Podcast
Questions and Answers
What is the primary cause of death for brain cells during a stroke?
What is the primary cause of death for brain cells during a stroke?
Which condition can lead to an ischemic stroke?
Which condition can lead to an ischemic stroke?
What immediate effect does a cardiac arrest have on brain metabolism?
What immediate effect does a cardiac arrest have on brain metabolism?
Which demographic group is more likely to experience a thrombotic stroke?
Which demographic group is more likely to experience a thrombotic stroke?
Signup and view all the answers
What percentage of cardiac output does the brain require to function properly?
What percentage of cardiac output does the brain require to function properly?
Signup and view all the answers
Which type of stroke is more common in women?
Which type of stroke is more common in women?
Signup and view all the answers
What is one of the primary nursing implications associated with diagnosing a stroke?
What is one of the primary nursing implications associated with diagnosing a stroke?
Signup and view all the answers
What is the leading cause of serious, long-term disability following a stroke?
What is the leading cause of serious, long-term disability following a stroke?
Signup and view all the answers
Which risk factor is least likely to be associated with stroke conditions?
Which risk factor is least likely to be associated with stroke conditions?
Signup and view all the answers
How long can the brain survive without adequate blood flow before cellular death occurs?
How long can the brain survive without adequate blood flow before cellular death occurs?
Signup and view all the answers
What is the primary factor that affects blood flow to the brain during a stroke?
What is the primary factor that affects blood flow to the brain during a stroke?
Signup and view all the answers
Which statement accurately describes the severity of stroke impairment?
Which statement accurately describes the severity of stroke impairment?
Signup and view all the answers
What is a significant consequence of interrupted blood flow to the brain?
What is a significant consequence of interrupted blood flow to the brain?
Signup and view all the answers
Which of the following groups sees a higher mortality rate from strokes?
Which of the following groups sees a higher mortality rate from strokes?
Signup and view all the answers
Which option is not a risk factor associated with stroke conditions?
Which option is not a risk factor associated with stroke conditions?
Signup and view all the answers
How quickly can brain metabolism cease after blood flow interruption?
How quickly can brain metabolism cease after blood flow interruption?
Signup and view all the answers
Which demographic is more likely to experience thrombolytic or embolic strokes?
Which demographic is more likely to experience thrombolytic or embolic strokes?
Signup and view all the answers
What is essential for effective nursing care management of stroke patients?
What is essential for effective nursing care management of stroke patients?
Signup and view all the answers
What is the third leading cause of death in Canada?
What is the third leading cause of death in Canada?
Signup and view all the answers
What implications do ischemic and hemorrhagic strokes have on patient care?
What implications do ischemic and hemorrhagic strokes have on patient care?
Signup and view all the answers
Study Notes
NSG 5130: Level III Nursing Theory - Stroke
- Learning Objectives: Differentiate between ischemic and hemorrhagic strokes, describe health patterns and risk factors associated with stroke conditions, identify diagnostic tests and procedures, utilize the nursing process for pre, during, and post-stroke care, assess associated clinical manifestations, identify nursing diagnoses, set goals, and implement collaborative care, drug therapy, nursing care, and acute/non-acute care.
Stroke = Cerebral Vascular Accident
- A stroke is the death of brain cells due to prolonged ischemia or hemorrhage into the brain.
- Functions controlled by the affected brain area (movement, sensation, emotions) are lost or impaired.
- Stroke severity varies depending on the location and extent of brain involvement.
Blood Flow to the Brain
- Blood flow to the brain is affected by factors like blood pressure (BP), cardiac output, and blood viscosity.
- Without adequate blood flow (oxygen and glucose), neurons cannot function.
- Brain needs at least 20% cardiac output.
- Interrupted blood flow (e.g., cardiac arrest) results in neurological metabolism changes within 30 seconds, complete metabolic failure within 2 minutes, and cellular death within 5 minutes.
Canadian Stroke Statistics
- Stroke is the third most common cause of death in Canada, following cancer and heart disease.
- Approximately 35% of individuals who experience an initial stroke die within one year.
