Sergi Lee Orate BSN 3

Introduction

Cerebrovascular Disease

Cerebrovascular disease is a group of brain dysfunction related to disease of blood vessels

supplying the brain. Hypertension is the most important cause that damage the blood vessel
lining endothelium exposing the underlying collagen where platelets aggregate to initiate a
repairing process which is not always complete and perfect. Primarily people who are elderly have
cerebrovascular disease.
Symptoms:

Facial droop: One side of the face may appear “droopy” or the person may be unable to smile.

Arm weakness: The person is unable to raise their arm above their head

Speech difficulty: The person has slurred speech, is unable to find words, or is unable to
understand what people are saying to them.

Nursing Management

Position to prevent contractures, relieve pressure, attain good body alignment, and prevent
compressive neuropathies.

Apply splint at night to prevent flexion of the affected extremity.

Prevent adduction of the affected shoulder with a pillow placed in the axilla.

Elevate affected arm to prevent edema and fibrosis.

Provide full range of motion four or five times a day to maintain joint mobility.

Exercise is helpful in preventing venous stasis, which may predispose the patient to thrombosis
and pulmonary embolus.

Teach patient to maintain balance in a sitting position, then to balance while standing and begin
walking as soon as standing balance is achieved.
Encourage personal hygiene activities as soon as the patient can sit up.

Approach patient with a decreased field of vision on the side where visual perception is intact.

Consult with a speech therapist to evaluate gag reflexes and assist in teaching alternate
swallowing techniques.

Analyze voiding pattern and offer urinal or bedpan on patient’s voiding schedule.

Frequently assess skin for signs of breakdown, with emphasis on bony areas and dependent body
parts.

Left Middle Cerebral Artery Stroke

An MCA stroke is an interruption of blood flow to the areas of the brain that receive blood through
the middle cerebral artery.

The MCA is by far the largest cerebral artery and is the vessel most commonly affected by
cerebrovascular accident. The MCA supplies most of the outer convex brain surface, nearly all
the basal ganglia, and the posterior and anterior internal capsules. Infarcts that occur within the
vast distribution of this vessel lead to diverse neurologic sequelae.

A stroke, which is also known as a cerebrovascular accident, is defined as a non-traumatic brain

injury that is caused by disruption of blood flow to part of the brain.

MCA strokes are generally embolic as opposed to thrombotic. This means that usually a middle
cerebral artery stroke is caused by a blood clot that travelled from elsewhere in the body,
typically from the heart or from the carotid artery, and lodged in the middle cerebral artery,
blocking blood flow.

This disruption of blood flow means that this specific part of the brain is being deprived of the
nutrients and oxygen it needs to survive, so it results in cell death to that area of the brain.
Effects

Movement
Changes in Movement
The loss of movement or weakness occurs on the right side of the body.
Often the muscles of the mouth, the tongue, and throat may be affected, making it hard to speak
or swallow.
Sensation
Not feeling when they are being touched or knowing where the touch is. Ì For example,
something touching their foot may feel a touch on the leg. Ì Not being able to tell what an object
is by touching it. Ì Not feeling pain or temperature in that area.
Not knowing where their body is and how it is moving.

Attention
A person that had a stroke on the left side may have problems with attention. They may not be
able to focus to complete a task, even when it is something they wish to do.
Problems with memory and motivation are common and it can be hard to form new memories.
Problems with reading, writing, and doing math are common.

The person with this stroke may confuse left and right.

Memory

Judgement

Speech
Most people have two parts of the brain that control language on the left side of their brain. Both
of these areas are supplied by different parts of the middle cerebral artery. Problems with speech
and understanding language, called aphasia, are common with this type of stroke.
• Non-fluent aphasia – The most common problems of non-fluent aphasia range from finding the
right word to being able to say that word. A person with non-fluent aphasia may sound hesitant
while searching for the right word to say. It can be frustrating for the person affected because he
or she usually understands better than he or she is able to express.
• Fluent aphasia – A person with fluent aphasia does not have trouble saying words, but the
words spoken may be nonsense or real words that are used incorrectly. The person with fluent
aphasia may be unaware that his or her speech is not meaningful. This can lead to frustration and
anger toward the listener for not understanding.
 General Objectives

After 8 hours of case presentation, the level III – Group 2 students will gain further understanding
and extensive knowledge, regarding Left Middle Cerebral Artery Stroke. To properly plan, provide
and evaluate holistic care provided to the patient during the clinical rotation.

Specific Objectives

The level III – group 2 students will be able to:

 Know the definition of the disease; its causes, signs and symptoms, and complications.
 Discuss and interpret data gathered through theoretical analysis of Nursing History,
Gordon’s 11 Functional Health Pattern, Physical Assessment and Laboratory Results.
 Know the anatomy and physiology of CVD left infarct Middle Cerebral Artery Stroke.
 Trace the pathophysiology of CVD Left Infarct Middle Cerebral Artery Stroke.
 Learn the appropriate nursing interventions, treatment plan, and prognosis of CVD Left
Infarct Middle Cerebral Artery Stroke.
 Discuss the medications taken by the client, its action, side effects and nursing
responsibilities.
 Formulate an effective Discharge Plan for the client experiencing CVD Left Infarct Middle
Cerebral Artery Stroke.