NSG 5130: Nursing Theory on Stroke

NSG 5130: Level III Nursing Theory - 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

Learning Objectives

• 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.

Learning Resources

• Lewis, et al. (2019). Medical-Surgical Nursing in Canada (4th ed.)

Stroke - Ischemic Strokes

• Inadequate perfusion due to artery occlusion (87% of all strokes)
• Transient Ischemic Attack (TIA):
• Brief neurological dysfunction, no permanent brain cell damage
• Symptoms <1 hour, often <15 minutes
• <50% reported to healthcare providers
• 1/3 never have another TIA, 1/3 have another TIA, 1/3 have a stroke.
• Start patient on antiplatelet drugs (ASA, clopidogrel)
• Thrombotic Stroke:
• Thrombosis in a cerebral vessel, often due to injury or narrowing
• Clots build over time, causing infarction
• Embolic Stroke
• Embolus lodges and occludes a cerebral artery (from elsewhere in the body)
• Causes infarction and edema of an area of the brain.
• Typically a single event, symptoms develop quickly
• Warning signs: TIA

Stroke - Hemorrhagic Strokes

• 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

Risk Factors

• 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).

Clinical Manifestations

• 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

Stroke Management

• 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.

Prevention

• Blood pressure control
• Blood glucose control
• Diet and Exercise
• Smoking Cessation
• Limiting alcohol consumption
• Teaching "ACT FAST" to families

Glossary

• Terms related to various aspects of stroke

Explore the critical aspects of stroke as a cerebral vascular accident (CVA) in this quiz based on NSG 5130. Understand the causes, effects, and implications of strokes, including differences in ischemic and hemorrhagic types. This quiz will reinforce your knowledge of the physiological factors influencing stroke severity and outcomes.