- Stroke is more common in men, who are more likely to have embolic or thrombolytic strokes.
- Women are more likely to experience hemorrhagic strokes.
Risk Factors
- Non-Modifiable: Age, gender, ethnicity/race, and heredity/family history.
- Modifiable: Hypertension, diabetes (4-5 times higher risk), heart disease, heavy alcohol consumption, oral contraceptive use (estrogen), physical inactivity, and smoking (2x higher risk).
Ischemic Strokes
- Occur due to inadequate perfusion caused by partial or complete artery occlusion (87% of all strokes).
- Types: Transient Ischemic Attack (TIA), thrombotic stroke, and embolic stroke.
Ischemic Stroke: Transient Ischemic Attack (TIA)
- A brief neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia (without infarction).
- Symptoms typically last less than 1 hour, often less than 15 minutes.
- Statistics: Up to 50% of TIAs are not reported, 1/3 will never have another TIA, 1/3 will have another TIA, and 1/3 will have a stroke.
- Patients should begin taking antiplatelet drugs (ASA, clopidogrel) and may start statins to reduce cholesterol.
Ischemic Stroke: Thrombotic Stroke
- Aka cerebral infarction, thrombosis occurs within a brain vessel due to vessel wall injury leading to clot formation.
- Often occurs over time from plaque build-up, narrowing the blood vessel.
- Common cause of stroke (approximately 50%).
- Symptoms progress stepwise with increasing ischemia.
- Warning sign often TIA.
Ischemic Stroke: Embolic Stroke
- Occurs when an embolus (formed elsewhere in the body) lodges in and blocks a cerebral artery.
- Often related to plaque in the heart.
- Results in infarction and edema.
- Usually single event, symptoms develop quickly.
Hemorrhagic Strokes
- Account for approximately 15% of all strokes.
- Result from bleeding into brain tissue itself, subarachnoid space, or ventricles.
- Types: Intracerebral hemorrhage and subarachnoid hemorrhage.
Intracerebral Hemorrhage
- Bleeding within the brain due to a ruptured blood vessel, typically caused by hypertension.
- Often sudden onset, symptoms progressing in minutes to hours.
- Warning signs: headaches, nausea, and vomiting.
Subarachnoid Hemorrhage
- Intracranial bleeding outside the brain, into cerebrospinal fluid, commonly due to a cerebral aneurysm rupture.
- Warning sign: severe headache.
- High stroke mortality rate.
Aneurysm
- A permanent, localized outpouching or dilation of a blood vessel wall.
- Can be congenital or acquired.
- Linked to atherosclerosis.
- May require surgical intervention.
- Often diagnosed in patients without symptoms.
Brain Aneurysm
- Congenital or acquired.
- Genetic component.
- Screening recommended.
- Clinical manifestations (unruptured): Pain behind eye, vision changes.
- Ruptured = hemorrhagic stroke.
Clinical Manifestations - Various Stroke Effects
- Manifestations related to brain area affected.
- Categories of function include motor function (affecting many body functions, communication ability), elimination, sensation, intellectual function, spatial-perceptual alterations, and personality/affect.
- Right-brain stroke: impulsive behavior, neglect, difficulty with perception and spatial reasoning.
- Left-brain stroke: memory problems, cautious movements, and difficulty with language related to memory and thought process.
Clinical Manifestations - Motor Function
- Most obvious effects involve mobility impairment, respiratory function, swallowing/speech issues, gag reflex, and self-care abilities.
- Initial period of flaccidity.
- May last from days to several weeks - related to nerve damage.
- Spasticity follows flaccidity, related to upper motor neuron disruption.
Clinical Manifestations - Communication
- Aphasia: total loss of language comprehension and use.
- Dysphasia: difficulty in language comprehension or use.
- Most associated with left-sided brain strokes (right-sided paralysis).
- Dysarthria: impaired articulation due to muscular control disruption.
Clinical Manifestations - Affect
- Stroke may cause difficulty controlling emotions.
- Emotional responses exaggerated or unpredictable.
