Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
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Included In This Lesson
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
- Pathophysiology
- Blood clot in vessel in brain
- No flow past clot
- 87% of all strokes
- Not immediately seen on CT scan (24 hours)
- MRI for better view
- Risk Factors
- Hypertension
- Diabetes
- Obesity
- Atherosclerosis
- Cardiac Dysrhythmias
- Oral Contraceptives
- Substance Abuse
- Presentation dependent on location of clot
- Basal
- Pontine
- MCA
- See Stroke Assessment Lesson
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
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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MS2EXAM1
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Medication Administration
- Central Nervous System Disorders – Brain
- Shock
- Shock
- Urinary System
- Adult
- Respiratory Emergencies
- Cardiovascular Disorders
- Postpartum Complications
- Emergency Care of the Neurological Patient
- Neurological Emergencies
- Emergency Care of the Respiratory Patient
- Pregnancy Risks
- Vascular Disorders
- Noninfectious Respiratory Disorder
- Respiratory System
- Cardiovascular
- Endocrine and Metabolic Disorders
- Hematologic Disorders
- Disorders of the Adrenal Gland
- Neurologic and Cognitive Disorders
- Upper GI Disorders
- Lower GI Disorders
- Nervous System
- Labor Complications
- Liver & Gallbladder Disorders
- Oncology Disorders
- Substance Abuse Disorders
- Renal and Urinary Disorders
- Integumentary Disorders
- Renal Disorders
- Gastrointestinal Disorders
- Acute & Chronic Renal Disorders
- Respiratory Disorders
- Disorders of Pancreas
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Gastrointestinal
- Renal
- Endocrine System
- Disorders of the Thyroid & Parathyroid Glands
- Integumentary Disorders
- Musculoskeletal Trauma
- Urinary Disorders
Study Plan Lessons
EKG Basics – Live Tutoring Archive
Dysrhythmia Emergencies
Electrical Activity in the Heart
EKG (ECG) Waveforms
The EKG (ECG) Graph
Normal Sinus Rhythm
Sinus Tachycardia
Sinus Bradycardia
Supraventricular Tachycardia (SVT)
Atrial Flutter
Atrial Fibrillation (A Fib)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Procainamide (Pronestyl) Nursing Considerations
Sympatholytics (Alpha & Beta Blockers)
Verapamil (Calan) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Amiodarone (Pacerone) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Dysrhythmias Labs
Dysrhythmias for Certified Emergency Nursing (CEN)
AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Cardiogenic Shock For PCCN for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Electrolytes Involved in Cardiac (Heart) Conduction
Nursing Care Plan (NCP) for Cardiomyopathy
3rd Degree AV Heart Block (Complete Heart Block)
2nd Degree AV Heart Block Type 2 (Mobitz II)
1st Degree AV Heart Block
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Advanced Cardiovascular Life Support (ACLS)
Acute Coronary Syndrome (ACS)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Obstructive Heart (Cardiac) Defects
Heart (Heart) Failure Exacerbation
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
02.09 12 Lead EKG- Leads 1, 2, 3, aVL, and aVF 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
Disseminated Intravascular Coagulation (DIC)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for Distributive Shock
Sepsis Labs
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Sepsis Concept Map
Ischemic (CVA) Stroke Labs
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
ACLS (Advanced cardiac life support) Drugs
Electrical A&P of the Heart
02.10 12 Lead EKG- Lead V1-V6 for CCRN Review
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
ARDS Case Study (60 min)
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Acute Respiratory Distress
HELLP Syndrome
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care and Pathophysiology for Arterial Disorders
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology for Heart Failure (CHF)
Restrictive Lung Diseases (Pulmonary Fibrosis, Neuromuscular Disorders)
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Rapid Sequence Intubation
Trach Suctioning
Trach Care
Pacemakers
Myocardial Infarction (MI) Case Study (45 min)
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
Fluid Volume Deficit
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Cardiomyopathies (Dilated, Hypertrophic, Restrictive) for Progressive Care Certified Nurse (PCCN)
02.02 Cardiomyopathy for CCRN Review
Hydralazine
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Nursing Case Study for Rheumatic Heart Disease
06.04 Differentiating Ectopy and Aberrancy for CCRN Review
Coronary Artery Disease Concept Map
