Stroke Cerebral Vascular Accident Pathophysiology: A Stroke is caused by an inadequate blood supply to the brain or part of the brain.

. Strokes may be classified as ischemic or hemorrhagic. An ischemic stroke results from inadequate blood flow to the brain from partial or complete occlusion of an artery. (Lewis 2011) Ischemic strokes may develop as a blockage within the brains circulation due to narrowing or thrombus formation (Thrombotic Stroke) or may be due to an emboli that originates elsewhere in the body and travels to the brain (Embolic Stroke). A third major category is a hemorrhagic stroke, in which there is a massive brain bleed due to a ruptured vessel. These are the most deadly of the three types. Overall, strokes are the third leading cause of death in the U.S. behind only heart disease and cancer. Men are more likely to suffer a stroke, but often have better out comes than women. Many ethnic cultures have higher incidence of strokes than whites, particularly AfricanAmericans. Risk Factors: Diabetes Mellitus and hypertension are the two most common indicators of stroke; especially when a patient suffers from both conditions. Additionally, age and family history play a role. Modifiable factors include: smoking, alcohol use, obesity, poor sleep, lack of exercise, poor diet, drug abuse and unmanaged hypertension. Additional diseases which may contribute to a stroke are dysrythmias, MI, congenital heart defects and a wide variety of other cardiac illnesses. Clinical manifestations: A stroke victim may present with a wide variety of symptoms which are relate to the location of the brain affected. A patient might have motor impairment, which is often unilateral / contralateral to the side of the brain affected (hemiplegia). Speech and cognitive impairment may also be a common indication of stroke. Diagnostic studies: Most commonly a stroke will be identified using a variety of imaging studies such as a CT / CTA scan or MRI / MRA has greater specificity compared to CT. (Lewis 2011). Collaborative Care: The best course of action is to prevent stroke in the first place. This largely falls into the nurses role in health promotion. Proper diet, exercise and healthy lifestyle are vital. Stroke risk can be reduced by up to 50% with appropriate treatment of hypertension. (Lewis 2011) For patients with a history of TIAs, anti-plately meds such as Aspirin or Plavix are usually prescribed. Surgical interventions are less common but are similar to many cardiac procedures, such as stents and balloons used to repair or improve vascular issues. Nursing care and teaching would involve lifestyle choices, educating patients about modifiable risk factors, medications and the importance of managing related diseases like hypertension and diabetes. For a client with significant motor or cognitive deficits after a CVA, the nurse would need to provide the family and caregivers information on outside support agencies. References: Dirksen, S. R., Lewis, S. L., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medicalsurgical nursing, assessment and management of clinical problems. (8th ed., Vol. 1). St. Louis, MO: Mosby Inc.