The Brain'The Bodyand You

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The Brain.The Bodyand You

• Presented by St. Lawrence College with support
  from MOHLTC Stroke System
• Professor Ruth Doran

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This project is supported by
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Learning Series Topics

• Stroke Care from Prevention to Life After Stroke
• Continence Care
• Mobility Positioning and Transferring
• Swallowing, Feeding and Hydration
• Communications and Behaviours

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Stroke Care

• From Prevention to Life After Stroke
• Presented by Professor Ruth Doran
• St. Lawrence College, Kingston Campus

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Overview of Workshop

• What is a Stroke (Cardiovascular Event)
• Types of Strokes
• Risk Factors for Strokes
• The Warning Signs
• The Effects on an Individual
• The Effects on their Significant Others
• Management and Care

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Stroke

• 4th leading cause of death in Canada
• 60 of Stroke Survivors are left with a moderate
  to severe disability
• Cost to Canadian economy 2.7 billion per year

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Stroke

• Is an interruption in the blood supply to the
  brain causing injury to that part of the brain

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Stroke

• Ischemic Strokeblood supply is interrupted or
  totally occluded

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Stroke

• interruption can be a Thrombus or an Embolus

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Stroke

• Hemorrhagic.active bleeding into the brain
  tissuefrom a ruptured blood vessel (Aneurysm) or
  an Atriovenous Malformation (AVM)

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Transient Ischemia Attacks

• Also termed TIAs, Mini Strokes
• Is temporary interruption in the blood supply to
  a specific region of the brain

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Risk Factors for Stroke

• Non Modifiable
• AGE
• GENDER
• RACE
• FAMILY HISTORY

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Risk Factors for Stroke

• Modifiable Risk Factors
• HYPERTENSION
• CARDIOVASCULAR DISEASE
• SMOKING

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Risk Factors for Stroke

• ELEVATED CHOLESTEROL
• ELEVATED RED BLOOD CELL
• COUNT

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Risk Factors for Stroke

• DIABETES MELLITUS
• OBESITY
• DRUG/ALCOHOL USE

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Signs and Symptoms of Acute Stroke

• Sudden Weakness
• -Sudden loss of strength or sudden numbness in
  the face, arm or leg, even if temporary
• Sudden Trouble Speaking
• - Sudden difficulty speaking or understanding or
  sudden confusion, even if temporary
• Sudden Trouble Seeing
• - Sudden Trouble with vision, even if temporary

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Signs and Symptoms of Stroke

• Sudden Headache
• Sudden severe and unusual headache
• Sudden Dizziness
• Sudden loss of balance, especially with any of
  the above signs

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Signs and Symptoms of Acute Stroke

• Weakness
• Trouble speaking
• Trouble seeing
• Dizziness
• Headache

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Circle of Willis

• Anterior Cerebral Artery
• Anterior Communicating Artery
• Middle Cerebral Artery
• Posterior Cerebral Artery
• Posterior Communicating Artery

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Cerebral Circulation Another view
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Ischemic Stroke Early CT Signs

• Hyperdense middle cerebral artery sign
• Subtle decreased attentuation of grey matter
• Loss of grey white differentiation
• Loss of coritical ribbon
• Disappearing basal ganglia
• Early Mass Effect
• Suical effacement
• Shift

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Ischemic Hemorrhagic
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Ischemic Stroke

• Hyperdense MCA Sign

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Ischemic Stroke

• Disappearing Basal Ganglia

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Ischemic Stroke

• Large Infarct

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How the Brain Functions

• Left Side of the BrainControls the movement
  senses on the right side of the body
• Left Sided Stroke. paralysis /or weakness on
  Right side of body

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How the Brain Functions

• .R visual field deficit
• Slow, continuous movement
• loss of ability to read, talk (aphasiaexpressive
  , receptive think, impaired intellectual ability

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Right Side of Brain

• Controls the movement senses on the left side
  of the body
• Also controls creativity, ability to enjoy music
  and art, ability to recognize people
• Right Sided Strokeparalysis /or weakness on
  Left side of body

