C. D.

• Cerebrovascular disorders

  Functional abnormality of the central nervous system (CNS) that occurs when the blood supply to the brain is disrupted

  
• Stroke


  Sudden death of some brain cells due to the lack of oxygen when the blood flow to the brain is impaired by blockage or the rupture of an artery of the brain
• Types of strokes


  • Ischemic (approximately 87%)
  • Hemorrhagic (approximately 13%)
• Differences exist in etiology, pathophysiology, medical management, surgical management, and nursing care between ischemic and hemorrhagic strokes
• Cerebrovascular accidents happen due to an accident to the brain where sudden cell death occur due to the lack of oxygen supply as the brain cannot function without oxygen
• The brain utilizes two-thirds (2/3) of the total oxygen of the body
• According to WHO (2020), stroke is the 4th leading cause of mortality worldwide
• Approximately, 5,000 of people are newly diagnosed with stroke
• Half of the population are able to live a normal life or survivor because of therapy, early interventions, and adherence to and changes in their lifestyle
• Causes of ischemic stroke

  • Large artery thrombosis
  • Small penetrating artery thrombosis
  • Cardiogenic embolic
  • Cryptogenic (no known cause)
  • Other
• Causes of hemorrhagic stroke

  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage
  • Cerebral aneurysm
  • Arteriovenous malformation
• Main presenting symptoms of ischemic stroke

  • Numbness or weakness of the face, arm, or leg, especially on one side of the body
• Main presenting symptoms of hemorrhagic stroke

  • Exploding headache
  • Decreased level of consciousness
• Functional recovery of ischemic stroke

  Usually plateaus at 6 months
• Functional recovery of hemorrhagic stroke

  Slower, usually plateaus at about 18 months
• Ischemic stroke


  Vascular occlusion and significant hypoperfusion that occurs in the brain

  
• Hemorrhagic stroke


  • Accounts 15% of the population
  • Extravasation of blood into the brain or the subarachnoid spaces
• Warning signs of stroke

  • Sudden onset of weakness or numbness on one side of the body
  • Sudden speech difficulty or confusion
  • Sudden difficulty seeing in one or both eyes
  • Sudden onset of dizziness, trouble walking or loss of balance
  • Sudden, severe headache with no known cause
• Ischemia


  Restriction in blood supply to tissues (due to blockage), causing a shortage of oxygen that is needed for cellular metabolism
• Infarction


  • When ischemia happens, could lead to tissue death (necrosis)
  • Due to prolonged hypoperfusion, the organ or system will become infarcted or there is necrosis
• Transient ischemic attack (TIA)


  • Also called mini-strokes, lasts only a few minutes
  • Warning stroke is a better label, because a transient ischemic attack often foreshadows a full-blown stroke and needs to be taken seriously
  • Caused by a clot or blockage in the brain that is short term
• Earliest signs of transient ischemic attack (TIA)


  • Facial drooping
  • Weakness (especially in the arms) and may report numbness
  • Slurred speech
  • Difficulty in walking
• Other signs of transient ischemic attack (TIA)

  • Complete paralysis of one side of the body
  • Sudden vision loss, blurred vision or double vision
  • Vertigo
  • Being sick
  • Dizziness
  • Confusion
  • Difficulty understanding what others are saying
  • Problems with balance and coordination
  • Difficulty swallowing (dysphagia): prone to aspiration

  
• FAST mnemonic for recognizing stroke symptoms

  • Face: Drooping, uneven smile
  • Arms: Weakness and numbness
  • Speech difficulty
  • Time: Call 911 if above 3 symptoms present
• What happens during transient ischemic attack (TIA)


  • Temporary but a warning sign of stroke
  • There is blockage and impeded blood flow but does not cause a permanent damage
  • When there is hypoperfusion, 3 seconds to 3 minutes of oxygen deprivation leads to decreased LOC
  • Within 3–5 minutes, the neurons will suffer and cause extensive damage of the brain
  • Within 5–10 minutes, it can cause an irreversible brain damage

  
• Causes of transient ischemic attack (TIA)

  • Smoking
  • High blood pressure (hypertension)
  • Obesity
  • High cholesterol levels
  • Regularly drinking an excessive amount of alcohol
  • Having a type of irregular heartbeat called atrial fibrillation
  • Having diabetes
  • People over 55 years of age and people of Asian, African or Caribbean descent
• Prevention of transient ischemic attack (TIA)

  • Maintain a healthy weight
  • Eat a nutritious diet
  • Exercise regularly
  • Avoid vices
• Medications for transient ischemic attack (TIA)

  • Anti-platelet drugs (e.g. aspirin, clopidogrel)
  • Anticoagulants (e.g. heparin, warfarin)
• Nursing responsibilities for anti-platelet medications

  • Advise patient to take aspirin with meal
  • Monitor for headaches
  • Discuss increased bleeding risk
  • Remove sharp objects
  • Advise patient not to perform certain activities
  • Monitor for pain and pyrexia
  • Perform BUN, liver function, hearing tests
• Nursing responsibilities for anticoagulants

  • Monitor for atrial fibrillation
  • Advise soft bristle toothbrush
  • Shave using electric razor
  • Compress venipuncture site
  • Monitor prothrombin time
  • Know antidote: Protamine sulfate
• Surgical management for transient ischemic attack (TIA)

  • Carotid endarterectomy
  • Carotid angioplasty or stenting
• Nursing actions for conscious TIA patient

  • Place in comfortable position
  • Loosen tight clothing
  • Keep warm
  • Check airway
  • Do not give food/liquids
  • Note signs/symptoms and time of onset
• Nursing actions for unconscious TIA patient

  • Lift chin and tilt head
  • Check for breathing
  • Begin CPR if no breathing
• Ischemic stroke


  • Sudden loss of function resulting from disruption of the blood supply to a part of the brain
  • Accumulates 85% of the total population
  • Vascular occlusion with the main problem of hypoperfusion
• Early treatment with thrombolytic therapy for ischemic stroke results in fewer stroke symptoms and less loss of function
• Urgency is needed on the part of the public and health care practitioners for rapid transport of the patient to a hospital for assessment and administration of the medication
• Clot retrieval device


  • A FDA approved type of procedure to open blocked arteries
  • Inserted via arteries using a stent which has a thrombolytic property
  • Causes vasodilation and opens the lumen thus returning the normal perfusion and blood flow
• Clot retrieval device is not recommended in the Philippines because it is expensive
• Outmost responsibility of a nurse with an ischemic stroke patient is the urgency of the catering of the patient's needs to prevent further deterioration in the physical and mental aspect of the patient
• Hypoperfusion


  Decreased perfusion