NSG 5130: Stroke Nursing Theory Quiz

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 the clinical significance and nursing implications of various diagnostic tests for ischemic and hemorrhagic strokes
  • Utilize the nursing process (assessment, diagnoses, goals, implementation) for pre, during, and post-stroke care
  • Implement collaborative care (drug therapy, nursing care, acute and non-acute care, health promotion)

• Stroke = Cerebral Vascular Accident:

  • Death of brain cells from prolonged ischemia or brain hemorrhage
  • Loss or impairment of functions controlled by the affected brain area
  • Severity dependent on location and extent of brain involvement

• Blood Flow to the Brain Affected by:

  • Blood pressure (BP)
  • Cardiac output
  • Blood viscosity
  • Inadequacy of blood flow (oxygen and glucose) causing neuron dysfunction
  • Brain needs at least 20% cardiac output
  • Interrupted blood flow (e.g., cardiac arrest) leads to altered metabolism within 30 seconds, metabolic stops in 2 minutes, and cellular death within 5 minutes.

• Canadian Stroke Statistics:

  • Third most common cause of death in Canada (behind cancer and heart disease)
  • Leading cause of serious long-term disability
  • Approximately 35% of individuals die within one year of a first stroke
  • More common in men, but women have higher mortality

• Risk Factors:

  • Non-Modifiable: Age, Gender, Ethnicity/Race, Heredity/Family History
  • Modifiable: Hypertension, Diabetes (4-5x risk), Heart Disease, Heavy alcohol consumption, Oral contraceptive use (estrogen), Physical inactivity, Smoking (2x risk)

• Ischemic Stroke Types:

  • Transient Ischemic Attack (TIA): Short episode of neurological dysfunction (symptoms for less than 1 hour, often less than 15 minutes) with no permanent brain cell damage.
    • Often a warning sign for future strokes
    • Risk factors for further events include 50% no further events, 33% another TIA, 33% stroke
    • Start appropriate antiplatelet medications (e.g., ASA, clopidogrel)
  • Thrombotic Stroke: Blood clot formation within a brain vessel (often over time), leading to blood vessel blockage. Account for approximately 50% of all strokes.
    • Collateral circulation
    • Stepwise progression of symptoms
    • Warning sign: TIA
  • Embolic Stroke: Blood clot (embolus) formed elsewhere in the body travels to and lodges in a brain vessel, blocking blood flow. Account for about 20% of strokes. Single stroke event.
    • Symptoms develop quickly. Often caused by the heart.

• Hemorrhagic Stoke Types:

  • Intracerebral Hemorrhage: Bleeding within the brain tissue (vessel rupture within brain tissue) due to hypertension, often in period of activity, with a sudden onset, headache, nausea, vomiting, and a progression of symptoms
  • Subarachnoid Hemorrhage: Bleeding into the subarachnoid space (area between brain and surrounding membranes) usually due to a ruptured cerebral aneurysm.
    • Severe headache is a common warning sign
    • High stroke mortality rates
    • Aneurysm = permanent, localized, outpouching or dilation of the blood vessel wall

• Brain Aneurysm:

  • Permanent, localized outpouching/dilation of a blood vessel
  • Can be congenital or acquired
  • Risk of rupture causing hypovolemia, ischemia/infarction to other cells and organs
  • May require surgery

• Clinical Manifestations:

  • Motor Function: Weakness, paralysis, difficulty with movement (including respiratory and swallowing, and self-care), reflexes
  • Communication: Aphasia, Dysphasia, or Dysarthria (difficulty with speech)
  • Affect: Emotional outbursts, unpredictable responses, frustration related to communication/mobility limitations, and depression (most present in the first year following a stroke
  • Intellectual Function: Problems with memory and judgment
  • Spatial-Perceptual Alterations: Issues with orientation, body awareness, depth perception, object recognition

• Diagnostics:

  • CT scan to identify if a stroke is ischemic or hemorrhagic, goal completed within 25 minutes of arrival to ER and within 45 minutes of reading result

• Prevention:

  • BP and blood glucose control
  • Diet and exercise
  • Smoking cessation
  • Routine health assessments
  • Teach families to ACT FAST (Face, Arms, Speech, Time)

• Stroke Management (Acute):

  • Managing the ABCs: Airway, Breathing, and Circulation
  • Comprehensive neuro-examination
  • Treating hypertension, electrolyte balance, fluids, and ICP
  • Prescribing medications (as appropriate-Fibrinolytic Therapy)

• Stroke Management (Nursing):

  • Complications: Risk for aspiration pneumonia, impaired skin integrity, Injury/falls, DVT, GI/Urinary (constipation and incontinence)
  • Rehabilitation Strategies: Learn self-care and problem-solving skills, strategies for each side of the body affected, and use supportive equipment for movements and comfort
  • Recovery: Learn impact of stroke on the brain and types of therapy for recovery.

• Learning Resources: Lewis, et al. (2019) and McMillan, K, (2020)

Test your knowledge on Level III Nursing Theory as it pertains to strokes. This quiz covers the differentiation between ischemic and hemorrhagic strokes, health patterns, risk factors, and nursing implications related to diagnostic tests. Evaluate your understanding of the nursing process in the context of stroke care.