Module 4C - Stroke PowerPoint Part 1 PDF

Stroke (CVA) (Brain Attack) NUR 211: Health Care Concepts Unit Four - Module 4C Part 1 Learning Outcomes: ● Collaborate with the interprofessional team to coordinate high -quality care for patients experiencing a stroke (brain attack). ● Implement nursing interventions to help the patient...

Stroke (CVA) (Brain Attack) NUR 211: Health Care Concepts Unit Four - Module 4C Part 1 Learning Outcomes: ● Collaborate with the interprofessional team to coordinate high -quality care for patients experiencing a stroke (brain attack). ● Implement nursing interventions to help the patient and family cope with the psychosocial impact caused by a stroke (brain attack). ● Apply knowledge of anatomy, physiology and pathophysiology to assess patients experiencing a stroke (brain attack). ● Use clinical judgment to plan care for patients experiencing a stroke. ● Teach the patient and caregiver(s) about common drugs for a patient experiencing a stroke (brain attack). Learning Resources ● Ignatavicius, D. (2021). pp. 898 -912 ● Ignatavicius, D. (2021). Study Guide. Chapter 41 (questions 1 -17) ● Silvestri, L. (2023). pp 864 -865 ● ATI RN Adult Medical Surgical Nursing 11.0 - Chapter 15 ● ATI RN Pharmacology for Nursing 8.0 - Chapter 25 Stroke “Disruption of cerebral blood flow” Incidence & Prevalence ● Fifth leading cause of death in US ● Women have higher incidence that men ● “Stroke Belt” ● Many survivors Transient Ischemic Attack (TIA) ● “Warning Sign” ● Brief Interruption of cerebral blood flow ● Symptoms Resolve Quickly Types of Strokes ● Ischemic ○ Thrombotic ○ Embolic ● Hemorrhagic ○ Intracerebral hemorrhage (ICH) ○ Subarachnoid hemorrhage (SAH) ○ Aneurysm ○ Arteriovenous malformation (AVM) Thrombotic Stroke ● Blood clot due to plaque ● Shuts off artery ● Ischemia distal to occlusion ● Symptoms progress ● Usually no LOC changes Embolic Stroke ● Embolus travels ● Blood flow shut off ● Sudden severe symptoms ** ● Few warning signs ● Remains conscious ● Atrial fibrillation is major risk factor Hemorrhagic Stroke ● “Bleeding” ● Sudden ● Altered LOC ● Headache ● Poor prognosis Risk Factors ● TIA ● Hypertension ● Cocaine Usage ● Diabetes ● Smoking ● Atrial fibrillation ● Cerebral aneurysm ● Obesity ● Atherosclerosis ● Hyperlipidemia ● Hypercoagulability ● Use of oral contraceptives Health Promotion and Maintenance ● ABCs: ○ A spirin use when appropriate ○ B lood pressure control ○ C holesterol management ○ S moking cessation Stroke Prevention ● Medications ○ Anticoagulants ■ Warfarin ■ Apixaban ■ Rivaroxaban ○ Antiplatelets ■ Aspirin ■ Platelet Inhibitors ● Dipyridamole ● Clopidogrel ● Procedures ○ Carotid endarterectomy ○ Extracranial -intracranial bypass Identifying a Stroke Right: ● Altered perception of deficits ● Unilateral neglect syndrome ● Loss of depth perception ● Poor impulse control ● Left hemiplegia or hemiparesis ● Left hemianopsia Left: ● Expressive/receptive aphasia ● Agnosia ● Alexia ● Agraphia ● Right hemiplegia or hemiparesis ● Depression ● Right hemianopsia Diagnostic Procedures ● Non -contrast computed tomography scan (CT) ● Computed tomography angiography (CTA) ● Magnetic Resonance Imaging (MRI) ● Magnetic Resonance Angiography (Cerebral Angiography) Non - Contrast CT Scan ● Non -Contrast ● Initial diagnostic test!! ● Performed within 25 minutes of arrival to ED ● Assess type of stroke ● Determines candidacy for thrombolytic therapy Computed Tomography Angiography (CTA) ● Uses contrast dye ● Blood vessels and tissues ● Diagnose occlusion of large intracranial arteries Magnetic Resonance Imaging (MRI) ● Identify: ○ Edema ○ Ischemia ○ Necrosis ● Highly Sensitive ● More detailed than CT ● Changes show sooner ● Can differentiate between: ○ Tissue at risk for damage ○ Tissue already irreparably damaged Magnetic Resonance Angiography (MRA) Cerebral Angiography ● Looks at blood vessels ● Can show presence of cerebral hemorrhage ● Perfusion of blood flow in carotid arteries/brain ● May use contrast dye ● Abnormal Vessel Structures ○ Aneurysm ○ AV malformation ○ Vessel ruptures Fibrinolytic Therapy ● Alteplase/Tissue Plasminogen Activator (TPA) ● Give within 4.5 hours of symptom onset ○ ESTABLISH LKW ● Ischemic Stroke ● Dose: 0.9mg/kg ○ Max: 90 mg ○ 10% given as bolus ○ Remaining given as infusion TPA (continued) Monitoring: ● Avoid invasive procedures after administration ● Goal BP <185/105 ● Frequent VS/Neuro Checks ● Monitor for bleeding ● Report change in condition ● Watch for seizure/headache ● Elevate HOB 30 degrees ● Bedrest Endovascular Interventions ● Intra -arterial thrombolysis ○ Within 6 hours ● Mechanical embolectomy ● Carotid Stent Placement/ Carotid Artery Angioplasty with stenting (CAS) Medications in treatment ● Aspirin ● Platelet Inhibitors ● Antihypertensives ○ Labetalol ○ Nicardipine ● Antiepileptic Medications ○ Phenytoin ○ Gabapentin