STROKE IN ENGLISH
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STROKE-
Ø Stroke
is defined as functional abnormality of the central nervous system (CNS) that
occurs when the normal blood supply to the brain is disrupted. stroke is a
leading cause of serious, long-term disability. Strokes can be divided into two
major types-
Ø Ischemic
stroke
Ø Hemorrhagic
stroke
Ø Ischemic stroke- In
this type of stroke there is reduced blood supply to the brain causing ischemia
of brain cells, due to occlusion in the arteries which supply oxygenated blood
to the brain. It accounts for 85% of total stroke cases.
Ø Hemorrhagic stroke- In
this type of stroke there is reduced blood supply to the brain due
extravasation of blood into the brain or hemorrhage. It accounts for 15% of
total stroke cases.
CAUSES OF STROKE-
Ø Ischemic
stroke is mainly caused by atherosclerosis and thrombus formation. Large artery
thrombotic strokes are caused by atherosclerotic plaques in the large blood
vessels of the brain. Due to
atherosclerosis plaque and thrombus lumen of arteries supplying oxygenated
blood to brain becomes narrow and blood supply/oxygen supply is reduced to the
brain tissues.
Ø Ischemic
stroke may also be caused by embolism. Emboli originate from the heart and
circulate to the cerebral vasculature, most commonly the left middle cerebral
artery, resulting in a stroke.
Ø Hemorrhagic
stroke may be caused by intracerebral hemorrhage, subdural hemorrhage,
aneurysms or arterio-venous malformations (AVM) . Due to bleeding, blood
supply/oxygen supply to the brain tissues is reduced.
CLINICAL MANIFESTATIONS-
Ø Clinical
manifestations of an ischemic stroke depend upon the location of the lesion,
the size of the area of inadequate perfusion, and the amount of collateral blood flow. The patient may present with any
of the following signs or symptoms:
Ø Numbness
or weakness of the face, arm, or leg, specially on one side of the body
(hemiparesis)
Ø Confusion
or change in mental status
Ø Difficulty
in speaking or understanding speech
Ø Visual
disturbances such as diplopia
Ø Difficulty
in walking,
Ø Dizziness,
depression and withdrawal symptoms.
Ø Loss
of balance or coordination of muscles
Ø Sudden
severe headache
Ø Paralysis of one side of the body (hemiplegia)
Ø Loss of or decreased deep tendon reflexes.
Ø Apraxia
(inability to perform a previously learned action)
Ø Homonymous
hemianopsia (loss of half of the visual field)
Ø difficulty
in interpreting visual, tactile, and auditory stimuli.
Ø The
patient with a hemorrhagic stroke may have clinical manifestations similar to
the patient with ischemic stroke.
Ø Other
symptoms that may be observed more frequently in patients with acute
hemorrhagic stroke are
Ø vomiting,
sudden change in level of consciousness, and possibly focal seizures due to
frequent brain stem involvement.
Ø The
patient with an intracranial aneurysm or arterio-venous malformations (AVM) may
have some unique clinical manifestations. such as
Ø Severe
headache and often loss of consciousness for a variable period of time.
Ø There
may be pain and rigidity of the back of the neck (nuchal rigidity) and spine
due to meningeal irritation
DIAGNOSTIC
INVESTIGATIONS-
Ø History
taking and Physical and neurologic examination.
Ø CT
scan and MRI to confirm the type of stroke, the size and location of the
hematoma
Ø Cerebral
angiography to confirms the diagnosis of an intracranial aneurysm or AVM.
Ø Lumber
puncture to check ICP
Ø ECG
TREATMENT
–
Ø Medical
management of ischemic stroke includes use of Platelet-inhibiting medications,
including aspirin, extended- release
dipyridamole plus aspirin, clopidogrel and ticlopidine to prevent further thrombus
and embolism formation
Ø Thrombolytic
agent t-PA (Tissue plasminogen activator)
isused to treat ischemic stroke by dissolving the blood clot that is
blocking blood flow to the brain.
Ø Surgical
management includes carotid endarterectomy. It is performed by removal of an
atherosclerotic plaque or thrombus from the carotid artery.
Ø Carotid
stenting, with or without angioplasty, is a less invasive procedure that may be
used for ischemic strokes.
Ø Management
of hemorrhagic stroke may consist of bed rest with sedation to prevent
agitation and stress, management of vasospasm, and surgical or medical
treatment to prevent re-bleeding.
Ø Antiseizure
agents are often administered prophylactically for a brief period of time.
Ø Analgesic
agents may be prescribed for head and neck pain.
Ø Surgical
management may be needed for large hematomas and aneurysms.
NURSING
MANAGEMENT-
Ø Proper
assessment is done by health history, and physical examination and a nursing
care plan is prepared.
Ø The
nurse should also assess mental status,
sensation, perception , motor control,
swallowing ability, nutritional and hydration status, skin integrity,
activity tolerance and bowel and bladder function
Ø A
patient with hemiplegia has unilateral paralysis have chances of developing
contractures. The nurse uses correct positioning for patient to prevent
contractures.
Ø Nurse assist in maintaining good body
alignment, and prevent compressive neuropathies, especially of the ulnar and
peroneal nerves neuropathies.
Ø To
prevent adduction contracture of the affected shoulder while the patient is in
bed during sleep, a pillow is placed in
the axilla.
Ø The
fingers are positioned in such a way that they are slightly flexed. The hand is
placed in slight supination which is its most functional and natural anatomical
position.
Ø The
nurse encourages the patient and assist to stretch the muscles of hand and
fingers because spasticity of hands can be prevented by stretching and
splinting.
Ø As soon as possible, the patient
is assisted out of bed and an active rehabilitation program is started.
Ø When
the patient is able to sit up, the nurse should encourage him/her for personal
hygiene activities .
Ø Patients
with a decreased field of vision should be approached on the side where visual
perception is intact.
Ø The
patient can be taught to turn the head in the direction of the defective visual
field to compensate for this loss.
Ø Increasing
the natural or artificial lighting in the room and providing eyeglasses help to
increase vision.
Ø After
a stroke, the patient may have transient urinary incontinence due to confusion,
inability to communicate needs, so the
nurse should use intermittent catheterization with sterile technique.
Ø The
voiding pattern is analyzed, and the urinal or bedpan is offered on this
pattern or schedule.
Ø A
regular turning schedule is adhered to even if pressure-relieving devices are
used to prevent tissue and skin breakdown
Ø Family
members play an important role in the patient’s recovery. Family members are
encouraged to participate in counseling and to use support systems to help the
patient in emotional and physical stress
Ø Patient
and family education is a fundamental component of rehabilitation. The nurse
provides teaching about stroke, its causes and prevention, and the
rehabilitation process during discharge planning.
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