STROKE CONT

STROKE

{ NUR2173
BY PN WAN NAPISAH WAN OMAR

On completion of this chapter, the learner will
be able to:
1.Describe the incident and impact of
cerebrovascular disorders.
2.Identify the risk factors for cerebrovascular
disorders and related measures for prevention.
3.Compare the various types of cerebrovascular
disorders: their causes,clinical manifestations
and medical management.

LEARNING OBJECTIVE

4. Explain the principles of nursing
management as they related to the care of a
patient in the acute stage of an ischemic
stroke.

5. Apply the nursing process as a framework
for care of a patient recovering from an
ischemic stroke & hemorrhagic stroke.

6. Discuss essential elements for family
education and preparation for home care of
the patient who has had stroke.

LEARNING OBJECTIVE

Stroke can be divided into two major
categories:

ISCHEMIC STROKE HEMORRHAGIC STROKE

INTRODUCTION

TYPES OF CAUSES MAIN RECOVERY
STROKE SYMPTOMS

ISCHEMIC • Large artery • Numbness or 6 months

thrombosis weakness of the

• Small penetrating face,arm, or leg,

artery thrmbosis esp one side of

• Cardiogenic the body.

embolic

• Cryptogenic

(unknown)

HEMORRHAGIC • AVM • “Exploiding 18months
• ICH
• SAH headache”
• Cerebral
aneurysm • Decrease level

of conciousness

5 Comparison



 About 80 percent of strokes are ischemic
strokes.

 Ischemic strokes occur when the arteries to
your brain become narrowed or blocked,
causing severely reduced blood flow
(ischemia).

 The most common ischemic strokes is
i. thrombotic stroke
ii. embolic stroke

Ischemic stroke

occurs when a blood clot (thrombus) forms
in one of the arteries that supply blood to
your brain.

A clot may be caused by fatty deposits
(plaque) that build up in arteries and cause
reduced blood flow (atherosclerosis) or
other artery conditions.

Thrombotic stroke

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occurs when a blood clot or other debris
forms away from your brain — commonly
in your heart — and is swept through your
bloodstream to lodge in narrower brain
arteries.

This type of blood clot is called an embolus

Embolic stroke

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occurs when a blood vessel in your brain
leaks or ruptures. Brain hemorrhages can
result from many conditions that affect your
blood vessels. These include:

1) Uncontrolled high blood pressure
(hypertension)

2) Overtreatment with anticoagulants (blood
thinners)

3) Weak spots in your blood vessel walls
(aneurysms)

Hemorrhagic stroke

1) Intracerebral hemorrhage.

 a blood vessel in the brain bursts and spills into the
surrounding brain tissue, damaging brain cells. Brain
cells beyond the leak are deprived of blood and are
also damaged.

 High blood pressure, trauma, vascular malformations,
use of blood-thinning medications and other
conditions may cause an intracerebral hemorrhage.

Types of hemorrhagic stroke

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2) Subarachnoid hemorrhage.

 an artery on or near the surface of your brain
bursts and spills into the space between the surface
of your brain and your skull. This bleeding is often
signaled by a sudden, severe headache.

 A subarachnoid hemorrhage is commonly caused
by the bursting of a small sack-shaped or berry-
shaped aneurysm.

 After the hemorrhage, the blood vessels in your
brain may widen and narrow erratically
(vasospasm), causing brain cell damage by further
limiting blood flow.

Types of hemorrhagic stroke
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1) Being overweight or obese
2) Physical inactivity
3) Heavy or binge drinking
4) Use of illicit drugs such as cocaine and

methamphetamines

Lifestyle risk factors

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 Blood pressure readings higher than 120/80
millimeters of mercury (mm Hg)

 Cigarette smoking or exposure to secondhand
smoke

 High cholesterol
 Diabetes
 Obstructive sleep apnea
 Cardiovascular disease, including heart failure,

heart defects, heart infection or abnormal heart
rhythm
 Personal or family history of stroke, heart attack
or transient ischemic attack

Medical risk factors

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1) Age —People age 55 or older have a higher risk of
stroke than do younger people.

2) Race — African-Americans have a higher risk of
stroke than do people of other races.

3) Sex — Men have a higher risk of stroke than
women. Women are usually older when they have
strokes, and they're more likely to die of strokes
than are men.

4) Hormones — use of birth control pills or hormone
therapies that include estrogen, as well as
increased estrogen levels from pregnancy and
childbirth.

Other factors

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 A stroke can sometimes
cause temporary or
permanent disabilities,
depending on how long
the brain lacks blood
flow and which part was
affected.

Complications

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1. Paralysis or loss of muscle movement. You

may become paralyzed on one side of your body.
Need Physical therapy ; such as walking, eating and
dressing.

2. Difficulty talking or swallowing. A stroke

might affect control of the muscles in your mouth and
throat, making it difficult for you to talk clearly
(dysarthria), swallow (dysphagia) or eat. You also
may have difficulty with language (aphasia),
including speaking or understanding speech, reading,
or writing. Therapy with a speech-language
pathologist might help.

Complication

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3. Memory loss or thinking
difficulties. Others may have difficulty

thinking, making judgments, reasoning and
understanding concepts.

4. Emotional problems - may have more
difficulty controlling their emotions, or they
may develop depression.

cont

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5. Pain, numbness or other strange sensations
may occur in the parts of the body affected by stroke.

People also may be sensitive to temperature changes,
especially extreme cold, after a stroke. This
complication is known as central stroke pain or central
pain syndrome. This condition generally develops
several weeks after a stroke, and it may improve over
time.

