LESSON PLAN

CLASS: Bsc Nursing 3rd year

SUBJECT: Medical Surgical Nursing
TOPIC: Cerebro Vascular Accident.
SUBMITTED BY
Miss Simranpreet kaur
Asst professor
APS College of nursing , malsian, jalandhar
Name of the Teacher: Miss Simranpreet kaur

Designation: Assistant Professor

Subject: Medical Surgical Nursing

Unit: 3

Topic: Cerebro vascular Accident

Previous Knowledge: Students are aware of anatomy and physiology of nervous system and the cerebral circulation.

Method of Teaching: Lecture cum Discussion

Media of Instruction: LCD

GENERAL OBJECTIVE:

At the end of the teaching the students are able to explain the definition, incidence, etiology, types, pathophysiology, clinical
manifestations, assessment, diagnostic findings and management of Cerebro vascular Accident and develop attitude and skills in
providing care to patients with Cerebro vascular Accident.

SPECIFIC OBJECTIVE:

At the end of the teaching, the students are able to

 Define Cerebro vascular Accident.

 Estimate the incidence of Cerebro vascular accident.
 List the etiology and risk factors of Cerebro vascular accident.
 Classify the types of Cerebro vascular accident.
 Explain the pathophysiology of Cerebro vascular accident.
 Identify the signs and symptoms of Cerebro vascular accident.
 Mention the diagnostic evaluation of Cerebro vascular accident.
 Discuss the Management of Cerebro vascular accident.
 Draw a Nursing care plan for patient with Cerebro vascular accident.
S.No Specific Time Content Teacher,s & Evaluation
Objective Learner,s
Activity/ AV
AIDS
1. Understand the 2 INTRODUCTION
concept of mins ABOUT SELF
cerebro vascular My Name is Lecture What is circle of willis?
accident. Ms.Simranpreet kaur , Asst Cum
Professor , A.P.S College of discussion
Nursing Malsian, Jalandhar
2 To assess the 1 Showing
QUESTION :
previous mins chart on
1. What do you mean
knowledge of Circle Of
by infarction ?
the group Willis
2. How many
chambers in the
heart?
3. How will you
What is the other name for CVA?
explain blood
circulation?
Lecture and
asking
Questions

3. Define cerebro 5 What is the incidence rate of CVA?

vascular mins INTRODUCTION:
accident Cerebro vascular accident is
also called as stroke or
brain attack that results How are the risk factors classified?
from lack of blood supply Lecture
to the brain due to
4. obstruction or hemorrhage
leading to death of brain
cells where the functions
Estimate the such as movement,
Incidence of sensations or emotions that
cerebro vascular were controlled by the
accident. affected area are lost or Lecture cum
impaired. Discussion

List the etiology DEFINITION:

and risk factors Cerebro vascular accident
of Cerebro occurs when there is
vascular ischemia (inadequate blood
accident. flow) to a part of the brain
or hemorrhage into the
brain that results in death of
the brain cells
Explaining in
INCIDENCE: blackboard
It is estimated that there are
160,000 deaths with stroke
and 16,000 deaths occur
every year.

ETIOLOGY\RISK
FACTORS:
i. Non- Modifiable Risk
Factors:
Age: The risk factor of
stroke increases with age,
doubling each decade after
55 yrs of age.
Gender: Strokes more
commonly occur in men
than women and they have
the tendency to suffer with
 stroke.
Race: Stroke is found
mostly in African
Americans and southern
white men.
Family History: A family
history of stroke increases
the risk of stroke in the
generation.
ii. Modifiable Risk Factors:
Hypertension: Increased
systolic and diastolic Bp
increases the risk of stroke.
Heart Disease: Hert
diseases like atrial
fibrillation, MI,
Cardiomyopathy, cardiac
valve abnormalities and
cardiac congenital defects
increases the risk of stroke
Smoking: Smoke contains
a substance called nicotine
which causes platelet
aggregation and release of
catecholamines which
causes vasoconstriction thus
3 reducing blood supply to
mins brain tissue.
Alcohol: People who drink What are the types of stroke?
more than one alcoholic
drinks per day are at higher
risk for cerebro vascular
accident.
5. Obesity: Obesity increases
ischemic stroke in all ethnic
groups. Individuals who are
overweight or obese
10 experience large decreases Lecture cum
mins the life expectancy. In discussion
addition obesity is also Using How does embolic stroke occur?
associated with blackboard to
Classify the hypertension and high explain the
types of Cerebro blood glucose. different
vascular Physical Inactivity: It types of
6. accident increases the risk of stroke stroke
as the energy is not released
due to loss of activity and
therefore there is deposition
of fats in the walls of the
arteries. Lecture cum
Oral Contraceptives: High discussion
levels of progestin and
Explain the estrogen increases the
pathophysiology woman’s chance of
of Cerebro experiencing a stroke.
vascular
accident TYPES OF STROKE: What are the signs and symptoms of stroke?
i. Ischemic stroke:
 Embolic
 Thrombotic
4  Lacunar
mins ii. Hemorrhagic stroke:
 Sub arachnoid
hemorrhage
 Intra cerebral
hemorrhage
7. PATHOPHYSIOLOGY

