General Objectives The purpose of this study is to enhance and gain knowledge, to develop communication and nursing skills,

, to provide privacy and maintain confidentiality of the patient and to apply the right attitudes of the student nurses in rendering and giving care to the patient with Cerebrovascular Accident, its importance and implication. Specific Objectives: To know and understand the condition of Cerebrovascular Accident and associate it with the patient through the introduction of the case. To be able to illustrate the Anatomy and Physiology of the affected organs and parts of the body. To discuss the pathophysiology of the disease. To be clinically aware of the clinical manifestation and its complication. To develop an effective skill on how to plan on how to plan and manage the proper care in patient with Cerebrovascular Accident. To formulate a drug study with regards to patients condition. To correlate laboratory result to its normal value. To provide the client nursing care plan to assure for clients total wellness during his hospitalization up to the time of discharge. To apply the right attitude by respect through providing privacy and maintaining clients confidentiality. I Introduction A. Background of the Study a. Incidence, race, gender, age, ratio and proportion Stroke could soon be the most common cause of death worldwide.Stroke is currently the second leading cause of death in the Western world, ranking after heart disease and before cancer, and causes 10% of deaths worldwide.Geographic disparities in stroke incidence have been observed, including the existence of a "stroke belt" in the southeastern United States, but causes of these disparities have not been explained. The incidence of stroke increases exponentially from 30 years of age, and etiology varies by age.Advanced age is one of the most significant stroke risk factors. 95% of strokes occur in people age 45 and older, and two-thirds of strokes occur in those over the age of 65.A person's

risk of dying if he or she does have a stroke also increases with age. However, stroke can occur at any age, including in childhood. Family members may have a genetic tendency for stroke or share a lifestyle that contributes to stroke. Higher levels of Von Willebrand factor are more common amongst people who have had ischemic stroke for the first time.The results of this study found that the only significant genetic factor was the person's blood type. Having had a stroke in the past greatly increases one's risk of future strokes. Men are 25% more likely to suffer strokes than women, yet 60% of deaths from stroke occur in women.Since women live longer, they are older on average when they have their strokes and thus more often killed (NIMH 2002). Some risk factors for stroke apply only to women. Primary among these are pregnancy, childbirth, menopause and the treatment thereof (HRT). b. Rationale for choosing the case The group decided to choose Cerebrovascular Accident to a specific patient because it is an interesting case for us. The group also took into consideration the age of the patient; she is 19 years old. She is the reliable source of information to be used in correlating the case to the care of the patient c. Significance of the study The significance of the study is to enhance /gain knowledge to develop skills and apply the right attitude of student nurses in rendering and giving care to the patient with Cerebrovascular Accident, its importance and implication. The study will serve as guidelines in assessing and providing proper nursing care to patient with the same disease. These are other significance of the study that would support the statement above 1. Understand the condition of Cerebrovascular Accident and associate it with the patient through the introduction of the case. 2. To know the nursing history; the personal data, health history and physical; assessment of the patient. 3. Illustrate the anatomy and physiology and pathophysiology of the affected organ or part of the body. 4. Develop an effective skill on how to manage a proper care in patients with Cerebrovascular Accident. 5. Formulate a drug study with regards to the patients condition. 6. Correlate the laboratory result to its normal value. 7. To provide the client nursing care plan to assure for clients total wellness during his hospitalization.

d. Scope and limitation of the study The study would focus on Cerebrovascular Accident which is indicative to the clients health condition within the 2 week duty at Dona Martha District Hospital. e. Conceptual and nursing theory In correlation with our patients condition we chose Self Care Deficit Theory by Dorothea Orem. In her theory, self care is a human regulating function that individuals must and deliberately perform themselves. Self care deficit is a term that expresses the relationship between individuals and their demand for care. In the patients case, Cerebrovascular Accident may have self care deficit as a result of impaired mobility or mental confusion. It is important for the client to perform as much of their own physical care and grooming as possible to promote functional ability, increase independence, decrease the feeling of powerlessness and improve self esteem. f. Related Literature A stroke, previously known medically as a cerebrovascular accident (CVA), is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood).As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field. Risk factors Hypertension (# 1 leading risk factor) Heart Disease Diabetes Mellitus Sleep Apnea Blood cholesterol levels Smoking Sickle cell disease Substance abuse Types of Cerebrovascular Accident Ischemic strokes, which account for about 80 percent of all strokes, are caused by an obstruction in an artery, generally one of the carotid arteries, the major arteries in the neck that carry oxygen-rich blood

