STROKE (BRAIN ATTACK)

DESCRIPTION:
A stroke or brain attack, formerly known as a cerebrovascular accident ( CVA) is a sudden focal neurological deficit caused by cerebrovascular disease. A stroke is a syndrome in which the cerebral circulation is interrupted, causing neurological deficits. Cerebral anoxia lasting longer than 10 minutes causes cerebral infarction with irreversible change. Cerebral edema and congestion cause further dysfunction Diagnosis is determined by a CT scan, electroencephalography, cerebral arteriography, and magnetic resonance imaging. The order in which function may return is facial swallowing, lower limb, speech, and arms. Carotid endarterectomy is a surgical intervention used in stroke management; it is targeted at stroke prevention, especially in clients with symtomatic carotid stenosis.

CAUSES
Thrombosis

Embolism
Hemorrhage from rupture of a vessel Transcient ischemic attack

RISK FACTORS:
Atherosclerosis

Hypertension
Anticoagulant Therapy Diabetes Mellitus Stress Obesity Oral Contraceptives

ASSESSMENT:
1. Assessment findings depending on the area of the brain affected.

Right-brain damage Paralyzed left side : hemiplegia Left-sided neglect

Left-brain damage Paralyzed right side: hemiplegia Impaired speech/language aphasias Impaired right/left discrimination Slow performance, cautious Aware of deficits: depression, anxiety Impaired comprehension related to language, math

Spatial-perceptual defect
Tends to deny or minimize problems Rapid performance, short attention span Impulsive, Safety Problems Impaired judgement Impaired time concepts

2. Lesions in the cerebral hemisphere results in manifestations on the contralateral side, which is the side of the body opposite the stroke.

3. Airway patency is always a priority.

4. Pulse (may be slow and bounding) 5. Respirations (Cheyne-Stokes) 6. Blood Pressure (Hypertension) 7. Headache, nausea, and vomiting 8. Facial drooping 9. Nuchal Rigidity

10. Visual Changes

11. Ataxia

12. Dysarthria
13. Dysphagia 14. Speech Changes 15. Decreased sensation to pressure, heat, and cold 16. Bowel and bladder dysfunctions 17. Paralysis

APHASIA
1. Expressive a. Damage occurs in the brocas area of the frontal brain. b. Client understands what is said but is unable to communicate verbally. 2. Receptive

a. Injury involves Wernickes area in the temporoparietal area.

b. Client is unable to understand the spoken and often the written word. 3. Global or mixed: Language dysfunction occurs in expression and reception. 4. Interventions for aphasia

a. Provide repetitive directions.

b. Break tasks down to one step at a time. c. Repeat names of objects frequently used. d. Allow time for the client to communicate

e. Use a picture board, communication board, or computer technology.

ASSESSMENT FINDINGS IN A STROKE (BRAIN ATTACK)

AGNOSIA - inability to use an object correctly APRAXIA -inability to carry out a purposeful activity HEMIANOPSIA -Blindness in the half of the visual field of both eyes NEGLECT SYNDROME -Client unaware of the existence of his or her paralyzed side PROPRIOCERTION ALTERATIONS -Altered position sense that places the client at increased risk of injury Pyramid Point: With visual problems, the client must turn the head to scan the complete range of vision.

INTERVENTIONS DURING ACUTE PHASE OF STROKE

1. Maintain a patent airway and administer oxygen as prescribed. 2. Monitor vital signs. 3. Maintain a blood pressure of 150/100 mmHg to maintain a cerebral perfusion.

4. Suction secretions as prescribed, but never suction nasally for longer than 10 seconds to prevent increasing ICP.
5. Monitor for increasing ICP because the client is most at risk during the first 72 hours following the stroke. 6. Position the client on the side, with the head of the bed elevated 15 tp 30 degrees as prescribed. 7. Monitor level of consciousness , pupillary response, motor and sensory response, cranial nerve function and reflexes. 8. Maintain a quiet environment, and carry out minimal handling of the client to prevent further bleeding. 9. Insert a Foley catheter as prescribed. 10. Administer intravenous fluids as prescribed.

11. Maintain fluid and electrolyte imbalance .

12. Prepare to administer anticoagulants, antiplatelets, diuretics, antihypertensives, and anticonvulsants as prescribed.
13. Establish a form of communication.

INTERVENTIONS IN THE POST ACUTE PHASE OF A STROKE

1. Continue with the interventions from the acute phase. 2. Position the client 2 hours on the unaffected side and 20 minutes on the affected side. 3. Position the client in the prone position if prescribed, for 30 minutes three times daily.

4. Provide skin, mouth and eye care.

5. Perform passive range -of motion exercises to prevent contractures. 6. Place antiembolism stockings on the client. 7. Measure thighs and calves for an increased in size. 8. Monitor gag reflex and ability to swallow. 9. Provide sips of fluids and and slowly advance diet to foods that are easy to chew and swallow. 10. Provide soft and semisoft foods and flavored, cool or warm, thickened fluids rather than thin liquids because the stroke client can tolerate these types of food better; speech therapists may do swallow studies to recommend consistency of food and fluids.

11. When the client is eating, position the client sitting in a chair or sitting up in a bed, with the head and neck positioned slightly forward and flexed. 12. Place food in the back of the mouth on the unaffected side to prevent trapping of food in the affected cheek.

INTERVENTIONS IN THE CHRONIC PHASE OF A STROKE

1. Neglect Syndrome a. Client is unaware of the existence of his or her paralyzed side ( unilateral neglect), which places the client at risk for injury.

b. Teach the client to touch and use both sides of the body.
2. Hemianopsia a. Client has blindness in half the visual field. b. Homonymous hemianopsia is blindness in the same visual field of both eyes.

c. Encourage the client to turn the head to scan the complete range of vision othewise,
he or she does not see half of the visual field. 3. Approach the client from the unaffected side. 4.Place the clients personal objects within the visual field.

5. Provide eye care for visual deficits.

6. Place a patch over the affected eye if the client has diplopia.

7. Increase mobility as tolerated.

8. Encourage fluid intake and a high fiber diet.

9. Administer stool softeners as prescribed. 10. Encourage independence in activities of daily living. 11. Encourage independence in activities of daily living. 12. Assess the need for assistive devices such as a cane, walker, splint or braces. 13. Teach transfer technique from bed to chair and from chair to bed. 14. Provide gait training. 15. Initiate physical and occupational therapy. 16. Refer client to a speech and language pathologist as prescribed. 17. Encourage the client and family to contact available community resources.

THE END!
THANK YOU FOR WATCHING!

GOD BLESS!
HOPE YOU LEARN A LOT FROM MY REPORT. PRESENTED BY: JOEY RYAN P. LODIA PRESENTED TO: LUDIVINA MAGPALI DEAN, CON