awareness of hemorrhagic stroke提高出血性脑卒中的认识课件

RaisingAwarenessofHemorrhagicStroke ByKellyA Taft RN BSNNursingmadeIncrediblyEasy July August20092 1ANCCcontacthoursOnline 2009byLippincottWilliams Wilkins Allworldrightsreserved StrokeStatistics ThirdleadingcauseofdeathintheU S 800 000Americansexperiencestrokeeachyear30 becomepermanentlydisabled20 requireinstitutionalcare4monthsafterthestroke DefinitionofStroke AcutefocalneurologicdeficitCausedbyavasculardisorderthatinjuresbraintissueTwomaintypes ischemicandhemorrhagic Ischemic causedbyinterruptionofbloodflowinacerebralvessel Hemorrhagic ruptureofacerebralbloodvessel HemorrhagicStroke SpontaneoushemorrhageintothebrainAccountsfortheminorityofcasesMostfrequentlyfatalstrokeMostcommonetiologyforindividualsages18to45 HemorrhagicStrokeCauses Intracranialhemorrhage bleedingdirectlyintobrainmatter accountsfor41 ofhemorrhagicstroke Usuallyoccursinbifurcationsofmajorarteries Asaresultofhypertensivehemorrhage leadstohyperplasiawithinthevesselwall whichcanleadto breaks atherosclerosis braintumors orcertainmedicationsSubarachnoidhemorrhage bleedingsurroundingthebraintissue Fromarteriovenousmalformation AVM trauma oraneurysm20 areofunknownetiology PicturingTwoTypesofHemorrhage CerebralAneurysm Cerebralaneurysm dilationofthewallsofcerebralarteriesthatdevelopsasresultofweaknessinthewall Causes atherosclerosis congenitaldefect hypertensivevasculardisease andtrauma Commonlyaffectedarteries internalcarotid anteriorcerebral anteriorandposteriorcommunicating andmiddleandposteriorcerebral PicturingCerebralAneurysm AVM AVM complextangleofabnormalarteriesandveinsthatlackacapillarybedandarelinkedbyoneormorefistulas Bloodisshuntedfromthehighpressurearterialsystemtothelowpressurevenoussystem Exposingthedrainingvenouschannelsthemtohighpressuresandpredisposingthemtorupture BrainEdema Twotypes vasogenicandcytotoxic Vasogenic influxoffluidandsolutesintothebrain developsrapidlyafterinjury Cytotoxic cellularswellingoccursinbrainischemiaandtraumaBrainedemaleadstoincreasedintracranialpressure ICP tissueshifts andbraindisplacement MajorRiskFactorsforHemorrhagicStroke ObesityHypertensionCigarettesmokingExcessivealcoholintake GeneticpredispositionforaneurysmformationMalegenderIncreasedageAfricanAmericanorHispanicdescent SymptomsofHemorrhagicStroke HemiparesisConfusionDizzinessorlossofbalanceDifficultyspeakingorunderstandingspeech SuddensevereheadacheLossofconsciousnessNuchalrigidityVisualdisturbancesTinnitus ImmediateComplicationsofHemorrhagicStroke CerebralhypoxiaDecreasedcerebralbloodflowExtensionoftheareaofinjuryVasospasm 40 to50 ofthemortalityassociatedwithsubarachnoidhemorrhage Vasospasm AssociatedwithincreasingamountsofbloodinthesubarachnoidcisternsandfissuresLeadstoincreasedvascularresistanceImpedescerebralbloodflowandcausesbrainischemiaandinfarctionFrequentlyoccurring4to14daysafterinitialhemorrhageSigns symptoms worseningheadache decreasedLOC andnewfocalneurologicdeficits DiagnosticTestsforHemorrhagicStroke Historyandphysicalexam Rapidityofsymptoms Timeofonset Patternofsymptoms Mentalstatus MedicationspatientistakingECGCompletebloodcellcount includingplateletsElectrolytes CardiacenzymesandtroponinBloodureanitrogenCreatinineSerumbloodglucoseProthrombintime INR partialthromboplastintimeOxygensaturation ImagingStudiesforDiagnosingHemorrhagicStroke Computedtomographyscan usedtodeterminetypeofstroke size location andpresenceofcerebrospinalfluidCerebralangiography usedtoconfirmdiagnosisofcerebralaneurysmorAVMLumbarpuncture usedtoconfirmsubarachnoidhemorrhage Hunt HessClassificationofSubarachnoidHemorrhages 1 Asymptomaticormildheadacheandnuchalrigidity stiffneck 2 Cranialnerve CN palsy oculomotor CNIII orabducens CNVI moderatetosevereheadache andnuchalrigidity3 Mildfocaldeficit lethargy orconfusion4 Stupor moderatetoseverehemiparesis andearlydecerebraterigidity5 Deepcoma decerebraterigidity andmoribundappearanceAddonegradeforserioussystemicdisease suchashypertensionorchronicobstructivepulmonarydisease orseverevasospasmonangiography NIHStrokeScale ImportanttoolinthediagnosisofacutehemorrhagicstrokeinpatientswithsuddenonsetofsymptomsShouldbereadilyavailabletoallhealthcareprofessionalswhoareindirectcontactwithpatienttreatmentandidentificationofstroke TreatmentGoalsforHemorrhagicStroke Consistsofacombinationofmedicalandsurgicalinterventions Windowofopportunity inwhichviablebraintissuecanbesavedGoalofmedicaltreatmentistoallowbraintorecoverfrombleedingandpreventorminimizerebleeding MedicalInterventionsforHemorrhagicStroke PatientshouldbemonitoredcloselyintheICUBedrestwithsedationtopreventagitationandstressAnalgesicsforheadandneckpain MinimizeexternalstimuliControlofbloodglucoselevelsICPandBPwillbemanagedSeizuremanagement asrecommendedbytheAHA SurgicalInterventionsforHemorrhagicStroke Removalofhemorrhageviacraniotomy recommendedforcerebralhemorrhagegreaterthan3cmindiameter Inaneurysmsthathaven truptured thesurgicalgoalistopreventbleedingLessinvasiveproceduresincludeaneurysmcoilingorobstruction ClippinganAneurysm ComplicationsofHemorrhagicStroke RebleedingPsychologicalsymptoms disorientation personalitychanges amnesiaIntraoperativeembolizationPostoperativearteryocclusionFluid electrolytedisturbancesGastrointestinalbleeding NeurologicNursingAssessmentAfterStrokeTreatment AlteredLOCSluggishpupillaryreactionMotorandsensorydysfunctionCranialnervedeficits SpeechandvisiondifficultiesHeadache nuchalrigidity otherneurologicdeficitsVitalsignchanges includinganincreaseordropinICP BP orheartrate RehabilitationAfterHemorrhagicStroke BeginsintheacutephaseGoalistoreturnthepatienttothehighestleveloffunctioni