STROKE/ BRAIN ATTACK By Cindy Mendez. ~Interesting notes~ Brain attack is the most comon nervous...

STROKE/ BRAIN STROKE/ BRAIN ATTACK ATTACK

By Cindy MendezBy Cindy Mendez

~Interesting notes~~Interesting notes~

• Brain attack is the most comon nervous Brain attack is the most comon nervous system diseasesystem disease

• 700,000 people suffer brain attacks 700,000 people suffer brain attacks evry year in the U.Sevry year in the U.S

• Third leading cause of death in the U.S Third leading cause of death in the U.S about 158,000 annually. about 158,000 annually.

• With sufferers with in the ages of 75 With sufferers with in the ages of 75 and 85and 85

• 85% ischemic and 15% hemorrhagic.85% ischemic and 15% hemorrhagic.

WHAT IS A STROKE/BRAIN WHAT IS A STROKE/BRAIN ATTACK?ATTACK?

• Is an abnormal condition of the Is an abnormal condition of the blood vessels of the brain, blood vessels of the brain, characterized by:characterized by:

• Hemorrhage Hemorrhage into the braininto the brain• EmbolusEmbolus formed in the brain itself formed in the brain itself • ThrombusThrombus being occcluded in the being occcluded in the

vessel of the brain.vessel of the brain.

Risk factors Risk factors

• AtherosclerosisAtherosclerosis

• Heart diseaseHeart disease• HypertensionHypertension• Kidney diseaseKidney disease• Peripheral Peripheral

vascular diseasevascular disease• Diabetes mellitus Diabetes mellitus • Family history Family history

• Obesity Obesity • High serum High serum

cholesterol levels cholesterol levels • Cigarette smokingCigarette smoking• Cocaine use Cocaine use • Sedentary lifestyle Sedentary lifestyle • Oral contraceptives Oral contraceptives • Hormone Hormone

replacement replacement

Clinical ManifestationsClinical Manifestations&&

Assessment Assessment • Deficits in: Deficits in:

– body functionsbody functions– Motor activity Motor activity – EliminationElimination– Intellectual functionIntellectual function– Spatial-perceptual alterationsSpatial-perceptual alterations– PersonalityPersonality– AffectAffect– SensationSensation


AssessmentAssessment

– DysphagiaDysphagia– CommunicationCommunication– Headache (sudden and explosive)Headache (sudden and explosive)– Numbness/tinglingNumbness/tingling– Inability to think clearlyInability to think clearly– Visual problemsVisual problems– Hemiparesis Hemiparesis


AssessmentAssessment– Hemiplegia Hemiplegia – Loc changes Loc changes – Increased ICPIncreased ICP– Changes in respiratory status Changes in respiratory status – Paralysis Paralysis – ParesisParesis– Hemianopia Hemianopia

Clinical ManifestationsClinical Manifestations

• The functions affected, are directly The functions affected, are directly correlated to the artery in the brain correlated to the artery in the brain that was affected.that was affected.

• Permanent damage is the result Permanent damage is the result from anoxia suffered to the brain.from anoxia suffered to the brain.

• Unconsciousness and seizures may Unconsciousness and seizures may also be experienced by the patient also be experienced by the patient

Types of strokes Types of strokes

• Thrombotic strokeThrombotic stroke( most common):( most common): – primarily caused by atherosclerosisprimarily caused by atherosclerosis– The carotid arteries are the common source The carotid arteries are the common source

of thrombiof thrombi– Population in the ages between 60-90Population in the ages between 60-90– Forms d/t the narrowing of blood vessels & Forms d/t the narrowing of blood vessels &

with plaque build up, debris begin to with plaque build up, debris begin to accumulate and the thrombus begins to accumulate and the thrombus begins to form.form.

– Usually occur in the a.m. d/t rumbency. Usually occur in the a.m. d/t rumbency.


