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STROKESTROKE
Presenter:Presenter:
Abdul MajidAbdul Majid
Aga Khan University HospitalAga Khan University Hospital
Date:Da...
LEARNING OBJECTIVESLEARNING OBJECTIVES
• Define Stroke, And Its Types?Define Stroke, And Its Types?
• What Is TIA?What Is ...
3
How Serious Is Stroke in theHow Serious Is Stroke in the
USUS??
• About 700,000 strokes occur eachAbout 700,000 strokes ...
Relative Incidence of AtherothromboticRelative Incidence of Atherothrombotic
Stroke and MI by Age and GenderStroke and MI ...
STROKESTROKE
A stroke is caused by the interruption ofA stroke is caused by the interruption of
the blood supply to the br...
TYPES:TYPES:
1) ISCHEMIC STROKE1) ISCHEMIC STROKE
Occurs when a clot or a mass clogs a bloodOccurs when a clot or a mass c...
2) HEMORRHAGIC STROKE2) HEMORRHAGIC STROKE
• Results from a weakened vessel that ruptures andResults from a weakened vesse...
Two Major Types of StrokeTwo Major Types of Stroke
Transient Ischemic StrokeTransient Ischemic Stroke
(TIA)(TIA)
• When blood flow to part of the brain stops forWhen blood f...
Up to approximately 30% of people who sufferUp to approximately 30% of people who suffer
transient attacks (TIAs) will dev...
DIRECT CAUSES:DIRECT CAUSES:
• CEREBRAL THROMBOSISCEREBRAL THROMBOSIS
• a blood clot or plaque blocks an artery thata bloo...
• RISK FACTORS:RISK FACTORS:
• Being over age 55Being over age 55
• Being an African-AmericanBeing an African-American
• H...
Risk Factors for Stroke ThatRisk Factors for Stroke That
Cannot Be ChangedCannot Be Changed
• Increased ageIncreased age
•...
Risk Factor For Stroke:Risk Factor For Stroke:
TreatableTreatable
MajorMajor
• HypertensionHypertension
• Heart disease, e...
Common STROKE symptomsCommon STROKE symptoms
Weakness or paralysisWeakness or paralysis
Numbness, tingling, decreased se...
ACT F.A.S.TACT F.A.S.T
F – FACEF – FACE
• Ask the person to smile. Does one side of the face droop?Ask the person to smile...
ASSESSMENTASSESSMENT
Monitor for signs and symptomsMonitor for signs and symptoms
• Symptoms will vary based on the area o...
Left and Right Hemisphere Stroke:Left and Right Hemisphere Stroke:
Left (Dominant)Left (Dominant)
Hemisphere Stroke:Hemisp...
STROKE PREVENTIONSTROKE PREVENTION
• Get screened for high BP.Get screened for high BP.
• Have your cholesterol level chec...
DiagnosisDiagnosis
• HistoryHistory
• Examination.Examination.
• (whooshing sound over neck,(whooshing sound over neck,
wh...
Cholestrol level:Cholestrol level:
22
Continue. .Continue. .
• Computerized tomography (CT) scan.Computerized tomography (CT) scan.
• Magnetic resonance imaging...
TreatmentTreatment
• Anticoagulants (Heparin, Warfarin)Anticoagulants (Heparin, Warfarin)
• Antiplatelets (aspirin, clopid...
NURSING DIAGNOSISNURSING DIAGNOSIS
• Ineffective tissue perfusion (cerebral)Ineffective tissue perfusion (cerebral)
• Dist...
NURSING CONSIDERATIONSNURSING CONSIDERATIONS
• Maintain patent airwayMaintain patent airway
• Monitor for changes in the c...
Continue. . .Continue. . .
• Maintain skin integrity.Maintain skin integrity.
• Encourage PROM every 2 hr to the affected ...
ComplicationsComplications
• Loss of Muscle Control/ParalysisLoss of Muscle Control/Paralysis
• Speech ProblemsSpeech Prob...
