A stroke, also medically known as a cerebrovascular accident (CVA) or cerebrovascular disease (CVD), is a medical emergency that can have severe consequences if not addressed quickly and effectively. It is one of the leading causes of disability and death worldwide, affecting millions of individuals and their loved ones annually.
In this article, we will discuss the causes, risks, disease process, treatment options, and diagnostic procedures associated with stroke, providing a comprehensive overview to help nurses and student nurses better understand this critical health issue and provide the necessary nursing interventions.
What is a stroke?
A stroke is a condition in which blood flow is disrupted to certain parts of the brain. This disruption can be caused by either a blockage (ischemic stroke) or bleeding (hemorrhagic stroke) in the blood vessels supplying the brain. Without the nutrients and oxygen carried by the blood, the brain cells will rapidly die, causing irreversible damage.
Types of Stroke
- Ischemic Stroke An ischemic stroke occurs when a blood vessel supplying the brain becomes blocked, preventing oxygen and nutrients from reaching the brain cells. This condition is usually reversible, and the blockage can be caused by either a thrombotic or embolic stroke.
- Thrombotic strokes: A blood clot forms within a blood vessel in the brain.
- Embolic strokes: A blood clot or plaque debris travels from another part of the body to the brain.
- Hemorrhagic Stroke A hemorrhagic stroke happens when a blood vessel in the brain leaks, causing bleeding into the surrounding tissues. This usually leads to irreversible damage. This can be due to:
- Intracerebral hemorrhage: Bleeding occurs from blood vessels within the brain, often due to high blood pressure.
- Subarachnoid hemorrhage: Bleeding occurs in the space between the brain and the membranes that cover it, often caused by an aneurysm or arteriovenous malformation (AVM).
Cause of Stroke
A stroke happens when the blood supply to the brain is interrupted, either due to a blockage (ischemic stroke) or a rupture (hemorrhagic stroke) in the blood vessels. The most common causes of stroke include the following:
- High Blood Pressure: Uncontrolled hypertension is one of the major risk factors for stroke, as it can damage blood vessels and increase the likelihood of blockages or ruptures.
- Atherosclerosis: The accumulation of fat deposits in the blood vessels can lead to blockages, reducing blood flow to the brain.
- Blood Clots: Clots that form in the blood can travel to the brain and block blood flow, leading to stroke.
- Heart Diseases: Conditions such as atrial fibrillation, heart failure, and heart valve problems can increase the risk of stroke.
- Atrial fibrillation: A type of irregular heartbeat where the atria (upper chambers of the heart) beat rapidly and irregularly. This can lead to blood clots forming in the heart, which can then travel to the brain and cause a stroke.
- Heart failure: This occurs when the heart is unable to pump enough blood to meet the body’s needs. This can lead to blood pooling in the veins, which can increase the risk of blood clots forming. These clots can then travel to the brain and cause a stroke.
- Diabetes: If not managed well, diabetes can damage blood vessels and increase the risk of stroke. Diabetes is often associated with high blood pressure, and increased blood sugar makes the blood more viscous, which can lead to blood clots.
- Smoking: Smoking is a significant risk factor for stroke, as cigarette components can damage blood vessels and increase blood pressure.
- Family History: Having a family history of stroke or other cardiovascular conditions can increase your risk.
Risks
Several factors can increase the risk of having a stroke. These include:
- Age: The risk of stroke increases with age, particularly at the age of 55 and above.
- Sex: Men are more likely to develop a stroke than women. The risk for women increases after menopause.
- Ethnicity: Certain ethnic groups, such as African Americans, Hispanics, and Native Americans, are at higher risk for stroke.
- Medical Conditions: Certain medical conditions, such as high blood pressure, diabetes, and heart disease, can increase the risk of stroke.
- Lifestyle Factors: Smoking, physical inactivity, and an unhealthy diet can all contribute to an increased risk of stroke.
Diagnostic Procedures
Diagnosing stroke requires a combination of medical history, physical examination, and diagnostic tests. The following procedures are commonly used:
- Computed Tomography (CT) Scan: A CT scan helps identify areas of bleeding in the brain and rule out other conditions.
- Magnetic Resonance Imaging (MRI): An MRI can provide detailed images of the brain and help detect areas of damage.
- Electroencephalogram (EEG): An EEG can help diagnose seizures and other neurological conditions associated with stroke.
- Blood Tests: Blood tests can help identify underlying medical conditions that may be contributing to the stroke.
F.A.S.T. Assessment Tool
There are many assessment tools utilized by healthcare professionals in determining the presence of stroke. Among these tools is the most common assessment – FAST (Face, Arms, Speech, Time). The FAST assessment tool is a simple and fast approach used by nurses to quickly identify the signs of a stroke and determine the need for urgent medical care. Remember that when a stroke occurs, it is better to assess and take action immediately because every minute counts when a certain part of the brain is not supplied with blood.
Here’s how to use the FAST assessment:
- Face: Ask the person to smile. Look for any facial drooping or an uneven smile, which can indicate one-sided facial weakness, a common sign of stroke.
- Arms: Ask the person to raise both arms. Look for one arm drifting downward, which can indicate arm weakness on one side.
- Speech: Ask the person to repeat a simple phrase. Listen for slurred, garbled, or incomprehensible speech, which can indicate language or speech difficulties.
- Time: If the person shows any of these signs (facial drooping, arm weakness, speech difficulties), it’s time to call the local emergency hotline for immediate services.
The FAST assessment tool is designed to be quick and easy to remember, allowing nurses and first aiders to rapidly identify the most common signs of a stroke. If an individual exhibits any one of the FAST signs, it is highly suggestive of a stroke, and it is recommended to call the local emergency hotline to provide emergency medical care as soon as possible.
