Adilene Lopez Objectives Understand the difference between ischemic
Adilene Lopez
Objectives ● Understand the difference between ischemic, hemorrhagic stroke and TIAs. ● Know the signs and symptoms of stroke. ● Learn about the treatments.
Statistics A leading cause of death 130, 000 die each year; 1 in every 19 deaths Stroke Belt: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. • No known cause
Cerebrovascular Accident Stroke is defined as an acute onset of focal or global neurological deficit lasting more than 24 hours; it is attributable to diseases of the intracranial or extracranial neurovasculature. Hemorrhagic Stroke occurs when a weakened blood vessel ruptures. Transient Ischemic Attacks (TIAs) is an event with stroke symptoms that last less than 24 hours before disappearing. No permanent damage but warning sign of stroke.
Risk Factors Controllable High Blood Pressure Atrial Fibrillation High Cholesterol Diabetes Atherosclerosis Circulation Problems Tobacco Use and Smoking Alcohol Use Physical Inactivity Obesity Uncontrollable Age Gender Race Family History Previous Stroke or TIA Fibromuscular Dysplasia Patent Foramen Ovale (PFO) http: //www. stroke. org/site/Doc. Server/scorecard_risk. pdf? doc. ID=601
Types of Stroke ● Ischemic Stroke – Embolic Stroke – Thrombotic Stroke ● Hemorrhagic Stroke – Intracranial hemorrhage – Subarachnoid hemorrhage ● Aneurysm
Signs and Symptoms ● Sudden numbness or weakness of face, arm or leg, especially on one side of the body. ● Sudden confusion, trouble speaking or understanding. ● Sudden trouble seeing in one or both eyes. ● Trouble walking, dizziness, loss of balance or coordination ● Sudden severe headache with no known cause.
Left and Right Stroke Left Aphasia Language apraxia Right Anomia Attention Span Denial Neglect Perseveration Visual/spatial problems
Effects ● ● Thinking and memory loss Muscle, joint, and nerve problems Bladder and bowel control Swallowing and eating difficulty ○ dysphagia
Prevent Another Stroke ● ● ● ● Lower Blood Pressure Find out if you have Afib Stop smoking Limit alcohol Lower cholesterol Diabetics need to follow recommendations Exercise Limit sodium and fat
Medical Management ● Ischemic Stroke ○ Thrombolytics “clot-busting” drugs • TPA – administered within 3 hrs Endovascular procedures Aspirin Hemorrhage ○ Endovascular procedures ○ Neurosurgery to relieve pressure ○ Rehabilitation and physical therapy ○ ○ ●
Medical Nutrition Therapy ● Initial Treatment – NPO with intravenous fluids for 24 -48 hrs. Avoid overhydration. – Tube feeding may be needed, especially gastrostomy or jejunostomy. – Comatose; tube feeding required • Raise head of bed 30°-40° to prevent aspiration
Medical Nutrition Therapy Recovery Liquids (thick pureed or mechanical soft diet) Adequate energy intake: 25 -45 kcal/kg and 1. 2 -1. 5 g protein/kg Texture modification: ↓choking and/or aspiration With ↓salivation, moisten foods Saturated and trans fatty acids <10% Replace with monounsaturated Cholesterol <300 mg/d Reduce fat by 20 -25%
Medical Nutrition Therapy Cont'd Recovery Use plant sterols and stanols ↑ omega-3 ↑ potassium = ↓ risk of additional strokes Fluid estimated needs, if tolerated, 30 m. L/kg and ↑ to 35 m. L/kg if dehydration occurs Adequate fiber Caution with supplemental vit C
Herbs, Botanicals, and Supplements ● Grapefruite juice – Avoid w/ alprazolam, buspirone, cisapride, cyclospirine, statins, tracolimus. ● Products containing phenylpropanolamine (PPA) – Some cough medicines ● ● No herbal or botanicals Coenzyme Q 10 – Avoid w/ gemfibrozil, TCAs, or warfarin ● Niacin – Avoid w/ antidiabetic medications (carbamazepine) Vit E – Avoid doses >400 IU/d ●
PES Statement ● Swallowing difficulty related to delayed swallow as evidenced by coughing while eating and drinking. ● Inadequate energy intake related to swallowing difficulty as evidenced by 5 lbs weight loss in a week.
My Life Check http: //mylifecheck. heart. org/Default. aspx? Nav. I D=1&Culture. Code=en-US
References ● ● ● ● Center for Disease Control and Prevention. Stroke statistics and map. http: //www. cdc. gov/stroke/statistics_maps. htm. Updated Decmeber 10, 2013. Accesses February 24, 2014. Mahan LK , Escott Stump S , Raymond JL. Krause's Food and the Nutrition Care Process. 12 th edition. St Louis, MO: Elsevier/Saunders; 2012; Sheth, K. Medline. Plus. Recovering after stroke. http: //www. nlm. nih. gov/medlineplus/ency/article/007419. htm. Updated February 3, 2014. Accessed February 20, 2014. American Stroke Association. Stroke treatments. http: //www. strokeassociation. org/STROKEORG/About. Stroke/Treatment/Stroke. Treatments_UCM_310892_Article. jsp#. Updated May 29, 2013. Accessed February 17, 2014. American Stroke Association. About stroke. http: //www. strokeassociation. org/STROKEORG/About. Stroke/Typesof. Stroke/Types-of. Stroke_UCM_308531_Sub. Home. Page. jsp. Updated October 10, 2012. Accessed February 18, 2014. National Stroke Association. Explaining stroke. http: //www. stroke. org/site/Doc. Server/Explaining. Stroke_web. pdf? doc. ID=3321. Accessed February 25, 2014. Stump, SE. Troke (cerebrovascular accident). Nutrition and Diagnoses Related Care. 2011: 259 -262. Wyatt, N. Study finds people raised in the stroke belt are at increased risk.
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