NUR2755 Section BTP3 Multidimensional Care IV
Module 02 Overview and Activities
Readings
Activity Time: 1 hour and 30 minutes
. Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 45
. Recommended Reading -
. Case Study from the Stroke Association
. NIH Stroke Scale
. ATI: RN Adult Medical Surgical Nursing – Chapters 9, 14, 15
Module 02 Transient Ischemic Attack
Transient Ischemic Attack
- Transient Ischemic Attack (TIA) is a neurologic dysfunction resulting from a brief,
temporary, disruption or disturbance in cerebral blood flow. The symptoms resolve within
30-60 minutes or usually by the time the client reaches the ER. The longest that TIA
symptoms last is 24 hours.
- The neurological deficits that may occur include visual disturbances, mobility, speech,
and sensory perception deficits. Upon arriving to the emergency department, the nurses
would anticipate a full panel laboratory work-up as well as ECG, and a CT scan.
- Monitoring the client’s vital signs is one of the first interventions with great concern for
BP. Elevated blood pressure is one of the main causes of TIA and eventually,
stroke/cerebral vascular accident (CVA). The client may need adjustments of
hypertensive-medications as well as an immediate intervention to lower BP. Anticipate
that the client will also be placed on an antiplatelet drug to prevent CVA. The client
should receive education on the risk factors for having a Stroke or CVA.
Module 02 Stroke/Cerebral Vascular Accident (CVA)
A client that is having a stroke is treated as a medical emergency. The earlier that medical
intervention occurs, the better the chance of reducing or even preventing permanent disability.
Glucose and Oxygen
Glucose and oxygen are the two things the brain cannot store, and therefore the brain requires
a constant uninterrupted blood flow (perfusion). It only takes a few moments for interrupted
blood flow to result in cerebral tissue death. That infarct causes permanent loss of neurological
function in various symptomatology.
Types of Strokes
There are two types of stroke, ischemic and hemorrhagic. Ischemic stroke is caused by a
blockage in the cerebral or carotid artery. A stroke can be caused either by a clot (thrombotic
stroke) or by an embolus (dislodged clot) known as an embolic stroke.
- Hemorrhagic Stroke
- Ischemic Stroke
There is a difference between the two types of strokes, as seen below in the table, in not only
how it occurs, but also in the presentation of the client. Understanding the symptoms and
treatment will assist in developing comprehension of the differences between the two types.
- Characteristics of Stroke/Cerebral Vascular Accident
- Evolution
- Ischemic Stroke
1
, NUR2755 Section BTP3 Multidimensional Care IV
- Thrombotic : Intermittent to complete stroke
- Embolic : Abrupt onset
- Hemorrhagic Stroke
- Abrupt onset
- LOC
- Ischemic Stroke
- Thrombotic : Client is awake
- Embolic : Client is awake
- Hemorrhagic Stroke
- Client is in a deep stupor or coma
- Primary Cause(s)
- Ischemic Stroke
- Thrombotic :
- HTN uncontrolled
- Obesity
- Diabetes
- Sedentary lifestyle
- Carotid stenosis
- Embolic : Cardiac disease (Atrial Fibrillation)
- Hemorrhagic Stroke
- HTN
- Aneurysms
- Arteriovenous malformation
- Cerebral aneurysm
- Cocaine use
- Warning Signs
- Ischemic Stroke
- Thrombotic :
- TIA (warning)
- Mild headache, speech deficits, visual problems
- Embolic : TIA (warning)
- Hemorrhagic Stroke
- Increased intracranial pressure (ICP)
- Treatment
- Ischemic Stroke
- Thrombotic :
- IV Fibrinolytic Therapy
- American Association new time frame to administer
after onset of symptoms to 4.5 hours
- Blood pressure has to be below 185/110. Best
practice to keep SBP between 140 and 150 to
promote cerebral tissue perfusion
- Contraindications of fibrinolytic therapy if client meets the
criteria of one or more of the following categories;
- Older than 80 years
- Anticoagulation regardless of international
normalized ratio (INR)
2
Module 02 Overview and Activities
Readings
Activity Time: 1 hour and 30 minutes
. Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 45
. Recommended Reading -
. Case Study from the Stroke Association
. NIH Stroke Scale
. ATI: RN Adult Medical Surgical Nursing – Chapters 9, 14, 15
Module 02 Transient Ischemic Attack
Transient Ischemic Attack
- Transient Ischemic Attack (TIA) is a neurologic dysfunction resulting from a brief,
temporary, disruption or disturbance in cerebral blood flow. The symptoms resolve within
30-60 minutes or usually by the time the client reaches the ER. The longest that TIA
symptoms last is 24 hours.
