CEREBROVASCULAR

ACCIDENT
(CVA)
 DEFINITION
 CVA also called brain attack ,cerebral infarction
,cerebral hemorrhage ,ischemic stroke or stroke

A stroke is caused by the interruption of the blood

supply to the brain ,usually because a blood vessel
burst or is blocked by a clot. This cuts off the supply of
oxygen and nutrients, causing damage to the brain
tissue.
 TYPE OF CVA
 TIA (Transient Ischemic Attack)
- Know as mini stroke
- Temporary blockage of artery
 TYPE OF CVA
 ISCHEMIC
- Blockage of artery
- 2 type: embolic and thrombotic
 TYPE OF CVA
 HEMORRHAGIC
- Rupture of blood vessel
- 2 type: intracerebral and subarachnoid
 ETIOLOGY

 Atherosclerosis
 Cerebral thrombus
 Cerebral embolus
 Embolism from the heart
 Intracranial hemorrhage
 ETIOLOGY
 Subarachnoid hemorrhage
 Intracranial small vessel disease
 Arterial aneurysms
 Arteriovenous malformation
 Haematologic disorders(hemoglobinopathies,
leukemia)
 PATHOPHYSIOLOGY
 Stroke
is a rapid development of focal neurologic deficit
caused by a disruption of blood supply to the
corresponding area of the brain

 Tobe classified as a stroke the neurological deficit need

to persist for at least 24 hours
 PATHOPHYSIOLOGY
A stoke is termed a transient ischemic attack (TIA) if less
than 24 hours, TIA risk factor.

A variety of focal deficits are possible

- Changes in consciousness
- Sensory motor, language, cognitive, and perceptual
impairments
- Motor deficit are characterized by paralysis
(hemiplegia) or weakness (hemiparesis)
 PATHOPHYSIOLOGY
 Ischemic

- Occlusion of the blood vessel from thrombus, embolism,

or condition that produce low systemic perfusion
pressure
- Cerebral thrombosis is a formation or developing clot
within the cerebral arteries
- Thrombosis can lead to ischemic or occlusion of an
artery which could result in a cerebral infarctions or tissue
death(atherothrombotic brain infarction)ABI
PATHOPHYSIOLOGY
 Subtype include

- Large artery ,atherosclerosis, cardiogenic embolism,

small vessel occlusive disease
 PATHOPHYSIOLOGY
 Hemorrhagic

- Rupture of a blood vessel with abnormal bleeding into

extravascular area of brain

- Usually the result of rupture of the cerebral vessel or

trauma
 PATHOPHYSIOLOGY
 Hemorrhagic

- Primary cerebral hemorrhage(non-traumatic

spontaneous hemorrhage) usually occur in small blood
vessel weakened by atherosclerosis which produce an
aneurysm
- Subarachnoid hemorrhage occurring from the bleeding
into the subarachnoid space typically from saccular or
berry aneurysm affecting large blood vessel
 DIRECT CAUSE
 CEREBRAL THROMBOSIS
A blood clot or plaque blocks an artery that supplies a vital brain center
 DIRECT CAUSE
 CEREBRAL HEMORRHAGE/ANEURYSM
An artery in the brain burst, weakens the aneurysm
Wall severe in rise BP causing hemorrhage and ischemia
 DIRECT CAUSE
 CEREBRAL EMBOLISM
A blood clot breaks off from a thrombus elsewhere in the
body lodge in a blood vessel in the brain and shut off
blood supply to the part of the brain
 SIGN AND SYMPTOMS
 EMBOLISM

- Usually occurs without warning

- History of cardiovascular disease
 SIGN AND SYMPTOMS
 THROMBOSIS

- Dizzy spells or sudden memory loss

- No pain
 SIGN AND SYMPTOMS
 CEREBRAL HEMORRHAGE

- May have warning like dizziness and ringing in the

ear (tinnitus)
- Headache with nausea and vomiting
 SIGN AND SYMPTOMS

 SUDDEN ONSET CVA

- Loss of consciousness
- Face become red
- Breathing is noisy and stained
- Pulse is slow but full and bounding
- Elevated BP
- May be in a deep coma
 SIGN AND SYMPTOMS
 COMMON SYMPTOMS

- Weakness or paralysis
- Numbness, tingling, decreased sensation
- Vision changes
- Speech problem
- Swallowing difficulties or drooling
- Loss of memory
 SIGN AND SYMPTOMS

