Cerebral vascular accident (CVA) or stroke is the disruption of the blood supply to the brain, resulting in neurological dysfunction.
Causes of CVA :
1. thrombosis, blood clot within a blood vessel in the brain or neck
2. cerebral embolism
3. stenosis of an artery supplying the brain
4. cerebral hemorrhage, rupture of a cerebral blood vessel with bleeding/pressure into brain tissue.
Risk Factors associated with CVA :
1. hypertension
2. previus transient ischemic attacks (TIA)
3. cardiac disease ( atherosclerosis, arrhythmias, valvular heart disease)
4. advanced age
5. diabetes
Signs and symptoms :
- higly dependent upon size and site of lesion
- motor loss : hemiplegia (paralysis on one side of the body) or hemiparesis (motor weakness on one side of the body)
- communication loss
- vision loss
- sensory loss
- bladder impairment
- impairment of mental activity
- in most instances onset of
- increased intracranial pressure is a frequent complication resulting from hemorrhage or ischemia and subsequent cerebral edema.
Medical and
nursing management during the acute phase of CVA :
- objective of care during the acute phase : keep the patient alive, minimize cerebral damage by providing adequately oxygenated blood to the brain
- support airway, breathing, and circulation.
- maintain neurological flow sheet with frequent observation of the following : level of consciousness, pupil size and reaction to light, patient's response to commands, movement and strength, patient's vital signs such as : blood pressure; pulse; respirations; and temperature.
- continually reorient patient to person, place, and time (day, month) even if patient remains in a coma. confusion may be a result of simply regaining consciousness, or may be due to a neurological deficit.
- maintain proper positioning / body alignment
- ensure adequate fluid and electrocyte balance
- administer medications, as ordered : anti hypertensives, antibiotics if necessary, seizure control medications, anticoagulants, sedatives and tranquillzers are not given because they depress the respirstory center and obscure neurological observations.
- maintain adequate elimination.
- include patient's family and significant others in plan of care to the maximum extent possible.