Cerebro Vascular Accident

Cerebro Vascular Accident also known as Brain attack or Accute Ischemic Stroke is a sudden neurologic impairment caused by a decreased blood flow to any vascular territory in the brain; it is considered a medical emergency. When blood flwow is impeded in the brain; the patient may have a gradual or rapid onset of symptoms that might resolve quickly (transient ischemic attack)(TIA) or last longer (cerebrovascular accident)(CVA). The goals of the management of the patient who has had a brain attack are to maximize neurologic function and prevent the development of complications or the extension of stroke. Risk Factors of Brain Attack Nonmodifiable Age Gender Prior stroke (brain attack) Heredity Modifiable Hypertension Heart disease(MI, heart failure,CAD) Hyperliidemia Diabetes Mellitus Cigarette smoking Excessive alcohol intake

Signs and Symptoms Left- sided Stroke Right Sided Hemiplegia Expressive Aphasia Receptive Aphasia Global Aphasia Defects in right visual field Right Sided Stroke Left sided hemiplegia Denial Impulsive behavior Poor judgment Defects in left visual field

y y y y y

Weakness/ Paralysis Dizziness Slurred Speech Head ache w Loss of consciousness

Dagnostic Examinations y y y CT scan Angiography EEG

Complications y y y Paralysis Visual Disturbances Death

Treatments  Maintain open airway  Surgical intervention y Endarterectomy- removal of plaques from inner wall of artery  Medical intervention y Stool softener to prevent constipation y Corticosteroids to reduce inflammation y Analgesics to reduce pain

Common problems and NURSING INTERVENTION PROBLEM Sensorimotor disability and immobility INTERVENTION y Assess and perform range of motion y Assess skin integrity for evidence of breakdown (especially pressure points heels, elbows, occiput) y Ensure adequate nutrition and hydration y y y y y Asess swallowing ability and presence of gag reflex Implement aspiration precaution Maintain patent airway Monitor for signs of aspiration pneumonia Ensure adequate nutrition(possible tube feeding) Assess for appropriateness of urinary catheter(if necessary to prevent occurrence of UTI) Implement bladder and bowel-training program Assess for the presence of UTI, diarrhea, fecal impaction

Dysphagia

Incontinence

y y