stroke

Focus on StrokeFocus on Stroke

Mr Alexander Elutilo RN MSNMr Alexander Elutilo RN MSN

Stroke Animation

http://www.youtube.com/watch?v=pcmrgwNCPwM

StrokeStroke

• Ischemia is inadequate blood flow Ischemia is inadequate blood flow

• Stroke occurs when there is ischemia to Stroke occurs when there is ischemia to a part of the brain that results in death a part of the brain that results in death of brain cellsof brain cells

• Also known as Also known as brain attackbrain attack

Stroke Stroke

• Functions are lost or impairedFunctions are lost or impaired Such as movement, sensation, or emotions Such as movement, sensation, or emotions

that were controlled by the affected area that were controlled by the affected area of the brain of the brain

• Severity of the loss of function varies Severity of the loss of function varies according to the location and extent of according to the location and extent of the brain involved the brain involved

Risk FactorsRisk Factors

• Most effective way to decrease the Most effective way to decrease the burden of stroke is preventionburden of stroke is prevention

• Risk factors can be divided into Risk factors can be divided into nonmodifiable and modifiable risksnonmodifiable and modifiable risks

Risk FactorsRisk FactorsNonmodifiableNonmodifiable• AgeAge

• GenderGender

• RaceRace

• Heredity/family history Heredity/family history

Risk FactorsRisk FactorsModifiableModifiable • HypertensionHypertension

• Metabolic syndromeMetabolic syndrome

• Heart diseaseHeart disease

• Heavy alcohol consumptionHeavy alcohol consumption

• Poor dietPoor diet

• Drug abuse Drug abuse

Risk FactorsRisk FactorsModifiableModifiable• ObesityObesity

• Physical inactivityPhysical inactivity

• Smoking Smoking

Etiology and PathophysiologyEtiology and Pathophysiology

• Blood is supplied to the brain by two Blood is supplied to the brain by two major pairs of arteriesmajor pairs of arteries Internal carotid arteriesInternal carotid arteries Vertebral arteries Vertebral arteries


• Carotid arteries branch to supply most Carotid arteries branch to supply most of theof the Frontal, parietal, and temporal lobesFrontal, parietal, and temporal lobes Basal gangliaBasal ganglia Part of the diencephalonPart of the diencephalon

Thalamus Hypothalamus


• Vertebral arteries join to form the Vertebral arteries join to form the basilar artery, which suppliesbasilar artery, which supplies Middle and lower temporal lobesMiddle and lower temporal lobes Occipital lobesOccipital lobes CerebellumCerebellum BrainstemBrainstem Part of the diencephalon Part of the diencephalon

Cerebral Arteries Cerebral Arteries

Fig. 58-1


• Brain requires a continuous supply of Brain requires a continuous supply of blood to provide the oxygen and blood to provide the oxygen and glucose neurons need to function glucose neurons need to function

Etiology and Pathophysiology Etiology and Pathophysiology

• If blood flow to brain is totally If blood flow to brain is totally interrupted interrupted Neurologic metabolism is altered in 30 Neurologic metabolism is altered in 30

secondsseconds Metabolism stops in 2 minutesMetabolism stops in 2 minutes Cellular death occurs in 5 minutes Cellular death occurs in 5 minutes

Etiology and Pathophysiology Etiology and Pathophysiology

• Brain is normally well protected from Brain is normally well protected from changes in mean systemic arterial changes in mean systemic arterial blood pressure by a mechanism known blood pressure by a mechanism known as cerebral autoregulationas cerebral autoregulation


• Atherosclerosis is the hardening and Atherosclerosis is the hardening and thickening of arteries and is a major thickening of arteries and is a major cause of strokecause of stroke

• Can lead to thrombus formation and Can lead to thrombus formation and contribute to emboli contribute to emboli

Sites for AtherosclerosisSites for Atherosclerosis

Fig. 58-2


• Around the core area of ischemia is a Around the core area of ischemia is a border zone of ↓ blood flow border zone of ↓ blood flow

• Ischemia is potentially reversible Ischemia is potentially reversible


• If adequate blood flow can be restored If adequate blood flow can be restored early (<3 hours) and the ischemic early (<3 hours) and the ischemic cascade can be interrupted cascade can be interrupted Less brain damage and less neurologic Less brain damage and less neurologic

function lost function lost


• Transient ischemic attackTransient ischemic attack (TIA) is a (TIA) is a temporary focal loss of neurologic temporary focal loss of neurologic function caused by ischemia function caused by ischemia

