MWAMI SCHOOLS OF NURSING AND MIDWIFERY
COURSE: MEDICINE & MEDICAL NURSING
TOPIC: CEREBRAL VASCULAR ACCIDENT(CVA)/STROKE
BY: BALDWIN HAMOONGA
5TH YEAR NURSING STUDENT (RU)
SUPERVISOR: MR.J NYERENDA
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GENERAL OBJECTIVE
By the end of this lesson, 2nd year RNs should be able to demonstrate
an understanding about cerebral vascular accident(CVA) stroke and be
able to manage a patient with it.
SPECIFIC OBJECTIVES
By the end of this lesson, 2nd years RNs should be able to;
Define cerebral vascular accident(CVA)/ stroke.
Discuss the incidence of CVA
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SPECIFIC OBJECTIVES CONT’
Outline the predisposing of CVA
State the causes of CVA
Discuss the types of CVA
Explain the signs and symptoms of CVA
Mention the investigations in making the diagnosis of CVA
Discuss the management of CVA
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INTRODUCTION
Cerebral vascular accident (CVA) or stroke, it is any functional
abnormality of the central nervous system that occurs when the normal
blood supply to the brain is disrupted. stroke is one of the highest cause
of death around the world, nearly 2M People globally suffer from
stroke.
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DEFINATION OF CVA/STROKE
• Stroke/Cerebral Vascular Accident(CVA) is a clinical syndrome that
occurs when blood supply to parts of the brain is disrupted causing
brain cells to die (Rosemary S, 2002)
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INCIDENCE
• AGE: higher in people above 65 years old, those who survive, 50% to
70% will function independently and 15% to 30% will live with
permanent disability.
• SEX: more common in men than women.
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PREDISPOSING FACTORS
NON-MODIFIABLE
AGE
Above 65 years.
GENDER
More in men than women
RACE
African American
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PREDISPOSING FACTORS CONT’
FAMILY HISTORY
Hereditary
MODIFIABLE
Hypertension
Can cause rapture of brain blood vessels leading to hemorrhagic stroke
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PREDISPOSING FACTORS CONT’
Heart diseases
heart diseases such as coronary heart disease or heart attack can cause
stroke by depositing of blood clot which can block the brain blood
vessels.
Smoking &Excessive alcohol consumption
can cause atrial fibrillation (irregular heart beat) which can cause clots
which can block the brain blood vessels.
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PREDISPOSING FACTORS CONT’
Obesity
Excessive fats can lead to poor blood circulation.
Sleep apnea
Reduced oxygen supply to the brain hence hypertension which can
cause brain blood vessels rapture
Oral contraceptives
By raising blood pressure and making blood hypercoagulable.
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CAUSES OF STROKE/CVA
Ischemia
Due to Loss of blood supply to the brain
Hemorrhage
Bleeding in the brain could be due to head injury or blood vessel
rapture.
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TYPES OF STROKE
Strokes are classified as ischemic or hemorrhagic based on the cause
findings.
1.ISCHEMIC STROKE
An ischemic stroke results from inadequate blood flow to the brain
from partial or complete occlusion of an artery. These accounts for
approximately 80% of all strokes. Ischemic stroke is further divided
into thrombotic and embolic.
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TYPES OF STROKE CONT’
A. Thrombotic stroke
It occurs from injury to a blood vessel walls and formation of a blood
clot. The lumen of the blood vessels becomes narrowed and if it
becomes occluded, infarction occurs. The occlusion readily occurs on
the narrowed arteries. Two third of thrombotic stroke are associated
with hypertension or diabetic mellitus.
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TYPES OF STROKE CONT’
B. Embolic stroke
This type of stroke occurs when a blood clot or a piece of
atherosclerotic plaque (cholesterol and calcium deposits on the wall of
the inside of the heart or artery) breaks loose, travels through the
bloodstream and lodges in the arteries in the brain.
(Rosemary S, 2002)
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TYPES OF STROKE CONT’
2. HEMORRHAGIC STROKE
• is when blood from an artery begins bleeding into the brain. This
happens when a weakened blood vessel bursts and bleeds into the
surrounding brain, Pressure from the leaked blood damages brains
cells, and, as a result, the damaged area is unable to function
properly. High blood pressure and trauma are two leading causes.
