Nursing Case Study On Cerebrovascular Accident


I. INTRODUCTIONCerebrovascular accident: The sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is impaired by blockageor rupture of an artery to the brain. A CVA is also referred to as astroke.Symptoms of a stroke depend on the area of the brain affected. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and evenunconsciousness.A stroke is a medical emergency. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis andtreatment.The causes of stroke: An artery to the brain may be blocked by a clot (thrombosis) which typically occurs in a blood vessel that has previously been narrowed due to atherosclerosis ("hardening of the artery"). When a blood clot or a piece of an atherosclerotic plaque (a cholesterol and calciumdeposit on the wall of the artery) breaks loose, it can travel through the circulation and lodge in an artery of the brain, plugging it up and stopping theflow of blood; this is referred to as an embolic stroke. A blood clot can form in a chamber of the heart when the heart beats irregularly, as in atrialfibrillation; such clots usually stay attached to the inner lining of the heart but they may break off, travel through the blood stream, form a plug (embolus)in a brain artery and cause a stroke. A cerebral hemorrhage (bleeding in the brain), as from an aneurysm (a widening and weakening) of a blood vessel inthe brain, also causes stroke.The diagnosis of stroke involves a medical history and a physical examination. Tests are done to search for treatable causes of a stroke and help prevent further brain damage. A CAT scan (a special X-ray study) of the brain is often done to show bleeding into the brain; this is treated differentlythan a stroke caused by lack of blood supply. A CAT scan also can rule out some other conditions that may mimic a stroke. A soundwave of the heart(echocardiogram) may be done to look for a source of blood clots in the heart. Narrowing of the carotid artery (the main artery that supplies blood toeach side of the brain) in the neck can be seen with a soundwave test called a carotid ultrasound. Blood tests are done to look for signs of inflammationwhich can suggest inflamed arteries. Certain blood proteins are tested that can increase the chance of stroke by thickening the blood.Stroke look-alikes: Just because a person has slurred speech or weakness on one side of the body does not necessarily mean that person has had astroke. There are many other nervous system disorders that can mimic a stroke including a brain tumor, a subdural hematoma (a collection of blood between the brain and the skull) or a brain abscess (a pool of pus in the brain caused by bacteria or a fungus). Virus infection of the brain (viral



Cerebrovascular AccidentCerebrovascular Accident is a sudden loss of function resulting from disruption of the blood supply to a part of the brain. Stroke, also called brain attack or ischemicstroke, happens when the arteries leading to the brain are blocked or ruptured. Whenthe brain does not receive the needed oxygen supply, the brain cells begin to die, astroke can cause paralysis, inability to talk, inability to understand, and other conditionsbrought on by brain damage.Four types of stoke:


Cerebral Thrombosis- caused by blood clots.


Cerebral Embolism- caused by blood clots.


Cerebral Hemorrhage- caused by bleeding inside the brain.4.Subarachnoid Hemorrhage- caused by bleeding inside the brain.Cerebral Thrombosis

 The most common type of brain attack.

Occurs when a blood clot (thrombus) forms and blocks blood flow in an arteryleading to the brain arteries primarily affected by atherosclerosis and moresusceptible to blood clots.

Most often occurs at night or in the morning when blood pressure in low.

Often preceded by a transient ischemic attack (TIA) or “mini-stroke”.Cerebral Embolism

Occurs when a wondering clot (embolus) or some other particle forms in a bloodvessel away from the brain, usually in the heart. The clot then travels and lodges inan artery leading on the brain.Cerebral Hemorrhage

Occurs when a defective artery in the brain busts.Subarachnoid Hemorrhage

Occurs when a blood vessel on the surface of the brain ruptures and bleeds intothe space between the brain and the skull. The World Health Organization (WHO) definition of stroke is “rapidly developingclinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting24 hours or longer or leading to death, with no apparent cause other than of (1) Non-communicable disease. WHO Geneva (2) vascular origin” (3) By applying this definitiontransient ischemic attack (TIA), which is defined to less than 24 hours, and patients withstroke symptoms caused by subdural hemorrhage, tumors, poisoning, or trauma, areexcluded.Based from the data gathered from TCGPH records section, there were 10 reportedcases of CVA as of January 2009 until December 2009 comprises of 2 mortality cases and8 morbidity cases.

Why this case?

We have chosen this case as our topic during the case presentation because wewould like that we, student-nurses, to be aware about CVA and also to broaden ourknowledge about the management and treatment of this disease.

Having awareness and gaining more knowledge about CVA would enhance ourskills and attitudes in handling patients suffering from this disease.

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