• Most TIAs resolve within 3 hoursMost TIAs resolve within 3 hours


• TIAs may be due to microemboli that TIAs may be due to microemboli that temporarily block the blood flowtemporarily block the blood flow

• TIAs are a warning sign of progressive TIAs are a warning sign of progressive cerebrovascular disease cerebrovascular disease

Types of Stroke Types of Stroke

• Strokes are classified based on the Strokes are classified based on the underlying pathophysiologic findings underlying pathophysiologic findings IschemicIschemic Hemorrhagic Hemorrhagic

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

• Ischemic Stroke Animation

http://www.youtube.com/watch?v=TurvAQqyVP0

Major Types of StrokeMajor Types of Stroke

Fig. 58-3

Ischemic StrokeIschemic Stroke

• Ischemic strokes result from Ischemic strokes result from Inadequate blood flow to the brain from Inadequate blood flow to the brain from

partial or complete occlusion of an arterypartial or complete occlusion of an artery

• 80% of all strokes are ischemic strokes80% of all strokes are ischemic strokes

Ischemic Stroke Ischemic Stroke

• Ischemic strokes can beIschemic strokes can be ThromboticThrombotic EmbolicEmbolic


• Thrombotic strokeThrombotic stroke Thrombosis occurs in relation to injury to Thrombosis occurs in relation to injury to

a blood vessel wall and formation of a a blood vessel wall and formation of a blood clotblood clot

Result of thrombosis or narrowing of the Result of thrombosis or narrowing of the blood vesselblood vessel

Most common cause of stroke Most common cause of stroke


• Thrombotic strokeThrombotic stroke Two-thirds are associated with Two-thirds are associated with

hypertension and diabetes mellitus hypertension and diabetes mellitus Often preceded by a TIAOften preceded by a TIA


• Embolic strokeEmbolic stroke Occurs when an embolus lodges in and Occurs when an embolus lodges in and

occludes a cerebral arteryoccludes a cerebral artery Results in infarction and edema of the Results in infarction and edema of the

area supplied by the involved vesselarea supplied by the involved vessel Second most common cause of strokeSecond most common cause of stroke


• Embolic strokeEmbolic stroke Onset of embolic stroke is usually sudden Onset of embolic stroke is usually sudden

and may or may not be related to activityand may or may not be related to activity Patient usually remains conscious Patient usually remains conscious

although may have a headache although may have a headache


• Embolic strokeEmbolic stroke Often occurs rapidlyOften occurs rapidly Recurrence is common unless the Recurrence is common unless the

underlying cause is aggressively treatedunderlying cause is aggressively treated

Hemorrhagic StrokeHemorrhagic Stroke

• Account for approximately 15% of all Account for approximately 15% of all strokesstrokes

• Result from bleeding into the brain Result from bleeding into the brain tissue itself or into the subarachnoid tissue itself or into the subarachnoid space or ventriclesspace or ventricles


• Intracerebral hemorrhageIntracerebral hemorrhage Bleeding within the brain caused by Bleeding within the brain caused by

rupture of a vesselrupture of a vessel Hypertension is the most important causeHypertension is the most important cause Hemorrhage commonly occurs during Hemorrhage commonly occurs during

periods of activity periods of activity


• Intracerebral hemorrhageIntracerebral hemorrhage Often a sudden onset of symptoms, with Often a sudden onset of symptoms, with

progression over minutes to hours progression over minutes to hours because of ongoing bleeding because of ongoing bleeding


• Intracerebral hemorrhageIntracerebral hemorrhage Manifestations Manifestations

Neurologic deficits Headache Nausea and/or vomiting Decreased levels of consciousness Hypertension


• Subarachnoid hemorrhageSubarachnoid hemorrhage An aneurysm may be saccular or berryAn aneurysm may be saccular or berry Majority of aneurysms are in the circle Majority of aneurysms are in the circle

of Willisof Willis ““Worst headache of one’s lifeWorst headache of one’s life””


• Subarachnoid hemorrhageSubarachnoid hemorrhage Most frequent surgical procedure to Most frequent surgical procedure to

prevent rebleeding is clipping of the prevent rebleeding is clipping of the aneurysm aneurysm

