Stroke (CVA) Overview

STROKE (CVA) NUR 181 CLASS NOTES

WHAT IS A TRANS-ISCHEMIC ATTACK? (TIA)

• Definition: A transient ischemic attack (TIA) is often a warning sign or precursor to a full-blown stroke.

• Characteristics:

  • It is characterized by brief neurological dysfunction due to interruption in cerebral blood flow.

  • No definitive diagnostic findings are available to confirm a TIA.

• Prognosis:

  • Approximately 40% of individuals who experience TIAs will have a stroke within one year, assuming lifestyle changes are not implemented.

WHAT’S THE BIG DEAL?

1. Stroke is the 5th leading cause of death in the United States.

2. It affects over 800,000 people in the US annually.

3. During an ischemic stroke, approximately 2 million brain cells die every minute due to lack of blood flow.

4. Stroke is a major cause of disabilities in patients.

5. Demographic Disparities: Stroke affects a higher percentage of African Americans, Native Americans, and Hispanics compared to other groups.

6. Gender Differences: Women generally wait longer to seek treatment for strokes than men.

TYPES OF STROKES

ISCHEMIC STROKE

• Definition: This type of stroke is caused by an obstruction within a blood vessel supplying blood to the brain, often due to a thrombus (blood clot).

HEMORRHAGIC STROKE

• Definition: Results from a rupture of a blood vessel, leading to bleeding (hemorrhage) in or around the brain.

TRANSIENT ISCHEMIC ATTACK (TIA)

• Description: Often referred to as a "mini stroke," TIA is caused by a temporary clot that temporarily blocks blood flow to the brain.

RISK FACTORS FOR STROKE

• Risk Assessment Tool: Each applicable risk factor counts for one point in assessing overall stroke risk. High-risk factors score higher.

  • Blood Pressure:

  • High Risk: >140/90 or unknown

  • Caution: 120-139/80-89

  • Low Risk: <120/80

  • Atrial Fibrillation: Irregular heartbeat counts as high risk.

  • Smoking Status:

  • High Risk: Smoker

  • Caution: Trying to quit

  • Low Risk: Nonsmoker

  • Cholesterol Levels:

  • High Risk: >240 or unknown

  • Caution: 200-239

  • Low Risk: <200

  • Diabetes Status:

  • Yes = high risk

  • Borderline = caution

  • Exercise Level:

  • Couch potato = high risk

  • Some exercise = caution

  • Regular exercise = low risk

  • Diet and Weight:

  • Overweight = high risk

  • Slightly overweight = caution

  • Healthy weight = low risk

NEUROLOGICAL ASSESSMENT

• Key Areas of Assessment:

  • Level of Consciousness (LOC)

  • Patient Orientation

  • Assess for sudden onset of:

  • Confusion

  • Difficulty speaking

  • Difficulty understanding others

  • Numbness or weakness in extremities or face

  • Vision changes

  • Dizziness or mobility issues

  • Loss of balance

  • Severe headache

SIGNIFICANT SYMPTOMS TO MONITOR

• The FAST Acronym:

  • Face: Check for drooping on one side.

  • Arms: Ask the patient to raise both arms; one arm may drop.

  • Speech: Assess for speech difficulty or confused speech.

  • Time: Call for an ambulance immediately if any symptoms are present.

QUESTIONS TO ASK PATIENT

1. Time symptoms first appeared; if unknown, inquire when the patient was last known to be symptom-free.

2. Recent injuries, especially head trauma.

3. Past medical history:

   • Previous strokes or TIAs

   • Hypertension

   • Diabetes

   • Heart issues

GLASGOW COMA SCALE (GCS)

• Purpose: Developed to provide a standardized and objective method for assessing and communicating a patient's level of consciousness, particularly in cases of impaired consciousness or coma.

STROKE HEMISPHERES

• **Cerebral Hemispheres: **

  • Right cerebral hemisphere: controls the left side of the body.

  • Left cerebral hemisphere: controls the right side of the body.

INCREASED INTRACRANIAL PRESSURE (ICP)

• Signs and Symptoms:

  • Changes in LOC

  • Eyes: Papilledema, pupillary changes, impaired eye movement.

  • Posturing:

  • Decerebrate posture: extended arms and legs.

  • Decorticate posture: flexed arms and extended legs.

  • Flaccid posturing: limp limbs.

  • Speech Changes: Impaired / slurred speech, severe headache.

  • Infants: Bulging fontanels, seizures, impaired sensory and motor function.

  • Vital Signs: Cushing's Triad, which includes:

  • Widening pulse pressure

  • Bradycardia

  • Irregular respiratory pattern.

  • Associated Symptoms: Vomiting; cranial suture separation.

NURSING INTERVENTIONS FOR ICP

• Elevate the head of the bed to 30 degrees or as ordered.

• Maintain midline alignment of head and body.

• Ensure drainage (if applicable).

• Provide supplemental oxygen.

• Administer pain control measures.

• Maintain normal body temperature.

• Keep environmental lights low.

• Monitor blood pressure, heart rate, oxygen saturation, and glucose levels vigilantly.

STROKE TREATMENT

FIBRINOLYTIC THERAPY

• Purpose: To dissolve the blood clot as a treatment for ischemic stroke.

ALTEPLASE vs TENECTEPLASE

• Alteplase (tPA):

  • Recombinant form of tissue Plasminogen Activator (tPA).

• Tenecteplase:

  • Bioengineered version of Alteplase with different pharmacokinetics.

  • FDA approved for acute ischemic stroke, acute myocardial infarction, and acute massive pulmonary embolism.

  • Administer as a 10% bolus followed by a one-hour infusion.

• Fibrin Specificity:

  • Tenecteplase is 14-15 times more fibrin specific compared to alteplase.

  • Altaeplase is less resistant to Plasminogen activator inhibitor - I, while Tenecteplase has a longer half-life and is more resistant.

IMPORTANCE OF BLOOD PRESSURE

• Maintaining healthy blood pressure is critical in reducing stroke risk.

APHASIA

• Definition: A language disability resulting from brain injury that may manifest as:

  • Difficulty understanding language.

  • Difficulty reading and writing.

  • Difficulty speaking.

PATIENT EDUCATION

• Key Topics to Discuss with Patients:

  • Understanding what constitutes a stroke.

  • Recognizing stroke risk factors.

  • Knowledge of prescribed medications.

  • When to call 911.

  • Addressing any other stroke-related questions.