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Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 38: Caring for Clients with Cerebrovascular Disorders
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HeadacheHeadache• Cephalgia
– Typically: Transient, benign
– Accompany many disorders
• Meningitis; Increased ICP; Brain tumors; Sinusitis
• Most Common
– Tension; Migraine; Cluster
• Without Sensory Nerves
– Skull; Brain
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Tension Headache Tension Headache • Pathophysiology, Etiology: Scalp, Facial Muscles
– Vast network of sensory, motor nerves
– Stressful conditions: Can result in prolonged neck, facial muscle contraction
• Assessment Findings: Mild to severe pain
• Diagnostic Findings: CT scan; Brain scan; Radiographs; Angiography
• Medical Management
– Rest; Analgesics
– Stress management; Counseling
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Migraine Headaches Migraine Headaches • Pathophysiology, Etiology: Dilation of cerebral blood
vessels
• Assessment Findings: Signs and Symptoms
– Aura; Mood change
– Fatigue; Nausea; Vomiting
– Vertigo; Sensitivity to light
• Diagnostic Findings
– CT scan; Angiography
– Brain scan; Radiographs
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Migraine HeadachesMigraine Headaches
Figure 38-1 Chemical developments in migraine headaches. Cerebral blood vessels dilate in response to serotonin from platelets. Peptides
released from the trigeminal nerve intensify pain.
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Migraine Headaches Migraine Headaches
• Medical Management
– Rest; Drug therapy; Biofeedback techniques
• Nursing Management
– Client instruction
• Self-administration of medications
• Measures to abort the migraine
• Lying in a dark room
• Minimizing noise and other stimuli
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Cluster Headache Cluster Headache • Pathophysiology, Etiology: Unknown
– Suggested lower-than-normal levels of serotonin
– Possible “triggers”
• Assessment Findings: Severe, unilateral head pain (usually behind one eye); Rhinorrhea
• Diagnostic Findings: HA pattern; Persistent HA: CT scan; Brain scan; Head, neck radiographs; Angiography
• Medical Management: Corticosteroids; Ergotamine derivatives; Vasoconstricting drugs; Anticonvulsants; Oxygen; Surgical intervention (if all else fails)
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Nursing ProcessNursing Process
• Assessment
– Pain: Location; Characteristics; History; Duration
– Triggers
– Other symptoms
– Clients with chronic headaches
• Complete medical, allergy, and family history
• Frequency and description of pain
• Vital signs
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Nursing ProcessNursing Process
• Diagnosis, Planning, and Interventions
– Pain related to
• Muscle tension
• Changes in cerebral blood flow
• Unknown etiology
• Evaluation of Expected Outcome
– Head pain is reduced or eliminated
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Transient Ischemic Attacks Transient Ischemic Attacks
• Pathophysiology, Etiology: Temporary interruption in cerebral blood flow
– Common causes
• Assessment Findings: Signs and Symptoms
– Speech, visual disturbances; Confusion; Partial paralysis
• Diagnostic Findings: Neurologic examination; Ultrasound; Carotid arteriogram; CT scan; MRI
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Transient Ischemic Attacks Transient Ischemic Attacks • Medical, Surgical Management
– Antiplatelet therapy
– Anticoagulant therapy
– Diet therapy
– Surgery
• Carotid endarterectomy
• Balloon angioplasty
Figure 38-2 In endarterectomy, plaque—a potential source of emboli in TIAs and CVAs—is surgically removed from the carotid artery.
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Transient Ischemic Attacks Transient Ischemic Attacks
• Nursing Management
– Complete client history
– Vital signs and weight
– Capillary blood sugar check
– Neurologic examination
– Client monitoring after carotid artery surgery
– Client education
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Cerebrovascular Accident (Stroke) Cerebrovascular Accident (Stroke) • Pathophysiology, Etiology
– Ischemic strokes: Thrombotic; Embolic
– Hemorrhagic strokes
• Assessment Findings: Signs and Symptoms
• Numbness; Weakness
• Mental confusion; Impaired ambulation
• Severe headache
• Hemiplegia; Aphasia; Hemianopia
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Cerebrovascular Accident (Stroke)Cerebrovascular Accident (Stroke)• Diagnostic Findings
– CT Scan; MRI; Transcranial Doppler ultrasonography
– Single photon emission CT; Lumbar puncture; Cerebral angiography
• Medical, Surgical Management
– Prevention measures
– Emergency treatment according to cause
– Supportive treatment
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Cerebrovascular Accident (Stroke)Cerebrovascular Accident (Stroke)• Nursing Management
– Client education: Medication: Administration, side effects; Eating, swallowing techniques
– Heimlich maneuver
– Follow-up care: Speech pathologist; Dietitian
– Community resources for special care devices
– Regular exercises; Maintain extremities in proper anatomic position
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Cerebral Aneurysms Cerebral Aneurysms • Pathophysiology, Etiology: Congenital; Secondary to
hypertension and atherosclerosis
Figure 38-7 Intracranial aneurysm within circle of Willis
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Cerebral Aneurysms Cerebral Aneurysms • Assessment Findings: Signs and Symptoms
– Sudden, severe headache; Dizziness; N/V; Loss of consciousness
• Diagnostic Findings
– Cerebral angiography
– CT Scan; MRI
– Lumbar puncture
– Hunt-Hess classification system
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Cerebral Aneurysms Cerebral Aneurysms
• Medical Management
– Complete bed rest; Prevention of rebleeding
– Treatment of complications
– Anticonvulsants; Tranquilizers
– Mechanical ventilation
• Surgical Management
– Craniotomy
– Ligation of carotid artery
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Nursing ProcessNursing Process• Assessment
– Neurologic examination
– Vital signs; History
• Diagnosis, Planning, and Interventions
– Increased intracranial pressure
– Seizures
– Pain
• Evaluation of Expected Outcomes
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End of Presentation
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