Clinical ManifestationsClinical Manifestations

• Affects many body functionsAffects many body functions

• Motor activityMotor activity

• EliminationElimination

• Intellectual functionIntellectual function

• Spatial-perceptual alterationsSpatial-perceptual alterations

Clinical ManifestationsClinical Manifestations

• PersonalityPersonality

• AffectAffect

• SensationSensation

• Communications Communications

Manifestations of Right-Brain Manifestations of Right-Brain and Left-Brain Strokeand Left-Brain Stroke

Fig. 58-5

Clinical ManifestationsClinical ManifestationsMotor FunctionMotor Function• Most obvious effect of strokeMost obvious effect of stroke

• Include impairment ofInclude impairment of MobilityMobility Respiratory functionRespiratory function Swallowing and speechSwallowing and speech Gag reflexGag reflex Self-care abilities Self-care abilities

Clinical ManifestationsClinical ManifestationsCommunicationCommunication• Patient may experience aphasia when a Patient may experience aphasia when a

stroke damages dominant hemisphere stroke damages dominant hemisphere of the brainof the brain AphasiaAphasia is a total loss of comprehension is a total loss of comprehension

and use of languageand use of language

Clinical ManifestationsClinical ManifestationsCommunicationCommunication• DysphasiaDysphasia refers to difficulty related to refers to difficulty related to

the comprehension or use of language the comprehension or use of language and is due to partial disruption or lossand is due to partial disruption or loss

Clinical ManifestationsClinical ManifestationsCommunicationCommunication• Many patients experience Many patients experience dysarthriadysarthria

Disturbance in the muscular control of Disturbance in the muscular control of speechspeech

• Impairments may involve Impairments may involve PronunciationPronunciation ArticulationArticulation Phonation Phonation

Clinical ManifestationsClinical ManifestationsCommunicationCommunication• Dysarthria does not affect the meaning Dysarthria does not affect the meaning

of communications or the of communications or the comprehension of languagecomprehension of language

• It does affect the mechanics of speechIt does affect the mechanics of speech

Clinical ManifestationsClinical ManifestationsAffectAffect• Depression and feelings associated with Depression and feelings associated with

changes in body image and loss of changes in body image and loss of function can make this worsefunction can make this worse

• Patients may also be frustrated by Patients may also be frustrated by mobility and communication problemsmobility and communication problems

Clinical ManifestationsClinical ManifestationsIntellectual FunctionIntellectual Function• Both memory and judgment may be Both memory and judgment may be

impaired as a result of strokeimpaired as a result of stroke

• A left-brain stroke is more likely to A left-brain stroke is more likely to result in memory problems related to result in memory problems related to languagelanguage

Clinical ManifestationsClinical ManifestationsSpatial–Perceptual AlterationsSpatial–Perceptual Alterations• Stroke on the right side of the brain is Stroke on the right side of the brain is

more likely to cause problems in more likely to cause problems in spatial-perceptual orientationspatial-perceptual orientation

• However, this may occur with However, this may occur with left-brain stroke left-brain stroke

Clinical ManifestationsClinical ManifestationsEliminationElimination • Most problems with urinary and bowel Most problems with urinary and bowel

elimination occur initially and are elimination occur initially and are temporarytemporary

• When a stroke affects one hemisphere When a stroke affects one hemisphere of the brain, the prognosis for normal of the brain, the prognosis for normal bladder function is excellentbladder function is excellent

Diagnostic StudiesDiagnostic Studies

• When symptoms of a stroke occur, When symptoms of a stroke occur, diagnostic studies are done todiagnostic studies are done to Confirm that it is a strokeConfirm that it is a stroke Identify the likely cause of the strokeIdentify the likely cause of the stroke

• CT is the primary diagnostic test used CT is the primary diagnostic test used after a strokeafter a stroke


• CT should be obtained within CT should be obtained within 25 minutes and read within 45 minutes 25 minutes and read within 45 minutes of arrival at ERof arrival at ER

• CT willCT will Indicate size and location of lesionIndicate size and location of lesion Differentiate between ischemic and Differentiate between ischemic and

hemorrhagic strokehemorrhagic stroke


• Other studies to diagnose a stroke, Other studies to diagnose a stroke, including extent of involvementincluding extent of involvement CTACTA MRI, MRAMRI, MRA SPECTSPECT PETPET MRSMRS


• For cardiac assessmentFor cardiac assessment Electrocardiogram Electrocardiogram Chest x-rayChest x-ray Cardiac enzymesCardiac enzymes Echocardiography Echocardiography


