Stroke Effects and Management 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 implications of stroke diagnostic tests and procedures.
  • Utilize the nursing process to discuss stroke care (pre, during, and post).
  • Assess associated clinical manifestations.
  • Identify nursing diagnoses related to stroke.
  • Develop goals for stroke management.
  • Describe implementation of collaborative care, drug therapy, nursing care, and acute/non-acute care for stroke.

Stroke = Cerebral Vascular Accident (CVA)

• Death of brain cells occurs due to prolonged ischemia (reduced blood flow) or hemorrhage (bleeding) into the brain.
• Loss of neurological functions including; movement, sensation, and emotions controlled by the affected brain area.
• Severity varies based on location and extent of brain involvement.

Stroke: Cerebral Vascular Accident (CVA) - Blood Flow to the Brain

• Blood flow to the brain affected by:
  • Blood pressure (BP)
  • Cardiac output
  • Blood viscosity
• Without adequate oxygen and glucose, neurons cannot function normally.
• Brain needs at least 20% cardiac output.
• If blood flow is interrupted (e.g., cardiac arrest)
  • Neurological metabolism altered within 30 seconds.
  • Metabolism stops in 2 minutes.
  • Cellular death within 5 minutes.

Stroke - Canadian Statistics

• Third most common cause of death in Canada (after cancer and heart disease).
• Leading cause of serious long-term disability.
• Approximately 35% of individuals who have an initial stroke die within one year.
• More common in men.
• Men more likely to have thrombolytic or embolic strokes
• Women more likely to have hemorrhagic strokes.

Risk Factors for Stroke

• Non-Modifiable:
  • Age
  • Gender
  • Ethnicity/race
  • Heredity/family history
• Modifiable:
  • Hypertension
  • Diabetes (4-5x increased risk)
  • Heart disease
  • Heavy alcohol consumption
  • Oral contraceptive use (estrogen)
  • Physical inactivity
  • Smoking (2x increased risk)

Ischemic Stroke

• Inadequate perfusion due to partial or complete artery occlusion (87% of all strokes).

  • Transient Ischemic Attack (TIA):

    • Brief episode of neurological dysfunction (symptoms last less than 1 hour, often less than 15 minutes).
    • No death of brain cells.
    • Statistics include < 50% reporting to HCPs, and 1/3 of TIA patients will experience another TIA or stroke.

  • Thrombotic Stroke:

    • Blood clot formation within a brain vessel (accounts for ~50% of all strokes).
    • Stepwise symptom progression related to increasing ischemia. TIA is a warning sign.

  • Embolic Stroke:

    • Blood clot forms elsewhere in the body and travels to the brain, obstructing a blood vessel.
    • Often a single event with symptoms appearing quickly.
    • Warning sign is often absent.

Hemorrhagic Stroke

• Bleeding into the brain tissue itself or into the subarachnoid space or ventricles (approximately 15% of all strokes).

  • Intracerebral hemorrhage:

    • Bleeding within the brain due to vessel rupture.
    • Increases intracranial pressure.
    • Hypertension is a common cause.
    • Often sudden onset with progressive symptoms over minutes to hours. Warning signs include headache, nausea, and vomiting.

  • Subarachnoid hemorrhage:

    • Bleeding into the cerebrospinal fluid (CSF) due to cerebral aneurysm rupture.
    • Commonly associated with very severe headaches.
    • Associated with increased stroke mortality rates.

Aneurysm

• Permanent, localized outpouching or dilation of the blood vessel wall.
• Can be congenital or acquired. Risk of rupture which may lead to hypovolemia, ischemia, or infarction to other cells and organs
• Atherosclerosis (plaque buildup) can often contribute to weakening of the vessel
• May require surgical intervention.

