Content Reviewers:Lisa Miklush, PhD, RNC, CNS, Jodi Berndt, PhD, RN, CCRN-K, PCCN-K, CNE, CHSE, Gabrielle Proper, RN, BScN, MN
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
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.
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.
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.
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. 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 speech
In 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. 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.
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.
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.