Chapter038

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 38: Caring for Clients with Cerebrovascular Disorders


HeadacheHeadache• Cephalgia

– Typically: Transient, benign

– Accompany many disorders

• Meningitis; Increased ICP; Brain tumors; Sinusitis

• Most Common

– Tension; Migraine; Cluster

• Without Sensory Nerves

– Skull; Brain


Tension Headache Tension Headache • Pathophysiology, Etiology: Scalp, Facial Muscles

– Vast network of sensory, motor nerves

– Stressful conditions: Can result in prolonged neck, facial muscle contraction

• Assessment Findings: Mild to severe pain

• Diagnostic Findings: CT scan; Brain scan; Radiographs; Angiography

• Medical Management

– Rest; Analgesics

– Stress management; Counseling


Migraine Headaches Migraine Headaches • Pathophysiology, Etiology: Dilation of cerebral blood

vessels

• Assessment Findings: Signs and Symptoms

– Aura; Mood change

– Fatigue; Nausea; Vomiting

– Vertigo; Sensitivity to light

• Diagnostic Findings

– CT scan; Angiography

– Brain scan; Radiographs


Migraine HeadachesMigraine Headaches

Figure 38-1 Chemical developments in migraine headaches. Cerebral blood vessels dilate in response to serotonin from platelets. Peptides

released from the trigeminal nerve intensify pain.


Migraine Headaches Migraine Headaches


– Rest; Drug therapy; Biofeedback techniques

• Nursing Management

– Client instruction

• Self-administration of medications

• Measures to abort the migraine

• Lying in a dark room

• Minimizing noise and other stimuli


Cluster Headache Cluster Headache • Pathophysiology, Etiology: Unknown

– Suggested lower-than-normal levels of serotonin

– Possible “triggers”

• Assessment Findings: Severe, unilateral head pain (usually behind one eye); Rhinorrhea

• Diagnostic Findings: HA pattern; Persistent HA: CT scan; Brain scan; Head, neck radiographs; Angiography

• Medical Management: Corticosteroids; Ergotamine derivatives; Vasoconstricting drugs; Anticonvulsants; Oxygen; Surgical intervention (if all else fails)


Nursing ProcessNursing Process

• Assessment

– Pain: Location; Characteristics; History; Duration

– Triggers

– Other symptoms

– Clients with chronic headaches

• Complete medical, allergy, and family history

• Frequency and description of pain

• Vital signs


Nursing ProcessNursing Process

• Diagnosis, Planning, and Interventions

– Pain related to

• Muscle tension

• Changes in cerebral blood flow

• Unknown etiology

• Evaluation of Expected Outcome

– Head pain is reduced or eliminated


Transient Ischemic Attacks Transient Ischemic Attacks

• Pathophysiology, Etiology: Temporary interruption in cerebral blood flow

– Common causes


– Speech, visual disturbances; Confusion; Partial paralysis

• Diagnostic Findings: Neurologic examination; Ultrasound; Carotid arteriogram; CT scan; MRI


Transient Ischemic Attacks Transient Ischemic Attacks • Medical, Surgical Management

– Antiplatelet therapy

– Anticoagulant therapy

– Diet therapy

– Surgery

• Carotid endarterectomy

• Balloon angioplasty

Figure 38-2 In endarterectomy, plaque—a potential source of emboli in TIAs and CVAs—is surgically removed from the carotid artery.


Transient Ischemic Attacks Transient Ischemic Attacks

• Nursing Management

– Complete client history

– Vital signs and weight

– Capillary blood sugar check

– Neurologic examination

– Client monitoring after carotid artery surgery

– Client education


Cerebrovascular Accident (Stroke) Cerebrovascular Accident (Stroke) • Pathophysiology, Etiology

– Ischemic strokes: Thrombotic; Embolic

– Hemorrhagic strokes


• Numbness; Weakness

• Mental confusion; Impaired ambulation

• Severe headache

• Hemiplegia; Aphasia; Hemianopia


Cerebrovascular Accident (Stroke)Cerebrovascular Accident (Stroke)• Diagnostic Findings

– CT Scan; MRI; Transcranial Doppler ultrasonography

– Single photon emission CT; Lumbar puncture; Cerebral angiography

• Medical, Surgical Management

– Prevention measures

– Emergency treatment according to cause

– Supportive treatment


Cerebrovascular Accident (Stroke)Cerebrovascular Accident (Stroke)• Nursing Management

– Client education: Medication: Administration, side effects; Eating, swallowing techniques

– Heimlich maneuver

– Follow-up care: Speech pathologist; Dietitian

– Community resources for special care devices

– Regular exercises; Maintain extremities in proper anatomic position


Cerebral Aneurysms Cerebral Aneurysms • Pathophysiology, Etiology: Congenital; Secondary to

hypertension and atherosclerosis

Figure 38-7 Intracranial aneurysm within circle of Willis


Cerebral Aneurysms Cerebral Aneurysms • Assessment Findings: Signs and Symptoms

– Sudden, severe headache; Dizziness; N/V; Loss of consciousness

• Diagnostic Findings

– Cerebral angiography

– CT Scan; MRI

– Lumbar puncture

– Hunt-Hess classification system


Cerebral Aneurysms Cerebral Aneurysms


– Complete bed rest; Prevention of rebleeding

– Treatment of complications

– Anticonvulsants; Tranquilizers

– Mechanical ventilation

• Surgical Management

– Craniotomy

– Ligation of carotid artery


Nursing ProcessNursing Process• Assessment

– Neurologic examination

– Vital signs; History

• Diagnosis, Planning, and Interventions

– Increased intracranial pressure

– Seizures

– Pain

• Evaluation of Expected Outcomes


End of Presentation

Chapter038

Documents

stimuli copyright

ct scan brain scan head

circle of willis copyright

etiology ischemic strokes

interventions pain

unilateral head pain

migraine headachesfigure

symptoms speech