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Right Side of the Brain

• Left visual field deficits
• Spatial Perceptual Deficits
• Decreased Attention Span
• Impulsive Behaviour and Poor Judgment

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Cerebral circulation review

• Brain derives its arterial supply from carotid
  and vertebral arteries
• Carotid and vertebral arteries begin
  extracranially
• Internal carotid arteries and branches supply
  anterior 2/3 of cerebral hemisphere
• Vertebral and basilar arteries supply posterior
  and medial regions of hemispheres, brainstem,
  diencephalon, cerebellum and cervical spinal cord

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When a Stroke Occurs

• Ischemic StrokeObstruction of blood vessel
  begins the ischemic cascade
• Neurons can no longer survive on aerobic
  respiration
• Neurons go to anaerobic respiration

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When Stroke Occurs

• Cells dietermed penumbra region
• Penumbra region can be salvaged
• Use of tPA (Tissue Plasminogen Activator)

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Ischemic Stroke Cerebellar Infarct

• Headache, nausea/vommitting
• Vertigo, imbalance
• Normal tone, power, reflexes
• Inability to sit or stand
• Ataxia
• Later signs Decreasing level of consciousness
• Diplopia, gaze palsy
• Ipsilateral,V, VII impairment

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Aneursym
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Brain Aneursym
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Hemorrhagic Stroke

• Bleeding into the brain tissue resulting in
• Increased pressure within the skull (Increased
  Intracranial Pressure)
• Decreased blood supply to cerebral tissues

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Clinical Management

• Thrombolytic Therapy t P A must be initiated
  within 3 hours of a stroke
• Criteria 18 years or older, clinical diagnosis
  of stroke with NIH score lt22
• B/P systolic lt 185 diastolic lt 110

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Clinical Management

• Not a minor or resolving stroke, no seizure at
  onset of stroke
• Not taking Coumadin, Prothrombin time lt 15
  seconds or INR 1.7
• Has not received Heparin with the last 48 hours

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Clinical Management continued

• Platelet count gt 100,000, no acute MI
• No prior intracranial hemorrhage, neoplasm, AV
  malformation, aneurysm
• No history of stroke or head injury within last 3
  months

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Clinical Management continued

• No GI or Urinary bleeding within last 21 days
• Not lactating or post partum

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Clinical Management continued

• t PA..recumbant t PA binds to fibrin and
  converts plasminogen to plasminstimulating
  fibrinolysis of the atherosclerosis lesions
• Minimum t PA dose is 0.9 mg/kg of body weight,
  maximum dose is 90 mg.

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Clinical Management continued

• Loading dose 10 of the calculated does, is
  given over 1 minute
• Remaining does is given over 1 hour (infusion
  pump)

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Immediate Management

• Thrombolytic Therapy

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Common Medications used in Stroke Management

• ACE INHIBITORS Enalapril (Vasotec)
• Ramipril
  (Altace)
• DIURETICS Hydrochlorthiazide

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Common Medications Used for Stroke

• LIPID LOWERING AGENTS Atorvastic (Lipitor)
• PLATELET INHIBITORS Acetylsalicylic Acid

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Common Medications used in Stroke Management

• ANTICOAGULANTS Warfarin (Coumadin)
• CALCIUM CHANNEL BLOCKERS Verapamil (Isoptin)

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Intraprofessional Support Care of the Stroke
Client

• Cardiovascular System Maintain balance of
  cardiac status
• Neurologic System Prevent further damage
• Musculo Skeletal System Maintain optimal
  functional positioning

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Intraprofessional Support continued

• Integumentary System Maintain Integument
• Urinary System Maintain fluid output
• Gastrointestinal System Monitor nutritional
  intake

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Individual and Family Effects

• Grief
• Frustration
• Fatigue
• Anxiety
• Emotional Liability

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Case Study

• Read Case Study given on way in
• Adopt role noted on your copy
• Divide into groups

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Thank you