Learning Exercise

Stroke November 21, 2011 Synthesis Project Summerly Foster Abstract This paper is designed to educate the public about strokes. Strokes are one of the top killers of Americans. There are many different types of strokes such as Ischemic, Embolic, Thrombotic, and Hemorrhagic. Each type is different and requires individualized treatment. Strokes can be prevented and it is important that the patient understands the common risks. If the patient is considered a high risk for having a stroke it is important that they work closely with their physicians to monitor their health to prevent having a stroke. Time loss is brain loss and it is important that you seek help immediately. Key words: stroke, CVA, ischemic, embolic, thrombotic, hemorrhagic. Arteries carry blood from the heart to specific areas of the brain. The blood contains the oxygen and the nutrients that the brain needs to function. A stroke occurs when one of the arteries ruptures or is blocked causing that area of the brain to not receive oxygen resulting in tissue death. The area that is damaged may no longer function as well as it did before the stroke such as walking, talking, seeing, or feeling. The left hemisphere of the brain controls the right side of the body including critical thinking, reasoning, and use with numbers. The right hemisphere of the brain controls the left side of the body including creativity, music, and artistic abilities. The populations that are more at risk for experiencing a stroke include: being over age 55, being male, being African American, Hispanic or Asian/Pacific Islander, or having a family history of stroke or transient ischemic attack (TIA p 1). There are many different types of strokes and each is a medical emergency. Strokes can be prevented and treated if caught early on. The common types of stroke include: ischemic, embolic, thrombotic, and hemorrhagic. An ischemic stroke transpires when an artery to the brain becomes blocked. It is the most common form of stroke. An embolic stroke occurs when a blood clot forms and dislodges from an area in the body and travels to the smaller vessels in the brain resulting in blocking the blood flow to the brain. This type of stroke results in instantaneous physical and neurological deficits. Thrombotic stroke transpires when a diseased or damaged vessel in the brain becomes blocked by the formation of a blood clot within the brain. There are two subcategories of a thrombotic stroke, large-vessel and small-vessel thrombosis. Large-vessel thrombosis occurs when the blockage is in one of the brain’s larger blood-supplying arteries such as the carotid or middle cerebral. Small-vessel thrombosis involves one or more of the brain’s smaller, deeper arteries. Hemorrhagic strokes occur when the artery ruptures in the brain. Uncontrolled hypertension and cerebral aneurysms are the two major causes of hemorrhagic strokes. The two types of strokes are subarachnoid and intracerebral. Subarachnoid hemorrhage (SAH) occurs when aneurism ruptures in a large artery on or close the thin, delicate membrane surrounding the brain. The blood leaks into the area around the brain which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid. The patient may have a sudden, intense headache, neck pain, and nausea or vomiting. It is described as the worst headache of one’s life. The rapid increase of pressure outside the brain may also cause rapid loss of consciousness or death. An intracerebral hemorrhage occurs when the blood leaks from the vessels within the brain. It is commonly caused by high blood pressure. Less common causes include trauma, infections, tumors, blood clotting deficiencies, and abnormalities in blood vessels such as arteriovenous malformations. The signs and symptoms of stroke include sudden numbness or weakness of face, arm or leg (especially on one side of the body), confusion, trouble speaking or understanding, trouble seeing in one or both eyes, trouble walking, dizziness, loss of balance or coordination, severe headache with no known cause. The warning signs of a stroke depend on the side and part of the brain that’s affected as well as how severely the brain is injured. Each individual may have different stroke warning signs. The stroke may be associated with a headache or could be painless. Having a stroke is a medical emergency and can be treatable if caught in time. It is also important to note what time the symptoms started and to notify the health care providers of this time. Having a stroke can be prevented. It is important to know the common risk factors of a stroke so the individual can prevent having a stroke. The common risk factors for a stroke include: family history of stroke, being 55 years old or older, high blood pressure, and high cholesterol. Other risk factors include: cigarette smoking, diabetes, obese, physical inactivity, cardiovascular disease, and use of birth control pills, heavy alcohol drinking, and the use of illicit drugs. A TIA is a momentary episode of stroke-like symptoms but generally causes no permanent damage or disability. TIA and stroke symptoms are