parietal, and temporal lobes Basal ganglia Part of the diencephalon
Thalamus Hypothalamus
Cerebral Circulation
The brain comprises only 2% of the body's weight but receives 20% of the blood supply. Over 150,000 people have strokes each year, largely resulting from blockages in the arteries and veins. Unimpeded circulation of blood to and from the brain is critical to health.
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Anatomy of Cerebral Circulation…
Vertebral arteries join to form the basilar artery, which supply the Middle and lower temporal lobes Occipital lobes Cerebellum Brainstem Part of the diencephalon
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Regulation of Cerebral Blood Flow
Blood flow: maintained at 20% of CO for optimal brain functioning.
Total interruption of blood flow: neurological metabolism altered in 30
seconds; metabolism stops in 2 minutes; cellular death occurs in 5 minutes
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Regulation of Cerebral Blood Flow….
Brain is normally well protected from changes in mean systemic arterial blood pressure by a mechanism known as cerebral autoregulation.
Cerebral autoregulation involves: Changes in the diameter of cerebral
blood vessels in response to changes in pressure so that the blood flow to the brain stays constant
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Regulation of Cerebral Blood Flow….
Factors that affect blood flow to the brain Systemic blood pressure Cardiac output Blood viscosity
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Regulation of Cerebral Blood Flow
Collateral circulation may develop to compensate for a decrease in cerebral blood flow
An area of the brain can potentially receive blood supply from another blood vessel if its original blood supply is cut off.
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Cerebral arteries & Circle of Willis
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Regulation of Cerebral Blood Flow
Atherosclerosis: a major cause of stroke
Can lead to thrombus formation and contribute to emboli
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Pathophysiology: Ischemic Stroke
Disruption of the cerebral blood flow from an obstructed or occluded vessel
Ischemic cascade Decrease of cerebral blood flow to < 25 mL/100
g/minute Energy failure: neurons no longer able to
maintain aerobic respiration Acidosis: result of large amt. of lactic acid
causing a change in the pH level Ion imbalance: membrane pump begins to fail
& cells cease to function
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Pathophysiology: Ischemic Stroke….
Ischemic cascade (cont.) Early: penumbra region around area of
infarct Glutamate: depolariztion of the cell wall
leading to increase in intracellular calcium and release of glutamate
Cell membrane destruction, protein breakdown, vasoconstriction, free radical formation = enlarge area of infarct into penumbra, extending the stroke
Cell injury and death
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Transient Ischemic Attack
TIA, mini-stroke Temporary focal loss of neurologic
function caused by ischemia Lasts <24 hrs & often lasts <15 min. Most resolve: within 3 hours Due to microemboli that temporarily
block blood flow Warning signs of progressive
cerebrovascular disease
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Clinical Manifestations Carotid system
involvement Temporary loss
of vision in one eye
Transient hemiparesis
Numbness or loss of sensation
Sudden inability to speak
Vertebrobasilar system Tinnitus Vertigo Darkened or blurred
vision Ptosis Dysphagia Ataxia Unilateral or bilateral
numbness or weakness
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Assessment/Dx/Management
Ct Scan w/without contrast Cardiac monitoring & testing Drugs that prevent platelet
aggregation Anticoagulation therapy
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Ischemic Stroke
Inadequate blood flow to the brain from partial or complete occlusion of an artery
Further divided into thrombotic & embolic
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Ischemic Stroke Thrombotic
Injury to a blood vessel & formation of a blood clot
Thrombotic stroke: result of thrombosis or narrowing of a blood vessel: most common cause of stroke: 60%
Gender: _______________Warning: ____________________Time of onset: ________________________Course/Prognosis: _______________________________________________________________
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Ischemic Stroke….. Embolic Occlusion of cerebral artery from the
lodging of an embolus = infarction & edema of area
2nd most common cause of stroke (24%) Majority emboli: originate in endocardial
(inside) layer of the heart Rapid occurrence of clinical symptoms
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Ischemic Stroke:
Embolic (cont.) Gender: _____________ Warning: ____________ Time of onset: _______________ Course/Prognosis: ______________________
__________________________________________________________________________
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Clinical Manifestations General s/s