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TYPES OF STROKE
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SIGNS & SYMPTOMS
• VISUAL FIELD DEFICITS
• Homonymous hemianopia (loss of half of the visual field)
• Unaware of person or objects on the side of visual loss
• Neglect of one side of the body
• Difficulty judging distance
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SIGNS & SYMPTOMS CONT’
Loss of peripheral vision
Difficulties seeing at night
Unaware of objects or the borders of objects
Diplopia (Double vision)
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SIGNS & SYMPTOMS CONT’
MOTOR DEFICITS
Hemiparesis
Weakness of the face, arm, and leg non the same side (due to a lesion
in the opposite hemisphere)
Hemiplegia
Paralysis of the leg non the same side (due to a lesion in the opposite)
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SIGNS & SYMPTOMS CONT’
Ataxia
Defective muscular co-ordination, unsteady gait unable to keep feet
together; needs to broad base to stand.
Dysarthria
Difficulties in forming words
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SIGNS & SYMPTOMS CONT’
Dysphagia
Difficulties in swallowing.
SENSORY DEFICIT
Paresthesia
Numbness and tingling of extremities.
Occurs on the side opposite the lesion.
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SIGNS & SYMPTOMS CONT’
VERBAL DEFICIT
Expressive aphasia
Unable to form words that are understandable; may be able to speak in
single-word responses.
Receptive aphasia
Unable to comprehend the spoken word; can speak but may not make
sense.
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SIGNS & SYMPTOMS CONT’
Global (mixed) aphasia
Combination of both receptive and expressive aphasia
COGNITIVE DEFICIT
Short and long term memory loss
Decreased attention span
Impaired ability to concentrate
Poor abstract reasoning
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SIGNS & SYMPTOMS CONT’
Altered judgement
EMOTIONAL DEFICIT
Loss of self-control
Emotional lnstability
Deceased tolerance to stressful situation
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SIGNS & SYMPTOMS CONT’
Depression
• Withdrawals
• Fear, hostility and anger
• Feelings of isolation
(Rosemary S, 2002)
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MANAGEMENT
GOALS
Minimize volume of brain reversibly damaged
Prevent complications
Rehabilitation
Reduce risk of occurrence.
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MANAGEMENT CONT’
INVESTIGATIONS
CT SCAN
Create images of the brain, detection of bleeding.
COMPUTED TOMOGRAPHY (CT)
Brain scan- creates high images; tumors, sinus blockage, bleeding.
LUMBAR PUNCTURE
Blood found in CSF indicate cerebral bleeding.
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MANAGEMENT CONT’
CEREBRAL ANGIOGRAM
images of blood vessels.
PHARMACOTHERAPY
Heparin
Action
anticoagulant prevents clotting.
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MANAGEMENT CONT’
Dose
5000 units SC q8-12 hourly(prophylaxis)
80 units/kg IV bolus, THEN continue infusion of 18 units/kg/hour.
Side effects
Thrombocytopenia , Bleeding (gums, nose, mouth etc)
Caution
Only given in ischemic type of stroke patients
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MANAGEMENT CONT’
Aspirin
Action
Blood thinner prevents clotting.
Dose
500mg-1g tds.
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MANAGEMENT CONT’
Side effects
Easily bleeding
Tinnitus
Nausea
Caution
Only given in ischemic type of stroke patients
(Bradberry, 2002).
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MANAGEMENT CONT’
SURGICAL MANAGEMENT
ISCHEMIC STROKE
Endovascular intervention
Angioplasty and stenting- a mechanism of clot disruption/clot
extraction.
Intracranial hemorrhage
Surgical evacuation of hematoma (craniotomy)
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MANAGEMENT CONT’
Intraventricular hemorrhage /hydrocephalus
External Ventricular drainage
NURSING MANAGEMENT
Airway
Keep the mouth clean free of foreign bodies & dentures.
Prevent tongue fall, can use tongue depressor
Elective tracheostomy should be performed after 2 weeks for
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MANAGEMENT CONT’
prolonged coma or pulmonary complications.
