Stroke%2C+Dementia+and+Delirium

Stroke Risk Factors

  • Nonmodifiable:

    • Age

    • Gender

    • Ethnicity or race

    • Family history

  • Modifiable:

    • Smoking

    • Hypertension (HTN)

    • Heart Disease

    • Diabetes Mellitus (DM)

    • Obesity

    • Sleep Apnea

    • Metabolic syndrome

    • Lack of physical exercise

    • Drug and Alcohol use

Types of Stroke

  • Transient Ischemic Attack (TIA):

    • Symptoms last less than 1 hour

    • Important to educate patients on signs/symptoms

  • Ischemic Stroke:

    • Caused by inadequate blood flow to the brain due to artery occlusion

    • Thrombotic vs. Embolic classification

    • Timeline crucial for intervention

  • Hemorrhagic Stroke:

    • Bleeding into brain tissue

    • Types:

      • Intracerebral (ruptured blood vessel)

      • Subarachnoid (ruptured cerebral aneurysm)

Clinical Manifestations of Stroke

  • General:

    • Related to stroke location and the area of the brain affected

    • Neural tissue destruction leads to dysfunction

    • Contralateral effects based on the artery involved

    • Ischemia duration matters for symptoms

Spatial-Perceptual Alterations

  • Right-side strokes can cause:

    • Incorrect self-perception

    • Unilateral neglect of the affected side (Homonymous hemianopsia)

    • Agnosia (inability to recognize objects)

    • Apraxia (difficulty with learned movements)

Right vs. Left Brain Damage

  • Right Brain Damage:

    • Paralysis on the left side (hemiplegia)

    • Neglect issues

    • Spatial-perceptual deficits

    • Impulsive behavior, denial of problems

  • Left Brain Damage:

    • Paralysis on the right side (hemiplegia)

    • Language impairments (aphasias)

    • Slow performance, awareness of deficits

Nursing Interventions for Stroke

  • Assessment:

    • History and physical assessment

    • Document symptom onset

  • Acute Stroke Care:

    • Maintain airway and fluid therapy

    • Manage blood pressure and cerebral edema to prevent secondary injury

  • Pharmacologic Management:

    • Ischemic Stroke Treatment:

      • Tissue plasminogen activator (tPA)

      • Endovascular therapy

    • Hemorrhagic Stroke Treatment:

      • Clipping or coiling of aneurysms

      • Surgical decompression

Communication Deficits

  • Aphasia Types:

    • Receptive: loss of comprehension

    • Expressive: loss of language production

    • Global: total inability to communicate

  • Dysphasia Types:

    • Nonfluent: minimal speech activity

    • Fluent: speech present but non-meaningful

  • Dysarthria:

    • Disturbance in muscular control affecting speech production

Ischemic Stroke Care Management

  • Fluid and Electrolyte Balance:

    • Ensure adequate hydration to promote perfusion

  • Intracranial Pressure (ICP) Management:

    • Interventions for improving venous drainage

    • Permissive hypertension (up to 220/120 for 48 hours)

  • Glycemic Control:

    • Monitor blood sugar levels regularly to prevent extremes

  • Anticoagulants and Antiplatelet Therapy:

    • For patients with thrombotic strokes

    • For atrial fibrillation patients: use oral anticoagulants

Hemorrhagic Stroke Management

  • Anticoagulants and Platelet Inhibitors:

    • Contraindicated; manage hypertension

Nursing Goals for Stroke Patients

  • Maintain consciousness and functional ability

  • Achieve maximum physical functioning and self-care skills

  • Prevent complications and ensure adequate nutrition

Nursing Management Focus Areas

  • Neurologic System Monitoring:

    • Assess for stroke extension and recovery

  • Respiratory Management:

    • Prevent atelectasis and aspiration pneumonia

    • May require endotracheal intubation

  • Cardiovascular Management:

    • Stability and monitoring for dysrhythmias

  • Musculoskeletal Management:

    • Prevent joint contractures and muscular atrophy through positioning and exercise

  • Integumentary System Management:

    • Prevention of skin breakdown via proper care and position changes

  • Gastrointestinal and Urinary System Management:

    • Address bowel and bladder control issues

    • Monitor for constipation and promote normal function

  • Nutritional Management:

    • Assess swallowing and provide appropriate feeding

Interprofessional Management and Education

  • Educate on stroke signs and urgency (FAST)

  • Support patient and family coping with the stroke impact

  • Planning for rehabilitation post-discharge

Dementia Overview

  • Dementia is progressive, not normal aging

Alzheimer's Disease

  • Most common dementia type with specific pathological signs.

Differences Between Delirium and Dementia

  • Delirium:

    • Sudden, reversible changes

  • Dementia:

    • Gradual, irreversible decline

Causes for Dementia-like Symptoms

  • Various medical and emotional factors can mimic dementia.

Progression and Signs of Alzheimer's Disease

  • Key signs include memory loss, difficulty with tasks, and personality changes.

Nursing Goals for Dementia Patients

  • Promote safety and dignity while meeting physical care needs.