THAT’S iT..!!THAT’S iT..!!
THANK YOU FORTHANK YOU FOR
LiSTENiNG!LiSTENiNG! 
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  1. 1. STROKESTROKE Presenter:Presenter: Abdul MajidAbdul Majid Aga Khan University HospitalAga Khan University Hospital Date:Date: 19 Jan 201519 Jan 2015
  2. 2. LEARNING OBJECTIVESLEARNING OBJECTIVES • Define Stroke, And Its Types?Define Stroke, And Its Types? • What Is TIA?What Is TIA? • Discuss Causes & Risk Factor OfDiscuss Causes & Risk Factor Of Stroke?Stroke? • Assess Sign & Symptom Of Stroke?Assess Sign & Symptom Of Stroke? • Discuss The Diagnosis & Management.Discuss The Diagnosis & Management. • Nursing Diagnosis & Consideration.Nursing Diagnosis & Consideration. • Complication Of Stroke.Complication Of Stroke.
  3. 3. 3 How Serious Is Stroke in theHow Serious Is Stroke in the USUS?? • About 700,000 strokes occur eachAbout 700,000 strokes occur each year.year. • Over 167,000 deaths each year.Over 167,000 deaths each year. • #3 killer.#3 killer. • A leading cause of serious long-termA leading cause of serious long-term disability in adults.disability in adults. • 4.7 million stroke survivors.4.7 million stroke survivors.
  4. 4. Relative Incidence of AtherothromboticRelative Incidence of Atherothrombotic Stroke and MI by Age and GenderStroke and MI by Age and Gender
  5. 5. STROKESTROKE A stroke is caused by the interruption ofA stroke is caused by the interruption of the blood supply to the brain, usuallythe blood supply to the brain, usually because a blood vessel bursts or isbecause a blood vessel bursts or is blocked by a clot. This cuts off theblocked by a clot. This cuts off the supply of oxygen and nutrients, causingsupply of oxygen and nutrients, causing damage to the brain tissue.damage to the brain tissue. Also called “Also called “brain attackbrain attack”, cerebral”, cerebral infarction, cerebral hemorrhage,infarction, cerebral hemorrhage, ischemic stroke or strokeischemic stroke or stroke
  6. 6. TYPES:TYPES: 1) ISCHEMIC STROKE1) ISCHEMIC STROKE Occurs when a clot or a mass clogs a bloodOccurs when a clot or a mass clogs a blood vessel, cutting off the blood flow to brain cells.vessel, cutting off the blood flow to brain cells. The underlying condition for this type ofThe underlying condition for this type of obstruction is the development of fatty depositsobstruction is the development of fatty deposits lining the vessel walls. This condition is calledlining the vessel walls. This condition is called atherosclerosis.atherosclerosis. Almost 85% of strokes are ischemicAlmost 85% of strokes are ischemic ATHEROSCLEROSISATHEROSCLEROSIS It’s the process in which deposits of fattyIt’s the process in which deposits of fatty substances, cholesterol, cellular waste products,substances, cholesterol, cellular waste products, calcium and other substances build up in the innercalcium and other substances build up in the inner lining of an artery. This buildup is called plaque.lining of an artery. This buildup is called plaque.
  7. 7. 2) HEMORRHAGIC STROKE2) HEMORRHAGIC STROKE • Results from a weakened vessel that ruptures andResults from a weakened vessel that ruptures and bleeds into the surrounding brain. The bloodbleeds into the surrounding brain. The blood accumulates and compresses the surrounding brainaccumulates and compresses the surrounding brain tissue.tissue. • About 15% of all strokes but responsible for 30% ofAbout 15% of all strokes but responsible for 30% of stroke deathsstroke deaths TWO (02) TYPESTWO (02) TYPES  SUBARACHNOID HEMORRHAGE (SAH)SUBARACHNOID HEMORRHAGE (SAH) occurs when a blood vessel on the surface of the brainoccurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and theruptures and bleeds into the space between the brain and the skullskull  INTRACEREBRAL HEMORRHAGE (ICH)INTRACEREBRAL HEMORRHAGE (ICH) Occurs when a blood vessel bleeds into the tissue deep withinOccurs when a blood vessel bleeds into the tissue deep within the brain.the brain.