 COMMON SYMPTOMS

- Vertigo
- Loss of balance and coordination
- Personality changes
- Mood changes (depression, apathy)
- Drowsiness, lethargy or loss of consciousness
- Uncontrollable eye movements or eyelid drooping
 RISK FACTORS
- Being over age 55
- Being an African-American
- Diabetes
- Family history
- Previous stroke
- High cholesterol
 RISK FACTORS
- High blood pressure
- Heart disease
- Smoking
- Overweight
- Drinking too much alcohol
 Investigation
 Blood test
- High cholesterol, sugar level, blood clotting time
 CT scan
- Detect bleeding in brain
 MRI scan
- Detect damage brain tissue
 Echocardiogram
- Find out abnormality of the heart
 Doppler ultrasound
- Measure blood flow blood vessel of hemorrhagic area
 Investigation
 MR angiography
- Visualize narrowing blood vessel
 EEG(electroencephalogram)
- Measure your brain waves
 PET(positron emission tomography)
- Glucose metabolic image
 SPECT (single-photon emission computed tomography)
- Depict the area of ischemia with greater accuracy
 TREATMENT
 Anticoagulants
- Sodium heparin
- Warfarin

 Antiplatelets
- Ticlid
- Clopidogrel
- Aspirin
- Persantine
 TREATMENT
 Antiepileptic

- Phenytoin
- Neurontin
 TREATMENT
 SURGERY
- Carotid endarterectomy
 COMPLICATION

 Sensoriperceptual deficit

- Hemianopia (loss half of the visual of one or both eyes)

- Agnosia (inability to recognize one or more subjects)

- Apraxia (inability to carry out some motor pattern eg:

drawing a figure)
 COMPLICATION
 Cognitive and behavioral changes

- Change in consciousness

- Emotional lability (may laugh or cry inappropriately)

- Loss of self control

 COMPLICATION
 Communication disorder
- Aphasia (inability to use or understand language)

 Motor deficits
- Hemiplegia (paralysis left or right half of the body)
- Hemiparesis (weakness left or right half of the body)
 COMPLICATION
 Elimination disorders

- May cause partial loss of the sensation that trigger

bladder elimination, urinary frequency, urgency, or
incontinence
 NURSING CARE
NURSING DIAGNOSIS Expected outcome Nursing intervention

1.Encourage active ROM

maintain or improve
Maintain and muscle strength, help
Impaired physical
improve cardiopulmonary function
mobility
functional abilities

2.Turn every 2 hours

alleviates pressure on bony
prominence that can lead
to skin breakdown.
NURSING CARE
NURSING DIAGNOSIS Expected outcome Nursing intervention

3.Monitor the lower extremities

Impaired Maintain and each shift for manifestations of
thrombophlebitis, provide care
physical improve compression stocking.
mobility functional
abilities 4.Collabrate with the physical
therapist as the patients gains
mobility using consistent
techniques.
 NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

Risk for Focuses on 1.Monitor respiratory

ineffective identifying status, oxygen saturation
changes that may
tissue perfusion and airway patency
indicate altered
cerebral perfusion 2. Suction as necessary
3. Monitor mental status
and LOC using GCS
chart.
NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

4. Assess for pain

Risk for Focuses on
ineffective identifying 5. Continously monitor
cardiac status
tissue changes that
perfusion may indicate 6. Monitor body
altered temperature
cerebral
perfusion 7. Maintain accurate intake
and output record
 NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

1.Encourage use of the

Self care For patient to unaffected arm to bathe, brush
deficit perform as much teeth, comb hair, eat to
of their own promote functional ability and
physical care and independence
grooming to
promote
functional ability 2.Teach patient to put on
clothing by first dressing the
affected extremities and then
dressing the unaffected
extremities for self dressing with
minimal assistance
NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

Self care For patient to 3.Collaborate with

perform as much therapist for training for
deficit of their own
activities of ADL
physical care and
grooming to
promote
functional ability
 NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

1.Do not assume that the patient who does

not respond verbally cannot hear and do
not raised voice when addressing patient.
Impaired verbal Intensive 2.Allow adequate time for patient to
respond
comunication speech therapy
3.Face the patient and speak slowly
and emotional
4.Use short, simple statement and question
support
 NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

5.Speech therapist with speech

rehabilitation
Impaired verbal Intensive
communication speech therapy
and emotional 6.Accept frustration and anger
as normal reaction to the loss of
support function

7.Try alternate methods of

communication including
writing, flash card
,computerized talking board
 NURSING CARE
Nursing diagnosis Expected outcome Nursing intervention

1.Be a good and active

listener for patient
POST STROKE EMOTIONAL 2.Support communication
DEPRESSION SUPPORT between the patient and
family
3.Stroke support group within
rehab facilities and
community are helpful
4.Seek professional help (
metal health professional)
 HEALTH EDUCATION

 Lifestylechanges that can reduce the risk of stroke and

improve overall health
 Eat healthy diet
 Get exercise that doctor can suggest a safe level of
exercise for you and stay at a healthy weight
 Control your cholesterol and blood pressure, diabetes
 Limit alcohol
 Take a daily aspirin or other medicines if your doctor
advises it.