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Chapter 2

NURSING 2MM3 Chapter Notes - Chapter 2: Heredity, Anosognosia, Apraxia


Department
Nursing
Course Code
NURSING 2MM3
Professor
Tracey Jewiss
Chapter
2

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Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
Lewis: Medical-Surgical Nursing in Canada, 4th Edition
Chapter 60: Nursing Management: Stroke
Key Points
Stroke, or cerebro-vascular accident (the medical term for stroke) occurs when
there is ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the
brain that results in death of brain cells. Functions such as movement, sensation, or
emotions that were controlled by the affected area of the brain are lost or impaired.
RISK FACTORS FOR STROKE
The most effective way to decrease the burden and incidence of stroke is prevention.
Nonmodifiable risk factors include age, gender, ethnicity and race, family history and
heredity, and low birth rate.
Hypertension is the single most important modifiable risk factor. Other modifiable
risk factors include heart disease, diabetes mellitus, increased serum cholesterol,
smoking, excessive alcohol consumption, obesity, physical inactivity, poor diet, and
drug abuse.
Atherosclerosis (hardening and thickening of arteries) is a major cause of stroke. It
can lead to thrombus formation and contribute to emboli.
TYPES OF STROKE
Ischemic Stroke
Ischemic strokes result from inadequate blood flow to the brain from partial or
complete occlusion of an artery, and account for approximately 87% of all strokes.
Ischemic strokes are further divided into thrombotic and embolic based on the
underlying pathophysiological findings.
A transient ischemic attack (TIA) is a transient episode of neurological dysfunction
caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of
the brain. Clinical symptoms typically last less than 1 hour. Most TIAs resolve.
A TIA is usually a precursor to an ischemic stroke.
A thrombotic stroke occurs when a blood clot forms in a diseased and narrowed
blood vessel in the brain. If the narrowed lumen of the blood vessel becomes
occluded, infarction occurs.
Embolic stroke occurs when an embolus lodges in and occludes a cerebral artery,
resulting in infarction and edema of the area supplied by the involved vessel.

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Key Points
Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
60-2
Hemorrhagic Stroke
Hemorrhagic strokes account for approximately 15% of all strokes and result from
bleeding into the brain tissue itself (intracerebral or intraparenchymal hemorrhage) or
into the subarachnoid space or ventricles.
Intracerebral hemorrhage is bleeding within the brain caused by a rupture of a
vessel. It is difficult to predict the prognosis of patients with intracerebral
hemorrhage.
Subarachnoid hemorrhage (SAH) occurs when there is intracranial bleeding into
the cerebro-spinal fluidfilled space between the arachnoid and pia mater membranes
on the surface of the brain. Subarachnoid hemorrhage is commonly caused by rupture
of a cerebral aneurysm (congenital or acquired permanent, localized outpouching or
dilation of the blood vessel wall).
Clinical Manifestations and Diagnostic Studies
A stroke can affect many body functions, including motor activity, bladder and bowel
elimination, intellectual function, spatial-perceptual alterations, personality, affect,
sensation, and communication.
Motor deficits include impairment of (1) mobility, (2) respiratory function, (3)
swallowing and speech, (4) gag reflex, and (5) self-care abilities.
The patient may experience aphasia (total loss of comprehension and use of
language) when a stroke damages the dominant hemisphere of the brain, or
dysphasia (impaired ability to communicate) due to partial disruption or loss.
Many stroke patients also experience dysarthria, a disturbance in the muscular
control of speech. Impairments may involve pronunciation, articulation, and
phonation (use of the voice).
Patients who have had a stroke may have difficulty controlling their emotions.
Both memory and judgement may be impaired as a result of stroke.
Spatialperceptual problems may be divided into four categories:
o Patients may deny their illnesses or their own body parts (anosognosia).
o The patient may neglect all input from the affected side. This may be worsened by
homonymous hemianopia, in which blindness occurs in the same half of the
visual fields of both eyes. The patient also has difficulty with spatial orientation,
such as judging distances.
o Agnosia is the inability to recognize an object by sight, touch, or hearing.
o Apraxia is the inability to carry out learned sequential movements on command.
Most problems with urinary and bowel elimination occur initially and are temporary.
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