Stroke, also known as cerebrovascular accident (CVA) is a disruption in cerebral perfusion causing neurological deficit.
Types of strokes
Thrombotic ischemic stroke: When cerebral arteries are blocked by blood clot.
Embolic stroke: Impaired cerebral perfusion due to embolism,
vasospasm or atherosclerotic plaque.
• Due to ruptured or leaking aneurysm, intravenous
malformation, bleeding disorder, arterial rupture or trauma.
• Most of the intracerebral hemorrhages are arterial in
。 Severe explosive headache is the characteristic of
Signs and symptoms depend on the affected artery and severity
of the damage.
• Hemiplegia: Paralysis of one side of the body.
• Hemiparesis: Weakness in one side of the body
• Paraplegia: Paralysis of lower extremities
• Quadriplegia: Paralysis of all four limbs of the body
Ataxia: Unsteady gait
Dysarthria: Difficulty in speaking
• Dysphasia or aphasia: Defective speech or loss of speech.
It can be expressive, receptive or mixed • Expressive aphasia: It is due to damage to brocca's area of speech, here client can understand what others are communicating but can't communicate back.
• Receptive aphasia: Wernicke's area in the temporal lobe is affected. In this condition, client is unable to understand spoken or written word.
Apraxia: It is the inability to perform previously learned
o Hemianopsia: Loss of half of the visual filed
o Diplopia: Double vision
Agnosia: Inability to recognize familiar object or person.
Anticoagulants are contraindicated in patients with
hemorrhagic stroke but useful in nonhemorrhagic stroke. The only fibrinolytic agent that has been shown benefit in selected patients with acute ischemic stroke is tissue
plasminogen activator (t-PA). NIH stroke scale/score (NIHSS) is done to ascertain the need of thrombolysis.
Surgical evacuation of clot or hematoma relieves increased ICP.
■ Carotid endarterectomy remove plaques. Anticonvulsants to prevent seizure. Analgesics to control pain.
*Key nursing interventions*
■ Assess LOC
■ Monitor ICP and vital signs
Bleeding is the most common side effect of t-PA. So closely monitor the client.
■Speak slowly and simply to patient.
■ Monitor fluid input and output hourly.
■ Positioning of the patient to prevent deformity.
■ Physical therapy to prevent contractures.Unilateral neglect or neglect syndrome: Seen in stroke patient who is unaware about the existence of paralyzed part.
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