Adult Medical-Surgical Nursing Neurology Module: Cerebrovascular Disease I (TIA)

Cerebrovascular Disease: Description Dysfunction of the Central Nervous System related to impaired cerebral circulation: the normal blood supply to brain tissue is disrupted This impairment leads to: Transient Ischaemic Attack (TIA) Stroke

Cerebrovascular Disease: Aetiology Impairment of the cerebral circulation occurs through: A thrombus or embolus partially or totally occluding a vessel Haemorrhage from a ruptured vessel Atherosclerosis narrowing the arterial lumen, reducing blood flow. This progressively leads to ischaemia (transient with no lasting damage) then to infarction Most ischaemic strokes are carotid-related

Cerebrovascular Disease: Risk Factors for TIA and Stroke Hypertension* DM (accelerated atherosclerosis) Cardiovascular disease (atherosclerosis) Cardiac dysrhythmia (atrial fibrillation) Family history High cholesterol Smoking; Alcoholism Obesity Oral contraceptives

Transient Ischaemic Attack (TIA) A temporary episode of neurological dysfunction: Sudden loss of motor, sensory or visual function Lasts from a few seconds up to 24 hours May precede stroke Warning of impending stroke (sooner or later)

TIA: Clinical Manifestattions Sudden, temporary: Dysphagia Dysphasia, speech difficulty ParesisNumbnessAtaxia Reduced visual field Loss of vision one eye

TIA: Diagnosis Patient history and clinical picture Physical/ neurological assessment reveals: Weak carotid pulse Carotid bruit on auscultation indicates interference with normal blood flow Carotid Doppler or angiography (to assess circulation to the brain)

TIA: Medical Management Anticoagulant therapy (IV Heparin pump or Klexane) Platelet aggregation inhibitors (Asprin, Plavix) longterm Surgery (next slide) Longterm management of hypertension, hyperglycaemia, hyperlipidaemia Encourage appropriate lifestyle changes

TIA: Surgery Carotid Endarterectomy: removal of plaque or thrombus from carotid artery Carotid Angioplasty: procedure via angiogram, balloon to press plaque against arterial wall Carotid Stent: to accompany either of the above to ensure patency of lumen (foreign body therefore requires antiplatelet aggregation cover for first months post-op)

TIA: Nursing Post-Surgery Neurological observations Maintain adequate BP: (Hypotension → ischaemia and thrombosis; hypertension → cerebral haemorrhage) (Nitroprusside: a vasodilator ↓ BP and promotes carotid blood flow) Cardiac monitoring Observe for haematoma in neck disrupting breathing (tracheostomy set available)

TIA: Other Nursing Considerations Careful monitoring on admission to assess that the initial condition is not developing to stroke Post-surgical care Encourage patient awareness and preventive lifestyle changes: ↓ smoking, dietary changes to reduce cholesterol, weight reduction, modest exercise to develop collateral circulation