• Additional studiesAdditional studies Complete blood count (CBC)Complete blood count (CBC) Platelets, prothrombin time, activated Platelets, prothrombin time, activated

partial thromboplastin timepartial thromboplastin time Electrolytes, blood glucoseElectrolytes, blood glucose Renal and hepatic studies Renal and hepatic studies Lipid profileLipid profile

Collaborative CareCollaborative CarePreventionPrevention • Priority for Priority for decreasingdecreasing morbidity and morbidity and

mortality from stroke mortality from stroke

• Goals of stroke prevention includeGoals of stroke prevention include Health promotion for the well individualHealth promotion for the well individual Education and management of modifiable Education and management of modifiable

risk factors to prevent a stroke risk factors to prevent a stroke

Collaborative CareCollaborative CarePreventionPrevention• Patients with known risk factors Patients with known risk factors

require close managementrequire close management Diabetes mellitusDiabetes mellitus HypertensionHypertension ObesityObesity High serum lipidsHigh serum lipids Cardiac dysfunctionCardiac dysfunction

Collaborative CareCollaborative CarePreventionPrevention• Smoking should be discontinuedSmoking should be discontinued

• Limited alcohol intakeLimited alcohol intake

• Healthy dietHealthy diet

• Weight controlWeight control

• Regular exerciseRegular exercise

• Routine health examinationsRoutine health examinations

Collaborative CareCollaborative CarePreventionPrevention• Antiplatelet drugs are usually the Antiplatelet drugs are usually the

chosen treatment to prevent further chosen treatment to prevent further stroke in patients who have had a TIAstroke in patients who have had a TIA

• Aspirin is the most frequently used Aspirin is the most frequently used antiplatelet agentantiplatelet agent

Collaborative CareCollaborative CarePreventionPrevention• Surgical interventions for the patient Surgical interventions for the patient

with TIAs from carotid disease includewith TIAs from carotid disease include Carotid endarterectomy Carotid endarterectomy Transluminal angioplastyTransluminal angioplasty StentingStenting Extracranial-intracranial bypass Extracranial-intracranial bypass

Carotid EndarterectomyCarotid Endarterectomy

Fig. 58-6Fig. 58-6

Brain Stent Brain Stent

Fig. 58-7Fig. 58-7

Collaborative CareCollaborative CareAcute CareAcute Care • Goals for collaborative care during the Goals for collaborative care during the

acute phase areacute phase are Preserving lifePreserving life Preventing further brain damagePreventing further brain damage Reducing disability Reducing disability

• Treatment differs according to type of Treatment differs according to type of stroke and as patient changesstroke and as patient changes

Collaborative CareCollaborative CareAcute CareAcute Care• Begins with managing the ABCsBegins with managing the ABCs

AirwayAirway BreathingBreathing CirculationCirculation

Collaborative CareCollaborative CareAcute CareAcute Care• Etiology Etiology

Sudden vascular compromise causing Sudden vascular compromise causing disruption of blood flow to the brain disruption of blood flow to the brain

Thrombosis Thrombosis Trauma Trauma AneurysmAneurysm Embolism Embolism Hemorrhage Hemorrhage

Collaborative CareCollaborative CareAcute CareAcute Care• Assessment findingsAssessment findings

Altered level of consciousnessAltered level of consciousness Weakness, numbness, or paralysisWeakness, numbness, or paralysis Speech or visual disturbancesSpeech or visual disturbances Severe headacheSevere headache ↑↑ or or ↓↓ heart rate heart rate Respiratory distressRespiratory distress Unequal pupils Unequal pupils

Collaborative CareCollaborative CareAcute CareAcute Care• Assessment findingsAssessment findings

HypertensionHypertension Facial drooping on affected sideFacial drooping on affected side Difficulty swallowingDifficulty swallowing SeizuresSeizures Bladder or bowel incontinenceBladder or bowel incontinence Nausea and vomitingNausea and vomiting Vertigo Vertigo

Collaborative CareCollaborative CareAcute CareAcute Care• Interventions: InitialInterventions: Initial

Ensure patient airwayEnsure patient airway Call stroke code or stroke teamCall stroke code or stroke team Remove denturesRemove dentures Perform pulse oximetryPerform pulse oximetry Maintain adequate oxygenationMaintain adequate oxygenation IV access with normal salineIV access with normal saline Maintain BP according to guidelines Maintain BP according to guidelines

Collaborative CareCollaborative CareAcute CareAcute Care• Interventions: Initial Interventions: Initial