- Frustration/limitations related to communication and mobility.
- Depression common in the first year following a stroke.
Clinical Manifestations - Intellectual Function
- Memory and judgment may be affected.
- Left-brain stroke increases risk of memory problems related to language.
- Slow and cautious movements.
- Right-brain stroke increases risk of impulsive and quick movements.
Clinical Manifestations - Spatial-Perceptual Alterations
- Stroke on right side of brain increases risk of spatial orientation and perceptual issues.
- Difficulty recognizing self, judging distance, difficulty determining sight, touch, and hearing, unable to carry out sequential commands.
Glossary
- A list of frequently used stroke-related terms and their definitions.
Diagnostics
- Diagnostic studies performed when stroke symptoms appear.
- Confirmation of stroke.
- Identification of the stroke cause (ischemic vs hemorrhagic).
- CT scan is the primary diagnostic tool after stroke (performed within 25 minutes of arrival and read within 45 min).
- MRI, Cardiac tests, rule out other conditions/risk factors.
Prevention is Key!
- BP control.
- Blood glucose control.
- Diet and exercise.
- Smoking cessation.
- Limiting alcohol consumption.
- Educating families on ACT FAST.
Acute Care
- Goals: Preserve life, prevent further brain damage, and reduce disability.
- Treatment varies by stroke type and patient changes.
- Patient history crucial, especially time of onset.
- Managing ABCs (airway, breathing, circulation).
- Preventing hypoxia.
- Comprehensive neuro examination.
- Level of consciousness assessment.
- Cognitive and motor ability evaluation.
- Neurological, sensation, and proprioception testing.
- Evaluating deep tendon reflexes.
- Managing hypertension post-stroke (only if significantly elevated).
- Manage fluids/electrolytes, avoid volume overload.
- Use cooling measures to reduce metabolic demand.
- Managing increased intracranial pressure (ICP) surgery if needed.
Tissue Plasminogen Activator (tPA)
- Thrombolytic therapy.
- Used to break up clots.
- Must be administered within 3-4.5 hours of stroke onset.
- Very careful patient screening prior to administering.
- Contraindicated for hemorrhagic strokes and certain medical conditions (e.g., recent bleeding/trauma).
Stroke Management - Nursing Management
- Nursing interventions based on patient complications and nursing diagnoses.
- Review interventions in case studies.
- All nursing management within Lewis, et al., (2020) pages 1520-1529.
Rehabilitation
- Rehabilitation begins 12-24 hours post-stroke stabilization.
- Goals include learning self-monitoring, maintaining physical wellness, and demonstrating self-care skills.
- Multidisciplinary approach.
Rehabilitation Strategies
- Right-sided stroke patients: difficulty judging position, distance, and movement; impulsive, impatient, minimize problems, lack insight; respond best to verbal directions.
- Left-sided stroke patients: slower in tasks, fearful, anxious; respond well to nonverbal cues.
Recovery from a Stroke
- Learning about stroke effects on the brain, and therapies involved in recovery.
Related Nursing Diagnoses and Complications
- Risk for injury/falls (environmental control, nonslip socks, appropriate lighting)
- Risk for impaired skin integrity (prevent pressure injuries)
- Risk for aspiration pneumonia (managing dysphagia, positioning)
- Risk for imbalanced nutrition (providing feeding strategies, wide variety of foods)
- Impaired swallowing (use adaptive tools, feeding techniques)
- Impaired communication (using appropriate communication methods, e.g., facial/tongue exercises, yes/no questions)
- GI/urinary complications (preventing constipation/incontinence, avoid catheters if possible)
- Impaired musculoskeletal function (using adaptive tools, and positioning)
- Risk for DVT (promoting mobility, using compression devices)
References
- List of referenced materials (books, websites, etc.).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz evaluates knowledge on stroke nursing theory, emphasizing the distinctions between ischemic and hemorrhagic strokes. It covers health patterns, risk factors, diagnostic approaches, and the nursing process in stroke care. Prepare to apply collaborative strategies and therapeutic interventions effectively.
