Embolic strokes can affect any age-group. DIAGNOSTIC STUDIESStroke • Have a higher incidence of smoking and obesity than whites, which are two risk factors for stroke. thrombolytic agents and nursing care regarding thrombolytic treatment. LICOX measures brain oxygenation and temperature (see discussion in Chapter 57 on p. 1365 and Fig. Describe the incidence of and risk factors for stroke. For patients who have atrial fibrillation, oral anticoagulation can include warfarin (Coumadin), rivaroxaban (Xarelto), and dabigatran etexilate (Pradaxa). Cerebral Blood Flow Rheumatic heart disease is one cause of embolic stroke in young to middle-aged adults. Describe nursing interventions associated with a patient diagnosed with an acute ischemic stroke. • Frequently speak in short phrases that make sense but are produced with great effort. TIAs may be due to microemboli that temporarily block the blood flow. African Americans Only gold members can continue reading. Modi_ed from Kothari RU, Pancioli A, Men more than womenOldest median age Stroke 2009;40;2911-2944. Preventive Therapy Emotional responses may be exaggerated or unpredictable. The major branches of the carotid arteries are the middle cerebral and anterior cerebral arteries. The initial hyporeflexia (depressed reflexes) progresses to hyperreflexia (hyperactive reflexes) for most patients. The second category occurs when the patient neglects all input from the affected side (erroneous perception of self in space). The topic is intentionally broad and welcomes papers, which relate to a wide variety of issues including (but not limited to) intimate partner violence, gender based violence, sexual violence, elder abuse and workplace violence in the context of healthcare • Lipid profile 3. • Are twice as likely to die from a stroke as whites. The embolic stroke often occurs rapidly, giving little time to accommodate by developing collateral circulation. TABLE 58-3 Nursing Information Only • NIHSS (National Institute of Health Stroke Scale) is a noninvasive and valid assessment tool used to evaluate The vertebral arteries join to form the basilar artery, which branches to supply the middle and lower parts of the temporal lobes, occipital lobes, cerebellum, brainstem, and part of the diencephalon. Have a higher incidence of smoking and obesity than whites, which are two risk factors for stroke. • Damage occurs in left temporal lobe, although it can result from damage to right lobe. • Limit consumption of alcohol to moderate levels. Compare and contrast the etiology and pathophysiology of ischemic and hemorrhagic strokes. Chapter 58: Nursing Management: Stroke STROKE •Stroke occurs when there is ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the brain that results in death of brain cells. Stroke is a major public health concern. The first is the result of damage of the parietal lobe and causes the patient to have an incorrect perception of self and illness. A blood clot within the closed skull can result in a mass that causes pressure on brain tissue, displaces brain tissue, and decreases cerebral blood flow, leading to ischemia and infarction. 8. Manifestations include neurologic deficits, headache, nausea, vomiting, decreased level of consciousness (in about 50% of patients), and hypertension. Progression over 24 hr. The patient may experience aphasia, which may be receptive aphasia (loss of comprehension), expressive aphasia (inability to produce language), or global aphasia (total inability to communicate). Nonmodifiable risk factors include age, gender, ethnicity or race, and family history or heredity. These metabolites can cause endothelial damage and vasoconstriction. One of your major goals when caring for a stroke patient is to reduce secondary injury related to increased ICP (see Chapter 57). May say, “You know that smoodle pinkered and that I want to get him round and take care of him like you want before.”