PATHOPHYSIOLOGY of CVA (Stroke
Non Modifiable Factors
Smoking, Obesity, Hypertension, High Cholesterol Level, Excessive Alcohol Consumption, Drug Addiction, High Dose of estrogen OC, Diabetes Mellitus, Atrial Fibrillation, Type A personality, Sedentary Life Style
Age, Family History of CVA, Family History of DM, Sex (Men), Race
Destruction of alpha and beta cells of the pancreas
Failure to produce insulin Production of excess glucagon Inc. Inc. Ketones Ketones
Inc. osmolarity due to glucose
Inc. serum glucose level
Production Production of of glucose glucose from from protein protein and and fat fat stores stores
Acetone Acetone breath breath Wasting Wasting of of lean lean body body mass mass
Glycoprotein cell wall deposits
Fatigue Fatigue Weight Weight loss loss
Impaired immune function (decrease level of morphonuclear leukocytes)
Small vessel disease
Diabetic Nephropathy Neuropath y
Delayed wound healing
POSTERIOR POSTERIOR CEREBRAL CEREBRAL A.Symmetri cal loss of protective sensation
Hypertension Loss of vision Blindness Increase LDL levels
Numbness and tingling in the extremities
Dry cracked skin
Wasting of intrinsic muscle
Impotence Charcot changes in joints
Thrombus Thrombus Emboli Emboli
CEREBROVASCULAR CEREBROVASCULAR ACCIDENT ACCIDENT Hemiparesis Hemiparesis Decreased Decreased Tissue Tissue perfusion perfusion (brain) (brain) Loss Loss of of speech speech Hemisensory Hemisensory loss loss Cerebral Cerebral Hypoxia Hypoxia Syncope/ Syncope/ Vertigo Vertigo
Cerebral Cerebral ischemia ischemia
Short Short term term Eschemia Eschemia (<10(<1015mins) 15mins)
Long Long term term Eschemia Eschemia (>10(>1015mins) 15mins)
Temporary Temporary Deficit Deficit
Permanent Permanent Deficit Deficit
No No permanent permanent damage damage
Irreversible Irreversible damage damage
MID MID CEREBRAL CEREBRAL ARTERY ARTERY
ANTERIOR ANTERIOR CEREBRAL CEREBRAL A.
VERTEBROBASILAR VERTEBROBASILAR ARTERY ARTERY
. A. A.
As a result. (Joyce M. Ischemic strokes account for about 83% strokes. (Joyce M. Two major types of stroke are ischemic and hemorrhagic. Black et al Medical Surgical Nursing 7 th edition Elsevier Suanders 2005) Diabetes Mellitus is a chronic systemic disease characterized by either a deficiency of insulin or a decreased ability of the body to use insulin Diabetes mellitus is sometimes referred to as “high sugars” by both clients and health care providers. the incidence increases to 700. A stroke is a medical emergency and can cause permanent neurological damage. health care professionals now refer to stroke as brain attack. This can be due to ischemia (lack of glucose and oxygen supply) caused by thrombosis or embolism or due to a hemorrhage. When second strokes are considered in the estimates. leading to inability to move one or more limbs on one side of the body. Modifiable
. To convey this sense of urgency regarding the evaluation and treatment of stroke.doh. 000 per year in the united States alone. Public education is focused on prevention. Stroke is a leading cause of adult disability and leading primary diagnosis for long term care. Black et al Medical Surgical Nursing 7th edition Elsevier Suanders 2005) Modifiable and Non Modifiable Factors 1. and death. A stroke (sometimes called a cerebrovascular accident (CVA)) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. Stroke is a term used to describe neurologic changes caused by an interruption in the blood supply to part of the brain.V. strokes produce significant morbidity in people who survive them. but people with diabetes can take preventive measures to reduce the likelihood of such occurrences. recognition of manifestation.ph/kp/statistics/morbidity) New therapies can now prevent or limit the extent can now prevent or limit the extent of damage to brain tissue caused by acute ischemic stroke. the affected area of the brain is unable to function. causing brain tissue to die because of lack of nutrients and oxygen. Along with a high mortality rate.000 strokes people experience a stroke each year. Bleeding into the brain of all tissue or the The subarachnoid remaining space causes a hemorrhagic stroke. More than four million stroke survivors are living with varying degrees of disability in the United States. Black et al Medical Surgical Nursing 7 th edition Elsevier Suanders 2005)
