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Stroke

Definition:

A stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. This leads to brain cell death within minutes.

Causes:

  1. Ischemic Stroke:

    • Caused by a blockage in a blood vessel supplying the brain.

    • Common causes include:

      • Thrombosis (blood clot formation in a blood vessel).

      • Embolism (blood clot or debris traveling to the brain).

  2. Hemorrhagic Stroke:

    • Caused by a rupture of a blood vessel in the brain.

    • Common causes include:

      • High blood pressure.

      • Aneurysm.

      • Arteriovenous malformations (AVMs).

  3. Transient Ischemic Attack (TIA):

    • Often called a "mini-stroke."

    • A temporary blockage of blood flow to the brain, lasting minutes to hours without permanent damage.

  4. Cryptogenic Stroke:

    • Stroke of unknown cause.

  5. Other Causes:

    • Trauma.

    • Blood disorders.

    • Cardiovascular diseases.

Types:

  1. Ischemic Stroke:

    • Thrombotic Stroke.

    • Embolic Stroke.

  2. Hemorrhagic Stroke:

    • Intracerebral Hemorrhage.

    • Subarachnoid Hemorrhage.

  3. Transient Ischemic Attack (TIA):

    • A warning sign for a potential stroke.

Medications:

  1. Ischemic Stroke:

    • Thrombolytics: Tissue plasminogen activator (tPA) to dissolve clots (administered within 3-4.5 hours of symptom onset).

    • Antiplatelets: Aspirin, Clopidogrel to prevent clot formation.

    • Anticoagulants: Warfarin, Dabigatran, Rivaroxaban for long-term clot prevention.

  2. Hemorrhagic Stroke:

    • Antihypertensives: To manage high blood pressure.

    • Medications to reduce intracranial pressure: Mannitol or hypertonic saline.

    • Antiepileptics: To prevent seizures (if indicated).

  3. Other Supportive Medications:

    • Statins for cholesterol management.

    • Pain relievers (non-opioid).

    • Stool softeners to avoid straining.

Nursing Management:

  1. Acute Phase:

    • Airway and Breathing: Ensure patent airway, administer oxygen if needed.

    • Circulation: Monitor vital signs and maintain blood pressure within prescribed limits.

    • Neurological Assessment: Perform frequent checks using tools like the Glasgow Coma Scale (GCS).

    • Positioning: Elevate head of the bed (30°) to reduce intracranial pressure.

    • Medications: Administer prescribed medications promptly and monitor for side effects.

    • Prevent Complications:

      • Monitor for deep vein thrombosis (DVT).

      • Prevent aspiration by managing dysphagia.

      • Regularly reposition to avoid pressure ulcers.

  2. Rehabilitation Phase:

    • Encourage independence in activities of daily living (ADLs).

    • Implement physical therapy to regain motor skills.

    • Include occupational therapy for fine motor skills.

    • Provide speech therapy for communication issues.

  3. Psychosocial Support:

    • Support emotional needs of the patient and family.

    • Educate about lifestyle changes and medication adherence.

    • Address depression and anxiety.

Rehabilitation:

  1. Physical Rehabilitation:

    • Exercises to improve strength, balance, and coordination.

    • Use of assistive devices like walkers or braces.

  2. Speech and Swallowing Therapy:

    • Work with a speech therapist to address aphasia or dysarthria.

    • Implement dietary modifications for safe swallowing.

  3. Occupational Therapy:

    • Training to regain skills for daily activities like dressing and eating.

  4. Cognitive Rehabilitation:

    • Activities to enhance memory, attention, and problem-solving skills.

  5. Emotional and Social Support:

    • Join support groups for stroke survivors.

    • Provide counseling to cope with lifestyle changes.

  6. Preventive Measures:

    • Maintain a healthy diet.

    • Regular exercise.

    • Smoking cessation.

    • Manage chronic conditions like diabetes and hypertension.

Stroke management is multidisciplinary, involving timely intervention, comprehensive nursing care, and ongoing rehabilitation to improve patient outcomes.

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