B. Etiology 1 . Cerebral infarction ( 80 % )a. embolism1 ) cardiogenic embolisma) Atrial fibrillation or other arrhythmiasb ) left ventrikek mural thrombusc ) mitral or aortic valve diseased ) Endocarditis2 ) paradoxical embolism ( patent foramen ovale )3 . Aortic arch embolismb . Aterotrombotik ( blood vessel disease medium-high )1 ) Disease ekstrakarniala) the internal carotid arteryb ) the vertebral artery2 ) Disease intrakarniala) the internal carotid arteryb ) middle cerebral arteryc ) the basilar arteryd ) Lakuner ( perforans small artery occlusion )2 . Intracerebral hemorrhage ( 15 % )a. hypertensiveb . Arteriovenous malformationc . amyloid angiopathy3 . Subarachnoid hemorrhage ( 5 % )4 . Other causes ( can lead to infarction or hemorrhage )a. Thrombosis dinus durab . Carotid or vertebral artery dissectionc . Central nervous system vasculitisd . Moya - moya disease ( occlusion of a large intracranial arterial progressive )e . migrainef . hypercoagulable conditiong . Misuse of drugs ( cocaine or amphetamines )h . Haematological disorders ( sickle cell anemia , polycythemia , or leukemia )i . atrial myxoma
C. PathophysiologyThrombosis ( disease trombo - occlusive ) is the most frequent cause of stroke . Cerebral arteriosclerosis and cerebral circulation slowdown is the main cause of cerebral thrombosis , which is a common cause of stroke . Signs of cerebral thrombosis varies . Onset of the headache is not common . Some patients experience dizziness , seizures , and cognitive changes or some other common onset . In general, cerebral thrombosis did not occur suddenly , and temporary loss of speech , hemiplegia or paresthesias in half body weight may precede the onset of paralysis in a few hours or days .Thrombosis occurs usually has something to do with the local damage blood vessel walls due atrosklerosis . The process of atherosclerosis is characterized by fatty plaque in the intima layer of the artery . Sereberi artery intima part becomes thin and stringy , whereas cells - muscle cells disappeared . Lamina interna elastika torn and frayed , so the vessel lumen partially filled by the sclerotic material . Plaques tend to form at branching or places - places curved . Thrombi were also associated with a place - such a special place . Vessels - vascular risk in order to have less and less are as follows : internal carotid artery , vertebral and basilar part of the bottom . Intima loss will make connective tissue exposed . Platelets stick to the exposed surface so that the surface of the blood vessel walls become rough . Platelets will let go of the enzyme , adenosine diphosphate mechanisms that initiate coagulation . Fibrinotrombosit stopper can be detached and form emboli , or it can remain in place and eventually all that will be clogged artery perfectly .Embolism : embolism sereberi including second leading cause of many strokes . Embolism patients are usually younger than patients with thrombosis . Most sereberi emboli originating from a thrombus in the heart , so the real problem faced is the embodiment of heart disease . Although less common , embolus may also originate from atheromatous plaques karotikus sinus or internal carotid artery . Each part of the brain can suffer embolism , but usually embolus embolus will clog parts - small parts .. the most frequently affected artery embolus sereberi is sereberi media , especially the top .Cerebral hemorrhage : cerebral hemorrhage including third leading cause of all cases GPDO ( Brain Blood Vessel Disorders ) and a tenth of all cases of the disease . Intracranial hemorrhage is usually caused by the rupture of cerebral arteries . Extravasation of blood occurs in the brain and / or subarachnoid , so the networks are located nearby will be displaced and depressed . Blood is very irritating to the brain tissue , resulting in vasospasm in arteries around the bleeding . These spasms can spread throughout the brain and the circle wilisi hemisper . Blood clot that initially resemble soft red jam will eventually dissolve and shrink . In the light of histological brain located around the clot can swell and undergo necrosis . Because the action of the enzyme - enzyme liquefaction process will occur , thus forming a cavity . After several months of all necrotic tissue will be replaced by astrocytes and capillaries - new capillaries to form the fabric around the cavity earlier . Finally cavities filled by fibers - fibers that experienced astroglia proliferation . Subarachnoid hemorrhage is often associated with rupture of an aneurysm . Most aneurysms of the circle of wilisi . Hypertension or bleeding disorders facilitate the possibility of rupture . Often there is more than one aneurysm .
D. CLINICAL1 . sudden headache .2 . Paraesthesia , paresis , Plegia part of the way .3 . dysphagia4 . aphasia5 . Impaired vision6 . Changes in cognitive abilities
E. RISK FACTORSWhich can not be changed : age , male gender , race , family history , history of TIA or stroke , coronary heart disease , atrial fibrillation , and heterozygous or homozygous for homo cystinuria .That can be changed : hypertension , diabetes mellitus , smoking , alcohol and drug abuse , oral contraceptives , increased hematocrit , asymptomatic carotid bruit , hyperuricemia , and dispidemia .
