Stroke

Cultural and Gender risk factors for Stroke

-strokes are more likely to occur at a younger age in African Americans. African Americans also have a harder road to recovery. -Strokes are worse in women of any race, they have more profound consequences.

Rehabilitation for Stroke

Physical Therapy Occupational Therapy Speech and Language Therapy

Who is most likely to suffer an Embolic Stroke?

Typically seen in younger clients than those experiencing thrombotic strokes, and it occurs when the client is awake and active.

Hemiplegia

Paralysis of the right or left side of the body.

Proprioception

The body's sense of its position.

Hemiparesis

Weakness of the left or right side of the body.

What is the Prevalence of Stroke?

- account for more than 273,000 deaths annually -Stokes are the 3rd leading cause of death -Each year, 700,000 people have a stroke 500,000 people experience their first stroke. 200,000 have recurrent strokes.

What is the Contralateral Deficit?

-Because the motor pathways cross at the junction of the medulla and the spinal cord, strokes lead to impairment of sensorimotor function of the body opposite the side of the brain that is affected. EX: a stroke in the right hemisphere of the brain is manifested by deficits in the left side of the body, and a stroke in the left hemisphere is manifested by deficits in the right side.

Manifestations of a stroke involving the "Internal Carotid Artery"

-Contralateral paralysis of the arm, leg, and face -Contralateral sensory deficits of the arm, leg and face -If the dominant hemisphere is involved: aphasia -If the nondominant hemisphere is involved: apraxia, agnosia, unilateral neglect -Homonymous hemianopia

Manifestations of a stroke involving the "Anterior Cerebral Artery"

-Contralateral weakness or paralysis of the foot and leg -Contralateral sensory loss of the toes, foot, and leg - Loss of ability to make decisions or act voluntarily -Urinary Incontinence

Manifestations of a stroke involving the "Middle Cerebral Artery"

-Drowsiness, stupor, coma -Contralateral hemiplegia of the arm and face -Contralateral sensory deficits of the arm and face -Global Aphasia (if the dominant hemisphere is involved) -Homonymous Hemianopia

General Risk Factors for Stroke

-Hypertension (leading cause) -Atrial Fibrilation -General heart diseases -Diabetes Mellitus -Sleep apnea (incresses blood pressure and causes decreased oxygen and decreased carbon dioxide) -Increased blood cholesterol levels -Sickle Cell disease -Substance abuse

Nursing Interventions for Stroke

-Maintain Cerebral Perfusion -Promote Physical Mobility -Promote Verbal Communication -Promote Urinary and Bowel Elimination -Maintain Safety

Manifestations of a stroke involving the "Vertebral Artery"

-Pain in the face, nose, or eye -Numbness or weakness of the face on the involved side -Problems with gait -Dysphagia

The public should know these following warning signs of a stroke and to seek medical care:

-Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body. -Sudden confusion, difficulty speaking, or difficulty understanding speech -Sudden trouble walking, dizziness, or loss of coordination -Sudden difficulty with vision in one or both eyes -Sudden severe headache without a cause.

Diagnostic Tests for Stroke

-The National Institutes of Health Stroke Scale -CT scan (used to identify increased risk for stroke or pathophysiological changes that have occurred after, used to distinguish type of stroke). -Perfusion-and-Diffusion-weighted imaging (DWI) can be used to identify cerebral ischemia immediately after the onset of the stroke and also identify areas of possible reversible damage (penumbra) -The PLAC test (high levels of lipo-protein phosphatase which is more common in those with a stroke). -Lumbar Puncture (May be performed to examine CSF if there is no danger of increased intracranial pressure. A thrombotic stroke may elevate CSF pressure; and stroke, frank blood may be seen in CSF after a hemorrhagic).

Goals for the client who have had a stroke include the following:

-The client's blood pressure will be maintained within prescribed limits -The client will understand the importance of cardiac rehabilitation -The client will ambulate and increase activity as tolerated -The client will participate in therapies that maximize communication techniques.

