CEREBROVASCULAR DISEASE ● Position head midline

DESCRIPTION ● Elevated head of bed 30 degrees if no symptoms of

● Group of conditions, diseases and disorder that affects shock or injury occurs
the blood vessels and blood supply to the brain ● Institute seizure precautions
● If the blockage, malformation or hemorrhage prevents ● Anticipate thrombolytic therapy for ischemic stroke
the brain cells from getting enough oxygen, brain ● First feeding should be approached carefully
damage can result ○ PT/OT performs swallowing test, chewing,
● Cerebrovascular diseases include stroke, transient gag reflex, and pocketing before beginning
ischemic attack, aneurysm and vascular malformation
oral feeding
● Initiate oral feeding slowly
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS)
○ Clear fluids and then full liquids to regular
● Severe or suddenheadach
● Prevention of aspiration during tube feeding
● Hemiplegia - paralysis on one side of the body
● Hemiparesis- weakness on one side of the body ● Assess for both the ability to speak and the ability to
● Confusion understand
● Difficulty communicating ● Speak slowly and calmly, using simple words or
● Loss on vision on one side sentences
● Loss of balance ● Gestures may be sued to support verbal cues
● In the acute phase, range of motion (ROM) exercises
DIAGNOSTIC AND LABORATORY TEST and positioning are important
● Medical history
○ Specific neurological, motor and sensory MEDICAL/ SURGICAL INTERVENTION
difficulties ● Surgical interventions for the patient with TIAs from
● Cerebral angiography, vertebral angiogram or carotid carotid disease include:
angiogram ○ Carotid endarterectomy
○ Involve injecting dye into the arteries to ○ Transluminal angioplasty
reveals clots and display their size and shape ○ Stenting
on MRI ○ Extracranial-intracranial bypass
○ To identify a vascular abnormality such as ● Recombinant tissue plasminogen activator (tPA)
blood clot or a blood vessel defect ○ Reestablishes blood glow through blocked
● CT scan artery to prevent cell death in acute onset of
○ Help diagnose and detect hemorrhagic strokes
ischemic stroke symptoms
● MRI scan
○ Must be administered within 3 to 4.5 hours
○ Can detect early stage strokes
of onset of clinical signs of ischemic stroke
● Electrocardiogram
● Platelet inhibitors and anticoagulants
○ Can detect cardiac arrhythmia, a risk factor
○ May be used in thrombus and embolus
for embolic strokes
stroke patients after stabilization
RISK FACTORS ■ Aspirin 325 mg is used within 24 to
● Hypertension 48 hours of stroke
● Smoking ■ Heparin IV or SQ
● Obesity ■ Warfarin (coumadin) or clopidogrel
● Poor diet,lack of exercise (Plavix)
● Diabetes ○ Contraindicated for patients with
● High blood cholesterol hemorrhagic stroke
● Surgical Interventions for stroke
NURSING DIAGNOSES BY PRIORITY ○ Ischemic stroke
1. Risk for ineffective vertebral tissue perfusion ■ Mechanical Embolus Removal in
2. Ineffective airway clearance Cerebral Ischemia (MERCI)
3. Impaired physical immobility ○ Hemorrhagic stroke
4. Imapired verbal communication ■ Immediate evacuation of
aneurysm-induced hematomas
NURSING MANAGEMENT/ INTERVENTION
■ Cerebellar hematomas >3cm
● Obtain CT scan immediately
● Obtain baseline lab tests DRUG ANALYSIS
● Tissue plasminogen activator (tPA)
○ Emergency treatment for stroke to break up
blood clots
● Platelet inhibitors and anticoagulants
○ Used in thrombus and embolus stroke
patients after stabilization
■ Aspirin 325 mg is used within 24 to
48 hours of stroke
■ Heparin IV or SQ
■ Warfarin (coumadin) or clopidogrel
(Plavix)