CEREBRAL VASCULAR ACCIDENT (CVA) [STROKE]

INTERRUPTION OF THE BLOOD FLOW TO THE BRAIN RESULTING IN DYSFUNCTION IN MOTOR, SENSORY, PERCEPTUAL, EMOTIONAL OR COGNITIVE ABILITIES

n   SOME MAY BE PREVENTABLE

n   S/S VARY DEPENDING ON AREA OF THE BRAIN AFFECTED    

CVA 

ETIOLOGY 

HEMORRHAGIC

ISCHEMICn  EMBOLUSn  THROMBUS    

CVA-

ISCHEMIC

HEMORRHAGIC CVA

n   VERY HIGH MORTALITY RATE

n   CAN REBLEED IN TWO WEEKS

HEMORRHAGIC CVA

are R/T

n   ARE R/T HTN, AV MALFORMATION, CEREBRAL ANEURYSM, DISEASES THAT CAUSE COAGULOPATHIES, OVER USE OF ANTICOAGULANTS

n  INTRACEREBRAL BLEED

n  SUBARACHNOID BLEED   

HEMORRHAGIC CVA

CLASSIC SYMPTOM

   "THIS IS THE WORST HA OF MY LIFE”

n   DEPENDS ON SEVERITY & LOCATION OF DAMAGE

n  LOC CHANGES, NUCHAL RIGIDITY, PHOTOPHOBIA, RESTLESSNESS, IRRITABLE, N/V, FOCAL S/S IE HEMIPARESIS, PUPIL CHANGES, COMA, RESP. PATTERNS, EYE DEVIATIONS    

HEMORRHAGIC CVA

DX

n   CT, MRI, LP (BLOODY FLUID), MAYBE ANGIOGRAM

HEMORRHAGIC CVA

MANAGEMENT

n   SURGERY FOR AV MALFORMATION OR ANEURYSM

n   NEW  -- PERCUTANEOUS BEAD INSERTION  

n   CONTROL BP, CORRECT COAGS

n   CA++ CHANNEL BLOCKERS TO RELIEVE VASOSPASMS

HEMORRHAGIC CVA

MONITOR FOR ­ICP, WORSENING HA, LOC CHANGES

n   MONITOR VITAL SIGNS ESP. BP

n   MAINTAIN QUIET CALM ENVIRONMENT

KEEP LIGHTS DIM

n   SEIZURE PRECAUTIONS

n   BR WITH HOB UP 30 DEGREES

n   NO STRAINING

EMBOLIC CVA

n   OCCURS WHEN A SUBSTANCE IS CARRIED FROM ANOTHER LOCATION TO THE BRAIN VIA AN ARTERY CAUSING OCCLUSION OF THE ARTERY

n   BACTERIAL ENDOCARDITIS, AIR, PLAQUE DURING MANIPULATION OF AN ARTERY OR ANGIOGRAMS, BLOOD CLOT R/T A-FIB,  LV ANEURYSM, OR CAROTIDS  

THROMBOTIC CVA -- BRAIN  ATTACK

n   MOST COMMON

n   ATHEROSCLEROTIC PROCESS USU. IN CAROTIDS – SAME AS MI (PLAQUE ® PLATELETS ® CLOT  OCCLUSION)

n   INTERRUPTED BLOOD FLOW TO BRAIN ®  O2 TO CEREBRUM  ANAEROBIC GLYCOLYSIS &  FUNCTION  ISCHEMIA, INFARCTION, CEREBRAL EDEMA

n   NEURO DEFICIT LASTING < 24H (USU. LASTS MINUTES TO 3 H)

n   TEACH PT. TO SEEK HELP STAT R/T WILL HAVE CVA SOON – CAN PREVENT CVA

THROMBOTIC CVA 

RISK FACTORS

n   HX. HTN n   HEART DISEASEn   ATHEROSCLEROSISn   STRESSn   SMOKINGn   HIGH CHOLESTEROL

n   COAGULOPATHIES (HIGH OR LOW)n   POLYCYTHEMIA

THROMBOTIC CVA  

CLINICAL MANIFESTATIONS

n   DEPEND ON SEVERITY & LOCATION OF DAMAGE

L CVA = DAMAGE ON L SIDE OF BRAIN

R HEMIPARESIS

n  DYSFUNCTION OF SPEECH & LANGUAGE IN 95% PT.

