Cerebrovascular Accident

Introduction

Cerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain. A CVA is also referred to as a stroke. Symptoms of a stroke depend on the area of the brain affected. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even unconsciousness

A stroke is a medical emergency. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The causes of stroke: An artery to the brain may be blocked by a clot (thrombosis) which typically occurs in a blood vessel that has previously been narrowed due to atherosclerosis ("hardening of the artery"). When a blood clot or a piece of an atherosclerotic plaque (a cholesterol and calcium deposit on the wall of the artery) breaks loose, it can travel through the circulation and lodge in an artery of the brain, plugging it up and stopping the flow of blood; this is referred to as an embolic stroke. A blood clot can form in a chamber of the heart when the heart beats irregularly, as in atrial fibrillation; such clots usually stay attached to the inner lining of the heart but they may break off, travel through the blood stream, form a plug (embolus) in a brain artery and cause a stroke. A cerebral hemorrhage (bleeding in the brain), as from an aneurysm (a widening and weakening) of a blood vessel in the brain, also causes stroke.

The diagnosis of stroke involves a medical history and a physical examination. Tests are done to search for treatable causes of a stroke and help prevent further brain damage. A CAT scan (a special X-ray study) of the brain is often done to show bleeding into the brain; this is treated differently than a stroke caused by lack of blood supply. A CAT scan also can rule out some other conditions that may mimic a stroke. A soundwave of the heart (echocardiogram) may be done to look for a source of blood clots in the heart. Narrowing of the carotid artery (the main artery that supplies blood to each side of the brain) in the neck can be seen with a soundwave test called a carotid ultrasound. Blood tests are done to look for signs of inflammation which can suggest inflamed arteries. Certain blood proteins are tested that can increase the chance of stroke by thickening the blood.

Stroke look-alikes: Just because a person has slurred speech or weakness on one side of the body does not necessarily mean that person has had a stroke. There are many other nervous system disorders that can mimic a stroke including a brain tumor, a subdural hematoma (a collection of blood between the brain and the skull) or a brain abscess (a pool of pus in the brain caused by bacteria or a fungus). Virus infection of the brain (viral encephalitis) can cause symptoms similar to those of a stroke, as can an overdose of certain medications. Dehydration or an imbalance of sodium, calcium, or glucose can cause neurologic abnormalities similar to a stroke.

Treatment of a stroke: Early use of anticoagulants to minimize blood clotting has value in some patients. Treatment of blood pressure that is too high or too low may be necessary. (Lowering elevated blood pressure into the normal range is no longer recommended during the first few days following a stroke since this may further reduce blood flow through narrowed arteries and make the stroke worse.) The blood sugar glucose in diabetics is often quite high after a stroke; controlling the glucose level may minimize the size of a stroke. Drugs that can dissolve blood clots may be useful in stroke treatment. Oxygen is given as needed. New medications that can help oxygen-starved brain cells survive while circulation is reestablished are being developed.

Rehabilitation: When a patient is no longer acutely ill after a stroke, the aim turns to maximizing the patient's functional abilities. This can be done in an inpatient rehabilitation hospital or in a special area of a general hospital and in a nursing facility. The rehabilitation process can involve speech therapy to relearn talking and swallowing, occupational therapy for regaining dexterity of the arms and hands, physical therapy for improving strength and walking, etc. The goal is for the patient to resume as many of their pre-stroke activities as possible.

Objectives
General Objective: To be able to acquire knowledge on how to deal or manage a patient with Cerebrovascular Accident. Specific Objective: To thoroughly assess the clinical manifestations of patient with CVA based on the patient s history. To formulate comprehensive nursing diagnosis for a client with CVA. To formulate a plan of care for patients with CVA. To formulate appropriate nursing interventions that can be applied for a patient with CVA. To evaluate the plan of care for a patient with CVA.

