Saturday, March 10, 2012

Cerebral Vascular Accident



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 symptoms is very sudden
  • 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 :
  1. objective of care during the acute phase : keep the patient alive, minimize cerebral damage by providing adequately oxygenated blood to the brain
  2. support airway, breathing, and circulation.
  3. 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.
  4. 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.
  5. maintain proper positioning / body alignment
  6. ensure adequate fluid and electrocyte balance
  7. 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.
  8. maintain adequate elimination.
  9. include patient's family and significant others in plan of care to the maximum extent possible.

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