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CEREBROVASCULAR ACCIDENT (CVA)/STROKE Cerebrovascular disease refers to any functional or structural abnormality of the brain caused by a pathological condition of the cerebral vessels or of the entire cerebrovascular system. This pathology either causes hemorrhage from a tear in the vessel wall or impairs the cerebral circulation by a partial or complete occlusion of the vessel lumen with transient or permanent effects. Over 700,000 Americans are affected by a CVA annually. CVA is the third leading cause of death after heart disease and cancer and is the leading cause of disability cost to the nation (approximately $30–$40 billion/year.) Thrombosis, embolism, and hemorrhage are the primary causes for CVA, with thrombosis being the main cause of both CVAs and transient ischemic attacks (TIAs). The most common vessels involved are the carotid arteries and those of the vertebrobasilar system at the base of the brain. A thrombotic CVA causes a slow evolution of symptoms, usually over several hours, and is “completed” when the condition stabilizes. An embolic CVA occurs when a clot is carried into cerebral circulation and causes a localized cerebral infarct. Hemorrhagic CVA is caused by other conditions such as a ruptured aneurysm, hypertension, arteriovenous (AV) malformations, or other bleeding disorders. Symptoms depend on distribution of the cerebral vessel(s) involved. Ischemia may be (1) transient and resolve within 24 hours, (2) reversible with resolution of symptoms over a period of 1 week (reversible ischemic neurological deficit [RIND]), or (3) progress to cerebral infarction with variable effects and degrees of recovery. CARE SETTING Although the patient may initially be cared for in the intensive care unit (ICU), this phase of care focuses on the step- down or medical unit and subacute/rehabilitation units to community level. RELATED CONCERNS Hypertension: severe Craniocerebral trauma (acute rehabilitative phase) Psychosocial aspects of care Seizure disorders Total nutritional support: parenteral/enteral feeding Patient Assessment Database Collected data are determined by location, severity, and duration of pathology. ACTIVITY/REST May report: Difficulties with activity due to weakness, loss of sensation, or paralysis (hemiplegia) tires easily; difficulty resting (pain or muscle twitching) May exhibit: Altered muscle tone (flaccid or spastic); paralysis (hemiplegia); generalized weakness Visual disturbances Altered level of consciousness CIRCULATORY May report: History of postural hypotension, cardiac disease (e.g., myocardial infarction [MI], rheumatic/valvular heart disease, HF, bacterial endocarditis), polycythemia May exhibit: Arterial hypertension (common unless CVA is due to embolism or vascular malformation) Pulse rate may vary (preexisting heart conditions, medications, effect of stroke on vasomotor center) Dysrhythmias, electrocardiogram (ECG) changes Bruit in carotid, femoral, or iliac arteries, or abdominal aorta EGO INTEGRITY May report: Feelings of helplessness, hopelessness
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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