Nervous system: Seizures and strokes
Definitions & Key takeaways
Both stroke and seizures are medical conditions that can affect the nervous system. A stroke occurs when a part of the brain loses its blood supply. There are two main types of stroke: an ischemic stroke, which occurs when there's a blockage of an artery, typically from a thrombus or embolus; and a hemorrhagic stroke, which occurs when an artery in the brain ruptures and leaks blood into the brain.
A stroke may result in permanent disability, like hemiplegia or aphasia. Acute care focuses on the early reestablishment of blood flow and supportive measures, while long-term care may include speech, physical, and occupational therapy.
On the other hand, seizures are sudden, abnormal electrical discharges in the brain that can cause changes in movement, behavior, and consciousness. These can be focal seizures, meaning that they affect one small area in one brain hemisphere, or generalized seizures, which affect both hemispheres and include tonic-clonic and absence seizures.
Intro0:00–0:22
The nervous system can develop several types of disorders, which can affect the clients you care for. The disorders can cause different problems depending on their cause and the area of the nervous system involved One of the most common nervous system disorders is stroke, also known as cerebrovascular accident or brain attack.
Classification of stroke0:22–0:46
This is when the brain gets damaged due to being deprived of oxygen- rich blood. There are two main types of stroke: an ischemic stroke, which occurs when there’s a blockage of an artery, and a hemorrhagic stroke, which occurs when an artery in the brain leaks into the brain tissue.
Now, most ischemic strokes are caused by thrombosis, meaning that a clot forms over an atherosclerotic plaque. This is when a buildup of fat and cholesterol forms on the inside of a blood vessel in the brain known as cerebral blood vessels and starts to obstruct arterial blood flow.
Causes & risk factors for ischemic strokes0:46–1:35
Another mechanism for ischemic stroke is an embolism. This happens when a blood clot breaks off from an atherosclerotic plaque from an artery outside the brain, breaks loose, and travels to the brain where it gets lodged in a cerebral artery.
Factors that can increase the client's risk for having a thrombotic or embolic stroke include anything associated with atherosclerosis, like smoking, hypertension, or high blood pressure; diabetes; and a diet high in saturated fat.
Now, sometimes a small clot can block a cerebral artery for a short period of time before dissolving, restoring normal blood flow.
Transient ischemic attacks1:35–1:58
So, if it self-resolves within 24 hours, usually within minutes to hours, it’s called a transient ischemic attack, or TIA for short.
The main risk factor for a TIA is atherosclerosis.All right, now in hemorrhagic strokes, a cerebral blood vessel ruptures and bleeds out, creating a pool of blood that increases pressure within the brain.
Causes & risk factors for hemorrhagic strokes1:58–2:30
In addition, less oxygen-rich blood is flowing downstream to the cells that need it. The main risk factor for hemorrhagic stroke is hypertension, or high blood pressure.
That's because hypertension can cause blood vessels to become more stiff and brittle and, therefore, more vulnerable to rupture.
Cerebral blood vessel deformities are another risk factor for hemorrhagic stroke. Okay, now, stroke symptoms depend on the exact part of the brain that is affected.
Clinical features of stroke2:30–3:17
For example, a stroke on the right cerebral hemisphere can cause numbness and sudden muscle weakness in the left part of the body.If a stroke affects the cerebellum, it can cause a loss of balance or coordination.
If it occurs in the parts of the brain controlling language, which are usually located in the left cerebral hemisphere, then it can cause slurred speech or difficulty understanding speechIn general, a useful acronym to remember some common stroke symptoms is FAST: facial drooping, arm weakness, speech difficulties, and time.
Time is obviously not a symptom, but it’s a reminder to get help as quickly as possible to minimize cell injury and maximize the chance of a full recovery.Acute management of stroke should be done as quickly as possible to prevent further cell death.
Acute care of stroke 3:17–3:48
For ischemic strokes, this involves restoring blood flow by removing or breaking down the clot. For hemorrhagic strokes, treatment should be aimed at stopping the bleeding, controlling hypertension, and relieving the pressure inside the brain caused by the built-up blood.
In both types of strokes, general measures will be implemented to stabilize the client and monitor their vital signs closely.A client who has suffered from a stroke is often left with permanent disability, which, once again, depends on the part of the brain damaged.
