D. A second stroke in 6 to 12 hours. Exercise is helpful in preventing venous stasis, which may predispose the patient to thrombosis and pulmonary embolus. Gives clear update of situation to seniors. Getting called to see unwell patients is part of the job of a junior doctor so it’s worth having a system in place! Help patient to set realistic goals; add a new task daily. Keep skin clean and dry, gently massage the healthy dry skin and maintain adequate nutrition. Stroke risk screenings. The Unconscious Patient – 10 Ways to Improve Management (SWE) by Jonathan ... Jonathan Ilicki offers a structured and evidence-based framework for assessing the unconscious patient. Your doctor may use several tests to determine your risk of stroke, including: 1. The following are the nonmodifiable and modifiable risk factors of Cerebrovascular accident: The disruption in the blood flow initiates a complex series of cellular metabolic events. How to Start an IV? Flaccid paralysis and loss of or decrease in the deep tendon reflexes (initial clinical feature) followed by (after 48 hours) reappearance of deep reflexes and abnormally increased muscle tone (spasticity), Dysphasia (impaired speech) or aphasia (loss of speech), Apraxia (inability to perform a previously learned action), Visual-perceptual dysfunctions (homonymous hemianopia [loss of half of the visual field]), Disturbances in visual-spatial relations (perceiving the relation of two or more objects in spatial areas), frequently seen in patients with right hemispheric damage, Sensory losses: slight impairment of touch or more severe with loss of proprioception; difficulty in interrupting visual, tactile, and auditory stimuli. Cryptogenic strokes have no known cause, and other strokes result from causes such as illicit drug use, coagulopathies, migraine, and spontaneous dissection of the carotid or vertebral arteries. Primary prevention of stroke remains the best approach. Health care workers call this sliding scale of awareness the levels of consciousness. The assessment and management of neurological symptoms presents a particular challenge in the community, as the differential diagnosis may be wide and include potentially serious conditions. D. Vasospasm. Provide full range of motion four or five times a day to maintain joint mobility, regain motor control, prevent contractures in the paralyzed extremity, prevent further deterioration of the neuromuscular system, and enhance circulation. Increase natural or artificial lighting in the room; provide eyeglasses to improve vision. 1. The degree of neurologic damage that occurs with an ischemic stroke depends on the: Size of the area of inadequate perfusion. B. Embolism All questions are given on a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. Patients who have experienced TIA or stroke should have medical management for secondary prevention. 9 Time and date of onset are relevant to interpreting stroke signs accurately. Continue focusing nursing assessment on impairment of function in patient’s daily activities. ASPECTS Study Group. Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis, prosthetic heart valves). In summary, here are some nursing interventions for patients with stroke: Improving Mobility and Preventing Deformities, Helping the Patient Cope with Sexual Dysfunction. The result is an interruption in the blood supply to the brain, causing temporary or permanent loss of movement, thought, memory, speech, or sensation. If tightness occurs in any area, perform a range of motion exercises more frequently. C: The degree of neurologic damage that occurs with an ischemic stroke depends on the amount of collateral blood flow. A systematic and logical approach is necessary to make the correct diagnosis; the broad diagnostic categories being neurological, metabolic, diffuse physiological dysfunction and functional. Whilst the practitioner may commonly encounter conditions such as stroke and the fitting patient, all patients will require careful assessment to avoid the pitfalls of missing a serious underlying diagnosis. Observe for signs of pulmonary embolus or excessive cardiac workload during exercise period (e.g., shortness of breath, chest pain, cyanosis, and increasing pulse rate). Prevent adduction of the affected shoulder with a pillow placed in the axilla. Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. Support patient: Observe performance and progress, give positive feedback, convey an attitude of confidence and hopefulness; provide other interventions as used for improving cognitive function after a head injury. A: Cardiogenic emboli is not the most common type of origin for strokes. Medical management will vary according to the original cause of the patient’s condition, but nursing care will be constant. Prepare for GI feedings through a tube if indicated; elevate the head of bed during feedings, check tube position before feeding, administer feeding slowly, and ensure that cuff of tracheostomy tube is inflated (if applicable); monitor and report excessive retained or residual feeding. 