Page 260 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 245

Nursing Interventions

The nurse will address all patient concerns honestly and compassionately.
Patient misconceptions about his or her illness will be clarified.
Explain all procedures to the patient to reduce anxiety prior to and during
treatment.
Provide reassurance as it pertains to prognosis.
Teach patient and family health care resources available to them to enhance
recovery.

Cerebrovascular Accident (CVA)

What Went Wrong?
A stroke or brain attack is a form of neurologic damage caused by an occlusion
or interruption of normal blood circulation to the brain. The two types of
strokes are ischemic and hemorrhagic. Hemorrhagic strokes are further subdi-
vided into subarachnoid and intracerebral hemorrhage.
An ischemic stroke usually results from a clot that occludes a blood vessel
and creates a loss of blood supply to the brain. Clots can develop from an accu- Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
mulation of fatty or atherosclerotic plaque in the blood vessels. Risk factors
include hypertension, obesity, smoking, elevated blood lipids, stress, diabetes,
and a familial history of cardiac and other vascular diseases.

Interpreting Test Results
A CAT scan is the initial step in identifying the cause of a stroke as clear images
of the brain structures are outlined to reveal offending blood clots, active bleeding,
or aneurysms. The results of an EEG, laboratory, and arterial blood gas analysis are
valuable in measuring the patient’s total baseline profile for comparison.

Hallmark Signs and Symptoms
A sudden onset of symptoms usually indicates an embolism as the incriminating
offender to an ischemic stroke. Symptoms are classic and include hemiparesis,
aphasia, and hemianopsia (which is blindness in one-half of the visual field).
At times individuals may experience TIAs or transient ischemic attacks,
which are brief episodes of strokelike symptoms that disappear within a short
period of time after onset and are precursors or warning signs to an actual
stroke event.
Medical management of an ischemic stroke includes treating complications
such as cerebral edema or seizure activity. Certain patients may be eligible to