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Nursing Care and Pathophysiology for Ischemic Stroke (CVA)

Nursing Care and Pathophysiology for Ischemic Stroke (CVA)

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Jon Haws
BS, BSN,RN,CCRN Alumnus
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Outline
ADPIE Related Lessons
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Study Tools For Nursing Care and Pathophysiology for Ischemic Stroke (CVA)

Stroke Pathochart (Cheatsheet)
Ischemic Stroke MCA (Image)
Circle Of Willis Showing Stroke (Image)
Cerebral Circulation (Image)
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Outline

Pathophysiology: An ischemic stroke is when there is a loss of blood circulating to an area of the brain. This can occur because blood flow is blocked by a blood clot.

Overview

Lack of blood flow to brain tissue caused by blood clot in cerebral vessels.

Nursing Points

General

  1. Pathophysiology
    1. Blood clot in vessel in brain
    2. No flow past clot
    3. 87% of all strokes
    4. Not immediately seen on CT scan (24 hours)
    5. MRI for better view
  2. Risk Factors
    1. Hypertension
    2. Diabetes
    3. Obesity
    4. Atherosclerosis
    5. Cardiac Dysrhythmias
    6. Oral Contraceptives
    7. Substance Abuse
  3. Presentation dependent on location of clot
    1. Basal
    2. Pontine
    3. MCA
    4. See Stroke Assessment Lesson
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Transcript

Now, let’s talk about ischemic strokes and the major points you need to know.

So Ischemia means low blood flow or low oxygen. Ischemic strokes are caused by a blood clot that blocks vessels within the brain. When that happens, there is no blood flow past that clot, which causes the brain tissue to die. So this is like having a rock plugging up your garden hose – you can’t water your flowers that way. It only takes 10 minutes without flow for brain cells to die completely. Ischemic strokes represent 87% of all strokes in the U.S. So when a patient presents to the Emergency Department with a stroke, one of the first things we do is to get a CT scan. But, ischemic strokes may not be seen right away on a CT scan. They begin to show up at about 6 hours and are obvious on a CT scan within 24 hours. You can see this scan shows this darker area here is showing that this tissue has no blood flow to it and it is dying. If we suspect damage, but can’t see detail on the CT scan, we’ll get an MRI for a better image.

Common risk factors for stroke are hypertension, diabetes, obesity, and atherosclerosis. Now, what do these disorders all have in common? They are all vascular issues or cause vascular damage. Just like we talked about in the cardiac course – any damage to the vessels can cause plaque to build up and clots to form, like the one you see here. Patients with cardiac dysrhythmias like atrial fibrillation are also at risk for clots, as well as women taking birth control and people who abuse illicit drugs, especially cocaine. These clots can form in the brain or they could form elsewhere and travel to the brain.

We’ll talk about this in more detail when we get to the assessments lesson, but we want you to be aware that the specific presentation will be different for every patient depending on where the clot is in their brain. We have a great cheatsheet on this, so make sure you check it out. But this structure here is called the Circle of Willis – it’s the main structure feeding all of the arteries in the brain. If you get a clot somewhere in this circle, you will lose a significant amount of blood flow. What you see here is as if there was a clot in the Middle Cerebral Artery here. You can see on the patient’s left side that it’s getting a little hazy and a little darker and less defined. This shows the beginnings of a Left MCA stroke. The CT scan from the first slide was actually a severe Right MCA stroke – so you can see how if it goes on for too long, it causes more and more damage. We’ll look in the therapeutic management lesson about what we do to stop it.

So remember that an ischemic stroke is a lack of blood flow to the brain caused by a blood clot in the cerebral vessels. The risk factors for stroke are anything that affects the integrity of the vessels or causes blood clots anywhere in the body. The specific symptoms and presentation will depend entirely on WHERE the clot is in the brain. Make sure you check out the cheatsheet and the assessment lesson to learn more!

So that’s the basics about ischemic stroke. Make sure you check out the rest of this module to learn more about how we manage patients with strokes. Happy nursing!