4,14 Concussion results in neurological signs and symptoms following a force injury to the brain, which may be minor, with the absence of macroscopic neural damage. c. breath sounds. Make sure patient does not neglect affected side; provide assistive devices as indicated. C. Hypertensive changes Deficient self-care related to stroke sequelae. RR 26. The most common cause of cerebrovascular accident is: A: Small penetrating artery thrombosis affects one or more vessels and is the most common cause of cerebrovascular accident. A. Cardiogenic emboli. A cluster randomized phase IIb trial, Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke. Consciousness is not a lights-on/lights-off proposition, which the term unconscious implies. Apply a splint at night to prevent flexion of affected extremity. This chapter has presented a physiologic approach to the differential diagnosis and the emergency management of the stuporous and comatose patient. Sa02 97% on high flow 02. The deeper you go, the darker the surroundings. Heavy alcohol drinking, obesity, smoking cigarettes, drugs, and substance abuse are manageable lifestyle factors that can increase the chances of stroke.Conditions that exacerbate the risk of stroke include: 1. If upper extremity spasticity is noted, do not use a hand roll; dorsal wrist splint may be used. As a first step, encourage patient to carry out all self-care activities on the unaffected side. C: Stroke is not the fourth leading cause of death in the United States. A systematic and logical approach is necessary to make the correct diagnosis; the broad diagnostic categories being neurological, metabolic, diffuse physiological A: Allergic reaction is not a side effect of tPA. The key components of the neurological examination of the comatose patient are: level of consciousness (Glasgow Coma Score — list the components; e.g. Position to prevent contractures; use measures to relieve pressure, assist in maintaining good body alignment, and prevent compressive neuropathies. Ischemic strokes are categorized according to their cause: large artery thrombotic strokes (20%), small penetrating artery thrombotic strokes (25%), cardiogenic embolic strokes (20%), cryptogenic strokes (30%), and other (5%). The focus of documentation should involve: Here’s a 5-item practice quiz for this Cerebrovascular Accident (Stroke) Study Guide: In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz. Supervise and support the patient during exercises; plan frequent short periods of exercise, not longer periods; encourage the patient to exercise unaffected side at intervals throughout the day. Temp 36.8 *BP 85/40. Make a referral for home speech therapy. P 120. Cardiovascular diseases with all heart complications included 4. She is a registered nurse since 2015 and is currently working in a regional tertiary hospital and is finishing her Master's in Nursing this June. Some other significant and chronic conditions can also cause stroke. If cerebral oxygenation is still inadequate; complications may occur. Reviewed and revised 30 March 2015 OVERVIEW Coma Coma is a state of unconsciousness caused by temporary or permanent impairment of the ascending reticular system in the brainstem, or both cerebral hemispheres. Sa02 92% on high flow 02. B. Remind spouse and family to attend to personal health and wellbeing. Encourage personal hygiene activities as soon as the patient can sit up; select suitable self-care activities that can be carried out with one hand. C. Severe vomiting. Immediate Consultation with stroke team (where available); Evaluate for Thrombolytic Contraindications. 2. Marianne is a staff nurse during the day and a Nurseslabs writer at night. Advise family that patient may tire easily, become irritable and upset by small events, and show less interest in daily events. Some patients will regain full consciousness without intervention, while others will require intensive management and intricate diagnostic testing. Direct and indirect costs for stroke cost $65.5 billion in 2008. Elevate affected arm to prevent edema and fibrosis. High blood pressure 2. 3 Posterior circulation stroke is placing the patient at particular risk to develop dysphagia, especially if pons and medulla are involved. Interventions for patient and partner focus on providing relevant information, education, reassurance, adjustment. It's because of this risk of stroke that doctors advise that even small ASD's be closed, by surgery or other methods. After the stroke is complete, management focuses on the prompt initiation of rehabilitation for any deficits. Make the atmosphere conducive to communication, remaining sensitive to patient’s reactions and needs and responding to them in an appropriate manner; treat the patient as an adult. Etiologies of persistent unconsciousness can be reversible or permanent. If you’re interested in improving this nursing skill, this article is for you. 3. B. Mental status (memory, attention span, perception, orientation, affect, speech/language). Some are potentially treatable while others can be prevented altogether. Individual findings including level of function and ability to participate in specific or desired activities. You cannot get enough in one sitting. One-Stop Management with Perfusion for Transfer Patients with Stroke due to a Large-Vessel Occlusion: Feasibility and Effects on In-Hospital Times, One-Stop Management of Acute Stroke Patients: Minimizing Door-to-Reperfusion Times, Stem cell transplantation for ischemic