1) Explain/Define the CVA. Define CVA.

CVA it’s called Cerebro vascular Accident (Cerebrovascular Accident).

Cerebrovascular accident is also called stroke.

A stroke is also often called a brain attack.

Cerebro vascular accident is a condition in which brain cells, tissues and any particular brain part are not supplied with sufficient amount of oxygen due to insufficient amount of blood supply to the brain cells, tissues and parts of the brain due to infraction of the part of the brain. (Death of the brain tissues) happens, so that part of the brain cannot function properly and the body function which is done by that part of the brain is also impaired.

• Explain the Classification of the Cerebrovascular Accident. State the classification of cerebro vascular accident.

Ischemic stroke:=

This type of stroke occurs due to interruption of blood supply to the brain.

Thrombotic Stroke:=

This type of stroke occurs due to the formation of blood clot in one or more blood vessels of the brain, the condition of thrombotic stroke arises.

Embolic Stroke:=

In this stroke, a blood clot is formed in any of the blood vessels of the body and that blood clot travels to the blood vessels of the brain and then if the traveled blood clot gets stuck in the vessels of the brain, an embolic stroke occurs.

Hemorrhagic Stroke:=

Hemorrhagic stroke is when any of the cerebral vessels rupture due to any reason and bleeding occurs in the brain and due to this the condition of hemorrhagic stroke arises.

Explain the Etiology/cause of the Cerebrovascular Accident. State the causes of cerebrovascular accidents.

Due to hyper tension.

Due to any heart related disease

Ex:= Coronary Artery Disease.

Due to diabetes mellitus.

due to congestive heart failure.

due to ischemia.

Because of obesity.

due to stress.

Due to increased cholesterol level.

Atrial fibrillation.

Due to cigarette smoking.

due to the use of cocaine.

due to alcohol intake.

Due to fatty cholesterol deposits in the artery wall.

Due to any kidney disease.

Due to blood clotting disorder.

Due to rheumatoid arthritis.

due to systemic lupus erythematosus.

Explain the clinical manifestation / sign and symptoms of the patient with the CerebroVascular Accident. State the symptoms and signs of cerebro vascular accident Wada patient.

Weakness in facial muscles.

Numbness.

headache.

Respiration becoming irregular.

Weakness in one side of the body.

Confusion.

Memory loss.

Changes in mental status.

Difficulty in swallowing (Dysphagia).

Difficulty in walking (Gait Ataxia).

Dizziness.

Loss of balance and coordination.

Loss of vision in one sided eye.

Slurred Speech (Dysarthia).

Change in alertness.

Loss of bowel and bladder control.

Personality, mood, and emotional changes.

Agnosia (individual cannot identify anything).

Aphasia (Inability in speaking).

Hemiplagia (paralysis of half side of the body).

Neck Stephenish. (Nuchal rigidity)

Disorientation.

Explain the Diagnostic evaluation of the patient with the Cerebro Vascular Accident. State the diagnostic evaluation of cerebro vascular accident Wada patient.

History taking and physical examination.

Neurological examination (Glasgo coma scale).

Angiography.

Laboratory test.

Blood test for assessing the cholesterol level.

Computerized Tomography (CT Scan).

Carotid Doppler ultrasound.

Complete Blood Count (CBC Test).

Magnetic resonance imaging.

Explain the medical management of the patient with the Cerebro Vascular Accident. State the medical management of cerebro vascular accident Wada patient.

1) Provide Thrombolytic Agent to the patient.

Thrombolytic agents break down blood clots in blood vessels and provide space for blood flow to the particular part.
Providing tissue plasminogen agent (tPA) to the patient in a thrombolytic agent.

2) Provide Anticoagulant drug to the patient.

Anticoagulant drugs prevent the formation of blood clots and play a role in maintaining the blood supply.
Ex:= Heparin, Warfarin.

3) Provide Antiplatelet drug to the patient.

This medicine prevents the aggregation of platelets, which prevents the formation of blood clots.

4) Provide Diuretics medication to the patient.

If there is an accumulation of fluid, to remove it and to decrease the intracranial pressure, diuretic medicine should be provided to the patient.

5) To continuously monitor patient’s vital signs.

6) Provide supplementary oxygen to the patient.

7) If the patient is having severe headache then providing pain killer meditation to the patient.

8) Advising the patient to make his life style modification.

Explain the surgical management of patients with the CerebroVascular Accident. State the surgical management of cerebro vascular accident Wada patient.

Surgery is mainly performed to repair blood vessels if they have ruptured and to remove blood clots if they have formed in the blood vessels.

Explain the Nursing management of patients with the Cerebro Vascular Accident. State the nursing management of cerebrovascular accident Wada patient.

1) Ineffective Cerebral tissue percussion related to interruption of blood supply.

2) Impaired physical mobility related to Neuromuscular Impairment.

3) Impaired Verbal communication related to loss of facial muscles tone.

4) Knowledge deficit related to disease condition and treatment.

Nursing management

Assess the patient’s neurological status.

Advise the patient to take proper waste.

Provide oxygen to the patient properly.

To properly monitor patient’s vital signs.

Changing the patient’s position frequently.

Advising the patient to speak slowly.

