Stroke and Prevention

• STROKE: A neurologic health problem is caused by an interruption of perfusion to any part of the brain, resulting in infarction (cell death).
• A stroke is a medical emergency caused by a disruption in blood supply to the brain, resulting in brain cell death and loss of function.

Health Promotion "ABCS"

• The CDC and other cardiovascular professional organizations recommend applying the ABCS of heart health under medical supervision to prevent strokes.
• Aspirin use when appropriate is part of the ABCS.
• Blood pressure control is part of the ABCS.
• Cholesterol management/smoking cessation is part of the ABCS.
• Lifestyle changes include smoking cessation if needed, a heart-healthy diet rich in fruits and vegetables, low in saturated fats, and regular physical activity, including planned exercise.
• Teaching is required for patients about identifying and managing risk factors such as hypertension, obesity, substance use disorder, and diabetes mellitus, which contribute to the potential for a major stroke.

Causes of Stroke

• Atherosclerosis
• Hypertension
• Diabetes
• Atrial fibrillation
• High cholesterol
• Smoking/alcohol use
• Obesity
• Substance abuse like cocaine, amphetamines
• Certain blood disorders like sickle cell disease, high red blood cell counts
• Arterial dissection
• Aneurysms
• Arteriovenous Malformation (AVM)
• Previous Vascular events (Ex: Myocardial infarction, pulmonary embolism)
• Hyperlipidemia
• Heart Disease
• Oral Contraceptives

Stroke Classification

• Strokes are generally classified as either ischemic (occlusive) or hemorrhagic.
• Acute ischemic strokes are either thrombotic or embolic in origin.
• Most strokes are ischemic.

Ischemic Stroke

• Acute Ischemic Stroke (AIS) is caused by the blockage of a cerebral or carotid artery by either a thrombus or an embolus.
• Acute ischemic strokes often follow warning signs such as a transient ischemic attack (TIA).
• TIA is a temporary neurologic dysfunction resulting from a brief interruption in cerebral blood flow.
• A stroke caused by a thrombus (clot) is referred to as a thrombotic stroke.
• A stroke caused by an embolus (dislodged clot) is referred to as an embolic stroke.
• Thrombotic Stroke occurs when a blood clot (thrombus) forms in an artery supplying blood to the brain, blocking the flow, which is often due to atherosclerosis or buildup of plaque.
• Embolic Stroke is caused by a wandering clot (embolus) that travels from another part of the body, such as the heart, and lodges in a cerebral artery, obstructing blood flow.
• TIA is a temporary neurologic dysfunction resulting from a brief interruption in cerebral blood flow.

Signs and Symptoms of Stroke

• Blurred vision
• Diplopia (double vision)
• Hemianopsia
• Tunnel vision
• Weakness (facial droop, arm or leg drift, hand grasp)
• Ataxia (lack of muscle control and coordination that affects gait, balance, and the ability to walk)
• Numbness (face, hand, arm, or leg)
• Vertigo (a feeling of spinning or dizziness)
• Aphasia (problems with speech and/or language)
• Dysarthria (slurred speech caused by muscle weakness or paralysis)

Hemorrhagic Stroke

• Results from bleeding within or around the brain when a weakened blood vessel ruptures.
• Bleeding puts pressure on brain tissue and disrupts its function.

