SANTHIA MIRTYL Transient Ischemic Attack (TIA). Importance of Blood Supply Blood supply is critical for successful functioning of our organs Arteries.

SANTHIA MIRTYL

Transient Ischemic Attack (TIA)

Importance of Blood Supply

Blood supply is critical for successful functioning of our organs

Arteries bring oxygenated blood from the heart to the body

What happens when this route is compromised?National Stroke Association (2011)

Hypoxic Brain Tissue

National Stroke Association (2011)

•S E C O N D L E A D I N G C A U S E O F M O R TA L I T Y W O R L D W I D E , F O U R T H I N T H E U N I T E D S TAT E S

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•S T R O K E C A N H A P P E N T O A N Y O N E AT A N Y T I M E , R E G A R D L E S S O F R A C E , S E X O R A G E

•A P P R O X I M AT E LY 5 5 , 0 0 0 M O R E W O M E N T H A N M E N H AV E A S T R O K E E A C H Y E A R .

•A F R I C A N A M E R I C A N S H AV E A L M O S T T W I C E T H E R I S K O F F I R S T- E V E R S T R O K E C O M PA R E D W I T H W H I T E S .

•T H E E S T I M AT E D D I R E C T A N D I N D I R E C T C O S T O F S T R O K E I N T H E U N I T E D S TAT E S I N 2 0 1 0 I S $ 7 3 . 7 B I L L I O N

Stroke AKA Brain Attack

National Stroke Association (2011)Nursing Central (2012)

Types of Stroke

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Nursing Central (2012)

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Nursing Central (2012)

TIA

Temporary state of ischemia due to blood supply blockage A blood clot in an artery of the brain A blood clot that travels to the brain from somewhere

else in the body (for example, from the heart) An injury to blood vessels Narrowing of a blood vessel in the brain or leading to

the brain“Mini-stroke”

Will have stroke like symptoms For up to 24 hours

Risk of stroke is greatest within 48 hours Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Nursing Central (2012)National Stroke Association (2011)

Modifiable Non-modifiable

HTN Atrial fibtillation Hyperlipidema Diabetes Mellitus Stress Excessive alcohol use Lifestyle Obesity Smoking Valvular disease Coronary artery disease

Family historyAgeRaceHeredity

TIA is a result of vascular disease

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Nursing Central (2012)National Stroke Association (2011)Easton, D., J., Saver, J., L., Albers, G.W. et.l (2009).

Use the FAST for signs of stroke.

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Nursing Central (2012)National Stroke Association (2011)A.D.A.M Medical Medical Encyclopedia.(2012)

Literature Hospital

Carotid EndarterectomyCarotid Angioplasty and

StentingtPaDiagnostics :MRIAntithrombotic Therapy

aspirin, combination aspirin/dipyridamole, clopidogrel, and ticlopidine.

Lab test

Physical assessmentComplete blood countCT scanMRS and X-ray orderedMRI without contrastCarotid Duplex Scan

BilateralPT and OT

Medical Interventions

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Easton et.al (2009).Adam et. al (2007)Summers et. Al (2007)

Literature Hospital

NIH Stroke Scale Continued assessment

O2, output Vitals

Hyperthermia, BP ABCs Monitoring: cardiac,

respiratory, neuro status Administering drug therapy Safety Labs

Glucose

NIH Stoke Scale Q2hHourly assessmentsHourly vitals

Close eye on high BP and temperature

ABCsLabsDrug therapy Safety

Nursing Interventions

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Adam et. al (2007)

Prognosis

TIA do not cause cell death of brain tissue

Symptoms usually resolve in less that 24 hrs

TIA is a warning sign for a stroke

Osborn, K., S., Wraa, C., E., Watson, A., V. (2010)Easton et.al (2009).Adam et. al (2007)Summers et. Al (2007)

ACUTE CONFUSION RELATED TO HYPOXIA.

