CEREBROVASCULAR ACCIDENT

• CVA is the medical term for a stroke. A stroke is when blood flow to a part of your brain
is stopped either by a blockage or the rupture of a blood vessel.

• Is a sudden loss of brain function resulting from a disruption of blood supply to a part of
the brain.

Epidemiology

• According to the latest WHO data published in 2017 Stroke Deaths in the Philippines
reached 87,402 or 14.12% of total deaths. The age adjusted Death Rate is 134.74 per
100,000 of population ranks Philippines #29 in the world.

• Stroke is the Philippines’ second leading cause of death.

Types of Cerebrovascular Accident

• There are two main types of CVA or stroke; ischemic stroke is caused by a blockage; a
hemorrhagic stroke is caused by the rupture of a blood vessel. Both types of stroke
deprive part of the brain of blood and oxygen, causing brain cells to die.

Ischemic stroke

- is the most common and occurs when a blood clot blocks a blood vessel and prevents
blood and oxygen from getting to a part of the brain. One way is an embolic stroke,
which occurs when a clot forms somewhere else in your body and gets lodged in a blood
vessel in the brain. The other way is a thrombotic stroke, which occurs when the clot
forms in a blood vessel within the brain.

Hemorrhagic stroke

- Occurs when a blood vessel ruptures, or hemorrhages, and then prevents blood from
getting to part of the brain. The hemorrhage may occur in any blood vessel in the brain,
or it may occur in the membrane surrounding the brain.
Pathophysiology

 The factors that affect cerebral blood flow can be divided into extracranial and
intracranial factors.
 Extra cranial factors are primarily related to the circulatory system. They include
(1) systemic blood pressure, (2) cardiac output, and (3) viscosity of blood.

 Intracranial factors
- Metabolic Factors – are important intracranial factors involved in the
regulation of cerebral blood flow. Metabolic factors which result in vasodilation
with restoration of blood flow toward normal include high carbon dioxide
concentration and low oxygen tension. Carbon dioxide, however, is the most
potent regulator of cerebral blood flow.

- Blood vessels – the condition of blood vessels supplying the brain also
influences the cerebral blood flow. Atherosclerosis from any cause increases
resistance in the blood vessels and further reduces blood flow.

- Intracranial Pressure – is another factor that influences cerebral blood flow.

 Atherosclerosis, a common pathophysiological process in stroke. Usually

Risk factors

Nonreversible:

• Age, race, and heredity. Incidence of stroke is higher for men than for women.

Reversible:

• Hypertension, cardiac disease, diabetes mellitus, blood lipid abnormalities, and certain
lifestyle factors. The most important risk factor associated with stroke is hypertension.
Available evidence suggests that treatment of HPN is the only significant contributor to
the prevention of stroke.

• Excessive intake of alcohol

• Obesity

Symptoms of CVA

• The quicker you can get a diagnosis and treatment for a stroke, the better your
prognosis will be. For this reason, it’s important to understand and recognize the
symptoms of a stroke.

• Stroke symptoms include:

• difficulty walking

• dizziness

• loss of balance and coordination

• difficulty speaking or understanding others who are speaking

• numbness or paralysis in the face, leg, or arm, most likely on just one side of the body

• blurred or darkened vision

• a sudden headache, especially when accompanied by nausea, vomiting, or dizziness

The symptoms of a stroke can vary depending on the individual and where in the brain it
has happened. Symptoms usually appear suddenly, even if they’re not very severe, and they
may become worse over time.

• Remembering the acronym “FAST” helps people recognize the most common symptoms
of stroke:

-Face: Does one side of the face droop?

-Arm: If a person holds both arms out, does one drift downward?

-Speech: Is their speech abnormal or slurred?

-Time: It’s time to call 911 and get to the hospital if any of these symptoms are
present.
Diagnosis of Cerebrovascular Accident

• Healthcare providers have a number of tools to determine whether you’ve had a stroke.
Your healthcare provider will administer a full physical examination, during which
they’ll check your strength, reflexes, vision, speech, and senses. They’ll also check for a
particular sound in the blood vessels of your neck. This sound, which is called a bruit,
indicates abnormal blood flow. Finally, they will check your blood pressure, which may
be high if you’ve had a stroke.

• Your doctor may also perform diagnostic tests to discover the cause of the stroke and
pinpoint its location. These tests may include one or more of the following:

• Blood tests: Your healthcare provider may want to test your blood for clotting time,
blood sugar levels, or infection. These can all affect the likelihood and progression of a
stroke.

• Angiogram: An angiogram, which involves adding a dye to your blood and taking an X-
ray of your head, can help your doctor find the blocked or haemorrhaged blood vessel.

• CT scan: A CT scan is often performed soon after symptoms of a stroke develop. The test
can help your provider find the problem area or other problems that might be
associated with stroke.

• MRI scan: An Magnetic Resonance Imaging can provide a more detailed picture of the
brain compared to CT scan. It’s more sensitive than a CT scan in being able to detect a
stroke.

• Echocardiogram: This imaging technique uses sound waves to create a picture of your
heart. It can help your provider find the source of blood clots.

• Electrocardiogram (EKG): This is an electrical tracing of your heart. This will help your
healthcare provider determine if an abnormal heart rhythm is the cause of a stroke.

Medical Management

• Administration of medications such as:

• Osmotic diuretics (Mannitol)

• Corticosteroids (Dexamethasone)

• Anticonvulsants (Tegretol, Dilantin)

• Analgesics (Morphine Sulfate)

• Anti-coagulants (Coumadin)

• Anti-hypertensive (Nicardipine)

• Neuroprotective (Nootropil)

Surgical management

• Craniectomy – surgical procedure wherein a portion of the cranium is removed to

• Craniotomy – surgical procedure wherein the cranial vault is opened to visualize and
relieve pressure on the brain.

Nursing priorities

• Promote adequate cerebral perfusion and oxygenation.

• Prevent/ minimize complications and permanent disabilities.

• Assist patient to gain independence in activity daily livings.

• Support coping process and integration of changes into self-concept.

• Provide information about the disease process/ prognosis and treatment/ rehabilitation
needs.

Nursing Interventions

• Determine factors related to individual situation

• Monitor / documentation neurological status frequently and compare with baseline

• Monitor vital signs

• Assess higher functions, including speech, if patient is alert.

• Position head slightly elevated and in neutral position.

• Maintain bed rest; provide rest periods between care activities, limit duration of
procedures.

• Administer supplemental oxygen as indicated.

• Ensure safety at all times.

Preventive Measures

• Leading a healthy lifestyle

• Quitting smoking

• Maintaining a healthy weight

• Daily exercise

• Following a healthy diet

• DASH (dietary approaches to stop hypertension) - high in fruits and vegetables, low fat
dairy products, low in animal proteins.