Remove clothingRemove clothing Obtain CT scan immediately Obtain CT scan immediately Perform baseline laboratory testsPerform baseline laboratory tests Position head midlinePosition head midline Elevate head of bed 30 degrees if no Elevate head of bed 30 degrees if no

symptoms of shock or injury symptoms of shock or injury

Collaborative CareCollaborative CareAcute CareAcute Care• Interventions: Initial Interventions: Initial

Institute seizure precautionsInstitute seizure precautions Anticipate thrombolytic therapy for Anticipate thrombolytic therapy for

ischemic stroke ischemic stroke

Collaborative CareCollaborative CareAcute CareAcute Care• Hypertension is common immediately after Hypertension is common immediately after

strokestroke Drugs to Drugs to lower BP are used only if BP is lower BP are used only if BP is

markedly increased markedly increased

• Fluid and electrolyte balance must be Fluid and electrolyte balance must be controlled carefullycontrolled carefully Adequate hydration promotes perfusion and Adequate hydration promotes perfusion and

decreases further brain injurydecreases further brain injury

Collaborative CareCollaborative CareAcute CareAcute Care• Interventions: Ongoing Interventions: Ongoing

Monitor vital signs and neurologic statusMonitor vital signs and neurologic status Level of consciousness Monitor and sensory function Pupil size and reactivity O2 saturation

Cardiac rhythm

Collaborative CareCollaborative CareAcute CareAcute Care• Recombinant tissue plasminogen Recombinant tissue plasminogen

activator (tPA)activator (tPA) Used to reestablish blood flow through a Used to reestablish blood flow through a

blocked artery to prevent cell death to blocked artery to prevent cell death to patients with acute onset of ischemic patients with acute onset of ischemic stroke symptoms stroke symptoms

Must be administered within 3 hours of Must be administered within 3 hours of onset of clinical signs of ischemic strokeonset of clinical signs of ischemic stroke

Collaborative CareCollaborative CareAcute CareAcute Care• Aspirin is used within 48 hours of Aspirin is used within 48 hours of

strokestroke

• Platelet inhibitors and anticoagulants Platelet inhibitors and anticoagulants may be used in thrombus and embolus may be used in thrombus and embolus stroke patients after stabilizationstroke patients after stabilization Contraindicated for patients with Contraindicated for patients with

hemorrhagic stroke hemorrhagic stroke

Collaborative CareCollaborative CareAcute CareAcute Care• Approximately 5% to 7% of patients Approximately 5% to 7% of patients

who experience a stroke will have who experience a stroke will have seizures, usually within 24 hours seizures, usually within 24 hours Phenytoin is given if seizures occurPhenytoin is given if seizures occur

Collaborative CareCollaborative CareAcute CareAcute Care• Surgical interventions for stroke Surgical interventions for stroke

Immediate evacuation of Immediate evacuation of Aneurysm-induced hematomas Cerebellar hematomas (>3 cm)

Clipping and Wrapping of Clipping and Wrapping of AneurysmsAneurysms

Fig. 58-8Fig. 58-8

Collaborative CareCollaborative CareRehabilitationRehabilitation • After stroke has stabilized for 12 to 24 After stroke has stabilized for 12 to 24

hours, collaborative care shifts from hours, collaborative care shifts from preserving life to lessening disability preserving life to lessening disability and attaining optimal functioningand attaining optimal functioning

• Patient may be transferred to a Patient may be transferred to a rehabilitation unit, outpatient therapy, rehabilitation unit, outpatient therapy, or home care–based rehabilitationor home care–based rehabilitation

Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment • If the patient is stable, obtainIf the patient is stable, obtain

Description of the current illness with Description of the current illness with attention to initial symptomsattention to initial symptoms

History of similar symptoms previously History of similar symptoms previously experiencedexperienced

Current medications Current medications History of risk factors and other illnessesHistory of risk factors and other illnesses Family history of stroke or cardiovascular Family history of stroke or cardiovascular

diseasedisease

Nursing ManagementNursing ManagementNursing AssessmentNursing Assessment• Comprehensive neurologic examinationComprehensive neurologic examination

Level of consciousnessLevel of consciousness CognitionCognition Motor abilitiesMotor abilities Cranial nerve functionCranial nerve function Sensation Sensation ProprioceptionProprioception Cerebellar function Cerebellar function Deep tendon reflexes Deep tendon reflexes

Nursing ManagementNursing ManagementNursing DiagnosesNursing Diagnoses• Ineffective tissue perfusionIneffective tissue perfusion

