I. Pathophysiology—Cerebrovascular accident (CVA, “stroke”
or “brain attack”) is injury or death to parts of the brain caused
by an interruption in the blood supply to that area causing disability,
such as paralysis or speech impairment.
a. Ischemic stroke: Impaired cerebral circulation caused by a
partial or complete occlusion of a blood vessel with transient
or permanent effects.
i. Accounts for 80% to 85% of all strokes (Morrison,
2007), with carotid stenosis as the leading cause
ii. Subdivided based on the underlying cause.
1. Large-vessel thrombotic and embolic strokes
2. Small-vessel thrombotic stroke
3. Cardioembolic stroke
iii. Ischemia may be transient and resolve within 24 hours,
be reversible with resolution of symptoms over a period
of 1 week (reversible ischemic neurological deficit
[RIND]), or progress to cerebral infarction with variable
effects and degrees of recovery.
b. Hemorrhagic stroke: result of a vessel wall rupture with
bleeding into the brain, compressing brain tissue
i. Accounts for approximately 15% to 20% of cerebrovascular
accidents (Morrison, 2007), with only 20% of
patients regaining functional independence (Nassisi,
a. Ischemic stroke
i. Large-vessel thrombotic and embolic strokes result from
hypoperfusion, hypertension, and emboli traveling from
large arteries to distal branches.
Although the client may initially be cared for in the intensive
care unit (ICU) for severe or evolving deficits, this plan
of care focuses on the step down from medical unit and subacute
and rehabilitation units to the community level.
Craniocerebral trauma (acute rehabilitative phase)
Psychosocial aspects of care
Total nutritional support: parenteral/enteral feeding
1. Promote adequate cerebral perfusion and oxygenation.
2. Prevent or minimize complications and permanent disabilities.
3. Assist client to gain independence in activities of daily
4. Support coping process and integration of changes into
5. Provide information about disease process, prognosis,
and treatment and rehabilitation needs.
1. Cerebral function improved and neurological deficits
resolving or stabilized.
2. Complications prevented or minimized.
3. ADLs needs met by self or with assistance of other(s).
4. Coping with situation in positive manner and planning for
5. Disease process, prognosis, and therapeutic regimen
6. Plan in place to meet needs after discharge.