. Diabetes mellitus is a significant risk factor for stroke. Bleeding into the subthalamic areas of the brain leads to problems with vision and eye movement. • Stroke is more common in men than in women. • Avoid cigarette smoking or tobacco products. Can Mirror Therapy Improve Functioning After Stroke? When manifestations of a stroke occur, diagnostic studies are done to (1) confirm that it is a stroke and not another brain lesion and (2) identify the likely cause of the stroke (Table 58-5). TABLE 58-4 About 28% of strokes occur in people younger than 65 years old.2 The arms and legs of the affected side may be weakened or paralyzed to different degrees depending on which part of and to what extent the cerebral circulation was compromised. • Clipping or coiling of aneurysm Describe the rehabilitative nursing management of a patient with a stroke. • High incidence of strokes may be related to their increased rates of hypertension, diabetes mellitus, and sickle cell anemia. Loss of consciousness may or may not occur. Functions such as movement, sensation, or emotions that were controlled by the affected area of the brain are lost or impaired. thrombotic stroke, p. 1391 Manifestations related to right- and left-brain damage differ somewhat and are shown in. Initially, patients experience a severe headache with nausea and vomiting. Risk factors can be divided into nonmodifiable and modifiable. The affected shoulder tends to rotate internally, and the hip rotates externally. Sudden-onset dizziness (vertigo) 2. Have a higher incidence of strokes than whites. Both memory and judgment may be impaired as a result of stroke. Cardiac Assessment Spatial-Perceptual Alterations Describe the incidence of and risk factors for stroke. D��ۄ��$��$i.��r��(A�'�^��+Pd��}~=��\^ 3R�T+ ��`Y����4�ypq�BH�C9�~d� Modifiable risk factors include hypertension, heart disease, diabetes mellitus, smoking, excessive alcohol consumption, obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet, and drug abuse. When a stroke affects one hemisphere of the brain, the prognosis for normal bladder function is excellent. This is important for all types of stroke, especially ischemic strokes, since the time can affect treatment decisions. About 28% of strokes occur in people younger than 65 years old.2, Stroke is the fourth most common cause of death in the United States, behind cancer, heart disease, and lung disease. 0000012920 00000 n • Sudden numbness, weakness, paralysis of the face, arm, or leg, especially on one side of the body, • Sudden confusion, trouble speaking or understanding, • Sudden trouble seeing in one or both eyes, • Sudden trouble walking, dizziness, loss of balance or coordination, • Sudden, severe headache with no known cause. • Damage occurs in left temporal lobe, although it can result from damage to right lobe. • Limiting alcohol intake Risks of angiography include dislodging an embolus, causing vasospasm, inducing further hemorrhage, and provoking an allergic reaction to contrast media. • Digital subtraction angiography Intracerebral Hemorrhage. Thrombosis develops readily where atherosclerotic plaques have already narrowed blood vessels. Modifiable risk factors include hypertension, heart disease, diabetes mellitus, smoking, excessive alcohol consumption, obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet, and drug abuse. The effect of alcohol on stroke risk appears to depend on the amount consumed. In other words, the vessels in the brain make an “alternate route” for blood flow to reach damaged areas. Illicit drug use, especially cocaine use, has been associated with stroke risk.1. Follow a diet that is low in saturated fat, total fat, and dietary cholesterol and high in fruits and vegetables. TIAs are a warning sign of progressive cerebrovascular disease. Primary prevention is a priority for decreasing morbidity and mortality risk from stroke (Table 58-6). Mirror therapy may improve motor function, ADLs, and pain compared with other interventions with effects lasting after 6 mo. Chapter 58 These impairments can occur with strokes affecting either side of the brain. 58-3). Other causes include vascular malformations, coagulation disorders, anticoagulant and thrombolytic drugs, trauma, brain tumors, and ruptured aneurysms. x�b```f``d`c``�db@ !V�(G�'��r����p��Ɂ�?r8/ ��͏1��[C�j�\�������z�����Ń��!