Transient Ischemic Attack
(TIA)
SANTHIA MIRTYL
Importance of Blood Supply
 Blood supply is critical
for successful
functioning of our organs
 Arteries bring
oxygenated blood from
the heart to the body
 What happens when this
route is compromised?
National Stroke Association (2011)
Hypoxic Brain Tissue
National Stroke Association (2011)
Stroke AKA Brain Attack
•S E C O N D L E A D I N G C A U S E O F M O R TA L I T Y W O R L D W I D E , F O U R T H
I N T H E U N I T E D S TAT E S
•A P P R O X I M AT E LY 7 9 5 , 0 0 0 S T R O K E S W I L L O C C U R T H I S Y E A R
•S T R O K E C A N H A P P E N T O A N Y O N E AT A N Y T I M E , R E G A R D L E S S
OF RACE, SEX OR AGE
•A P P R O X I M AT E LY 5 5 , 0 0 0 M O R E W O M E N T H A N M E N H AV E A
STROKE EACH YEAR.
•A F R I C A N A M E R I C A N S H AV E A L M O S T T W I C E T H E R I S K O F F I R S T -
E V E R S T R O K E C O M PA R E D W I T H W H I T E S .
•T H E E S T I M AT E D D I R E C T A N D I N D I R E C T C O S T O F S T R O K E I N
T H E U N I T E D S TAT E S I N 2 0 1 0 I S $ 7 3 . 7 B I L L I O N
National Stroke Association (2011)
Nursing Central (2012)
Types of Stroke
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Nursing Central (2012)
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Nursing Central (2012)
TIA
 Temporary state of ischemia due to blood supply
blockage
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A blood clot in an artery of the brain
A blood clot that travels to the brain from somewhere else in
the body (for example, from the heart)
An injury to blood vessels
Narrowing of a blood vessel in the brain or leading to the brain
 “Mini-stroke”
 Will have stroke like symptoms


For up to 24 hours
Risk of stroke is greatest within 48 hours
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Nursing Central (2012)
National Stroke Association (2011)
TIA is a result of vascular disease
Modifiable
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HTN
Atrial fibtillation
Hyperlipidema
Diabetes Mellitus
Stress
Excessive alcohol use
Lifestyle
Obesity
Smoking
Valvular disease
Coronary artery disease
Non-modifiable
 Family history
 Age
 Race
 Heredity
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Nursing Central (2012)
National Stroke Association (2011)
Easton, D., J., Saver, J., L., Albers, G.W. et.l (2009).
Use the FAST for signs of stroke.
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Nursing Central (2012)
National Stroke Association (2011)
A.D.A.M Medical Medical Encyclopedia.(2012)
Medical Interventions
Literature
Hospital
 Carotid Endarterectomy
 Physical assessment
 Carotid Angioplasty and
 Complete blood count
Stenting
 tPa
 Diagnostics :MRI
 Antithrombotic Therapy

aspirin, combination
aspirin/dipyridamole,
clopidogrel, and ticlopidine.
 Lab test
 CT scan
 MRS and X-ray ordered
 MRI without contrast
 Carotid Duplex Scan
Bilateral
 PT and OT
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Easton et.al (2009).
Adam et. al (2007)
Summers et. Al (2007)
Nursing Interventions
Literature
Hospital
 NIH Stroke Scale
 Continued assessment
 O2, output
 Vitals
 Hyperthermia, BP
 ABCs
 Monitoring: cardiac,
 NIH Stoke Scale Q2h
respiratory, neuro status
 Administering drug therapy
 Safety
 Labs