identical. If the individual suffers from one or more of the common risk factors it is important that they work closely with their physician to control and monitor the risk factors to prevent a stroke from occurring. The treatment of a stroke is individualized to the person as well as to the type of stroke the individual suffered. A carotid endarterectory is a surgical procedure where the surgeon removes fatty deposits from one of two main arteries in the neck. Medications that are used to prevent stroke or used during the treatment of stroke include: antiplatelets (Aspirin, Plavix, and Aggrenox), Thrombolytics (tPA, Activase), and anticoagulants (Heparin and Coumadin). During an ischemic stroke the most common treatments include the use of antiplatelets and thrombolytics. Thrombolytics may be used within a three hour window period beginning when the onset of symptoms began, it cannot be given to patients who are experiencing an hemorrhagic stroke. If the patient is experiencing a hemorrhagic stroke the common treatment includes an aneurysm clipping, coiling (aneurysm embolization), or surgical AVM removal. After treatment the patient may require rehabilitation either inpatient or outpatient. Rehabilitation teaches the stroke victim basic activities of daily living such as walking, talking, use of extremities, and swallowing. In conclusion a stroke is an emergency and it is very important that the individual recognizes the signs and symptoms and call 911 immediately. Do not wait to see if the symptoms resolve it is vital that the patient receives emergency treatment. A stroke can be preventable if the patient follows up with their physician regularly and controls their health. Time loss is brain loss and the failure to seek treatment can result in death. Resources American Heart Association. (2010, October). Transient ischemic attack. Retrieved August 27, 2011. http://www.americanheart.org/presenter.jhtml?identifier=4781 Antithrombotic Therapy & Stroke Prophylaxis | Internet Stroke Center. (n.d.). Retrieved September 23, 2011, from http://www.strokecenter.org/education/gage/ Asplund K. Haemodilution for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD000103. DOI: 10.1002/14651858.CD000103. Brott, T, Marks , M, Patel, S, Rowley, H, & Tilley, B. (2010, October). Pathogenisis & pathophysiology. Retrieved from http://www.strokecenter.org/education/ais_pathogenesis/13_evol_cereb_athero.htm Brott, T, Marks , M, Patel, S, Rowley, H, & Tilley, B. (2010, October). Stroke Diagnosis.http://www.strokecenter.org/patients/diagnosis/blood_tests.htm Burton, C., Bennett, B., & Gibbon, B. (2009). Embedding nursing and therapy consultantship: the case of stroke consultants. Journal of Clinical Nursing, 18(2), 246-254. doi:10.1111/j.1365-2702.2007.02028.x. Curioni C, André C, Veras R. Weight reduction for primary prevention of stroke in adults with overweight or obesity. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006062. DOI: 10.1002/14651858.CD006062.pub2. Emergency Stroke Evaluation & Diagnosis | Internet Stroke Center. (n.d.). Retrieved September 23, 2011, from http://www.strokecenter.org/education/ais_evaluation/clinical_presentations.htm Hackett ML, Anderson CS, House A, Halteh C. Interventions for preventing depression after stroke. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003689. DOI: 10.1002/14651858.CD003689.pub3. Mansfield, A., Inness, E. L., Komar, J., Biasin, L., Brunton, K., Lakhani, B., & McIlroy, W. E. (2011). Training Rapid Stepping Responses in an Individual With Stroke. Physical Therapy, 91(6), 958-969. doi:10.2522/ptj.20100212 Mayo Foundation for Medical Education and Research. (2010). Stroke. Retrieved August 27, 2011, from:http://www.mayoclinic.com/health/stroke/DS00150 McGinnes, A., Easton, S., Williams, J., & Neville, J. (2010). The role of the community stroke rehabilitation nurse. British Journal of Nursing (BJN), 19(16), 1033-1038. Preventing & Managing Post-Stroke Complications | Internet Stroke Center. (n.d.). Retrieved September 23, 2011, from http://www.strokecenter.org/education/rx_complications/ Sandercock PAG, Counsell C, Kamal AK. Anticoagulants for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000024. DOI: 10.1002/14651858.CD000024.pub3. Stroke: A Presentation. (n.d.). Retrieved September 23, 2011, from http://www.scribd.com/doc/17870574/Stroke-A-Presentation Stroke Presentation and Hospital Management. (n.d.). Retrieved September 23, 2011, from http://stroke.ahajournals.org/content/40/6/2143.short Squizzato A, Romualdi E, Dentali F, Ageno W. Statins for acute ischemic stroke. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD007551. Stroke Unit DOI: 10.1002/14651858.CD007551.pub2. Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000197. DOI: 10.1002/14651858.CD000197.pub2. Thompson, H., & Ryan, A. (2009). The impact of stroke consequences on spousal relationships from the perspective of the person with stroke. Journal of Clinical Nursing, 18(12), 1803-1811. doi:10.1111/j.1365-2702.2008.02694.x Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000213. DOI: 10.1002/14651858.CD000213.pub2. Stroke November 21, 2011 Synthesis Project Summerly Foster Abstract This paper is designed to educate the public about strokes. Strokes are one of the top killers of Americans. There are many different types of strokes such as Ischemic, Embolic, Thrombotic, and Hemorrhagic. Each type is different and requires individualized treatment. Strokes can be prevented and it is important that the patient understands the common risks. If the patient is considered a high risk for having a stroke it is important that they work closely with their physicians to monitor their health to prevent having a stroke. Time loss is brain loss and it is important that you seek help immediately. Key words: stroke, CVA, ischemic, embolic, thrombotic, hemorrhagic. Arteries carry blood from the heart to specific areas of the brain. The blood contains the oxygen and the nutrients that the brain needs to function. A stroke occurs when one of the arteries ruptures or is blocked causing that area of the brain to not receive oxygen resulting in tissue death. The area that is damaged may no longer function as well as it did before the stroke such as walking, talking, seeing, or feeling. The left hemisphere of the brain controls the right side of the body including critical thinking, reasoning, and use with numbers. The right hemisphere of the brain controls the left side of the body including creativity, music, and artistic abilities. The populations that are more at risk for experiencing a stroke include: being over age 55, being male, being African American, Hispanic or Asian/Pacific Islander, or having a family history of stroke or transient ischemic attack (TIA p 1). There are many different types of strokes and each is a medical emergency. Strokes can be prevented and treated if caught early on. The common types of stroke include: ischemic, embolic, thrombotic, and hemorrhagic. An ischemic stroke transpires when an artery to the brain becomes blocked. It is the most common form of stroke. An embolic stroke occurs when a blood clot forms and dislodges from an area in the body and travels to the smaller vessels in the brain resulting in blocking the blood flow to the brain. This type of stroke results in instantaneous physical and neurological deficits. Thrombotic stroke transpires when a diseased or damaged vessel in the brain becomes blocked by the formation of a blood clot within the brain. There are two subcategories of a thrombotic stroke, large-vessel and small-vessel thrombosis. Large-vessel thrombosis occurs when the blockage is in one of the brain’s larger blood-supplying arteries such as the carotid or middle cerebral. Small-vessel thrombosis involves one or more of the brain’s smaller, deeper arteries. Hemorrhagic strokes occur when the artery ruptures in the brain. Uncontrolled hypertension and cerebral aneurysms are the two major causes of hemorrhagic strokes. The two types of strokes are subarachnoid and intracerebral. Subarachnoid hemorrhage (SAH) occurs when aneurism ruptures in a large artery on or close the thin, delicate membrane surrounding the brain. The blood leaks into the area around the brain which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid. The patient may have a sudden, intense headache, neck pain, and nausea or vomiting. It is described as the worst headache of one’s life. The rapid increase of pressure outside the brain may also cause rapid loss of consciousness or death. An intracerebral hemorrhage occurs when the blood leaks from the vessels within the brain. It is commonly caused by high blood pressure. Less common causes include trauma, infections, tumors, blood clotting deficiencies, and abnormalities in blood vessels such as arteriovenous malformations. The signs and symptoms of stroke include sudden numbness or weakness of face, arm or leg (especially on one side of the body), confusion, trouble speaking or understanding, trouble seeing in one or both eyes, trouble walking, dizziness, loss of balance or coordination, severe headache with no known cause. The warning signs of a stroke depend on the side and part of the brain that’s affected as well as how severely the brain is injured. Each individual may have different stroke warning signs. The stroke may be associated with a headache or could be painless. Having a stroke is a medical emergency and can be treatable if caught in time. It is also important to note what time the symptoms started and to notify the health care providers of this time. Having a stroke can be prevented. It is important to know the common risk factors of a stroke so the individual can prevent having a stroke. The common risk factors for a stroke include: family history of stroke, being 55 years old or older, high blood pressure, and high cholesterol. Other risk factors include: cigarette smoking, diabetes, obese, physical inactivity, cardiovascular disease, and use of birth control pills, heavy alcohol drinking, and the use of illicit drugs. A TIA is a momentary episode of stroke-like symptoms but generally causes no permanent damage or disability. TIA and stroke symptoms are identical. If