Long-term effects of stroke3:48–4:21
The most common forms of disability are hemiplegia, or inability to move one side of the body, and aphasia, which refers to speech and language problems.
Aphasia can be expressive, which means the client will have difficulty talking, or receptive, which means the client will have difficulty understanding the meaning of words, making it difficult for them to understand what others are saying and for others to understand them.
Long-term care considerations4:21–5:16
Now, when caring for clients with permanent disability from a stroke, the goal is to provide them with tools that can maximize their quality of life, prevent injuries due to impaired mobility and sensations, and prevent another stroke in the future.
Depending on the type of stroke, these clients will work with speech therapists and physical and occupational therapy to build their strength, help them regain ability to perform activities of daily living, and improve language function.
It’s also important to keep in mind that depression, a sense of loss, frustration, or anxiety are very common following stroke.
As a nursing assistant, you will play an important role to support the client both physically and emotionally during rehabilitation.
Reducing the risk of a future stroke requires quitting smoking; maintaining healthy blood pressure; following a healthy diet low in saturated fat; and controlling other diseases, like diabetes.Another common nervous system disorder is epilepsy.
Epilepsy & seizures5:16–6:59
This is characterized by recurring seizures, where neurons fire over and over again when they’re not supposed to. Seizures are broadly classified into two types: focal and generalized seizures.
Focal seizures only affect one localized area of the brain in one hemisphere and can present with jerking movements in specific muscle groups or the experience of strange sensations, like hearing or tasting something.
On the other hand, generalized seizures affect both hemispheres of the brain, and the most common subtypes are generalized tonic-clonic and absence seizures.
In generalized tonic-clonic seizures, clients experience a tonic phase, where the muscles suddenly tense up, followed by the clonic phase, where muscles rapidly contract and relax.
Contraction of the jaw muscles may cause the client to bite on their tongue. Clients with tonic-clonic seizures may also develop urinary or fecal incontinence.
In contrast, absence seizures are characterized by a sudden, brief loss of consciousness without any change in the muscle tone.
So, they could be sitting on their bed or talking to someone and suddenly “space out” or stare blankly into space for a couple of seconds.
In most cases, the cause of epilepsy remains unidentified, but it’s possible that epilepsy occurs after a stroke, head trauma, infection, or brain tumor.
Reporting and Documenting6:59–7:30
When caring for your clients, there are a few things you should report to the nurse right away. Let the nurse know if there are any signs of a stroke or a transient ischemic attack, like sudden facial drooping, arm weakness, or speech difficulties.
Also, notify the nurse if you observe any signs of an epileptic seizure, like jerking or losing consciousness, a bitten tongue, urinary or fecal incontinence, or if the client complains of experiencing strange sensations.
Recap7:30–9:04
In any case, document the date and time of your observations.All right, as a quick recap… A stroke occurs when a part of the brain loses its blood supply.
There are two main types of stroke: an ischemic stroke, which occurs when there’s a blockage of an artery, typically from a thrombus or embolus, and a hemorrhagic stroke, which occurs when an artery in the brain ruptures and leaks blood into the brain.
Risk factors for an ischemic stroke include smoking, hypertension, diabetes, and a high-fat diet, while hemorrhagic stroke is more common in those with hypertension or blood vessel abnormalities.
Stroke symptoms depend on the part of the brain affected and can be remembered with the acronym FAST: facial drooping, arm weakness, speech difficulties, and time.
If symptoms self-resolve within 24 hours, that event is referred to as transient ischemic attack, or TIA, and there are only temporary neurological problems.
A stroke may result in permanent disability, like hemiplegia or aphasia. Acute care focuses on the early reestablishment of blood flow and supportive measures, while long-term care may include speech, physical, and occupational therapy.
Now, epilepsy is a disorder that predisposes the client to recurrent seizures. These can be focal seizures, meaning that they affect one small area in one brain hemisphere, or generalized seizures, which affect both hemispheres and include tonic-clonic and absence seizures.Treatment involves medications and avoiding high-risk activities.
As a nursing assistant, you are responsible for recognizing and reporting any signs or symptoms of a stroke or
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