6. Changes in behavior and self-care ability.
People who have had strokes may become more
withdrawn and less social or more impulsive. They
may need help with grooming and daily chores.

cont.

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2019/9/19

1. Controlling high blood pressure (hypertension).
Exercising, managing stress, maintaining a healthy
weight and limiting the amount of sodium and
alcohol you eat and drink can all help to keep high
blood pressure in check. In addition to
recommending lifestyle changes, your doctor may
prescribe medications to treat high blood pressure.

2. Eating less cholesterol and fat, especially saturated
fat and trans fats, may reduce the plaque in your
arteries. If you can't control your cholesterol through
dietary changes alone, your doctor may prescribe a
cholesterol-lowering medication.

Prevention 2019/9/19

3. Quitting tobacco use. Smoking raises the risk
of stroke for smokers and nonsmokers
exposed to secondhand smoke.

4. Controlling diabetes - manage diabetes with
diet, exercise, weight control and medication.

5.Maintaining a healthy weight. Being
overweight contributes to other stroke risk
factors, such as high blood pressure,
cardiovascular disease and diabetes.

cont. 2019/9/19

6. Eating a diet rich in fruits and vegetables. -olive oil,
fruit, nuts, vegetables and whole grains, may be
helpful.

7. Exercising regularly - Aerobic or "cardio" exercise.
Exercise can lower your blood pressure, increase
your level of high-density lipoprotein cholesterol,
and improve the overall health of your blood vessels
and heart. It also helps you lose weight, control
diabetes and reduce stress.

8. Heavy alcohol consumption increases your risk of
high blood pressure, ischemic strokes and
hemorrhagic strokes.

cont. 2019/9/19

9. Treating obstructive sleep apnea (OSA). a sleep
disorder in which the oxygen level intermittently
drops during the night. Treatment for OSA includes
oxygen at night or wearing a small device in your
mouth to help you breathe.

10. Avoiding illegal drugs. Certain street drugs, such
as cocaine and methamphetamines, are established
risk factors for a TIA or a stroke. Cocaine reduces
blood flow and can narrow the arteries.

cont. 2019/9/19

1.Physical examination. Doctor will ask patient
or a family member :

what symptoms
 when they started and
what were doing when they began.
 what medications you take
whether have experienced any head injuries.
 history of heart disease, transient ischemic

attack and stroke

Diagnosis 2019/9/19

2.Blood tests.
3.Computerized tomography (CT) scan. A CT

scan can show a hemorrhage, tumor, stroke
and other conditions. Doctors may inject a
dye into bloodstream to view blood vessels
in neck and brain in greater detail
(computerized tomography angiography)

4.Magnetic resonance imaging (MRI). An
MRI uses powerful radio waves and
magnets to create a detailed view of your
brain. An MRI can detect brain tissue
damaged by an ischemic stroke and brain
hemorrhages.

cont. 2019/9/19

5.Carotid ultrasound. sound waves - shows buildup
of fatty deposits (plaques) and blood flow in the
carotid arteries.

6.Cerebral angiogram - doctor inserts a thin, flexible
tube (catheter) through a small incision, usually via
groin, and guides it through major arteries and into
carotid or vertebral artery. Then the doctor injects a
dye into blood vessels to make them visible under
X-ray imaging.

7.Echocardiogram

- uses sound waves to create detailed images of the
heart

-can find a source of clots in the heart that may have
traveled from heart to brain and caused stroke.

cont. 2019/9/19

8.transesophageal echocardiogram.

- doctor inserts a flexible tube with a small device
(transducer) attached into the throat and down into
the tube that connects the back of mouth to
stomach (esophagus).

- esophagus is directly behind the heart, a
transesophageal echocardiogram can create clear,
detailed ultrasound images of the heart and any
blood clots.

cont. 2019/9/19

 Anti-platelet drugs. The most commonly used anti-platelet
medication is aspirin . Doctor may instead prescribe an anti-
platelet drug such as clopidogrel (Plavix).

 Anticoagulants. These drugs, which include heparin and
warfarin (Coumadin, Jantoven), reduce blood clotting.
Heparin is fast acting and may be used over a short period of
time in the hospital. Slower acting warfarin may be used over
a longer term.Warfarin is a powerful blood-thinning drug, so
patient need to take it exactly as directed and watch for side
effects.

Treatment 2019/9/19

1.Intravenous injection of tissue plasminogen
activator (tPA). -also called alteplase, is
considered the gold standard treatment for
ischemic stroke.

-given through a vein. This potent clot-busting
drug ideally is given within three hours.

2.Emergency endovascular procedures.

-Medications delivered directly to the brain.

-Removing the clot with a stent retriever.

3.Other procedures.

-Carotid endarterectomy.

-Angioplasty and stents.

Treatment (ischemic stroke)
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-focuses on controlling bleeding and reducing
pressure in the brain.

-might need surgery to help reduce future
risk.

Surgical blood vessel repair.
1. Surgical clipping.
2. Coiling (endovascular embolization).
3. Surgical AVM removal.
4. Stereotactic radiosurgery.

Emergency treatment of hemorrhagic stroke 2019/9/19

 The impact of your stroke depends on the area of
the brain involved and the amount of tissue
damaged.

 If your stroke affected the right side of your brain,
your movement and sensation on the left side of
your body may be affected.

 If your stroke damaged the brain tissue on the left
side of your brain, your movement and sensation
on the right side of your body may be affected.

 Brain damage to the left side of your brain may
cause speech and language disorders.

Stroke recovery and rehabilitation

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Nursing Management

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