Numbness or weakness: face, arm or leg e specially on one side of the body-Major presentation-Ischemic stroke
Confusion or change in MS Trouble speaking or understanding speech Visual disturbances Loss of balance, dizziness Difficulty walking Sudden severe headache
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Clinical Manifestations: Motor Loss Hemiplegia: most common motor
dysfunciton, Hemiparesis Early stage: Flaccid paralysis &
loss or decrease in DTR (INITIAL clinical feature)
Abnormal increased muscle tone (spasticity): After 48 hours
COMPARISON OF LEFT AND RIGHT HEMISPHERIC STROKES
Left Hemispheric Stroke Paralysis or weakness on
right side of body of body Right visual field deficit Aphasia (expressive,
receptive, or global) Altered intellectual ability Slow, cautious behavior
Right Hemispheric Stroke
Paralysis or weakness on left side of body
Left visual field deficit Spatial-perceptual deficits Increased distractibility Altered intellectual ability Impulsive behavior and poor
judgment Lack of awareness of deficits
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Communication Loss Language & communication disturbance Stroke: most common cause of aphasia Dysarthria Dysphagia or aphasia
Expressive aphasia (L frontal damage) Receptive aphasia (temporal lobe damage) Global aphasia (mixed)
Apraxia
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Perceptual Disturbance Ability to understand sensation Disturbances can result in: Visual-perceptual: disturbance of primary
sensory pathways b/w eye & visual cortex Homonymous Hemianopsia (loss of half of
the visual field) Visual-spatial relations
Perceiving the relationship of two or more objects in spatial areas
Frequently seen in patients with R hemispheric damage
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Sensory Loss May take form of impairment of touch More severe: loss of prioprioception
(inability to perceive the position and motion of body parts)
Difficulty interpreting visual, tactile and auditory stimuli.
Agnosias (deficits in the ability to recognize previously familiar objects perceived by one or more of the senses.
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Cognitive Impairment & Psychological Effects
Frontal lobe damage: Learning capacity, memory or other higher cortical
intellectual functions are impaired Dysfunctions reflected in a limited attention span,
difficulty w/comprehension, forgetfulness, lack of motivation
Depression: Common Other: emotional lability; frustration, resentment,
lack of cooperation, as well as other psychological issues
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Assessment/Dx Complete H&P, neurologic exam Initial assessment: focuses on: airway patency;
Cardiovascular status: BP, cardiac rhythm, rate, carotid bruit; gross neurologic deficits
Initial dx test: Ct Scan: noncontrast 12-lead EKG Carotid u/s, dopplers Cerebral angiography Transcranial doppler, MRI of brain, neck or
both Xenon-CT scan, Singple photon emission
(SPECT) scan, PET scan
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Assessment/Dx..
Additional studies Complete blood count Platelets, prothrombin time, activated
partial thromboplastin time Electrolytes, blood glucose Renal and hepatic studies Lipid profile
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Prevention
Primary prevention: best approach Stroke screenings Help patients alter risk factors for
stroke Prepare & support pt through carotid
endarectomy Administer anticoagulant agents: low-
dose ASA Rx); Coumadin (if a-fib)
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Medical Managment Afib: Coumadin: unless contraindicated.
INR: target 2.5 ASA: best option if coumadin
contraindicated Platelet-inhibiting medications
Plavix, Persantine, Ticlid (rarely used) Statins: simvastatin (Zocor) Antihypertensive meds: after acute stroke
period: Ace inhibitors & thiazide diuretics
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Thrombolytic Therapy
Dissolve blood clot Recombinat t-PA
Binds to fibrin and converts plaminogen to plasmin, which stimulates fibrinolysis of the atherosclerotic lesion
Rapid dx of stroke and initiation of thrombolytic therapy (within 3 hours) with ischemic stroke
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Enhancing Prompt Dx
Upon immediate notification: Stroke team awaits pts arrival
Initial mgmt: CT Scan, determination of pt meeting criteria for t-PA
Once pt meets t-PA criteria: No anticoagulant given for next 24 hrs
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Dosage & Administration Weight-based Dosage: 0.9 mg/kg, max. dose of 90 mg 10% calculated dose: adm. IV bolus over 1 minute;
remaining given IV over 1 hour via infusion pump Vital signs- obtained frequently, with particular
attention to blood pressure Goal of lowering the risk of intracranial
hemorrhage). Blood pressure should be maintained with the systolic pressure less
than 180 mm Hg and the diastolic pressure less than 105 mm Hg Airway management is instituted based on the patient’s clinical
condition and arterial blood gas values.
