14 Chapter 28 Cerebrovascular Accident ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the hemispheres of the cerebrum
and the fact that each controls the opposite
side of the body. Which hemisphere is
dominant in most people? What does each
hemisphere control?
• Discuss the modifiable and nonmodifiable
risks for CVA.
• Discuss several chronic disorders and
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Discuss ischemic and hemorrhagic strokes.
• Divide the class into four groups. Assign
each group one of the four types of CVA.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Differentiate
between an ischemic stroke and a
3
DISCUSS
• Discuss the signs and symptoms of a
transient ischemic attack and medical
interventions.
• Discuss the various types of stroke and how
they differ from each other in signs,
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
use of anticoagulants in stroke therapy.
• Post the following discussion topic online
and have students comment. Describe the
________________________________________________________ Chapter 28 Cerebrovascular Accident 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.1
4
DISCUSS
• Discuss three types of communication
disorders that may result from a CVA,
focusing on the differences between aphasia
and dysarthria.
• Discuss the possible complications of
dysphagia.
• Discuss the types of sensory impairments
that the stroke patient may encounter.
• Create two columns on the board:
“Right-Brain Damage” and “Left-Brain
Damage.” Next, call out the following long–
term effects of stroke and have the class
discuss and define each—identifying
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
of the components of a head to toe
assessment. List abnormal findings on
assessment that may be seen in a patient
having a stroke.
5
DISCUSS
• Discuss how the dosage for warfarin therapy
is calculated.
• Discuss the medical tests that are likely to
be performed if stroke is suspected.
• Discuss the use of a lumbar puncture in the
diagnosis of stroke and under what
conditions it is contraindicated.
• Divide the class into small groups. Assign
each group one of the following diagnostic
tests and have the group identify the
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Differentiate
the purpose of an MRI and a CT scan in
diagnosing a stroke.
• Post the following discussion topic online
and have students comment. Why is it
critical to receive a rapid CT for a patient
having a new stroke?
• Post the following discussion topic online
and have students comment. You are caring
for a patient that had a stroke 24 hours ago.
16 Chapter 28 Cerebrovascular Accident ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.1
6
DISCUSS
• Discuss the advantages and benefits of rt–
PA.
• Discuss indications for prescribing rt-PA.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Perform an
Internet search to find indications and
contraindications for rt-PA. What did you find
out?
Critical Thinking Question
A nurse is speaking to a group of teenagers about lifestyle choices that can affect the risk of
developing a stroke. What could the nurse tell this group that would be relevant and
important for them to know?
Discussion Guidelines: The nurse should explain that strokes can occur in any age group and the
future.
Instructor Notes/Student Feedback
________________________________________________________ Chapter 28 Cerebrovascular Accident 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
Instructor Preparation
Textbook Objectives Covered
8. Assist in developing a nursing care plan for a CVA patient during the acute phase and
rehabilitation phase.
10. Identify resources for the CVA patient and family.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying cerebrovascular accident including:
• The types of CVA
• Diagnosis and treatment of CVA
• Short-term and long-term neurologic deficits resulting from CVA
• Nursing assessment and interventions
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• aphasia (p. 489)
• diplopia (p. 498)
• ptosis (p. 498)
• receptive aphasia (p. 489)
18 Chapter 28 Cerebrovascular Accident ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
Student Preparation
Assignments 2 hours
7
READ – Textbook (pp. 493-497)
ANSWER – Study Guide
• Part IB: 1-6 (p. 165)
8
READ – Textbook (pp. 493-507)
REVIEW
• Figure 28-6: Assistive devices (p. 503)
• Figure 28-7: Assistive devices for eating (p. 505)
• Nursing Care Plan 28-1: Stroke Patient (pp. 494-495)
ANSWER – Text
• Review Questions for the NCLEX Examination: 10 (p. 508)
ANSWER – Study Guide
• Part IIE: 1, 2, 6, 8-11 (p. 167)
• Part IIIF: 1-6, 8, 9 (pp. 168-169)
• Part IIIG: 1-8 (pp. 169-170)
9
READ – Textbook (pp. 493-507)
REVIEW
10
READ – Textbook (pp. 493-507)
50-Minute Lesson Plan
Lecture Outline 20 minutes
7
Slide 28
Nursing Care in the Acute Phase
• Assessment
• Evaluate type and extent of the stroke: time of onset, symptoms, other details
• Cincinnati Pre-hospital Stroke Scale
• Health history
• Chief complaint and history of present illness
• Medical history
• Family history
• Review of systems
• Functional assessment
TALKING POINTS:
• The Cincinnati Pre-hospital Stroke Scale is a quick and easy tool that is often used in the
________________________________________________________ Chapter 28 Cerebrovascular Accident 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
Slide 29
• Evaluate the alert patient’s ability to swallow
• Inspect pupils for size, equality, and reaction to light
Nursing Care in the Acute Phase (cont.)
