CEREBROVASCULAR

ACCIDENTS
JULIUS CEASAR P. SINCO, R.N
 CEREBROVASCULAR ACCIDENTS
• An umbrella term that refers to any
functional abnormality of the CNS
related to disrupted blood supply
 CEREBROVASCULAR ACCIDENTS
• Can be divided into two major categories
• 1. Ischemic stroke- caused by thrombus and
embolus
• 2. Hemorrhagic stroke- caused commonly by
hypertensive bleeding
 CEREBROVASCULAR ACCIDENTS
The stroke continuum
• 1. TIA- transient ischemic attack, temporary
neurologic loss less than 24 hours duration
• 2. Reversible Neurologic deficits
• 3. Stroke in evolution
• 4. Completed stroke
General manifestations
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
• There is disruption of the cerebral blood flow
due to obstruction by embolus or thrombus
 RISKS FACTORS
Non-modifiable
• Advanced age Modifiable
• Gender • Hypertension
• race • Cardio disease
• Obesity
• Smoking
• Diabetes mellitus
• hypercholesterolemia
Pathophysiology of ischemic stroke
• Disruption of blood supply
• Anaerobic metabolism ensues
• Decreased ATP production leads to impaired
membrane function
• Cellular injury and death can occur
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
• DIAGNOSTIC test
• 1. CT scan
• 2. MRI
• 3. Angiography
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
CLINICAL MANIFESTATIONS
• 1. Numbness or weakness
• 2. confusion or change of LOC
• 3. motor and speech difficulties
• 4. Visual disturbance
• 5. Severe headache
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
Motor Loss
• Hemiplegia
• Hemiparesis
CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke

Communication loss
• Dysarthria= difficulty in speaking
• Aphasia= Loss of speech
• Apraxia= inability to perform a previously
learned action
CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke

Perceptual disturbances
• Hemianopsia

Sensory loss
• paresthesia
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
1. Improve Mobility and prevent joint
deformities
• Correctly position patient to prevent
contractures
– Place pillow under axilla
– Hand is placed in slight supination- “C”
– Change position every 2 hours
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
2. Enhance self-care
• Carry out activities on the unaffected side
• Prevent unilateral neglect
• Keep environment organized
• Use large mirror
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
3. Manage sensory-perceptual difficulties
• Approach patient on the Unaffected side
• Encourage to turn the head to the affected
side to compensate for visual loss
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
4. Manage dysphagia
• Place food on the UNAFFECTED side
• Provide smaller bolus of food
• Manage tube feedings if prescribed
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
5. Help patient attain bowel and bladder control
• Intermittent catheterization is done in the
acute stage
• Offer bedpan on a regular schedule
• High fiber diet and prescribed fluid intake
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
6. Improve thought processes
• Support patient and capitalize on the
remaining strengths
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke

NURSING INTERVENTIONS
7. Improve communication
• Anticipate the needs of the patient
• Offer support
• Provide time to complete the sentence
• Provide a written copy of scheduled activities
• Use of communication board
• Give one instruction at a time
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke

NURSING INTERVENTIONS
8. Maintain skin integrity
• Use of specialty bed
• Regular turning and positioning
• Keep skin dry and massage NON-reddened
areas
• Provide adequate nutrition
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke

NURSING INTERVENTIONS
9. Promote continuing care
• Referral to other health care providers
 CEREBROVASCULAR ACCIDENTS: Ischemic
Stroke
NURSING INTERVENTIONS
10. Improve family coping
11. Help patient cope with sexual dysfunction
 CVA: Hemorrhagic Stroke
• Normal brain metabolism is impaired by
interruption of blood supply, compression and
increased ICP
• Usually due to rupture of intracranial
aneurysm, AV malformation, Subarachnoid
hemorrhage
 CVA: Hemorrhagic Stroke
• Sudden and severe headache
• Same neurologic deficits as ischemic stroke
• Loss of consciousness
• Meningeal irritation
• Visual disturbances
 CVA: Hemorrhagic Stroke
• DIAGNOSTIC TESTS
• 1. CT scan
• 2. MRI
• 3. Lumbar puncture (only if with no increased
ICP)
 CVA: Hemorrhagic Stroke
• NURSING INTERVENTIONS
• 1. Optimize cerebral tissue perfusion
• 2. relieve Sensory deprivation and anxiety
• 3. Monitor and manage potential
complications