Stroke Education for New Grad Nurses

What is a stroke?

A stroke or CVA is a disruption in blood flow to any area of the brain. There are two major types of strokes: ischemic and hemorrhagic. An ischemic stroke can either be embolic or thrombotic, but almost 90% of strokes are ischemic in nature. Embolic strokes occur when a clot is formed in an area of the body besides the brain, but is carried to the brain via the circulatory system where it eventually lodges in a vessel and blocks blood flow to a section of the brain. One of the most common causes of this type of ischemic stroke is atrial fibrillation. A thrombotic stroke occurs when a clot is formed in the brain or a vessel the supplies blood to the brain such as a carotid artery, blocking blood flow to the brain. The most common cause of this type of stroke is atherosclerosis. This decrease in blood flow leads to decreased oxygenation of the brain tissue and eventual necrosis or cell death. A less common type of stroke is the hemorrhagic stroke. In this type of stroke a vessel in the brain is weakened such as with a cerebral aneurysm and this vessel ruptures, causing blood to leak into the brain. Although this type of stroke is rare, it represents almost half of all the deaths associated with strokes. For more information please go to stroke.org. 

There is also something called a transient ischemic attack or TIA for short which is also known as a warning stroke. This is where blood flow is disrupted to the brain for a short period of time. Although the symptoms are similar to stroke, the symptoms usually last less than one day and subside without any treatment. TIA's can however be a sign that a person is at increased risk for a more serious stroke in the future. People who have had a stroke or TIA in the past should take as many precautions as possible to decrease this risk and prevent further brain tissue. damage. 

Signs and symptoms of strokes

The American Heart Association (AHA) (2018) teaches that the symptoms of a stroke present suddenly and in the following ways:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing or blurred vision in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause

Remember this! A stroke that occurs in one hemisphere will affect the opposite side of the body. So a left hemisphere stroke will cause weakness on the right side of the body. A brainstem or cerebellar stroke will present differently usually causing symptoms such as lack of balance, dizziness, nausea, vomiting or blurred vision in both eyes. 

Do not ever delay calling 911 if you experience any one of the signs listed above. It is very important to remember when the symptoms started. The responding Emergency Medical Services agency, and the nurse at the hospital will need to know when the first symptom occurred.

Diagnosis of stroke 

The American Heart Association (AHA) (2018) reports that the best outcomes in treating strokes come from recognizing and diagnosing early (American Heart Association, 2018). The path of treatment is dictated on the results of the diagnostic imaging. Sometimes, other conditions such as a transient ischemic attack, migraines, and hypoglycemia can present as a stroke.

The following are diagnostic tests that the AHA (2018) says can best image the brain to determine whether the patient is experiencing a stroke:

CT (computed tomography) or CAT scan. This test uses radiation to create a picture of the brain. It’s usually one of the first tests given to a patient with stroke symptoms. This imagine result gives quick and accurate results to the provider.

MRI (magnetic resonance imaging). This test uses a large magnetic field to produce an image of the brain. Like the CT scan, it shows the location and extent of brain injury. An MRI produces a more detailed image than a CT scan, this is typically used to diagnose deep injuries.

MRA (magnetic resonance angiography).
In this test, the blood vessels are imaged through a magnetic resonance scanner to locate a cerebral aneurysm.

Treatment options for strokes 

Ischemic Stroke Treatment

tPA

The only FDA approved treatment for ischemic strokes is tissue plasminogen activator. tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If this is given within 3 hours (and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke (American Heart Association, 2013).

Endovascular Procedures
Another treatment option is a procedure called mechanical thrombectomy. A doctor tries removing a large blood clot by sending a wired-caged device called a stent retriever to the site of the blocked blood vessel in the brain. The stent opens and grabs the clot, allowing doctors to remove the stent with the trapped clot. This procedure should be done within six hours of acute stroke symptoms, and only after a patient receives tPA (American Heart Association, 2013).

Hemorrhagic Stroke Treatment

Endovascular Procedures

Endovascular procedures may be used to treat certain hemorrhagic strokes similar to the way the procedure is used for treating an ischemic stroke. These procedures are less invasive than surgical treatments, and involve the use of a catheter introduced through a major artery in the leg or arm, then guided to the aneurysm. Then a mechanical agent such as a coil, is placed to prevent rupture (American Heart Association, 2013).

Surgical Treatment
For strokes caused by a bleed within the brain (hemorrhagic stroke), or by an abnormal tangle of blood vessels (AVM), surgical treatment may be done to stop the bleeding. If the bleed is caused by a ruptured aneurysm (swelling of the vessel that breaks), a metal clip may be placed surgically at the base of the aneurysm to secure it (American Heart Association, 2013).

Prevention of strokes 

When looking at how one can prevent a stroke from occurring, there are both modifiable and non-modifiable risk factors. Modifiable risk factors are those that a patient can affect either positively or negatively and non-modifiable risk factors are those that no one can change.

Modifiable risk factors for stroke include: hypertension, smoking, diet, exercise, alcohol intake, heart disease, diabetes, high cholesterol, atrial fibrillation, oral contraceptives, polycythemia and stress. Although some of the aforementioned health hazards are incurable such as heart disease and diabetes, it does not mean that the patient cannot manage them appropriately in order to decrease their chances of having a CVA.

Non-modifiable risk factors for stroke include: Age, gender, family history and ethnicity. 

In order to prevent a stroke patients should avoid smoking cigarettes, drink alcohol sparingly, follow a low cholesterol and heart healthy diet, exercise regularly, maintain a healthy body mass index (BMI), learn to manage their stress and take care of health concerns they may have such as high blood pressure or diabetes mellitus. 

For more information about stroke prevention please click here: 

Things You Can Do to Prevent Strokes