CVA

• cerebral vascular accident (CVA); stroke (hemorrhagic - bleed OR ischemic - clot)
• risk factors for CVA: hypertension, cigarette smoking, hypercholesterolemia, illicit drug use, over 55, heavy alcohol use, sympathetic nervous system stimulants
• ischemic stroke: a clot blocking blood flow to an area of the brain
• hemorrhagic stroke: bleeding inside or around brain tissue
• what type of stroke is the most common?

  ischemic
• cause of ischemic stroke: sudden blockage of cerebral blood vessel which reduces blood supply
• cardiac causes of ischemic strokes: a fib, MI, septal defect, valvular disease
• medical treatment for ischemic stroke: recombinant tissue plasminogen activator; ALTEPLASE
• complications of ischemic strokes: hemorrhage, cytotoxic edema, weakness, paralysis
• hemorrhagic stroke causes: traumatic or nontraumatic, ruptured aneurysm, or arteriovenous malformation
• medical treatment for hemorrhagic stroke: prevent and mitigate complications
• complications of hemorrhagic strokes: ischemic stroke, cerebral edema, pulmonary edema, myocardial ischemia
• physical assessment for strokes: serial neurological assessments (NIH stroke scale every 1-2 hours), vital signs (BP, HR, and RR), neurovascular assessment, I&Os
• labs for stroke: CT scan (as soon as symptoms start; 30 minutes), MRI, carotid duplex, echocardiogram, ECG, lab test (electrolytes, cardiac enzymes, blood glucose)
• NIH stroke scale: used to assess severity of stroke; the higher the score the worse (highest score is a 42); if a low score becomes high = NOT good; a score goes down = GOOD
• goal for CVA: the patient will regain as much as their baseline function as possible and/or adapt to neuro deficits
• CVA patients need to pass a swallow study before they can have liquids
• interventions for strokes: administer meds as ordered (ischemic stroke = aspirin suppository to prevent more clots), perform bedside swallow study, elevate HOB 30 degrees, place feeding tube (ONLY xray to check placement), aspiration precautions, bleeding precautions, and frequent repositioning
• teaching for strokes: warning signs of stroke (FAST), activation of EMS, patient specific risk factors (smoking cessation, ETOH cessation, HTN reduction), and medication education
• FAST:

  F - facial drooping

  A - arm weakness

  S - speech difficulty (slurring, gargling)

  T - time
• key points:

  • time is brain
  • if stroke-like symptoms do a fingerstick BG immediately (hypoglycemia has similar symptoms)
  • call a code stroke
  • note the time of onset of symptoms
  • airway management is important