What is a Stroke | NCLEX Review (2019)

Welcome to this video tutorial on strokes. Approximately 700,000 strokes occur in the
United States every year. A stroke is a medical emergency that occurs
when the blood flow to the brain is interrupted. A stroke is often called a CVA, or cerebrovascular
accident; however, a stroke is usually caused by an underlying disorder and is therefore
no accident. More recently, the term ‘brain attack’ is
used due to the similarities between a stroke and a heart attack. As with a heart attack, the most common form
of brain attack occurs when a blood vessel in the brain becomes clogged, cutting off
the oxygen to the brain, resulting in death of brain cells. There are two types of strokes ischemic and
hemorrhagic. Ischemic strokes are by far the most common,
and occur when a blood vessel carrying blood to the brain is blocked. Hemorrhagic strokes occur when a blood vessel
breaks and bleeds into the brain. First we’ll talk about the most common type,
the ischemic stroke, which accounts for 87% of all strokes. They occur when an artery in the brain or
an artery carrying blood to the brain becomes blocked, either by a blood clot or by a narrowing
of the artery due to plaque buildup (atherosclerosis). When blood flow is blocked to part of the
brain, within minutes brain cells and tissues begin to die from lack of oxygen and nutrients. The area of tissue death is called an infarct. Ischemic strokes can be further divided into
2 groups, to include thrombotic strokes and embolic strokes. Thrombotic strokes are caused by a thrombus
(blood clot) that develops in an artery in the brain. Often, a blood clot that triggers a thrombotic
stroke usually develops inside an artery that has already been narrowed by atherosclerosis. Embolic strokes are caused by a blood clot
or plaque debris that forms somewhere else in the body, such as the heart, traveling
through the bloodstream to a blood vessel in the brain, where it is too small to pass. They are often a result of heart disease or
heart surgery and occur quickly without any warning signs. It is often difficult to determine whether
a stroke is thrombotic or embolic, because the signs and symptoms can be identical. Signs of stroke vary depending on which area
of the brain is affected. The most widely recognized signs involve motor
deficits, such as weakness or paralysis on one side of the body and trouble speaking. Other symptoms include sudden confusion; visual
disturbance, including sudden loss of vision; sudden, severe numbness anywhere on the body;
sudden dizziness, difficulty walking; coordination problems with arms and hands; and difficulty
swallowing. Symptoms may go away, stay the same, or gradually
get worse over hours or days. Knowing the signs and symptoms of a stroke
can be lifesaving. You can remember the classic stroke symptoms
with the acronym BE FAST, in which each letter stands for a sign you should watch for in
a stroke victim. Balance There is a loss of balance, headache,
dizziness, or confusion. Eyes Blurred vision the eyes are not receiving
enough oxygen for optimal functioning Face The face is uneven, there is sudden weakness
or droopiness of the face. Arms Sudden weakness or numbness in one or
both arms or legs Speech The individual has difficulty speaking,
or their speech is slurred or garbled. Time It’s time to call 911. Time is very important in stroke treatment
the sooner treatment begins, the better the chances are for recovery. Brief episodes of stroke-like symptoms often
occur before a stroke, and are referred to as a transient ischemic attack (TIA). Most TIAs last less than 30 minutes, in which
symptoms appear suddenly and then get better over the next few minutes to hours. However, TIAs generally reflect advanced atherosclerotic
disease and are a warning sign of an impending stroke. TIAs are sometimes referred to as mini-strokes. A person who has had a TIA is more than nine
times as likely to have a stroke as a person without a TIA, and therefore should be treated
aggressively before a stroke occurs. Hemorrhagic strokes, or bleeds, account for
about 13% of stroke cases.They occur when there is a weakened blood vessel in the brain
that ruptures. When an artery bleeds into the brain, brain
tissues and cells do not receive oxygen and nutrients. At the same time, pressure builds up in surrounding
tissues, causing irritation and swelling, which leads to further brain damage. Hemorrhagic strokes are divided into 2 main
categories. These include: Intracerebral hemorrhage
Subarachnoid hemorrhage Intracerebral hemorrhage involves bleeding
from the blood vessels within the brain and is usually caused by hypertension. Bleeding occurs suddenly and quickly; and
there are usually no warning signs. It may be severe enough to cause death. Subarachnoid hemorrhage results from bleeding
between the brain and the meninges in the subarachnoid space. This type of hemorrhage is usually due to
an aneurysm or an arteriovenous malformation (AV malformation). An aneurysm is the ballooning of a weak area
on an artery wall, which if left untreated, will continue to weaken until it ruptures
and bleeds into the brain. Aneurysms may be congenital, or may develop
later in life due to hypertension or atherosclerosis. An AV malformation is a congenital disorder
that consists of a cluster of abnormally formed blood vessels, which can rupture and also