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Medical surgical 1 (Cardiac and respiratory)

Concepts Covered:

  • Cardiac Disorders
  • Emergency Care of the Cardiac Patient
  • Cardiovascular
  • Shock
  • Shock
  • Noninfectious Respiratory Disorder
  • Respiratory
  • Acute & Chronic Renal Disorders
  • Hematologic Disorders
  • Respiratory Emergencies
  • Documentation and Communication
  • Preoperative Nursing
  • Immunological Disorders
  • Intraoperative Nursing
  • Vascular Disorders
  • Renal Disorders
  • Disorders of Pancreas
  • Newborn Complications
  • Medication Administration
  • Central Nervous System Disorders – Brain
  • Studying
  • Emergency Care of the Trauma Patient
  • Infectious Respiratory Disorder
  • Endocrine
  • Disorders of the Adrenal Gland
  • Disorders of the Thyroid & Parathyroid Glands
  • Musculoskeletal Trauma
  • Oncology Disorders
  • Integumentary Disorders
  • Integumentary Disorders
  • Liver & Gallbladder Disorders
  • Circulatory System
  • Disorders of Thermoregulation
  • Multisystem
  • Upper GI Disorders
  • Neurological Emergencies
  • Communication
  • Perioperative Nursing Roles
  • Sexually Transmitted Infections
  • Peripheral Nervous System Disorders
  • Disorders of the Posterior Pituitary Gland
  • Lower GI Disorders
  • Postoperative Nursing
  • Emergency Care of the Respiratory Patient
  • Emergency Care of the Neurological Patient
  • Respiratory Disorders
  • Respiratory System
  • Infectious Disease Disorders

