Chapter 38 Caring for Clients With Cerebrovascular Disorders

Caring for Cilaapten Gebrovascular Disorders

Overview

This document covers various cerebrovascular disorders, specifically focusing on headaches, transient ischemic attacks (TIAs), and strokes. It outlines their pathophysiology, assessment findings, diagnostic and medical management, as well as nursing care considerations.

Headaches (Cephalalgia)

Types of Headaches

  • Tension Headache: The most common type, resulting from prolonged contraction of neck and facial muscles, leading to sustained pressure.

  • Migraine Headache: Characterized by recurrent and severe attacks that last for a day or more, originating from vascular changes in the brain.

  • Cluster Headache: Episodic headaches recurring over 6-8 weeks with brief recovery periods; may relate to migraine headaches.

Pathophysiology and Etiology

Tension Headaches

  • Triggered by muscle contraction in the head and neck, sensitizing nociceptors and altering neurochemical signaling in the brain.

Migraine Headaches

  • Contributing factors include changes in serotonin receptors leading to blood vessel dilation, reproductive hormone fluctuations, and dietary triggers.

Cluster Headaches

  • The exact cause is unidentified but can be precipitated by certain vasodilating agents, alcohol, and histamines.

Assessment Findings

  • Tension Headache: Described as a pressure or steady constriction across both sides of the head.

  • Classic Migraines: Accompanied by aura which may include mood changes, difficulty concentrating, and various physical symptoms such as nausea and sensitivity to light.

  • Cluster Headache: Pain localized to one side of the head, often associated with nasal congestion and tearing.

Diagnostic Findings

  • Imaging studies such as CT scans or angiography are used to rule out other medical conditions.

Medical Management

  • Tension Headaches: May be relieved through rest, mild analgesics, and stress management techniques.

  • Migraine Headaches: Treatment options include mild analgesics and preventive medications such as topiramate and methysergide, while sumatriptan is utilized for acute management.

  • Cluster Headaches: Treated with substances that include ergot derivatives and corticosteroids, as well as oxygen therapy and reconsideration of surgical options in recurrent cases.

Transient Ischemic Attacks (TIA)

Pathophysiology and Etiology

  • A TIA represents a brief episode of neurologic dysfunction due to temporary interruptions in cerebral blood flow, often signifying a risk of future cerebrovascular accidents (CVAs).

Assessment Findings

  • Symptoms include brief episodes of confusion, dizziness, and other neurologic impairments that may persist for a short time.

Diagnostic Findings

  • Carotid auscultation may reveal a bruit; imaging such as ultrasound or MRI is used to assess blood flow and rule out obstructions.

Medical Management

  • Focuses on controlling risk factors such as hypertension and cholesterol. Medications may include antiplatelets like aspirin.

Surgical Management

  • Techniques such as carotid endarterectomy may be indicated based on diagnostic findings.

Cerebrovascular Accident (Stroke)

Pathophysiology and Etiology

  • A stroke results from prolonged interruption of blood flow to the brain, which can lead to infarction. There are two primary types:

    • Ischemic Stroke: Caused by thrombus or embolus obstructing arteries.

    • Hemorrhagic Stroke: Occurs due to the rupture of blood vessels leading to bleeding inside or around the brain.

Assessment Findings

  • Symptoms include weakness on one side of the body, confusion, difficulty speaking, and severe headache, amongst others.

Diagnostic Findings

  • Various imaging techniques, including CT, MRI, and angiography, are essential for identifying the type and extent of the stroke.

Medical and Surgical Management

  • For ischemic strokes, tissue plasminogen activator (TPA) may be indicated. Surgical options may include endarterectomy.

Nursing Care Plan for CVA

Nursing Considerations

  • Focus on impaired swallowing, ensuring adequate nutrition and hydration, and monitoring for skin integrity issues related to immobility.

  • Utilize communication aids and encourage the utilization of personal strengths for coping with changes post-stroke.

Cerebral Aneurysms

Pathophysiology and Etiology

  • Aneurysms form due to weaknesses in blood vessel walls, potentially leading to ruptures and severe complications depending on their location and nature.

Assessment Findings

  • Sudden severe headaches, nausea, visual disturbances, and loss of consciousness may indicate complications.

Diagnostic Findings and Management

  • Diagnostics may include angiography and imaging to assess blood flow; management often involves medication to control symptoms and prevent complications, alongside surgical options for rupture cases.