n  SLOW & CAUTIOUS

n  MEMORY DEFICITS

R CVA = DAMAGE ON R SIDE OF BRAIN

S/S

n   L HEMIPARESIS

n   L SIDED NEGLECT

n   FALL RISK R/T QUICK, IMPULSIVE BEHAVIOR, POOR JUDGMENT

n   MEMORY DEFICIT

CEREBRAL VASCULAR ACCIDENT (CVA)

DX.

CT, MRI, ? LP & ANGIOGRAMS TO R/O HEAD BLEEDING, CAROTID DOPPLER

CBC, CHEMISTRIES, COAGS 

CEREBRAL VASCULAR ACCIDENT (CVA)

n   ACUTE CARE IN ICU

n   REHAB BEGINS ON ADMISSION

n   MOST SIGNIFICANT RECOVERY OCCURS WITHIN 1^ST SIX WEEKS

n   TREAT CONCURRENT CONDITIONS: HEART DISEASE,  HT,   DM, COAGULOPATHY

FOR EMBOLIC OR THROMBOTIC R/T CLOT

TPA TO DISSOLVE CLOTS IF CRITERIA MET

n   HEPARIN GTT THEN COUMADIN

n   ASA QD (81 MG)

n   PLAVIX

n   CAROTID ENDARTERECTOMY   

 NURSING CARE

  VITAL SIGNS & NEURO CHECKS AS INDICATEd

 NURSING CARE

CVA

HOB

   HOB UP AT LEAST 30 DEGREES TO DECREASE ICP & RISK OF ASPIRATION

n   NURSING CARE

CVA

WHEN EATING 

NURSING CARE

CVA

DYSPHAGIA DIET 

n   THICK LIQUIDS & SEMI SOLID SOFT IE MASHED POTATOES, CUSTARD, PUDDING, EGGS

n  NO THIN LIQUIDS, PEANUT BUTTER, DRY FOODS IE CRACKERS, CHUNKS IE GRAPES, ORANGES, HOT DOGS

CVA

PREVENT HAZARDS OF IMMOBILITY

n   MAINTAIN PT. DIGNITY DURING CARES

n   MONITOR FOR BLADDER DISTENTION  & CONSTIPATION

n   BOWEL & BLADDER TRAINING

CVA

 APHASIC

EXPRESSIVE – BROCA’S – L. FRONTAL LOBE

n   CAN UNDERSTAND BUT CAN’T EXPRESS

n   MAY OR MAY NOT BE ABLE TO WRITE

n   SPEECH SLOW, LABORED, PT. AWARE OF DIFFICULTY SO FRUSTRATED & DEPRESSED

CVA

n   CAN’T UNDERSTAND VERBAL OR WRITTEN

n   SPEECH NORMAL EXCEPT MISUSE WORDS

n   PT. OFTEN UNAWARE OF DIFFICULTY SO NOT FRUSTRATED

CVA

GLOBAL 

COMBINATION OF BOTH R/T MASSIVE INJURY

n   PROGNOSIS TO REGAIN SPEECH POOR

CVA

AFFECTED JOINTS 

n   HANDLE AFFECTED JOINTS CAREFULLY R/T NO MUSCLE TONE ® EASY DISLOCATION

n   ARM SLING

CVA

MOBILIZE 

CVA

HOW TO COMPENSATE FOR HEMIANOPSIA 

n   TURN HEAD TO SCAN ROOM & LOOK AT WEAK SIDE TO DECREASE NEGLECT

MIRROR

CVA

  PICTURE

CVA

TRANSFERRING

n   BEAR WT. & PIVOT ON STRONG SIDE WHEN TRANSFERRING

CVA

WALKING