Differential Features of Stroke Types

• Thrombotic strokes feature intermittent or stepwise improvement between episodes of worsening symptoms, resulting in a completed stroke.
• Thrombotic strokes onset is gradual (minutes to hours).
• Thrombotic strokes level of consciousness is usually preserved (patient is awake).
• Contributing associated factors of Thrombotic stokes are hypertension and atherosclerosis.
• Prodromal symptoms of Thrombotic stokes are transient ischemic attack (TIA).
• Neurologic deficits of Thrombotic stokes may be deficits during the first few weeks: slight headache, speech deficits, visual problems, and confusion.
• Cerebrospinal fluid in Thrombotic strokes is normal, with a possible presence of protein.
• Seizures do not usually occur with Thrombotic strokes.
• Duration of Thrombotic strokes: improvements usually occur over weeks to months, and permanent deficits are possible.
• Embolic strokes feature abrupt development of completed stroke and study progression.
• Embolic strokes onset is sudden.
• Embolic strokes level of consciousness is preserved (patient is awake).
• Contributing associated factors to Embolic stokes are cardiac disease.
• Prodromal symptoms of Embolic stokes a transient ischemic attack (TIA).
• Neurologic deficits of Embolic stokes are maximum deficit at onset, paralysis, and expressive aphasia.
• Cerebrospinal fluid in Embolic strokes is normal.
• Seizures do not usually occur with Embolic strokes.
• Duration of Embolic strokes: usually rapid improvements.
• Hemorrhagic strokes feature usually abrupt onset.
• Hemorrhagic strokes onset is sudden, maybe gradual caused by hypertension.
• Hemorrhagic strokes level of consciousness is deepening lethargy/stupor or coma.
• Contributing associated factors to Hemorrhagic stokes are hypertension, vessel disorders, and genetic factors.
• Prodromal symptoms of Hemorrhagic stokes are headache.
• Neurologic deficits of Hemorrhagic stokes are focal deficits, severe, and frequent.
• Cerebrospinal fluid in Hemorrhagic stokes is bloody.
• Seizures usually occur with Hemorrhagic strokes.
• Duration of Hemorrhagic strokes: variable, with possible permanent neurological deficits.

Side Effects of Strokes

• Side effects of embolic strokes may include a heart murmur, dysrhythmias (most often atrial fibrillation), heart failure, endocarditis, and/or hypertension.
• Side effects of Thrombotic strokes caused by atherosclerosis, tend to have a slower, progressive onset over hours or days.
• Symptoms are similar but may fluctuate as the clot temporarily blocks then moves through the narrowed artery.
• Symptoms include weakness, numbness, vision changes, and difficulty speaking or understanding.
• Side effects of Hemorrhagic strokes, from bleeding into the brain, typically cause a severe sudden headache along with nausea, vomiting, seizures, and neurological deficits like weakness, speech difficulties, difficulty seeing in one or both eyes, and decreased consciousness depending on the area of bleeding, dizziness/confusion, loss of balance or coordination, and difficulty walking

General Stroke Symptoms

• Stroke symptoms can appear at any time of the day or night. The five most common symptoms are:
• Sudden confusion or trouble speaking or understanding others
• Sudden numbness or weakness of the face, arm, or leg
• Sudden trouble seeing in one or both eyes
• Sudden dizziness, trouble walking, or loss of balance or coordination
• Sudden severe headache with no known cause

Specific Stroke Symptom

• More specific stroke symptoms depend on the extent and location of the ischemia and the arteries and parts of the brain affected.
• The right cerebral hemisphere is more involved with visual and spatial awareness and proprioception (sense of body position).
• A person with a stroke involving the right cerebral hemisphere is often unaware of any deficits and may be disoriented to time and place.
• Personality changes with right cerebral hemisphere stroke include impulsivity (poor impulse control) and poor judgment.
• The left cerebral hemisphere, the dominant hemisphere in people who are right- handed (70% of the population), is the center for speech, language, mathematic skills, and analytic thinking.
• Problems are expected in these areas for patients with a left-sided stroke.

Middle Cerebral Artery Strokes

• Middle Cerebral Artery Strokes are most common.
• Contralateral (opposite side) hemiparesis (one-sided weakness) or hemiplegia (one-sided paralysis) occurs with Middle Cerebral Artery Strokes; typically, the arm is flaccid, and the leg is spastic if both extremities are affected.
• Dysphagia
• Contralateral sensory perception deficit (numbness, tingling, unusual sensations)
• Ptosis
• Nystagmus
• Homonymous hemianopsia
• Unilateral neglect or inattention
• Dysarthria
• Aphasia
• Anomia
• Apraxia
• Agnosia
• Alexia, agraphia, and/or acalculia
• Impaired vertical sensation
• Visual and spatial deficits
• Memory loss (amnesia)
• Altered level of consciousness: drowsy to comatose

Posterior Cerebral Artery Strokes

• Perseveration (word or action repetition)
• Aphasia, amnesia, alexia, agraphia, visual agnosia, and ataxia
• Loss of deep sensation
• Decreased touch sensation
• Increased lethargy/stupor, coma

