Stroke Acute Care CEU Course. All Rights Reserved. LEARNING OUTCOME: Upon completion of this continuing education course, you will demonstrate an understanding of the anatomical alterations, pathophysiology, diagnosis, evaluation, and treatment options, emphasizing acute care and initial rehabilitation, for patients who have experienced a stroke. A stroke—also called a cerebrovascular accident (CVA) or a brain attack—is a reduction or an interruption of the flow of blood through an artery to one or more areas of the brain within the territory supplied by that artery. The end result is varying degrees of neurological and/or cognitive malfunction lasting longer than 2. A very severe stroke can cause sudden death. Stroke is a medical emergency, and for persons experiencing a stroke, the difference between recovery and disability or death is measured in hours. For healthcare professionals it is imperative that an understanding of stroke and the ways to take action become part of day- to- day practice. Providers are responsible for improving their skills along the continuum of care from prehospital/acute stroke to post- stroke education. In addition, educating patients about stroke prevention and recognition of stroke should be part of every provider’s practice. EPIDEMIOLOGYAn estimated 6. Americans aged 2. The American Heart Association projects that by 2. Each year over 7. Americans experience a new or recurrent stroke. An estimated 6. 10,0. On average, someone in the United States has a stroke every 4. In 2. 01. 3, stroke was the cause of one of every 2. Find patient medical information for GRAPE on WebMD including its uses, effectiveness, side effects and safety, interactions, user ratings and products that have it. Chemical elements (below are listed alterations of plasma concentrations; see also alterations of urinary concentrations). United States. Stroke is the fifth- leading cause of death in the United States and the leading cause of serious long- term disability in America.(Mozaffarian et al., 2. AHA/ASA, 2. 01. 5b)By Age. The chance of having a stroke approximately doubles for each decade of life after 5. Although the prevalence of stroke is higher among older adults, approximately 1. Stroke may also occur in infants and children and can even occur before birth (AHA/ASA, 2. Chapter 15 - Health Protection and Promotion HEALTH PROTECTION AND PROMOTION IN THE WORKPLACE: AN OVERVIEW. Warshaw and Jacqueline Messite. Acetaminophen: Take It Safely Acetaminophen is a very safe drug to take according to label instructions. In overdose, too much.
By Gender. Each year, women have more strokes than men, and a stroke kills more women than men. About 6. 0% of stroke deaths occur in females and 4. The use of birth control pills, pregnancy, history of preeclampsia/eclampsia or gestational diabetes, smoking, and post- menopausal hormone therapy are believed to account for this difference (AHA/ASA, 2. By Race. The risk of having a first stroke is almost twice as high for blacks than for whites, and blacks are more likely to die following a stroke than are whites, partially due to the higher prevalence of high blood pressure, diabetes, and obesity among this population (AHA, 2. The incidence of stroke among Hispanics lies between that of whites and blacks. Native Americans, Alaska Natives, and blacks are more likely to have a stroke than are other groups (CDC, 2. A higher incidence of intracerebral hemorrhage has been noted in Chinese, Japanese, and other Asian populations, possibly due to environmental factors (e. Get timely, reliable, health and safety information about food, drugs, medical devices, vaccines, pet food, pet medicine and more.Liebeskind, 2. 01. By Geographic Location. The southeastern part of the United States has been nicknamed the “stroke belt,” which includes the following eleven states: Alabama. Arkansas. Georgia. Indiana. Kentucky. Mississippi. Louisiana. North Carolina. South Carolina. Tennessee. Virginia. This part of the country has an 1. This is believed to be the result of more limited access to healthcare as well as lower economic status affecting the quality and frequency of healthcare visits. In addition, ethnic- specific risks and unhealthy lifestyle traditions and patterns are believed to be contributors (Jensen, 2. Source: CDC.)Effects of Stroke. Worldwide, stroke is the second- leading cause of death and the leading cause of adult disability (AHA/ASA, 2. WHO, 2. 01. 4). Receiving the diagnosis of stroke is frightening. A stroke can have profound effects on the body as well as the mind and emotions. Effects on the body may include weakness or paralysis of the extremities, swelling of the arms or legs, stiff or painful joints, muscle tingling and spasms, or the loss of ability to perceive heat or cold. A stroke can leave a person with fatigue that makes everyday tasks difficult to accomplish. Strokes can seriously affect how the brain processes information, depending on where the damage has occurred. Memory, ability to learn, and general awareness of surroundings can be affected, as well as the ability to communicate through speech and writing. Reading ability and concentration may also be impaired. Sleep disturbances may result in increased impairment of memory and perception. Emotionally, a stroke can cause feelings of fear, anxiety, or depression and can result in damage to areas of the brain responsible for regulating emotions, leading to emotional lability and personality or character changes. Finally, the loss of independence that results from all of these can be the most devastating consequence of having a stroke. Economically, in 2. CDC, 2. 