Cerebrovascular Accident (Stroke) aka Stroke or Brain Attack Definition: o Stroke is a sudden impairment of cerebral circulation in one or more

of the blood vessels supplying the brain. It interrupts or diminishes oxygen supply and commonly causes serious damage or necrosis in brain tissues. Half of those who survive a stroke remain permanently disabled and experience recurrence w/in weeks, months, or years. No. 1 cause of disability. -Divided into left and right hemisphere. The left hemisphere controls the majority of functions on the right side of the body while the right hemisphere controls the left side of the body. -The cerebrum is composed of: Frontal lobe: Judgement (logical thought), foresight, and Voluntary movement, smell Left/Right Parietal lobe: sensation, comprehension of language Left/Right Temporal lobe: Visual memory, verbal memory, hearing, intellectual and emotional functions Occipital lobe: Visual reception o Cerebellum- 2nd largest. -reflexes -balance -movement and coordination o Brain Stem- Swallowing, breathing, heartbeat, involuntary actions, digestion - Alertness, arousal (state of being awake)

Common cause of stroke: Thrombosis (1st) Embolism (2nd) Hemorrhage (3rd) Anatomy & Physiology: Anatomy of the Brain: Lobes of the Brain o o 3 Main components of the brain: Cerebrum, Cerebellum and Brainstem. Cerebrum- largest and most developmentally advanced portion of the brain. -higher intellectual function -speech -emotion -sensory stimuli -initiation of the final common pathways for movement -fine control of movement

Blood Vessels of the Brain Major Blood Vessels o Blood is supplied to the brain, face, and scalp via two major sets of vessels: the right and left common carotid arteries and the right and left vertebral arteries.
face and scalp with blood.

The external carotid arteries supply the

 Internal carotid arteries supply blood to the anterior three-fifths of cerebrum, except for parts of the temporal and occipital lobes. Vertebrobasilar arteries supply the posterior two-fifths of the cerebrum, part of the cerebellum, and the brain stem. Minor blood vessels o Anterior Cerebral Artery- Supplies frontal lobe. Stroke in the anterior cerebral artery results in opposite leg weakness. Middle Cerebral Artery- supplies a portion of the frontal lobe and the lateral surface of the temporal and parietal lobes. Most often occluded in stroke. Posterior Cerebral Artery- supplies the temporal and occipital lobes of the left cerebral hemisphere and the right hemisphere.

Etiology: Predisposing factors: Age (increasing) Gender (Male) Hereditary Prior Stroke Attack

Precipitating Factors: Hypertension Diabetes Mellitus Smoking Alcoholism Sedentary Lifestyle High serum cholesterol level

Symptomatology: Severe headache Nausea & Vomiting Visual Disturbances Confusion or change in mental status Dysarthria (Diff. in speaking); Dysphasia (impaired speech); Aphasia (loss of speech) Apraxia (inability to perform a previously learned action) Hemiplegia (paralysis of one side of the body) Hemiparesis (weakness of one side of the body) Loss of balance Loss of body coordination

Pathophysiology: Predisposing Factors Precipitating Factors

Cerebral Hemorrhage

Occlusion of major vessel by embolism

Thrombosis

Cerebral infarction Dec. blood flow to the brain

Hypoxia Cerebral edema Vascular congestion Compression of tissue Impaired function: Anterior cerebral artery, Middle cerebral artery, Posterior cerebral artery

Continued inadequate blood flow Further compression of tisues Cerebral Death

Medical Mgt.: o Lab tests: CT Scan MRI Angiography

8. Advise to seek for aid of a physical therapist and an occupational therapist. 9. Teach patients about the importance of ff. a low cholesterol, low-salt diet. 10. Encourage use of assistive devices. Nursing Dx:

o Medications: Anticonvulsants (treat or prevent seizures) Antiplatelet drugs like heparin or warfarin (decrease platelet aggregation and inhibit thrombus formation) Corticosteroids (minimize cerebral edema) Analgesics (relieve headache) Thrombolytic therapy (dissolve thrombus)

1. Ineffective Airway Clearance r/t dec. LOC 2. Impaired physical mobility r/t CVA effects, paralysis, neuromuscular impairments 3. Disturbed sensory perception: Kinesthetic, visual, gustatory, tactile, olfactory r/t stroke 4. Imbalanced nutrition: less than body requirements r/t to stroke, inability to ingest food 5. Self-care deficits r/t stroke, paralysis, dec. muscle strength

o Surgery: Endarterectomy (removal of atherosclerotic plaques from the internal arterial wall) Microvascular bypass (surgical anastomosis of an extracranial vessel to an intracranial vessel). Nursing Mgt.: 1. Maintain patent airway & oxygenation. If unconscious prevent aspiration. 2. Check VS & neurologic status 3. Maintain fluid and electrolyte balance. IV not too fast bec. It can inc. ICP 4. Ensure adequate nutrition. 5. Perform/Assist patient in ROM exercises to all extremities. 6. Give meds as ordered 7. Provide psychological support