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CVA (1).pptx
- 1. CEREBROVASCULAR ACCIDENT (CVA) or STROKE Transient Ischemic Attack (TIA) NSG 2640
- 2. OBJECTIVES Review and discuss types of stroke Identify causes of stroke Review and discuss nursing interventions for prevention, treatment of acute and post-acute stroke Identify complications of stroke and interventions for long-term treatment
- 3. CEREBROVASCULAR ACCIDENT (CVA) Condition that involves the blood vessels that supply blood to the brain Without adequate supply of oxygen, nerve cells of the brain can't work and may die within minutes. Condition in which decrease blood flow to a localized area of the brain causes neurologic deficits Cell death may occur after 5 minutes
- 4. Stroke is the fifth leading cause of death in the United States 795,000 people in the United States suffer a stroke each year (About 610,000 of these are first or new strokes) 1 in 4 strokes are people who have had a previous stroke Risk of having a first stroke is nearly twice as high for blacks as for whites, and blacks have the highest rate of death due to stroke. In 2018, 1 in every 6 deaths from cardiovascular disease was due to stroke. Four million Americans who have survived a stroke are living with impairments and 15% to 30% are permanently disabled Stroke-related costs in the United States came to nearly $46 billion between 2014 and 2015 https://www.cdc.gov/stroke/facts.htm
- 5. On average, someone in the U.S. has a stroke every 40 seconds. On average, someone dies of a stoke every 3.59 minutes in the U.S. There are about 401 deaths from stroke each day, based on 2017 data. Stroke risk increases with age, but strokes canand dooccur at any age. In 2009, 34% of people hospitalized for stroke were less than 65 years old. https://www.cdc.gov/stroke/facts.htm https://professional.heart.org/en/science-news/heart-disease-and- stroke-statistics-2020-update
- 7. STROKE RISK FACTORS Smoking High blood pressure Cigarette smoking Rhythm changes (atrial fibrillation or flutter) Coronary artery disease/High Cholesterol Oral contraceptives Diabetes Obesity/Lack of exercise Heavy use of alcohol or drugs (Cocaine) Family Hx Age Previous hx of TIA
- 8. STROKE PREVENTION Healthy Diet Healthy Weight Physical Activity No Smoking Limited Alcohol
- 10. ISCHEMIC STROKE Occurs because of blood clots or narrowing of blood vessels Approximately 87% of all strokes HEMORRHAGIC STROKE Occurs when a blood vessel in the brain breaks leaking blood into the brain. Account for 13% of all strokes Responsible for 30% of all stroke deaths. Most fatal type of stroke
- 11. Transient Ischemic Attack (TIA) Mini-stroke Temporary decrease in blood flow occurs (ischemia) Patient exhibits stroke-like symptoms due to transient hypoxia but cells do not die Ischemia resolves and function returns to normal condition over a 24-hour period A warning sign (precursor) to thrombotic CVA
- 14. NURSING DIAGNOSES: Ineffective Cerebral Tissue Perfusion Impaired Physical Mobility Impaired Verbal Communication Disturbed Sensory Perception Ineffective Coping Self-Care Deficit Risk for Impaired Swallowing Activity Intolerance Risk for Unilateral Neglect Deficient Knowledge
- 15. NURSING INTERVENTIONS Monitor Vital Signs Neuro Checks around the clock Cranial nerves-pupillary response NIH Stroke Scale Blood pressure meds Monitor for Increased ICP increased BP, decreased hr, decreased resp, N/V, decreased LOC Airway issues with swallowing suction at the bedside
- 16. TPA TISSUE PLASMINOGEN ACTIVATOR May administer tPA Monitor for bleeding if tPA given Monitor for EKG changes Avoid Unnecessary venipunctures if tPA given Avoid IM injections if tPA given
- 17. NURSING INTERVENTIONS POST-ACUTE: Bowel/bladder function bedpan, foley Skin & Limb Integrity: Neglect syndrome (Unilateral neglect), alignment and ROM exercises Diet evaluate by speech therapy Bowel/bladder function bedpan, foley Assist with communication difficulties Patient Education Fall/Injury prevention Family Education Multidisciplinary Approach
- 20. MOTOR DEFICITS Hemiplegia Paralysis of one side of the body Hemiparesis Weakness of one side of the body. Flaccidity Absence of muscle tone (hypotonia). Spasticity Increased muscle tone (hypertonia)
- 21. SENSORY-PERCEPTUAL DEFICITS Hemianopia blindness in vision in one half of the visual field due to damage of the optic pathway in the brain. This is how a street scene looks with normal vision This is how the same scene looks with right hemianopia
- 22. COMMUNICATION DEFICITS APHASIA - language deficits (expressive, receptive or mixed) EXPRESSIVE comprehends speech but cannot respond back with speech (BROCAs area) RECEPTIVE unable to comprehend speech (WERNICKEs area) MIXED combination of expressive & receptive GLOBAL complete inability to understand or produce speech
- 24. COMMUNICATION DEFICITS Dysarthria unable to speak d/t weak muscles (hard to understand) Apraxia cant perform voluntary movements even though muscle function is normal Agraphia loss of ability to write Alexia loss of ability to read (dont understand or see the words) Agnosia doesnt understand sensations or recognize known objects or people
- 25. COGNITIVE DEFICITS A change in the level of consciousness Mild confusion to coma. Intellectual change Memory loss, decreased attention span, poor judgment, inability to think abstractly Behavioral Emotionally labile (laugh ,cry, inappropriately) Loss of Self Control Swearing, refusing to wear clothing Decreased tolerance for stress Resulting in anger or depression (Smeltzer,Bare, Hinkle, & Cheever, 2010)
- 26. DYSPHAGIA Difficulty swallowing Dysphagia screen Swallow evaluation May result in choking, drooling, ***Aspiration*** (Smeltzer,Bare, Hinkle, & Cheever, 2010)
- 27. ASPIRATION PRECAUTIONS Careful when feeding clients may have to add a thickening agent to liquids Think safety Position in upright sitting position with neck slightly flexed (chin to chest) Order soft or pureed food Teach or feed client by putting food behind teeth on the unaffected side of mouth Feed slowly. One bite at a time. Check pockets of mouth (Smeltzer,Bare, Hinkle, & Cheever, 2010)
- 28. THERAPIES Physical Therapy Prevent contractures and improve muscle strength and coordination Occupational Therapy Provide assistive devices and a plan for regaining lost motor skills that greatly improve quality of life after a stroke Speech Therapy For communication & swallowing disorders