A Nursing Approach in the Management of

CEREBROVASCULAR DISORDERS

BY: DAVE JAY S. MANRIQUEZ BSN,RN.

CEREBROVASCULAR DISORDERS
An umbrella term that refers to any functional abnormality of the central nervous system that occurs when the normal blood supply to the brain is disrupted.

STROKE
a sudden neurological event which results in the new onset of neurological symptoms.

TYPES of STROKE

ISCHE MIC STROK E

MOTOR LOSS
-disturbance of voluntary motor control on the side of the body opposite the location of the stroke lesion

Hemiplegia Hemiparesis

COMMUNICATION LOSS
Dysarthria Apraxia Agnosia Dysphasia or Aphasia

PERCEPTUAL DISTURBANCES
Homonymous Hemianopsia Disturbance in Visual-Spatial Relations - Unilateral Neglect Loss of Peripheral Vision Night Blindness Diplopia Horners Syndrome

SENSORY LOSS
Slight Impairment of Touch Loss of Proprioception Difficulty in interpreting visual, tactile, and auditory stimuli

COGNITIVE IMPAIRMENT & PSYCHOLOGICAL EFFECTS

Memory Loss Poor Comprehension Limited Attention Span Forgetfulness Lack of Motivation Depression Emotional Lability Hostility Frustration Resentment Lack of Cooperation

ASSESSMENT & DIAGNOSTICS

Patient History Complete Physical and Neurologic Examination Initial Assessment: Airway Patency, Cardiovascular Status, Gross Neurologic Losses Stroke Time Course Classification

STROKE TIME COURSE CLASSIFICATION

Stage 1: Transient Ischemic Attack Stage 2: Reversible Ischemic Neurologic Deficits Stage 3: Stroke in Evolution

Stage 4: Completed Stroke

DIAGNOSTIC TESTS
CT Scan 12-Lead ECG Carotid ultrasound Cerebral Angiography Transcranial Doppler Flow Studies Transthoracic or Transesophageal Echocardiography MRI of the brain and/or neck Xenon CT Single Photon Emission CT

MEDICAL MANAGEMENT
1. Treatment of TIA from atrial fibrillation or suspected embolic or thrombotic causes 2. Thrombolytic Therapy for Ischemic Stroke 3. Therapy for Patients with Ischemic Stroke NOT Receiving Thrombolytic Therapy 4. Managing Potential Complications

SURGICAL MANAGEMENT
CAROTID ENDARTERECTOMY - Main surgical procedure for the management of TIAs and small stroke - Indicated for patients with symptoms of TIA or mild stroke found to be due to carotid stenosis - Complications: stroke, cranial nerve injuries, infection, hematoma at the incision site, carotid artery disruption

NURSING MANAGEMENT
Improving Mobility and Preventing Joint Deformities Managing Sensory-Perceptual Difficulties Attaining Bowel and Bladder Control Improving Thought Processes Improving Communication Maintaining Skin Integrity Improving Family Coping Helping the Patient Cope with Sexual Dysfunction

HEMMORH AGIC STROKE

CEREBRAL ANEURYSM SUBARACHNOID