• Emboli strokeEmboli stroke::– Younger population Younger population – 22ndnd most common type of stroke most common type of stroke – Usually originate from a thrombus in Usually originate from a thrombus in

the endocardial layer of the heart. the endocardial layer of the heart. – Occurring primarily in the mid-cerebral Occurring primarily in the mid-cerebral

arteryartery


• Hemorrhagic:Hemorrhagic: – 33rdrd most common type of stroke most common type of stroke – In population between the ages of 35-60In population between the ages of 35-60– Intracerebral or intracranial bleeding into the Intracerebral or intracranial bleeding into the

brain or the subarachnoid spacebrain or the subarachnoid space– An aneurysm is often the cause of a stroke. An aneurysm is often the cause of a stroke.

With a risk for another rupture with in 7-10 With a risk for another rupture with in 7-10 daysdays

– 50% of hemorrhagic stroke victims will die50% of hemorrhagic stroke victims will die– 20 % of the patients suffering this stroke will 20 % of the patients suffering this stroke will

be functionally independent after 6 months.be functionally independent after 6 months.


• Transient ischemic attackTransient ischemic attack::– Transient cerebrolvascular insufficiency Transient cerebrolvascular insufficiency

with episodes of neurological with episodes of neurological dysfunctiondysfunction• Lasting up to 24 hrs Lasting up to 24 hrs • Usually less than 15 minUsually less than 15 min• But resolved with in 3 hrs But resolved with in 3 hrs

– Caused my micro-emboli that Caused my micro-emboli that temporarily blocks the blood flow temporarily blocks the blood flow

– This warns the patient of other This warns the patient of other underlying conditionsunderlying conditions


– At least 1/3 of patients suffering a TIA At least 1/3 of patients suffering a TIA will suffer a stroke within a 2-5 year will suffer a stroke within a 2-5 year periodperiod

Diagnostics Diagnostics

• CT scan CT scan • CT angiography CT angiography • MRIMRI• MR angiography MR angiography

Medical Management Medical Management

• Surgery (if aneurysm was the case) Surgery (if aneurysm was the case) craniotomy, clipping off of the affected craniotomy, clipping off of the affected artery to prevent a rebleedartery to prevent a rebleed

• Calcium channel blocker (Nimotop) Calcium channel blocker (Nimotop) prevevnts vasospasm prevevnts vasospasm

• Thrombolytics (plasminogen activator)Thrombolytics (plasminogen activator)• Platelet inhibitors and anticoagulants Platelet inhibitors and anticoagulants • ICP reducing drugs ICP reducing drugs

Medical Management Medical Management

• Suppositories, stool softeners, Suppositories, stool softeners, laxatives, enemaslaxatives, enemas

• Restricted fluid intake Restricted fluid intake • Early ambulation w/in 1-2 days (dr. Early ambulation w/in 1-2 days (dr.

order only)order only)

Nursing InterventionsNursing Interventions

• Neurological assessments at least each Neurological assessments at least each shift. shift.

• Nutrition (tube feedings, thicker liquids, or Nutrition (tube feedings, thicker liquids, or IV.IV.

• One handed feeding and one handed One handed feeding and one handed dressing. dressing.

• Bladder training, bowel training.Bladder training, bowel training.• Exercises to prevent contractures ( bobath Exercises to prevent contractures ( bobath

approach)approach)• Communication boardCommunication board

Patient Teaching Patient Teaching

• Teach about medications ( provide Teach about medications ( provide written instructions).written instructions).

• Stroke club supportStroke club support• Teach about different rehab and Teach about different rehab and

skilled nursing facilities skilled nursing facilities • Swallowing precautions if applicableSwallowing precautions if applicable

PrognosisPrognosis

• Depends on the severity of the Depends on the severity of the attack and the region of the brain attack and the region of the brain that was affected that was affected

• With therapy significance functional With therapy significance functional gains can be made.gains can be made.

• With plasminogen activator for With plasminogen activator for thrombolysis prognosis is very good thrombolysis prognosis is very good

STROKE/ BRAIN ATTACK By Cindy Mendez. ~Interesting notes~ Brain attack is the most comon nervous...

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