from the heart to the brain. The path to an ischemic stroke begins when atherosclerosis, in which fatty deposits build up on the inner wall of an artery, develops in one of the carotid arteries (see Arteriosclerosis). As the fatty deposit grows, it narrows the space through which blood can flow. Atherosclerosis does not actually cause ischemic strokes, but it sets up the conditions that make them likely to occur. The actual obstruction that cuts off blood flow in an ischemic stroke is a blood clot. Often the obstruction develops by a process known as thrombosis, the formation of a clot inside a blood vessel. A clot is likely to form at the site of an atherosclerotic deposit because the deposit causes blood to flow in a turbulent, disorderly fashion. This turbulence can cause blood to clot just as it does in response to a wound. When the blood clot, or thrombus, develops at the site of an atherosclerotic deposit and cuts off blood flow to part of the brain, a stroke results. An ischemic stroke can also be caused by a traveling clot, or embolus (see Embolism). In this case, the clot develops at some other location in the circulation, usually in one of the hearts chambers. The clot then travels through the bloodstream until it encounters a vessel too small to let it pass throughoften a vessel narrowed by atherosclerosis. A transient ischemic attack (TIA) sometimes precedes an ischemic stroke. In a TIA, also known as a ministroke, strokelike symptoms develop but disappear within five minutes to 24 hours. TIAs can occur when a clot develops at the site of an atherosclerotic deposit but dissolves right away, or an embolism lodges in a narrowed vessel but is soon dislodged on its own. A TIA can also be caused by atherosclerosis alone when the narrowing of blood vessels by atherosclerosis restricts blood flow to part of the brain enough to cause strokelike symptoms. Regardless of the cause, the oxygen deprivation is not severe enough to kill brain cells, and the cells are able to bounce back from their injury. About 10 percent of ischemic strokes are preceded by TIAs. Thrombosis (obstruction of a blood vessel by a blood clot forming locally) Embolism (obstruction due to an embolus from elsewhere in the body, see below), Systemic hypoperfusion (general decrease in blood supply, e.g. in shock) Venous thrombosis.

Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin); this constitutes 30-40% of all ischemic strokes.[2][10] There are various classification systems for acute ischemic stroke. The Oxford Community Stroke Project classification (OCSP, also known as the Bamford or Oxford classification) relies primarily on the initial symptoms; based on the extent of the symptoms, the stroke episode is classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) or posterior circulation infarct (POCI). These four entities predict the extent of the stroke, the area of the brain affected, the underlying cause, and the prognosis.[11][12] The TOAST (Trial of Org 10172 in Acute Stroke

Treatment) classification is based on clinical symptoms as well as results of further investigations; on this basis, a stroke is classified as being due to (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) embolism of cardiac origin, (3) occlusion of a small blood vessel, (4) other determined cause, (5) undetermined cause (two possible causes, no cause identified, or incomplete investigation). b. Hemorrhagic Hemorrhagic strokes account for the remaining 20 percent of all strokes. They occur when weakened blood vessels within the brain rupture and bleed into the surrounding tissue. The escaped blood can compress or pinch nearby blood vessels, cutting off blood flow and depriving the surrounding tissue of oxygen. Though hemorrhagic strokes occur less frequently than ischemic strokes, they tend to affect larger areas of the brain. Symptoms of a hemorrhagic stroke may be more sudden and more severe, and these strokes carry a greater risk of death than ischemic strokes. Hemorrhagic strokes can result from an aneurysm, which develops when the wall of a blood vessel weakens and thins, ballooning outward. If left untreated, the aneurysm continues to expand and weaken, increasing the likelihood of rupture. Hemorrhagic strokes can also result from an arteriovenous malformation (AVM), a cluster of enlarged, structurally weak blood vessels that forms during fetal development or possibly at birth. These malformed blood vessels are susceptible to rupture from the normal forces exerted by the flowing blood. Signs and Symptoms Early Signs Neurologic Deficit Altered level of consciousness Headache Fever Nuchal rigidity Late Signs/Complications Agnosia Apraxia Hemianopia Aphasia

Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms depend on the area of the brain affected. The more extensive the area of brain affected, the more functions that are likely to be lost. Some forms of stroke can cause additional symptoms. For example, in intracranial hemorrhage, the affected area may compress other structures. Most forms of stroke are not associated with headache, apart from subarachnoid hemorrhage and cerebral venous thrombosis and occasionally intracerebral hemorrhage.

