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Stroke
• third leading cause of death in US, fourth in MS
What is a stroke?
• Disability
Types of Stokes
• Ischemic-most common
o Subarachnoid
• Arteries and veins are not formed like they are suppose to
be in the brain- too much pressure on venous wall
• Age
• Sex
• Race
• Heredity
• Hypertension
• Prior stroke
• “TIA”
• Diabetes
• Heart disease
o Atrial fibrillation
• High cholesterol
• Socioeconomic status
• Geography
• Alcohol abuse
Lifespan Considerations
Pathophysiology
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o The arteries
o The heart
• Hemorrhagic
Vessel rupture
Vasospasm
Symptoms of a stroke
Primary Prevention
• Limit alcohol
• Exercise regularly
• Indications
• Procedure
• Potential complication
o Obstruction
o Hemorrhage
o Infection
• Nursing Management
o Monitor BP
o Cardiac monitoring
Hoarseness
Swallowing problems
Secondary Prevention
Clinical Manifestations
• Motor Loss
• Communication loss
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o Visually
Diploplia-double vision
Visual-spatial disturbance
o Sensation
o Cognitive deficits
Memory
Attention span
Concentration
Abstract reasoning
Judgement
o Emotional deficits
Emotional lability
Loss of self-control
• CT scan
• MRI
• Cerebral angiography/arteriogram
• EKG
• Echocardiogram
• Ischemic
o Anticoagulants
Heparin-watch PTT
Plavix-antiplatelet
Aspirin
Elevate HOB
Secure airway
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Monitory hemodynamics
• Hemorrhagic
o Manage vasospasms
Stoke Rehabilitation
• Physical therapy
• Occupational therapy
• Speech therapy
• Treat depression
• Self-care deficits
• Impaired swallowing
• Incontinenece
Nursing Interventions
o Proper positioning
o Shoulder positioning
• Enhancing self-care
o Adequate lighting
• Managing dysphagia
o Speech therapy
o Thick substances
o Re-orient, re-assure
• Improving communication
Intracranial Aneurysm
• Localized dilation of a cerebral artery resulting from weakness in arterial wall
Causes
• Atherosclerosis
• Hypertension
• Head trauma
• Advancing age
Pathophysiology
o Increased ICP
Clinical Manifestations
• Loss of consciousness
• Dizziness, tinnitus
Diagnostic Tests
• CT scan
• Cerebral angiography
Medical Management
• Prevent re-bleeding
o Complete bedrest
o Reducing stimuli
• Control vasospasm
o BP around 150
• Control hypertension
Surgical Management
• Aneurysm clipping
• Trapping of aneurysm
• Wrapping of Aneurysm
• Interventional neuroradiology
Nursing Diagnosis
• Anxiety
Potential Complications
• Vasospasm
o Worsening headache
o Change in LOC
• Seizures
• Hydrocephalus
• Re-bleeding
Hydrocephalus
Overview: CSF
Types
• Congenital
o Genetic predisposition
• Acquired
• Other types
o Hydrocephalus ex-vacuo
Clinical Manifestations
Diagnostic Tests
• Infants-head circumference
• CT scan
• MRI
• Cisternogram-inject dye into space thru lumbar puncture and watch dye over
a series of days to watch how the CSF circulates to determine if it is an
absorption problem, or what the problem is to see how to fix it. Will a shunt
fix the problem
Medical Management
o Mannitol
Surgical Management
Nursing Management
Redness
Long-Term Management
• Considerations for Children
o Condition is life-long
• Prognosis depends on
o Cause
o Number of complications