F. ACUTE STROKE UNIT IN EMERGENCYTime is brain is an expression that shows the importance of stroke treatment as early as possible , because the ' therapeutic window ' of a stroke is only 3-6 hours . Management of rapid , precise , and accurate , emegang dasil major role in determining the end of treatment . Things that should be done is :1 . Stabilization of patients with ABC action2 . Consider intubation bil a kesadaranstupor tau respiratory failure or coma3 . Put an intravenous infusion line with normal saline solution 0.9 % in water and saline 0.45 % , due to brain edema memperhebar4 . Give oxygen 2-4 liters / minute via nasal cannula5 . Do not give food or drink by mouth6 . Create recording electrocardiogram (ECG ) and chest X-ray did Rongen photo7 . Take samples for blood tests : complete examination of peripheral blood with platelets , blood chemistry ( glucose , electrolytes , urea and creatinine ) . Asa prothrombin and partial thromboplastin time8 . If there is any indication, do the following tests : jadar alcohol , liver function , arterial blood gases , and toxicology screening9 . Enforce diagnosis based on history and physical examination10 . CT scans or magnetic resonance tool when available . If not, the Siriraj score to determine the type of stroke .G. Nursing care1 . ASSESSMENT1 . Changes in level of consciousness or responivitas as evidenced by the movement , refused to change its position and response to stimulation , oriented towards the time, place and person2 . Presence or absence of a volunteer or involuntary limb movements , muscle tone , posture and head position .3 . Flaksiditas stiffness or neck .4 . Eye opening , comparative pupil size , and pupil reaction to light and ocular position .5 . Color of the face and extremities , skin temperature and humidity .6 . Quality and frequency of pulse , respiration , arterial blood gases as indicated , body temperature and arterial pressure .7 . Ability to speak8 . The volume of fluid you drink and urine volume issued every 24 hours .2 . MANAGEMENTa. Acute phase :
Maintain vital functions : airway, breathing , oxygenation and circulation
Reperfusion with trombolityk or vasodilation : Nimotop
Prevention of increased ICP
Reduce cerebral edema with diureticsb . Post acute phase
Prevention spatik paralysis with antispasmodics
program Fisiotherapi
Handling psychosocial problemsc . First Aid In Stroke PatientsFirst Aid In Stroke ( By way of bleed on each end of the leaf tips of fingers and ears ) . There is one best way to provide first aid to people who had suffered a STROKE . This way can save lives in addition to the patient , also does not cause any side effects . The first aid is aid EMERGENCY guaranteed to work 100 % .As we know , people who had suffered a STROKE , whole blood in the body will drain very fast towards the blood vessels in the brain . If the activities of aid given terlambatsedikit course , the blood vessels in the brain will not withstand the flow of blood flowing profusely and will soon be broken little by little .In the face of such circumstances not to panic but to be quiet . Sipenderita should remain its original place where he fell ( eg in the bathroom , bedroom , or anywhere else ) . DO NOT MOVED ! ! ! because by moving the patient from the original will hasten rupture small blood vessels in the brain .Patients should be assisted take a good sitting position in order not to fall again , and at that time extravasation can be done . It is best to use a syringe , but if not there , then NEEDLE SEWING / pin / pin can be used to advance first sterilized by burning over the fire . As soon as sterile needles , do the stabbing on 10 END FINGER . Insertion point is approximately 1cm from the tip of the nail . Each finger is quite stabbed one time only in the hope of every finger dispense 1 drop of blood . Extravasation can also be assisted by the push of blood if it was not out of his fingertips . In a period of approximately 10 minutes , the patient will regain consciousness soon .When sipenderita looks lopsided mouth / not normal , then BOTH EARS sipenderita LEAF - DRAWN TO PULL until goldenReddish . After that do 2 TIMES stabbing at each END DOWN LEAF EAR so that 2 drops of blood out of each end of the ear . Thus in a few minutes form the mouth sipenderita will return to normal .After the state sipenderita recovered and no significant abnormalities , then take sipenderita carefully to the doctor or the nearest hospital to get further help .
