CHAPTER 5 Nervous System^249
- Need for turning and positioning or special rotating bed to decrease pressure.
- Monitor intake and output.
- Home care needs—accessibility, equipment needs.
- Proper way to transfer from bed to wheelchair.
- Care of pin sites for cervical traction devices (e.g. halo traction).
Stroke
WHAT WENT WRONG?
A stroke is also known as a cerebrovascular accident (CVA) or a brain attack. Blood
supply is interrupted to part of the brain, causing brain cells to die; this results in the
patient losing brain function in the affected area. Interruption is usually caused by
an obstruction of arterial blood flow (ischemic stroke), such as formation of a blood
clot, but can also be caused by a leaking or ruptured blood vessel (hemorrhagic
stroke). A blood clot may develop from a piece of unstable plaque lining a vessel
wall that breaks free, or an embolus that travels from elsewhere in the body and
lodges within the vessel. The bleeding may occur as a result of trauma or sponta-
neously, as in the setting of uncontrolled hypertension. Ischemia occurs when insuf-
ficient blood is getting to the brain tissue. This leads to lack of available oxygen
(hypoxia) and glucose (hypoglycemia) for the brain. When these nutrients are not
available for a sustained period, the brain cells die, causing an area of infarction.
Permanent deficits result from infarction. There is increased risk for stroke in
patients with a history of hypertension, diabetes mellitus, high cholesterol, atrial
fibrillation, obesity, smoking, or oral contraceptive use.
Patients may also experience a transient ischemic attack (TIA) in which the
symptoms result from a temporary problem with blood flow to a specific area of
the brain. The symptoms have a duration between a few minutes and 24 hours.
PROGNOSIS
The degree of damage and location of the stroke will determine the outcome for the
patient. Strokes occur suddenly and patients should seek immediate treatment for
the best possible outcome. The majority of strokes are ischemic. Rapid entry into
the healthcare system and treatment with thrombolytic agents (unless there are con-
traindications to this treatment) to break up a clot that has caused the ischemia gives
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