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Cerebrovascular Accident Report
Cerebrovascular Accident Report
DEFINITION
Cerebrovascular accident (CVA) is the medical term for what is commonly termed a
stroke. It refers to the injury to the brain that occurs when flow of blood to brain tissue is
interrupted by a clogged or ruptured artery, causing brain tissue to die because of lack of
nutrients and oxygen.
DESCRIPTION
The severity associated with cerebrovascular accident can best be demonstrated by the following
facts:
Strokes affect men more often than women, although women are more likely to die from
a stroke.
The incidence of strokes among people ages 30 to 60 is less than 1%. This figure triples
by the age of 80.
Stroke Society of the Philippines (SSP) by Artemio A. Roxas Jr., MD (2016). Stroke is a
leading cause of disability and the second leading cause of death in the Philippines. With
an epidemic of unmanaged stroke risk factors and an aging population, we expect to see
more stroke patients.
RISK FACTORS
A Non-Modifiable
3 Race- - Statistics show that African-Americans have a much higher risk of death from a
stroke than Caucasians do. This is partly because blacks have higher risks of high blood
pressure, diabetes and obesity
B Partially Modifiable
1 Hypertension- during this case the blood vessel will narrow causing to decreased
blood circulation
4 Blood Lipid Abnormalities- Large amounts of cholesterol in the blood can build up and
cause blood clots, leading to a stroke
C Modifiable
1 Smoking- When you smoke, you inhale tobacco smoke, which contains over
7,000 toxic chemicals including carbon monoxide, formaldehyde and hydrogen
cyanide. These chemicals are transferred from your lungs into your bloodstream,
changing and damaging cells all around your body. The carbon monoxide you
inhale from cigarette smoke increases levels in your blood, making it more likely
for artery walls to become damaged. The chemicals you inhale also affect the
stickiness of your blood and production of a type of blood cell called a platelet.
This increases your bloods tendency to form clots. These factors increase
smokers risk of developing atherosclerosis whereby arteries become more narrow
and furred up. This reduces the blood flow through them so blood clots are more
likely to form. If a clot forms in an artery leading to the brain, it can then cause a
blockage, cutting off the blood supply and causing a stroke.
2 Obesity- individuals with higher degrees of obesity tended to have higher blood
pressure levels, diabetes prevalence, and higher cholesterol, which are all risk
factors for stroke
3 Stress- our bodies react by releasing stress hormones (adrenaline and cortisol) into
the blood. These hormones prepare the body for the fight or flight response by
making the heart beat faster and constricting blood vessels to get more blood to
the core of the body instead of the extremities.
5 Use of oral contraceptives- it contains estrogen that increases the clotting factor
that can cause ischemic stroke.
CAUSES
1. Thrombosis
- It is the formation of blood clot in the blood vessels and it is the most frequent
cause of CVA
2. Embolism
3. Intracranial Hemorrhage
- It involves interruption in the integrity of the blood vessels supplying the brain
TYPES
1. Ischemic Stroke
- refers to the loss of oxygen and nutrients for brain cells that occurs because the
blood supply to a portion of the brain has been cut off. It is caused by a blocked
blood vessel that supplies blood to the brain.
- can be seen in nearly all aging populations worldwide. . As people grow older,
atherosclerosis, or hardening of the arteries, occurs. This result in a build-up
of a waxy, cholesterol-laden substance in the arteries, which eventually
narrows the interior space, or lumen, of the artery. This arterial narrowing
occurs in all parts of the body, including the brain. As the process continues,
the occlusion, or shutting off, of the artery eventually becomes complete so
that no blood supply can pass through. Usually the occurrence of the
symptoms of a thrombotic stroke are much more gradual and less dramatic
than other strokes due to the slow, ongoing process that produces it.
e.g Transient ischemic attacks (TIAs) is usually the least serious. TIAs represent the
occlusion of a very small artery, or arteriole. This blockage affects only a small
portion of brain tissue and does not leave noticeable permanent ill effects. These
transient ischemic attacks last only a matter of minutes, but are a forewarning that
part of the brain is not receiving its necessary supply of blood, and, consequently,
an insufficient amount of oxygen and nutrients.
- They take place when the heart's rhythm is changed for a number of reasons,
and blood clot formation takes place. Such a blood clot can move through the
circulatory system until it blocks a blood vessel and stops the blood supply to
cells in a specific portion of the body. If the blood clot occludes an artery that
nourishes heart muscle, it causes myocardial infarction, or heart attack. If it
blocks off a vessel that feeds brain tissue, it is termed an embolic stroke.
Normally, these blockages occur in the brain itself, as when arteries directly
feeding portions of brain tissue are blocked by a clot. But occasionally, the
obstruction is found in the arteries of the neck, especially the carotid artery.
2. Hemorrhagic strokes
- occur when an artery to the brain has a weakness and balloons outward, producing
an aneurysm. Such an aneurysm often ruptures due to this inflation and thinning
of the arterial wall, causing a hemorrhage in the affected portion of the brain.
paralysis or weakness on the right side paralysis or weakness on the left side of
of the body the body
right visual field deficit Left visual field deficit
CLINICAL MANIFESTATIONS
CVA can cause a wide variety of neurologic deficits depending on the location of the
lesion/damage, the size of the area of inadequate perfusion and the amount of collateral blood
flow. The patient may present with any of the following signs and symptoms:
- Numbness or weakness of the face, arm, or leg especially on one side of the body
- Slurred speech. Sometimes weakness in the muscles of the face can cause drooling.
