1. NURSING MANAGEMENT OF A CLIENT WITH ALTERED CEREBRAL TISSUE PERFUSION
Miss M. N. PRIYADARSHANIE
( BSc . Nursing )
NURSING MANAGEMENT OF A CLIENT WITH ALTERED CEREBRAL TISSUE PERFUSION

2. Stroke Definition : That stroke is a disease affects the blood vessels That blood supply to the brain.
Without blood to supply oxygen and Nutrients and to remove waste products, brain cells begin to die Quickly.

3. What are the Risk factors for stroke
Trombus
Emboli
Haemorrhage (ICH) DM

4. The cause of stroke
An interruption in the blood supply, with a resulting depletion of oxygen and glucose in the affected area. This reduces or abolishes IMMEDIATELY neuronal function,
Impairing brain function

5. TRANSIENT ISCHAEMIC ATTACK
It is a focal deficit lasting less than 24 hours
Due to passage of microemboli
Complete neurological recovery
Risk factor is the thromboembolic stroke

6. Clinical features Aphasia Hemiparesis Hemi sensory loss
Hemi anopic visual loss

7. Investigations MRI CT BLOOD GLUCOSE UREA AND ELECTROLYTE FBC INR ESR
ECG

8. TREATMENT r- TPA therapy for trombolysis (within 3 hours) for TIA
WHAT ARE THE CONTRAINDICATIONS….
Heparin therapy
Anti hypertensives
Aspirin – 300mg daily

9. Secondary prevention Aspirin – 75 mg daily Statin – 40mg daily
Warfarin therapy
Internal carotid endartectomy

10. Prognosis
Die Within 2yrs
25% cure

11. In the Acute phase Maintain airway and adequate ventilation
Maintain neurologic flow sheets
Assess quality and PR
Monitor UOP
Note any bleeding
Elevate head of the bed

12. Meeting Physical Care Needs
Care of the Stroke Affected Side
Loss of Consciousness
Promoting Urinary Continence
- the use of urinary catheters
Promoting Faecal Continence
Care of the Patient Wearing Anti Embolism Stockings
Prevention of Pressure Ulcers
Dysphagia
Nutrition
Oral Hygiene
Care of the Dying

13. Psychological, emotional and communication needs.
Visual Changes
Communication
Safety
Thinking Processes
Emotions
Behavioural Changes
Monitor patient’s pulmonary complications
Monitor for heart abnormalities

14. Watching for Bowel and Bladder Problems
Stroke patients often have bowel and bladder problems
Constipation.
Mobilizing the Patient
When the progression of a stroke has been stabilized, it is time to mobilize the patient the deaths within 30 days after an ischemic stroke

15. Protecting Against Skin Damage
Neurological deficits, e.g., a reduced level of consciousness or a loss of sensation, put stroke patients at increased risk for skin damage
Maintaining Hydration and Nutrition
Dehydration or malnutrition will slow a patient’s recovery. Dehydration also predisposes a patient to deep venous thrombosis.

16. Patient Education Why they are taking an antiplatelet drug
How the drug works
What specific dangers the drug poses
The addition of which other drugs will worsen the risk of bleeding
That antiplatelet therapy will continue for their entire lifetime

17. 1. A 77-year-old woman was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms:
- paralysis of the right face and arm - loss of sensation to touch on the skin of the right face and arm - inability to answer questions but ability to understand what was said to her - ability to write down her thoughts more easily than to speak them

18. 2.A 61-year-old business executive with a long history of high blood pressure collapsed while jogging over the lunch hour. His jogging mate quickly contacted a police officer who helped carry the man to a hospital just down the road. At the hospital, an MRI was performed that revealed a blockage of a major cerebral artery and ischemic changes to the portion of the brain supplied by that artery. With quick medical attention, the man was stabilized, and he slowly improved over the next three weeks. The following signs and symptoms did persist, however:
- paralysis of the right leg and foot - loss of sensation on the skin of the right leg and foot - inability to throw the tennis ball with his left hand, but ability to throw it with his right hand