  8. 8. Two Major Types of StrokeTwo Major Types of Stroke
  9. 9. Transient Ischemic StrokeTransient Ischemic Stroke (TIA)(TIA) • When blood flow to part of the brain stops forWhen blood flow to part of the brain stops for a short period of time, also called transienta short period of time, also called transient ischemic attack (TIA). These symptomsischemic attack (TIA). These symptoms appear and last less than 24 hours beforeappear and last less than 24 hours before disappearing. While TIAs generally do notdisappearing. While TIAs generally do not cause permanent brain damage, they are acause permanent brain damage, they are a serious warning sign that a stroke mayserious warning sign that a stroke may happen in the future and should not behappen in the future and should not be ignored.ignored. • When people use the term "ministroke," whatWhen people use the term "ministroke," what they're really often referring to is a transientthey're really often referring to is a transient ischemic attack (TIA) — a temporaryischemic attack (TIA) — a temporary interruption of blood flow to part of the brain.interruption of blood flow to part of the brain.
  10. 10. Up to approximately 30% of people who sufferUp to approximately 30% of people who suffer transient attacks (TIAs) will develop a stroketransient attacks (TIAs) will develop a stroke within 5 years.within 5 years.
  11. 11. DIRECT CAUSES:DIRECT CAUSES: • CEREBRAL THROMBOSISCEREBRAL THROMBOSIS • a blood clot or plaque blocks an artery thata blood clot or plaque blocks an artery that supplies a vital brain centersupplies a vital brain center • CEREBRAL HEMORRHAGE/ANEURYSMCEREBRAL HEMORRHAGE/ANEURYSM • an artery in the brain bursts, weakens thean artery in the brain bursts, weakens the aneurysm wall; severe rise in BP causinganeurysm wall; severe rise in BP causing hemorrhage and ischemiahemorrhage and ischemia • CEREBRAL EMBOLISMCEREBRAL EMBOLISM • a blood clot breaks off from a thrombus elsewherea blood clot breaks off from a thrombus elsewhere in the body, lodges in a blood vessel in the brainin the body, lodges in a blood vessel in the brain and shuts off blood supply to that part of the brainand shuts off blood supply to that part of the brain
  12. 12. • RISK FACTORS:RISK FACTORS: • Being over age 55Being over age 55 • Being an African-AmericanBeing an African-American • Having diabetesHaving diabetes • Having a family history of strokeHaving a family history of stroke • MEDICAL STROKE RISKMEDICAL STROKE RISK • Previous strokePrevious stroke • Previous episode of transient ischemic attack (TIA)Previous episode of transient ischemic attack (TIA) • High cholesterolHigh cholesterol • High blood pressureHigh blood pressure • Heart diseaseHeart disease
  13. 13. Risk Factors for Stroke ThatRisk Factors for Stroke That Cannot Be ChangedCannot Be Changed • Increased ageIncreased age • Being maleBeing male • Race (e.g., African-Americans)Race (e.g., African-Americans) • Diabetes mellitusDiabetes mellitus • Prior stroke/transient ischemic attacksPrior stroke/transient ischemic attacks • Family history of strokeFamily history of stroke • Asymptomatic carotid bruitAsymptomatic carotid bruit
  14. 14. Risk Factor For Stroke:Risk Factor For Stroke: TreatableTreatable MajorMajor • HypertensionHypertension • Heart disease, esp. atrial fibrillationHeart disease, esp. atrial fibrillation • Cigarette smokingCigarette smoking • Transient ischemic attacksTransient ischemic attacks • DyslipidemiaDyslipidemia • Physical inactivityPhysical inactivity • ObesityObesity
