INTRODUCTION
A stroke is a serious medical disorder that occurs when the blood supply to part of the brain is cut off.
Like other organs in body, brain also need the oxygen and nutrients provided by blood to function properly. If the supply of blood is stopped, brain cells begin to die. This can lead to brain damage and possibly death.
DEFINITION. :-
Stroke is an infarction (death) of a specific portion of brain due to interruption of blood flow that results to neurological deficit or loss of brain functions.
CAUSES
- Thrombosis: Blood clot in blood vessels of brain or neck.
- Cerebral Embolism: The condition in which an embolus becomes lodged in an artery and obstruction of blood flow.
- Ischemia: Low blood supply in any part of brain.
- Vascular compression: Vein compression.
- Arterial spasm: Artery contraction.
RISK FACTORS
- Hypertension
- Heart disease (Atherosclerosis)
- Diabetes mellitus
- Cigarette smoking
- Emotional stress
- Carotid bruit, red blood cell disorders
- Dyslipidemia
- Previous transient ischemic attack
- Elevated cholesterol level
- Obesity
- Oral contraceptive
- Familiar history
- Physical inactivity
CLINICAL MANIFESTATIONS
The abnormal narrowing of a passage or opening. Such as a blood vessel or heart valve. Stenosis of greater blood vessel in neck.
Paralysis: Muscle weakness that varies in it.
Hemiplegia: Paralysis of one side of the body. It is caused by disease affecting the opposite hemisphere of the brain.
Transient loss of speech.
Paraesthesia (Spontaneous occurring abnormal tingling and prickling sensation “pina and needles” sensations
Common Sign & Symptoms:
- Headache
- Vomiting
- Seizure
- Nose bleeding (Epistaxis)
- Retinal haemorrhage
- Motor and sensory disturbances
- Vertigo
- Nuchal rigidity
- Fever
- Confusion
- Disorientation
- Memory impairment
- Weakness
- Language disorder
- Reflex changes
- Improper sexual abnormalities
- Depression
- Numbness.
SPECIFIC DEFICITS AFTER CVA
- Hemiplegia: Paralysis of one side of body.
- Aphasia: Defect in using and interpretating the symbols of language.
- Agnosia:Unable to recognize the object.
- Apraxia: It is a condition in which a client can move the affected part but cannot use it for specific purposeful actions.
- Kinesthesia:Alterations in sensation.
- Incontinence: Inability to control the bladder and bowel.
DIAGNOSTIC EVALUATIONS
- Physical examination
- Computer tomography
- History collection
- CSF culture
- Angiography
- MRI
- Echoencephalography
PET: Positron Emission Tomography
- General blood and urine examination.
MANAGEMENT
MediCal management of client after CVA is directed toward:
- Preserving life
- Minimizing residual deformity
- Reducing ICP
- Preventing recurrence.
Pharmacological Management
- Mild analgesics, e.g., ibuprofen,
- Steroids (anti-inflammatory).
- Antiepileptics, e.g., phenytoin
- Anticoagulant, e.g., heparin
- Osmotics diuretics (for oedema), e.g., mannitol
- Antihypertensive agents, e.g., verapamil
Dietary Management
Fluid diet should be given because patient is unable to swallow properly.
Surgical Management
It Depends upon the site of infection and on particular causes. If ICP is more than 30-40 mm Hg than only surgery will performed.
Surgeries are:
- Evacuation of Haematoma.
- Carotid endarterectomy (removal of material on inside of an artery) it is the surgical procedure used to reduce the risk of stroke by correcting stenosis in common carotid artery.
Nursing Management
- Give position to prevent contractures; use measures to relieve pressure, assist in maintaining good body alignment and prevent compressive neuropathies.
- Change position frequently place patient in a prone position for 15 to 30 minutes several times a day.
- Provide full range of motion 4-5 times a day to maintain joint mobility, regain motor control, prevent contractures in the paralyzed extremity, prevent further deterioration of the neuromuscular system and increase circulation
- Start an active rehabilitation program when consciousness returns.
- Never lift patient by the flaccid shoulder or pull on the affected arm or shoulder
- We should elevate arm and hand to prevent dependent edema of the hand, administer analgesic agents as needed.
- We should encourage personal hygiene activities as soon as the patient can sit up, select suitable self care activities that can be carried out with one hand.
- Provide emotional support and encouragement to prevent fatigue and discouragement
- Nurse should consult with speech therapist to evaluate gas reflexes, assist in teaching Alternate swallowing techniques, advise patient to take smaller boluses of food and inform patient of foods that are easier to swallow; provide thicker liquids or pureed diet as indicated.
- Provide high fiber diet and adequate fluid intake 2 to 3 litres per day
- Provide strong emotional support and understanding to relieve anxiety
- While caring CVA’s patient be consistent in schedule, routines and repetitions. A written schedule, checklists and audiotapes may help with memory and concentration and a communication board may be used.
- Maintain patient’s attention when talking with patient, speak slowly and give one instruction at a time; allow patient time to process.
- Encourage patient to perform self-care to maximum of ability to promote sense of control and independence
- Nurse should assess the skin for changes in colour, turgor and redness vascularity.
- Monitor fluid intake and hydration condition of skin and mucous membranes to detect dehydration.
- Nurse should provide soothing skin care, restrict use of soaps and apply ointments or creams because soap may dry the skin area
- Use baking soda baths to decrease itching and dryness than soaps identify bowel/bladder elimination patterns. Recommend adequate hydration and intake of fiber.
- Use of use of stool softeners, laxatives and bowel training program to avoid constipation.
- Refer for vocational rehabilitation as needed or as possible.
- Instruct patient to regular medical follow-up to evaluate and progression of degenerative disease.
Nursing Diagnosis****
- Altered cerebral tissue perfusion related to increased ICP.
- Impaired physical mobility related to paralysis.
- Self care deficit related to paralysis.
- Risk of injury related to paralysis.
- Risk for aspiration related to loss of swallowing reflex.
- Imbalanced nutrition less than body requirement related to inability to swallow/paralysis.
- Impaired verbal communication related to aphasia.
- Altered thought process related to impaired cerebral blood flow, altered sensations.
- Disturbed sensory perception related to altered sensory transmission or neurological deficient