cause bleeding into the brain. The classic symptom of a hemorrhagic stroke
is a sudden violent headache. Immediate loss of consciousness may occur
from the sudden rise in intracranial pressure. Some patients also experience seizures. A stroke is initially diagnosed by means of
a careful history and physical. It is necessary to differentiate between ischemic
and hemorrhagic strokes, by a CT scan or MRI. The CT scan is used to rule out bleeding and
the MRI can determine the ischemic zone within the first few hours after stroke; however,
its high cost and limited accessibility usually make MRI the second option. A variety of other tests, such as MR-angiograms,
CT-angiograms, and cerebral angiography, can be used to provide important information regarding
the location of the occlusion and the degree of brain tissue affected. When a stroke is diagnosed, early and aggressive
intervention is necessary to attempt reperfusion of the ischemic portions of the brain. If reperfusion can be provided within 1 to
3 hours, blood flow and metabolism in the stunned cells may be normalized. Once infarction (cell death) occurs, damage
is irreversible. Treatment for a stroke depends on the type
of stroke — Ischemic stroke requires clot-busting or clot-removal. Commonly known as ‘clot-busters,’ thrombolytics
or fibrinolytics can help reduce the damage to brain cells caused by the stroke. Dissolving the clot allows blood flow to the
brain to be restored, and can decrease the severity of symptoms. The gold standard clot-busting medication
is IV tissue plasminogen activator (tPA). tPA works by dissolving the clot and improving
blood flow to the part of the brain being deprived of blood flow. When given within the first 3 hours of symptom
onset, tPA can reduce the long-term effects of stroke. After the 3 hour window, the tPA is not as
effective and the risks may outweigh the benefits. Another treatment option for ischemic stroke
is to physically remove the blood clot, known as a thrombectomy. By threading a catheter through an artery
in the groin, a stent retriever is then used to grab and remove the clot from the blocked
artery in the brain, or a suction tube may also be used to remove the clot. The procedure should be done only after the
patient has received tPA and within six hours of acute stroke symptoms. Treatment for a hemorrhagic stroke involves
controlling the bleeding in the brain, and reducing the pressure caused by the bleeding. Surgical treatment can then be considered,
which usually involves an endovascular procedure to surgically repair the bleed. A catheter is inserted through a major artery
in an arm or leg, guided by a camera to the source of bleeding in the brain, and then
a mechanical agent, such as a coil, is deposited to prevent further rupture. Depending on the location and size of an aneurysm,
it may be repaired with surgical clipping. If the stroke is caused by an AV malformation,
surgery may be used to remove it, if is is in an accessible location. Once a patient has had a stroke, the risks
are much higher for having another one. Preventing a second stroke can be the most
important treatment of all. Prevention measures include adopting healthy
lifestyle habits and reducing key risk factors. These risk factors include high blood pressure,
atrial fibrillation, and cigarette smoking. Medications for hypertension, elevated cholesterol,
and atrial fibrillation are given, as well as antiplatelet agents or anticoagulants to
prevent a blood clot from forming again. Lifestyle changes such as losing weight, exercising
regularly, and quitting smoking are also necessary to reduce risk of another stroke. Every stroke is unique, but the effects seen
in patients are very similar. When a stroke occurs, blood flow cannot reach
all areas of the brain, therefore, the effects of the stroke are dependent on the location
of the obstruction and the extent of brain tissue affected. Since one side of the brain controls the opposite
side of the body, a stroke occurring in the right side of the brain will result in neurological
complications on the left side of the body. These may include any or all of the following
paralysis on the left side of the body; vision problems; quick, inquisitive behavioral style;
and/or memory loss. If the stroke occurs on the left side of the
brain, the right side of the body will be affected, producing paralysis on the right
side of the body; speech or language problems; slow, cautious behavioral style; and/or memory
loss. If a stroke occurs in the brain stem, it may
affect both sides of the body or leave the patient in a ‘locked-in’ state, where the
patient is generally unable to speak or achieve any movement below the neck. Strokes generally cause five types of disabilities: The first and most common is paralysis or
problems with motor control. This usually involves hemiplegia (one-sided
paralysis) or hemiparesis (one-sided weakness); dysphagia (problems with swallowing); and
ataxia (loss of control of the body’s ability to coordinate movement), which causes problems
with body posture, walking, and balance. Stroke patients may also have sensory disturbances
in which they lose the ability to feel touch, pain, temperature, or position. Some patients may experience paresthesias,
in which they feel pain, numbness, tingling, or prickling in paralyzed or weakened limbs. Urinary incontinence often results from a
