STROKE/ BRAIN ATTACK By Cindy Mendez

~Interesting notes~ Brain attack is the most comon nervous system diseaseBrain attack is the most comon nervous system disease 700,000 people suffer brain attacks evry year in the U.S700,000 people suffer brain attacks evry year in the U.S Third leading cause of death in the U.S about 158,000 annually.Third leading cause of death in the U.S about 158,000 annually. With sufferers with in the ages of 75 and 85With sufferers with in the ages of 75 and 85 85% ischemic and 15% hemorrhagic.85% ischemic and 15% hemorrhagic.

WHAT IS A STROKE/BRAIN ATTACK? Is an abnormal condition of the blood vessels of the brain, characterized by:Is an abnormal condition of the blood vessels of the brain, characterized by: Hemorrhage into the brainHemorrhage into the brain Embolus formed in the brain itselfEmbolus formed in the brain itself Thrombus being occcluded in the vessel of the brain.Thrombus being occcluded in the vessel of the brain.

Risk factors AtherosclerosisAtherosclerosis Heart diseaseHeart disease HypertensionHypertension Kidney diseaseKidney disease Peripheral vascular diseasePeripheral vascular disease Diabetes mellitusDiabetes mellitus Family historyFamily history Obesity High serum cholesterol levels Cigarette smoking Cocaine use Sedentary lifestyle Oral contraceptives Hormone replacement

Clinical Manifestations & Assessment Deficits in:Deficits in: –body functions –Motor activity –Elimination –Intellectual function –Spatial-perceptual alterations –Personality –Affect –Sensation

Clinical Manifestations & Assessment –Dysphagia –Communication –Headache (sudden and explosive) –Numbness/tingling –Inability to think clearly –Visual problems –Hemiparesis

Clinical Manifestations & Assessment –Hemiplegia –Loc changes –Increased ICP –Changes in respiratory status –Paralysis –Paresis –Hemianopia

Clinical Manifestations The functions affected, are directly correlated to the artery in the brain that was affected.The functions affected, are directly correlated to the artery in the brain that was affected. Permanent damage is the result from anoxia suffered to the brain.Permanent damage is the result from anoxia suffered to the brain. Unconsciousness and seizures may also be experienced by the patientUnconsciousness and seizures may also be experienced by the patient

Types of strokes Thrombotic stroke( most common):Thrombotic stroke( most common): – primarily caused by atherosclerosis –The carotid arteries are the common source of thrombi –Population in the ages between –Forms d/t the narrowing of blood vessels & with plaque build up, debris begin to accumulate and the thrombus begins to form. –Usually occur in the a.m. d/t rumbency.

Types of strokes Emboli stroke:Emboli stroke: –Younger population –2 nd most common type of stroke –Usually originate from a thrombus in the endocardial layer of the heart. –Occurring primarily in the mid-cerebral artery

Types of strokes Hemorrhagic:Hemorrhagic: –3 rd most common type of stroke –In population between the ages of –Intracerebral or intracranial bleeding into the brain or the subarachnoid space –An aneurysm is often the cause of a stroke. With a risk for another rupture with in 7-10 days –50% of hemorrhagic stroke victims will die –20 % of the patients suffering this stroke will be functionally independent after 6 months.

Types of strokes Transient ischemic attack:Transient ischemic attack: –Transient cerebrolvascular insufficiency with episodes of neurological dysfunction Lasting up to 24 hrsLasting up to 24 hrs Usually less than 15 minUsually less than 15 min But resolved with in 3 hrsBut resolved with in 3 hrs –Caused my micro-emboli that temporarily blocks the blood flow –This warns the patient of other underlying conditions

Types of strokes –At least 1/3 of patients suffering a TIA will suffer a stroke within a 2-5 year period

Diagnostics CT scanCT scan CT angiographyCT angiography MRIMRI MR angiographyMR angiography

Medical Management Surgery (if aneurysm was the case) craniotomy, clipping off of the affected artery to prevent a rebleedSurgery (if aneurysm was the case) craniotomy, clipping off of the affected artery to prevent a rebleed Calcium channel blocker (Nimotop) prevevnts vasospasmCalcium channel blocker (Nimotop) prevevnts vasospasm Thrombolytics (plasminogen activator)Thrombolytics (plasminogen activator) Platelet inhibitors and anticoagulantsPlatelet inhibitors and anticoagulants ICP reducing drugsICP reducing drugs

Medical Management Suppositories, stool softeners, laxatives, enemasSuppositories, stool softeners, laxatives, enemas Restricted fluid intakeRestricted fluid intake Early ambulation w/in 1-2 days (dr. order only)Early ambulation w/in 1-2 days (dr. order only)

Nursing Interventions Neurological assessments at least each shift.Neurological assessments at least each shift. Nutrition (tube feedings, thicker liquids, or IV.Nutrition (tube feedings, thicker liquids, or IV. One handed feeding and one handed dressing.One handed feeding and one handed dressing. Bladder training, bowel training.Bladder training, bowel training. Exercises to prevent contractures ( bobath approach)Exercises to prevent contractures ( bobath approach) Communication boardCommunication board

Patient Teaching Teach about medications ( provide written instructions).Teach about medications ( provide written instructions). Stroke club supportStroke club support Teach about different rehab and skilled nursing facilitiesTeach about different rehab and skilled nursing facilities Swallowing precautions if applicableSwallowing precautions if applicable

Prognosis Depends on the severity of the attack and the region of the brain that was affectedDepends on the severity of the attack and the region of the brain that was affected With therapy significance functional gains can be made.With therapy significance functional gains can be made. With plasminogen activator for thrombolysis prognosis is very goodWith plasminogen activator for thrombolysis prognosis is very good