CEREBROVASCULAR

ACCIDENT
Reporter: John Marlo R. Olaybar
Cerebrovascular Accident (CVA)is a medical term for Stroke.

“Blood flow to a part of your brain is

stopped either by a blockage or the
rupture of a blood vessel. “

“So basically, The brain cells cannot get the oxygen and nutrients they need from blood because as
I have said a while ago, blood flow is stopped/blocked or either the rupture of the blood vessels, and
the brain cells start to die within a few minutes. This can cause lasting brain damage including; long-
term disability, or even death.”
 Three types of Stroke
Ischemic stroke I Hemorrhagic stroke
 Most common type of cancer
 This happens when blood flow
through the artery that supplies
oxygen-rich blood to the brain
becomes blocked.
I Transient ischemic attack
 A transient ischemic attack
(TIA) is sometimes called a
 It's less common than an “mini-stroke.”
ischemic stroke but can be
more serious.
 This 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.
2 types:
 Intracerebral hemorrhage
 Subarachnoid hemorrhage
 Three types of Stroke
Ischemic stroke I Hemorrhagic stroke I Transient ischemic attack
We have Major three types of stroke:
The Ischemic, Hemorrhagic & Transient Ischemic attack.
The Ischemic stroke is- Most common type of cancer where in it makes up to 87% of strokes in the
human population who experience this disease.

This happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes
blocked. so

The blockage reduces the blood flow and oxygen to the brain, leading to damage or death of brain cells.

Hemorrhagic Stroke 2 types:

Intracerebral hemorrhage

- is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts,
flooding the surrounding tissue with blood.

Subarachnoid hemorrhage

- is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain
and the thin tissues that cover it.
 Three types of Stroke
Ischemic stroke I Hemorrhagic stroke I Transient ischemic attack
We have three types of stroke:
The Ischemic, Hemorrhagic & Transient Ischemic attack.
A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different
from the major types of stroke because blood flow to the brain is blocked for only a
short time—usually no more than 5 minutes

-A TIA is a warning sign of a future stroke.

-A TIA is a medical emergency, just like a major stroke.

Etiology/ Causative Factors/ Risk Factors of CVA
 High blood pressure
-It's the biggest cause of strokes.

- If your blood pressure is typically 140/90 or higher

 Tobacco
-Smoking or chewing it raises your odds of a stroke. Nicotine makes your blood pressure
go up. Cigarette smoke causes a fatty buildup in your main neck artery. It also thickens
your blood and makes it more likely to clot. Even secondhand smoke can affect you.

 Heart Disease -This condition includes defective heart valves as well as atrial fibrillation, or
irregular heartbeat, which causes a quarter of all strokes among the very
elderly. You can also have clogged arteries from fatty deposits.

 Diabetes
-People who have it often have high blood pressure and are more likely to be
overweight. Both raise the chance of a stroke. Diabetes damages your blood vessels,
which makes a stroke more likely. If you have a stroke when your blood sugar levels
are high, the injury to your brain is greater.
 ASSESSMENT & DIAGNOSTIC TOOLS
 strength
 reflexes
 vision
 speech
 senses
 check for a particular sound in the blood vessels of
your neck
 blood pressure

Healthcare providers have a number of tools to determine whether you’ve had a stroke. Your healthcare provider
will administer a full physical examination, during which they’ll check your strength, reflexes, vision, speech, and
senses. They’ll also check for a particular sound in the blood vessels of your neck. This sound, which is called a bruit,
indicates abnormal blood flow. Finally, they will check your blood pressure, which may be high if you’ve had a
stroke.
ASSESSMENT & DIAGNOSTIC TOOLS

 Blood tests
 Angiogram
 Carotid ultrasound
 CT scan
 MRI scan
 Echocardiogram
 Electrocardiogram
ASSESSMENT & DIAGNOSTIC TOOLS
Blood tests: Your healthcare provider may want to test your blood for
clotting time, blood sugar levels, or infection. These can all affect the
likelihood and progression of a stroke.

Angiogram: An angiogram, which involves adding a dye to your blood and

taking an X-ray of your head, can help your doctor find the blocked or
hemorrhaged blood vessel.

Carotid ultrasound: This test uses sound waves to create images of the
blood vessels in your neck. This test can help your provider determine if
there’s abnormal blood flow toward your brain.

CT scan: A CT scan is often performed soon after symptoms of a stroke

develop. The test can help your provider find the problem area or other
problems that might be associated with stroke.

MRI scan: An MRI can provide a more detailed picture of the brain
compared to CT scan. It’s more sensitive than a CT scan in being able to
detect a stroke.

Echocardiogram: This imaging technique uses sound waves to create a

picture of your heart. It can help your provider find the source of blood
clots.