4 . Nursing Diagnosisa. Damage to physical mobility bd decreased muscle strength , controlb . Ineffective tissue perfusion related to cerebral hemorrhage . brain edemac . B.d self care less physical weaknessd . Verbal communication b.d damage brain damagee . Risk of damage to skin integrity bd mechanical factorsf . Decrease the risk of infection b.d primary defense
5 . INTERVENTIONNo Diagnosis Goals / Interventions Rationale KH1 . Damage to physical mobility bd penuruna n NOC muscle strength : Ambulation / maintained normal ROM .After the act of nursing 5x24 hoursKH :o The joints are not stiffo No muscle atrophy occurs NIC :1.Terapi exercisejoint mobilityo Explain to the client & kelg purpose joint movement exercises .o Monitor the location and discomfort during exerciseo Use loose clothingo Assess client's ability to moveo Encourage active ROMo Teach ROM active / passive on the client / family .o Change the client's position every 2 hours .o Assess development / progress exercises2 . Self Care Assistanceo Monitor client independenceo assist the client in terms of self-care : eating , bathing , toileting .o Teach the family in meeting self-care clients .Movement of active / passive aims to maintain flexibility of jointsPhysical and psychological disabilities clients can reduce their daily self-care and can be fulfilled with the help of clients that personal hygiene can be maintained2 . Ineffective cerebral tissue perfusion bd brain hemorrhage , edema o NOC : cerebral tissue perfusion . After the act of nursing for 5 x 24 hours with adequate tissue perfusion indicator :o adequate tissue perfusion is based on peripheral pulse pressure , the warmth of the skin , urine output is adequate and there is no interference with respiration NIC : Nursing circulationIncrease in brain tissue perfusionactivity :1 . Monitor neurologic status2 . monitor the status of respitasi3 . monitor heart sounds4 . place the head with a slightly elevated position and in a neutral position5 . appropriate medication management order6 . Oxygen is given as indicated 1 . tk identify trends and potential increase ICT awareness and find out the location . Extensive CNS damage and progress2 . Respiratory irregularity can give you an idea location of damage / increase in ICT3 . Bradycardia could occur as a result of brain damage .4 . Lowers arterial pressure by improving drainage and improve circulation5 . Prevention / treatment decreased ICT6 . lowering hypoxia3 . Decrease the risk of infection bd primary defense NOC : Risk Control After nursing action for 3 x 24 hours the client does not have an infectionKH :o Clients are free of signs of infectiono The client is able to explain the signs and symptoms of infection NIC : Prevent infection1 . Observe and report signs and symptoms of infection , such as redness , warm , discharge and an increase in body temperature2 . assess client netropeni temperature every 4 hours , reported if the temperature is more than 380C3 . Using electronic or mercury thermometer to assess temperature4 . Record and report the value of laboratory5 . Assess skin color , skin moisture , texture and turgor do proper documentation on any changes6 . Support for the consumption of a balanced diet , the emphasis on protein for the formation of the immune system1 . Onset of infection with the immune system is activated and signs of infection appear2 . Clients with netropeni not produce enough heat inflammatory response because it is usually a sign and often the only sign of3 . Temperature values have important consequences for the proper treatment4 . Lab values correlated with client history and physical examination to give him a holistic view5 . Can prevent skin damage , skin intact is the first defense against microorganisms6 . Immune function is affected by protein intake4 . Self-care deficit bd physical weakness NOC : Self Care Assistance ( bathing , dressing , eating , toileting .After the act of nursing for 5 x 24 hour client can meet the needs of self-careKH :- The client is free from odor , can feed themselves , and dress himself
NIC : Self Care1 . Observation of the client's ability to bathe , dress and eat .2 . Assist the client in a sitting position , make sure the head and shoulders upright for eating and 1 hour after meals3 . Avoid exhaustion before eating , bathing and dressing4 . Encourage clients to continue to eat little but often1 . By using direct intervention to determine appropriate interventions for clients2 . Seated position helps prevent ingestion and aspiration3 . Improve energy conservation and activity tolerance improved self-care skills4 . To increase appetite5 . Risk of damage to the skin intagritas bd mechanical factors NOC : maintain skin integrityAfter a 5 x 24- hour care skin integrity remains adequate indicators:No significant damage to the skin characterized by redness , sores decubitus NIC : Give stress management1 . Perform replacement loom every day and place the appropriate mattress2 . Monitor the skin area kemerahan/pecah23 . monitor the depressed area4 . give masage on back / depressed area and provide moisturizing pad area pecah25 . monitor nutritional status1 . Improve comfort and reduce the risk of itchinglajutan damage kulità2 integrity . Indicates the initial symptoms3 . Depressed area usually less than optimal circulation allows for trigger blisters4 . facilitate the circulation of. 5. Good nutritional status can help prevent skin integrity keruakan .6 Lack of knowledge bd less access to health information NOC : Knowledge increased clientKH :- The client and family understanding of disease Stroke , care and treatment NIC : Health Education1 . Assess the client's readiness and ability to learn2 . Assess the knowledge and skills of previous clients about the disease and its effect on the desire to learn3 . Give the most important material on the client4 . Identify the main source of support and attention to the client's ability to learn and support the behavior change necessary5 . Assessing the family wishes to support changes in client behavior6 . Highly priced hasi evaluation pembelajarn through demonstrations and restates the material being taughtThe learning process depends on the particular situation , the interaction of social , cultural and environmental valuesNew information is absorbed meallui previous facts and assumptions and biases affect the process of transformationInformation will be more striking when explained from a simple concept to complexFamily support is needed to support behavior change.
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HOW i got a cure for stroke
I really want to take this time out to show my appreciation to a doctor who advised me correctly. I had stroke for 12 years and my full left side was paralyzed because of this i could say i was half human because i could not function where others are functioning. I knew i needed help and i began to search and i saw his contact from a testimony some people were giving, i never believed because i have tried so many medicines and therapies yet no cure. I still contacted him to see what he had to offer. I got the medicine (herbal medication) he told me about and i could not believe my eyes. In a matter of 3 months i was completely okay. If you have any stroke related illness or paralysis feel free to reach him for info and cure on (josephalberteo@gmail.com) he treated me and he can treat you too. cheers.
great exhaustive and very informative post about non-hemorrhagic stroke and its consequences. many thanks!
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