1. Cerebrovascular Disorders
Ischemic vs. Hemorrhagic
Stroke

2. Stroke (Brain Attack) What are the Implications?
Sudden disruption in the normal blood supply to the brain
fka: Cerebrovascular Accident (CVA)
Medical emergency
Immediate treatment required
Third most common cause of death in US
Primary cause of adult disability
Why is disrupted blood supply a concern?
What are the Implications?

3. Stroke Risk Factors History: History: TIA ASCVD HTN
Dysrhythmia (Atrial Fib)
ECG changes
Rheumatic heart disease
Diabetes Mellitus
Gout
History:
Cardiac enlargement
Hyperlipidemia
Lack of exercise
Hormonal contraceptive use
Drug abuse
Smoking
Family history of stroke
Sickle cell disease

4. Classifications Transient Ischemic Attack (TIA) Progressive Complete
Least severe
Temporary
Complete return to normal functioning
Progressive
Begins with slight neurologic deficit and worsens over a day or two
Complete
Most severe
Causes maximum neurologic deficits at onset

5. To remember important points of TIA
T: Transient episode that clears in hrs
I: Warning sign of Impending stroke
A: Aspirin and Anticoagulants to minimize risk of thrombosis

6. Types of Strokes
Compare and contrast the two types of strokes Identify the three major causes of stroke in order of incidence
Ischemic
Caused by occlusion of a cerebral artery
Hemorrhagic
Ruptured sacular aneurysm
Ruptured atreriovenous malformation (AVM)
Hypertension

7. Pathophysiology Of Ischemic Stroke
Create a flow-chart concept map of the Pathophysiology of an Ischemic Stroke.

8. Pathophysiology of Hemorrhagic Stroke
What do you need to know to be able to discuss the pathophysiology of a Hemorrhagic Stroke?

9. Stroke: Assessments Accurate History Activity when stroke began
Ischemic: sleep
Hemorrhagic: activity
Progression of Sx
Objective assessment:
Loss of consciousness, dizziness, seizure
Level of Consciousness
Current LOC
Presence of deficits
Medical History
Head trauma
HTN
Heart disease
Anemia
Obesity
Headache
Current meds
Anticoagulants
ASA
Vasodilators
Illegal drugs

10. Assessment What will physical findings depend upon?
How will data be gathered if patient is unable to give history information?

11. Diagnostics Why should contrast not be used for the CT?
Noncontrast CT
12 Lead ECG
Carotid ultrasound
Cerebral angiography
Trancranial doppler studies
Transthoracic or transesophageal echo
MRI
Xenon enhanced CT
SPECT
Which of these are considered the standard diagnostics?
Why should contrast not be used for the CT?
What is the role of the nurse in these diagnostics?

12. Collaborative Problems/Potential Problems
Ischemic
↓cerebral blood flow due to ↑ ICP
Inadequate oxygen to the brain
Pneumonia
Hemorrhagic
Vasospasms
Seizures
Hydrocephalus
Rebleeding
Hyponatremia

13. Ischemic Stroke: Medical Management
Secondary prevention
Thrombolytic therapy
Maintenance of cerebral perfusion
Managing potential complications
Surgical prevention
What measures will be included for these interventions?

14. Ischemic Stroke: Nursing Interventions (Recovery)
Improve mobility and prevent joint deformity
Prevent shoulder pain
Enhance self-care
Manage sensory-perceptual difficulties
Assist with nutrition
Attaining bowel and bladder control
Improving thought processes
Improving communication
Maintaining skin integrity
Improving family coping
Helping patient cope with sexual dysfunction

15. Hemorrhagic Stroke: Nursing Interventions
Optimizing cerebral tissue perfusion
Relieving sensory deprivation and anxiety
Monitoring and managing potential complications

16. Stroke: Impaired Verbal Communication
Occurs in dominant hemisphere/majority in left hemisphere
Dysarthria due to loss of motor function
Aphasia caused by cerebral hemisphere damage
Expressive (Broca’s or motor) aphasia
Receptive (Wernicke’s or sensory) aphasia
Discuss how impaired verbal communication impacts the patient/client, the family and the caregiver.

17. Impaired Communication
Compare and Contrast the different types of aphasia.
How would your plan of care differ in regards to the type of aphasia experienced?

18. Left Frontal Stroke

19. Left Frontal Stroke (underside)

20. Right Sided Stroke

21. Right Sided Stroke