Hello Everyone, here is a Cerebrovascular Disorders lecture on the topics of Cerebrovascular Accident (CVA) and Aneurysm made easy to understand to help aide in your study sessions. I have gathered all of the important information from my Med- Surg Book (Brunners and Suddarth 12th edition) that will prepare you for your nursing test whether it is for school or NCLEX.
Part 2 of this lecture will be located under the Pharmacology section due to the fact that it will cover more about the treatment of various medications.
Here are some Extra information that may help and guide you in understanding Cerebrovascular Disorders, complications of ischemic and hemorrhagic surgical procedures, safety measures for patient after a stroke, and NIH Stroke Scale; along with links to visualize some surgical procedures:
Carotid Endarterectomy Complications and Nursing Interventions
COMPLICATION: Incision Hematoma
CHARACTERISTICS: Occurs in 5.5% of patients. Large or rapidly expanding hematomas require emergency treatment. If the airway is obstructed by the hematoma, the incision may be opened at the bedside.
NURSING INTERVENTIONS: Monitor neck discomfort and wound expansion. Report swelling, subjective feelings of pressure in the neck, difficulty breathing.
COMPLICATION: Hypertension (HTN)
CHARACTERISTICS: Poorly controlled hypertension increases the risk of postoperative complications, including hematoma and hyperperfusion syndrome. There is an increased incidence of neurologic impairment and death due to intracerebral hemorrhage. May be related to surgically induced abnormalities of carotid baroreceptor sensitivity.
NURSING INTERVENTIONS: Risk is highest in the first 48 h after surgery. Check blood pressure frequently and report deviations from baseline. Observe for and report new onset of neurologic deficits.
COMPLICATION: Postoperative hypotension
CHARACTERISTICS: Occurs in approximately 5% of patients. Treated with fluids and low-dose phenylephrine infusion. Usually resolves in 24–48 h. Patients with hypotension should have serial ECGs to rule out myocardial infarction.
NURSING INTERVENTIONS: Monitor blood pressure and observe for signs and symptoms of hypotension.
COMPLICATION: Hyperperfusion syndrome
CHARACTERISTICS: Occurs when cerebral vessel autoregulation fails. Arteries accustomed to diminished blood flow may be permanently dilated; increased blood flow after endarterectomy coupled with insufficient vasoconstriction leads to capillary bed damage, edema, and hemorrhage.
NURSING INTERVENTIONS: Observe for severe unilateral headache improved by sitting upright or standing.
COMPLICATION: Intracerebral hemorrhage
CHARACTERISTICS: Occurs infrequently, but is often fatal (60%) or results in serious neurologic impairment. Can occur secondary to hyperperfusion syndrome. Increased risk with advanced age, hypertension, presence of high-grade stenosis, poor collateral flow, and slow flow in the region of the middle cerebral artery.
NURSING INTERVENTIONS: Monitor neurologic status and report any changes in mental status or neurologic functioning immediately.
Complications of Surgical Procedures of a Hemorrhagic Stroke:
Secondary stroke and rupture of the aneurysm are still potential complications. Postoperative complications include psychological symptoms (disorientation, amnesia, Korsakoff’s syndrome, personality changes), intraoperative embolization, postoperative internal artery occlusion, fluid and electrolyte disturbances (from dysfunction of the neurohypophyseal system), and gastrointestinal bleeding.
Assistive Devices to Enhance Self-care After Stroke:
Eating Devices
• Nonskid mats to stabilize plates
• Plate guards to prevent food from being pushed off plate
• Wide-grip utensils to accommodate a weak grasp
Bathing and Grooming Devices
• Long-handled bath sponge
• Grab bars, nonskid mats, handheld shower heads
• Electric razors with head at 90 degrees to handle
• Shower and tub seats, stationary or on wheels
Toileting Aids
• Raised toilet seat
• Grab bars next to toilet
Dressing Aids
• Velcro closures
• Elastic shoelaces
• Long-handled shoe horn
Mobility Aids
• Canes, walkers, wheelchairs
• Transfer devices such as transfer boards and belts
NIH Stroke Scale
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coiling of Aneurysm
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clipping of Aneurysm
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Carotid Endarterectomy
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Carotid Artery Stenting
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Carotid Angioplasty and stenting
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