�T������ X�U����0�8(��a`�m� �X��ې� ����qvä�֕�}��}c:u@k����6���u>j������|=�HX�������;0�"����d[����E��7R��)�Rn0�4�2�|>\�����J��W�%S�'N�]x ���*�Y&��]j�WY��{���棪�9�*��G*8k� T7�W The brain requires a continuous supply of blood to provide the oxygen and glucose that neurons need to function. Differentiate among the collaborative care, drug therapy, and surgical therapy for patients with ischemic strokes and hemorrhagic strokes. Manifestations related to right- and left-brain damage differ somewhat and are shown in Fig. When a stroke affects one hemisphere of the brain, the prognosis for normal bladder function is excellent. An estimated 7 million people over the age of 20 in the United States have had a stroke, with 795,000 individuals affected annually.1 With an aging population, a further increase in the incidence of stroke can be expected. Dysphasia refers to impaired ability to communicate. Sudden onset of a severe headache that is different from a previous headache and typically the “worst headache of one’s life” is a characteristic symptom of a ruptured aneurysm. Reviewed by Carol C. Annesser, RN, MSN, BC, CNE, Assistant Professor, Nursing, Mercy College of Northwest Ohio, Toledo, Ohio; and Molly L. McClelland, RN, PhD, Assistant Professor of Nursing, University of Detroit Mercy, Detroit, Michigan. Nutrition teaching is important for the individual at risk for stroke, since a diet high in fat and low in fruits and vegetables may increase stroke risk. The brain is normally well protected from changes in mean systemic arterial blood pressure (BP) over a range from 50 to 150 mm Hg by a mechanism known as cerebral autoregulation. The risk associated with smoking decreases substantially over time after the smoker quits. For example, the bloodstreams of the internal carotid system and the basilar system meet in the posterior communicating arteries. The effects of the emboli are initially characterized by severe neurologic deficits, which can be temporary if the clot breaks up and allows blood to flow. Cerebral angiography is a definitive study to identify the source of SAH. Functions, such as movement, sensation, or emotions, that were controlled by the affected area of the brain are lost or Poor prognosis, fatality more likely with presence of coma. Because patients may or may not be aware of their spatial-perceptual alterations, you need to assess for this potential problem, since it will affect rehabilitation and recovery. Serial CT scans may be used to assess the effectiveness of treatment and to evaluate recovery. *A lumbar puncture to obtain cerebrospinal fluid is avoided if increased intracranial pressure is suspected. • Typically understand speech of others fairly well. Cerebral arteries and the circle of Willis. Anatomy of Cerebral Circulation Most problems with urinary and bowel elimination occur initially and are temporary. • In most age-groups, more men than women will have a stroke in a given year. Collateral circulation may develop over time to compensate for a decrease in cerebral blood flow. Clinical manifestations of putaminal and internal capsule bleeding include weakness of one side (including the face, arm, and leg), slurred speech, and deviation of the eyes. Also, check the time so you will know when the first symptoms appeared. The characteristic motor deficits include loss of skilled voluntary movement (akinesia), impairment of integration of movements, alterations in muscle tone, and alterations in reflexes. Tags: Medical-Surgical Nursing Assessment and Management of Clinical P 7. TIAs are a warning sign of progressive cerebrovascular disease. Heavy alcohol drinking, obesity, smoking cigarettes, drugs, and substance abuse are manageable lifestyle factors that can increase the chances of stroke.Conditions that exacerbate the risk of stroke include: 1. Facial droop 2. • Native Americans are more likely than whites to have at least two risk factors for stroke. Types of Stroke Acute Stroke – Diagnosis and Management Dr Gemma Smith (Specialty Trainee in Elderly Care and Stroke Medicine) Correspondence - Gemma Smith: gem.eaton@gmail.com ABSTRACT Stroke (noun): a sudden disabling attack… caused by an interruption … It is considered safer than cerebral angiography because less vascular manipulation is required. Embolic In the past, TIAs were operationally defined as any focal cerebral ischemic event with symptoms lasting less than 24 hours. During normal activity, oxygen requirements vary considerably, but changes in cardiac output, vasomotor tone, and distribution of blood flow normally maintain adequate blood flow to the head. Impairment may involve pronunciation, articulation, and phonation. At least partial sensation for bladder filling remains, and voluntary urination is present. May be extremely limited in ability to speak or comprehend language. An estimated 7 million people over the age of 20 in the United States have had a stroke, with 795,000 individuals affected annually.1 