Presented by

Maria G. Nelson and

Imelda de los Santos

CVA or Stroke
An interruption of blood supply to a

vital center in the brain

Also called brain attack, cerebral
infarction, cerebral hemorrhage,
ischemic stroke or stroke

The Human Brain

Stroke 101
Third leading cause of death in America,

behind heart disease and cancer

Kills 160,000 people each year
Leading cause of adult disability
About 750,000 strokes will occur this
year, 500,000 of those strokes could be
prevented
Costs the nation $62.7 billion in direct
and indirect costs

Brain Attack

Direct Causes of Stroke

Cerebral thrombosis a blood clot or

plaque blocks an artery that supplies a

vital brain center
Cerebral hemorrhage or aneurysm an
artery in the brain bursts, weakens the
aneurysm wall; severe rise in BP causing
hemorrhage and ischemia
Cerebral embolism a blood clot breaks
off from a thrombus elsewhere in the
body, lodges in a blood vessel in the
brain and shuts off blood supply to that
part of the brain

Types of Stroke
Ischemic stroke - when arteries are

blocked by blood clots or by gradual

build up of plaque and other fatty
deposits.
Almost 85% of strokes are ischemic.

Hemorrhagic stroke when a blood

vessel in the brain breaks leaking

blood into the brain.
About 15% of all strokes but responsible

for 30% of stroke deaths

Stroke

Points to Consider
2,000,000 brain cells die every

minute during stroke, increasing risk

of permanent brain damage,
disability or death.
Recognizing symptoms and acting
fast to get medical attention can
save life and limit disabilities.

Stages of CVA
Transient ischemic attack (TIA) sudden

and short-lived attack

Reversible ischemic neurologic deficit
(RIND) similar to TIA, but symptoms can
last up to a week
Stroke in evolution (SIE) - gradual
worsening of symptoms of brain ischemia
Completed stroke (CS) symptoms of
stroke stable over a period and rehab can
begin

Signs and Symptoms

In embolism
Usually occurs without warning
Client often with history of cardiovascular

disease

In thrombosis
Dizzy spells or sudden memory loss
No pain, and client may ignore symptoms

In cerebral hemorrhage
May have warning like dizziness and ringing

in the ears (tinnitus)

Violent headache, with nausea and vomiting

Signs and Symptoms

Sudden-onset CVA
Usually most severe
Loss of consciousness
Face becomes red
Breathing is noisy and strained
Pulse is slow but full and bounding
Elevated BP
May be in a deep coma

Time is Critical!
The longer the time period that the

person remains unresponsive, the

less likely it is that the person will
recover.
The first few days after onset is critical.
The responsive person may:
Show signs of memory loss or inconsistent

behavior
May be easily fatigued, lose bowel and
bladder control, or have poor balance.

Common Stroke Symptoms

Weakness or paralysis
Numbness, tingling,
decreased sensation
Vision changes
Speech problems
Swallowing difficulties or
drooling
Loss of memory
Vertigo (spinning sensation)
Loss of balance and
coordination
Personality changes
Mood changes (depression,
apathy)
Drowsiness, lethargy, or loss
of consciousness
Uncontrollable eye
movements or eyelid drooping

Act F.A.S.T.
F = Face

Ask the person to smile.

Does
one side of the face droop?
A = Arms
Ask the person to raise
both
arms. Does one arm drift
downward?
S=
Speech Ask the person to repeat
a simple
sentence. Does the
speech sound
slurred or strange?
T = Time
Call 911 immediately!

Risk Factors
Being over age 55
Being an African-American
Having diabetes
Having a family history of stroke

Medical Stroke Risks

Previous stroke
Previous episode of transient

ischemic attack (TIA) or mini-stroke

High cholesterol
High blood pressure
Heart disease
Atrial fibrillation and carotid
artery disease

Lifestyle Stroke Risks

Smoking
Being overweight
Drinking too much alcohol
You can control lifestyle risks by quitting

smoking, exercising regularly, watching

what and how much you eat and limiting
alcohol consumption.

