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ACCIDENT/STROKE
RODNEY R. REYES, RN
EPIDEMIOLOGY
Stroke Survivors
16%
31% Assistance with self care
Assistance with ambulation
Impairment in vocational ability
33% Institutionalized
20%
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
CEREBRAL BLOOD FLOW
DEFINITION
A stroke, also called a “brain attack”, occurs when a portion of the brain is
damaged due to a lack of blood supply to that part of the brain.
It is caused by either a blockage (ischemic) or rupture of the blood vessel
(hemorrhagic) in the brain.
Due to the lack of oxygen and nutrients carried by the blood, brain cells
(called “neurons”) die and the connections between neurons (called
“synapses” or junctions) are lost.
That part of the brain rapidly loses functions and starts to die.
The larger area of the damage, the more deficits the patients will have.
TYPES
Subtypes:
a. Thrombotic Stroke
- occurs when an artery becomes blocked by the formation of a blood clot
(thrombus) within it.
- Atherosclerosis is the primary cause wherein fatty material deposit and
form plaques on vessel walls.
- Total blockage may subsequently occur due to clumping together of
blood cells (platelets) or other substances normally found in the blood.
TYPES
Subtypes:
b. Embolic Stroke
- It is the occlusion of a cerebral artery by an embolus that is formed outside
the brain, detaches and travels through the cerebral circulation until it
lodges in and occludes a cerebral artery.
- These materials could be blood clots (e.g. from the heart) or fatty materials
(e.g. from another artery in the neck – carotid artery disease).
- Causes: Chronic atrial fibrillation, mechanical prosthetic heart valves,
bacterial and non bacterial endocarditis, tumor, fat, bacteria and air.
TYPES
Transient ischemic attack (TIA) — aka “mini stroke” are episodes in which a
person has signs or symptoms of a stroke (e.g, numbness; inability to speak)
that last for a short time, but without any sign of stroke on brain scans such
as MRI or CT.
Symptoms of a TIA usually last between a few minutes and a few hours. A
person may have one or many TIAs. People recover completely from the
symptoms of a TIA.
A TIA is a warning sign that a person is at high risk for a stroke; immediate
treatment can decrease or eliminate this risk.
TYPES
Etiology
Modifiable Non-Modifiable
Blood pressure Age (> 40 years old)
Heart disease Gender (Female > Male)
Blood cholesterol Race (African American)
Diabetes Genetics
Clotting problem Previous stroke
Cigarette smoking
Heavy alcohol intake
Obesity
Sedentary lifestyle
PATHOPHYSIOLOGY (ISCHEMIC STROKE)
Modifiable Risk Factors Non modifiable Risk Factors
Plaques continue to
enlarge(Stenosis)
Rupture of arteriosclerotic
Rupture of aneurysm
and hypertensive vessels
HEMORRHAGIC STROKE
SYMPTOMS
SYMPTOMS
Face Drooping Does one side of the face droop or is it numb? Ask the
person to smile.
Arm Weakness Is one arm weak or numb? Ask the person to raise both
arms. Does one arm drift downward?
Speech Difficulty Is speech slurred, are they unable to speak, or are they
hard to understand? Ask the person to repeat a simple sentence, like "the
sky is blue." Is the sentence repeated correctly?
Time to call 911 If the person shows any of these symptoms, even if the
symptoms go away, call 9-1-1 and get them to the hospital immediately.
SYMPTOMS
0 No stroke symptoms
Facial droop: Have the person smile or show his or her teeth. If one side doesn't
move as well as the other so it seems to droop, that could be a sign of a stroke.
Normal: Both sides of face move equally
Abnormal: One side of face does not move as well as the other (or at all)
Arm drift: Have the person close his or her eyes and hold his or her arms straight
out in front with palms facing up for about 10 seconds. If one arm does not
move, or one arm winds up drifting down more than the other, that could be a
sign of a stroke.
Normal: Both arms move equally or not at all
Abnormal: One arm does not move, or one arm drifts down compared with the other
side
Speech: Have the person say, "You can't teach an old dog new tricks," or some
other simple, familiar saying. If the person slurs the words, gets some words
wrong, or is unable to speak, that could be a sign of a stroke.
Normal: Patient uses correct words with no slurring
Abnormal: Slurred or inappropriate words or mute
STROKE ASSESSMENT SCALE
1 2 3 4 5 6
Oriented,
Makes no Makes Confused,
Verbal Words converses N/A
sounds sounds disoriented
normally
Abnormal
Extension to Flexion /
flexion to
Makes no painful stimuli Withdrawal Localizes to Obeys
Motor painful stimuli
movements (decerebrate to painful painful stimuli commands
(decorticate
response) stimuli
response)
LABORATORY AND DIAGNOSTIC
PROCEDURES
HEALTH EDUCATION
17. Prevent skin breakdown: turn q2hrs, ensure adequate protein intake, off-
loading, pillow support, keep linen clean and dry
There are many reasons why a stroke patient will be at risk for skin breakdown…
from an inability to feel or move extremities, incontinence, inability to
communicate needs/pain/discomfort, decreased nutritional status.
18. Facilitate communication; promote family coping and communication
Having a stroke is a major life event. Roles within families and support systems
may change, especially if the patient played a caregiving role within their
family structure
NURSING MANAGEMENT (REHABILITATIVE)
PHYSICAL ACTIVITIES
Motor-skill exercises. These exercises can help improve your muscle
strength and coordination. You might have therapy to strengthen your
swallowing.
Mobility training. You might learn to use mobility aids, such as a walker,
canes, wheelchair or ankle brace. The ankle brace can stabilize and
strengthen your ankle to help support your body's weight while you relearn
to walk.
Constraint-induced therapy. An unaffected limb is restrained while you
practice moving the affected limb to help improve its function. This
therapy is sometimes called forced-use therapy.
Range-of-motion therapy. Certain exercises and treatments can ease
muscle tension (spasticity) and help you regain range of motion.
NURSING MANAGEMENT (REHABILITATIVE)
Pain management
Emotional turmoil and grief
Physical limitations such as loss of strength or balance
Nutrition and nutrition disorders caused by stroke
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