Cerebrovascular Accident Nursing Care Plan & Management

 Definition

  • A cerebrovascular accident (CVA), an ischemic stroke or “brain attack,” is a sudden loss of brain function resulting from Cerebral Vascular Accident (Ischemic Stroke) a disruption of the blood supply to a part of the brain.
Description
  • Stroke is the primary cerebrovascular disorder in the United States.
  • Strokes are usually hemorrhagic (15%) or ischemic/nonhemorrhagic (85%).
  • Ischemic strokes are categorized according to their cause: large artery thrombotic strokes (20%), small penetrating artery thrombotic strokes (25%), cardiogenic embolic strokes (20%), cryptogenic strokes (30%), and other (5%).
  • Cryptogenic strokes have no known cause, and other strokes result from causes such as illicit drug use, coagulopathies, migraine, and spontaneous dissection of the carotid or vertebral arteries.
  • The result is an interruption in the blood supply to the brain, causing temporary or permanent loss of movement, thought, memory, speech, or sensation.
Risk Factors
Nonmodifable
  • Advanced age (older than 55 years)
  • Gender (Male)
  • Race (African American)
Modifable
  • Hypertension
  • Atrial fibrillation
  • Hyperlipidemia
  • Obesity
  • Smoking
  • Diabetes
  • Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis, prosthetic heart valves)
  • Periodontal disease
Pathophysiology

 Clinical Manifestations

General signs and symptoms include numbness or weakness of face, arm, or leg (especially on one side of body); confusion or change in mental status; trouble speaking or understanding speech; visual disturbances; loss of balance, dizziness, difficulty walking; or sudden severe headache.

Motor Loss
  • Hemiplegia, hemiparesis
  • Flaccid paralysis and loss of or decrease in the deep tendon reflexes (initial clinical feature) followed by (after 48 hours) reappearance of deep reflexes and abnormally increased muscle tone (spasticity)
Communication Loss
  • Dysarthria (difficulty speaking)
  • Dysphasia (impaired speech) or aphasia (loss of speech)
  • Apraxia (inability to perform a previously learned action)
Perceptual Disturbances and Sensory Loss
  • Visualperceptual dysfunctions (homonymous hemianopia [loss of half of the visual field])
  • Disturbances in visualspatial relations (perceiving the relation of two or more objects in spatial areas), frequently seen in patients with right hemispheric damage
  • Sensory losses: slight impairment of touch or more severe with loss of proprioception; difficulty in interrupting visual, tactile, and auditory stimuli