- Visual disturbances
Motor loss
Since the upper motor neurons decussate, a disturbance of the voluntary motor control on
one side of the body may reflect damage to the upper motor neurons on the opposite side of the
brain.
Perceptual disturbances
Visual-perceptual dysfunctions are due to disturbances of the primary sensory pathways
between the eye and visual cortex.
Sensory loss
The sensory loss from stroke may take the form o f slight impairment of touch or maybe
more severe, with loss of proprioception as well as difficulty in interpreting visual, tactile, and
auditory stimuli.
Facial weakness: can the person smile? Has the mouth or eye drooped?
Speech problems: can the person speak clearly and understand you?
DIAGNOSIS
3. Electrocardiogram (EKG), angiography, and lumbar puncture are all used to rule out
any other possible causes of the symptoms.
MANAGEMENT
Immediate Treatment
- If a blood clot is the cause, 'clot busting' medication may be used to dissolve the
clot, but this must be given within three hours of the stroke. Anti-clotting
medication such as aspirin may also be given to stop the stroke from getting
worse.
1. Medical
Preventive Medications:
d. Clot-busting drugs (thrombolytic therapy) - This medicine breaks up blood clots and
helps bring back blood flow to the damaged area.
2. Surgical
3. Nursing Interventions
3. Monitor for increasing ICP because the client is at most risk during this phase.
4. Position client on bed with head of the bed elevated at 15-30 degrees or as prescribed.
5. Monitor LOC, papillary response, motor and sensory response, cranial nerves and reflexes.
7. Monitor I and O.
2. Position the client on the unaffected side for 2 hours and on the affected side for 20 mins. As
indicated.
6. Measure thighs and calves for increase in size and assess for (+) Homans sign.
c. CHRONIC PHASE
1. Neglect Syndrome
-teach the client to touch the affected side every now and then
2. Homonymous Hemianopsia
-encourage client to turn head to scan the complete range of visual field.
3. Contractures
-use footboard during the flaccid period following a stroke to keep the feet dorsiflexed, thus
preventing footdrop and plantar flexion
-to prevent external rotation of the hip joint, apply a trochanter roll from the iliac crest to the
midthighs.
-to prevent abnormal adduction of the affected shoulder, place a pillow under the axilla to keep
the arm away from the chest
-to prevent knee and hip flexion contractures, position the client in prone position 15-30 minutes,
2-3x a day.
MANAGEMENT:
GADGETS:
1. Mechanical-ventilator
- A mechanical ventilator is a machine that makes it easier for patients to breathe until they
are able to breathe completely on their own. Sometimes the machine is called just a
ventilator, respirator or breathing machine. Usually, a patient is connected to the
ventilator through a tube (called an endotracheal tube) that is placed in the windpipe.
Sometimes, patients can use a machine that assists breathing through a mask or
mouthpiece but this may not work with severe respiratory problems. Despite their life-
saving benefits, mechanical ventilators carry many risks. Therefore, the goal is to help
patients recover as quickly as possible to get them off the ventilator at the earliest
possible time.
2. Defibrillator
3. ECG machine
4. pulse oximetry
- It monitors the level of oxygen in a patient's blood and alert the health-care worker if
oxygen levels drop below safe levels, allowing rapid intervention. These devices are
essential in any setting in which a patient's blood oxygen levels requires monitoring like
operations, emergency and intensive care, and treatment and recovery in hospital wards.
5. Suction machine
- A portable suction apparatus used in wards and theatres for aspirating fluids and vomit
from the mouth and airways, and from operation sites by sucking the material through a
catheter into a bottle. The term could also apply to devices which operate from piped
vacuum supplies or bottle gas cylinders but is more commonly used to mean electric
suction units which contain a vacuum pump (piston, diaphragm, or rotary vane),
bacterial filter, vacuum gauge, trap for moisture (or any debris accidentally drawn into
the mechanism), a reservoir for the aspirated material, and a suction catheter or nozzle
6. Oxygenation treatment
8. Foley Catheter
- This is a flexible rubber tube (catheter) placed into the bladder to drain urine. This helps us to
measure the amount of urine coming out.
- This is a small pressure sensor that is placed surgically beneath the skull. It attaches to the
ICP monitor at the top of the bed. It allows staff to continuously watch the ICP.
11. Monitor
- The monitor is a machine at the side or head of the bed. It helps to watch the heart rate and
rhythm. It also gives readings of blood pressure, respirations, and heart and lung pressures
when needed.
Mariano Marcos State University
COLLEGE OF HEALTH SCIENCES
Department of Nursing
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In Partial Fulfillment
Of the Requirements in the Subject
NSG 163
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CEREBROVASCULAR ACCIDENT
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Presented by:
CID, JEROME CLARK C.
TUNGPALAN, JOSHUA S.
NALUNDASAN, ARNEEH MAE B.
SORIANO, JENNY ANNE LOREIN B.
Presented to:
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April 2017