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EXAM 3 - REVIEW
Module 9 - Cerebrovascular Disorders
• Functional abnormality of the CNS that occurs when the blood supply to the brain is
disrupted
• Stroke is the primary cerebrovascular disorder and the fifth leading cause of death in the
United States
• Stroke is the leading cause of serious long-term disability in the United States
• Financial impact is profound
Agnosia - Failure to recognize familiar objects perceived by the senses
Aphasia - is an inability to express oneself or to understand language.
Apraxia - is an inability to perform previously learned purposeful motor acts on a voluntarily
Ataxia - is an impaired ability to coordinate movement, often seen as a staggering gait or
postural imbalance
Prevention
• Nonmodifiable risk factors
◦ Age (older than 55 years), male, gender, African Americans
• Modifiable risk factors
◦ Hypertension is the primary risk factor
◦ Cardiovascular disease: esp. Afib and/or carotid stenosis
◦ Elevated cholesterol or elevated hematocrit
◦ Obesity
◦ Diabetes
◦ Oral contraceptive use
◦ Smoking and drug and alcohol abuse
◦ Sedentary lifestyle
◦ Sleep apnea
Question
Is the following statement true or false?
Ischemic stroke account for 80% to 85% of strokes, and hemorrhagic stroke accounts for 15% to
20%
Answer
True - ischemic stroke account for 80% to 85% of strokes, while hemorrhagic stroke accounts for
15% to 20%
◦
Stroke - “Brain attack”
Sudden loss of function resulting from a disruption of the blood supply to a part of the brain
,2
Type of stroke Causes Main Presenting Functional Recovery
Symptoms
Ischemic (~ • Large or small • Numbness or Usually plateaus at 6
87%) artery thrombosis weakness of months
• Cardiogenic the face, arm,
embolic leg, especially
• Cryptogenic (no on one side of
known cause) the body
• Other
Hemorrhagic • Intracerebral • “Exploding Slower, usually plateaus at
(~ 13%) hemorrhage headache” about 18 months
• Subarachnoid • Decreased
hemorrhage LOC
• Cerebral aneurysm
• Arteriovenous
malformation
Manifestations of Ischemic Stroke
• Symptoms depend on the location and size of the affected area
o Numbness or weakness of face, arm, or leg, especially on one side
o Confusion or change in mental status
o Trouble speaking or understanding speech
o Difficulty in walking, dizziness, or loss of balance or coordination
o Sudden, severe headache
o Perceptual disturbances
◦ FAST – Face irregularities, Arm irregularities, speech irregularities, time to call
Terms
◦ Hemiplegia: paralysis of one side of the body.
◦ Hemiparesis: unilateral paresis, is weakness of one entire side of the body (hemi- means
"half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body.
◦ Dysarthria: difficult or unclear articulation of speech that is otherwise linguistically
normal.
◦ Aphasia: is an inability to express oneself or to understand language.
◦ expressive aphasia: also known as Broca's aphasia, is characterized by partial loss of the
ability to produce language (spoken, manual, or written), although comprehension
generally remains intact. A person with expressive aphasia will exhibit effortful speech
,3
◦ receptive aphasia: Wernicke's aphasia, also known as receptive aphasia, sensory
aphasia, or posterior aphasia, is a type of aphasia in which individuals have difficulty
understanding written and spoken language.