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Side Effects
BLEEDING: most common Intracranial bleeding (major
complication)
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Other Requires ICU or acute stroke unit setting Airway assessment Continous cardiac assessment/monitoring Frequent neuro assessment Frequent vs. esp. BP: goal of lowering IC
hemorrhage) BP: maintain SBP <180 and DBP < 105 ABG
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Therapy for Pts w/Ischemic Not Receiving t-PA
Anticoagulation Rx: IV Heparin, low-molecular weight heparin
Maintenance of cerebral hemodynamics Administration of osmotic diuretics: mannitol Maintaining PaCO2 with range of 30-35 mm Hg Positioning to avoid hypoxia HOB elevated to promote venous drainage to
lower increased ICP Intubation to establish patent airway, if necessary Maintain CO 4-8 L/min
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Managing Potential Complications
Cerebral hypoxia: give supplemental O2 Decreased cerebral blood flow &
extension of the area of injury: hydraton and avoid HTN or hypotension, maintain airway, give O2
Monitor for UTI, cardiac abnormalities, immobility
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Surgical Prevention Carotid Endarectomy
Removal of an atherosclerotic plaqued or thrombus from carotid artery to prevent stroke in patients with occlusive disease of the extracranial cerebral arteries.
Indicated for symptoms of TIA or mild stroke found to be caused by severe: 70-90% carotid artery stenosis Moderate stenosis (50-69%) with other
significant risk factor
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Carotid Endarterectomy
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Carotid Stenting
Less invasive Used for severe
stenosis Selected pts who
are high risk for surgery
Medical Management—Acute Phase of Stroke
Prompt diagnosis and treatmentAssessment of stroke: NIHSS assessment toolThrombolytic therapy
Criteria for tPA IV dosage and administration Patient monitoring Side effects—potential bleeding
Elevate HOB unless contraindicated Maintain airway and ventilationContinuous hemodynamic monitoring and neurologic assessment
Nursing Process: The Patient Recovering from an Ischemic Stroke—Assessment
Acute phase Ongoing/frequent monitoring of all systems including
vital signs and neurologic assessment—LOC, motor symptoms, speech, eye symptoms
Monitor for potential complications including musculoskeletal problems, swallowing difficulties, respiratory problems, and signs and symptoms of increased ICP and meningeal irritation
After the stroke is complete Focus on patient function; self-care ability, coping,
and teaching needs to facilitate rehabilitation
Assessment Acute phase Neuro assessment & document on flow
sheet Change in LOC or responsiveness Presence of absence of voluntary or involuntary
movements of extremities; muscle tone, body posture and position of head
Eye opening Stiffness of neck See notes below**
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Nursing Process: The Patient Recovering from an Ischemic Stroke—Diagnoses
Impaired physical mobility Acute pain Self-care deficits Disturbed sensory perception Impaired swallowing Urinary incontinence Disturbed thought processes Impaired verbal communication Risk for impaired skin integrity Interrupted family processes Sexual dysfunction
Nursing Process: The Patient Recovering from an Ischemic Stroke—Planning
Major goals may include: Improved mobility Avoidance of shoulder pain Achievement of self-care Relief of sensory and perceptual deprivation Prevention of aspiration Continence of bowel and bladder Improved thought processes Achieving a form of communication Maintaining skin integrity Restored family functioning Improved sexual function Absence of complications
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Nursing Management Primary complication: CE: Stroke, CN
injuries, infection or hematoma at incision & carotid artery disruption
Maintain BP in immediate postop phase
Avoid hypotension: To prevent cerebral ischemia and thrombosis
Sodium nitroprusside: to reduce BP Close cardiac monitoring
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Nursing Management… Post:
Neuro assessments & record; notify surgeon if deficit occurs
Monitor CN involvement: difficulty swallowing, hoarseness or other signs
Focus assessment of CN: CN: ________________ CN:_________________ CN: ________________ CN:_________________ Edema: expected postop; extensive edema and
hematoma: obstruct airway Emergency airway supplies: _______________
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Interventions Focus on the whole person
Provide interventions to prevent complications and to promote rehabilitation
Provide support and encouragement
Listen to the patient
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Improving Mobility and Preventing Joint Deformities
Turn and position the patient in correct alignment every 2 hours
Use splints Practice passive or active ROM 4 to 5 times day Position hands and fingers Prevent flexion contractures; Prevent shoulder