Brain Aneurysm

• Congenital or acquired
• Genetic component
• Screening recommended
• Pain behind the eye, changes in vision

Clinical Manifestations (general)

• Manifestations directly related to the affected brain region.
• Possible manifestations in multiple categories of function including:
  • Motor function
  • Sensation
  • Elimination
  • Intellectual function
  • Spatial-perceptual alterations
  • Personality and Affect

Clinical Manifestations (specifc to strokes)

• Motor Function: Most obvious effect of stroke, involves impairments in mobility; respiratory function; swallowing and speech; gag reflex; self-care abilities; neurological assessment, muscle tone and reflexes

• Communication:

  • Dysphasia (partial loss or impairment in language comprehension or production). Often related to the left sided brain
  • Dysarthria (speech impairment due to neurological issues with muscles controlling speech), often affected in the right side of the brain
  • Alexia (inability to read)

• Affect: Patients may experience fluctuating emotions, exaggerated emotional responses. Frustrations from communication and mobility issues are also symptoms noted. Depression common in the first year after a stroke.

• Cognitive: Stroke may affect memory and judgment abilities

  • Left-brain strokes may cause memory problems, slow movements, and cautious responses
  • Right-brain strokes may cause impulsive movements, impaired judgment and time concept.

• Spatial-Perceptual Stroke on right brain may result in spatial perceptual alteration -erroneous perception of self in place, forgetting other side of the body, difficulty in distance judgement, inability to recognize objects or carry out learned, ordered movements

Diagnostics for Stroke

• Diagnostic studies done when stroke or stroke symptoms occur include tests (CT, MRI), cardiac, blood tests to evaluate factors related to the likely cause of the stroke (ischemic or hemorrhagic)
• Goal is to confirm the nature of the stroke, identify its reason, and determine its effects.
  • CT and MRI scans perform within 25 minutes of arrival to ER and read within 45.
  • Other tests may be done if needed to check for risk factors and other causes .

Prevention for Stroke

• Blood pressure control
• Blood glucose control
• Diet and exercise
• Smoking cessation
• Routine health assessments
• ACT FAST initiative instruction

Stroke Management

• Acute Phase:

  • Collaborating with healthcare providers to preserve life, prevent further brain damage, and reduce disability
  • Single most important patient history assessment: time of the initial onset of symptoms.
  • Initial management (ABCs of management): airway, breathing, circulation and altered level of consciousness
  • Comprehensive neurological assessment (level of consciousness, cognition, motor abilities, cranial nerve function, sensation, and deep tendon reflexes)

• Management of increased intracranial pressure (ICP): Measures to lower metabolic demand on brain cells, to reduce cerebral edema, and pain management

• Ischemic strokes: Thrombolytic therapy (e.g., tPA). If given within the time window of 3-4.5 hours of the onset of the stroke symptoms.

• Hemorrhagic strokes: Manage hypertension, other interventions as required in acute care phase

• Nursing management: Identifying complications related to acute care (Risk for aspiration pneumonia, Risk for injury/falls, Risk for impaired skin integrity, Risk for DVT, Impaired communication, GI/Urinary disorders). Interventions include positioning, nutrition, risk prevention in the environment, and other interventions to meet the specific needs for the patient post stroke.

• Rehabilitation strategies: Post stroke stabilization at 12-24 hours. Learn techniques to self-monitor and maintain physical wellness. Self-care skills exhibition and problem solving. Physician, nurse, physiotherapist, occupational therapist, speech-language pathologist, psychologist will be involved. Specific rehabilitation strategies will be provided based on the specific side of the brain affected.

• Recovery from a Stroke: Learning about the impact of the stroke on the brain, and understanding the different therapies involved in recovery.

Related Nursing Diagnoses and Complications

• Risk for Injury/Falls
• Risk for Impaired Skin Integrity
• Risk for Aspiration Pneumonia
• Risk for Imbalanced Nutrition/less than body requirements
• Impaired swallowing/feeding self-care deficits
• Impaired communication
• Impaired Urinary system
• Risk for DVT

Test your knowledge on the immediate impacts of strokes on neurons, risk factors for ischemic strokes, and relevant statistics. This quiz covers critical cellular consequences of ischemia, demographic associations with stroke types, and important nursing implications in stroke management.