◦ Hemianopsia: a decreased vision or blindness (anopsia) in half the visual field, usually
on one side of the vertical midline
◦ Agnosia: inability to interpret sensations and hence to recognize things, typically as a
result of brain damage
Transient Ischemic Attack (TIA)
◦ Temporary neurologic deficit resulting from a temporary impairment of blood flow
◦ “Warning of an impending stroke”
◦ May see drooping on one side of the face
◦ Diagnostic workup is required to treat and prevent irreversible deficits
Medical Management
◦ Prevention: control of hypertension
◦ Diagnosis: CT scan (1st intervention), cerebral angiography, lumbar puncture if CT is
negative and ICP is not elevated to confirm subarachnoid hemorrhage
◦ Care is primarily supportive
◦ Bed rest with sedation
◦ Oxygen
◦ Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention
of further bleeding
Preventive Treatment and Secondary Prevention
◦ Health maintenance measures including a healthy lifestyle, not smoking, exercise,
healthy diet and weight
◦ Carotid endarterectomy for carotid stenosis
◦ Anticoagulant therapy for atrial fibrillation
◦ Antiplatelet therapy
◦ “Statins”
◦ Antihypertensive medications
◦ Carotid Endarterectomy
Medical Management: Acute Phase of Stroke
◦ Prompt diagnosis and treatment
◦ Assessment of stroke: NIHSS assessment tool
◦ Thrombolytic therapy
◦ Criteria for TPA
Over 18 years old INR: less than 1.7 second
Must be diagnosed with ischemic stroke (CAT scan to No heparin in 58 hours
diagnose)
, 4
3 hours from onset of symptoms No neoplasm
BP less than 185/ 110 No aneurisms
no seizures No bleeding issue in the last 21 days
No comadin No surgical procedure in 14 days
PT: less than 15 second No stroke/ head injury in past 3 months
No ICP issue
o IV dosage and administration
◦ Patient monitoring
◦ Side effects: potential bleeding
◦ Elevate head of bed (HOB) unless contraindicated
◦ Maintain airway and ventilation
◦ Continuous hemodynamic monitoring and neurologic assessment
Hemorrhagic Stroke
◦ Caused by bleeding into brain tissue, the ventricles, or subarachnoid space
◦ May be caused by spontaneous rupture of small vessels primarily related to
hypertension; subarachnoid hemorrhage caused by a ruptured aneurysm; or
intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations
(AVMs), intracranial aneurysms, or medications such as anticoagulants
◦ Brain metabolism is disrupted by exposure to blood
◦ ICP increases caused by blood in the subarachnoid space
◦ Compression or secondary ischemia from reduced perfusion and vasoconstriction causes
injury to brain tissue
Manifestations
◦ Similar to ischemic stroke
◦ Severe headache
◦ Early and sudden changes in LOC – level of consciousness
◦ Vomiting
◦ Bleeding
Nursing Process: The Patient Recovering From an Ischemic Stroke—Assessment
Acute phase:
◦ Ongoing, frequent monitoring of all systems, including vital signs and neurologic
assessment
◦ LOC
◦ motor symptoms
◦ speech
◦ pupil changes one bigger than the other
EXAM 3 - REVIEW
Module 9 - Cerebrovascular Disorders
• Functional abnormality of the CNS that occurs when the blood supply to the brain is
disrupted
• Stroke is the primary cerebrovascular disorder and the fifth leading cause of death in the
United States
• Stroke is the leading cause of serious long-term disability in the United States
• Financial impact is profound
Agnosia - Failure to recognize familiar objects perceived by the senses
Aphasia - is an inability to express oneself or to understand language.
Apraxia - is an inability to perform previously learned purposeful motor acts on a voluntarily
Ataxia - is an impaired ability to coordinate movement, often seen as a staggering gait or
postural imbalance
Prevention
• Nonmodifiable risk factors
◦ Age (older than 55 years), male, gender, African Americans
• Modifiable risk factors
◦ Hypertension is the primary risk factor
◦ Cardiovascular disease: esp. Afib and/or carotid stenosis
◦ Elevated cholesterol or elevated hematocrit
◦ Obesity
◦ Diabetes
◦ Oral contraceptive use
◦ Smoking and drug and alcohol abuse
◦ Sedentary lifestyle
◦ Sleep apnea
Question
Is the following statement true or false?
Ischemic stroke account for 80% to 85% of strokes, and hemorrhagic stroke accounts for 15% to
20%
Answer
True - ischemic stroke account for 80% to 85% of strokes, while hemorrhagic stroke accounts for
15% to 20%
◦
Stroke - “Brain attack”
Sudden loss of function resulting from a disruption of the blood supply to a part of the brain
,2
Type of stroke Causes Main Presenting Functional Recovery
Symptoms
Ischemic (~ • Large or small • Numbness or Usually plateaus at 6
87%) artery thrombosis weakness of months
• Cardiogenic the face, arm,
embolic leg, especially
• Cryptogenic (no on one side of
known cause) the body
• Other
Hemorrhagic • Intracerebral • “Exploding Slower, usually plateaus at
(~ 13%) hemorrhage headache” about 18 months
• Subarachnoid • Decreased
hemorrhage LOC
• Cerebral aneurysm
• Arteriovenous
malformation
Manifestations of Ischemic Stroke
• Symptoms depend on the location and size of the affected area
o Numbness or weakness of face, arm, or leg, especially on one side
o Confusion or change in mental status
o Trouble speaking or understanding speech
o Difficulty in walking, dizziness, or loss of balance or coordination
o Sudden, severe headache
o Perceptual disturbances
◦ FAST – Face irregularities, Arm irregularities, speech irregularities, time to call
Terms
◦ Hemiplegia: paralysis of one side of the body.
