Adult Medical-Surgical Nursing

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Adult Medical-Surgical Nursing

• Neurology Module
• Cerebrovascular Disease I (TIA)

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Cerebrovascular Disease Description

• Dysfunction of the Central Nervous System related
  to impaired cerebral circulation the normal
  blood supply to brain tissue is disrupted
• This impairment leads to
• Transient Ischaemic Attack (TIA)
• Stroke

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Cerebrovascular Disease Aetiology

• Impairment of the cerebral circulation occurs
  through
• A thrombus or embolus partially or totally
  occluding a vessel
• Haemorrhage from a ruptured vessel
• Atherosclerosis narrowing the arterial lumen,
  reducing blood flow. This progressively leads to
  ischaemia (transient with no lasting damage) then
  to infarction
• Most ischaemic strokes are carotid-related

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Cerebrovascular Disease Risk Factors for TIA
and Stroke

• Hypertension
• DM (accelerated atherosclerosis)
• Cardiovascular disease (atherosclerosis)
• Cardiac dysrhythmia (atrial fibrillation)
• Family history
• High cholesterol
• Smoking Alcoholism
• Obesity
• Oral contraceptives

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Transient Ischaemic Attack (TIA)

• A temporary episode of neurological dysfunction
• Sudden loss of motor, sensory or visual function
• Lasts from a few seconds up to 24 hours
• May precede stroke
• Warning of impending stroke (sooner or later)

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TIA Clinical Manifestattions

• Sudden, temporary
• Dysphagia
• Dysphasia, speech difficulty
• Paresis
• Numbness
• Ataxia
• Reduced visual field
• Loss of vision one eye

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TIA Diagnosis

• Patient history and clinical picture
• Physical/ neurological assessment reveals
• Weak carotid pulse
• Carotid bruit on auscultation indicates
  interference with normal blood flow
• Carotid Doppler or angiography (to assess
  circulation to the brain)

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TIA Medical Management

• Anticoagulant therapy (IV Heparin pump or
  Klexane)
• Platelet aggregation inhibitors (Asprin, Plavix)
  longterm
• Surgery (next slide)
• Longterm management of hypertension,
  hyperglycaemia, hyperlipidaemia
• Encourage appropriate lifestyle changes

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TIA Surgery

• Carotid Endarterectomy removal of plaque or
  thrombus from carotid artery
• Carotid Angioplasty procedure via angiogram,
  balloon to press plaque against arterial wall
• Carotid Stent to accompany either of the above
  to ensure patency of lumen (foreign body
  therefore requires antiplatelet aggregation cover
  for first months post-op)

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TIA Nursing Post-Surgery

• Neurological observations
• Maintain adequate BP (Hypotension ? ischaemia
  and thrombosis hypertension ? cerebral
  haemorrhage)
• (Nitroprusside a vasodilator ? BP and promotes
  carotid blood flow)
• Cardiac monitoring
• Observe for haematoma in neck disrupting
  breathing (tracheostomy set available)

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TIA Other Nursing Considerations

• Careful monitoring on admission to assess that
  the initial condition is not developing to stroke
• Post-surgical care
• Encourage patient awareness and preventive
  lifestyle changes ? smoking, dietary changes to
  reduce cholesterol, weight reduction, modest
  exercise to develop collateral circulation