Due to fatty streak

deposition or injury to the
walls of the cerebral arteries Lecture cum
discussion
How will you Diagnose patients with stroke?
Attraction of the platelets to
Identify the the injured site
signs and
symptoms of
Cerebro 3 Development of thrombus
vascular mins
accident Narrowing of the lumen of
the blood vessel

Obstruction of blood flow

8. to the tissues

Infarction of brain tissue

CLINICAL Lecture, What is the medical management of stroke?

MANIFESTATION discussion
Mention the  Impaired mobility and
diagnostic  Impaired respiratory demonstration
evaluation of function of
Cerebro  Impaired reflexes neurological
vascular  Impaired speech assessment
accident  Akinesia
10  Aphasia
 mins  Dyspahasia
 Homonymous
hemianopsia
 Agnosia
 Apraxia
9.  Ataxia
 Bladder and bowel
disturbances.

DIAGNOSTIC FINDINGS
 History collection
Lecture cum
 Physical Examination
discussion
Discuss the  Neurological
Management of Examination
Cerebro  Stroke Pack Analysis
vascular  CT scan
accident  CT angiography
 MRI
 MR Angigraphy
 Positron Emission Tell some nursing diagnosis related to stroke?
Tomography
 MR Spectroscopy
 Cerebral Angiography
 Trans cranial Doppler
 Lumbar Puncture with
CSF Analysis
 Electroencephalogram

MANAGEMENT
i. Drug Therapy:
Anti platelet drugs
Fibrinolytic therapy
 Calcium channel
10 blockers
mins Anti seizure drugs
Osmotic diuretics
Loop diuretics
ii. Maintain ABC’s of the
patient
iii. Oxygen administration
10. iv.Artificial airway
insertion
v. Endo tracheal Intubation
& Mechanical Lecture cum
ventilation discussion
vi. Adequate hydration
vii. Monitor intake output
chart.
Draw a nursing Surgical Management:
care plan for a i. Burrhole with
patient with craniotomy I case oh
cerebro vascular hemorrhagic stroke to
accident. decrease ICP.
ii. Transluminal
Angioplasty to open a
stenosed artery.
iii. Carotid Endartectomy
to remove the plaque
from the arteries.
iv. Extra cranial- Intra
2 carnial Bypass to
mins anastamose the artery
beyond obstruction.

NURSING
 MANGEMENT:
 Impaired physical
mobility related to
11. altered neural function
secondary to stenosis of
1 cerebral artery.
min  Impaired cerebral tissue
perfusion related to
ischemia of the cerebral
arteries.
 Ineffective airway
clearance related to
decreased reflexes
12. secondary to infarction
of brain tissue.
 Ineffective Breathing
pattern related to
ischemia to the brain
cells.
 Deficient self care
related to impaired motor
and sensory function.
 Deficient Knowledge
regarding prognosis ad
self care management.

SUMMARY: Till now we

have seen the definition,
incidence, etiology & risk
factors, pathophysiology,
clinical manifestation,
diagnostic findings and
management of a patient
 with cerebro vascular
accident.

CONCLUSION:
I hope you all understood
the topic and you would be
able to give compassionate
care for patients admitted
with cerebro vascular
accident.

Recapitalization:

1. What is cerebro vascular accident?

2. List down the types of cerebro vascular accident?

3. What do you mean by aphasia?

4. What is the use of osmotic diuretic in treating stroke?

5. What is the nursing management done to prevent bed sores for a bedridden patient after stroke attack?

Assignment:

Draw a nursing care plan for a patient with stroke.

BIBLIOGRPHY:
 Lewis Hitkemper, (2009) “Text book of Medical surgical Nursing, Mosby Publishers, Pg.1563-1571.ov.in

Black. M.Joyce, (2007) “ Text book of Medical Surgical Nursing, W.B. Saunder’s, Philadelphia, Pg. 1732-1742.

Brunner & Suddharth, (2008) “ Text book of Medical Surgical Nursing”, Vol-II, Lippincott Williams & Wilkins company.

Guyton.A & Hall, (2002)”Text book of Medical Physiology” 10th Edition, Philadelphia, W.B.Saunder’s Company.

Miessers .M.H.(2000) “Thronmbosis & Atherosclerosis development” Journal Of Vascular Surgery 32 (1) pg. 48-56.

Http://www.Arterial thrombosis info.com

Http://www. Nhlbi.nih.g