CEREBROVASCULAR

ACCIDENT

Presented by,
Ms. Anupama .Varghese
I year M.Sc. Nursing
Bishop Benziger College of Nursing, Kollam
Introduction
◦ A cerebrovascular accident (CVA), an ischemic stroke or “brain attack,” is a
sudden loss of brain function resulting from a disruption of the blood supply to
a part of the brain.
 Definition

◦ Stroke or cerebrovascular
accident occurs when there is
ischemia (inadequate blood
flow) to a part of the brain or
hemorrhage into the brain
that results in death of brain
cells.
Incidence
◦ Stroke is a major public health concern.
◦ Prevalence- 40 to 270 per 1 lakh in
India.
◦ Second leading cause of death globally.
◦ WHO- 15 million people worldwide
suffer a stroke.
◦ 5 million die and 5 million are left
permanently disabled.
 Classification
Strokes can be divided into two classifications.

Ischemic stroke Hemorrhagic stroke

This is the loss of function in Hemorrhagic strokes are

the brain as a result of a caused by bleeding into the
disrupted blood supply. brain tissue, the ventricles, or
the subarachnoid space.
 Etiology
Nonmodifiable
• Advanced age (older than 55 years)
• Gender (Male)
• Race (African American)

Modifiable
• Hypertension
• Heart Disease
• Hyperlipidemia
• Obesity
• Smoking, Alcoholism
• Diabetes
• Physical Inactivity
• Diet
• Illicit drug use
• Birth control pills
• Other diseases
 Pathophysiology
◦ Ischemia
◦ Energy failure
◦ Acidosis
◦ Ion imbalance
◦ Increased Glutamate
◦ Depolarization
◦ Intracellular Calcium increased
◦ Cell membranes and proteins break down
◦ Formation of free radicals
◦ Protein production decreased
◦ Cell injury and death
 Clinical Manifestations

Stroke can cause a wide variety of neurologic deficits, depending

on the location of the lesion, the size of the area of inadequate
perfusion, and the amount of the collateral blood flow.

General signs and symptoms include numbness or weakness of

face, arm, or leg (especially on one side of the body); confusion or
change in mental status; trouble speaking or understanding
speech; visual disturbances; loss of balance, dizziness, difficulty
walking; or sudden severe headache.
 General Signs & Symptoms
• Without adequate perfusion, oxygen is also low, and
Numbness or facial tissues could not function properly without
weakness of the face. them.

Change in mental • Due to decreased oxygen, the patient experiences

status. confusion.

Trouble speaking or
• Cells cease to function as a result of inadequate
understanding perfusion.
speech.
 PERCEPTUAL DISTURBANCES

Visual • The eyes also need enough oxygen for optimal

disturbances. functioning.

Homonymous • There is loss of half of the visual field.

hemianopsia.
Loss of • The patient experiences difficulty seeing at night
peripheral and is unaware of objects or the borders of
objects.
vision.
HOMONYMOUS HEMIANOPSIA
 Motor Loss
Hemiparesis. • There is a weakness of the face, arm, and leg on the
same side due to a lesion in the opposite hemisphere.

Hemiplegia. • Paralysis of the face, arm, and leg on the same side
due to a lesion in the opposite hemisphere.

Ataxia. • Staggering, unsteady gait and inability to keep feet

together.

Dysphagia. • There is difficulty in swallowing.

 Sensory Loss

Paresthesia • There is numbness and tingling of

extremities and difficulty with
. proprioception.

Difficulty
in • Visual, Tactile & Auditory Stimuli

interpreting
 Communication Loss

Dysarthria. • This is the difficulty in forming words.

• The patient is unable to form words that is

Expressive understandable yet can speak in single-word
aphasia.  responses.

Receptive • The patient is unable to comprehend the spoken word

aphasia.  and can speak but may not make any sense.

• This is a combination of both expressive and

Global aphasia.  receptive aphasia.
Cognitive Impairment- damage to frontal lobe
Learning Capacity
impairment

Limited attention span

Forgetfulness

Lack of motivation

Depression

Emotional liability

Lack of co-operation
Diagnostic Findings
History Collection
• Any past medical or surgical history leading to stroke?
• Any family history of stroke?
• Any medication history?
Physical Examination & neurological Examination

CT scan
• Demonstrates structural abnormalities, edema, hematomas, ischemia, and infarctions.
• Note: May not immediately reveal all changes, e.g., ischemic infarcts are not evident on
CT for 8–12 hr; however, intracerebral hemorrhage is immediately apparent; therefore,
emergency CT is always done before administering tissue plasminogen activator (t-PA).
• In addition, patients with TIA commonly have a normal CT scan
Diagnostic Findings
PET scan. 
• Provides data on cerebral metabolism and blood flow changes.

