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Miss M. N. PRIYADARSHANIE ( BSc . Nursing )

Miss M. N. PRIYADARSHANIE ( BSc . Nursing ) NURSING MANAGEMENT OF A CLIENT WITH ALTERED CEREBRAL TISSUE PERFUSION. Stroke Definition : That stroke is a disease affects the blood vessels That blood supply to the brain.

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Miss M. N. PRIYADARSHANIE ( BSc . Nursing )

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  1. Miss M. N. PRIYADARSHANIE ( BSc . Nursing ) NURSING MANAGEMENT OF A CLIENT WITH ALTERED CEREBRAL TISSUE PERFUSION

  2. Stroke Definition :That stroke is a disease affects the blood vessels That blood supply to the brain. • Without blood to supply oxygen and Nutrients and to remove waste products, brain cells begin to die Quickly.

  3. What are the Risk factors for stroke • Trombus • Emboli • Haemorrhage (ICH) • DM

  4. The cause of stroke • An interruption in the blood supply, with a resulting depletion of oxygen and glucose in the affected area. This reduces or abolishes IMMEDIATELY neuronal function, • Impairing brain function

  5. TRANSIENT ISCHAEMIC ATTACK • It is a focal deficit lasting less than 24 hours • Due to passage of microemboli • Complete neurological recovery • Risk factor is the thromboembolic stroke

  6. Clinical features • Aphasia • Hemiparesis • Hemi sensory loss • Hemi anopic visual loss

  7. Investigations • MRI • CT • BLOOD GLUCOSE • UREA AND ELECTROLYTE • FBC • INR • ESR • ECG

  8. TREATMENT • r- TPA therapy for trombolysis (within 3 hours) for TIA • WHAT ARE THE CONTRAINDICATIONS…. • Heparin therapy • Anti hypertensives • Aspirin – 300mg daily

  9. Secondary prevention • Aspirin – 75 mg daily • Statin – 40mg daily • Warfarin therapy • Internal carotid endartectomy

  10. Prognosis • Die Within 2yrs • 25% cure

  11. In the Acute phase • Maintain airway and adequate ventilation • Maintain neurologic flow sheets • Assess quality and PR • Monitor UOP • Note any bleeding • Elevate head of the bed

  12. Meeting Physical Care Needs • Care of the Stroke Affected Side • Loss of Consciousness • Promoting Urinary Continence - the use of urinary catheters • Promoting Faecal Continence • Care of the Patient Wearing Anti Embolism Stockings • Prevention of Pressure Ulcers • Dysphagia • Nutrition • Oral Hygiene • Care of the Dying

  13. Psychological, emotional and communication needs. • Visual Changes • Communication • Safety • Thinking Processes • Emotions • Behavioural Changes • Monitor patient’s pulmonary complications • Monitor for heart abnormalities

  14. Watching for Bowel and Bladder Problems • Stroke patients often have bowel and bladder problems • Constipation. • Mobilizing the Patient When the progression of a stroke has been stabilized, it is time to mobilize the patient the deaths within 30 days after an ischemic stroke

  15. Protecting Against Skin Damage • Neurological deficits, e.g., a reduced level of consciousness or a loss of sensation, put stroke patients at increased risk for skin damage • Maintaining Hydration and Nutrition Dehydration or malnutrition will slow a patient’s recovery. Dehydration also predisposes a patient to deep venous thrombosis.

  16. Patient Education • Why they are taking an antiplatelet drug • How the drug works • What specific dangers the drug poses • The addition of which other drugs will worsen the risk of bleeding • That antiplatelet therapy will continue for their entire lifetime

  17. 1. A 77-year-old woman was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms: - paralysis of the right face and arm- loss of sensation to touch on the skin of the right face and arm - inability to answer questions but ability to understand what was said to her - ability to write down her thoughts more easily than to speak them

  18. 2.A 61-year-old business executive with a long history of high blood pressure collapsed while jogging over the lunch hour. His jogging mate quickly contacted a police officer who helped carry the man to a hospital just down the road. At the hospital, an MRI was performed that revealed a blockage of a major cerebral artery and ischemic changes to the portion of the brain supplied by that artery. With quick medical attention, the man was stabilized, and he slowly improved over the next three weeks. The following signs and symptoms did persist, however: - paralysis of the right leg and foot - loss of sensation on the skin of the right leg and foot - inability to throw the tennis ball with his left hand, but ability to throw it with his right hand

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