STROKE (THE COMPLICATED BRAIN DISEASE)

  stroke

 

 

stroke is also called as CVA(cerebral vascular accident) or brain attack.

 

what is a stroke?

 

it is the loss of function due to disruption of blood supply to a part of the brain.

 

ü     mainly our brain has two parts or made up of two hemispheres .if there is the disruption of blood supply to any part of the brain then it leads to brain attacks like loss of function, memory loss and paralysis.

 

stroke is mainly two types

 

ü ischemic stroke

 

ü haemorrhagic stroke

 

what is an ischemic stroke?

 

ü ischemic stroke occurs in 80% of cases.

 

ü ischemic a stroke occurs due to mainly two cases one is thrombosis and another one is an embolism.

 

ü here thrombosis means hard clot and embolism means moveable clot.

 

ü besides it atherosclerosis and atrial fibrillation also the main cause of stroke.

 

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what is a haemorrhagic stroke?

 

ü in 20% of cases the hemorrhagic stroke occurs.

 

ü it occurs because the cerebral blood vessels rupture.

 

ü the increase blood pressure, thrombus formation, av malfunction, aneurism, anticoagulation therapy are the main factors of haemorrhagic stroke.

 

TIA(transient ischemic attack)

 

ü it is a vital warning sign before the stroke.

 

ü it occurs when blood flow to the brain is temporarily blocked.

 

ü it is for few seconds to minutes( not for 24 hrs)

 

ü recovery occurs between the stroke.

 

clinical features

 

ü if the brain stroke occurs in the left side of the brain than the right side body parts become paralysed.

 

ü hemiplegia( opposite side body parts paralysed)

 

ü hemiparesis ( weakness)

 

ü dysarthria( difficulty in speaking)

 

ü dysphasia( defect in speak)

 

Ø expressive dysphasia

 

Ø receptive dysphasia

 

Ø global dysphasia

 

ü apraxia(in ability to perform the previously learnt activity)

 

ü agnosia( patient unable to recognize familiar objects like memory loss)

 

ü hemianopia( half blindness or half of the visual field becomes loss)

 

ü common           (both eye half visual field blindness occurs)

 

ü neglect syndrome ( unaware about the existence of paralysis )

 

ü loss of proprioception(ability to perceive the position and motion of body part)

 

management

 

ü thrombolytic therapy is used in ischemic stroke.

 

ü it  is as a recombinant tPA(tissue plasminogen activator)

 

ü it should be given within 3 hrs in 0.9 mg /mm in min and maximum is 90 mg/ mm

 

ü 10% of the calculated dose calculated for I min and the remaining amount should be given in an infusion pump.

 

ü after giving thrombolytic therapy the iv line should be flushed in 20ml of normal saline.

 

ü after that we should check the vitals of the first 2hr in every 15 mins. then the next vitals checked in next 3 hrs in every 30 mins.

 

ü then the remaining 16 hrs, the vitals should be checked in every 1 min.

 

ü the side effects of the thrombolytic agents are bleeding.

 

CRITERIA FOR ADMINISTRATION OF THROMBOLYTIC AGENTS

 

ü blood pressure should be checked, the systolic should be less than 185 and diastolic should be less than 110

 

ü the client should not receive heparin in the past 48 hrs.

 

ü history of the patient is that there is no intracranial haemorrhage.

 

ü there was no surgical procedure occurs within 14 days.

 

ü there is no history of stroke or serious head injury in the past 3 months.

 

ü there is no history of gi bleed and any kind of urinary bleeding.

 

ü administration of heparin in low molecular weight.

 

ü try to reduce the ICP( intracranial pressure)

 

ü carotid enterotomy to remove thrombus

 

ü craniotomy

 

ü we should approach the pt in the unaffected side. ( heminorexia means unaffected site approach)

 

ü position of the pt should be a change in 2 hrly in the unaffected side and 20 mins in the affected site.

 

conclusion

 

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