Stroke can be classified as either ischemic or hemorrhagic in nature. While ischemic cerebrovascular disease predominates worldwide, cerebral hemorrhage may explain 30-40% of stroke among Chinese and Japanese. Because patient's cerebral hemorrhage can be fully prepared and clinically similar to those who suffer ischemic vascular disease, stroke treatment should be based on radiological firm identification of the underlying disease. The cause of stroke must be clearly identified so that the specific risk factors are controlled, and the treatment is tailored to individual needs.
General Management of acute stroke.
Good management of the stroke patient should start with sound basic nursing diagnosis, investigation and treatment. Dedicated to strict medical supervision and nursing care in acute stroke units has been shown to reduce functional disability and the need for long-term hospitalization, even when drug therapy is identical to that given in general medical units. The difference in the result appears to be attributable simply to greater care in the diagnosis, treatment and overall management of preventable complications. Adequate nutrition, fluid and electrolyte balance should be ensured; naso-gastric feeding may be necessary in those who cannot be fed.
Stuperouo's patients in a coma or airway protection may be necessary to prevent aspiration, aspiration frequent as well as semi-Fowler position. The position Tredelenberg is indicated in the case of proporsional cerebral ischemia. Prolonged bed confinement leads to complications such as infection, thrombophlebitis, pulmonary embolism, and decubitus ulcers. The patient must be immobilized shot at least 2-hourly to prevent necrosis of the skin and the development of pressure sores, as well as infection. More frequent changes of position are likely to be useful because the kinetic therapy using a rotating bed that transforms patients 8 turns / hour has been reported to further reduce the rate of infection. Joint contractures can be prevented with physical therapy, while the anterior dislocation of the humeral head can be prevented with a good placement and use of harnesses. Rehabilitation should begin as soon as possible.
Fever
Fever in a patient with ischemic stroke is usually secondary to infection, most commonly aspiration or infectious pneumonia. Pulmonary atelectasis can be prevented by periodic hyperventilation and severe cough. Movement of the chest on the hemiplegic side tends to be reduced so you should pay attention to that side. Pneumonia is one of the leading causes of death in stroke patients, and raised respiratory rate and the development of fever may help in the early detection of this complication. Urinary tract infection is also common due to the frequent use of catheters, as well as the inability to empty the bladder filled with urine, with statistics derived from it in those without a catheter. Venous thrombosis in the leg paralyzed perhaps prevented using leg wraps, passive leg movements, adequate hydration and the use of low-dose heparin subcutaneously. This complication, however, is rare among Chinese so that only selective use of anticoagulant is necessary in this population. Particular care should be taken in times cerebral complications, including aspiration, and cardio-respiratory sleep apnea are common.
Hypertension.
Hypertension is a risk factor for stroke, and is therefore, frequently at the time of admission. However, many patients will have spontaneous reduction of hypertension in a few days. In deciding how soon an increase in blood pressure should be brought to normal levels after a stroke, it is worth considering that when cerebral autoregulation is impaired in acute ischemic stroke and cerebral blood flow becomes passively as a function of blood pressure, twilight marginal artery disease may suffer reduced blood flow with blood pressure reduction. In addition, the decrease in blood pressure can reduce the flow and thus promote the formation of thrombi.
In the case of cerebral hemorrhage, however, a higher pressure may be necessary to provide adequate cerebral perfusion pressure in the presence of raised intracranial pressure. For these reasons, aggressive treatment of hypertension in the acute phase may be unnecessary and dangerous. And prudent to aim to stabilize at a lower level, rather than a normal level, and reduce blood pressure gradually if there is extreme hypertension, hypertensive encephalopathy, ischemic myocardia aggravated by hypertension, or aortic dissection. In addition, drugs such as nitroprusside, hydralazine, clonidine, diazoxide that reduces cerebral perfusion, should be avoided or used with great caution.
Experimental studies have shown that hyperglycemia intensifies ischemic brain damage. There is also evidence that stroke patients with higher glucose levels do less well. While controversy exists whether this represents a deleterious effect of hyperglycemia or inversely the effect of the stress of a large myocardial glucose homeostasis, the observation point is the need to monitor glucose levels in patients with stroke and a more judicious use of infusion's glucose.
Steroids.
Steroids are frequently prescribed for cerebral edema in stroke. However, unlike the extracellular vasogenic edema following ischemia does not respond to steroid therapy. A controlled study has shown that high doses of steroids administered to patients with cerebral infarction has no beneficial effect. In addition, complications of infections were more common with steroids. Dehydrating agent's mannitol and others, while having fewer side effects, were equally ineffective. Surgery, however, can be useful in case of severe ischemia cerebellar compression of the brain stem, causing swelling.
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