STROKE

Ikhda Ulya
 Goal
• Definition
• Pathological
• Causes
• Risk factor
• Classification
• Clinical manifest
• Diagnostic procedure
• Management
• Complication
• Life style treatment
• Nursing care
 Definition
• A stroke or brain attack  sudden focal
neurological deficit caused by cerebrovascular
disease
• A stroke is a syndrome in which the cerebral
circulation is interrupted, causing neurological
deficit (Silvestri, 2014)
 Cont’...
• Stroke is a clinical syndrome characterized by
the rapid onset of focal neurological signs,
lasting >24 hours or leading to death, with a
presumed vascular cause (infarction and/or
haemorrhage) (Markus, 2016)
 Causes
(Brunner and Suddarth, 2010)
 Risk factor
a. Atherosclerosis
b. Hypertension
c. Anticoagulation therapy
d. Diabetes mellitus
e. Stress
f. Obesity
g. Oral contraceptives
Risk factor
ischaemia stroke
(Howard, 2016)
Risk Factor for Haemorrrhage (Howard, 2016)
Risk factor haemorrhagic stroke (Howard,
2016)
Brunner and Suddarth, 2010)
 Classification
ICHAEMIA (time course) HAEMORRHAGE

Transient Ischemic Attack (TIA)  <24 hr Subarachnoid haemorrhage (SAH)

- Aneurism
Reversible ischemic neurologic deficit  - Malformation
more pronounced than TIA and > 24 hr
Intracerebral haemorrhage (ICH)
Stroke in evolution  Worsening of
neurologic signs and symptoms over
several minutes

or hours. This is a progressing stroke

Completed stroke  stabilization of
neurological sign and symptom, no
further progression
 Clinical manifest
• Ischaemia : Right and Left brain damage
• Haemorrhagic
Clinical Manifest - ischaemia
 Neurological deficit
(Brunner and Suddarth, 2010)

• Visual field deficit (diplopia, loss peripheral

vision)
• Motor deficit (hemiplegia, hemiparese)
• Sensori deficit (paresthesia)
• Verbal deficit (aphasia)
• Cognitive deficit (memory loss, decrease
atention)
• Emotional deficit (lability, depression)
 RIGHT-brain damage
• Paralyzed left side : hemiplegia
• Left-sided neglect
• Spatial-perceptual deficits
• Tends to deny or minimize problems
• Rapid performance, short attention span
• Impulsive, safety problems
• Impaired judgment
• Impaired time concepts
 LEFT-brain damage
• Paralyzed right side: hemiplegia
• Impaired speech/language aphasias
• Impaired right/left discrimination
• Slow performance, cautious
• Aware of deficits: depression, anxiety
• Impaired comprehension related to language,
math
 Clinical manifest-haemorrhage
• Progressive focal and neurological deficit
• Headache
• Vomiting
• Decrease level of concioussness
• Seizure
 Pathological
• Cerebral anoxia lasting longer than 10 minutes
 CEREBRAL INFARCTION with irreversible
change
• Cerebral edema and congestion cause further
dysfunction
 Diagnostic procedure
• CT scan
• MRI
• Electroencephalography
• Cerebral arteriography
 Other diagnostic procedure
• Blood glucose
• Electrolytes
• Renal function
• Full blood count
• Coagulation profile
• Cardiac marker
• ECG
(Howard, 2016)
 Goal Stroke Management (ischaemia)

1. Reperfusion
2. Neuroprotection
3. Antiplatelet treatment

(Howard, 2016)
 Acute management (ischaemia)
• Initial assessment  history, causes, onset,
progression of neural deficit
• Emergency treatment  focused on
stabilization of the ABC followed assessment
neurological deficits and comorbidities
• Investigation  CT & MRI + other diagnostical
procedure
• Maintenance of homoeostasis
 Maintenance of homoeostasis
• Stabilization ABC
• SaO2 > 95%
• Bood glucose level at 6-9 mmol/L  insulin
may be necessary
• Blood pressure  threshold 220/120 mmHg
• Hypotension  should be corrected
• Pyrexia  should be treated aggresively
 Cont’...
• Intravenous or intraarterial thrombolysis
• Traetment of cerebral oedema 
mannitolaspirin (100-300 mg daily)
• Antiplatelet therapy 
• Neuroprotection  neuroprotective agents
 Acute Management
(haemorrahege)

(Howard, 2016)
(Howard, 2016)
 Complication
• Cerebral hypoxia
• Vasospasm (not clear, but associated with increasing
amounts of blood in the subarachnoid cisterns and cerebral
fissures
• Increased ICP
• Systemic hypertensioan
(Howard, 2016)
 Nursing care goal
• Improving mobility and preventing joint
deformities  exercise programme,
ambulation, change position
• Preventing shoulder pain
• Enhancing self-care
• Managing sensory-perceptual difficulties
• Managing dysphagia
• Improving communication
TERIMA KASIH