MRI. 
• Shows areas of infarction, hemorrhage, AV malformations, and areas of ischemia.

Cerebral angiography.
• Helps determine specific cause of stroke, e.g., hemorrhage or obstructed artery, pinpoints site of occlusion
or rupture.
Lumbar puncture. 
• Pressure is usually normal, and CSF is clear in cerebral thrombosis, embolism, and TIA.
• Pressure elevation and grossly bloody fluid suggest subarachnoid and intracerebral hemorrhage.
• CSF total protein level may be elevated in cases of thrombosis because of inflammatory process.
Diagnostic Findings
Transcranial Doppler ultrasonography.
• Evaluates the velocity of blood flow through major intracranial
vessels; identifies AV disease, e.g., problems with carotid system
(blood flow/presence of atherosclerotic plaques).
EEG.
• Identifies problems based on reduced electrical activity in specific
areas of infarction; and can differentiate seizure activity from CVA
damage.
Diagnostic Findings
ECG and echocardiography. 
• To rule out cardiac origin as source of embolus (20% of
strokes are the result of blood or vegetative emboli
associated with valvular disease, dysrhythmias, or
Laboratory
endocarditis). studies to rule out systemic
causes: 
• CBC, platelet and clotting studies, erythrocyte
sedimentation rate (ESR), chemistries (glucose, sodium),
ABG
Management
Management: Acute care
Maintenance of Airway

Fluid Therapy

Management of increased intracranial pressure

Management of Hyperthermia

Pain Management, Management of Constipation, Avoidance of

hypervolemia
Management : Drug Therapy

1.Thrombolysis:

◦ Recombinant tissue plasminogen activator (t-PA)

is administered to re-establish blood flow through
a blocked artery to prevent cell death in patients
with the acute onset of ischemic stroke
symptoms.
◦ Mainstay of early treatment of acute ischemic
stroke
Contraindications
• Recent intracranial hemorrhage (ICH)
• Structural cerebral vascular lesion
• Intracranial neoplasm
• Ischemic stroke within three months
• Possible aortic dissection
• Active bleeding
• Significant head injury or facial trauma within three months
• Recent Intracranial or spinal surgery 
• Severe uncontrolled hypertension
• For streptokinase, previous treatment within six months
 tPA Mechanism of Action

Plasmin is
The plasmin breaks up
tPA attaches to the subsequently cleaved
It activates the fibrin- the molecules of
fibrin on the clot from the plasminogen
bound plasminogen. fibrin, and the clot
surface. affiliated with the
dissolves.
fibrin.
 Perform a regular neurologic assessment on the patient.
Monitorin
g During Check thoroughly for major or minor bleeding.

Therapy Continuously monitor the blood pressure of the patient.

With tPA Check for the signs and symptoms of ICH.

Discontinue tPA infusion and order an emergency CT scan if the patient develops a severe headache,
severe hypertension, nausea/vomiting, or a worsening neurologic examination.

Follow the patient to monitor for any neurologic deterioration.

Monitorin
g After Check for any major or minor bleeding.

Therapy Monitor and strictly control blood pressure.

With tPA Order a follow-up CT scan or MRI at least 24 hours before initiating anticoagulants or antiplatelet
agents.
Continue to monitor for hypersensitivity and signs of orolingual angioedema
Management : Drug Therapy
2. Anti coagulants Eg: Warfarin

3. Anti Platelets- Eg Aspirin, Clopidogrel

4. Acetaminophen is used to treat Hyperthermia

5. Antiepileptics are used for seizure
management
Surgical Management
◦ Aneurysms and Hemorrhage
Immediate evacuation of aneurysm induced hematoma or cerebellar hematomas larger than 3cm.
 Surgical Management
◦ Subarachnoid and Intracranial Hemorrhage causes bleeding into the ventricles
Ventriculostomy aids CSF drainage and helps to reduce Intracranial pressure
Nursing Care of Patient with CVA
Nursing Care
» Nurses play a pivotal role in all phases of care of the
stroke patient.
» 2 phases of stroke care:
(1) The emergency or hyper-acute care phase, which
includes the prehospital setting and the emergency
department (ED)
(2) The acute care phase, which includes critical care
units, intermediate care units, stroke units, and general
medical units.
PHASE I IN THE PREHOSPITAL SETTINGS