Teaching for the prevention of Strokes

-The importance of stopping smoking and drug abuse -Cholesterol levels should be screened regularly -Maintaining normal weight through diet and exercise -Heart function checks and detection of infections like infective endocarditis

What are the treatment stages of stroke?

1. Stroke Prevention 2. Acute care immediately after a stroke 3. Rehabilitation after a stroke.

What is the National Institutes of Health Stroke Scale?

A clinical evaluation tool widely used to assess neurological outcome and degree of recovery.

"Expressive Aphasia"

A motor speech problem in which an individual can understand what is being said but cannot verbally respond "Broca's Aphasia"

"Receptive Aphasia"

A sensory speech problem in which one cannot understand the spoken (and often written) word. Speech may be fluent but with inappropriate content "Wernicke's Aphasia"

Flaccidity

Absence of muscle tone.

Pharmacological Therapies for Ischemic Stroke

Anticoagulant therapy (Coumadin, Heparin, Lovenox)

Pharmacological Therapies used to treat clients with TIAs or those who have had previous strokes.

Antiplatelet agents (prevents clot formation and blood vessel occlusion). -Aspirin -Plavix

Dysarthria

Any disturbance in muscular control of speech.

What are Hemorrhagic Strokes?

Bleeding within the brain from: -Cerebral hemorrhage ( in the parenchymal tissue) -Subarachnoid Hemorrhage, ( in the layers between the brain and skull)

Thrombotic Stroke

Caused by occlusion of a large cerebral vessel by a thrombus (blood clot).

What is the focus of treatment of the client in the acute phase of a stroke?

Diagnosing the type and cause of the stroke, supporting cerebral circulation, and controlling and preventing further deficits.

what is the act F.A.S.T. acronym?

F: Face: Is there facial drooping? A: Arm: Is there Arm weakness? S: Speech: Is speech Slurred? T: Time: Call 911 if these are present

Pharmacological Therapies for a Thrombotic Stroke?

Fibrinolytic Therapy (tPA), sometimes given concurrently with an anticoagulant. -To be effective, it must be given within 3 hours after the onset of manifestations.

How do most Embolic Strokes Form?

Formed during atrial fibrilation

Onset of Symptoms in a Thrombotic Stroke?

Gradual. It often begins with a TIA and continues to worsen over 1-2 days (this is called a stroke in evolution). When Maximum neurological deficit has been reached, usually in 3 days, this is called a completed stroke.

Onset of Symptoms of an Embolic Stroke?

Has a sudden onset and causes immediate deficits.

Spasticity

Increased muscle tone, usually with some degree of weakness. The flexor muscles are usually more strongly affected in the upper extremities and the extensor muscles are usually more affected in the lower extremities.

Risk factors for hemorrhagic stroke

Increased risk with age -Young people at risk from cocaine use, or traumatic brain injury -Older: high blood pressure, carotid artery dissection -Men more likely to suffer a first stroke/and or recurrent stroke -Women more likely to die of stroke

What are the Two Classifications of a Stroke?

Ischemic and Hemorrhagic

"Mixed or Global Aphasia"

Language dysfunction in both understanding and expression.

General Clinical Manifestations of Stroke

Manifestations are always sudden in onset and focal and usually one-sided. The most common manifestation is weakness involving the face and arm and sometimes the leg. The various deficits associated with with involvement of a specific artery are referred to as stroke syndromes and have their own clinical manifestations.

What is the goal of stroke care and how do you achieve this?

Minimize brain injury and Maximize recovery by: -Rapd recognition and reaction to stroke warning signs -Rapid emergency medical services dispatch -Rapid EMS system transport and hospital prenotification -Rapid diagnosis and treatment in the hospital (preferably at the nearest stroke center).

Who is most likely to suffer a thrombotic stroke?

Most often occur in older individuals who are resting or sleeping. This is because the blood pressure is lower during sleep so there is less pressure to push the blood through an already narrowed lumen, and ischemia may result.