• Physical examination
• Assess patient’s general appearance, responsiveness, and behavior
• Record restlessness or agitation
• Measure vital signs; weight and height if possible
Slide 30
Nursing Care in the Acute Phase (cont.)
• Physical examination
• Conduct a gross vision assessment
• Inspect skin color and palpate for moisture and turgor
• Assess extremities for muscle tone and strength, sensation, and voluntary movement
8
Slide 31
Nursing Care in the Acute Phase (cont.)
• Interventions
• Ineffective airway clearance and Ineffective breathing patterns
• Risk for injury
• Deficient fluid volume or Excess fluid volume
• Imbalanced nutrition
• Disturbed sensory perception
• Ineffective thermoregulation
• Disturbed thought processes
Slide 32
Nursing Care in the Acute Phase (cont.)
• Interventions
• Impaired verbal communication
• Impaired physical mobility
• Total or Functional urinary incontinence
• Constipation and/or Bowel incontinence
• Ineffective coping
• Interrupted family processes
Slide 33
Nursing Care in the Rehabilitation Phase
• Assessment
• Reassess patient’s abilities, expectations, knowledge, motivation, and resources
20 Chapter 28 Cerebrovascular Accident ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
Slide 34
Nursing Care in the Rehabilitation Phase (cont.)
• Interventions
• Self-care deficit
• Risk for injury
• Ineffective coping
• Impaired verbal communication
• Imbalanced nutrition
TALKING POINTS:
• Point out the many devices that are available to use during the rehabilitation phase of
care. There are special tools for eating, dressing, bathing, walking, etc.
10
Slide 35
Discharge
• Patients may be discharged to home or go to specialized rehabilitation centers for
continued therapy
• Outpatient therapy is an option for some patients
TALKING POINTS:
• In acute rehabilitation settings, patients will be evaluated by all disciplines and goals will
be set; continuous assessments and goal-setting occur throughout the rehabilitation
process.
• What support groups are available for the patient and family?
Discharge (cont.)
TALKING POINTS:
• Discharge planning begins upon admission and should include family members and
significant others as well as the patient.
________________________________________________________ Chapter 28 Cerebrovascular Accident 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
Activities
Classroom Choose from below to make 30 minutes
Online
7
DISCUSS
• Discuss the importance of the health history
in the assessment of the CVA patient.
• Discuss what to look for during the physical
examination of a suspected CVA patient.
• As a class, identify each component of the
health history and physical assessment of a
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Identify
common signs and symptoms associated
with CVA. What do you think are some of
the causative factors for those signs and
symptoms?
8
DISCUSS
• Discuss ways of reducing the danger of
respiratory complications in the CVA patient.
• Discuss how to assess a patient for Fluid
volume deficit or Fluid volume excess.
Discuss how to prevent Fluid volume deficit
or Fluid volume excess.
• Divide the class into several small groups.
Assign each group one of the following
scenarios and have the group identify
nursing goals and interventions for each of
the nursing diagnoses. Have each group
share its results with the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe how
sensory perception deficits may be dealt
with differently during the acute phase.