• Ineffective airway clearance Ineffective airway clearance

• Impaired physical mobilityImpaired physical mobility

• Impaired verbal communicationImpaired verbal communication

• Unilateral neglectUnilateral neglect

Nursing ManagementNursing ManagementNursing DiagnosesNursing Diagnoses• Impaired urinary elimination Impaired urinary elimination

• Impaired swallowingImpaired swallowing

• Situational low self-esteemSituational low self-esteem

Nursing ManagementNursing ManagementPlanningPlanning• Goals are that the patient willGoals are that the patient will

Maintain stable or improved level of Maintain stable or improved level of consciousnessconsciousness

Attain maximum physical functioningAttain maximum physical functioning Maximize self-care abilities and skillsMaximize self-care abilities and skills Maintain stable body functionsMaintain stable body functions

Nursing ManagementNursing ManagementPlanningPlanning• Goals for patientGoals for patient

Maximize communication abilities Maximize communication abilities Avoid complications of stroke Avoid complications of stroke Maintain effective personal and family Maintain effective personal and family

copingcoping

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• Health promotionHealth promotion

To reduce the incidence of stroke, the To reduce the incidence of stroke, the nurse should focus teaching toward nurse should focus teaching toward stroke preventionstroke prevention Particularly in persons with known risk

factors

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• Health promotionHealth promotion

Teaching patients and families about Teaching patients and families about Early symptoms

Stroke TIA

When to seek health care for symptoms

Loss of Postural Loss of Postural Stability After StrokeStability After Stroke

Fig. 58-12Fig. 58-12

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• Nutrition Nutrition

Nutritional needs require quick Nutritional needs require quick assessment and treatmentassessment and treatment

May initially receive IV infusions to May initially receive IV infusions to maintain fluid and electrolyte balancemaintain fluid and electrolyte balance

May require nutrition supportMay require nutrition support

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• NutritionNutrition

First feeding should be approached First feeding should be approached carefullycarefully Test the swallowing, chewing, gag reflex, and

pocketing before beginning oral feeding Feedings must be followed by scrupulous Feedings must be followed by scrupulous

oral hygiene oral hygiene

Assistive Devices for EatingAssistive Devices for Eating

Fig. 58-13Fig. 58-13

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• CommunicationCommunication

Nurse’s role in meeting psychologic needs Nurse’s role in meeting psychologic needs of the patient is primarily supportive of the patient is primarily supportive

Patient is assessed for both the ability to Patient is assessed for both the ability to speak and the ability to understandspeak and the ability to understand

Speak slowly and calmly, using simple Speak slowly and calmly, using simple words or sentenceswords or sentences

Gestures may be used to support verbal Gestures may be used to support verbal cues cues

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• Sensory-perceptual alterationsSensory-perceptual alterations

Blindness in same half of each visual field Blindness in same half of each visual field is a common problem after strokeis a common problem after stroke Known as homonymous hemianopsia

Other visual problems may include Other visual problems may include Diplopia (double vision) Loss of the corneal reflex Ptosis (drooping eyelid)

Homonymous Hemianopsia Homonymous Hemianopsia (Food on left side is not seen)(Food on left side is not seen)

Fig. 58-11Fig. 58-11

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• CopingCoping

Often a family diseaseOften a family disease Affects family Affects family

Emotionally Socially Financially

Changing roles and responsibilitiesChanging roles and responsibilities

Nursing ManagementNursing ManagementNursing ImplementationNursing Implementation• Ambulatory and home careAmbulatory and home care

Patient is usually discharged from the Patient is usually discharged from the acute care setting to home, an acute care setting to home, an intermediate or long-term care facility, or intermediate or long-term care facility, or a rehabilitation facility a rehabilitation facility


Person who has had a stroke may be Person who has had a stroke may be concerned about the loss of sexual concerned about the loss of sexual function function

Common concerns about sexual activity Common concerns about sexual activity are impotence and the occurrence of are impotence and the occurrence of another stroke during sex another stroke during sex


Speech, comprehension, and language Speech, comprehension, and language deficits are the most difficult problem for deficits are the most difficult problem for the patient and familythe patient and family

Speech therapists can assess and Speech therapists can assess and formulate a plan to support formulate a plan to support communicationcommunication

Nurses can be a role model for patients Nurses can be a role model for patients with aphasiawith aphasia

stroke

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incidence of stroke

inadequate blood flow

brain attack stroke