Internal Carotid Artery Strokes

• Contralateral hemiparesis
• Sensory perception deficit
• Hemianopsia, blurred vision, blindness • Aphasia (dominant side)
• Headache
• Carotid bruit

Anterior Cerebral Artery Strokes

• Contralateral hemiparesis: leg more than arm
• Bladder incontinence
• Personality and behavioral changes
• Aphasia and amnesia
• Positive grasp and sucking reflex
• Sensory perception deficit (lower extremity)
• Memory impairment
• Ataxic gait

Vertebrobasilar Artery Strokes

• Headache and vertigo
• Possible coma
• Memory loss and confusion
• Flaccid paresis or paralysis (quadriparesis affecting all four extremities)
• Ataxia
• Vertigo
• Cranial nerve dysfunction such as dysphagia from cranial nerve X involvement
• Visual deficits (one eye) or homonymous hemianopsia
• Sensory loss: numbness

Ischemic Stroke Treatments

• Intravenous thrombolytic (clot-busting) drugs such as alteplase to dissolve the clot if given within 4.5 hours of symptom onset.
• Endovascular thrombectomy to mechanically remove a large clot.
• Antiplatelet medications such as aspirin to prevent further clots.
• Anticoagulants for those with atrial fibrillation or other clot risk factors.

Core Measures for Ischemic Stroke Care

• Thromboembolism (VTE) prophylaxis
• Discharge with antithrombotic therapy
• Discharge with anticoagulation therapy for atrial fibrillation/flutter
• Thrombolytic therapy is indicated
• Antithrombotic therapy reevaluated by end of hospital day 2
• Discharge on statin medication
• Stroke education provided and documented
• Assessment for rehabilitation

Major Treatment Modalities for Patients with Acute Ischemic Stroke

• IV fibrinolytic therapy includes IV alteplase, the only drug approved at this time for the treatment of acute ischemic stroke.
• Endovascular interventions to improve perfusion include intraarterial thrombolysis using drug therapy, mechanical embolectomy (surgical blood clot [thrombosis] removal), and carotid stent placement.

Acute Pharmacological Treatment for Ischemic Stroke

• Thrombolytic/fibrinolytic therapy with recombinant tissue plasminogen activator (tPA) is used to reestablish blood flow and prevent cell death.
• Patients of ischemic stroke are given low-molecular-weight heparin (LMWH) or unfractionated heparin.

Hemorrhagic Stroke Treatments

• Medications to control blood pressure and prevent vasospasm
• Surgical clipping or coiling to repair ruptured aneurysms
• Surgical drainage or removal of accumulated blood (hematoma evacuation)
• Reversal of anticoagulant medications if the patient was taking them
• Monitoring for Increased Intracranial Pressure

Acute Pharmacological Treatment for Hemorrhagic Stroke

• Intravenous Medication like Mannitol given
• Chronic Pharmacological Treatment includes Antiplatelet drugs (usually Aspirin), Coumadin, and Statins
• Calcium channel blocking drugs such as nimodipine
• Stool softeners, analgesics for pain, and antianxiety drugs may also be prescribed as needed for symptom management.
• Rehabilitation, prevention of complications, and addressing underlying causes like hypertension are important for all stroke types.
• Prompt treatment is crucial to minimize brain damage.

Stroke Medications

• Zocor (simvastatin) is a cholesterol-lowering statin drug.
• Zocor side effects: Muscle pain, liver enzyme elevation, headache, and abdominal pain.
• Zocor interventions: Monitor liver enzymes, instruct patient to report muscle pain/weakness, and avoid excessive alcohol.
• Zocor patient teaching: Take with food, avoid grapefruit juice, and report muscle pain/weakness.
• Alteplase is a fibrinolytic agent (clot-busting drug).
• Aspirin is an antiplatelet drug.
• Aspirin side effects: Stomach pain, heartburn, bruising, and ringing in the ears.
• Aspirin interventions: Administer with food/antacids, assess for bleeding, and instruct on NSAID precautions.
• Aspirin patient teaching: Take with food/milk, do not lie down after taking, and watch for bleeding.
• Plavix (clopidogrel) is an antiplatelet drug.
• Plavix side effects: Bruising, bleeding, headache, and diarrhea.
• Plavix interventions: Monitor platelets, instruct not to stop without doctor's order, and watch for bleeding.
• Plavix patient teaching: Do not stop taking without doctor's advice, and watch for bleeding.
• Coumadin (warfarin) is an anticoagulant.
• Coumadin side effects: Bleeding, bruising, fatigue, and dizziness.
• Coumadin interventions: Routine INR monitoring, consistent vitamin K intake, watch for bleeding, and instruct on foods/meds to avoid.
• Coumadin patient teaching: Consistent vitamin K intake, routine INR monitoring, watch for bleeding.