  15. 15. Common STROKE symptomsCommon STROKE symptoms Weakness or paralysisWeakness or paralysis Numbness, tingling, decreased sensationNumbness, tingling, decreased sensation Vision changesVision changes Speech problemsSpeech problems Swallowing difficulties or droolingSwallowing difficulties or drooling Loss of memoryLoss of memory Vertigo (spinning sensation)Vertigo (spinning sensation) Loss of balance and coordinationLoss of balance and coordination Personality changesPersonality changes Mood changes (depression, apathy)Mood changes (depression, apathy) Drowsiness, lethargy, or loss of consciousnessDrowsiness, lethargy, or loss of consciousness Uncontrollable eye movements or eyelidUncontrollable eye movements or eyelid droopingdrooping
  16. 16. ACT F.A.S.TACT F.A.S.T F – FACEF – FACE • Ask the person to smile. Does one side of the face droop?Ask the person to smile. Does one side of the face droop? A – ARMSA – ARMS • Ask the person to raise both arms. Does one arm driftAsk the person to raise both arms. Does one arm drift downward?downward? S – SPEECHS – SPEECH • Ask the person to repeat a simple sentence. Does theAsk the person to repeat a simple sentence. Does the speech sound slurred or strange?speech sound slurred or strange? T – TIMET – TIME • Call 911 ImmediatelyCall 911 Immediately
  17. 17. ASSESSMENTASSESSMENT Monitor for signs and symptomsMonitor for signs and symptoms • Symptoms will vary based on the area of the brain thatSymptoms will vary based on the area of the brain that is not adequately supplied with oxygenated bloodis not adequately supplied with oxygenated blood • Assess/Monitor Airway patencyAssess/Monitor Airway patency • Swallowing ability/aspiration riskSwallowing ability/aspiration risk • Level of consciousnessLevel of consciousness • Neurological statusNeurological status • Motor, sensory and cognitive functionsMotor, sensory and cognitive functions • Glasgow Coma Scale scoreGlasgow Coma Scale score
  18. 18. Left and Right Hemisphere Stroke:Left and Right Hemisphere Stroke: Left (Dominant)Left (Dominant) Hemisphere Stroke:Hemisphere Stroke: Right (Non-dominant)Right (Non-dominant) Hemisphere Stroke:Hemisphere Stroke: • AphasiaAphasia • Right hemiparesisRight hemiparesis • Right-sided sensory lossRight-sided sensory loss • Right visual field defectRight visual field defect • Poor right conjugate gazePoor right conjugate gaze • DysarthriaDysarthria • Difficulty reading, writing,Difficulty reading, writing, or calculatingor calculating • Neglect of left visual fieldNeglect of left visual field • Extinction of left-sidedExtinction of left-sided stimulistimuli • Left hemiparesisLeft hemiparesis • Left-sided sensory lossLeft-sided sensory loss • Left visual field defectLeft visual field defect • Poor left conjugate gazePoor left conjugate gaze • DysarthriaDysarthria • Spatial disorientationSpatial disorientation
  19. 19. STROKE PREVENTIONSTROKE PREVENTION • Get screened for high BP.Get screened for high BP. • Have your cholesterol level checked.Have your cholesterol level checked. LDL should be lower than 70 mg/dL.LDL should be lower than 70 mg/dL. • Follow a low-fat diet.Follow a low-fat diet. • Quit smoking!Quit smoking! • Exercise!Exercise! • Limit alcohol intake!Limit alcohol intake!