• Post the following discussion topic online
and have students comment. Describe the
effects of Impaired mobility.
22 Chapter 28 Cerebrovascular Accident ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
8
• Discuss ways in which the nurse can help
the patient with Disturbed thought
processes.
• Discuss ways of intervening for Impaired
verbal communication in the acute phase.
• Discuss how sensory perception deficits
may be managed differently during the
rehabilitation phase.
• Discuss how to intervene for urinary and
bowel problems in the CVA patient.
• Divide the class into several small groups.
• A 32-year-old woman, who experienced
a stroke immediately after delivering a
healthy newborn, is in the rehabilitation
phase of a stroke with the nursing
9
DISCUSS
• Discuss goals associated with airway
clearance and breathing patterns and how
the outcome is assessed.
• Discuss how the goals of acute care differ
from those of the rehabilitation phase for
CVA patients.
• Keeping the same groups from the previous
activity, have each group specify outcome
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
outcomes that should be measured when
caring for a patient with a stroke.
• Post the following discussion topic online
and have students comment. What are key
quality indicators that should be evaluated
when providing care for a patient who has
________________________________________________________ Chapter 28 Cerebrovascular Accident 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 28.2
10
DISCUSS
• Discuss the advantages and disadvantages
of living in a rehabilitation facility for care
following a CVA.
• Discuss how to find resources for the special
needs of a CVA patient and his or her family.
• Have students research and prepare an
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Research what
patient resources are available for a stroke
patient in your area. Describe your findings.
Critical Thinking Question
A frail 83-year-old female patient with a history of multiple strokes has joint contractures
and is confined to bed. She has been crying and moaning for 2 days. The physician orders a
shoulder x-ray, which demonstrates a shoulder dislocation that the physician suspects may
have resulted from moving the patient. How could the nurse help prevent this from
happening?
Discussion Guidelines: To prevent injury to both the patient and nurse, proper body mechanics
must be used when moving a patient. A frail, elderly patient with impaired mobility is prone to
Instructor Notes/Student Feedback
24 Chapter 28 Cerebrovascular Accident ________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
28
Assessments for
Cerebrovascular Accident
CHAPTER OBJECTIVES
Lesson 28.1:
1. Discuss the risk factors for cerebrovascular accident (CVA).
3. Describe the pathophysiology, signs and symptoms, and medical treatment for each type of CVA.
5. Explain the tests and procedures used to diagnose a CVA, and nursing responsibilities for patients
Lesson 28.2:
8. Assist in developing a nursing care plan for a CVA patient during the acute phase and rehabilitation
phase.
10. Identify resources for the CVA patient and family.
Assessments by Lesson & Objective
Lesson 28.1
1
Evolve Instructor Resources
• Test Bank: 2
Evolve Student Resources
• NCLEX Review: 1, 6, 9
2
Study Guide
• Part ID: 1-3 (p. 166)
Evolve Student Resources
• NCLEX Review: 2, 4
3
Study Guide
• Part IA: 1-17 (pp. 165-166)
Evolve Instructor Resources
• Test Bank: 1, 4, 5, 12, 25-28, 32
4
Study Guide
• Part IIE: 4 (p. 167)
Evolve Instructor Resources
• Test Bank: 9
________________________________________________________ Chapter 28 Cerebrovascular Accident 25
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
5
Evolve Instructor Resources
• Test Bank: 11
Evolve Student Resources
• NCLEX Review: 3
6
Study Guide
• Part IIE: 12 (p. 167)
Evolve Instructor Resources
• Test Bank: 10, 30
Lesson 28.2
7
Study Guide
Evolve Instructor Resources
• Test Bank: 7, 8, 33
Evolve Student Resources
• NCLEX Review: 10
8
Study Guide
Evolve Instructor Resources
• Test Bank: 13-19, 21-23, 31
Evolve Student Resources
• Prioritization: 1-5
9
Evolve Instructor Resources
• Test Bank: 20
Evolve Instructor Resources
Instructor’s Notes/Student Feedback