NURSING HEALTH HISTORY

BIOGRAPHIC DATA Name: Mr. F.H.L Address: San Bartolome, Novaliches, QC Age: 65 yrs old Sex: M Race: Filipino Marital Status: Married Occupation: Markerting Manager Religious Orientation: Roman Catholic Health Care Financing: Phil health

CHIEF COMPLAINT

Nahihilo ako . As stated

HISTORY OF PRESENT ILLNESS Few hours prior to admission, the patient experienced dizziness and the patient was rushed to the hospital because his son saw him that he fell down in the ground. The patient was conscious but not responsive. He was admitted December 8, 2011 at 3:30 P.M. with vital sign of Temp: 36.8C, PR: 90 bpm, RR: 21 cpm, BP: 200/110 mmHg. The patient was diagnosed with C.V.A.

PAST HISTORY The client received 2 immunizations only (BCG and DPT) because the family is not aware of its importance. The client commonly had cough and fever. The childhood diseases that he acquired are mumps, measles, and chicken pox and sore eyes .There were no known food or medication allergy. Client has no history of accidents or injuries. She does not smoke or drink alcohol. Had PTB before.

FAMILY HISTORY OF ILLNESS The clients father and mother has a history of hypertension.

Laboratory Result
CBC Hgb: 12.7 Hct: 39 WBC: 54.6 APC: 168 Seg: 87 Lym: 06 Bo: 04 Mono:83 BUN: 2.64 CREA: 527 K: 4.2 NA: 112

Diagnostic Procedure

Name of Diagnostic Procedure - CT Scan Definition: - is a medical imaging method employing tomography. Digital geometry processing is used to generate a threedimensional image of the inside of an object from a large series of two dimensional x-ray images taken around a single axis of rotation.

Indication: CT Scanning of the head is typically used to detect: Bleeding, brain injury and skin fractures Brain Tumors A blood clot or Bleeding Enlarged brain cavities ,etc..

Name of Diagnostic Procedure - Hematology Description: The branch of biology (physiology), pathology, clinical laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood forming organs, and blood diseases.

Indication: - this is used to evaluate anemia, leukemia, reaction to inflammation and infections, peripheral blood cellular characters, state of hydration and dehydration, polycythemia, hemolytic disease of the newborn, to manage chemotheraphy decisions

Name of Diagnostic Procedure - Magnetic Resonance Imaging Description: is a medical imaging technique used in radiology to visualize detailed internal structures. MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body.

Indication: MRI provides good contrast between the different soft tissues of the body, which makes it especially useful in imaging the brain, muscles, the heart, and cancers compared with other medical imaging techniques such as computed tomography (CT) or Xrays. Unlike CT scans or traditional Xrays, MRI does not use ionizing radiation.

Anatomy and Physiology

Cerebrum- The biggest part of the brain is the cerebrum. The cerebrum makes up 85% of the brain's weight, and it's easy to see why. The cerebrum is the thinking part of the brain and it controls your voluntary muscles Cerebellum- The cerebellum is at the back of the brain, below the cerebrum. It's a lot smaller than the cerebrum at only 1/8 of its size. But it's a very important part of the brain. It controls balance, movement, and coordination (how your muscles work together). Brain Stem- The brain stem sits beneath the cerebrum and in front of the cerebellum. It connects the rest of the brain to the spinal cord, which runs down your neck and back. The brain stem is in charge of all the functions your body needs to stay alive, like breathing air, digesting food, and circulating blood

Midbrain/ Mesencephalon- the rostral part of the brain stem, which includes the tectum and tegmentum. It is involved in functions such as vision, hearing, eyemovement, and body movement. The anterior part has the cerebral peduncle, which is a huge bundle of axons traveling from the cerebral cortex through the brain stem and these fibers (along with other structures) are important for voluntary motor function. Pons- part of the metencephalon in the hindbrain. It is involved in motor control and sensory analysis... for example, information from the ear first enters the brain in the pons. It has parts that are important for the level of consciousness and for sleep. Some structures within the pons are linked to the cerebellum, thus are involved in movement and posture. Medulla oblongata is the lower portion of the brainstem. It deals with autonomic functions, such as breathing and blood pressure. The cardiac center is the part of the medulla oblongata responsible for controlling the heart rate.

Hypothalamus- The hypothalamus is like your brain's inner thermostat (that little box on the wall that controls the heat in your house). The hypothalamus knows what temperature your body should be (about 98.6 Fahrenheit or 37 Celsius).

Pathophysiology