Observations
Check vital signs quarter hourly (BP, respirations, pulse)
Use of a Glasgow coma scale (used to assess the level of conscious)
It has three parameters; eye opening(E), verbal response(V), motor
response(M)
Check for oxygen saturation using a pulse oximeter 4/1 hourly.
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MANAGEMENT CONT’
Monitor blood glucose levels using a glucometer to prevent
hypoglycemia and hyperglycemia.
Prevent Muscle atrophy
Do passive muscle exercises
Call a physiotherapist for daily patient exercises.
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MANAGEMENT CONT’
Electrolyte balance
Fluids such as normal saline should be administered IV in case of
hypovolemia.
Typically, 3 liters per day is given
Oxygen therapy
Administer oxygen as necessary if the patient is hypoxic, use nasal
tubing or mask, sometimes the patient might have to be intubated if
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MANAGEMENT CONT’
-unable to breath on his/her own.
Nutrition
The patient might lose conscious or be paralyzed, feed the patient if
possible orally, if unconscious dextrose IV can be given or NGT
feeding has to be done.
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MANAGEMENT CONT’
Elimination
The patient might not be able to visit the toilet due to loss of
consciousness or paralyzed, nurses should offer bedpan if conscious.
Catheterization has to be done and wearing the patient dippers in their
unconscious state. The elimination process has to be checked hourly
and be documented in order to rule out constipation.
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MANAGEMENT CONT’
Psychological care
If the patient is able to get the voice, talk to the patient about the
condition and other things to avoid depression.
Talk to the family members that we are doing everything possible to
the best interest of the patient.
Encourage family support be shown to the patient.
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MANAGEMENT CONT’
Medication
Give prescribed drugs as ordered and make sure to look out for any
improvement for drug efficacy, monitor for drug side effects for
possible drug change if undesired results are seen.
Blood pressure management
Blood pressure should be kept in the normal ranges (systolic 120-139,
diastolic (80-89 mmhg) as hypertension or hypotension can worsen -
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MANAGEMENT CONT’
-the condition, fluids and blood pressure drugs should be used for
regulations.
Prevention of bed sores
Do decubitus sore care
Hourly turning of the patient
Bed making routinely
Change the soiled beddings frequently
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MANAGEMENT CONT’
IEC
Educate patient and family to notify the staffs immediately of
neurological changes.
Instruct patient to ask for help when changing position, make sure
position doesn’t hinder blood flow
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COMPLICATIONS
• Cerebral oedema
• Aspiration pneumonia
• Hypertension
• Hypoglycemia
• Pressure sores
• Constipation
• Deep vein thrombosis
• Epileptic seizure
(Behrouz, 2019)
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SUMMARY
• Stroke/CVA is a clinical syndrome that occurs when blood supply to
parts of the brain is disrupted causing brain cells to die. There are two
main causes of stroke we discussed today namely; hemorrhagic and
ischemic, we have looked at the signs and symptoms, the
investigations carried out to diagnose stroke, the management which is
in three forms; surgical, pharmacotherapy and nursing management.
We further discussed the complications of stroke.
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EVALUATION
• What is cerebral vascular accident(CVA)/ stroke.
• How is the incidence of Cerebral Vascular Accident?
• What are the predisposing of Cerebral Vascular Accident?
• What are the causes of Cerebral Vascular Accident?
• What are the types of Cerebral Vascular Accident?
• What are the signs and symptoms of Cerebral Vascular Accident?
• What are the investigations in making the diagnosis of Cerebral
Vascular Accident?
• what is the management of Cerebral Vascular Accident?
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ASSIGNMENT
Write briefly in your note books explaining how the listed complications
can come about.
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REFERENCES
Behrouz, Reza et all (2019). complications of acute stoke. Spring
Publishers, New York, America
Bradberry JC, Fragan SC, (2002) stroke: pharmacotherapy, fifth edition.
McGraw-Hill publication division, New York, America.
http://www.utoledo.edu /policies/utmc/nursingstandards/S19.pdf
Retrieved on 27/02/2020.
Rosemary S, (2002) understanding stroke. McGraw-Hill, America
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