NURS 308: TOPIC 16 - ALTERATIONS IN NEUROLOGIC FUNCTION: STROKE

What is a stroke (CVA/brain attack)?

Sudden interruption of cerebral blood flow, leading to brain cell death.

Why is a stroke considered a medical emergency?

Because lack of blood flow quickly causes irreversible brain damage.

Where does stroke rank among causes of death in the United States?

It is the 5th most common cause of death.

How many strokes occur each year in the United States?

Approximately 800,000 per year.

Why is stroke a major public health concern beyond mortality?

It is the leading cause of serious, long-term disability.

What percentage of stroke survivors experience permanent disability?

About 15–30%.

How does stroke impact patients and families long-term?

It can cause lifelong physical, cognitive, and emotional impairments, significantly affecting quality of life.

What are the two main types of stroke?

Ischemic stroke & hemorrhagic stroke

Which type of stroke is most common?

Ischemic stroke (about 87%)

What causes an ischemic stroke?

Blockage of cerebral circulation by a thrombus (forms in place) or embolus (travels from elsewhere)

What happens to brain cells during an ischemic stroke?

They are deprived of oxygen & glucose

What percentage of strokes are hemorrhagic?

About 13%

What causes a hemorrhagic stroke?

Ruptured artery or aneurysm leading to bleeding into or around the brain

How does a hemorrhagic stroke affect the brain?

Increased intracranial pressure compresses surrounding brain tissue

What conditions are commonly associated with hemorrhagic stroke?

HTN & bleeding disorders

Which type of stroke has a higher mortality rate?

Hemorrhagic stroke

What does the brain require continuously to function properly?

Oxygen & glucose, with no stored reserve.

Why is the brain highly vulnerable to interruptions in blood flow?

It has no reserve supply of oxygen or glucose.

How quickly does brain metabolism begin to change after complete interruption of blood flow?

Within 30 seconds.

When does brain metabolism completely stop after blood flow is cut off?

About 2 minutes.

How long does it take for brain cells to begin dying after no blood flow?

Within 5 minutes.

What is cerebral autoregulation?

The brain’s ability to maintain stable blood flow despite changes in systemic blood pressure.

How does cerebral autoregulation work?

By adjusting the diameter of blood vessels.

How does stroke affect cerebral autoregulation?

It disrupts the brain’s ability to regulate blood flow properly.

Which side of the body is affected in a right hemisphere stroke?

Left-sided hemiplegia or hemiparesis

Which side of the body is affected in a left hemisphere stroke?

Right-sided hemiplegia or hemiparesis

How is language typically affected in a right hemisphere stroke?

Usually intact

How is language affected in a left hemisphere stroke?

Aphasia or dysphasia

Which hemisphere controls language?

Left hemisphere

What behavioral changes are seen in a right hemisphere stroke?

Impulsive, poor judgment, lack of awareness of deficits

What behavioral changes are seen in a left hemisphere stroke?

Cautious, anxious, slow, fearful

What type of memory is affected in a right hemisphere stroke?

Visual-spatial memory

What type of memory is affected in a left hemisphere stroke?

Language/verbal memory

What perceptual issues occur with a right hemisphere stroke?

Spatial-perceptual problems, unilateral neglect of the left side, hemianopsia

What perceptual issues occur with a left hemisphere stroke?

Impaired spatial discrimination

What is a transient ischemic attack (TIA)?

Temporary episode of neurologic dysfunction caused by focal ischemia without acute brain infarction.

What causes a TIA?

Microemboli that temporarily block cerebral blood flow.

How long do TIA symptoms usually last?

Less than 1 hour.

Does a TIA cause permanent brain damage?

No; by definition, there is no permanent damage.

Why is a TIA considered serious?

It is a warning sign of progressive cerebrovascular disease.

What is the stroke risk after a TIA?

About 10–15% of patients will have a stroke within 3 months.

When is the highest risk for stroke after a TIA?

Within the first few days after the TIA.

What does FAST stand for in recognizing a TIA or stroke?

F = face drooping, A = arm weakness, S = speech difficulty, T = time to call 911.

How do you assess for face drooping in a suspected TIA?

Ask the patient to smile and check if one side droops.

How do you assess for arm weakness in a suspected TIA?

Ask the patient to raise both arms and see if one drifts downward.

What speech changes may indicate a TIA?

Slurred speech, strange speech, or inability to speak.

What should you do if any FAST signs are present?

Call 911 immediately.

What are additional manifestations of a TIA besides FAST?

Visual disturbances, dizziness, weakness of an extremity, numbness, or tingling.

What determines the specific signs and symptoms of a TIA?

Which blood vessel is affected.

What is the most important patient teaching for TIA symptoms?

Seek immediate medical attention, even if symptoms resolve.

What is the main difference between a TIA and a stroke?

TIA has no permanent brain infarction & symptoms fully resolve; stroke has permanent infarction & lasting deficits

How do imaging findings differ between a TIA and a stroke?

TIA shows no infarction on imaging; stroke shows visible brain infarction

Do symptoms resolve in a TIA or a stroke?

TIA symptoms fully resolve; stroke symptoms often persist

Are TIA and stroke both considered emergencies?

Yes, both are medical emergencies

How are TIA and stroke initially managed?