combination of sensory and motor deficits and is fairly common immediately after a stroke. At least one-fourth of all stroke survivors
experience problems understanding or using language, called aphasia. The type of problem is dependent on the area
of the brain’s language-control center that was damaged. Patients may have expressive aphasia, in which
it is difficult to convey thoughts through words or writing. They lose the ability to speak the words they
are thinking and put words together in coherent sentences. Patients with receptive aphasia have difficulty
understanding spoken or written language and usually have incoherent speech. Global aphasia is the most severe form, in
which the patient loses nearly all language capabilities they cannot understand language
or use it to convey thought. Stroke can also cause problems with memory
and thinking. Learning may be affected, as well as the ability
to make plans, comprehend meaning, or engage in complex mental activities. There may be deficits in short-term memory
and the ability to follow a set of instructions. Finally, many stroke survivors deal with emotional
disturbances. They may feel fear, anxiety, sadness, frustration,
anger, and a sense of grief for their physical and mental losses. Some emotional disturbances and personality
changes are caused by the physical effects of brain damage. However, clinical depression is the most common
emotional disorder experienced by stroke survivors. For the stroke patient, one of the most important
phases of recovery involves rehabilitation. Depending on the severity of the stroke and
the amount of tissue damage that occurred, different types of therapy may be involved,
including physical therapy, occupational therapy, or speech therapy. Though rehab doesn’t “cure” the effects of
stroke, or reverse brain damage, it does significantly help people achieve the best possible long-term
outcome. The primary goal of therapy for the stroke
patient is to restore as much function as possible and attain the best possible quality
of life. Rehabilitation will depend on what the patient
needs to become independent. This may include: Mobility skills such as walking, transferring,
or moving a wheelchair Self-care skills such as dressing, bathing,
grooming, feeding, and toileting Communication skills in language and speech
Social skills for interacting with other people Cognitive skills such as memory or problem
solving Rehabilitative therapy begins in the hospital
once the patient has been medically stabilized, often within 24 to 48 hours after the stroke. For some stroke survivors, rehab will be an
ongoing process, working with specialists for months or years after the stroke. Nursing education for the stroke survivor
and family includes several important points: Teach the patient to resume as much self care
as possible, providing assistive devices as needed. Help the family coordinate care of the various
health care professionals and therapists needed. Instruct the family that the patient may tire
easily, show less interest in daily activities, and become irritable and upset by small events. Discuss the patient’s depression with the
family and physician for possible antidepressant therapy. Encourage the patient to continue with hobbies
and leisure interests, and contact friends to prevent social isolation. Encourage the family to support the patient
and give positive reinforcement. Teach the patient to prevent another stroke
by implementing the following: Keep blood pressure low
Lower cholesterol Eat healthy food
Exercise regularly Maintain an healthy weight
Treat sleep apnea Manage diabetes
Drink in moderation Quit smoking
Avoid stress These prevention measures apply to all individuals
who may be at increased risk for a stroke.

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  2. I am 34 years old, a wife to Bakers and mummy to Ava and George. I was a lawyer but have been a stay at home mum for nearly nine years now, which is slightly scary. I have loved it and I would count it as a job because I have worked harder at home than I ever did anywhere else. What happened to me? I was going to say that I have recently become disabled. It’s actually five years ago, now so it isn’t that recent, but it still only feels like yesterday that I felt I had a burst AVM. A lot of other people have explained it a lot better, so I am not even going to attempt if you want to know more type ‘Arteriovenous Malformation’ into any Internet search engine. In search for a better health I came across people talking of Dr. Adebola on the internet, on how he uses herbs to treat so many chronic diseases, I was reluctant to give his herbal fomular a try. At first it was like a miracle to me and my loved ones, I later realized that it was the miracle powers in his herbs that help my brain cells to function normal, after 5 years I now have my health in order, I now do everything I couldn't do while I was disabled, am so grateful to God and Dr Adebola, I can't thank him enough so I pray his nature's knowledge be multiplied to help reach out to more people in need of a stable health.

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  3. Great video! Very clear and straight to the point. I am a new grad and need some review, so glad I found your site, definitely subscribing. Thank you for taking time to share your knowledge

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