Cardiovascular Diseases Contributing to Stroke

• Hypertension (high blood pressure) damages blood vessels over time.
• Coronary artery disease - Buildup of plaque in arteries can lead to clots.
• Atrial fibrillation - Irregular heartbeat allows clots to form and travel to the brain
• Cerebral aneurysm
• Arteriovenous malformation (AVM)
• Previous Vascular events (MI, peripheral embolism
• Hypercoagulability, or High fibrinogen
• Diabetes mellitus, Type 1

Other diseases contributing to stroke

• Asymptomatic carotid stenosis
• Previous Stroke
• Heart disease (atrial fibrillation, heart failure, endocarditis)

Metabolic Disorders Contributing to Stroke

• Diabetes mellitus - Damages blood vessels and increases clotting risk
• Hyperlipidemia (high cholesterol) - Contributes to atherosclerosis

Blood Factors Contributing to Stroke

• Sickle cell disease
• Polycythemia vera

Other conditions Contributing to Stroke

• Obesity increases the risk of hypertension, diabetes, and other risk factors
• Substance abuse, like Cocaine and amphetamines, can cause ruptured vessels
• Autoimmune disorders like antiphospholipid antibody syndrome raise clot risk

Non-modifiable Risk Factors for Stroke

• Older Age
• Male Gender
• Gender (women more likely to die)
• Race (Latin, African Americans, Asian, European)
• Family History/Hereditary (of stroke or cardiovascular disease)
• Cerebral aneurysm
• Arteriovenous malformation (AVM)
• Previous Vascular events (MI, peripheral embolism
• Hypercoagulability, or High fibrinogen
• Diabetes mellitus, Type 1
• Asymptomatic carotid stenosis
• Previous Stroke
• Sickle cell disease or other blood disorders
• Atrial fibrillation (irregular heartbeat)
• Atherosclerotic disease
• Diagnosis of aneurysm

Modifiable Risk Factors for Stroke

• High cholesterol/Hyperlipidemia
• Heavy alcohol consumption
• Hypertension
• Heart disease (atrial fibrillation, heart failure, endocarditis)
• Diabetes Mellitus (type 2)
• Smoking
• Alcohol consumption
• Oral contraceptives
• Obesity
• Sedentary lifestyle
• Use of illicit drugs like cocaine
• Lack of physical activity
• Unhealthy diet

Difference between TIA and Stroke

• TIA and stroke are both caused by interrupted blood flow to the brain, but they differ in duration and severity.
• A TIA is a temporary blockage of blood flow that results in stroke-like symptoms lasting less than 24 hours, usually resolving within an hour where symptoms go away and do not cause permanent brain damage.
• A stroke is caused by a longer-lasting blockage or bleeding in the brain that leads to brain cell death and lasting neurological deficits if not treated promptly.
• TIAs are warning signs that should not be ignored, strokes require emergency treatment to minimize brain injury and potential long-term disability.

Function of Brain Hemispheres

• The brain is divided into two hemispheres - the right and left.
• While there is some overlap, each hemisphere tends to specialize in certain functions.
• The left hemisphere is typically dominant and controls intelligence, creativity, memory, language, and analytical skills.
• The right hemisphere specializes in visual-spatial abilities, facial recognition, music perception, and emotional expression.

Right Side Brain Functions

• Responsible for controlling the left side of the body.
• More artistic and creative side of the brain.
• Includes art awareness, creativity, imagination, intuition, insight, holistic thought, music awareness, 3-D forms and left-hand control.

Right Side Brain Damage Clinical Manifestations

• Hemiplegia, minimize problem, perceptual deficits, impulsive, and impaired Judgement. .