» The key elements of prehospital care are stabilization

of the airway, breathing, and circulation (the ABCs);
» Identification of signs and symptoms of stroke;
» Establishment or verification of the last known well
time;
» Provision of supplemental oxygen to patients with
hypoxemia;
IN PHASE I IN THE PREHOSPITAL SETTINGS

» Checking the blood glucose level;

» Avoidance of the administration of glucose-containing
fluids (unless the patient is hypoglycemic);
» Rapid initiation of transport (load and go); and
» Delivery of patients to receiving centers capable of
rapidly caring for acute stroke.
PHASE I In ED

» The triage nurse uses specialized checklists, protocols,

and other tools to identify stroke patients.
» Once stroke is confirmed, the patient is referred to the
acute stroke team or appropriate neurological
consultant.
» Time is critical.
» Studies have shown that the sooner thrombolytic
therapy is started, the greater the benefit.
PHASE I In ED

» Benchmark treatment time for AIS with intravenous

rtPA is within 60 minutes of arrival in the ED.
» Patients with AIS are at risk of hypoxemia and oxygen
desaturation.
PHASE I In ED

» Hypoxic patients will benefit from supplemental

oxygen. Positioning of the head of the bed must be
individualized for each patient.
» The bed should be elevated at least 30° if the patient
is at risk of aspiration or airway obstruction due to
dysphagia. Otherwise, the head-flat position
maximized blood flow to the brain.
» When significant hemiparesis is present, positioning
on the paretic side may be more desirable to allow the
patient to communicate and to prevent aspiration.
PHASE I In ED

» Patients are kept NPO, including no oral medications, until

ability to swallow can be assessed.
» A bedside swallowing assessment to establish whether
the patient can safely receive oral intake and swallow ED
medications such as aspirin.
» If swallowing is impaired, medications can be
administered rectally or by nasogastric tube.
» Ideally, 2 to 3 intravenous sites should be established if
the acute stroke patient will receive thrombolytic therapy.
» One site is used for administration of intravenous fluids,
another for administration of thrombolytic therapy, and
the third for administration of intravenous medications.
PHASE I In ED

» Before administering rtPA, the nurse should make sure

that all intravenous lines are inserted. If needed, a
Foley catheter and any other indwelling lines or tubes,
including endotracheal tubes, should be inserted as
well.
» However, placement of lines and tubes should be
rapid and should not delay administration of rtPA by
more than a few minutes.
 APPLICATION OF
OREM'S SELF-CARE
DEFICIT THEORY
 NURSING CARE PLAN
ACCORDING TO OREM’S
THEORY OF SELF CARE
DEFICIT
OREM’S THEORY OF SELF CARE DEFICIT

◦ The self care deficit theory proposed by Orem is a combination of three theories,
i.e. theory of self care, theory of self care deficit and the theory of nursing systems.

◦ In the theory of self care, she explains self care as the activities carried out by the
individual to maintain their own health.

◦ The self care agency is the acquired ability to perform the self care and this will be
affected by the basic conditioning factors such as age, gender, health care system,
family system etc.
◦ Therapeutic self-care demand is the totality of the self care measures required.

◦ The self care is carried out to fulfill the self-care requisites.

◦ There are mainly 3 types of self care requisites such as universal, developmental
and health deviation self care requisites
◦ Whenever there is an inadequacy of any of these self care requisite, the person
will be in need of self care or will have a deficit in self care.

◦ The deficit is identified by the nurse through the thorough assessment of the
patient.
◦ Once the need is identified, the nurse has to select required nursing systems to
provide care: wholly compensatory, partly compensatory or supportive and
educative system.

◦ The care will be provided according to the degree of deficit the patient is
presenting with.

◦ Once the care is provided, the nursing activities and the use of the nursing
systems are to be evaluated to get an idea about whether the mutually planned
goals are met or not.