Major Effects of Stroke

Hemiplegia - most common result of CVA
Paralysis of one side of the body
May affect other functions, such as hearing,

general sensation and circulation

The degree of impairment depends on the part
of the brain affected
Stages:
Flaccid numbness and weakness of affected side
Spastic muscles contracted and tense,
movement hard
Recovery therapy and rehab methods successful

 Aphasia and Dysphasia

Brain Damage extent of brain damage

determines chances of recovery

Hemianopsia blindness in half of the visual
field of one or both eyes
Pain usually very little; injection of local
anesthetic provides temporary relief
Autonomic Disturbances
Such as perspiration or goose flesh above the

level of paralysis
May have dilated pupils, high or low BP or headache
Treated with atropine-like drugs

Personality Changes either functional or

organic

Diagnostic Procedures
Magnetic resonance imaging (MRI) and/or

computed tomography (CT) imaging, computed

axial tomography (CAT) scan
Used to identify edema, ischemia and necrosis

Magnetic resonance angiography (MRA) or

cerebral angiography

To identify presence of cerebral hemorrhage,

abnormal vessel structures, vessel ruptures, and

regional perfusion of blood flow in the brain

Lumbar puncture
Used to assess presence of blood in the CSF

Carotid endarterectomy
Performed to open the artery by removing

atherosclerotic plaque

Interventional radiology
Performed to treat cerebral aneurysm

Assessments
Monitor for signs and symptoms
Symptoms will vary based on the area of the

brain that is not adequately supplied with

oxygenated blood

The left cerebral hemisphere is responsible for

language, mathematic skills and analytic thinking
The right cerebral hemisphere is responsible for
visual and spatial awareness and proprioception

Assess/Monitor

Airway patency
Swallowing ability/aspiration risk
Level of consciousness
Neurological status
Motor, sensory and cognitive functions
Glasgow Coma Scale score

Nursing Diagnoses
Ineffective tissue perfusion (cerebral)
Disturbed sensory perception
Impaired physical mobility
Risk for injury
Self-care deficit
Impaired verbal communication
Impaired swallowing

Nursing Considerations
Maintain patent airway.
Monitor for changes in the clients level

of consciousness (increased intracranial

pressure sign).
Elevate the clients head to reduce ICP
and to promote venous drainage. Avoid
extreme flexion or extension, maintain
the head in a midline neutral position
and elevate the head of bed to 30
degrees.
Institute seizure precautions.

 Maintain a non-stimulating

environment.
Assist with communication skills if the
clients speech is impaired.
Assist with safe feeding.
Assess swallowing reflexes.
Thicken liquid to avoid aspiration.
Eat in an upright position and swallow

with the head and neck flexed slightly

forward.
Place food in the back of the mouth on
the unaffected side.
Suction on standby.

 Maintain skin integrity.

Encourage PROM every 2 hr to the

affected extremities and AROM every 2

hr to the unaffected extremities.
Elevate the affected extremities to
promote venous return and to reduce
swelling.
Maintain a safe environment to reduce
the risks of falls.
Scanning technique (turning head from
side to side) when eating and ambulating
to compensate for hemianopsia.

 Provide care to prevent deep-vein

thrombosis (sequential compression

stockings, frequent position changes,
mobilization).
Administer medications as prescribed.
Systemic or catheter directed thrombolytic

therapy restores cerebral blood flow. It must

be administered within hours of the onset of
symptoms. It is contraindicated for
treatment of hemorrhagic stroke and for
clients with an increased risk of bleeding.
Rule out hemorrhagic stroke with an MRI
prior to initiation of thrombolytic therapy.

Thrombolytic Therapy
Anticoagulants: Sodium heparin,

warfarin (Coumadin)
Antiplatelets: Ticlopidine (Ticlid),
clopidogrel (Plavix)
Antiepileptic medications: Phenytoin
(Dilantin), gabapentin (Neurontin)

Stroke Prevention
Get screened for high BP.
Have your cholesterol level checked.

LDL should be lower than 70 mg/dL.

Follow a low-fat diet.
Quit smoking!
Exercise!
Limit alcohol intake!

Stroke Resources
www.strokeassociation.org
www.americanstroke.org
www.stroke.org
www.strokecenter.org
www.ced.gov
www.ahajournals.org
Thanks Batch 17 and Ms. Shiela
for being a great audience!!!
Margi & Imeeh