Clinical Manifestations right -- Right-brain damage (stroke on right side of the brain)

• Paralyzed left side: hemiplegia
• Left-sided neglect
• Spatial-perceptual deficits
• Tends to deny or minimize problems
• Rapid performance, short attention span
• Impulsive, safety problems
• Impaired judgment
• Impaired time concepts

Left Side Brain Functions

• Responsible for control of the right side of the body.
• The more academic and logical side of the brain.
• Includes analytic thought, logic, language, reasoning, science and math, written, numbers skills and Righy-hand control.

Clinical Manifestations- Left-brain damage (stroke on left side of the brain)

• Paralyzed right side: hemiplegia
• Impaired speech/language aphasias
• Impaired right/left discrimination
• Slow performance, cautious
• Aware of deficits: depression, anxiety
• Impaired comprehension related to language, math

Left Side Brain Damage Clinical Manifestations

• Impaired Speech, Hemiplegia, Cautious, Anxiety and Impaired Comprehension.

Aphasia

• Aphasia is an acquired impairment of language comprehension or production with problems speaking and/or language caused by brain dysfunction, often due to stroke or injury.
• Main types of Aphasia are: Expressive (Broca's), Receptive (Wernicke's),and Global or mixed Aphasia
• Expressive (Broca's) Aphasia results from damage in the Broca area of the frontal lobe causing a motor speech problem in which the patient understands what is said but cannot speak/talk (verbally).
• Receptive (Wernicke's) Aphasia is caused by injury involving the Wernicke area in the temporoparietal area.
• People with Receptive (Wernicke's) can not understand the spoken or written word but may be able to talk, although the language is often meaningless.
• Global or mixed aphasia occurs when both expressive and receptive language abilities are significantly impaired.
• Nursing interventions include providing repetitive, simple directions one step at a time, repeating object names (repetitive directions), allowing extra time for communication, and using picture boards or computer devices to facilitate understanding and expression in an encouraging environment aid communication.

Signs and Symptoms of a Client Who has a Stroke on the Left Side

• Paralysis or weakness on the right side of the body
• Aphasia (difficulty speaking, understanding speech, reading, or writing)
• Problems with analytical thinking and memory
• Visual field deficits on the right side

Signs and symptoms of a client who has a stroke on the right side

• Paralysis or weakness on the left side of the body
• Impaired judgment and behavior changes
• Denial of deficits (anosognosia)
• Visual-spatial deficits like inability to dress or feed oneself
• Left-sided neglect (ignoring the left side of space)
• Short-term memory deficits

Risk of Stoke in Elderly Client

• Age-related changes in blood vessels make them more prone to atherosclerosis, leading to narrowed or blocked arteries that can cause ischemic strokes.
• The prevalence of chronic conditions like hypertension, diabetes, and atrial fibrillation, VTE, and DVT, which can lead to a PE, increases with age, which are major risk factors for stroke.
• Elderly adults may have impaired mobility and balance, increasing their risk of falls that can lead to hemorrhagic strokes from head trauma.
• Medications taken by the elderly for various conditions can interact and affect blood clotting or blood pressure, indirectly raising stroke risk.
• Lifestyle factors common in older adults like smoking, obesity, physical inactivity, and unhealthy diets contribute to stroke risk.
• The aging brain has reduced plasticity and ability to compensate for vascular injuries, making strokes more likely to cause severe disability.

Communication with a Client who had a Stroke

• For clients who have had a stroke affecting their ability to communicate verbally, using a communication board can be an effective method.
• A communication board contains letters, words, phrases, or pictures that the client can point to in order to express their needs, thoughts, or respond to questions.
• The board should be tailored to the client's specific deficits and abilities with common requests or pain scale for clients with expressive aphasia who understand language but cannot speak fluently.
• Assess the ability to understand speech by asking the client to follow simple commands avoid using yes/no questions (in expressive aphasia).
• provide the client with alternate forms of communication; a communication board, computer, mobile device, picture board of commonly requested items/needs.
• Speak slowly and clearly using one-step commands for expressive and receptive aphasia.
• Collaborate with speech language pathologist (SLP) for communication concerns

Diagnostic Study Done Within 3hr Window after Stroke

• A non-contrast CT scan of the head within the 3-hour window from symptom onset is critically important.
• It can rule out hemorrhagic stroke and helps determine eligibility for IV fibrinolytic therapy like alteplase (tPA).
• The CT scan must show no evidence of intracranial hemorrhage before administering tPA, as this clot-busting medication can worsen bleeding.
• Timely CT imaging is essential to quickly identify patients who may benefit from alteplase's clot-dissolving effects.
• The most important factor in determining whether to give alteplase is the time between symptom onset and time seen in the stroke center. The FDA approves administration of alteplase within 3 hours of stroke onset.
• Imaging allows for accurate identification of the stroke type, rapid treatment decisions, thrombolytic therapy can begin within hours if ischemic.
• Early detection of the ischemic penumbra and initiating reperfusion therapy can reduce permanent brain damage.