Vascular Disease which includes C. Ischemic stroke is caused by thrombotic or embolic blockage of blood flow to the brain. (Joyce M. caused by a blocked or burst blood vessel. The notion of associating sugar with diabetes is appropriate because the passage of large amounts of sugar-laden urine is characteristic of poorly controlled diabetes. Along with this are 37. However high levels of blood glucose are only one component of the pathologic process and clinical manifestation associated with DM. complications. a treatment window 3 hours from the onset of manifestations has been established. 17% of strokes are hemorrhagic. or inability to see one side of the visual field.092 who survived with it. An estimated 550. and early treatment of brain attack. (http://www. It refers to the injury to the brai n that occurs when flow of blood to brain tissue is interrupted by a clogged or ruptured artery. DM can be associated serious complications.DEFINITION OF DISEASE] Cerebrovascular accident (CVA) is the medical term for what is commonly termed as stroke. inability to understand or formulate speech.680 according to DOH 2004. is the second leading cause of death in the Philippines with a total of 51. Cerebrovascular disorders are the third leading cause of death in United States and account for about 164. 000 mortalities annually.A.gov. Thrombolytic therapy must be administered as soon as possible after onset of the stroke.
Type A personality –stress causes hypertension thereby increasing chance of having hemorrhagic stroke. High dose Estrogen Oral Contraceptives –increases the risk of stroke in women. j.a. Hypertension –this is due to plaque deposits on the wall of the arteries which causes narrowing of the blood vessel thereby causing hypertension which may lead to
one’s risk c. i. b. Family history of CVA – Family history of stroke increase
vasoconstriction there by resulting hypertension which may lead to CVA.
a. Hyperlipidemia –too much lipid in the blood may cause increase plaque formation which may cause thrombus formation. The glucose is not utilized by the body and it remains in the blood stream. This triggers more frequent urination. the excess sugar is excreted into your urine along with fluids drawn from your tissues. Diabetes Mellitus –The mechanism is related to macrovascular changes in people with diabetes mellitus. POLYDIPSIA Polydipsia is an increased thirst and fluid intake. k. There is an increase viscousity of blood which may cause formation of thrombus formation. e. This may be
f. Atrial fibrillation –pulling of blood from poorly emptying atrial which leads to formation of tiny clots in Left atrium which can move on the cerebral circulation. Sex (Male) –Incidence of stroke in men is slightly higher
hemorrhagic stroke. Sedentary lifestyle –increase of having DM and Obesity which one of the factors of having CVA Non-Modifiable
due to the osmotic diuretic effect of the glucose.
than that of women.
consumption increases one’s risk of a stroke. If your kidneys can't keep up. it leads to an accumulation of glucose in the intravascular space. b. Therefore. Obesity –This is due to increase cholesterol in the body which may contribute plaque formation that will narrow the blood vessel or may cause thrombus formation. e. When you have diabetes. This may be due to the activation of the thirst center in the hypothalamus resulting from the intracellular dehydration or volume depletion caused by excessive urine production. which may leave you dehydrated. hypercoagulability and cerebral eschemia which may cause CVA. wherein it attracts water during urination. Family history of DM –Family which has history of DM especially type 2 is high risk of having stroke due to accelerated atherosclerosis. Drug addiction –This may cause vasopasm. d. hypertension. Race – (more prevalent among African Americans than whites or Hispanics) SIGNS AND SYMPTOMS DIABETES MELLITUS HYPERGLYCEMIA (INCREASED BLOOD SUGAR LEVEL) Diabetes Mellitus type II may be due to lack of
physiologically active insulin that stimulates glucose uptake in the muscles and tissues. Age –Intracranial hemorrhage is most often secondary to hypertension and is most common after age 50 years. d. POLYPHAGIA
. g. excess sugar (glucose) builds up in your blood. POLYURIA Polyuria is an increased frequency of urination. Your kidneys are forced to work overtime to filter and absorb the excess sugar. light or moderate alcohol may protect against ischemic stroke. c. h.