IMPAIRED VERBAL COMMUNICATION RELATED TO DECREASED CIRCULATION TO THE BRAIN IN SPEECH CENTER INFORMATIONAL SOURCES

RISK FOR IMPAIRED PHYSICAL IMMOBILITY RELATED TO DECREASED STRENGTH AND ENDURANCE

INEFFECTIVE HEALTH MAINTENANCE RELATED TO DEFICIENT KNOWLEDGE REGARDING SELF CARE FOR STROKE RISKS

Nursing Diagnosis

Ackely, Ladwig. (2011)

Myth Fact

Stroke is not preventable

Stroke cannot be treated

Stroke is a elderly problem

Stroke happens in the heart

Stroke recovery ends after 6 months

Up to 80% percent of strokes are preventable

Stroke requires emergency treatment

Anyone can be a victim to stroke

Stroke happens in the brain AKA “Brain Attack”

Stroke recovery can last a lifetime

Conclusion

National Stroke Association (2011)

Case Study

The patient is a 53 year old African American male admitted to the emergency department on 10/14/2012 for slurred speech and facial drooping. He was brought in by a concerned friend that stated a change in the patient’s mentation, slurred speech as well as left sided facial drooping the previous night. Patient has a past medical history of Bells palsy 20 years ago and chronic knee pain. Patient also has had family history of kidney disease, hypertension, and heart disease. Upon admission patient had a high blood pressure of 220/140. He denies any chest pain, shortness of breath, fevers, chills, nausea and vomiting. Patient has a current complaint of a headache but not a symptom prior to hospitalization. Chest x ray is pending. Brain CT revealed lateral ventricles atrophy and small vessel ischemia. Labs were done which revealed elevated creatinine and BUN.

Questions

Of the 500,000 strokes that occur annually, 80% of them are ischemic strokes. Which of the following accurately reflects this type of stroke?1. The strokes are hemorrhagic in nature2. The signs and symptoms, though acute, resolve

without permanent disability3. The stokes ate commonly caused my arthrosclerosis4. Patients experiencing the type of stroke are usually

younger

Rationals

Correct answer: 380% of all strokes are ischemic in

nature and most are caused my atherosclerosis. Hemorrhagic stokes are commonly associated with hypertension. Patients experiencing ischemic stoke are generally older than those experiencing hemorrhagic stoke

References

1) A.D.A.M. Medical Encyclopedia.(2012). Transient ischemic attack. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001743/

2) Adams Jr, H., P., del Zoppo,G., Alberts, M., J., Bhatt, D., L., Brass, L., Furlan, A., Grubb, R., L., Higashida, R., L., Jauch, E., C., Kidwell, C., Lyden, P., D., Morgenstern, R., Qureshi, A., I., Rosenwasser, R., H., Scott, P., A., Wijdicks, E., F. (2007). Guidelines for the Early Management of Adults With Ischemic Stroke. STROKEAHA.107(86), 1814.  

3)Ackle, B., Ladwig, G. (2011) Nursing Diagnosis Handbook.. 9 th edition.

4) Easton, D., J., Saver, J., L., Albers, G.W., Alberts, M., J., Chaturvedi, S., Feldmann,E., Hatsukami, T., S., Higashida, R., T., Johnston, C., Kidwell, C.,S., Lutsep, H., L., Miller, E., Sacco, R., L. (2009). Definition and Evaluation of Transient Ischemic Attack. STROKEAHA., 108(18), 1922. 

5) National Stroke Association. The Complete Guide to Stroke. 2011. At: http://www.stroke.org/site/DocServer/NSA_complete_guide.pdf?docID=341

6) Summers, D., Leonard, A., Wentworth, D., Saver, L., J., Simpson, J., Spilker, J., A., Hock, N., Miller, E., Mitchell, P.,H. (2009). Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient. STROKEAHA.109(62), 1923.

7) Osborn, K., S., Wraa, C., E., Watson, A., V. (2010). Medical-Surgical Nursing Preparation for Practice. 756-761.