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Medical-Surgical Nursing

Summary

Medical-Surgical NursingSummary

15.1 The Cerebrovascular System and Cerebral Vascular Accidents

  • The brain is a complex collection of vasculature and tissues. The brain itself comprises the cerebrum, the brainstem, and the cerebellum. The brain is protected by the skull and the meninges. The cranial nerves are responsible for the sensory and motor functions of the head and neck.
  • Different areas of the brain are perfused by different branches of the circle of Willis (CoW). The functions of brain cells are dependent on perfusion needs.
  • A CVA, or stroke, is an interruption of the blood flow to areas of the brain. Treatment of CVA is targeted at rapidly restoring perfusion needs, since the longer the brain is without proper blood flow, the greater the damage.
  • A CVA can be ischemic (resulting from a vessel occlusion impairing blood flow) or hemorrhagic (resulting from bleeding within the brain impairing blood flow).

15.2 Ischemic Stroke

  • An ischemic stroke results from a thrombus or embolus occluding blood flow in the brain. Ischemic strokes account for 87 percent of strokes.
  • A head CT without contrast is the standard for first diagnosing a stroke. Subsequent imaging and laboratory blood testing will help practitioners determine the cause and treatment.
  • The presentation and treatment of acute ischemic stroke differ from those of hemorrhagic strokes, but the care provided by the nurses and other intradisciplinary care team members is relatively similar.
  • The medical treatments for acute ischemic stroke include administration of IV tPA and thrombectomy.
  • The goals of care focus on saving the brain, minimizing the lasting effects or disability caused by the stroke, and preventing future strokes.

15.3 Hemorrhagic Stroke

  • A hemorrhagic stroke results from bleeding into the brain caused by the rupture of a blood vessel. Hemorrhagic strokes are classified as intracerebral hemorrhages (ICH) or subarachnoid hemorrhages (SAH).
  • A head CT is the standard for first diagnosing a stroke. Subsequent imaging and laboratory blood testing will help practitioners determine the cause and treatment.
  • The presentation of and treatment for hemorrhagic strokes may differ from those of ischemic strokes, but the care provided by the nurses and other interdisciplinary care team members is relatively similar. All methods are focused on patient safety and providing the best possible outcome.
  • The medical treatments for hemorrhagic stroke include hematoma evacuation and craniectomy.
  • The goals of care focus on stopping the bleeding, determining the cause of the bleeding, controlling blood pressure, and monitoring and controlling intracranial pressure.
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