Stroke

Prepared by:
-tharwat Mohamed Abdelkader (215719)
-philopater hazkial bebawy (212198)
-seif ahmed elmasry (21068)
-omar Yasser (200615)

Supervised by:
T.A. Asmaa Hamed
Degree Year One
Semester One (2021-2022)

Assess Neurologic System

Level of consciousness:
When nurse interact with patient and ask him some questions
 Alert: Without stimulation, the person is awake
 Lethargy: When spoken to in a loud voice, patient appears drowsy but opens eye, and
look at you, responds to questions, then falls asleep.
 Obtundation: When shaken gently, patient opens eye and looks at you but responds
slowly and is somewhat confused.
 Stupor: Patient arouses from sleep only after painful stimuli.
 Coma: Despite repeated painful stimuli, patient remains silent with eyes closed

Cerebellar Function:
 Ask the patient to go to end of room and comeback.
 Ask the patient to stand on heel
 Ask the patient to stand on toe
 Ask the patient to put heel to toe

Romberg's test:
Observe the patient’s balance by stands with his eyes open, feet together and arms at his sides.
Then ask him to close his eyes.-Hold the arms out on either side of him to protect him if he falls
down. If he falls to one side, the result of the Romberg’s test is positive.
Corneal Reflex: The corneal reflex, also known as the blink reflex, is an involuntary
blinking of the eyelids elicited by stimulation of the cornea.
Whisper Test: This test is done to assess a patient’s hearing by Stand 30-60 cm behind a
patient so that the patient cannot read the lip. Instruct the patient to place one finger on
the any ear and tell patient some words and ask him to repeat it and do it again with
another ear.
Olfactory Nerve: Ask the patient to close his eye and close with your finger one nose
opening and give patient something to smell and tell you what it is and try it with other
open with other thing to smell.
Range of motion of neck: Flexion, Extension, rotation.
Spinal Accessory: Ask the patient to move his head in every side against your hand and
shoulder against hand.

Glasgow Coma Scale [GCS]

GCS: It is a scale to monitor the level of consciousness of the patient, divided into three
components [Eye contact - Verbal response – Motor function], Nurse must use GCS every day to
know if the level of consciousness of the patient improved or not, the most high grade can patient
get is 15\15 and the most low grade is 3\15.

Eye Contact:
 4 ↦ spontaneous ↦ the patient can does eye contact without external stimulation.
 3 ↦ sound ↦ the patient does eye contact when nurse raise his voice.
 2 ↦ pressure ↦ the patient response by painful stimuli such as: eye bone, sternum Rup,
bridge of nose and trapeze squeezing.
 1 ↦ No response

Verbal Response:
 5 ↦ oriented ↦ patient oriented with time-place-person-memory
 4 ↦ confused ↦ patient tell the nurse confused answer
 3 ↦ words ↦ patient use words without meaning
 2 ↦ sounds ↦ patient say song which not understanding
 1 ↦ no response
Note:
1. Patient with tracheostomy cannot deal with nurse so the patient take grade T.
2. Alert: patient can interact with nurse but he will not be always oriented with time-place-
person

Motor Function:
 6 ↦ obey commands ↦ when nurse ask the patient to move any joint he do it
 5 ↦ move hand in localizing pain
 4 ↦ move hand with painful stimuli
 3 ↦ flexion to pain
 2 ↦ extension to pain
 1 ↦ no response
Result

13-15 [minor] 9-12 [moderate] 3-8 [severe]

What is stroke?
A stroke occurs when the blood supply to part of your brain is interrupted or
reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells
begin to die in minutes.

A stroke is a medical emergency, and prompt treatment is crucial. Early action can
reduce brain damage and other complications.

Stroke Signs and Symptoms

Sudden severe headache with no known cause is a stroke sign in men and women.
During a stroke, every minute counts! Fast treatment can lessen the brain damage
that stroke can cause.

By knowing the signs and symptoms of stroke, you can take quick action and
perhaps save a life—maybe even your own.

Signs of Stroke in Men and Women

 Sudden numbness or weakness in the face, arm, or leg, especially on one side

of the body.
 Sudden confusion, trouble speaking, or difficulty understanding speech.
 Sudden trouble seeing in one or both eyes.
 Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
 Sudden severe headache with no known cause.

