Stroke

Chapter Overview

Stroke, also known as a Cerebral Vascular Accident (CVA), results from ischemia or hemorrhage in the brain. It impacts functions such as movement, sensation, or emotions, with severity depending on the affected brain area's location and extent.

Stroke Definition and Impact

  • Stroke Definition: Ischemia to part of the brain or hemorrhage into the brain.

  • Common Consequences: Loss or impairment of functions, significant physical, cognitive, and emotional aftermath.

  • Statistics: Third leading cause of death in Canada.

Risk Factors

Nonmodifiable Risk Factors

  • Age, sex, ethnicity, race, heredity, personal circumstances, and arteriovenous malformation.

Modifiable Risk Factors

  • Hypertension

  • Diabetes mellitus

  • Heart disease

  • High cholesterol

  • Heavy alcohol use

  • Smoking

  • Physical inactivity

  • Obesity

Types of Stroke

Classification

  • Ischemic Stroke: Caused by inadequate blood flow due to artery occlusion.

  • Hemorrhagic Stroke: Results from bleeding into brain tissue or the subarachnoid space.

    • Intracerebral hemorrhage: Ruptured blood vessels, often due to hypertension.

    • Subarachnoid hemorrhage: Intracranial bleeding due to aneurysm rupture.

Ischemic Stroke Details

  • Majority of strokes are ischemic.

  • Two Types:

    • Thrombotic Stroke: Derived from arterial plaque forming clots.

    • Embolic Stroke: Occurs when debris blocks cerebral arteries, often with rapid onset symptoms.

Clinical Manifestations

General Effects

  • Physical: Motor, sensory, intellectual, personality, and communication impairments.

  • Combination of effects: Unique to the side of the brain affected (left vs. right).

Right Brain Damage

  • Left-side paralysis, spatial deficits, impulsiveness.

Left Brain Damage

  • Right-side paralysis, language deficits, slower performance.

Specific Motor Function Impairments

  • Loss of mobility, speech, self-care abilities, and alterations in tone and reflexes.

Nursing Management

Assessment

  • Initial and comprehensive evaluations, focusing on level of consciousness, cognitive abilities, motor functions, and cranial nerve assessments.

Nursing Diagnoses

  • Include reduced adaptive capacity, potential for aspiration, reduced mobility, urinary elimination issues, and self-esteem concerns.

Planning and Environmental Control

  • Goals involve stable consciousness, maximized functionality, and coping mechanisms. Focus on education around healthcare and symptom management.

Implementation Strategies

  • Respiratory system management: Manage risks of atelectasis and aspiration pneumonia.

  • Cardiovascular monitoring: Vital sign checks and prevention of deep vein thrombosis (DVT).

  • Musculoskeletal support: Range-of-motion exercises, joint positioning, and prevention of contractures.

  • Nutritional and communication strategies: Early nutrition management and adaptive communication techniques.

Rehabilitation

  • Focus on maximizing recovery post-stabilization, with interprofessional care aiding in mobility, nutritional needs, and emotional coping strategies throughout recovery.