Glucose
 Hourly assessments
 Hourly vitals
 Close eye on high BP and
temperature
 ABCs
 Labs
 Drug therapy
 Safety
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Adam et. al (2007)
Prognosis
 TIA do not cause cell death of brain tissue
 Symptoms usually resolve in less that 24 hrs
 TIA is a warning sign for a stroke
Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)
Easton et.al (2009).
Adam et. al (2007)
Summers et. Al (2007)
Nursing Diagnosis
A C U T E C O N F U S I O N R E L A T E D T O H Y P O X I A .
I M P A I R E D V E R B A L C O M M U N I C A T I O N
RELATED TO
DECREASED CIRCULATION TO THE BRAIN IN SPEECH
CENTER INFORMATIONAL SOURCES
 RISK FOR IMPAIRED PHYSICAL IMMOBILITY RELATED TO
DECREASED STRENGTH AND ENDURANCE
I N E F F E C T I V E H E A L T H M A I N T E N A N C E R E L A T E D T O
DEFICIENT KNOWLEDGE REGARDING SELF CARE FOR
STROKE RISKS
Ackely, Ladwig. (2011)
Conclusion
Myth
Fact
 Stroke is not preventable
 Up to 80% percent of
strokes are preventable
 Stroke cannot be treated
 Stroke is a elderly
problem
 Stroke happens in the
heart
 Stroke recovery ends
after 6 months
 Stroke requires
emergency treatment
 Anyone can be a victim
to stroke
 Stroke happens in the
brain AKA “Brain Attack”
 Stroke recovery
a lifetime
can last
National Stroke Association (2011)
Case Study
 The patient is a 53 year old African American male admitted
to the emergency department on 10/14/2012 for slurred
speech and facial drooping. He was brought in by a concerned
friend that stated a change in the patient’s mentation, slurred
speech as well as left sided facial drooping the previous night.
Patient has a past medical history of Bells palsy 20 years ago
and chronic knee pain. Patient also has had family history of
kidney disease, hypertension, and heart disease. Upon
admission patient had a high blood pressure of 220/140. He
denies any chest pain, shortness of breath, fevers, chills,
nausea and vomiting. Patient has a current complaint of a
headache but not a symptom prior to hospitalization. Chest x
ray is pending. Brain CT revealed lateral ventricles atrophy
and small vessel ischemia. Labs were done which revealed
elevated creatinine and BUN.
Questions
 Of the 500,000 strokes that occur annually, 80% of
them are ischemic strokes. Which of the following
accurately reflects this type of stroke?
1.
2.
3.
4.
The strokes are hemorrhagic in nature
The signs and symptoms, though acute, resolve without
permanent disability
The stokes ate commonly caused my arthrosclerosis
Patients experiencing the type of stroke are usually younger
Rationals
 Correct answer: 3
 80%
of all strokes are ischemic in nature
and most are caused my atherosclerosis.
Hemorrhagic stokes are commonly
associated with hypertension. Patients
experiencing ischemic stoke are generally
older than those experiencing hemorrhagic
stoke
References
1) A.D.A.M. Medical Encyclopedia.(2012). Transient ischemic attack.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001743/
2) Adams Jr, H., P., del Zoppo,G., Alberts, M., J., Bhatt, D., L., Brass, L.,
Furlan, A., Grubb, R.,
L., Higashida, R., L., Jauch, E., C., Kidwell, C.,
Lyden, P., D., Morgenstern, R., Qureshi, A., I.,
Rosenwasser, R., H.,
Scott, P., A., Wijdicks, E., F. (2007). Guidelines for the Early
Management of Adults With Ischemic Stroke. ​STROKEAHA.107(86), 1814.
3)Ackle, B., Ladwig, G. (2011) Nursing Diagnosis Handbook.. 9th edition.
4) Easton, D., J., Saver, J., L., Albers, G.W., Alberts, M., J., Chaturvedi, S.,
Feldmann,E.,
Hatsukami, T., S., Higashida, R., T., Johnston, C.,
Kidwell, C.,S., Lutsep, H., L., Miller, E., Sacco,
R., L. (2009).
Definition and Evaluation of Transient Ischemic Attack. STROKEAHA., 108(18),
1922.
5) National Stroke Association. The Complete Guide to Stroke. 2011. At:
http://www.stroke.org/site/DocServer/NSA_complete_guide.pdf?docID=341
6) Summers, D., Leonard, A., Wentworth, D., Saver, L., J., Simpson, J.,
Spilker, J., A., Hock, N.,
Miller, E., Mitchell, P.,H. (2009). Comprehensive Overview of Nursing and Interdisciplinary Care of the
Acute Ischemic Stroke Patient. ​STROKEAHA.109(62), 1923.
7) Osborn, K., S., Wraa, C., E., Watson, A., V. (2010). Medical-Surgical Nursing Preparation for Practice.
756-761.