Stroke and Hemorrhage Nursing

• Neurologic disorders includes cerebrovascular disorders, ischemic stroke, hemorrhagic stroke, arteriovenous malformation, herniated intervertebral disk, Bell's palsy, Parkinson's disease, tuberculosis of the brain, multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome, brain abscess, and brain tumor.

Cerebrovascular Disorders

• Functional abnormality of the central nervous system when the normal blood supply to the brain is disrupted.
• Major categories include ischemic and hemorrhagic stroke.

Ischemic Stroke

• Sudden loss of function resulting from disruption of the blood supply to the brain.
• Types include large artery thrombotic, small penetrating artery thrombotic, cardiogenic embolic, cryptogenic strokes and brain aneurysm.
• Risk factors include hypertension, atrial fibrillation, hyperlipidemia, diabetes mellitus, smoking, asymptomatic carotid stenosis, obesity.

Ischemic Stroke: Clinical Manifestations

• Numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Confusion or change in mental status.
• Trouble speaking or understanding speech.
• Visual disturbances.
• Difficulty walking, dizziness, or loss of balance of coordination.
• Sudden severe headache.

Ischemic Stroke: Prevention and Management

• Stroke risk screenings are an ideal opportunity to lower stroke risk.
• Screenings identify at-risk people, educate patients, and educate the community about recognition and prevention.
• Pharmacologic management includes using streptokinase to dissolve the blood clot blocking blood flow to the brain.
• Nursing management includes SOP nursing care, medications, labs and education on prevention.

Hemorrhagic Stroke

• Bleeding into the brain tissue, the ventricles, or the subarachnoid space.
• Primary intracerebral hemorrhage from spontaneous rupture of small vessels accounts for about 80% of hemorrhagic strokes.
• Hemorrhagic stroke is chiefly caused by uncontrolled hypertension.
• Types include intracerebral hemorrhage, intracranial aneurysm, arteriovenous malformations (AVM) and subarachnoid hemorrhage.

Hemorrhagic Stroke: Clinical Manifestations and Complications

• Clinical manifestations include exploding headache, decreased level of consciousness, sluggish pupillary reaction, motor and sensory dysfunction. and cranial nerve deficits
• Complications include vasospasm, seizures, hydrocephalus, re-bleeding and hypo-natremia.

Hemorrhagic Stroke: Prevention and Nursing Management

• Prevention involves lifestyle modification, control of hypertension and diet.
• The patient is closely monitored for neurologic deterioration, increased ICP, or vasospasm.
• A neurologic flow record is maintained.
• Check blood pressure, pulse, level of consciousness, pupillary responses, and motor function hourly.
• Respiratory status is monitored.

Prevention and Nursing Management

• Primarily supportive.
• Bed rest with sedation to prevent agitation and stress, management of vasospasm, and treatment to prevent re-bleeding.
• Analgesics may be prescribed for head and neck pain.
• Fitted with sequential compression devices to prevent deep vein thrombosis (DVT).

Arteriovenous Malformation (AVM)

• An abnormal tangle of blood vessels connecting arteries and veins.
• Risk factors include age (20-40 years old), pregnancy, family history and hereditary.
• Signs and symptoms include buzzing sound, changes in vision, facial paralysis, drooping eyelids, speaking problems and change of smell sensation.

Arteriovenous Malformation: Signs, Symptoms and Pathophysiology

• Seizure, loss of sensation, muscle weakness, mobility problems, dizziness, loss of consciousness and cold fingers and toes.
• The pathophysiology is unknown, but seems to emerge from fetal development.
• Medical management includes anti-epileptic drugs (phenobarbitals, carbamazepine, clonazepam).

Arteriovenous Malformation: Nursing Management

• Nursing management consists of ECG and ICP monitoring, and being alert for sudden changes.
• 15-30 minute BP monitoring to monitor for headache.
• Avoid activities causing increase ICP
• Maintain an open airway and lessen stimuli
• Embolization,re-sectioning vessels assistance and endovascular embolization are important.
• Sedate and give stool softners and administer meds as ordered.

Herniated Intervertebral Disk

• Herniation is when the intervertebral disk with causes subsequent nerve compression.
• Degeneration/trauma/congenital or spinal nerve compression causes motor movement problems, pain.
• May happen without symptoms with varying symptoms.

Herniated Intervertebral Disk: Clinical Manifestations & Diagnosis

• Cervical issues include stiffness in the neck, region of scapula, pain in upper extremities, paresthesia, numbness and weakness of upper extremities.
• Lumbar difficulties are low back pain, sensory and motor dysfunction, pain radiating to buttocks down the leg, postural deformation and sensory loss.
• Diagnostic evaluations include myelogram, CT scan/MRI, and electromyography (localizes spinal nerves).

Herniated Intervertebral Disk: Nursing Interventions

• Complications include permanent neurologic dysfunction and/or chronic pain with psychosocial issues.
• Apply moist heat to affected area and use bed boards.
• Encourage lifestyle changes and discourage prolonged bed rest.
• Assist with activities in bed and monitor skin.
• Administer pain meds.