Because glucose cannot enter cells of the satiety center of the brain without insulin.
nephropathy. BODY MALAISE This is due to the decreased glucose uptake by the tissues leading to decreased energy production. ANEMIA If there are renal affectations. hemisensory loss 4. Glucose was filtered out and excreted in the urine. Due to the excess glucose ad compared to the kidney threshold. SLOW-HEALING SORE AND FREQUENT INFECTION High levels of blood sugar impair your body's natural healing process and your ability to fight infections. tactile or other sensory information. Apraxia .a condition in which a client can move the affected part but cannot use it for purposeful actions. This effect. loss of speech 3. CEREBROVASCULAR ACCIDENT
GLYCOSURIA Clinical Manifestations The kidney filters the blood. bladder and vaginal infections are especially common. usually occurs as hyperglycemia increases. 4. Hemiparesis/Hemiplegia – the former means weakness of one side of the body while the latter means paralysis of one side of the body. and compressing the medulla oblongata 2. resulting in an exaggerated appetite. ECG changes – problem with the medulla oblongata Warning Signs 1. transient hemiparesis 2. vitreous. making it to its normal state. Visual blurring may develop acutely as the lens changes shape with marked changes in blood glucose concentrations.
1. long before it would be on routine urinalysis. 3.Increased hunger and food intake. and retina. TINGLING SENSATION/ NUMBNESS IN THE HAND AND FEET Excess sugar in your blood can lead to nerve damage. You may notice tingling and loss of sensation in your hands and feet. For women. 1. hands. vertigo/syncope
. WEIGHT LOSS Despite eating more than usual to relieve constant hunger by the stimulation of satiety center. the satiety center in the hypothalamus is stimulated resulting in a “hunger sensation” as if there were very little blood glucose. weight loss may still exist. PROTEINURIA
2. which is caused by osmotic fluxes of water into and out of the lens. this might bring to decrease production of erythropoietin which brings to decrease production of RBC from the bone marrow that may result to anemia. changes in mental status – affectation in the RAS 4. causing visual symptoms. Homonymous Hemianopsia – a defective vision or vision loss in the same half of the visual field. Aphasia – defects on using and interpreting symbols of language 3. Without the glucose supplies. legs and feet. fever – affectation in the hypothalamus 5. which results to the excretion of glucose in the urine. BLURRED VISION Diabetes can affect the lens. Agnosia – a problem in interpreting visual. 5. as well as burning pain in your arms. headache and vomiting – due to an increase ICP which causes cerebral edema. muscle tissues and fat stores may deplete. seizures – due to hyper-excitability of neurons because of irritation.
constriction of pupil. Kinesthesia – alteration in sensation. 9. emotional factors. Unilateral neglect – inability to respond to stimulus on the contralateral side. ptosis of the upper eyelid.6. Dysarthia – imperfect articulation condition. and lack of tearing in the eye. 12. memory lapses. and inability to communicate. Dysphagia (01/29/09 -01/31/09) – difficulty of swallowing 13. Shoulder pain – severe pain in the affected shoulder after CVA 10. 7. 8. Incontinence – due to inattention. Ataxia (01/29/09 -01/31/09) –Problem with motor coordination
. 11. Horner’s syndrome – paralysis of sympathetic nerves to the eye causing sinking of the eyeball.