the individual suffers from one or more of the common risk factors it is important that they work closely with their physician to control and monitor the risk factors to prevent a stroke from occurring. The treatment of a stroke is individualized to the person as well as to the type of stroke the individual suffered. A carotid endarterectory is a surgical procedure where the surgeon removes fatty deposits from one of two main arteries in the neck. Medications that are used to prevent stroke or used during the treatment of stroke include: antiplatelets (Aspirin, Plavix, and Aggrenox), Thrombolytics (tPA, Activase), and anticoagulants (Heparin and Coumadin). During an ischemic stroke the most common treatments include the use of antiplatelets and thrombolytics. Thrombolytics may be used within a three hour window period beginning when the onset of symptoms began, it cannot be given to patients who are experiencing an hemorrhagic stroke. If the patient is experiencing a hemorrhagic stroke the common treatment includes an aneurysm clipping, coiling (aneurysm embolization), or surgical AVM removal. After treatment the patient may require rehabilitation either inpatient or outpatient. Rehabilitation teaches the stroke victim basic activities of daily living such as walking, talking, use of extremities, and swallowing. In conclusion a stroke is an emergency and it is very important that the individual recognizes the signs and symptoms and call 911 immediately. Do not wait to see if the symptoms resolve it is vital that the patient receives emergency treatment. A stroke can be preventable if the patient follows up with their physician regularly and controls their health. Time loss is brain loss and the failure to seek treatment can result in death. Resources American Heart Association. (2010, October). Transient ischemic attack. Retrieved August 27, 2011. http://www.americanheart.org/presenter.jhtml?identifier=4781 Antithrombotic Therapy & Stroke Prophylaxis | Internet Stroke Center. (n.d.). Retrieved September 23, 2011, from http://www.strokecenter.org/education/gage/ Asplund K. Haemodilution for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD000103. DOI: 10.1002/14651858.CD000103. Brott, T, Marks , M, Patel, S, Rowley, H, & Tilley, B. (2010, October). Pathogenisis & pathophysiology. Retrieved from http://www.strokecenter.org/education/ais_pathogenesis/13_evol_cereb_athero.htm Brott, T, Marks , M, Patel, S, Rowley, H, & Tilley, B. (2010, October). Stroke Diagnosis.http://www.strokecenter.org/patients/diagnosis/blood_tests.htm Burton, C., Bennett, B., & Gibbon, B. (2009). Embedding nursing and therapy consultantship: the case of stroke consultants. Journal of Clinical Nursing, 18(2), 246-254. doi:10.1111/j.1365-2702.2007.02028.x. Curioni C, André C, Veras R. Weight reduction for primary prevention of stroke in adults with overweight or obesity. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006062. DOI: 10.1002/14651858.CD006062.pub2. Emergency Stroke Evaluation & Diagnosis | Internet Stroke Center. (n.d.). Retrieved September 23, 2011, from http://www.strokecenter.org/education/ais_evaluation/clinical_presentations.htm Hackett ML, Anderson CS, House A, Halteh C. Interventions for preventing depression after stroke. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003689. DOI: 10.1002/14651858.CD003689.pub3. Mansfield, A., Inness, E. L., Komar, J., Biasin, L., Brunton, K., Lakhani, B., & McIlroy, W. E. (2011). Training Rapid Stepping Responses in an Individual With Stroke. Physical Therapy, 91(6), 958-969. doi:10.2522/ptj.20100212 Mayo Foundation for Medical Education and Research. (2010). Stroke. Retrieved August 27, 2011, from:http://www.mayoclinic.com/health/stroke/DS00150 McGinnes, A., Easton, S., Williams, J., & Neville, J. (2010). The role of the community stroke rehabilitation nurse. British Journal of Nursing (BJN), 19(16), 1033-1038. Preventing & Managing Post-Stroke Complications | Internet Stroke Center. (n.d.). Retrieved September 23, 2011, from http://www.strokecenter.org/education/rx_complications/ Sandercock PAG, Counsell C, Kamal AK. Anticoagulants for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000024. DOI: 10.1002/14651858.CD000024.pub3. Stroke: A Presentation. (n.d.). Retrieved September 23, 2011, from http://www.scribd.com/doc/17870574/Stroke-A-Presentation Stroke Presentation and Hospital Management. (n.d.). Retrieved September 23, 2011, from http://stroke.ahajournals.org/content/40/6/2143.short Squizzato A, Romualdi E, Dentali F, Ageno W. Statins for acute ischemic stroke. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD007551. Stroke Unit DOI: 10.1002/14651858.CD007551.pub2. Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000197. DOI: 10.1002/14651858.CD000197.pub2. Thompson, H., & Ryan, A. (2009). The impact of stroke consequences on spousal relationships from the perspective of the person with stroke. Journal of Clinical Nursing, 18(12), 1803-1811. doi:10.1111/j.1365-2702.2008.02694.x Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000213. DOI: 10.1002/14651858.CD000213.pub2.