A key feature of stroke symptoms is that they are unexpected and develop suddenly, though they may worsen over the next several hours or days. The symptoms often primarily affect only one side of the body because blood flow is cut off to only part of the brain during a stroke. One of the most common symptoms is a sudden weakness or numbness of one side of the face or of one arm or leg. Some stroke sufferers experience a sudden dimness or loss of vision, particularly in only one eye. They may also suddenly become unable to speak or have trouble understanding speech. Sudden, severe headaches with no known cause and sudden, unexplained dizziness, unsteadiness, or falls, can also be warning signs of a stroke. Anyone who experiences one or more of these symptoms should seek medical attention immediately. Diagnosis Stroke is diagnosed through several techniques: a neurological examination (such as the Nihss), CT scans (most often without contrast enhancements) or MRI scans, Doppler ultrasound, and arteriography. The diagnosis of stroke itself is clinical, with assistance from the imaging techniques. Imaging techniques also assist in determining the subtypes and cause of stroke. Two other imaging techniques, single photon emission computed tomography (SPECT) and positron emission tomography (PET), involve injecting a radioactive substance into the bloodstream. As the substance travels through the circulatory system, it constantly emits radiation, which is collected by a radiation detector. The images produced enable doctors to see regions of the brain with abnormally low blood flow, indicating brain tissue that has been injured or damaged by a stroke.

Other diagnostic tests include: a. CSF analysis b. Cerebral Angiogram c. EEG

Treatment An ischemic stroke is caused by a thrombus (blood clot) occluding blood flow to an artery supplying the brain. Definitive therapy is aimed at removing the blockage by breaking the clot down (thrombolysis), or by removing it mechanically (thrombectomy). The more rapidly blood flow is restored to the brain, the fewer brain cells die.

Other medical therapies are aimed at minimizing clot enlargement or preventing new clots from forming. To this end, treatment with medications such as aspirin, clopidogrel and dipyridamole may be given to prevent platelets from aggregating Angioplasty and stenting have begun to be looked at as possible viable options in treatment of acute ischemic stroke.

For most stroke patients, physical therapy (PT) and occupational therapy (OT), speech-language pathology (SLP) are the cornerstones of the rehabilitation process. Often, assistive technology such as a wheelchair, walkers, canes, and orthosis may be beneficial. PT and OT have overlapping areas of working but their main attention fields are; PT involves re-learning functions as transferring, walking and other gross motor functions. OT focusses on exercises and training to help relearn everyday activities known as the Activities of daily living (ADLs) such as eating, drinking, dressing, bathing, cooking, reading and writing, and toileting. Speech and language therapy is appropriate for patients with the speech production disorders: dysarthria and apraxia of speech, aphasia, cognitive-communication impairments and/or dysphagia (problems with swallowing). Prevention Oral anticoagulants such as warfarin have been the mainstay of stroke prevention for over 50 years. Fortunately, a healthy lifestyle can help minimize some risk factors for stroke, such as high blood pressure, smoking, and high blood cholesterol. High blood pressure places abnormally high stress on the walls of blood vessels which, over time, weakens and damages the vessels. Certain chemicals found in cigarette smoke can affect the properties of the blood, making it more prone to forming clots. In addition, the nicotine in cigarette smoke damages blood vessel walls and makes them more susceptible to atherosclerosis. And when excess cholesterol is present in the bloodstream, it accumulates along the walls of blood vessels, accelerating the progression of atherosclerosis and thereby increasing the risk of a stroke. Quitting smoking, controlling high blood pressure through diet or medication, eating a low-fat, healthy diet, and becoming physically active can greatly decrease a persons risk of having a stroke

 To prevent rupture of the weakened blood vessels that cause hemorrhagic stroke, physicians try to provide an obstruction to protect a weakened vessel from further damage and redirect blood flow through normal vessels feeding the same regions of the brain. An aneurysm can be treated surgically by placing a metal clip at its base to seal off the weakened vessel. An AVM, on the other hand, is cut away from the normal brain tissue and removed. An alternative to surgery, which attempts to treat the diseased blood vessel from the outside, is endovascular therapy, which addresses the problem from within the vessel. In a typical endovascular procedure, a cathetera long, thin, flexible tubeis inserted into a major artery, usually in the thigh, and guided through the blood vessels to the location of the aneurysm or AVM. Tiny platinum coils are then deposited from the end of the catheter into the diseased vessel, providing a physical barrier to prevent the forces exerted by blood flow from further damaging the weakened vessel. These treatments can be beneficial even when performed after a hemorrhagic stroke because they can prevent an aneurysm or AVM from rupturing a second time and causing another stroke