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Cerebral Vascular
Accident

Assigned by Mam Mariam

Assinged to Sheeza Khalid
Maria Javed

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Objectives
 Define cerebral vascular accident(stroke)
 Explain its types
 Enlist its causes, sign & symptoms
 Discuss pathophysiology & complication
 Describe its dietary, medical, nursing, surgical

management
 Discuss its nursing diagnosis

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Introduction
 A stoke is a serious medical disorder that
occurs when the blood supply to part of that
brain is cut off.
 Like other organs in body, brain also need the

oxygen and nutrients provided by blood to

function properly. If the supply of blood is
stopped, brain cells begin to died this can lead
brain damage and possibly dead.

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Definition
 Stoke (cerebral vascular accident, cerebral
haemorrhage) is an infarction (death) of a specific
portion of brain due to interruption of blood flow that
results to neurological deficit or loss of brain
functions.

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Type of stroke
Ischemic Stroke
 Most strokes (87%) are ischemic strokes.An ischemic

stroke happens when blood flow through the artery

that supplies oxygen-rich blood to the brain becomes
blocked.
Hemorrhagic Stroke
 A hemorrhagic stroke happens when an artery in the

brain leaks blood or ruptures (breaks open).The

leaked blood puts too much pressure on brain cells,
which damages them.

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Causes
 Thrombosis; Blood colt in blood vessels of brain or
neck.
 Cerebral Embolism; The condition in which an

embolus becomes lodged in an artery and obstruction

of blood flow.
 Ischemia; Low blood supply in any part of brain.
 Vascular compression; Veincompression.
 Arterial spasm; Artery contration.

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 Pathophysiology
Due to cause, e.g ,thrombosis ,embolism

Partial or complete obstruction in cerebral blood flow

Ischemia

Necrosis in affected parts of brain

Brain cells/tissue dysfunction

Neurological deficits
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Clinical Manifestations
 Paralysis: Muscle weakness that varies in it.
 Hemiplegia: Pralysis of one side of the body. It is

caused by disease affecting the opposite hemisphere

of the brain.
 Transient loss of speech.
 Paraesthesia; (Spontaneous occuring abnormal
tingling sensation): PMS and needle symptoms of
parts of damage to a peripherial nerve.

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Common Clinical Menifestations
 Headache  Depression
 Vomiting
 Seizure
 Confusion
 Retinal haemorrhage
 Nose
 Vertigo
bleeding(Epistaxis)
 Disorientation
 Numbness
 Language disorder  Memory impairment
 Reflex change  Motor and sensory
disturbance

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Specific deficits after CVA
 Hemiplegia: Paralysis of one side of body.
 Aphasia: Defect in using and interpretating the

symbols of language.
 Agnosia: Unable to recognize the object.
 Apraxia: It is a condition in which a client can move

the affected part but cannot use it for specific

purposeful actions.
 Kinesthesia: Alterations in sensation.

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Diagnostic Evaluation
 Physical examination  History collection
 Computer tomography  Angiography

 CSF culture  Echoencephalography

 General blood and urine
 MRI
 PET:Position-Emission-
examination
Tomograpy

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Pharmacological Management
 Mild analgesics, e.g, Ibuporfen
 Antiepileptics ,e.g , Phenytoin
 Osmotics diuretics (for odema) ,e.g ,Mannitol
 Satroids (anti-inflammatory)
 Anticogulant , e.g , Heparine
 Antihypertensive agents , e.g , verapamil

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Dietary management
 Fluid
diet should be given because patient is
unable to swallow properly.

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Surgical Management
 It depends upon the site of infection and on particular
causes.
 If ICP is more than 30-40mm Hg than only surgery

will be performed.
Surgeries are:
 Evacuation of Haematoma.
 Carotid endarterectomy (removal of material on

inside of an artery) it is the surgical procedure used to

reduce the risk of stoke by correcting stenosis in a
common artery.

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Nursing Management
 Check the vital sign.
 Give position to prevent contractures, use measures

to relieve pressure.
 Start an active rehabilitation program when
consciousness returns.
 Encourage patient to perform self care to maximum

of ability to promote senses of control and

independence.
 Nurse should assess the skin change in color, turgor,

and redness vascularity.

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Cont.
 Monitor fluid intake and hydration condition of skin
and mucous membranes to detect.
 Provide high fiber diet and adequate fluid

intake 2 to 3 litres per day.

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Nursing Diagnosis
 Altered cerebral tissue perfusion related to increase
ICP.
 Disturbed sensory perception related to altered

sensory transmission as evidence by disorientation.

 impair physical mobility related to paralysis as

evidence by muscle weakness.

 Altered thought process related to altered sensation as

evidence by confusion.
 Low self esteem related to dependence to other as

evidence by paralysis.

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