CVA

( CEREBROVASCULAR ACIDENT)
COMMONLY CALLED BRAIN ATTACK
Risk factors:
1. Age: Above 40
2. Gender: Male > Female
*male= Post menopausal
*male ( Blood is viscous in nature)
Normal hematocrit
M- 42-52%
Female 37-47%
3. Race: Black Americans ( high cases)
4. Hereditary
5. HPN
- VC of the blood vessels
-Ischemic shock
-Aneurysm
-Hemorrhagic shock
6 DM
-viscous
-poor circulation
-dec. of blood flow to the brain
-ischemia
7. smoking
-nicotine causes vasoconstriction
-clot formation
-obstruction
8. Hyperlipidemia
-common obese pt.
9 hypercholesterolemia
- Increase fats in the blood
- Atherosclerosis
- Ischemic stroke
10. atrial fibrillation
- irregular, rapid disorganized impulse transmission of the atria
-clot formation in the atria
-embolism in the brain
-obstruction

Signs/symptoms

1. ALOC
2. Hemianopsia- Loss of half the vision
- Scanning of the environment
3. Hemiplegia
- paralysis of the half of the body
-decussation
( crossing of nerves bet. Medulla oblongata and cervical spine)
4. Hemiparesis
Weakens of the half of the body
-opposite side the damage part ( contralateral)
5.Facial Paralysis
-same side (ipsilateral)
6. Muscle Atrophy
Nursing int.
 ROM exercises to prevent muscle atrophy
Affected side- passive ROM
Unaffected side Active ROM
7. Low or no sensation on affected side
Risk for developing: Decubitus ulcer ( Pressure ulcer)
Nursing int.
Mgt. turn pt q 2hrs.
8. UNILATERL NEGLECT/ NEGLECT SYNDROME
-UNAWARE OF AFFECTED HALF OF THE BODY
-MGT. DAILY INSPECTION OF THE AFFECTED PART USING THE
MIRROR.
9. DYSPHAGIA
- CHECK GAG REFLEX BEFORE GIVING A MEAL
-UPRIGHT WHEN EATING
- SOFT/ THICK LIQUIDS
-PLACE THE FOOD ON UNAFFECTED SIDE
10. MEMRY LOSS
11. Emotional lability
12. Aphasia
Broca’s Area Wernicke’s Area
-frontal lobe -Temporal lobe
- motor speech center - Sensory speech center
- Speaking

-damage speech Receptive Aphasia

- Expressive aphasia
-X to speak cannot understand

GLOBAL APHASIA- BOTH BROCA’S AND WERNICKE’S ARE AFFECTED

( CANNOT UNDERSTAND AND CANOOT SPEAK)

MANAGEMENT
1. Expressive aphasia
- Let the pt speak slowly and clearly
- write
2. Expressive Aphasia
- Nurse: Use simple words
-aks questions answerable by Yes or No
- Gestures
NOTE:
Mgt. for receptive and expressive aphasia are both
applicable in global aphasia

MEDICAL MGT.
1. THROMBOLYTICS
-DISSOLVE CLOTS
-“KINASE”
- UROKINASE
-STREPTOKINASE
-tpa ( tissue plasminogen activator)
-must given within 3H of CVA
Note: s/sx of bleeding
Contraindicated
Hemorrhagic CVA
ANTIDOTE: AMINOCAPROIC ACID ( amicar)
Anticoagulants
- Prevents clot formation

HEPARIN WARFARIN
-IV,SQ -ORAL
INITIALLY -MAINTAINANCE
PPT -PT
ANTIDOTE: Protamine SO4 -ANTIDOTE: VIT. K

2. ANTIPLATELETS
- PREVENTS PLATELET AGREGATION TO PREVENT
CLOTS (ASPIRIN)
-S/SX OF BLEDDING
3. CORTICOSTEROIDS ‘’sone’’
- Lower brain infla.
- DEXAMETHASONE ( CROSS BBB)

4. OSMOTIC DUIRETICS
-PREVENT INCREASED ICP (NORMAL ICP: 5-
15mmhg)
-MANNITOL

5. ANTICONVULSANTS ‘’pam’’
-TO PREVENT SEIZURES
- (DIAZEPAM, LORAZEPAM)