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Stroke

Agraphia ------->loss of the ability to speak


aphasia ------->Damage to the part of the brain which control language
Apraxia ------->inability to perform purposeful movement in absence of
motor problems
Ataxia ------->is an impaired ability to coordinate movement
CVA
Nursing Process: Nursing Interventions ------->Turn/reposition, correct
alignment every 1-2 hours/prn. Use splints, pillows to prop/reposition
patient.
Passive and/or active ROM 4-5 times a day
Position hands and fingershand rolls
Maintain prevention of contractures
Encourage patient to exercise affected extremities.
Assist OOB ASAPOOB to chairpivot, begin teaching/
training on positioning, sitting and ambulating and use of
assistive devices.
Diplogia ------->Double vision
Drugs used to treat CVA ------->First generation NSAIDS aspirin
Anticoagulants heparin Lovenox
Antiplatelet dipyridamole aspirin
Thrombolytics Plasminogen, tPA alteplase
Dysarthria ------->difficulty articulating
dysphagia ------->difficulty swallowing
expressive aphasia ------->patient cannot communicate thoughts but
understands what is being communicated
Flaccidity ------->absence of muscle tone
Hemiparesis ------->weakness one side of body
Hemiplegia ------->paralysis one side
Hemorrhagic strokes ------->Bleeding in the Brain tissues, ventricles, or
subarachnoid space
Brain metabolism is disrupted by exposure to

blood
ICP increases from blood in subarachnoid space
Reduced perfusion
Vasoconstriction
Homonymous hemianopsia ------->loss of half the visual field of each
eye
How is CVA diagnose ? ------->Cranial CT Scan
MRI
Doppler flow studies
Ultrasound imaging
Presenting symptoms
FAST
If patient is have a hemorrhage stroke which drug NOT to give ?
------->tPA
Left Hemisphere stroke ------->Right side brain loss
Aphasia loss of ability to speak
Agraphia loss of ability to write
No memory loss
Unable to discriminate words and letters
Problem reading , altered intellectual ability
Deficits in right visual field
Behavior change, slow and caution
Modifiable Risk factor for Stroke CVA ------->Hypertension
Atrial fibrillation
atrial flutter
Diabetes Mellitus
Smoking
Obesity
physical activity
diet
High Cholesterol
carotid stenosis
clotting disorder
alcohol consumption greater than 2 drinks per day
atherosclerosis
contraceptive
street drugs cocaine heroin
Motor Disorders of CVA ------->Flaccidity
Hemiplegia
Hemiparesis

Non Modifiable Risk factor for Stroke CVA ------->Age, Advance in age
TIA transient ischemic attack
Family history
Race, African American
Prior Stroke
heart attack
Nursing Care: for TIA Stroke ------->Monitor and assess frequently
Neurological assessment q4 hours and prn
Vital signs q4 hours and prn
Acetylsalicylic/Aspirin
Prevents platelets from clumping or aggregating.
TIA & CVA prevention.
Side Effects: bleeding, GI upset
Nursing Diagnoses ------->Impaired physical mobility
self care deficit
Impaired urinary elimination
Impaired verbal communication
Ineffective coping
Ineffective family coping
Disturbed body image
Nursing Interventions:
Prevention of further strokes ------->Treat headache
Decadron medication to decrease ICP.
Positioning alignment
Assistive devicespillow props, positioning pillows,
protection of airway
ROMpassive
Calm, quiet environment
Prevention & Health Promotion CVA
Teaching: ------->Prevention of further strokes
Health promotion
Signs and symptoms of complications
Medication teaching
Safety measures
Follow-up care after discharge
Right Hemisphere stroke ge ------->Left side brain loss
May be alert and orient
Disoriented
Cannot recognize faces
Loss of depth perception

Neglect of left side visual field


Visual/spatial deficits
Behavior change
Poor judgment
Impulsive
Constantly smiles
Poor judgment
Loss ability to hear tonal variation
Risk for hemorrhagic stroke ------->High Blood pressure , hypertension
What are the clinical manifestations of Ischemic stroke ? ------->Motor
loss
communication loss
Perceptual disturbance
Sensory loss
Cognitive Impairment
Psychological effects
What do you assess if your patient present with stroke signs and
symptoms ? ------->Check for neurologic deficit
Need to get a good and careful history of early onset, time is important
A complete physical and neurological examination
Assess Airway patency.
Assess for gag or cough reflexex loss
Check for altered respiratory pattern
Check Cardiovascular status
Blood pressure,cardiac rhythm, and rate
What does FAST warning sign of stroke mean? ------->Face, look for one
side of face drooping
Arms, Does one of the arms drift downwards
Speech, Is the speech slurred or strange sounding
Time, If you see any of the Call immediately
What is a Ischemic strokes ------->Forms a thrombus (blood clot) due to
an obstruction in the blood vessel.
Accounts for 87% of strokes
What is a Stroke CVA Cerebraal Vascular Accident , Brain Attack ?
------->Sudden loss of brain function resulting from adistruption in blood
supply to a part of the brain, classified as thrombotic or hemorrhagic
What is an aura ? ------->premonition of an impending seizure

What is Dysarthria ? ------->difficulty in speaking caused by paralysis of


the muscle responsible for the producing speech
What is F.A.S. T. ? ------->warning sign of a stroke
What is receptive aphasia ? ------->the inability to understand what
someone else is saying , often associated with damage to the temporal
lobe area
What is TIA ? ------->Transient Ischemic attack, a temporary neurologic
deficit which last typically last less than 1 hour.