Miss M N PRIYADARSHANIE BSc Nursing NURSING MANAGEMENT OF A CLIENT WITH ALTERED CEREBRAL TISSUE PERFUSION Stroke Definition That stroke is a disease affects the blood vessels That blood supply to the brain ID: 761502
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Miss M. N. PRIYADARSHANIE ( BSc . Nursing ) NURSING MANAGEMENT OF A CLIENT WITH ALTERED CEREBRAL TISSUE PERFUSION
Stroke Definition : That stroke is a disease affects the blood vessels That blood supply to the brain. Without blood to supply oxygen and Nutrients and to remove waste products, brain cells begin to die Quickly.
What are the Risk factors for stroke Trombus Emboli Haemorrhage (ICH) DM
The cause of stroke An interruption in the blood supply, with a resulting depletion of oxygen and glucose in the affected area. This reduces or abolishes IMMEDIATELY neuronal function, Impairing brain function
TRANSIENT ISCHAEMIC ATTACK It is a focal deficit lasting less than 24 hours Due to passage of microemboli Complete neurological recovery Risk factor is the thromboembolic stroke
Clinical features Aphasia Hemiparesis Hemi sensory loss Hemi anopic visual loss
Investigations MRI CT BLOOD GLUCOSE UREA AND ELECTROLYTE FBC INR ESR ECG
TREATMENT r- TPA therapy for trombolysis (within 3 hours) for TIA WHAT ARE THE CONTRAINDICATIONS…. Heparin therapy Anti hypertensives Aspirin – 300mg daily
Secondary prevention Aspirin – 75 mg daily Statin – 40mg daily Warfarin therapy Internal carotid endartectomy
Prognosis Die Within 2yrs 25% cure
In the Acute phase Maintain airway and adequate ventilation Maintain neurologic flow sheets Assess quality and PR Monitor UOP Note any bleeding Elevate head of the bed
Meeting Physical Care Needs Care of the Stroke Affected Side Loss of Consciousness Promoting Urinary Continence - the use of urinary catheters Promoting Faecal Continence Care of the Patient Wearing Anti Embolism Stockings Prevention of Pressure Ulcers Dysphagia Nutrition Oral Hygiene Care of the Dying
Psychological, emotional and communication needs. Visual Changes Communication Safety Thinking Processes Emotions Behavioural Changes Monitor patient’s pulmonary complications Monitor for heart abnormalities
Watching for Bowel and Bladder Problems Stroke patients often have bowel and bladder problems Constipation. Mobilizing the Patient When the progression of a stroke has been stabilized, it is time to mobilize the patient the deaths within 30 days after an ischemic stroke
Protecting Against Skin Damage Neurological deficits, e.g., a reduced level of consciousness or a loss of sensation, put stroke patients at increased risk for skin damage Maintaining Hydration and Nutrition Dehydration or malnutrition will slow a patient’s recovery. Dehydration also predisposes a patient to deep venous thrombosis.
Patient Education Why they are taking an antiplatelet drug How the drug works What specific dangers the drug poses The addition of which other drugs will worsen the risk of bleeding That antiplatelet therapy will continue for their entire lifetime
1. A 77-year-old woman was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms: - paralysis of the right face and arm - loss of sensation to touch on the skin of the right face and arm - inability to answer questions but ability to understand what was said to her - ability to write down her thoughts more easily than to speak them
2.A 61-year-old business executive with a long history of high blood pressure collapsed while jogging over the lunch hour. His jogging mate quickly contacted a police officer who helped carry the man to a hospital just down the road. At the hospital, an MRI was performed that revealed a blockage of a major cerebral artery and ischemic changes to the portion of the brain supplied by that artery. With quick medical attention, the man was stabilized, and he slowly improved over the next three weeks. The following signs and symptoms did persist, however: - paralysis of the right leg and foot - loss of sensation on the skin of the right leg and foot - inability to throw the tennis ball with his left hand, but ability to throw it with his right hand