NSG 5130: Nursing Theory on Stroke

Stroke is a cerebral vascular accident (CVA)
Death of brain cells due to prolonged ischemia or hemorrhage
Functions lost or impaired include movement, sensation, and emotions
Severity depends on location and extent of brain involved
Blood flow to the brain is affected by blood pressure, cardiac output, and blood viscosity
Without adequate oxygen & glucose, neurons can't function
Brain needs at least 20% of cardiac output
If blood flow is interrupted (e.g., cardiac arrest), neurological metabolism is altered within 30 seconds, and metabolism stops in 2 minutes, leading to cellular death within 5 minutes.
Stroke is the third most common cause of death in Canada, behind cancer and heart disease
Approximately 35% of initial stroke patients die within one year
Men are more prone to thrombolytic or embolic stroke
Women are more prone to hemorrhagic stroke

Differentiate between ischemic and hemorrhagic stroke types
Describe health patterns and associated risk factors for stroke conditions
Identify diagnostic tests and nursing implications for various stroke types
Utilize the nursing process for client care (pre, during, and post-stroke)
Perform assessments of clinical manifestations of a stroke.
Identify common associated nursing diagnoses
Implement collaborative care, drug therapy, nursing care, acute care, and non-acute care/health promotion strategies.

Accounts for approximately 15% of strokes
Result from bleeding into the brain tissue, subarachnoid space, or ventricles
Intracerebral Hemorrhage
Bleeding inside the brain, due to a ruptured blood vessel
Increases intracranial pressure, often during periods of activity.
Symptoms Sudden onset, ongoing bleeding leading to progression over minutes or hours.
Common Warning signs: Headache, nausea, and vomiting.
Subarachnoid Hemorrhage:
Bleeding outside the brain, into the cerebrospinal fluid, usually due to a ruptured cerebral aneurysm
Common warning sign: intense, extremely severe headache
Associated with high stroke mortality

Non-modifiable: Age, gender, ethnicity/race, and family/heredity history
Modifiable: Hypertension, diabetes (4-5x risk), heart disease, heavy alcohol consumption, oral contraceptive use, physical inactivity, smoking (2x risk).

Motor Function: Disability
Communication: Aphasia (loss of language), Dysphasia (communication difficulties), Dysarthria (impaired speech)
Affect: Difficulty controlling emotions, exaggerated or unpredictable responses, frustration, and anxiety.
Intellectual Functions: Impaired memory and judgment
Spatial-Perceptual Alterations: Difficulty with orientation and perception of oneself in space, recognizing objects etc.
Other possible complications: Gastrointestinal and urinary system problems, Risk of injury/falls, Impaired skin integrity, Risk for aspiration pneumonia, Risk for imbalances in body nutrition

Acute Care: Preserving life, preventing further brain damage, reducing disability, assessing time of stroke onset, managing ABCs (airway, breathing, circulation), performing comprehensive neuro-examination, managing hypertension, managing fluids and electrolytes, possible thrombolytic therapy (tPA), possible surgical intervention for severe cases.
Nursing Management: Addressing complications identified (e.g., risk of falls, risk for aspiration, risk for impaired skin integrity). Performing related interventions (e.g., positioning, swallowing assessment and procedures, ensuring hydration and nutrition needs fulfilled). Implementing collaborative measures in consultation with specialists and other team members.
Rehabilitation: Techniques to self-monitor wellness, self-care skills, problem-solving, multidisciplinary approach involving neurologists, physical therapists, speech therapists, occupational therapists, psychologists and other healthcare professionals. Specific strategies may differ if right or left-brain is affected
Diagnostics: CT and MRI are crucial for determining the type of stroke (ischemic versus hemorrhagic) and are important for timeliness of diagnosis and treatment.