Glasgow Coma Scale

• A standardized tool used to assess the level of consciousness and neurological function in patients with acute brain injury or impairment.
• Three components are eye opening, verbal response, and motor response, with scores ranging from 3-15.
• A score of 15 indicates a fully awake and alert patient, while 3 indicates complete unresponsiveness.
• Used to rate Level of alertness, level of consciousness, and patient's alertness and responsiveness to the environment and stimuli around them

National Institutes of Health Stroke Scale

• A systematic assessment tool used to evaluate neurological deficits in stroke patients.
• It consists of 11 items that test specific abilities like level of consciousness, gaze, visual fields, facial palsy, motor strength, sensory function, language, and inattention.
• Scores range from 0 (no deficits) to 42 (severe impairment).
• Higher scores indicate more severe neurological damage from the stroke
• Used to assess function and sensory impairment
• Evaluate specific ability using scale 0-4, indicates severity of the stroke, required appropriate treatment, and predict patient outcomes.

Nursing Care of a Stroke Patient

• Assess LOC, maintain airway patency, and check vital signs and circulation. Every 15 min every i-2 hrs.
• Notify the provider immediately of unexpected findings such as increased blood pressure (greater than 185/110 mm Hg)
• Provide oxygen therapy to maintain oxygen saturation level greater than 94%, or if the client's level of consciousness is decreased.
• Place the client on a cardiac monitor to detect dysrhythmias and conduct cardiac assessment .and ECG
• Monitor for increased ICP (change in level of consciousness).
• Elevate the head of the client's bed to approximately 30° to reduce ICP and to promote venous drainage.
• Avoid extreme flexion or extension of the neck, and maintain the client's head midline. Avoid extreme flexion or extend the neck
• Check blood glucose level (monitor for hyperglycemia, which is associated with poor neurologic outcome).
• Institute seizure precautions.
• Perform neuro checks frequently.
• Ensure client has peripheral IV access (might need 2 large-bore IVs) and administer isotonic saline (no fluids containing dextrose).
• Obtain history of current condition and perform GCS and National Institutes of Health Stroke screenings
• Assist with alternate forms of communication; a communication board, computer, mobile device, picture board.
• Keep the client NPO monitor for dysphagia (drooling, choking, coughing, gagging, pocketing food) and thorough assessment of the client's swallowing.
• Monitor for dysphagia until swallowing assessed by SLP
• Position upright to eat head neck flexed slightly forward. Have suction on standby and provide adaptive feeding equipment.
• Prevent immobility (Atelectasis, pneumonia, pressure ulcers, and deep vein thrombosis)
• Encourage ROM exercises every 2 hr to affected area .
• Elevate affected extremities to reduce venous return and swelling . Elastic glove
• Maintain falls. Safe environment, assistive device and belts during transfers
• If has one sided neglect. QTC and teach to care for effect extremity due to Shoulder subluxation

Compressed Nursing Care Action

• Assess LOC, pupillary responses, motor/sensory deficits, and cranial nerve function.
• Monitor vital signs frequently. Every 15 min to 1-2 hrs. Notify provider for BP > 185/110 mm Hg.
• Oxygen therapy to maintain SpO2 > 94% or if LOC decreased.
• Cardiac monitor for dysrhythmias. Perform 12-lead ECG. Cardiac assessment Auscultate apical heart rate.
• Monitor for increased ICP (change in LOC). And elevate head of patient to 30 degrees
• Check blood glucose; monitor for hyperglycemia. Avoid neck flexion/extension, keep head midline and implement Seizure precautions.
• Use IV access (2 large-bore IVs) and Obtain history (ask family) with isotonic saline
• Provide assistive devises and communicate slowly monitor food and medication and aspiration
• Administer meds for prevent DVT Use SCDa and antiembolism Stckings.
• Exercise Rom every 2 h and elevate effected extremities Use elevate glvoes if severe