◦ Hemiparesis: unilateral paresis, is weakness of one entire side of the body (hemi- means
"half"). Hemiplegia is, in its most severe form, complete paralysis of half of the body.
◦ Dysarthria: difficult or unclear articulation of speech that is otherwise linguistically
normal.
◦ Aphasia: is an inability to express oneself or to understand language.
◦ expressive aphasia: also known as Broca's aphasia, is characterized by partial loss of the
ability to produce language (spoken, manual, or written), although comprehension
generally remains intact. A person with expressive aphasia will exhibit effortful speech
,3
◦ receptive aphasia: Wernicke's aphasia, also known as receptive aphasia, sensory
aphasia, or posterior aphasia, is a type of aphasia in which individuals have difficulty
understanding written and spoken language.
◦ Hemianopsia: a decreased vision or blindness (anopsia) in half the visual field, usually
on one side of the vertical midline
◦ Agnosia: inability to interpret sensations and hence to recognize things, typically as a
result of brain damage
Transient Ischemic Attack (TIA)
◦ Temporary neurologic deficit resulting from a temporary impairment of blood flow
◦ “Warning of an impending stroke”
◦ May see drooping on one side of the face
◦ Diagnostic workup is required to treat and prevent irreversible deficits
Medical Management
◦ Prevention: control of hypertension
◦ Diagnosis: CT scan (1st intervention), cerebral angiography, lumbar puncture if CT is
negative and ICP is not elevated to confirm subarachnoid hemorrhage
◦ Care is primarily supportive
◦ Bed rest with sedation
◦ Oxygen
◦ Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention
of further bleeding
Preventive Treatment and Secondary Prevention
◦ Health maintenance measures including a healthy lifestyle, not smoking, exercise,
healthy diet and weight
◦ Carotid endarterectomy for carotid stenosis
◦ Anticoagulant therapy for atrial fibrillation
◦ Antiplatelet therapy
◦ “Statins”
◦ Antihypertensive medications
◦ Carotid Endarterectomy
Medical Management: Acute Phase of Stroke
◦ Prompt diagnosis and treatment
◦ Assessment of stroke: NIHSS assessment tool
◦ Thrombolytic therapy
◦ Criteria for TPA
Over 18 years old INR: less than 1.7 second
Must be diagnosed with ischemic stroke (CAT scan to No heparin in 58 hours
diagnose)
, 4
3 hours from onset of symptoms No neoplasm
BP less than 185/ 110 No aneurisms
no seizures No bleeding issue in the last 21 days
No comadin No surgical procedure in 14 days
PT: less than 15 second No stroke/ head injury in past 3 months
No ICP issue
o IV dosage and administration
◦ Patient monitoring
◦ Side effects: potential bleeding
◦ Elevate head of bed (HOB) unless contraindicated
◦ Maintain airway and ventilation
◦ Continuous hemodynamic monitoring and neurologic assessment
Hemorrhagic Stroke
◦ Caused by bleeding into brain tissue, the ventricles, or subarachnoid space
◦ May be caused by spontaneous rupture of small vessels primarily related to
hypertension; subarachnoid hemorrhage caused by a ruptured aneurysm; or
intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations
(AVMs), intracranial aneurysms, or medications such as anticoagulants
◦ Brain metabolism is disrupted by exposure to blood
◦ ICP increases caused by blood in the subarachnoid space
◦ Compression or secondary ischemia from reduced perfusion and vasoconstriction causes
injury to brain tissue
Manifestations
◦ Similar to ischemic stroke
◦ Severe headache
◦ Early and sudden changes in LOC – level of consciousness
◦ Vomiting
◦ Bleeding
Nursing Process: The Patient Recovering From an Ischemic Stroke—Assessment
Acute phase:
◦ Ongoing, frequent monitoring of all systems, including vital signs and neurologic
assessment
◦ LOC
◦ motor symptoms
◦ speech
◦ pupil changes one bigger than the other
