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CVA

(Cerebrovascular Accident)

Objectives
By the end of this session one will be able to:
Define CVA
Identify the different types of CVA
Risk factors of CVA
Identify the causes of CVA
Identify the signs and symptoms of CVA
Identify the various ways of diagnosing CVA
Prevent CVA
Medical and surgical management of CVA
Nursing management of CVA

Definition
Cerebrovascular Accident (CVA) is a
brain stroke/attack caused by the
rapid loss of brain function due to
disruption of the blood supply to the
brain. As a result, the affected area
of the brain cannot function resulting
in an inability to move, inability to
understand or formulate speech or
inability to see one side of the visual
field.

Types
There are two types:
Ischemic stroke
interruption of the blood
supply
Hemorrhagic stroke
rupture of blood vessel

Ischemic Stroke
Ischemic Stroke is caused by:
Thrombosis (obstruction of a blood
vessel by a blood clot forming locally)
Embolism (obstruction due to an
embolus from elsewhere in the body)
Systemic hypo perfusion (general
decrease in blood supply, e.g., in
shock)
Venous thrombosis

Embolism

Hemorrhagic Stroke
An intracranial hemorrhage is the accumulation of
blood anywhere within the cranial vault, bleeding
within the brain tissue.
The main types of intracranial hemorrhage
are:
Epidural Hematoma (bleeding between the dura
mater and the skull),
Subdural Hematoma (in the subdural space, space
between arachnoid matter and the dura mater) and
Subarachnoid Hemorrhage (between the arachnoid
mater and pia mater).

Risk Factors
Non modifiable

Modifiable

Age

Hypertension

Male sex

Diabetes

Race

Smoking

Heredity

Hyperlipidemia

Causes
Ischemic stroke is caused by
thrombus or embolus that blocks the
blood flow to the brain
Hemorrhagic stroke caused by
uncontrolled high blood pressure,
head injury

Signs and Symptoms


Sudden numbness or weakness
Sudden blurred vision
Sudden inability to move certain
parts of the body
Sudden dizziness or headache with
nausea
Difficulty in swallowing
Sudden confusion

Diagnosing

Physical assessment
Ultrasound
Arteriography
CT scan
MRI
CT and MRI with angiography
Echocardiography
EEG
Lumbar Puncture
Transcranial Doppler Ultrasonography

Prevention
Control high blood pressure
Lower the amts of cholesterol and
saturated fats
Quit tobacco use
Control diabetes
Maintain a healthy diet
Exercise regularly
Avoid using illicit drugs

Medical and surgical


management
Thrombolytic Therapy
Thrombolytic agents are used to treat ischemic stroke by dissolving the
blood clot that is blocking blood flow to the brain.
Elevation of the head of the bed to promote venous drainage and to
lower increased ICP
Possible hemicraniectomy for increased ICP from brain edema in a
very large stroke
Intubation with an endotracheal tube to establish a patent airway, if
necessary
Continuous hemodynamic monitoring (the goals for blood pressure
remain controversial for a patient who has not received thrombolytic
therapy; antihypertensive treatment may be withheld unless the
systolic blood pressure exceeds 220 mm Hg or the diastolic blood
pressure exceeds 120 mm Hg)
Neurologic assessment to determine if the stroke is evolving and if
other acute complications are developing; such complications may
include seizures, bleeding from anticoagulation, or medication

Carotid Endarterectomy
A carotid endarterectomy is the removal of an
atherosclerotic plaque or thrombus from the carotid
artery to prevent stroke in patients with occlusive
disease of the extracranial cerebral arteries. This
surgery is indicated for patients with symptoms of TIA
or mild stroke found to be caused by severe (70% to
99%) carotid artery stenosis or moderate (50% to
69%) stenosis with other significant risk factors.
Carotid stenting, with or without angioplasty, is a less
invasive procedure that is used, at times, for severe
stenosis. It is used for selected patients who are at
high risk for surgery, and its efficacy continues to be
investigated.

Nursing management
Promote adequate cerebral perfusion and
oxygenation.
Prevent/minimize complications and
permanent disabilities.
Assist patient to gain independence in ADLs.
Support coping process and integration of
changes into self-concept.
Provide information about disease
process/prognosis and
treatment/rehabilitation needs

Thank you

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