Question

What is CVA ? What is pathophysiology ?

What is system  disorder of CVA include all of this

Alterations in Health (Diagnosis)

Pathophysiology Related to Client Problem

Disease Prevention

Risk Factors

Expected Findings

Diagnostic Procedures

Nursing Care

Medications

Client Education

Complications

Therapeutic Procedures

Inter professional Care

  

Answer 1

CEREBROVASCULAR ACCIDENT (CVA)

Definition: A Cerebro vascular accident, an ischemic syrstr or brain attack is a sudden loss of brain function resulting from a disruption of the blood supply to a part of the brain.

Types: HEMORRHAGIC (15%) & ISCHEMIC/ NON HEMORRHAGIC (85%)

Ischemic strokes are categorised according to their cause: LARGE ARTERY THROMBOTIC STROKE, SMALL PENETRATING ARTERY THROMBOTIC STROKE, CARDIOGENIC EMBOLIC STROKE, CRYPTOGENIC STROKE & others.

Risk factors:

Non modifiable:

1. advanced age (older than 55)
2. Gender (male)
3. Race (African American)

Modifiable:

1. hypertension
2. Atrial fibrillation
3. Hyperlipidemia
4. Obesity
5. Smoking
6. Diabetes
7. Asymptomatic carotid stenosis & valvular heart disease (eg: endocarditis, prosthetic heart valves)
8. Periodontal disease

Clinical manifestations: general signs and symptoms include NUMBNESS OR WEAKNESS OF FACE, ARM, OR LEG, CONFUSION OR CHANGE IN MENTAL STATUS, TROUBLE SPEAKING OR UNDERSTANDING SPEECH, VISUAL DISTURBANCES, LOSS OF BALANCE, DIZZINESS, DIFFICULTY WALKING, SUDDEN OR SEVERE HEADACHE

Motor loss;

• hemiplegia or hemiparesis
• Flaccid paralysis & loss of or decrease in the deep tendon reflexes followed by reappearance of deep reflexes and abnormally increased muscle tone

​​​​​​​Communication loss

• dysarthria
• Dysphasia
• Apraxia

​​​​​​​Perceptual disturbances & sensory loss

• visual perceptual dysfunction
• Disturbances in visual spatial relations, frequently seen in patients with right hemispheric damage
• Sensory losses: slight impairment of touch or more severe with loss of proprioception, difficulty in interrupting visual, tactile & auditory stimuli

​​​​​​​Impaired cognitive & psychological effects

• frontal lobe damage: learning capacity, memory or other higher cortical intellectual functions maybe impaired
• Depression or other psychological problems: emotional lability, hostility, frustration

​​​​​​​Pathophysiology

​​​​​​​

​​​​​​​Assessment & Diagnostic methods

• History & complete physical & neurological examination
• Non contrast CT scan
• 12- lead ECG & carotid ultrasound
• CT angiography or MRI & angiography
• transcranial Doppler flow studies
• Transthoracic or transesophageal echocardiography
• Xenon enhanced CT scan
• Single photon emission CT scan

​​​​​​​Disease prevention

• Help patients to alter risk factors for stroke, encourage toquit smoking, maintain a healthy weight, follow Healthy diet & exercise daily
• Prepare & support patient through carotid endarterectomy
• Administer anticoagulant agents as prescribed ( low dose aspirin therapy)

​​​​​​​Medical management

• Recombinant tissue plasminogen activator, unless contraindicated
• Anticoagulation therapy
• Management of increased ICP: Osmotic diuretics, maintain PaCO2 at 30-35mm Hg, position to avoid hypoxia
• Possible hemicraniectomy for increased ICP
• Intubation with an endotracheal tube to establish patent airway
• Continue hemodynamic monitoring
• Neurologic assessment

​​​​​​​Complications

• Decreased cerebral blood flow: pulmonary care, maintenance of patent airway, administration of supplemental oxygen
• Monitor for UTIs, cardiac dysrhythmias & complications of immobility