CEREBROVASCULAR DISORDERS

A Nursing Approach in the Management of

BY: DAVE JAY S. MANRIQUEZ BSN,RN.

CEREBROVASCULAR DISORDERS

An umbrella term that refers to any functional abnormality of the central nervous system that occurs when the normal blood supply to the brain is

disrupted.

STROKEa sudden neurological event which results in

the new onset of neurological symptoms.

TYPES of

STROKE

ISCHEMIC STROKE

“BRAIN ATTACK”

MOTOR LOSS-disturbance of voluntary motor control on the side of the body opposite the location of the stroke lesion

•Hemiplegia•Hemiparesis

COMMUNICATION LOSS

•Dysarthria•Apraxia•Agnosia•Dysphasia or Aphasia

PERCEPTUAL DISTURBANCES

•Homonymous Hemianopsia•Disturbance in Visual-Spatial Relations

- Unilateral Neglect•Loss of Peripheral Vision•Night Blindness•Diplopia•Horner’s Syndrome

SENSORY LOSS

•Slight Impairment of Touch•Loss of Proprioception•Difficulty in interpreting visual, tactile, and auditory stimuli

COGNITIVE IMPAIRMENT & PSYCHOLOGICAL EFFECTS

ASSESSMENT & DIAGNOSTICS

•Patient History•Complete Physical and Neurologic Examination•Initial Assessment: Airway Patency, Cardiovascular Status, Gross Neurologic Losses•Stroke Time Course Classification

STROKE TIME COURSE CLASSIFICATION

Stage 1: Transient Ischemic Attack

Stage 2: Reversible Ischemic Neurologic Deficits

Stage 3: Stroke in Evolution

Stage 4: Completed Stroke

DIAGNOSTIC TESTS

•CT Scan•12-Lead ECG •Carotid ultrasound•Cerebral Angiography•Transcranial Doppler Flow Studies•Transthoracic or Transesophageal Echocardiography•MRI of the brain and/or neck •Xenon CT •Single Photon Emission CT

MEDICAL MANAGEMENT

1. Treatment of TIA from atrial fibrillation or suspected embolic or thrombotic causes

2. Thrombolytic Therapy for Ischemic Stroke3. Therapy for Patients with Ischemic Stroke

NOT Receiving Thrombolytic Therapy4. Managing Potential Complications

SURGICAL MANAGEMENT

CAROTID ENDARTERECTOMY- Main surgical procedure for the management of TIAs and small stroke- Indicated for patients with symptoms of TIA or mild stroke found to be due to carotid stenosis - Complications: stroke, cranial nerve injuries, infection, hematoma at the incision site, carotid artery disruption

NURSING MANAGEMENT

•Improving Mobility and Preventing Joint Deformities•Managing Sensory-Perceptual Difficulties•Attaining Bowel and Bladder Control•Improving Thought Processes•Improving Communication•Maintaining Skin Integrity•Improving Family Coping•Helping the Patient Cope with Sexual Dysfunction

HEMMORHAGIC STROKE

CEREBRAL ANEURYSMSUBARACHNOID HEMORRHAGE