◦ Thus the theory could be successfully applied into the nursing practice.
Nursing Diagnosis –In Acute/Post Acute Phase

Based on the assessment data, the major nursing diagnoses for a

patient with stroke include the following:
» Impaired physical mobility related to hemiparesis, loss of
balance and coordination, spasticity, and brain injury.
» Acute pain related to hemiplegia and disuse.
» Deficient self-care related to stroke sequelae.
» Disturbed sensory perception related to altered sensory
reception, transmission, and/or integration.
» Impaired urinary elimination related to flaccid bladder,
detrusor instability, confusion, or difficulty in communicating.
Nursing Diagnosis –In Acute/Post Acute Phase
» Disturbed thought processes related to brain damage.
» Impaired verbal communication related to brain
damage.
» Risk for impaired skin integrity related to hemiparesis
or hemiplegia and decreased mobility.
» Interrupted family processes related to catastrophic
illness and caregiving burdens.
» Sexual dysfunction related to neurologic deficits
or fear of failure.
Nursing diagnosis Outcome and plan Implementation Evaluation
(diagnostic operations) (Prescriptive (control operations) (regulatory operations)
operations)

Based on self care Outcome Nurse- patient actions 1. Effectiveness of the

deficits Nursing goal and to nurse patient action to
objectives - Promote patient as -Promote patient as self
Design of nursing self care agent care agent
system - Meet self care needs - Meet self care needs
Appropriate method of - Decrease the self - Decrease the self
helping care deficit. care deficit.
2. Effectiveness of the
selected nursing system
to meet the needs.
ASSESSMENT DIAGNOSTIC NURSING METHOD OF CONTROL REGULATORY
OPERATIONS SYSYTEM HELPING OPERATION OPERATION

THERA ADEQU IMPAIRED PATIENT WILL PARTLY • ASSESS THE PATINET

PEUTIC ACY OF PHYSICAL MAINTAIN COMPENSATOR EXTENT OF STARTED TO SIT
SELF SELF MOBILITY STRENGTH & Y IMPAIRMENT AND STAND
CARE CARE RELATED TO FUNCTION OF • ASSISST WITH SUPPORT
DEMA AGENC WEAKNESS AFFECTED PATIENT IN
ND Y OVER LEFT SIDE DEVELOPING
DEFICI INADE AS EVIDENCED SITTING
ENT QUATE BY INABILITY TO BALA NCE,
AREA : MOVE EFT ARM STANDING
PHYSIC AND LEFT LEG BALANCEETC
AL
MOBIL
ITY
Phase II Bleeding assessment after
IN ICU administration of rtPA

» Bleeding assessment after administration of rtPA is the

responsibility of the clinical nurse, who monitors the
patient for major and minor bleeding complications in
the first 24 to 36 hours after administration of rtPA.
» ICH is the major bleeding complication associated with
thrombolytic therapy.
» Hemorrhagic transformation should be suspected if
there is a change in level of consciousness, elevation of
blood pressure, deterioration in motor examination,
onset of new headache, or nausea and vomiting.
Phase II Bleeding assessment after
IN ICU administration of rtPA

» Blood pressure is a critical vital sign in the AIS

patient. It is not uncommon to see variations in
blood pressure after AIS.
» Rapid lowering of blood pressure may induce
worsening of neurological symptoms by inducing
lowered perfusion pressures to the area of ischemia.
Phase II Vitals Monitoring

» Fever appears to exacerbate the ischemic injury to

neurons and is associated with increased morbidity
and mortality, particularly in acute stroke.
» Even an increase of 1°F is a predictor of poorer
patient outcome.
Phase II Vitals Monitoring

» Cardiac monitoring is recommended for all ischemic

stroke patients.
» Cardiac arrhythmias (ventricular ectopy, tachycardia,
and heart blocks) and sudden cardiac death can
occur.
Phase II Vitals Monitoring

» Monitoring of oxygen saturation will reduce the risk

of neurological deterioration related to hypoxemia.
Supplemental oxygen at 2 to 4 L/min is recommended
for maintaining appropriate oxygen saturation. (Based
on Physician Order)
Phase II
» Hyperglycemia and hypoglycemia, both cause
adverse effects and should be corrected promptly.
Phase II
» Seizures are a possible life-threatening
complication of large cortical strokes and if an
anticonvulsant drug is required, nurse must
educate the patient and family
 Improving Mobility and Preventing
Phase II Deformities

» Position to prevent contractures; use measures to

relieve pressure, assist in maintaining good body
alignment, and prevent compressive neuropathies.
» Apply a splint at night to prevent flexion of
affected extremity.
» Prevent adduction of the affected shoulder with a
pillow placed in the axilla.
 Improving Mobility and Preventing
Phase II Deformities

» Elevate affected arm to prevent edema and fibrosis.

