7. Stroke 1 - Easy summary from simple nursing on head injuries and neurological disorders PDF

Preview

Summary

Easy summary from simple nursing on head injuries and neurological disorders including stroke...

Description

Stroke ‘’CVA’’ Pathophysiology

Types of Strokes

Cerebral Vascular Accident (CVA) happens when the brain lacks oxygen resulting in long-term permanent damage. Typically resulting from a blood clot, narrowed blood vessels (arteriosclerosis) or a ruptured blood vessel (aneurysm).

• TIA - Transient Ischemic Attack - tiny lack of oxygen • Transient: short time frame • Ischemic: Low oxygen • Attack: Happens suddenly ...TIA’s come & go often resolving • CVA - Cerebral vascular accident - no oxygen causing long-term damage! • Ischemic CVA - Clot = Low O2 (called embolic or thrombotic stroke) • Hemorrhagic CVA - Bleed = HIGH ICP (from an aneurysm)

Causes #1 Hypertension (Over 140 sys) MOST TESTED Most important to PREVENT a stroke: • y

HESI Question Highest risk for stroke

KAPLAN Question Hypertension = highest risk factor for CVA

Tricky NCLEX Question For clients recovering from Stroke with HIGH BP:

Smoking: Scars the blood vessels making them weak Hyperlipidemia (HIGH cholesterol) create narrowed blood vessels Uncontrolled Diabetes: THICK sugar in the blood puts loads of pressure on the vessels

Over 200 systolic Intervention: Keep Systolic BP above 170 mmHg for the first 24 - 48 hours

Signs & Symptoms

Hemiparesis - Unilateral weakness One sided weakness New, Sudden “Arm Drift”

F

A

S

Facial & Smile Droop

Arm Drift “1 sided weakness” NCLEX TIP

Speech Impairment

T Time to CALL 911! CT scan Immediately

NCLEX TIP

NCLEX Question

Hemorrhagic Stroke “Ruptured cerebral aneurysm” Severe headache

Most concerning patient statement with diplopia and new weakness, & onset vomiting without nausea: “I have the worst headache of my life”...