Medication: Usage, Side Effects, Contraindications, and Teaching

• Alteplase (IV fibrinolytic): dissolves blood clots in acute ischemic stroke if given within 4.5 hours of symptom onset, Side effects: Bleeding, and angioedema cannot be mixed. Contradicted if active bleeding, recent surgery & BP is greater than 185/110 mmHg so monitor bleeding in neurological status and teaching

Medication for Stroke

• Teach to anticoagulants Warfarin used for A-fib and dvt. SE bleeding pt/inr diet restrictions and teaching compliance signs of dietary restrictions
• Teach heparin for short term prevents clots se bleeding thrombocytopenia monitor the PTT if active bleeding . Teach in injection
• Teach aPTT 80-100 and pT/Iner is 2-3

Stroke Medications

• Teach direct oral dabigatran is for A fib to prevent stroke se increased stroke renal function assess compliance bleeding
• Low antiplaletes asprin clopidogril second stroke
• Anti-seizures dilantin with seviures. Post stroke. Se dizziness Ataxia rash. Contradicted if Hyosensitiv. Momitor SE and take with food..

Stroke Risk Factors

• The leading causes of stroke include smoking, obesity, hypertension, diabetes mellitus, and elevated cholesterol.
• Stroke risk increases with a strong family history of hypertension, atherosclerotic disease, and a diagnosis of aneurysm.

Causes

• Hypertension • Coronary artery disease Atrial fibrillation
• Cerebral aneurysm • Arteriovenous malformation (AVM) • Previous Vascular events; MI peripheral embolism • Hypercoagulability – High fibrinogen • Diabetes mellitus, Type 1 • Asymptomatic carotid stenosis • Previous Stroke • Heart disease; atrial fibrillation, heart failure, and endocarditis

Risk Factors

• Obesity increases risk hyperteion, diabietes and other rsk factros
• Other = cocain amphatemines,
• • Anti-iummute-pholipid antibody syndrome Risk factors: old, maled, gender, race Modif: high cholesterol hyperlipidema

Risk Factors of Transient ischemic attack (TIA)

TIA and stroke are caused by blood flow tothebrin .TIA tempoarly blocks.

Different Hemispheres

Both. Brain divided rigth and left Each hemisphere to specialize. Left: creative memory. right: visual spatial ablities , and personal expressios

Right Side Symptoms

Rt side = clinical manifestation. Fucitons - leftside left

• Hemiplegia minimize progle perceptual judgement
• Hemiplegia Minimize problem Perceptual Deficits Impulsive judgement

Left Side Symptoms

left. Contril ight A phasia.

• parallyed right side
• Spteech/languase aprhasias Impir right disrimation Slow perromrnac e cautious
• awqre of deciciftts Ipmried comprehnes

Symptoms of a Client Whos Stole

• Paarlysis wewknes
• Aphasiasi Problrmas withanalit Visiral deficits

Symtpms Right Stroke

WEaknes left side. Impaire djudgenment Delial of deficits. ANso SPatail deficiesr Left side neglect shord term memofry.

Agign brion leadins to stroke

• Age is more prone
• Hypertension diabetes
• Old may have to hemroghhga

Methods to Communicate with stroke patient

• COunmications boarc
• Assess abilitiyn yes no qs.

Diagnostic Imporant

• Provides clinate for alternate forms
• s[eads of restrorations Dignositic Compa Acurate Rapid treates

Coma Impoaent

Alertness level and awareness

Aphasia Details

• Aphsia : is loss if lmanguage
• Expresive brucas aophasion
• recepruinivwe aohasia S[eech inpared Hoolistic approach.