Treatment
Prompt medical attention is crucial for effective treatment of stroke. The goal of treatment is to restore blood flow to the brain and prevent further damage. Treatment options include:
Medications Medications such as aspirin, warfarin, and clopidogrel can help prevent blood clots from forming and reduce the risk of further strokes. Thrombolytics such as tPA (tissue plasminogen activator) can help dissolve blood clots and restore blood flow to the brain.
Surgical Procedures Surgical procedures such as carotid endarterectomy can help remove blockages in the blood vessels and improve blood flow to the brain.
Rehabilitation Rehabilitation programs can help patients regain lost motor and cognitive functions after a stroke.
Surgical Treatments
Ischemic Stroke
Surgical treatments for ischemic strokes aim to restore blood flow and prevent further damage. The most common surgical procedures include:
Mechanical Thrombectomy: This involves using a catheter to remove the blood clot from the blocked blood vessel. This procedure is often performed in conjunction with intravenous thrombolytic therapy, which helps dissolve the clot.
Mechanical Embolectomy: Similar to mechanical thrombectomy, this procedure uses a catheter to remove the blood clot from the blocked blood vessel. However, it is typically used for more complex cases where the clot is located in a smaller blood vessel.
Hemorrhagic Stroke
Surgical treatments for hemorrhagic strokes focus on stopping the bleeding, resolving the hematoma (collection of clotted blood outside the blood vessels), and relieving intracranial pressure (pressure within the skull). The primary surgical procedures include:
Craniotomy: This surgical procedure involves opening the skull to access the area of bleeding. The surgeon will remove the blood, repair any damaged blood vessels, and ensure there are no blood clots present that may restrict blood flow to the brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced with an artificial metal plate.
Surgical AVM Removal: If the hemorrhagic stroke is due to an aneurysm or arteriovenous malformation (AVM), the surgeon may remove the AVM to prevent further bleeding.
Angioplasty and Stents: This procedure uses a catheter to open up narrowed arteries and insert stents to support the opened arteries. This helps to improve blood flow to the brain and reduce the risk of further bleeding.
Additional Procedures Other procedures that may be used to treat complications of hemorrhagic strokes include:
- Hydrocephalus Treatment: If the stroke leads to an accumulation of cerebrospinal fluid in the ventricles of the brain, a shunt may be inserted to drain the fluid.
- External Ventricular Drainage: This procedure places a tube in the brain to drain cerebrospinal fluid and relieve pressure on the brain.
- Stereotactic Aspiration: This procedure is minimally invasive. The needle is inserted into the brain to drain the hematoma.
Nursing Interventions for Stroke
Nurses play a vital role in the care and management of patients who have experienced a stroke. Here are some key nursing interventions for stroke patients:
Neurological Assessment and Monitoring
- Continuously monitor the patient’s level of consciousness, pupillary response, motor function, and sensory function.
- Assess for any changes in neurological status, which may indicate the development of complications.
- Perform regular neurological assessments using standardized tools like the National Institutes of Health Stroke Scale (NIHSS).
Airway and Respiratory Management
- Ensure a patent airway and provide supplemental oxygen as needed to maintain adequate oxygenation.
- Monitor for signs of respiratory distress, such as shallow breathing or difficulty breathing.
- Suction secretions as needed and provide respiratory treatments like chest physiotherapy.
Cardiovascular Management
- Monitor vital signs, including blood pressure, heart rate, and temperature.
- Administer medications as prescribed to manage blood pressure and heart rhythm, and prevent complications like deep vein thrombosis.
- Provide positioning and range of motion exercises to promote circulation and prevent complications.
Dysphagia Management
- Assess the patient’s swallowing function and collaborate with a speech therapist.
- Provide appropriate diet modifications, such as thickened liquids, to prevent aspiration.
- Ensure proper positioning during meals and monitor for signs of choking or aspiration.
Skin and Wound Care
- Frequently reposition the patient to prevent pressure ulcers.
- Inspect the skin for any signs of breakdown and implement preventive measures.
- Provide proper skin care, including moisturizing and protecting bony prominences.
Mobility and Rehabilitation
- Collaborate with physical and occupational therapists to develop a rehabilitation plan.
- Assist the patient with a range of motion exercises, ambulation, and activities of daily living as tolerated.
- Provide assistive devices, such as walkers or canes, to promote safe mobility.
- Assess the patient’s emotional and cognitive status, and provide emotional support.
- Involve the patient’s family and caregivers in the rehabilitation process.
- Provide education and resources to help the patient and family cope with the effects of the stroke.
Prevention of Complications
- Implement measures to prevent complications like deep vein thrombosis, pneumonia, and urinary tract infections.
- Administer prophylactic medications, such as anticoagulants or antibiotics, as prescribed.
- Encourage early mobilization and provide appropriate assistive devices.
Conclusion
Stroke is a serious medical condition that requires immediate attention and effective treatment. Understanding the causes, risks, treatment options, and diagnostic tests associated with stroke can help nurses take steps to reduce the risk and improve the chances of recovery. By recognizing the signs and symptoms of stroke and seeking medical help immediately, nurses can help save lives and prevent long-term damage.
Stroke Pathophysiology in Schematic Diagram
References
- Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
- Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. International journal of molecular sciences, 21(20), 7609. https://doi.org/10.3390/ijms21207609
- Murphy, S. J., & Werring, D. J. (2020). Stroke: causes and clinical features. Medicine (Abingdon, England : UK ed.), 48(9), 561–566. https://doi.org/10.1016/j.mpmed.2020.06.002