stroke, Neuroprotection in the Treatment of Acute Ischemic Stroke, Neuroprotection for ischemic stroke in the endovascular era: A brief report on the future of intra-arterial therapy, Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018, https://www.strokeaudit.org/Guideline/Guideline-Home.aspx, https://www.strokebestpractices.ca/recommendations/acute-stroke-management/acute-ischemic-stroke-treatment, https://informme.org.au/en/Guidelines/Clinical-Guidelines-for-Stroke-Management, https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Acute-Stroke.pdf?la=en, Government of Jersey General Hospital: Consultants in Psychiatry – Various posts, Martlets Hospice: Consultant in Palliative Medicine, Isle of Wight NHS Trust: Consultant Physician in Stroke Medicine, The Mid Yorkshire Hospitals NHS Trust : Consultant in Emergency Medicine (Post 2), Women’s, children’s & adolescents’ health. Proper assessment of the condition of the skin must be done when giving a bed bath. Management of stroke has been revolutionised over the past decade, and therapeutic nihilism is no longer justified. *patient unconscious. It's like being underwater. Presence or absence of voluntary or involuntary movements of extremities. Nursing Standard, 20,1, 54-64. The major nursing care planning goals for the patient and family may include: Nursing care has a significant impact on the patient’s recovery. Strokes can be divided into two classifications. Keep training periods for ambulation short and frequent. It needs continual and regular top ups. Diabetes 3. Maintain patient’s attention when talking with the patient, speak slowly, and give one instruction at a time; allow the patient time to process. Depression, other psychological problems: emotional lability, hostility, frustration, resentment, and lack of cooperation. Encourage patient to attend community-based stroke clubs to give a feeling of belonging and fellowship to others. Management after reassessment *if patient deteriorating. Leading a healthy lifestyle which includes not smoking, maintaining a healthy weight, following a healthy diet, and daily exercise can reduce the risk of having a stroke by about one half. C. Large artery thrombotic. Any patient with neurologic deficits need a careful history and complete physical and neurologic examination. Mr. Smith, a businessman, has a history of hypertension. Teach patient to resume as much self care as possible; provide assistive devices as indicated. The unconscious patient should not be treated differently. Plan of care and those involved in planning. Encourage family involvement. BP 100/60. The unconscious patient Tim Cooksley Mark Holland Abstract The unconscious patient is a medical emergency which can challenge the diagnostic and management skills of any clinician. Change in level of consciousness or responsiveness. Provide highfiber diet and adequate fluid intake (2 to 3 L/day), unless contraindicated. If this activity does not load, try refreshing your browser. The most common cause of cerebrovascular accident is: A. Arteriosclerosis 3. The approach is based on the belief that after a history and a general physical and neurologic examination, the informed physician can, with reasonable confidence, place the patient into one of four major groups of illnesses that cause coma. Talk to aphasic patients when providing care activities to provide social contact. DASH diet. A 68-year-old male patient with a stroke is unconscious and unresponsive to stimuli. 3. b. bowel sounds. See CVA Blood Pressure Control; Failure to control Blood Pressure <185/110 mmHg with the following agents contraindicates Thrombolysis; Consider administering Labetalol 10 mg dose while obtaining CT Head … Never lift patient by the flaccid shoulder or pull on the affected arm or shoulder. In 1994, a panel appointed by the Stroke Council of the American Heart Association authored guidelines for the management of patients with acute ischemic stroke. Peter Davies Learning Outcomes 1. General signs and symptoms include numbness or weakness of face, arm, or leg (especially on one side of the body); confusion or change in mental status; trouble speaking or understanding speech; visual disturbances; loss of balance, dizziness, difficulty walking; or sudden severe headache. Dysphagia with aspiration pneumonia and insufficient nutritional intake lead to worse outcome after stroke. Any items you have not completed will be marked incorrect. Chapter 58 Nursing Management Stroke Meg Zomorodi Motivation is like food for the brain. After a day, he started feeling numbness on his face, and he cannot see objects beyond his periphery. The ABCDE approach is used for performing an initial systematic assessment of any critically unwell or deteriorating patient, and intervening as necessary. Begin walking as soon as standing balance is achieved (use parallel bars and have a wheelchair available in anticipation of possible dizziness). Involve others in patient’s care; teach stress management techniques and maintenance of personal health for family coping. 