ANSWER
Cerebrovascular Accident Pathophysiology (CVA)
A disruption in cerebral blood flow causes cerebrovascular accidents (CVAs), also referred to as strokes, which lead to brain tissue ischemia and neuronal damage. There are two main categories:
A cerebral artery blockage, such as a thrombus or embolus, results in an ischemic stroke, which lowers the flow of oxygen and nutrients to the brain.
A ruptured blood vessel causes a hemorrhagic stroke, which results in immediate brain tissue destruction, elevated intracranial pressure, and intracranial hemorrhage (Benjamin et al., 2020).
Hypoxia, or rapid oxygen deprivation of neurons in the afflicted area, causes excitotoxicity due to excessive glutamate release and calcium influx. Proteolytic enzymes are activated by this cascade, which causes brain edema and cell death (Powers et al., 2019). The size of the damaged vessel, the length of the ischemia, and the presence of collateral circulation all determine how much damage is done.
Cultural, Economic, and Environmental Consequences of CVA Cultural Consequences:
High salt intake is one ethnic dietary practice that might raise the risk of hypertension, a significant risk factor for CVA. High salt diets may increase the risk of hypertension and stroke in Asian groups, especially Japanese Americans like Mr. Kim (Chow et al., 2021).
Treatment may be delayed due to cultural attitudes about obtaining medical attention, which could lead to worse results.
Financial Consequences:
The treatment of CVAs sometimes entails high expenses for acute care, rehabilitation, and long-term disability management.
Access to follow-up therapies, drugs, and preventive care may be difficult for patients without insurance or sufficient financial resources, which could affect their quality of life and ability to recover.
Environmental Consequences:
Living in a place with poor access to medical facilities might cause life-saving treatments, including thrombolytic therapy, to be delayed.
Environmental stressors, such air pollution, can increase the incidence of stroke by contributing to cardiovascular risks (Benjamin et al., 2020).
Nursing Interventions of Priority
Maintain Breathing and Airway Stability:
Keep your airway open, check your oxygen saturation levels, and give more oxygen if needed.
Start the Stroke Procedures:
Execute time-sensitive measures, such as quick transfer to imaging and, if necessary, thrombolytic medication administration.
Track Your Neurological Health:
To evaluate the severity of a stroke and track any changes, use instruments like the National Institutes of Health Stroke Scale (NIHSS).
Control Blood Pressure: Reduce hypertension without appreciably lowering cerebral perfusion pressure.
Assure IV Access: Provide IV access so that fluids and medications can be administered.
Diagnostic testing and labs
The goal of an MRI or CT scan is to distinguish between hemorrhagic and ischemic stroke, which dictates the course of treatment.
The existence of ischemia or bleeding regions is a critical indicator.
Blood Glucose: Goal: Stroke symptoms can be mimicked or made worse by hypoglycemia or hyperglycemia.
The goal of the coagulation panel (PT/INR, aPTT) is to screen for coagulopathies, particularly prior to the administration of thrombolytics.
The goal of the electrolyte panel is to detect abnormalities that can exacerbate neurological consequences.
ECG and cardiac enzymes are used to identify common stroke risk factors, such as atrial fibrillation or myocardial infarction.
Multidisciplinary Group Members
Neurologist:
oversees the administration of stroke-specific therapies and offers specialist evaluation.
A speech-language pathologist (SLP) assesses and treats communication issues including dysphagia.
Occupational and physical therapists: Support functional independence, mobility, and recovery.
A social worker can help with discharge planning, community support, and financial resources.
Dietitian: Offers instruction on dietary changes to lower the risk of stroke recurrence.
Justification: By addressing the physical, emotional, and social facets of recovery, a multidisciplinary approach maximizes patient-centered outcomes (Powers et al., 2019).
Citations
Muntner, P., Alonso, A., Benjamin, E. J., et al. (2020). The American Heart Association’s 2020 update on heart disease and stroke data. e139–e596 in Circulation, 141(9). 10.1161/CIR.0000000000000757 https://doi.org
Teo, K. K., Rangarajan, S., Chow, C. K., et al. (2021). A worldwide investigation on the relationship between dietary potassium and salt intake and cardiovascular event risk. 1817–1827 in Journal of the American College of Cardiology, 77(14). 10.1016/j.jacc.2021.02.035 https://doi.org
Rabinstein, A. A., Powers, W. J., Ackerson, T., et al. (2019). Recommendations for the prompt treatment of acute ischemic stroke patients. 50(12), Stroke, e344–e418. STR.0000000000000211 https://doi.org/10/
QUESTION
You are caring for a 68-year-old Akio Kim in the emergency department for rule-out Cerebrovascular Accident (CVA). Mr. Kim’s daughter reported that he woke up that morning with left-sided weakness and slurred speech.
Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of Cerebrovascular Accident (CVA), respond to the following prompts:
- Thoroughly explain the pathophysiology of Cerebrovascular Accident (CVA). Use a scholarly or authoritative source to support your answer.
- Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
- cultural
- financial
- environmental implications
- Identify 3-5 priority nursing interventions for the client while in the emergency department.
- Describe labs and diagnostic testing you would want to include in client’s plan of care and why. What are critical indicators? Support with a scholarly source.
- What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.