Nursing Management of Stroke

Stroke Management for Nurses

Stroke can be defined as a neurological deficit of sudden onset that has lasted 24 hours as a result of cerebrovascular disease (CVD), which is a common neurologic disorder in adults (Huddak & Gallo, 1996).

Based on the cause, stroke can be divided into two kinds, namely:

1. Ischemic stroke

Stroke occurs as a result of the blockage of the arteries that causes a decrease suply of oxygen in brain tissue (ischemic) to induce necrosis. 87% of strokes being caused because of blockage in the form of thrombus or embolus. Thrombus is a clot / blockage bersasal of brain blood vessels. Embolus is a clot / blockage from elsewhere, such as the heart or other major artery. Another influential factor is an irregular heartbeat (atrial fibrillation), which is a sign of a blockage in the heart to go out to the brain. The presence of fat accumulation in the brain blood vessels (atherosclerosis) will increase the risk of ischemic stroke.

2. Hemorrhage stroke

Stroke occurs as a result of rupture of the fragile blood vessels in the brain. Two types of blood vessels of the brain that can cause hemorrhagic stroke, namely, aneurysms and arteriovenous malformations (AVMs). Aneurysms are blood vessels developing brain more vulnerable so that the data burst. Arteriovenous malformations are blood vessels that have an abnormal shape, so easy to break and cause a brain hemorrhage.

Risk Factors

Stroke risk factors that can be modified are:
  • high blood pressure
  • diabetes mellitus
  • smoke
  • carotid artery disease and peripheral
  • atrial fibrillation
  • cardiovascular disease (heart failure, congenital heart defects, coronary heart disease, cardiomegaly, kardiomyopathy)
  • transient ischemic attack (TIA)
  • hypercholesterolemia
  • sickle cell disease
  • obesity and lack of activity
  • use of alcohol
  • the use of illegal drugs

Stroke risk factors that can not be modified are:
  • Age: the age, the increased risk of stroke.
  • Gender: Men have a greater risk of suffering a stroke than women.
  • Family history
  • Ever had a stroke

Clinical Manifestations

Patients with vascular disease may indicate a TIA (transient ischemic attact). It is a neurological deficit that can recover within 24 hours, the average duration was 10 minutes, after which the symptoms disappear. Patients also may exhibit reversible ischemic neurologic deficit. These events can occur at TIA that lasted more than 24 hours, but can eventually recover completely. The symptoms seen with TIA is highly dependent on the affected vessels. If the carotid and cerebral arteries are affected, patients can suffer blindness in one eye, hemiplegia, hemianesthesia, speech disorders, and mental derangement. If the vertebrobasilar arteries affected, there will be dizziness, diplopia, tingling, abnormal vision in one or both fields of view, and dysarthria (speech disorder in the muscles). Possible disability related to stroke.

Nursing Management of Stroke

With cerebral infarction are irreversible loss of central brain tissue. Zone around the dead tissue, there may still be salvaged tissue. Early action should be focused as much as possible to save an ischemic area. The three most important elements for the area is oxygen, glucose, and blood flow adequately. Oxygen levels can be monitored via the arterial blood gases and oxygen can be administered to patients if indicated. Hypoglycemia can be evaluated with a series of blood glucose checks. Cerebral perfusion pressure is a reflection of systemic blood pressure, ICT, still functioning autoregulation in the brain as well as heart rate and rhythm. The easiest parameter to be controlled externally is rhythm, heart rate, and blood pressure. Dysrhythmias can usually be repaired. The causes of tachycardia include fever, pain, and dehydration that can be handled. If ICT increases in stroke patients, it usually occurs after the first day. While this is a natural response of the brain to some cerebrovascular lesions, but it is damaging the brain. Destructive responses such as edema, or atrial spasm, sometimes can be prevented or overcome. Common method to control increased intracranial pressure may be performed such as hyperventilation, fluid retention, raised his head, avoiding flexion of the head, and excessive head rotation that could compromise venous return to the head.

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