STROKE BRAIN ATTACK By Cindy Mendez Interesting notes

STROKE/ BRAIN ATTACK By Cindy Mendez

~Interesting notes~ • Brain attack is the most comon nervous system disease • 700, 000 people suffer brain attacks evry year in the U. S • Third leading cause of death in the U. S about 158, 000 annually. • With sufferers with in the ages of 75 and 85 • 85% ischemic and 15% hemorrhagic.

WHAT IS A STROKE/BRAIN ATTACK? • Is an abnormal condition of the blood vessels of the brain, characterized by: • Hemorrhage into the brain • Embolus formed in the brain itself • Thrombus being occcluded in the vessel of the brain.

Risk factors • • • Atherosclerosis Heart disease Hypertension Kidney disease Peripheral vascular disease • Diabetes mellitus • Family history • Obesity • High serum cholesterol levels • Cigarette smoking • Cocaine use • Sedentary lifestyle • Oral contraceptives • Hormone replacement

Clinical Manifestations & Assessment • Deficits in: – body functions – Motor activity – Elimination – Intellectual function – Spatial-perceptual alterations – Personality – Affect – Sensation

Clinical Manifestations & Assessment – Dysphagia – Communication – Headache (sudden and explosive) – Numbness/tingling – Inability to think clearly – Visual problems – Hemiparesis

Clinical Manifestations & Assessment – Hemiplegia – Loc changes – Increased ICP – Changes in respiratory status – Paralysis – Paresis – Hemianopia

Clinical Manifestations • The functions affected, are directly correlated to the artery in the brain that was affected. • Permanent damage is the result from anoxia suffered to the brain. • Unconsciousness and seizures may also be experienced by the patient

Types of strokes • Thrombotic stroke( most common): – primarily caused by atherosclerosis – The carotid arteries are the common source of thrombi – Population in the ages between 60 -90 – Forms d/t the narrowing of blood vessels & with plaque build up, debris begin to accumulate and the thrombus begins to form. – Usually occur in the a. m. d/t rumbency.

Types of strokes • Emboli stroke: – Younger population – 2 nd most common type of stroke – Usually originate from a thrombus in the endocardial layer of the heart. – Occurring primarily in the mid-cerebral artery

Types of strokes • Hemorrhagic: – 3 rd most common type of stroke – In population between the ages of 35 -60 – Intracerebral or intracranial bleeding into the brain or the subarachnoid space – An aneurysm is often the cause of a stroke. With a risk for another rupture with in 7 -10 days – 50% of hemorrhagic stroke victims will die – 20 % of the patients suffering this stroke will be functionally independent after 6 months.

Types of strokes • Transient ischemic attack: – Transient cerebrolvascular insufficiency with episodes of neurological dysfunction • Lasting up to 24 hrs • Usually less than 15 min • But resolved with in 3 hrs – Caused my micro-emboli that temporarily blocks the blood flow – This warns the patient of other underlying conditions

Types of strokes – At least 1/3 of patients suffering a TIA will suffer a stroke within a 2 -5 year period

Diagnostics • • CT scan CT angiography MRI MR angiography

Medical Management • Surgery (if aneurysm was the case) craniotomy, clipping off of the affected artery to prevent a rebleed • Calcium channel blocker (Nimotop) prevevnts vasospasm • Thrombolytics (plasminogen activator) • Platelet inhibitors and anticoagulants • ICP reducing drugs

Medical Management • Suppositories, stool softeners, laxatives, enemas • Restricted fluid intake • Early ambulation w/in 1 -2 days (dr. order only)

Nursing Interventions • • • Neurological assessments at least each shift. Nutrition (tube feedings, thicker liquids, or IV. One handed feeding and one handed dressing. Bladder training, bowel training. Exercises to prevent contractures ( bobath approach) • Communication board

Patient Teaching • Teach about medications ( provide written instructions). • Stroke club support • Teach about different rehab and skilled nursing facilities • Swallowing precautions if applicable

Prognosis • Depends on the severity of the attack and the region of the brain that was affected • With therapy significance functional gains can be made. • With plasminogen activator for thrombolysis prognosis is very good