- The neurological deficits that may occur include visual disturbances, mobility, speech,
and sensory perception deficits. Upon arriving to the emergency department, the nurses
would anticipate a full panel laboratory work-up as well as ECG, and a CT scan.
- Monitoring the client’s vital signs is one of the first interventions with great concern for
BP. Elevated blood pressure is one of the main causes of TIA and eventually,
stroke/cerebral vascular accident (CVA). The client may need adjustments of
hypertensive-medications as well as an immediate intervention to lower BP. Anticipate
that the client will also be placed on an antiplatelet drug to prevent CVA. The client
should receive education on the risk factors for having a Stroke or CVA.
Module 02 Stroke/Cerebral Vascular Accident (CVA)
A client that is having a stroke is treated as a medical emergency. The earlier that medical
intervention occurs, the better the chance of reducing or even preventing permanent disability.
Glucose and Oxygen
Glucose and oxygen are the two things the brain cannot store, and therefore the brain requires
a constant uninterrupted blood flow (perfusion). It only takes a few moments for interrupted
blood flow to result in cerebral tissue death. That infarct causes permanent loss of neurological
function in various symptomatology.
Types of Strokes
There are two types of stroke, ischemic and hemorrhagic. Ischemic stroke is caused by a
blockage in the cerebral or carotid artery. A stroke can be caused either by a clot (thrombotic
stroke) or by an embolus (dislodged clot) known as an embolic stroke.
- Hemorrhagic Stroke
- Ischemic Stroke
There is a difference between the two types of strokes, as seen below in the table, in not only
how it occurs, but also in the presentation of the client. Understanding the symptoms and
treatment will assist in developing comprehension of the differences between the two types.
- Characteristics of Stroke/Cerebral Vascular Accident
- Evolution
- Ischemic Stroke
1
, NUR2755 Section BTP3 Multidimensional Care IV
- Thrombotic : Intermittent to complete stroke
- Embolic : Abrupt onset
- Hemorrhagic Stroke
- Abrupt onset
- LOC
- Ischemic Stroke
- Thrombotic : Client is awake
- Embolic : Client is awake
- Hemorrhagic Stroke
- Client is in a deep stupor or coma
- Primary Cause(s)
- Ischemic Stroke
- Thrombotic :
- HTN uncontrolled
- Obesity
- Diabetes
- Sedentary lifestyle
- Carotid stenosis
- Embolic : Cardiac disease (Atrial Fibrillation)
- Hemorrhagic Stroke
- HTN
- Aneurysms
- Arteriovenous malformation
- Cerebral aneurysm
- Cocaine use
- Warning Signs
- Ischemic Stroke
- Thrombotic :
- TIA (warning)
- Mild headache, speech deficits, visual problems
- Embolic : TIA (warning)
- Hemorrhagic Stroke
- Increased intracranial pressure (ICP)
- Treatment
- Ischemic Stroke
- Thrombotic :
- IV Fibrinolytic Therapy
- American Association new time frame to administer
after onset of symptoms to 4.5 hours
- Blood pressure has to be below 185/110. Best
practice to keep SBP between 140 and 150 to
promote cerebral tissue perfusion
- Contraindications of fibrinolytic therapy if client meets the
criteria of one or more of the following categories;
- Older than 80 years
- Anticoagulation regardless of international
normalized ratio (INR)
2