They are treated the same initially until imaging differentiates them

What are nonmodifiable risk factors for stroke?

Age (risk doubles each decade after 55), male gender, Black race, family/personal history of stroke or TIA, heredity

What is the most important nonmodifiable risk factor for stroke?

Age

What are modifiable risk factors for stroke?

• HTN

• DM

• heart disease (esp. AFib)

• elevated cholesterol

• smoking/vaping

• obesity

• sleep apnea

• metabolic syndrome

• sedentary lifestyle

• poor diet

• drug & alcohol use

• hypercoagulable states

What is the single most important modifiable risk factor for stroke?

HTN

Why is atrial fibrillation a risk factor for stroke?

It can lead to clot formation due to irregular heart rhythm, increasing risk of embolic stroke

What is a key nursing education point for patients with hypertension to reduce stroke risk?

BP monitoring, medication adherence, & lifestyle changes (diet, exercise, weight control)

What education is important for patients with atrial fibrillation to prevent stroke?

Anticoagulant therapy education (e.g., warfarin, DOACs) to prevent clot formation

What should patients with diabetes be taught to reduce stroke risk?

Blood glucose control through medication adherence, diet, and monitoring

What is an important intervention for stroke prevention related to smoking?

Smoking cessation counseling and providing resources

How does hyperlipidemia contribute to stroke risk?

It promotes atherosclerosis, increasing the likelihood of vessel blockage

What are key education points for patients with hyperlipidemia to reduce stroke risk?

Statin therapy adherence and dietary modifications (low fat, low cholesterol diet)

What are the most obvious deficits after a stroke?

Motor function deficits

What is hemiplegia?

Paralysis on one side of the body (contralateral to the stroke)

What is hemiparesis?

Weakness on one side of the body (contralateral to the stroke)

What functions can be impaired with stroke-related motor deficits?

Mobility, respiratory function, swallowing, speech, gag reflex, and self-care

What is akinesia?

Loss of skilled voluntary movement

What changes occur in muscle tone after a stroke?

Initially hyporeflexia, progressing to hyperreflexia

What is dysarthria?

Muscular control problem with speech affecting pronunciation, articulation, & phonation; does not affect language comprehension or meaning.

What is aphasia (dysphasia)?

Impaired ability to communicate caused by damage to the dominant hemisphere, usually the left.

What is receptive aphasia?

Loss of comprehension; the patient cannot understand spoken or written language.

What is expressive aphasia?

Inability to produce language; the patient understands but cannot speak or write.

What is global aphasia?

Loss of both comprehension and expression; the most severe form of aphasia.

What is anomic aphasia?

The patient understands language but has difficulty finding words, often described as the “tip-of-the-tongue” phenomenon.

What type of communication deficit affects speech production but not understanding?

Dysarthria.

What type of aphasia occurs with damage to the dominant (left) hemisphere?

Aphasia (dysphasia).

Which type of aphasia involves inability to understand language?

Receptive aphasia.

Which type of aphasia involves inability to express language but intact comprehension?

Expressive aphasia.

Which aphasia affects both understanding and expression?

Global aphasia.

Which aphasia is characterized by word-finding difficulty despite understanding language?

Anomic aphasia.

What emotional difficulty may occur after a stroke?

Difficulty controlling emotions with exaggerated or unpredictable responses

What can magnify emotional deficits after a stroke?

Depression, changes in body image, loss of function, and loss of mobility

What mental health condition is very common after a stroke?

Post-stroke depression

What should be addressed in a patient after a stroke in relation to emotional changes?

Psychosocial needs, including emotional support and mental health care

What is homonymous hemianopsia in stroke?

Loss of half of the visual field on the same side as the motor deficit.

What is unilateral neglect in right hemisphere stroke?

Inattention to or ignoring of the affected side of the body.

What is agnosia in stroke?

Inability to recognize familiar objects, persons, or sounds.

What is apraxia in stroke?

Inability to perform purposeful movements despite intact motor function.

What is a common deficit related to spatial-perceptual processing in stroke?

Difficulty judging distance, position, and rate of movement.

What behavioral changes are associated with right hemisphere stroke?

Impulsive behavior and poor judgment.

What elimination problems are common after a stroke?

Why do patients have urinary incontinence after a stroke?
Neurologic impairment affecting bladder control in the acute phase

What is the most common bowel problem after a stroke?
Constipation

What factors contribute to constipation in stroke patients?
Immobility, weak abdominal muscles, dehydration, and diminished defecation reflex

How do communication and mobility impairments affect elimination after a stroke?
They worsen elimination problems by limiting the patient’s ability to communicate needs and access toileting independently

Urinary urgency, frequency, incontinence (often temporary in the acute phase) and constipation

Why do patients have urinary incontinence after a stroke?

Neurologic impairment affecting bladder control in the acute phase

What is the most common bowel problem after a stroke?

Constipation

What factors contribute to constipation in stroke patients?

Immobility, weak abdominal muscles, dehydration, and diminished defecation reflex

How do communication and mobility impairments affect elimination after a stroke?

They worsen elimination problems by limiting the patient’s ability to communicate needs and access toileting independently

What is the first diagnostic test that must be performed when a stroke is suspected?

Non-contrast CT scan of the head