Electrocardiogram (EKG): This is an electrical tracing of your heart. This will

help your healthcare provider determine if an abnormal heart rhythm is the
cause of a stroke.
CVA Pathology
CVA Pathology
 Nursing Care Plan
Asessment Diagnosis Planning

Subjective:N/AObjective Cues:- - Impaired Physical Mobility Within 8 hours of nursing

Weakness noted- Hemiparesis noted r/t decreased muscle interventions the patient will
- Absence of control in movement of strength/control secondary to maintain optimal position of body
the left part of the body- Patient cerebrovascular accident function.
observe to be at bed always resting -
Loss of muscle control to some of the
body parts- Left hand is always
dropped - Head cannot resist
application of slight amount of force-
Vital signs are taken as follows:T:
38.5 DC PR:90 bpm RR: 20 cpm
BP: 130/90 mmHg O2 sat:
97%
 Nursing Care Plan
Implementation
- Assess extent of impairment initially and on a regular
basis. Classify according to 0–4 scale.
- Observe affected side for color, edema, or other signs
of compromised circulation.
- Asked patient to rate pain or discomfort on the scale of bony prominences. Gently massage any
1-10
- Change positions at least every 2 hr (supine, side
lying) and possibly more often if placed on affected side. sensation and is more predisposed to
- Prop extremities in functional position; use footboard
during the period of flaccid paralysis. Maintain neutral
position of head.
- Use arm sling when patient is in upright position, as
indicated.
Rationale
- Identifies strengths and deficiencies
Evaluation
After 8 hours of nursing interventions the
that may provide information regarding patient maintain optimal position of function
recovery. Assists in choice of as evidenced by absence of contractures
interventions, because different and foot drop. - Endorsed to staff nurse on
techniques are used for flaccid and duty with the latest vital signs of:T: 37.5 DC
spastic paralysis. PR:90 bpm RR: 17 cpm BP: 120/80
- Edematous tissue is more easily O2 sat: 97% ---------------------J.M.R.
traumatized and heals more slowly. OLAYBAR,FSUU,SN
- Inspect skin regularly, particularly over
reddened areas and provide aids such
as sheepskin pads as necessary.
- Reduces risk of tissue injury. Affected
side has poorer circulation and reduced
skin breakdown.
-Prevents contractures and footdrop and
facilitates use when function returns.
Flaccid paralysis may interfere with
ability to support head, whereas spastic
paralysis may lead to deviation of head
to one side.
- During flaccid paralysis, use of sling
may reduce risk of shoulder subluxation
and shoulder-hand syndrome.
 Nursing Care Plan
Implementation
- Place pillow under axilla to abduct arm
- Elevate arm and hand
- Place hard hand-rolls in the palm with fingers and
thumb opposed.
- Maintain leg in neutral position with a trochanter roll
- Assist patient with exercise and perform ROM
exercises for both the affected and unaffected sides.
Teach and encourage patient to use his unaffected side
to exercise his affected side
.- Assist patient to develop sitting balance by raising
head of bed, assist to sit on edge of bed, having patient
to use the strong arm to support body weight and move
using the strong leg. Assist to develop standing balance
by putting flat walking shoes, support patient’s lower
back with hands while positioning own knees outside
patient’s knees, assist in using parallel bars.
Rationale Evaluation
After 8 hours of nursing interventions the
- Prevents adduction of shoulder and patient maintain optimal position of function
flexion of elbow. as evidenced by absence of contractures
and foot drop. - Endorsed to staff nurse on
- Promotes venous return and helps duty with the latest vital signs of:T: 37.5 DC
prevent edema formation. PR:90 bpm RR: 17 cpm BP: 120/80
- Hard cones decrease the stimulation of O2 sat: 97% ---------------------J.M.R.
finger flexion, maintaining finger and OLAYBAR,FSUU,SN
thumb in a functional position.
- Prevents external hip rotation.
- ROM exercise helps in reducing
muscle stiffness and spasticity. It can
also helps prevent contractures.
- Aids in retraining neuronal pathways,
enhancing proprioception and motor
response.
Complications
According to Hoffman (2018) complications after stroke are medical,
emotional and neurological problems that can affect a survivor after a stroke
event. In one study, 85% of patients hospitalized for stroke experienced at
least one complication following the stroke. A survivor may experience
major or minor complications, depending on the severity of the stroke and
other factors. Complications are not always permanent. In many cases, they
can be addressed with timely and appropriate treatment. After an individual
suffers from cardiovascular accident, the symptoms will not usually end
there as for the reason that there will be cascading effects of this disease to
the individual who experienced it. If patient who suffers from CVA did not
further adhere unto the management of the disease it might lead to
complications or further degradation of health.
 Complications
According to American Heart Association (2015) the most common complications that a patient who
suffers from CVA will most likely experience the following:

Brain edema — swelling of the brain after a stroke.

Pneumonia — causes breathing problems, a complication of many major illnesses. Pneumonia occurs
as a result of not being able to move as a result of the stroke. Swallowing problems after stroke can
sometimes result in things ‘going down the wrong pipe’, leading to aspiration pneumonia.
Urinary tract infection (UTI) and/or bladder control - UTI can occur as a result of having a foley
catheter placed to collect urine when the stroke survivor cannot control bladderd function
Seizures — abnormal electrical activity in the brain causing conv
Bedsores — pressure ulcers that result from decreased ability to move and pressure on areas of the
body because of immobility.
Limb contractures — shortened muscles in an arm or leg from reduced ability to move the affected
limb or lack of exercise.
Deep venous thrombosis (DVT) — blood clots form in veins of the legs because of immobility from
stroke.
Clinical depression — a treatable illness that often occurs with stroke and causes unwanted
emotional and physical reactions to changes and losses. This is very common after stroke or may be
worsened in someone who had depression before the stroke
 References:
American Heart Association (2015). Complications After Stroke. Retrieved from:
https://www.stroke.org/-/media/stroke-files/lets-talk-about-stroke/life-after-
stroke/ltas_complications-after-stroke.pdf?la=en

Hoffman H. (2018). Common Complications After Stroke: What Are They and What Can Be
Done?. Retrieved from: https://www.saebo.com/blog/common-complications-stroke-can-done/
THANK YOU