With an aging population, a further increase in the incidence of stroke can be expected. An example of behavior in people with right-brain stroke is that they try to rise quickly from a wheelchair without locking the wheels or raising the footrests. • Treatment of underlying cardiac problem, • Anticoagulation therapy for patients with atrial fibrillation, • Surgical interventions for aneurysms at risk of bleeding, • Tissue plasminogen activator (tPA) IV or intraarterial, • Focus on helping patient achieve independence and functional recovery. Thrombotic stroke, which is the result of thrombosis or narrowing of the blood vessel, is the most common cause of stroke, accounting for about 60% of strokes.1 Two thirds of thrombotic strokes are associated with hypertension or diabetes mellitus, both of which accelerate atherosclerosis. An additional assessment question that you need to ask is the time of the onset of symptoms. The neurologic manifestations do not significantly differ between ischemic and hemorrhagic stroke. Gender Differences Other causes include vascular malformations, coagulation disorders, anticoagulant and thrombolytic drugs, trauma, brain tumors, and ruptured aneurysms. The embolic stroke often occurs rapidly, giving little time to accommodate by developing collateral circulation. d;+��rl�"�56F�bQ S fq�@RfǢ���R(0�x`���LJX,f� `6^�x�D`��%Ρ��@����=0X,�T� �V`��1�3�c0���/���x��!r�)L8x�2|`�d�b `�s`g�%��1d�v�����0T4�X2���}��C(CWC�#f�v��-2�a|��r� �ӁL���"L&�ʄ1��ߗ�ຐ1��?^$� 0�y� Antiplatelet drugs are usually the chosen treatment to prevent stroke in patients who have had a TIA. After 5 to 10 years of no tobacco use, former smokers have the same risk of stroke as nonsmokers.5, The effect of alcohol on stroke risk appears to depend on the amount consumed. The extent of the symptoms varies depending on the amount, location, and duration of the bleeding. • At all ages, more women than men die from strokes. The lumen of the blood vessel becomes narrowed and, if it becomes occluded, infarction occurs. Peter Davies Cardiac imaging is also recommended because many strokes are caused by blood clots from the heart. The affected foot is plantar flexed and inverted. The most effective way to decrease the burden of stroke is prevention and teaching, especially about risk factors. • Increase level of physical exercise. • Have a higher incidence of strokes than whites. 1. 58-4. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. Genetic variations in this area are common, and all connecting vessels may not be present. The embolus travels upward to the cerebral circulation and lodges where a vessel narrows or bifurcates (splits). Important diagnostic tools for patients who have experienced a stroke are a noncontrast computed tomography (CT) scan or magnetic resonance imaging (MRI).12 These tests can rapidly distinguish between ischemic and hemorrhagic stroke and help determine the size and location of the stroke. In this situation, patients may deny their illnesses or their own body parts. This involves changes in the diameter of cerebral blood vessels in response to changes in pressure so that the blood flow to the brain stays constant. It is a functional abnormality of the central nervous system. For patients who have atrial fibrillation, oral anticoagulation can include warfarin (Coumadin), rivaroxaban (Xarelto), and dabigatran etexilate (Pradaxa). The extent of the stroke depends on rapidity of onset, the size of the damaged area, and the presence of collateral circulation. TYPES OF STROKE The main branch of the basilar artery is the posterior cerebral artery. • Hispanics, Native Americans, and Asian Americans have a higher incidence of strokes than whites. Peak time for vasospasm occurs 6 to 10 days after the initial bleed. Collaborative Therapy Hemorrhagic strokes account for approximately 15% of all strokes and result from bleeding into the brain tissue itself (intracerebral or intraparenchymal hemorrhage) or into the subarachnoid space or ventricles (subarachnoid hemorrhage or intraventricular hemorrhage).1 Profile of Stroke Care in Canada 5 III. Clinical symptoms typically last less than 1 hour. Slightly higher in womenYoungest median age Two thirds of all strokes occur in individuals older than 65 years, but stroke can occur at any age. Urinary and bowel elimination problems may also be related to inability to express needs and to manage clothing.