» Position fingers so that they are barely flexed; dorsal
wrist splint may be used.
» Change position every 2 hours; place patient in
a prone position for 15 to 30 minutes several times a
day.
 Establishing an Exercise Program
Phase II
» Provide full range of motion four or five times a day
to maintain joint mobility, regain motor control,
prevent contractures in the paralyzed extremity,
prevent further deterioration of the neuromuscular
system, and enhance circulation.
» If tightness occurs in any area, perform range of
motion exercises more frequently.
 Establishing an Exercise Program
Phase II
» Exercise is helpful in preventing venous stasis, which
may predispose the patient to thrombosis and
pulmonary embolus.
» Observe for signs of pulmonary embolus or excessive
cardiac workload during exercise period (eg,
shortness of breath, chest pain, cyanosis, and
increasing pulse rate).
 Establishing an Exercise Program
Phase II
» Supervise and support patient during exercises; plan
frequent short periods of exercise, not longer
periods; encourage patient to exercise unaffected
side at intervals throughout the day.
 Preparing for Ambulation
Phase II
» Start an active rehabilitation program when
consciousness returns (and all evidence of bleeding is
gone, when indicated).
» Teach patient to maintain balance in a sitting
position, then to balance while standing (use a tilt
table if needed).
» In transferring the client from the wheelchair to
bed, patient’s affected side should be supported &
positioned away from the bed to facilitate safe
transfer.
Phase II Preparing for Ambulation
» Begin walking as soon as standing balance is
achieved (use parallel bars and have wheelchair
available in anticipation of possible dizziness).
» Keep training periods for ambulation short and
frequent.
» Initiate a full rehabilitation program even for elderly
patients.
Phase II Preventing Shoulder Pain

» Never lift patient by the flaccid shoulder or pull on

the affected arm or shoulder.
» Use proper patient movement and positioning (eg,
flaccid arm on a table or pillows when patient is
seated, use of sling when ambulating).
Phase II Preventing Shoulder Pain

» Range of motion exercises are beneficial, but avoid

over strenuous arm movements.
» Elevate arm and hand to prevent dependent edema
of the hand; administer analgesic agents as indicated.
Phase II Enhancing Self Care

» Encourage personal hygiene activities as soon as the

patient can sit up; select suitable self care activities
that can be carried out with one hand.
» Help patient to set realistic goals; add a new task
daily.
» As a first step, encourage patient to carry out all self
care activities on the unaffected side.
Phase II Enhancing Self Care

» Make sure patient does not neglect affected side;

provide assistive devices as indicated. Improve
morale by making sure patient is fully dressed during
ambulatory activities.
» Assist with dressing activities (eg, clothing with
Velcro closures; put garment on the affected side
first); keep environment uncluttered and organized.
» Provide emotional support and encouragement to
prevent fatigue and discouragement.
 Managing Sensory-Perceptual Difficulties
Phase II
» Approach patient with a decreased field of vision on
the side where visual perception is intact; place all
visual stimuli on this side.
» Teach patient to turn and look in the direction of the
defective visual field to compensate for the loss;
make eye contact with patient, and draw attention to
affected side.
 Managing Sensory-Perceptual Difficulties
Phase II
» Increase natural or artificial lighting in the room;
provide eyeglasses to improve vision.
» Remind patient with hemianopsia of the other side
of the body; place extremities so that patient can see
them.
» Patch the eye when sleeping if left open to avoid
exposure keratitis.
Phase II Assisting with Nutrition

» Observe patient for paroxysms of coughing, food

dribbling out or pooling in one side of the mouth,
food retained for long periods in the mouth, or nasal
regurgitation when swallowing liquids.
» Consult with speech therapist to evaluate gag
reflexes; assist in teaching alternate swallowing
techniques, advise patient to take smaller boluses of
food, and inform patient of foods that are easier to
swallow; provide thicker liquids or pureed diet as
indicated.
Phase II Assisting with Nutrition

» Have patient sit upright, preferably on chair, when

eating and drinking; advance diet as tolerated.
» Prepare for GI feedings through a tube if indicated;
elevate the head of bed during feedings, check tube
position before feeding, administer feeding slowly,
and ensure that cuff of tracheostomy tube is inflated
(if applicable); monitor and report excessive retained
or residual feeding.
 Attaining Bowel and Bladder Control
Phase II

» Perform intermittent sterile catheterization during

period of loss of sphincter control.
» Analyze voiding pattern and offer urinal or bedpan on
patient’s voiding schedule.
 Attaining Bowel and Bladder Control
Phase II
» Provide high fiber diet and adequate fluid intake (2 to
3 L/day), unless contraindicated. Establish a regular
time (after breakfast) for toileting.
Phase II Improving Thought Processes

» Reinforce structured training program using cognitive

perceptual retraining, visual imagery, reality
orientation, and cueing procedures to compensate
for losses.
» Support patient: Observe performance and progress,
give positive feedback, convey an attitude of
confidence and hopefulness; provide other
interventions as used for improving cognitive
function after a head injury.
Phase II Improving Communication

» Reinforce the individually tailored program. Jointly

establish goals, with patient taking an active part.
» Make the atmosphere conducive to communication,
remaining sensitive to patient’s reactions and needs
and responding to them in an appropriate manner;
treat patient as an adult.
» Provide strong emotional support and understanding
to allay anxiety; avoid completing patient’s
sentences.
Phase II Improving Communication

» Be consistent in schedule, routines, and repetitions.