Bell's Palsy

• Bell’s Palsy occurs due to virus
• Primarily paralyses the facial muscles of one side due to inflammation on the seventh cranial nerve.
• Largely from wind, infection or damage in the ears.

Bell's Palsy: Pathophysiology, Manifestations, & Treatment

• Epstein Barr is a virus that causes nerve infection, facial paralysis which leads to facial distortion.
• Clinical manifestations include the patient's eyes not shutting completely, mouth gets twisted, the affected cheek cannot be blown completely etc
• Treatment can include steroids, proper eye care,optimum physiotherapy
• Antiviral agents like acyclovir help with herpes virus infection as part of supportive measures.

Parkinson's Disease

• Progressive cell degeneration in the region of the brain known as substantia nigra.
• Lack of dopamine affects the biochemical substance.
• Aging/unknown and degeneration of substantia nigra causes.

Parkinson's Disease: Pathophysiology, Manifestations, & Treatment

• Pathophysiology aging/unknown.
• Results in decreased production/inability to absorb dopamine and motor involuntary movements
• Clinical manifestations include tremor, lethargy, slow movement, handwriting becomes smaller, balance deteriorates.
• There is no available treatment or medicine to stop the destruction of the cells.
• Treatment includes exercise, counselling and medical treatments consisting of levodopa.

Tuberculosis of the Brain

• May be viral or fungal.
• The tuberculosis in the chest may be there for a long time.
• a decrease in the immunity might cause TB in the brain that crosses the BBB.
• Haemophilus influenza, cryptococcal M, or nosomial M cross the BBB for immune client.

Tuberculosis of the Brain: Pathophysiology, Manifestations, & Nursing Management

• Increased ICP results in physiological symptoms.
• Clinical manifestations include altered metal satuts, fever, photophobia, rashes
• Nuchal rigidity and bulging fontanel for pedia.
• diagnostic exams include lumbar puncture and blood and cultures tests
• Administer drugs and streptomycin injections as treatments.

Multiple Sclerosis

• Myelin sheath or white matter is affected are known as demyelinating diseases.
• It is a progressive disease and demyelination causes disordered transmission of nerve impulses.
• Diagnostic test increases cell count and increase in protein levels.

Multiple Sclerosis: Signs, Complications and Management

• Common in females from 15–50 years of age
• Clinical manifestations include paralysis of one or more parts of the body, loss of vision, and loss of sensation in parts of the body.
• Loss of memory and seizures are symptoms
• Nursing interventions include corticosterooids (inflammation), gamma-globulin therapy.
• Complications are respiratory dysfunction and infection.

Myasthenia Gravis

• Chronic autoimmune disease infecting neuromuscular transmission of impulses in the voluntary muscles
• Results in acetylcholine depletion.
• Causes a painful and long-term descending progression disorders.

Myasthenia Gravis: Signs, Diagnostic, & Management

• Signs and Symptoms of drooping eye
• Weak eye muscles,laughing, talking
• Muscle fatigue
• Diagnostic test- Acetylcholine receptor antibody test
• Neostigmine or pyridostigmine are anticholinesterase drugs.
• Immunoglobulin therapy can also be used

Guillain-Barré Syndrome

• Acute, rapidly progressive inflammation demyelination
• Polyneuropathy of the peripheral and motor nervous system
• Autoimmune Disease

Guillain-Barré Syndrome: Diagnostics, Symptoms & Complications

• Diagnostic test include CSF examination
• The electrophysiologic studiesbah
• Symptom includes paresthesia as well as paralysis
• DEC vital capacity and spasms are symptoms
• Complications include respiratory failure and cardiac dysrhythmia.

Guillain-Barré Syndrome: Nursing Management

• Nursing management includes maintain air way assistance

Brain Abscess

• Material of brain between the dura mater and the arachnoid lining or between dura mater and the skull is infected.
• Spinal abscess typically occur in the epidural, subdural and inter-medullar regions.

Brain Abscess: Pathophysiology, Diagnostics, Manifestations & Complications

• S. Aureus is the common pathogen.
• Pathophysiology related
• Inoculation of organisms causes necrotc lesions, Siezure increases ICP
• Diagnostic includes cultures and blood tests.
• Headache,loc,seizure,atxia are manifestation and complications
• Basic safety of interventions assists evaluation of nerves and is a comfort
• Administer meds and educate.

Brain Tumor

• Composed of a proliferation of normal cells within the central nervous system, can be metastatic.
• alterations effect neurotransmitter cycle and the neurologic state.

Types and Clinical Manifestations

• Common types of astrocytoma, oligodendrogliomas, glioblastoma, medulloblastoma, meningioma, and acoustic neuroma.
• Manifestations depend on the location and size of the lesion
• Headache, vomiting, papilledema are common but can alter cognitive levels and result in paralysis.

Explore nursing interventions for stroke and hemorrhage including subarachnoid hemorrhage, intracranial aneurysms, and arteriovenous malformations. Learn about managing increased intracranial pressure and preventing stroke recurrence through lifestyle modifications.