“Stroke is a medical emergency that strikes suddenly and it should be treated immediately to prevent neurological deficit and permanent disability.” Stroke results from an alteration in normal blood to the brain.
“Cerebrovascular accident (CVA) is a medical condition in which poor blood flow to the brain results in brain cells die.”
“Stroke is a term used to describe neurological changes caused by an interruption in blood supply to a part of the brain.”
Causes and Types of Stroke:-
- Ischemic Stroke:- An acute ischemic stroke caused by blockage of a cerebral artery by either thrombus or embolism.
- Thrombotic Stroke:- Stroke that is caused by blood clots or a thrombus. A thrombotic stroke is an account for more than half of all stroke. It is commonly associated with atherosclerosis, arthritis, or vasculitis.
- Embolic Stroke:- An embolic stroke is caused by a traveling thrombus or a group of thrombin that breaks off from one area of the body and travels through the cerebral artery via the carotid artery. It is caused by or associated with arterial fibrillation, rheumatic heart disease, myocardial infarction, ischemic heart disease, or atherosclerosis.
- Hemorrhagic Stroke:- In this hemorrhagic stroke blood vessel’s integrity is interrupted and bleeding occurs into the brain tissues and the space surrounding the brain commonly intracerebral hemorrhage and subarachnoid hemorrhage.
- Intracerebral Hemorrhage:- Bleeding into the brain cerebral tissue which is generally resulting from hypertension.
- Subarachnoid Hemorrhage:- It is much more common and results from bleeding into the subarachnoid space. This type of stroke caused by a ruptured aneurysm or arteriovenous malformation.
Risk factors of Stroke:-
- Age (above 60 years).
- Gender (male has 30% more chances then female).
- Family History.
- Head Injury.
- History of migraine or Headache.
- Sickle cell disease.
- Smoking, chronic alcoholism.
- Tobacco using.
- Drug abuse (cocaine).
Pathophysiology of Stroke:-
1. Ischemic Condition:-
Due to Ischemic condition — lack or loss of blood supply to brain tissue — Brain tissue ceases to function (within 60 second) — cell death and permanent changes with 3-10 minutes (after approximately 2-3 hours irreversible injury possible occur) — Altered central metabolism — Infarction — Neuronal injury — Penumbra (infarcted area or area of hypoperfusion in the brain) — coma or death.
2. Hemorrhagic Condition:-
Due to hemorrhage — rupture of vessels and bleeding — Haematoma — Tissue injury by compression of tissues from hematoma — Pressure of hematoma leads to loss of blood supply — Infarction — Neuronal injury — Penumbra — Coma or death.
Clinical Manifestation of Stroke:-
1.General Problems or Symptoms:-
- Change in mental status.
2. Early Warning Signs:-
- F = Facial drooping.
- A = Arms weakness.
- S = Speech difficulty.
- T = Time to call emergency services.
3. Ischemic Stroke:-
- Transient Hemiparesis.
- Loss of speech and sensory loss.
4. Hemorrhagic Stroke:-
- Occipital or neutral headache.
- Syncope (sudden fall down).
- Paraesthesia (something is pinning to patient or pricking).
- Transient paralysis.
- Epistaxis (bleeding from the nose).
- Retinal hemorrhage.
5. Cognitive Manifestation:-
- Aphasia:- Communication disorder or deficit in the ability to communicate in all aspects like speaking, writing, reading, and understanding.
- Alexia/Dyslexia:- Difficulty in reading or learning to read.
- Agraphia:- writing difficulty or disorder.
- Acalculia:- Inability to calculate.
6. Motor Changes:-
- Apraxia:- Inability to perform correct movements.
- Ataxia:- Failure of muscle co-ordination leads to unsteadiness in standing and walking.
7. Sensory Changes:-
Decreases senses typically occur on the affected site of the body.
- Agnosia:- It is a disturbance or inability to recognize familiar objects or things, the most common types are visual and auditory.
- Hemianopia (Homonymous Hemianopia):- It is the visual loss on the same half of the visual field of each eye so that client has half or normal vision.
- Horner’s Syndrome:- It is the paralysis of sympathetic nerves to eyes causing sinking of the eyeball, ptosis, myosis (constricted pupils), and lack of tearing in eyes.
In this the client is unaware of the existence of his/her paralysed site. manifestation of unilateral neglect include:-
- Failure to attempt to one side of the body.
- Failure to respond to stimuli on one side of the body.
- Failure to Use one extremity.
- Failure to orient the head and eye to one side.
- Incontinence (bowel or bladder).
- Physical Examination.
Stroke Medical Management:-
1.Fibrinolytic or Thrombolytic Therapy:-
Example:- rt-PA (recombinant tissue plasminogen activator).
This drug is used for the treatment of acute ischemic stroke. rt-PA degrade thrombus by breaking down fibrin. [dose;- The dose of rt-PA for ischemic stroke is 0.9 mg/kg administered intravenously over 1 hour] after thrombolytic therapy the client is sent to ICU for careful monitoring of vital signs nutrition status and bleeding.
It include intra-arterial thrombolysis or mechanical thrombectomy or embolectomy.
Stroke Nursing Management:-
- Altered cerebral tissue perfusion.
- Goal:- to maintain tissue perfusion.
- Assess factor related to individual situation for decrease cerebral perfusion and potential for increased ICP.
- Monitor the vital sign.
- Position with head slightly elevated of in neutral position.
- Prevent straining of sterile and holding breath.
- Impaired Physical Mobility.
- Goal:- To ensure proper physical mobility.
- Assess extend for impairment initially and on a regular basis.
- Use aron sling form when patient is in upright position as indicated.
- Place pillow under axilla to abduct arm to prevent abduction of shoulder or flexion of a elbow.
- Encourage exercise such as quadriceps exercise, squeezing rubber ball, extension of finger.
- Impaired verbal Communication.
- Goal:- To establish method of communication in which need can be expressed.
- Assess extend of disfunction pattern cannot understand words or has trouble speaking or making self understood.
- Listen for errors in conversations and provide feedback.
- Ask patient to follow simple comments.
- Point to object to ask patient to name them to test for aphasia.
- Provide alternative method of communication writing and pictures.
- Altered sensory perception.
- Goal:- To maintain visual level of consciousness of perceptual functioning.
- Establish and maintain communication with patient to set up a sample method of communicated basic needs.
- Eliminate external noise and stimuli as necessary with sensory overload.
- Orient patient frequently to environment staff procedures as it assists patients to identify in conscious in reception and may release perceptual disorientation of reality.
- Stimulate sense of touch give patient object to touch and hold.