1. Because the patient of a stroke may be unconscious or have a reduced gag reflex, it is most important to maintain a patent airway for the patient and provide oxygen if respiratory effort is impaired. The unconscious patient is completely dependent on the nurse to manage all their activities of daily living and to monitor their vital functions. A: Cancer is the second leading cause of death in the United States. Healthy lifestyle. Nurseslabs – NCLEX Practice Questions, Nursing Study Guides, and Care Plans, 8+ Cerebrovascular Accident (Stroke) Nursing Care Plans, Arterial Blood Gas Interpretation for NCLEX (40 Questions), Arterial Blood Gas Analysis Made Easy with Tic-Tac-Toe Method, Select All That Apply NCLEX Practice Questions and Tips (100 Items), IV Flow Rate Calculation NCLEX Reviewer & Practice Questions (60 Items), EKG Interpretation & Heart Arrhythmias Cheat Sheet. A patient who is initially observed to be unconscious can ultimately manifest a variety of clinical states. Location of the lesion. Color of the face and extremities; temperature and moisture of the skin. Results of laboratory tests, diagnostic studies, and mental status or cognitive evaluation. Disclaimer: this is a short and sweet explanation of a nursing assessment of an unconscious neuro patient. Reinforce the individually tailored program. Range of motion exercises are beneficial, but avoid over strenuous arm movements. 1,2 The validity of various proposed predictors remains limited. 1. A stroke is an injury to the brain. To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. Size of the area of inadequate perfusion. Approximately 780, 000 people experience a stroke each year in the United States. Get helpful tips on performing first aid. Answer: D. Combination of the above factors. D. Combination of the above factors. Give family information about the expected outcome of the stroke, and counsel them to avoid doing things for the patient that he or she can do. C. Amount of collateral blood flow. He does not take any maintenance medications and smokes three packs of cigarettes every day. D: Small artery thrombotic is the most common type of origin for strokes. D: A second stroke is not a side effect of tPA. Date of acceptance: July 18 2005. Stroke patients should be transported to the nearest hospital with an available stroke unit or with organised stroke care. Hair care should not be neglected. 5. Recommendations 9.0 Appropriate investigations and management strategies should be implemented for all hospitalized stroke and TIA patients to optimize recovery, avoid complications, prevent stroke recurrence, and provide palliative care when required. Marianne is also a mom of a toddler going through the terrible twos and her free time is spent on reading books! The degree of neurologic damage that occurs with an ischemic stroke depends on the: A. Teach patient to turn and look in the direction of the defective visual field to compensate for the loss; make eye contact with patient, and draw attention to affected side. It may cause weakness or paralysis of an arm or leg, or inability to speak or unconsciousness. Approach patient with a decreased field of vision on the side where visual perception is intact; place all visual stimuli on this side. P 130. Perform indepth assessment to determine sexual history before and after the stroke. Discuss patient’s depression with the physician for possible antidepressant therapy. 38 mathewvmaths@yahoo.co.in 39. Explain mechanisms that affect cerebral blood flow. An acute stroke can result in unconsciousness for any patient. Have patient sit upright, preferably on chair, when eating and drinking; advance diet as tolerated. B: A patient taking tPA should be monitored for bleeding. Please wait while the activity loads. The most common side effect of tPA is: A. Change position every 2 hours; place patient in a prone position for 15 to 30 minutes several times a day. Coordinate care provided by numerous health care professionals; help family plan aspects of care. 4. A written schedule, checklists, and audiotapes may help with memory and concentration; a communication board may be used. The first priority in acute management of the patient with a stroke is the preservation of life. Approximately 600, 000 of these are new strokes, and 180, 000 are recurrent strokes. The unconscious patient is a medical emergency which can challenge the diagnostic and management skills of any clinician. Cerebrovascular accident or stroke is the primary cerebrovascular disorder in the United States. Expected patient outcomes may include the following: Patient and family education is a fundamental component of rehabilitation. Employ pressure relieving devices; continue regular turning and positioning (every 2 hours minimally); minimize shear and friction when positioning. Jointly establish goals, with the patient taking an active part. Sensation and perception (usually the patient has decreased awareness of pain and temperature). Analyze voiding pattern and offer urinal or bedpan on patient’s voiding schedule. Our ultimate goal is to help address the nursing shortage by inspiring aspiring nurses that a career in nursing is an excellent choice, guiding students to become RNs, and for the working nurse – helping them achieve success in their careers! You have not finished your quiz. While consciousness is usually defined as the opposite of unconscious, recent research suggests that this kind of interpretation is too simplistic and should be updated and the