Stroke Nursing (CVA) Cerebrovascular Accident Ischemic Hemorrhagic Symptoms Treatment tPA

Stroke nursing NCLEX review (CVA) cerebrovascular accident lecture on ischemic and hemorrhagic strokes along with nursing care, tPA, symptoms, treatments, and pathophysiology.

A stroke occurs when blood rich in oxygen can NOT reach brain cells (due to either a blockage or bleeding) and the cells begin to die.

Types of stroke:

Ischemic (most common) is due to a blood clot within the blood vessel or stenosis of an artery feeding the brain tissue. This limits the blood that can reach the brain cells. This can happen due to:

-Embolism: where a clot has left a part of the body (example the clot has left the heart due to a heart valve problem or atrial fibrillation) and has travelled to the brain, which stops blood flow.

-Thrombosis: a clot forms within the artery wall within the neck or brain. This is seen in patients with hyperlipidemia and atherosclerosis

Hemorrhagic: there is bleeding in the brain due to a break in a blood vessel. There will be limited blood flow to the brain cells and this can cause excessive swelling in the brain from the leakage of blood in the brain tissue. A ruptured brain aneurysm or uncontrolled hypertension can cause this.

In addition, a patient can experience a TIA (transient ischemic attack) also called a mini-stroke. This is where signs and symptoms of a stroke last only a few minutes to hours and resolve. It is a warning signs an impending stroke may occur.

Stroke symptoms include: facial drooping, arm numbness or weakness, slurred speech or difficulty talking etc.

Treatment for stroke (specifically an ischemic type) is tPA (tissue plasminogen activator). This medication works to dissolve the clot that has caused th decreased blood flow. However, tPA must be administered within 3 hours of the onset of stroke symptoms.

Nursing care for stroke includes: monitoring vitals (especially blood pressure, respiratory status), watching and educating the patient with neglect syndrome (this most likely occurs with patients who've had a right brain injury), diet and swallowing techniques, hemianopsia, and how to communicate with a patient with aphasia (watch the video for more in depth nursing interventions for stroke).

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