Should you administer Anticoagulants for a patient with a hemorrhagic Stroke?

NO

Embolic Stroke

Occurs when a blood clot or clump of matter traveling through the cerebral vessels becomes lodged in a vessel that is too narrow to permit further movement.

What are Ischemic Strokes?

Result from blockage and/or stenosis of a cerebral artery, decreasing or stopping blood flow and ultimately causing brain infarction. The blockage may result from a blood clot (either thrombosis or emboli) or from stenosis of a vessel caused by a buildup of plaque. Classified by: Transient, Thrombotic, or embolic

Transient Ischemic Attack

Sometimes called a "mini-stroke," is a brief period of localized cerebral ischemia that causes neurological deficits lasting for less than 24 hours. -Often warning signs of an Ischemic thrombotic stroke -Symptoms present just like a stroke.

Who is at the highest risk of developing a subarachnoid hemorrhage?

Specifically, children with sickle cell anemia are at high risk of developing a subarachnoid hemorrhagic stroke-highly deadly. You need to recognize the signs and symptoms early so that you can treat.

What is the Pneumbra?

The 'Pea Size" piece of brain that gets threatened every 12 minutes someone is having a stroke. A central core of dead or dying cells is surrounded by a band of minimally perfused cells. The survival of these cells depends on a timely return of adequate circulation, the volume of toxic products released by adjacent dying cells, the degree of cerebral edema, and alterations of local flood flow.

Neglect Syndrome

The client has a disorder of attention. The client cannot integrate and use perceptions from the affected side of the body or from the environment on the affected side and therefore ignores that part. In severe cases, the client may even deny the paralysis.

Apraxia

The inability to carry out some motor pattern (ie, drawing a figure or getting dressed) even when strength and coordination are adequate.

Agnosia

The inability to recognize one or more subjects that were previously familiar; may be visual, tactile, or auditory.

Aphasia

The inability to use or understand language; may be expressive, receptive, or global.

Hemianopia

The loss of half of the visual field on one or both eyes. When the same half is missing in each eye, the condition is called homonymous hemianopia

Signs and Symptoms of a hemorrhagic stroke

The onset is usually rapid. Depends on the location of the hemorrhage Migraine usually precedes -Confusion -Nausea/vomiting -Severe headache

Signs and Symptoms of an Ischemic Stroke?

The symptoms depend on the side of the brain or the lobe of the brain that has been affected or the specific artery that has been included in the thrombus or the embolism. -Both may include: -Unilateral blindness or hearing deficit -Dizziness -Nausea/vomiting -Numbness on one side of the body -Seizures -Severe headache

What is the definition of a stroke?

The syndrome of acute focal neurologic deficit from a vascular disorder that injures the brain tissue. - a sudden disturbance in brain perfusion associated with a neurologic deficit. - a form of cerebrovascular disease (CBVD). If it severe or prolonged, neuronal death develops. -Known as cerebral infarction or "brain attack"

What is a thundercap headache?

Thundercap headache. Usually starts at the top of the head and radiates down. (additional sign of pain upon looking at or into a light and painful or stiff neck.)

Signs and symptoms of a subarachnoid hemorrhage

Thundercap headache. Usually starts at the top of the head and radiates down. (additional sign of pain upon looking at or into a light and painful or stiff neck.) May also have symptoms that mimic meningitis. Neurologic tissue hates blood (that is why we have a blood brain barrier), when blood hits brain it kills it. Blood does not belong in the CSF and blood can go directly into the cerebral circulation. If a subarachnoid hemorrhage happened, you would see red blood cells in the cerebral spinal fluid. The patient would also have a possible kurnegs sign. A resistance in pain down the thigh. The burbenski sign. These can be caused by trauma or spontaneously.

How do Hemorrhagic Strokes occur?

When a cerebral blood vessel ruptures. It occurs most often in individuals with sustained increase in systolic-diastolic blood pressure. Or an Aneurysm that ruptures.