abduction Do not lift by flaccid shoulder
Implement measures: prevent and treat shoulder problems
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Positioning to Prevent Shoulder Abduction
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Prone Positioning to Help Prevent
Hip Flexion
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Improving Mobility and Preventing Joint Deformities
Perform passive or active ROM 4 to 5 times day
Encourage patient to exercise unaffected side Establish regular exercise routine Use quadriceps setting and gluteal exercises Assist patient out of bed as soon as possible:
assess and help patient achieve balance and move slowly
Implement ambulation training
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Interventions Enhance self-care
Set realistic goals with the patient Encourage personal hygiene Ensure that patient does not neglect the affected side Use assistive devices and modification of clothing
Provide support and encouragement
Implement strategies to enhance communication: see Chart 62-4
Encourage the patient with visual field loss to turn his head and look to side
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Interventions… Nutrition
Consult with speech therapist or nutritionist Have patient sit upright to eat, preferably OOB Use chin tuck or swallowing method Feed thickened liquids or pureed diet
Bowel and bladder control Assess and schedule voiding Implement measures to prevent constipation:
fiber, fluid, and toileting schedule Provide bowel and bladder retraining
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Interventions….
Improve thought processes Maintain skin integrity Improve family coping Help patient cope with sexual
dysfunction Promote home and community-
based care
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Charts: Review
62-3: Assistive devices to Enhance Self-care after Stroke
62-4: Communicating with the Patient with aphasia
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Hemorrhagic Stroke Primarily caused by: intracranial or subarachnoid
hemorrhage Bleeding into brain tissue, ventricles or
subarachnoid space Primary:
Spontaneous rupture of small vessels (80%) primarily related to uncontrolled hypertension;
Subarachnoid hemorrhage due to a ruptured aneurysm;
Secondary intracerebral hemorrhage related to amyloid angiopathy,
arterial venous malformations (AVMs), intracranial aneurysms, neoplasm or medications such as anticoagulants, amphetamines.
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Pathophysiology
Aneurysm or AVM ruptures, causing subarachnoid hemorrhage (hemorrhage into the cranial subarachnoid space)
Normal brain metabolism disrupted from entry of blood into subarachnoid space
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Intracerebral hemorrhage
Bleeding into brain substance Most common in pts: HTN & cerebral
atherosclerois Bleeding: most common in cerebral lobes,
basal ganglia, thalamus, brain stem (pons), & cerebellum
Bleeding ruptures wall of lateral ventricle leading to intraventricular hemorrhage: fatal
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Intracranial (Cerebral) Aneurysm
Dilation of the walls of a cerebral artery Develops as a result of a weakness in
arterial wall Cause: unknown Lesions occur: bifurcations of large arteries
at circle of Willis Cerebral arteries most commonly affected:
ICA (internal carotid), ACA ( anterior carotid), ACoA (anterior communicating artery), PCoA (post. Communicating artery), PCA (post. Cerebral artery), MCA (middle cerebral artery)
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Arteriovenous Malformations
AVM Due to an abnormality in embryonic
development that leads to a tangle of arteries and veins in brain that lacks a capillary bed
Absence of capillary bed leads to dilation of arteries and veins & eventual rupturee
Common cause of hemorrhagic stroke: young people
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Intracranial Aneurysms
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Subarachnoid Hemorrhage Hemorrhage into
subarachnoid space Occurs as a result of
AVM, intracranial aneurysm, trauma or HTN
Most common causes Leaking aneurysm in area
of circle of Willis Congential AVM of the
brain
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Clinical Manifestations
Conscious pt: Severe headache Neurologic deficits: motor, sensory,
cranial nerve, cognitive Other: vomiting Early: sudden change in LOC Possible focal seizures (brain stem
involvement)
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Clinical Manifestations… Unique s/s besides those similar to
ischemic Aneurysm rupture or AVM: sudden,
unsually severe headache, often LOC for a variable period of time
Pain, rigidity in back of neck (nuchal rigidity) & spine due to meningeal irritation
Visual disturbance: loss, diplopia, ptosis: aneurysm near oculomotor nerve
Tinnitus, dizziness, hemiparesis
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Assessment/Dx CT Scan: type of stroke, size, location of
hematoma, presence or absence of ventricular blood & hydrocephalus.