02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review
Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Anti-Platelet Aggregate
Nursing Care Plan (NCP) for Cardiogenic Shock
Mixed (Cardiac) Heart Defects
Nursing Care and Pathophysiology of Angina
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Angina
Hemodynamics
Preload and Afterload
Nursing Care and Pathophysiology for Cardiogenic Shock
MI Surgical Intervention
Heart Failure for Certified Emergency Nursing (CEN)
02.05 Calculating PAWP on PEEP for CCRN Review
Heart Failure 2 – Live Tutoring Archive
Nitro Compounds
Cardiac/Vascular Catheterization (Diagnostic, Interventional) for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology for Valve Disorders
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Gastritis
Gastrointestinal (GI) Bleed Concept Map
Methylprednisolone (Solu-Medrol) Nursing Considerations
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Anemia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Parasympathomimetics (Cholinergics) Nursing Considerations
Peptic Ulcer Disease Case Study (60 min)
Tocolytics
Cholecystitis for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care Plan (NCP) for Cholecystitis
Cirrhosis Case Study (45 min)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Cirrhosis for Certified Emergency Nursing (CEN)
Esophageal Varices for Certified Emergency Nursing (CEN)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Hepatitis for Certified Emergency Nursing (CEN)
Liver Cancer
Liver Function Tests
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care Plan (NCP) for Encephalopathy
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Liver Cancer
Bowel Obstruction Concept Map
Epispadias and Hypospadias
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan for Hiatal Hernia
Cirrhosis Case Study (45 min)
Colorectal Cancer (colon rectal cancer)
Encephalopathy Case Study (45 min)
Fluid Shifts (Ascites) (Pleural Effusion)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Liver Cancer
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care Plan (NCP) for Hepatitis
Nursing Care Plan (NCP) for Nephrotic Syndrome
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan for Liver Cancer
Nursing Case Study for Hepatitis
Stomach Cancer (Gastric Cancer)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care Plan (NCP) for Cholecystitis
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Acute Abdomen for Certified Emergency Nursing (CEN)
Appendicitis
Appendicitis for Certified Emergency Nursing (CEN)
Dialysis & Other Renal Points
Nursing Care and Pathophysiology for Diverticulosis – Diverticulitis
Nursing Care Plan (NCP) for Bowel Obstruction
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Peritoneal Dialysis (PD)
Peritonitis for Certified Emergency Nursing (CEN)
Cystic Fibrosis (CF)
Diabetes Mellitus (DM) Module Intro
Diabetes Mellitus & Those Dang Blood Sugars! – Live Tutoring Archive
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Metabolic Acidosis (interpretation and nursing diagnosis)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Chronic Kidney Disease
Nursing Care Plan (NCP) for Diabetes
Nursing Care Plan (NCP) for Diabetes Mellitus (DM)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Case Study for Diabetic Foot Ulcer
Nursing Case Study for Type 1 Diabetes
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
03.02 Diabetes Insipidus for CCRN Review
Diabetes Insipidus Case Study (60 min)
Diabetes Insipidus Nursing Mnemonic (DDD)
Enuresis
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Diabetes Insipidus
03.04 DKA vs HHNK for CCRN Review
05.01 Pancreatitis and Large Bowel Obstruction for CCRN Review
09.05 Chronic Renal Failure for CCRN Review
Adrenal Gland
Diabetes Management
Diabetes Mellitus Case Study (45 min)
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Gestational Diabetes (GDM)
Glipizide (Glucotrol) Nursing Considerations
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia
Injectable Medications
Insulin
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin Drips
Insulin Mixing
Insulin Mnemonic (Ready, Set, Inject, Love)
IV Infusions (Solutions)
IV Pump Management
Hyperthyroidism Case Study (75 min)
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care Plan (NCP) for Hashimoto’s Thyroiditis
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Hypothyroidism
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
09.02 Acute Tubular Necrosis for CCRN Review
Burn Injuries
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Compartment Syndrome for Certified Emergency Nursing (CEN)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Urinary Tract Infection (UTI)
Nursing Care Plan for Gastritis
Wound Care – Assessment
Wound Care – Selecting a Dressing