01. 5). RISK FACTORSSome risk factors are nonmodifiable: Low birth weight is reported to be associated with increased hemorrhagic stroke risk in adult life. Male gender increases the risk for ischemic stroke. Early menopause increases the risk for subarachnoid hemorrhage in women. Stroke increases markedly with age in both men and women for both ischemic and hemorrhagic stroke. People of African origin have a higher risk than whites. Genetics may play a role in the increased susceptibility of stroke (e. Other risk factors are modifiable: Hypertension is the most important treatable risk factor for stroke. Atrial fibrillation can cause emboli to travel to the brain. Coagulation disorders have been implicated in ischemic stroke. Diabetes mellitus causes hyperglycemia, which in turn leads to increased fatty deposits or clots on blood vessel walls. Lifestyle factors impact the risk. Smoking (doubles the risk for ischemic stroke)Excessive alcohol consumption (however, individuals who do not use any alcohol may have a slightly increased risk as well)Drug abuse. Obesity. Lack of physical activity. Psychological stress. Lower socioeconomic status. Poor or inadequate nutrition(Lindgren, 2. Scientists at the National Institute of Neurological Disorders and Stroke (2. Americans should be able to prevent 8. For instance, improved nutrition—including a high- vegetable, low- fat, high- fiber diet—and regular aerobic exercise have been shown to reduce risk. CLASSIFICATIONS OF STROKEThere are two major categories of stroke, which are diametrically opposite conditions. One is characterized by an insufficient supply of blood to a part of the brain (ischemic) and the other by an excessive amount of blood within the closed cranial cavity (hemorrhagic). Two types of stroke—hemorrhagic and ischemic. In the United States, ischemic stroke accounts for 8. AHA/ASA, 2. 01. 4a). Ischemic strokes may occur in two ways: Thrombotic stroke: Cerebral thromboses are clots that form in the cerebral arterial tree. Blood clots usually form in arteries that are damaged by plaque. There are two types of thrombotic stroke: large vessel thrombosis and small artery thrombosis (lacunar infarction). Embolic stroke: Cerebral emboli occur due to clots or other debris (such as pieces of plaque) that arise from outside the cerebral arterial tree—usually from the heart, pulmonary trunk, or pulmonary arteries—and travel through the arterial system until they become lodged within smaller arteries. Ischemic strokes typically give rise to specific (focal) and often painless neurological symptoms. Onset is abrupt and may progressively evolve over 2. A transient ischemic attack (TIA) is a type of ischemic stroke—sometimes referred to as a “warning stroke” or a “mini stroke”—that results in no lasting damage (CDC, 2. Although it is due to ischemia (most often the result of blood clots), TIA is different from the major types of stroke because blood flow is blocked for only a short period of time. Neurologic dysfunction resulting from a TIA typically lasts less than an hour and results from focal cerebral, spinal cord, or retinal ischemia. It is not associated with acute tissue infarction (Nanda, 2. The incidence of stroke following a TIA is as high as 1. Nanda, 2. 01. 5). More than one third of persons who experience a TIA end up having a major stroke within one year if they do not receive treatment, and 1. TIA (CDC, 2. 01. 3). Hemorrhagic Stroke. Bleeding caused by a blood vessel in the brain that has leaked or ruptured is called a hemorrhagic stroke. Hemorrhagic stroke often causes tissue damage due to pressure- related changes. Most commonly, intracerebral hemorrhages are caused by rupture of vessels due to long- term atherosclerotic damage and arterial hypertension, resulting in bleeding into the brain (intracranial hemorrhage) or the space surrounding the brain (subarachnoid hemorrhage). Such ruptures may occur due to: Weakened vascular walls (cerebral aneurysms)Congenital arteriovenous malformations (AVMs), which are dilated, often tangled, blood vessels where the arterial blood flows directly into the venous system bypassing the usual capillary bed. Over time, local damage to the tissue occurs due to compression, insufficient blood flow, irritation, or micro- hemorrhages. Ten percent of all strokes are intracranial hemorrhages, and 3% are subarachnoid hemorrhages (Mozaffarian, et al., 2. A typical location of a cerebral aneurysm in the arteries that supply blood to the brain. The blood supply to the brain is delivered by anterior and posterior circulation systems. The anterior circulation of the brain is formed by cerebral blood vessels that branch off the internal carotid arteries, while the posterior circulation of the brain is formed by those cerebral blood vessels that branch off the vertebral arteries. The anterior and posterior circulations communicate through a circular anastomosis of arteries called the Circle of Willis, located at the base of the brain. From this circle, other arteries arise and travel to all areas of the brain.
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