Cerebral angiography: confirms dx of IC aneurysm or AVM
Lumbar puncture: if evidence of ICP Drug Toxicology screen: dx hemorrhagic
stroke in pt under age 40 Hunt-Hess classification system: guides
physician in dx severity of subarachnoid hemorrhage after an aneurysmal bleed (see Chart 62-6)
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Prevention Primary prevention: best approach Manage HTN and other risk factors Stroke screenings Increase public awareness regarding
association between phenylpropanolamine (PPA), an ingredient in appetite suppresants as well as cold and cough meds
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Complications
Rebleeding Cerebral vasospasm resulting in
cerebral ischemia Seizures
Complications Acute hydrocephalus: free blood
obstructing reabsorption of CSF by arachnoid villi 1st 24 h post subarachnoid hemorrhage or
several days [subacute] to weeks [delayed] Hyponatremia-post subarachnoid
hemorrhage Must check serum Na & report if <135 mEq/L to provider if
persistent for 24h or longer Must then evaluate for SIADH or cerebral salt wasting
syndrome
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Cerebral Hypoxia & Decreased Blood Flow
Immediate hemorrhagic stroke complications: Cerebral hypoxia Decreased blood flow Extension of the area of injury
Provide adequate O2 to brain Maintain supplemental O2Maintain H&HMaintain hydration (IVF): reduce blood viscosity and
improve blood flowAvoid extremes of HTN or hypotensionObserve for seizure activity
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Vasospasm
Cerebral vasospasm (narrowing of the lumen of the involved cranial blood vessel)
Serious complication of subarachnoid hemorrhage and
Accounts for 40% to 50% of the morbidity and mortality of those who survive initial IC bleed
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Vasospasm.. Worsening headache, a decrease in level of
consciousness (confusion, lethargy, and disorientation), or a new focal neurologic deficit (aphasia, hemiparesis
Frequently occurs 4 to 14 days after initial hemorrhage, when the clot undergoes lysis (dissolution)
administration of calcium-channel blockers: nimodipine (Nimotop) during the critical period in which vasospasm may occur can prevent delayed ischemic deterioration
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Increased ICP Often follows a subarachnoid hemorrhage CSF drainage may be instituted by
cautious Lumbar puncture or ventricular catheter drainage
Mannitol: Used as long-term measure to control ICP: dehydration and disturbances in e-lyte balance (hyponatremia or hypernatremia, hypokalemia or hyperkalemia)
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Systemic HTN
Prevention is critical SBP lowered to less than 150 mmHg
to prevent hematoma enlargement Elevated BP: antihypertensive meds:
Labetalol: Normodyne Nicardipine (Cardene) Nitroprusside (Nitro-press
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Systemic HTN Arterial hemodynamic monitoring: to detect
and avoid a precipitous drop in blood pressure, which can produce brain ischemia.
Antiseizure agents are often administered prophylactically.
Stool softeners are used to prevent straining, which can also elevate the blood pressure.
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Medical Management Allow brain to recover from initial insult Supportive mainly Bedrest, sedation Stress management of vasospasm Surgial or medical tx to prevent rebleeding Anagesics: codeine, acetaminophen: head
and neck pain SCDs: prevent DVT
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Surgical Management
Diameter of bleed > 3 cm & GCS decreases
Surgical evacuation: most frequently done via a craniotomy
Goal: prevent bleeding in an unruptured aneurysm or further bleeding in an already ruptured aneurysm.