  20. 20. DiagnosisDiagnosis • HistoryHistory • Examination.Examination. • (whooshing sound over neck,(whooshing sound over neck, which may indicate hardening orwhich may indicate hardening or narrowing (atherosclerosis) of thenarrowing (atherosclerosis) of the carotid arteries.)carotid arteries.) • use an ophthalmoscope to checkuse an ophthalmoscope to check for signs of tiny cholesterolfor signs of tiny cholesterol crystalscrystals or clots in the bloodor clots in the blood vessels at thevessels at the back of your eyes.back of your eyes. 21
  21. 21. Cholestrol level:Cholestrol level: 22
  22. 22. Continue. .Continue. . • Computerized tomography (CT) scan.Computerized tomography (CT) scan. • Magnetic resonance imaging (MRI).Magnetic resonance imaging (MRI). • Carotid ultrasound.Carotid ultrasound. • Cerebral angiogram.Cerebral angiogram. • Echocardiogram.Echocardiogram. 23
  23. 23. TreatmentTreatment • Anticoagulants (Heparin, Warfarin)Anticoagulants (Heparin, Warfarin) • Antiplatelets (aspirin, clopidogrelAntiplatelets (aspirin, clopidogrel • StatinStatin • ARB (-sartan), or ACE inhibitor + HCTZARB (-sartan), or ACE inhibitor + HCTZ • Carotid endarterectomy if indicatedCarotid endarterectomy if indicated • Carotid or intracranial stent.Carotid or intracranial stent. • Risk factor control!!!Risk factor control!!!
  24. 24. NURSING DIAGNOSISNURSING DIAGNOSIS • Ineffective tissue perfusion (cerebral)Ineffective tissue perfusion (cerebral) • Disturbed sensory perceptionDisturbed sensory perception • Impaired physical mobilityImpaired physical mobility • Risk for injuryRisk for injury • Self-care deficitSelf-care deficit • Impaired verbal communicationImpaired verbal communication • Impaired swallowingImpaired swallowing
  25. 25. NURSING CONSIDERATIONSNURSING CONSIDERATIONS • Maintain patent airwayMaintain patent airway • Monitor for changes in the client’s level ofMonitor for changes in the client’s level of consciousnessconsciousness • Assist with communication skills if the client’sAssist with communication skills if the client’s speech is impaired.speech is impaired. • Assist with safe feeding.Assist with safe feeding. • Assess swallowing reflexes.Assess swallowing reflexes. • Thicken liquid to avoid aspiration.Thicken liquid to avoid aspiration. • Eat in an upright position and swallow with the head and neckEat in an upright position and swallow with the head and neck flexed slightly forward.flexed slightly forward. • Place food in the back of the mouth on the unaffected side.Place food in the back of the mouth on the unaffected side. • Suction on standby.Suction on standby.
  26. 26. Continue. . .Continue. . . • Maintain skin integrity.Maintain skin integrity. • Encourage PROM every 2 hr to the affected extremitiesEncourage PROM every 2 hr to the affected extremities and AROM every 2 hr to the unaffected extremities.and AROM every 2 hr to the unaffected extremities. • Elevate the affected extremities to promote venousElevate the affected extremities to promote venous return and to reduce swelling.return and to reduce swelling. • Maintain a safe environment to reduce the risks of falls.Maintain a safe environment to reduce the risks of falls. • Provide care to prevent deep-vein thrombosisProvide care to prevent deep-vein thrombosis (sequential compression stockings, frequent position(sequential compression stockings, frequent position changes, mobilization)changes, mobilization)
  27. 27. ComplicationsComplications • Loss of Muscle Control/ParalysisLoss of Muscle Control/Paralysis • Speech ProblemsSpeech Problems • Swallowing DifficultiesSwallowing Difficulties • Cognitive ImpairmentsCognitive Impairments • NumbnessNumbness • PainPain • Loss of IndependenceLoss of Independence • Personality and Mood ChangesPersonality and Mood Changes • DepressionDepression • Shortened Life SpanShortened Life Span 28
  28. 28. THAT’S iT..!!THAT’S iT..!! THANK YOU FORTHANK YOU FOR LiSTENiNG!LiSTENiNG! 
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