Cerebrovascular Accident (CVA)

• Definition: Occurrence of ischemic or hemorrhagic lesions within the intracranial vasculature (often called a stroke or apoplexy).
• Pathophysiology: Obstruction of the supply of oxygen and nutrients to the brain, which results in varying degrees of cellular injury and neurologic dysfunction.
• Etiology: Thrombus, embolism, or bleeding into an intracranial vessel. Predisposing or causative factors include atherosclerosis, hypertension, and AV malformation.
• Manifestations: S&S of ICP; headache, altered LOC; pupillary changes; seizures; sensorimotor dysfunctions; alterations in speech, cognition, or cranial nerve functions.
• Med Tx: Airway maintenance, ICP management, IV hemodilution, anticoagulation and thrombolytic therapy, vasodilators, diuretics, dexamethasone, anticonvulsants, possible surgery, early institution of rehabilitation therapy.
• Nsg Dx: Alteration in tissue perfusion (cerebral), impaired physical mobility, impaired swallowing, impaired verbal communication, alteration in thought processes, numerous psychosocial diagnoses.
• Nsg Care: Maintain airway. Monitor VS and neurologic status frequently. Evaluate effects of medical regimen. Monitor I&O and nutritional status. Turn every 1 to 2 hours. Coordinate and support rehabilitative regimens. Provide emotional support and patient and family education.
• Prognosis: Varies from full recovery to persistent vegetative state or death depending on type, location, and severity of the event as well as complicating factors.