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Surgical Interventions…
Endovascular procedures Endovascular tx
(occlusion of parent artery)
Aneurysm coiling (obstruction of the aneurysm site with a coil)
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Postop Complications
Psychological symptoms: disorientation, amnesia, Korsakoff’s syndrome, personality changes
Intraoperative embolization, postop internal artery occlusion, f/e disturbances from dysfunction of neurohypophyseal system) & GI bleeding
Nursing Process: The Patient with a Hemorrhagic Stroke—Assessment
Complete and ongoing neurologic assessment—use neurologic flow chart
Monitor respiratory status and oxygenation Monitoring of ICP Patients with intracerebral or subarachnoid
hemorrhage should be monitored in the ICU Monitor for potential complications Monitor fluid balance and laboratory data All changes must be reported
immediately
Nursing Diagnoses
Ineffective tissue perfusion (cerebral) Disturbed sensory perception Anxiety
Collaborative Problems/Potential Complications
Vasospasm Seizures Hydrocephalus Rebleeding Hyponatremia
Planning
Goals may include: Improved cerebral tissue perfusion Relief of sensory and perceptual
deprivation Relief of anxiety The absence of complications
Aneurysm Precautions
Absolute bed rest Elevate HOB 30° to promote venous drainage or flat
to increase cerebral perfusion Avoid all activity that may increase ICP or BP;
Valsalva maneuver, acute flexion or rotation of neck or head
Exhale through mouth when voiding or defecating to decrease strain
Nurse provides all personal care and hygiene Nonstimulating, nonstressful environment; dim
lighting, no reading, no TV, no radio Prevent constipation Visitors are restricted
Home Care and Teaching for the Patient Recovering from a Stroke
Prevention of subsequent strokes, health promotion, and follow-up care
Prevention of and signs and symptoms of complications Medication teaching Safety measures Adaptive strategies and use of assistive devices for
ADLs Nutrition—diet, swallowing techniques, tube feeding
administration Elimination—bowel and bladder programs, catheter use Exercise and activities, recreation and diversion Socialization, support groups, and community resources
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Interventions Optimize cerebral tissue perfusion Relieve sensory deprivation and anxiety Keep sensory stimulation to a minimum for
aneurysm precautions Implement reality orientation Provide patient and family teaching Provide support and reassurance Implement seizure precautions Implement strategies to regain and promote self-
care and rehabilitation
Question
What are expected patient outcomes for a patient recovering from a hemorrhagic stroke?
A. Exhibits absence of vasospasmB. Residual aphasia C. One to four seizuresD. Complains of visual changes
Practice A nurse is caring for a patient diagnosed with a
transient ischemic attack [TIA] is scheduled for a carotid endarterectomy. What rationale for the procedure should the nurse give the patient?
a. “It will decrease cerebral edema b. “It will help prevent seizure activity that is
common following a TIA .” c. “It helps prevents a stroke by removing fatty
plaques blocking cerebral flow.” d. “It will help determine the cause of the mini
stroke.”
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Practice
What is the earliest sign of decompensation in a patient with a hemorrhagic stroke?
a. Headache b. Change in level of
consciousness c. Grand mal seizures d. Dyspnea
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Practice A nurse is caring for a patient diagnosed
with a hemorrhagic stroke. What is the priority goal for the patient?
a. Maintain urine output greater than 30 mL/hour.
b. Maintain and improve cerebral tissue perfusion.
c. Relieve anxiety. d. Relieve sensory deprivation.
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Practice A nurse is caring for a patient with a cerebral
aneurysm who suddenly reports a “very severe” headache. What priority nursing action should the nurse take immediately?
a. Sit with the patient for a few minutes. b. Administer an analgesic. c. Inform the nurse-manager. d. Call the physician immediately.
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Practice Which patient has the highest risk for a
stroke? a. White female, age 60, with history of
chronic alcohol intake b. White male, age 60, with history of
uncontrolled high blood pressure c. Black male, age 60, with history of type 2
diabetes d. Black male, age 50, with history of 20
year smoking history102
Practice A _________________ is a neurological deficit lasting
less than 24 hours, with the most episodes resolving in less than 1 hour.
Administration of ______________________ such as Coumadin inhibits clot formation and may prevent both thrombotic and embolic strokes.
Research has shown that the time period of ____________hours is necessary for eligibility of thrombolytic therapy.
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Practice
When positioning a stroke patient, it is recommended that the __________ position be implemented for 15 to 30 minutes several times a day to promote hyperextension of the hip joints and prevent contracture deformities of the shoulders and knees.
_______________________is the most common and serious psychological problem in a patient who has had a stroke.
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