Study Plan Lessons

02.06 Heart Murmurs for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
02.14 Shock Stages for CCRN Review
02.15 Hypovolemic Shock for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
02.18 Cardiovascular Practice Questions for CCRN Review
10.04 Pulmonary Question Review for CCRN Review
1st Degree AV Heart Block
2nd Degree AV Heart Block Type 1 (Mobitz I, Wenckebach)
2nd Degree AV Heart Block Type 2 (Mobitz II)
3rd Degree AV Heart Block (Complete Heart Block)
Acute Kidney Injury Case Study (60 min)
Acute Renal (Kidney) Module Intro
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
ACE (angiotensin-converting enzyme) Inhibitors
Absolute Neutrophil Count (ANC) Lab Values
Absolute Reticulocyte Count (ARC) Lab Values
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Admissions, Discharges, and Transfers
Airway Suctioning
Anaphylaxis Nursing Interventions for Certified Perioperative Nurse (CNOR)
Anemia for Progressive Care Certified Nurse (PCCN)
Aneurysm (Dissecting, Repair) for Progressive Care Certified Nurse (PCCN)
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Angiotensin Receptor Blockers
Anion Gap
Anion Gap Acidosis 1 Nursing Mnemonic (KULT)
Aortic Aneurysm – Management Nursing Mnemonic (CRAM)
Aortic Aneurysm – Thoracic signs Nursing Mnemonic (PEE BADS)
Aortic Stenosis Symptoms Nursing Mnemonic (SAD)
Artificial Airways
ASA (Aspirin) Nursing Considerations
Aspiration for Certified Emergency Nursing (CEN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
Asthma for Certified Emergency Nursing (CEN)
Atenolol (Tenormin) Nursing Considerations
Atorvastatin (Lipitor) Nursing Considerations
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
AVPU Mnemonic (The AVPU Scale)
Bacterial Endocarditis – Symptoms Nursing Mnemonic (Be Joan Of Arc)
Bleeding Complications (Minor) Nursing Mnemonic (BEEP)
Bleeding for Certified Emergency Nursing (CEN)
Bleeding Precautions Nursing Mnemonic (RANDI)
Blood Flow Through The Heart
Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Blunt Chest Trauma
Bronchoscopy
Calcium Channel Blockers
Cardiac Course Introduction
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Stress Test
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
Cardiovascular Angiography
Cardiovascular Disorders (CVD) Module Intro
Causes of Anaphylaxis Nursing Mnemonic (Many Boys Love Food)
Causes of Dyspnea Nursing Mnemonic (The 6 P’s)
Chest Tube Assessment Nursing Mnemonic (Two AA’s)
Chest Tube Management
02.02 Cardiomyopathy for CCRN Review
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
02.14 Shock Stages for CCRN Review
02.16 Cardiogenic Shock for CCRN Review
02.17 Septic Shock for CCRN Review
03.03 Hypoglycemia for CCRN Review
06.05 Wide Complex Tachycardia for CCRN Review
ACE (angiotensin-converting enzyme) Inhibitors
Acute Inflammatory Disease (Myocarditis, Endocarditis, Pericarditis) for Progressive Care Certified Nurse (PCCN)
Acute Kidney Injury Case Study (60 min)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Allergic Reactions and Anaphylaxis for Certified Emergency Nursing (CEN)
Amputation for Certified Emergency Nursing (CEN)
Anemia for Progressive Care Certified Nurse (PCCN)
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Angiotensin Receptor Blockers
Anti Tumor Antibiotics
Antineoplastics
Aspiration for Certified Emergency Nursing (CEN)
Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Atrial Fibrillation (A Fib)
Atrial Flutter
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
AVPU Mnemonic (The AVPU Scale)
Blood Flow Through The Heart
Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Brain Natriuretic Peptide (BNP) Lab Values
Burns for Certified Emergency Nursing (CEN)
Calcium Acetate (PhosLo) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Calcium Channel Blockers
Cardiac (Heart) Enzymes
Cardiac A&P Module Intro
Cardiac Anatomy
Cardiac Arrest Nursing Interventions for Certified Perioperative Nurse (CNOR)
Cardiac Course Introduction
Cardiac Labs – What and When to Use Them – Live Tutoring Archive
Cardiac Labs – What and When to Use Them 2 – Live Tutoring Archive
Cardiac Stress Test
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Cardiac Valves Blood Flow Nursing Mnemonic (Toilet Paper my Ass)
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
Cerebral Metabolism
Chemotherapy Patients
Cirrhosis for Certified Emergency Nursing (CEN)
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Compartment Syndrome for Certified Emergency Nursing (CEN)
Congestive Heart Failure Concept Map
Coronary Artery Disease Concept Map
Creatine Phosphokinase (CPK) Lab Values
Cushing’s Syndrome Case Study (60 min)
Day in the Life of a Med-surg Nurse
Disease Specific Medications
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Dysrhythmias for Certified Emergency Nursing (CEN)
Dysrhythmias Labs
Echocardiogram (Cardiac Echo)
Endocarditis Case Study (45 min)
Endocarditis for Certified Emergency Nursing (CEN)
Envenomation Emergencies for Certified Emergency Nursing (CEN)
Epinephrine (EpiPen) Nursing Considerations
General Anesthesia
GERD (Gastroesophageal Reflux Disease)
Heart (Cardiac) and Great Vessels Assessment
Heart (Cardiac) Failure Module Intro
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Hiatal Hernia
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Hypertensive Crisis Case Study (45 min)