» A written schedule, checklists, and audiotapes may
help with memory and concentration; a
communication board may be used.
» Maintain patient’s attention when talking with
patient, speak slowly, and give one instruction at a
time; allow patient time to process.
» Talk to aphasic patients when providing care
activities to provide social contact.
Phase II Maintaining Skin Integrity

» Frequently assess skin for signs of breakdown, with

emphasis on bony areas and dependent body parts.
» Employ pressure relieving devices; continue regular
turning and positioning (every 2 hours minimally);
minimize shear and friction when positioning.
» Keep skin clean and dry, gently massage healthy dry
skin, and maintain adequate nutrition.
Phase II Improving Family Coping

» Provide counseling and support to family.

» Involve others in patient’s care; teach stress
management techniques and maintenance of
personal health for family coping.
» Give family information about the expected outcome
of the stroke, and counsel them to avoid doing things
for patient that he or she can do.
Phase II Improving Family Coping

» Develop attainable goals for patient at home by

involving the total health care team, patient, and
family.
» Encourage everyone to approach patient with a
supportive and optimistic attitude, focusing on
abilities that remain; explain to family that emotional
lability usually improves with time.
 Patient & Family Education

Teach patient to resume as much self care as possible; provide

assistive devices as indicated.

Have occupational therapist make a home assessment

and recommendations to help the patient become more independent.

Coordinate care provided by numerous health care professionals; help

family plan aspects of care.

Advise family that patient may tire easily, become irritable and upset
by small events, and show less interest in daily events.
 Patient & Family Education

Make a referral for home speech therapy. Encourage

family involvement. Provide family with practical instructions
to help patient between speech therapy sessions.

Discuss patient’s depression with the physician for

possible antidepressant therapy.
 Patient & Family Education

Encourage patient to attend community-based stroke clubs to give a

feeling of belonging and fellowship to others.

Encourage patient to continue with hobbies, recreational and leisure

interests, and contact with friends to prevent social isolation.

Encourage family to support patient and give positive reinforcement.

Remind spouse and family to attend to personal health and

wellbeing.
 Discharge and Home Care Guidelines
Patient and family education is a fundamental component of
rehabilitation.
» Consult an occupational therapist. An occupational therapist may be
helpful in assessing the home environment and recommending
modifications to help the patient become more independent.
» Physical therapy. A program of physical therapy may be beneficial,
whether it takes place in the home or in an outpatient program.
 Discharge and Home Care Guidelines

» Antidepressant therapy. Depression is a common and serious problem

in the patient who has had a stroke.
» Support groups. Community-based stroke support groups may allow
the patient and the family to learn from others with similar problems
and to share their experiences.
» Assess caregivers. Nurses should assess caregivers for signs of
depression, as depression is also common among caregivers of stroke
survivors.
 Conclusion
"Time is brain" is the most important concept in
acute stroke care.

"FAST" approach is most important in educating

the public about acute stroke. It stands for
facial asymmetry, unilateral arm weakness or
drift, speech problem and time - note the time
of onset and call for ambulance immediately.

Non-contrast CT head is the imaging modality

of choice in acute stroke.

IV thrombolysis within 3 - 4.5 hours with

slightly different contraindications.
 References

Book References

1. Smeltzer S, Bare G. Brunner & Suddharth’s textbook of medical surgical nursing. 10 th

edition. Philadelphia: Lippincott Williams & Wilkins;2004.
2. Lewis SM, Collier IC, Heitkemper MM. Medical surgical nursing assessment and
management of clinical problems. 4th edition. Volume 1. Missouri: Mosby; 1996.
3. Black J, Hawks J. Medical surgical nursing clinical management for positive outcomes. 7 th
edition. Vol 2. Missouri: Saunders; 2005.
4. Lemone P, Burke K. Medical surgical nursing. New Delhi: Dorling Kindersely Pearson;
2008
 References

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