Patient Care

Asse, ssee what patient

• provide skin

Medcations for stroke

• Tiie Plasmigin = Dissolve clots

• SE beed Contraindt: ative bleedibn

• Anticagulants =

• PRevrnrs clots

• SE bleed Pt 14 and less

• Coumdan couladin p Mointor

• Dietary restriction

Meds and other Factors

• Sltake ris in smoker abeasty and elvaltied chlsestrrl. Stroke isk in familty Hypertension is great Cholesterol up high
• Hyperfibrongen up

Factors to Stroke

Stroke has 45 percent Older age 77 Mod factors = high chlesterols

Ta=i

Differences of hemispheres

Stroe on left is langaeug Rt side is awarebess

• Rt are awarees, art. Imaginati. Crativty

Stroke side

• Let side impared = dffuculty speae
• right. = leftg. side

Apashia

Difficulty speaking

Stroke is left side

Paralyesd Right side Af phasia Analyric problem Visual issues

Stroke treatment

Lisinopril Alteplace

What to do till you ger to hospital

• Time is brain
• Act fa.
• stroke.

Stroke

2types

• Tia and stroke
• stroke leads is longer lasring

How to work wuth stroek

Togurher - reatment

Types of Stroke

• Isheimc more comin

Contribue t

• Obesuty high Cholersert

Stroke Facts

Sudden, on set Face weakness. Dropin Stroke time. Meds Clit busritnns

Seizures Complicated

1-10 minutes if can't bresthe may die

• Ingecrioons
• Aclohold
• head injury coma
• Metabilo

1, rapid spontons

Sizeres- general

• Tonci Avtoic Miclonic Shaking c;

Amnsia- diffictly remembering

P atints

Amnesias Black out Temopraring losss

Seizures is newrly

• Hyptnsion cardia
• Fall

Tpe1

Not assc with lesions. Genetic

Siza

Latter Hyptensuon

Cva

Sertolij = 3426 mins. Siezier

Nursing

Safetd.

Sieure phase

Prodromal phase

Dads beffore. Mood chanes

Preictal phase-

Patient is having

If havint. Clear and remove

11 monitor Protect and safetyy

To ask

• What seizure What med

Seizrues in a Woman

Monothr

Alzheimter patj

• Pathohysilogjca = pafirents over 65. Degerabtion i
• Proetin deplsoirs in hrain

AD symtpms

• Lose contetx
• deprtesuom.

AD = treat

• COld liquids thick.

Early AD charc

Mempry loss . lose ings and dfficutkues ording Shott term definc

AD trear

Familiarity

AD meds to give

Arusept

Beter for

• GABA

AD Care and Managemetnt

• AD is made to based on hsrorty presentation

Ad nursing

Ad

• A=D is neuro degrd

Pathogy of dement

S. is proter degradation

• alzhiemerse = amyloids
• Vasocualer

Dementias =s and sympt

• memory loss disrubpt
• challenges
• trouble familia

Dementions

• Detail from pt and caregiver and syptoms

Dement

• Labyrorut to check vit d
• CT -

Diff betenwn dimentia and delirium d

• Delruim actue flauati. A shorn time with medication
• Demtrum chronuc is no medication

Elderlay

• Falls can subdruals
• Poorily stress

Care of althirner

• Strucrue and validate thetapy

Delirium. Delirium :

• Acut

S & Stypes - Elect.

• hypo sremnia
• ALtert matelonin

Nursing for alze

Fmaily and oritent

Care plan

- D

AD

Non medicaln-

Pharmocol =halpderitdo;

4/5 of sedations

Hyperthyrio dism

• Hypioidssjm os reduce abserncs from thyroid

M and Symps

Hhypertiidsi sn sd symptoms

D

High or lows

Nursing action for thytod

Low body temp=

• give fls

Thyroid storm

To ask

• How is pt feeling
• Monitor med

After the surgent

Hemorrhage .

Comport - semi fr

THYTOI

• Do the thetoryf

Hyperthroidisms.

Tsybroid problems

Hashitos

Hasimitos

• Antobdy attack tyhrid

-signs and symptpsn

• goiter. Dypapig

-Nussng

Thyorisd

Thyroid

Reduces Hots to reduce Cahcnte if anti

T1 and T2 Meds

• 1 diabetic messuits is auto immune
• 2 resutance Srtmpoms-polturia poluyphaigia
• Fatuige weight lows Ranges fronim

Dm

• Metabioic : obesitys
• sym[tms
• The hrowning
• High fasig

Dm elery

• Resists t

Diabetes

-high bs for gluvose

Hypolylyw

Hyplyxmeiz

Diabetic meds