DEFINITION: rapid occurrence of neurological dysfunction that results
from impeded vascular blood flow to the brain. This incident results from
one of two types of stroke: ischemic (arterial occlusion) or hemorrhagic
(arterial rupture and bleeding). The part(s) of the brain affected can suffer
permanent or temporary damage, leading to deficit(s) in associated
functions. Impairment can be slight to severe, or even fatal.
RELATED DIAGNOSTIC TESTS: various tests are used to assess
the type and size of a stroke:
- CT scan
- MRI
- EEG
- radionuclide scan
- angiography
- CSF draw
ETIOLOGY:
Nonmodifiable risk factors: gender (male), age (65+ years), race (AfricanAmerican) and heredity.
Modifiable risk factors: hypertension, cardiac disease, diabetes mellitus,
serum lipid deviations, smoking, diet.
MEDICAL MANAGEMENT:
Prevention: anticoagulant tx (Heparin, Coumadin, ASA, Persantine,
Ticlid) in case of potential infarction; carotid endarterectomy,
extracranial-intracranial bypass and transluminal angioplasty are
surguries to maintain arterial blood flow.
Acute: maintain a patent airway and breathing (O2, intubation,
mechanical
ventilator);
hyperosmotic
agents to reduce
cerebral edema;
surgical repair of
cerebral
hemorrhage.
PATHOPHYSIOLOGY: Vascular flow of blood to the brain is impeded
by either ischemic or hemorrhagic stroke. In the former a thrombosis
(blood clot) or embolus (usually cardiac plaque or tissue) occludes the
lumen of a cerebral artery. The latter results from the rupturing of a
cerebral vessel and bleeding into brain tissue or ventricles. The stroke can
be classified based on neurological deficits:
- transcient ischemic attack (TIA) - deficits are temporary, lasting only
minutes or up to 24 hours.
- reversible ischemic attack - deficits are temporary, but last days to weeks.
- evolution - progressive deterioration of neurological dysfunction over
hours or days.
- completed - deficits remain unchanged after 2-3 days.
NURSING MANAGEMENT:
- maintain patent airway
- monitor s/s stroke in evolution or intracranial pressure: change if
LOC, eye response, motor abilities, mental function, VS
- monitor for fluid overload: edema I&O
- minimize risk of thrombophlebitis: range-of-motion exercises,
compression stockings, admin. anticoagulant meds
- prevention of contractures, atrophy: positioning, range-of-motion
exercises
- monitor change in integumen, circulation
- monitor changes in GI / GU function
- assist patient in understanding effects of illness and in performing
ADL’s; monitor coping ability
- direct rehabilitation: prevent deformity, maintain & restore function;
assist in family teaching
- incorporate health care team into rehabilitation (eg: PT, OT, D/C
nurse, dietician)
SIGNS & SYMPTOMS: symptoms vary greatly as they are dependent on
the stroke’s site, size and rate, and on the presence of collateral circulation.
Listed are broad categories:
- neuromotor: akinesia, hypo- or hyperrefexia, dysphagia, bladder and
bowel dysfunction
- communication: aphasia
- affective: loss of control of emotion
- cognitive: impaired judgement and memory
- perception: impaired spatial orientation
HEALTH DEVIATION SELF-CARE REQUISITES:
- follow prescibed, preventative medical treatment
- adhere to physical, cognitive therapies to improve function
- maintain prescribed exercise program
- follow strict diet regimen
- be alert to impending symptoms of another stroke (eg: headache,
vertigo, numbness, visual problems, emotional lability)
REFERNCE PAGES:
- Lewis & Collier, Medical-Surgical Nursing, 4th Ed., p. 1723-1748
- Dirksen, Lewis & Collier, Clinical Companion to Medical-Surgical
Nursing, p. 101-112