concept of unconscious emotion is increasingly gaining scientific literacy. This method involves ordered examination, investigation and intervention, focusing on each major body system in turn. The unconscious patient presents a special challenge to the nurse. D: Vasospasm is not the most common cause of cerebrovascular accident. Elevate arm and hand to prevent dependent edema of the hand; administer analgesic agents as indicated. Acute stroke is a medical emergency requiring the same care as that of a heart attack. Nursing management of unconscious patient (emergency care) 13. During the acute phase, a neurologic flow sheet is maintained to provide data about the following important measures of the patient’s clinical status: During the postacute phase, assess the following functions: Based on the assessment data, the major nursing diagnoses for a patient with stroke may include the following: Main article: 8+ Cerebrovascular Accident (Stroke) Nursing Care Plans. Reinforce structured training program using cognitive, perceptual retraining, visual imagery, reality orientation, and cueing procedures to compensate for losses. B: Embolism is not the most common cause of cerebrovascular accident. Treating Increased ICP : mannitol, corticosteroids Management of temperature regulation (fever): ice packs, tepid sponging, Antipyretics, NSAIDS Management of elimination : laxatives Management of nutrition: TPN and RT feeds DVT prophylaxis 12. Endovascular Thrombectomy for Mild Strokes: How Low Should We Go? The DASH (Dietary Approaches to Stop Hypertension) diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein and can lower the risk of stroke. Have occupational therapist make a home assessment and recommendations to help the patient become more independent. Please visit using a browser with javascript enabled. oxygen saturations, blood pressure, pulse) Eye opening, comparative size of pupils, and pupillary reaction to light. This causes a STROKE. Tracheostomy in the Nonventilated Stroke Patient. Teach patient to maintain balance in a sitting position, then to balance while standing (use a tilt table if needed). All critically unwell patients should have continuous monitoringequipment attached for accurate observations (e.g. RR 30 Continues high flow oxygen. During one of his meetings, he felt like he cannot speak properly. Bleeding. Describe the incidence of and risk factors for stroke. A: The degree of neurologic damage that occurs with an ischemic stroke depends on the location of the lesion. This post contains affiliate links. Assist the male patient to an upright posture for voiding. As an outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her also an excellent study guide writer for student nurses. Any problems are addressed as they are identified w… As a cause of death in the United States, stroke currently ranks: B: Stroke is the third leading cause of death after heart disease and cancer. Since we started in 2010, Nurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. Provide family with practical instructions to help patient between speech therapy sessions. Practice Mode: This is an interactive version of the Text Mode. Establish a regular time (after breakfast) for toileting. Position fingers so that they are barely flexed; place hand in slight supination. Prolonged loss of consciousness (coma, defined as a Glasgow Coma Score of 8 or less) is seen commonly: (1) following head injury, (2) after an overdose of sedating drugs, and (3) in the situation of ‘nontraumatic coma’, where there are many possible diagnoses, but the most common are postanoxic, postischaemic, systemic infection, and metabolic derangement, e.g. Stroke is the leading cause of serious, long-term disability in the United States. Improve morale by making sure patient is fully dressed during ambulatory activities. The majority of strokes have what type of origin? The current guidelines of the National Institute for Health and Care Excellence (NICE) on the management of acute stroke, published in 2008 and updated in 2017, make it clear that, when acute stroke is suspected, rapid assessment and intervention are critical to limit the risk of death and long-term disability. Once you are finished, click the button below. After learning that the patient has a history of gastroesophageal reflux disease (GERD), the nurse will plan to do frequent assessments of the patient's a. apical pulse. Patient more responsive and confused. The reported incidences for dysphagia in the acute phase of stroke range from 30% to 80%. Compare and contrast the etiology and pathophysiology… Encourage family to support patient and give positive reinforcement. Response to interventions, teaching, and actions performed. A neuro assessment is a critical skill for any nurse (not just neuro ICU nurses) This goes beyond simple neuro checks. B: Cryptogenic is not the most common type of origin for strokes. Stroke is regularly accompanied by dysphagia and other factors associated with decreased nutritional intake. Provide counseling and support to the family. Stroke is a worldwide phenomenon suffered through all walks of life. Unconsciousness, when a person suddenly becomes unable to respond to stimuli, requires immediate medical attention. C: Large artery thrombotic is