Advise the patient to limit activity.

Advising the patient to take medication properly.

Properly maintain the patient’s hydration status.

To properly maintain the nutritional status of the patient.

Advising the patient to do daily routine activities in small amounts.

If the patient is in pain, provide analgesic medicine.

Collaborating properly with other health care personnel for proper patient care.

Providing occupational therapy, physical therapy, speech therapy to patients.

Advise patient to avoid fatty food.

Advise the patient to avoid smoking and alcohol.

Advise the patient to exercise regularly.

Advise the patient to maintain his blood cholesterol level in the normal range.

Assessing the scale in the patient’s proper glass go co.

Advising the patient to exercise properly.

Advise the patient to practice speaking in small amounts.

Advise the patient to reduce weight if he is obese.

Advising the patient to take proper medication.

Advising the patient to follow up properly.

2) Explain/Define the Brain injury. Define brain injury.

Brain injury is a condition in which the tissues of the brain are harmed. It is mainly caused by brain trauma, stroke and various other medical conditions.

Brain injury is a condition in which when any external mechanical force is applied to the brain, the function of the brain is temporarily or permanently impaired in that condition.

Explain the Etiology/cause of the brain injury.

Due to head injury.

Due to header traversal.

Due to fall down.

Due to penetrating injury.

Due to stroke.

Due to infection.

Due to tumor formation.

Due to the occurrence of neurological diseases.

Due to intracranial hemorrhage.

Due to hypoxia.

Due to skull fracture.

Due to neurological disease.

Because of Alzheimer’s disease.

Due to multiple sclerosis.

Due to degenerative diseases.

Due to toxic effect.

Explain the types of brain injury. State the types of brain injury.

There are mainly three types of brain injury.

1) Contusions,

2) Concussions,

3) Hematoma

Subdural hematoma,

Epidural hematoma

1) Contusions,

Contusions are a major type of head injury. Most commonly, brain injury is caused by hitting the head with a movable object. This brain tissue is damaged, resulting in brain hemorrhage and internal bleeding, i.e. internal hemorrhage. Blood is absorbed into the cerebrospinal fluid (CSF) causing permanent brain damage. And the person becomes unconscious.

2) Concussions,

Contusions are a mild type of brain injury in which no structural damage is seen in this no brain tissues are injured Mild brain damage causes temporary loss of neurological function and in this injury the person becomes unconscious for only five minutes.

3) Hematoma

Internal bleeding is seen in hematoma due to intracranial haemorrhage and the blood becomes clotted. This clotted blood is called hematoma. There are two other types of hematoma.

Subdural hematoma,

If a blood clot occurs in the subdural space of the brain, it is called a subdural hematoma.

Epidural hematoma

If blood clots in the epidural space, it is called an epidural hematoma.

Explain the clinical manifestation / sign and symptoms of the patient with the head injury. State the symptoms and signs of a head injury Wada patient.

Disturbing the patient’s consciousness.

Increased intracranial pressure.

headache.

Dizziness.

to be startled

Nausea and Vomiting.

Pupillary abnormality.

Changes in vital signs.

Tachycardia,

Tachyapnia.

Alteration of the gag reflex.

Sensory, visual, and hearing impairment.

Disturbance of mental function.

becoming paralyzed.

Sleep disturbance.

Personality change.

Hemiplegia.

Difficulty in concentration.

Increases mood swings.

feeling tired

Slip pattern disturbance.

Internal bleeding.

Bleeding from ears and nose.

“Halo sign (leakage of cerebrospinal fluid in linen and blood around it)” will be seen.

Explain the diagnostic evaluation of the patient with the brain injury. State the diagnostic evaluation for brain injury.

History taking and physical examination.

X-rays.

Ct scan.

MRI.

PET (Positron Emission Tomography).

Angiography.

Neuropsychological test.

LabInvestigation.

Explain the management of the patient with the head injury. (State the management of a patient with head injury.)

Keep the patient’s airway properly patent.

Provide adequate amount of oxygen to the patient.

Provide proper ventilatory support to the patient.

Keep the patient’s head elevated at a 30° angle.

Keep the patient’s head and neck in a neutral position.

Maintain the patient’s body temperature properly.

Provide adequate amount of fluid to the patient.

Provide sedation if the patient is agitated.

Provide osmotic diuretic medicine to the patient.

Ex:=
Inj.mannitol, syrup glycerol and glucocorticoid.

Provide antibiotic medicine if the patient has an infection.

If the patient has seizures, provide antiepileptic medicine.

Maintain the patient’s fluid and electrolyte levels.

Provide nutritional support to the patient.

If the patient is in pain, provide analgesic medicine.

To monitor patient’s vital signs properly.

Advise the patient to take complete bed rest.

If the patient has inflammation in the brain, then corticosteroid medicine should be provided.

Perform arterial blood gas proper analysis (ABG Analysis) of the patient.

Fluids to the patient in adequate amount.

Properly monitor the patient’s serum electrolyte level.

Provide proper skin care to the patient.

Assess the cognitive level of the patient.

Providing proper psychological support to the patient.

To provide proper work and comfortable environment to the patient.

Provide proper medication to the patient.