Hyperthyroidism Case Study (75 min)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoparathyroidism
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Influenza for Certified Emergency Nursing (CEN)
Intake and Output (I&O)
Interdisciplinary Team Participation for Certified Perioperative Nurse (CNOR)
Intraoperative Positioning
Lactate Dehydrogenase (LDH) Lab Values
Lung Cancer
Malignant Hyperthermia
MI Surgical Intervention
Minimally-Invasive Cardiac Surgery (Non-Sternal Approach) for Progressive Care Certified Nurse (PCCN)
Myocardial Infarction (MI) Case Study (45 min)
Neurogenic Shock for Certified Emergency Nursing (CEN)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Norepinephrine (Levophed) Nursing Considerations
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Gonorrhea (STI)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care and Pathophysiology for Myasthenia Gravis
Nursing Care and Pathophysiology for Pneumothorax & Hemothorax
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Valve Disorders
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care Plan (NCP) for Activity Intolerance
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Anaphylaxis
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Blunt Chest Trauma
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Cushing’s Disease
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Gastroesophageal Reflux Disease (GERD)
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypoparathyroidism
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Lyme Disease
Nursing Care Plan (NCP) for Myasthenia Gravis (MG)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Pericarditis
Nursing Care Plan (NCP) for Pneumonia
Nursing Care Plan (NCP) for Pulmonary Embolism
Nursing Care Plan (NCP) for Sepsis
Nursing Care Plan (NCP) for Stroke (CVA)
Nursing Care Plan (NCP) for Syncope (Fainting)
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan for Coronary Artery Disease (CAD)
Nursing Care Plan for Distributive Shock
Nursing Care Plan for Myocarditis
Nursing Care Plan for Pulmonary Edema
Nursing Case Study for Acute Kidney Injury
Nursing Case Study for Cardiogenic Shock
Nursing Case Study for Hepatitis
Nursing Case Study for Rheumatic Heart Disease
Nursing Case Study for Type 1 Diabetes
Nutrition (Diet) in Disease
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Pacemakers
Peptic Ulcer Disease Case Study (60 min)
Performing Cardiac (Heart) Monitoring
Pericardial Tamponade for Certified Emergency Nursing (CEN)
Phenobarbital (Luminal) Nursing Considerations
Pleural Effusion for Certified Emergency Nursing (CEN)
Post-Anesthesia Recovery
Premature Ventricular Contraction (PVC)
Product Evaluation and Selection for Certified Perioperative Nurse (CNOR)
Protein in Urine Lab Values
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Renal Failure for Certified Emergency Nursing (CEN)
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Respiratory Trauma for Certified Emergency Nursing (CEN)
Seizure Disorders for Certified Emergency Nursing (CEN)
Sepsis Labs
Septic Shock (Sepsis) Case Study (45 min)
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Sinus Bradycardia
Sinus Tachycardia
Specialty Diets (Nutrition)
Stroke Case Study (45 min)
Stroke for Certified Emergency Nursing (CEN)
Stroke for Progressive Care Certified Nurse (PCCN)
Stroke Therapeutic Management (CVA)
Supraventricular Tachycardia (SVT)
Sympatholytics (Alpha & Beta Blockers)
Thrombolytics
Thyroxine (T4) Lab Values
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
Triiodothyronine (T3) Lab Values
Troponin I (cTNL) Lab Values
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vasopressin
Ventilator Settings
Ventricular Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Ventricular Fibrillation (V Fib)
Wound Bleeding (Uncontrolled External Hemorrhage) for Certified Emergency Nursing (CEN)
02.02 Cardiomyopathy for CCRN Review
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
AIDS Case Study (45 min)
Airway Suctioning
Anemia for Progressive Care Certified Nurse (PCCN)
Anesthetic Agents
Anesthetic Agents
ARDS Case Study (60 min)
ARDS causes Nursing Mnemonic (GUT PASS)
Artificial Airways
Aspiration for Certified Emergency Nursing (CEN)
Assessment for Myasthenic Crisis Nursing Mnemonic (BRISH)
Asthma for Certified Emergency Nursing (CEN)
AVPU Mnemonic (The AVPU Scale)
Carbon Dioxide (Co2) Lab Values
Chest Tube Management
Chest Tube Management Case Study (60 min)
Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Coronavirus (COVID-19) Nursing Care and General Information
Day in the Life of a Med-surg Nurse
General Anesthesia
Heart Failure Case Study (45 min)
Heart Failure for Certified Emergency Nursing (CEN)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology for Asthma
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of Pneumonia
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Case Study for Pneumonia
Respiratory A&P Module Intro
Respiratory Alkalosis
Respiratory Course Introduction
Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections Module Intro
Respiratory Procedures Module Intro
Respiratory Trauma for Certified Emergency Nursing (CEN)
Respiratory Trauma Module Intro
Thoracentesis
Trach Suctioning
Tuberculosis for Certified Emergency Nursing (CEN)
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)