not the most common type of origin for strokes. B. Cryptogenic. D: Stroke is not the fifth leading cause of death in the United States. The day that he was brought to the emergency room, he cannot move his right arm and leg. See CVA Fibrinolytic Checklist; Blood Pressure (if SBP >185 mmHg or DBP >110 mmHg). Provide emotional support and encouragement to prevent fatigue and discouragement. Consult with speech therapist to evaluate gag reflexes; assist in teaching alternate swallowing techniques, advise patient to take smaller boluses of food, and inform patient of foods that are easier to swallow; provide thicker liquids or pureed diet as indicated. Observe patient for paroxysms of coughing, food dribbling out or pooling in one side of the mouth, food retained for long periods in the mouth, or nasal regurgitation when swallowing liquids. 15 Abstract. Motor control (upper and lower extremity movement); swallowing ability, nutritional and hydration status, skin integrity, activity tolerance, and bowel and bladder function. 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Surgical management may include prevention and relief from increased ICP. Encourage everyone to approach the patient with a supportive and optimistic attitude, focusing on abilities that remain; explain to the family that emotional lability usually improves with time. Physical examination. An allergic reaction. Patient Positioning: Complete Guide for Nurses, Registered Nurse Career Guide: How to Become a Registered Nurse (RN), NCLEX Questions Nursing Test Bank and Review, Nursing Care Plans (NCP): Ultimate Guide and Database, Nursing Diagnosis Guide: All You Need to Know to Master Diagnosing. Relief of sensory and perceptual deprivation. 5 h of symptom onset (PRE-FLAIR): a multicentre observational study, MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset, EXTEND, ECASS-4, and EPITHET Investigators, Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data, Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial, Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study, A randomized trial of tenecteplase versus alteplase for acute ischemic stroke, Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial, Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke, Tenecteplase versus alteplase before endovascular thrombectomy (EXTEND-IA TNK): A multicenter, randomized, controlled study, Evidence that Tenecteplase Is Noninferior to Alteplase for Acute Ischemic Stroke, American Heart Association Stroke Council; 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C: Hypertensive changes are not the most common cause of cerebrovascular accident. People who remain unconscious after a stroke usually have a stroke that affects regions of the brain responsible for sleep and/or wake cycles. 2. B: The degree of neurologic damage that occurs with an ischemic stroke depends on the size of the area of inadequate perfusion. Encourage patient to continue with hobbies, recreational and leisure interests, and contact with friends to prevent social isolation. Attainment or progress toward desired outcomes. General signs and symptoms include numbness or weakness of face, arm, or leg (especially on one side of the body); confusion or change in mental status; trouble speaking or understanding speech; visual disturbances; loss of balance, dizziness, difficulty walking; or sudden severe headache. Use proper patient movement and positioning (e.g., flaccid arm on a table or pillows when patient is seated, use of sling when ambulating). He was diagnosed with ischemic stroke by the attending physician. It can be a very serious problem, sometimes. Remind patient with hemianopsia of the other side of the body; place extremities so that patient can see them. Posts related to Cerebrovascular Accident (Stroke): Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. Therapeutic Communication Techniques Quiz. Start an active rehabilitation program when consciousness returns (and all evidence of bleeding is gone, when indicated). As a cause of death in the United States, stroke currently ranks: 2. Assist with dressing activities (e.g., clothing with Velcro closures; put garment on the affected side first); keep environment uncluttered and organized. Primary prevention of stroke remains the best approach. Develop attainable goals for the patient at home by involving the total health care team, patient, and family. A cerebrovascular accident (CVA), an ischemic stroke or “brain attack,” is a sudden loss of brain function resulting from a disruption of the blood supply to a part of the brain. D: Stroke can cause a wide variety of neurologic deficits, depending on the location of the lesion, the size of the area of inadequate perfusion, and the amount of the collateral blood flow. Unconscious patients with an acute neurological condition should be discussed with either a neurosurgeon, neurologist or stroke physician to determine further management. Nursing the unconscious patient NS309 Geraghty M (2005) Nursing the unconscious patient. C: Severe vomiting is not a side effect of tPA. As you get closer to the surface you start to see more things and be more cognizant of what's out there, until you break through to total awareness. 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