Causes of stroke
The cause of a stroke depends on the type of stroke such as:
ischemic strokes:
Ischemic strokes are the most common type of stroke. They happen when a blood
clot blocks the flow of blood and oxygen to the brain.
These blood clots typically form in areas where the arteries have been narrowed or
blocked over time by fatty deposits known as plaques. This process is known as
atherosclerosis.
Your arteries may naturally become narrower as you age, but there are some things
that dangerously speed up this process.
These include:
Smoking-
high blood pressure (hypertension)-
obesity-
high cholesterol levels-
diabetes-
excessive alcohol intake-
Another possible cause of ischemic stroke is a type of irregular heartbeat
called atrial fibrillation.
This can cause blood clots in the heart that break apart and end up in the blood
vessels that supply the brain.
Hemorrhagic strokes:
Hemorrhagic strokes (also known as cerebral hemorrhage or intracranial
hemorrhage) are less common than ischemic strokes. The two types of
hemorrhagic strokes are intracerebral and subarachnoid:
-An intracerebral hemorrhagic stroke is the most common type of hemorrhagic
stroke. It happens when the tissues surrounding the brain fill with blood after an
artery bursts.
-A subarachnoid hemorrhagic stroke is less common. It causes bleeding in the
area between the brain and the tissues that cover it.
The main cause of haemorrhagic stroke is high blood pressure, which can weaken
the arteries in the brain and make them more likely to split or rupture.
Things that increase the risk of high blood pressure include:
-overweight
-smoking
-stress
-lack of exercise
-drinking excessive amount of alcohol.
Transient ischemic attack (TIA):
A transient ischemic attack, often called a TIA or ministroke, occurs when blood
flow to the brain is blocked temporarily.
Symptoms are similar to those of a full stroke. However, they’re typically
temporary and disappear after a few minutes or hours, when the blockage moves
and blood flow is restored.
A blood clot usually causes a TIA. While it’s not technically categorized as a full
stroke, a TIA serves as a warning that an actual stroke may happen. Because of
this, it’s best not to ignore it. Seek the same treatment you would for a major
stroke and get emergency medical help.
Treatment:
Because ischemic and hemorrhagic strokes have different causes and effects on the
body, both require different treatments.

Ischemic stroke: Treatment starts with taking drugs that break down clots and
prevent others from forming. A doctor may administer blood thinners such
as aspirin or an injection of tissue plasminogen activator (TPA).
-Emergency procedures include administering TPA directly into an artery in the
brain or using a catheter to physically remove the clot.
-Another option is angioplasty. This involves a surgeon inflating a small balloon
inside a narrowed artery using a catheter. Afterward, they will insert a mesh tube,
or a stent, into the opening. This prevents the artery from narrowing again.
Hemorrhagic stroke:
Treatment often begins with taking drugs that reduce pressure in the brain and
control overall blood pressure, as well as preventing seizures and any sudden
constrictions of blood vessels.
Surgeons can repair some of the problems with blood vessels that have led or could
lead to hemorrhagic strokes.
When an aneurysm — or a bulge in a blood vessel that may burst — causes a
hemorrhagic stroke, a surgeon can place small clamps at the base of
the aneurysm or fill it with detachable coils to stop the blood flow and shrink the
aneurysm.
Rehabilitation:
Successful recovery from a stroke will often involve specific therapies and support
systems, including:
-Speech therapy: This helps with problems producing or understanding speech.
Practice, relaxation, and changing communication style can all make
communicating easier.
-Physical therapy: This can help a person relearn movement and coordination. It
is important to stay active, even though this may be difficult at first.
-Occupational therapy: This can help a person improve their ability to carry out
daily activities, such as bathing, cooking, dressing, eating, reading, and writing.
-Support from friends and family: Close friends and relatives should try to offer
practical support and comfort after a stroke. Letting friends and family know what
they can do to help is very important.

What are common complications of stroke?

• Brain edema — swelling of the brain after a stroke.
• Pneumonia — causes breathing problems, a complication of many major
illnesses. Pneumonia occurs as a result of not being able to move as a result of the
stroke. Swallowing problems after stroke can sometimes result in things ‘going
down the wrong pipe’, leading to aspiration pneumonia.
• Urinary tract infection (UTI) and/or bladder control. UTI can occur as a result
of having a foley catheter placed to collect urine when the stroke survivor cannot
control bladder function.
• Seizures — abnormal electrical activity in the brain causing convulsions. These
are common in larger strokes.
• Clinical depression — a treatable illness that often occurs with stroke and causes
unwanted emotional and physical reactions to changes and losses. This is very
common after stroke or may be worsened in someone who had depression before
the stroke.
• Bedsores — pressure ulcers that result from decreased ability to move and
pressure on areas of the body because of immobility.
• Limb contractures — shortened muscles in an arm or leg from reduced ability
to move the affected limb or lack of exercise.
• Shoulder pain — stems from lack of support of an arm due to weakness or
paralysis. This usually is caused when the affected arm hangs resulting in pulling
of the arm on the shoulder.
• Deep venous thrombosis (DVT) — blood clots form in veins of the legs because
of immobility from stroke.