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Title

Stroke Pathogenesis, Awareness, and Treatment (2.5 credit hours)

Abstract

Heightened public awareness of the signs and symptoms of stroke is crucial to the current initiatives for primary and secondary prevention guided by the compendium of clinical data on modifiable risk factors for the disease. Nurses and allied health personnel play a vital role in educating the public and in enhancing their own knowledge of etiologies and pathophysiological changes specific to the sub-classifications of ischemic and hemorrhagic strokes. Application of assessment tools such as the Glasgow Coma Scale and National Institute of Health Stroke Scale will have more relevance when coupled with the knowledge of anatomical correlates, vascular territories affected and various stroke syndromes.

This activity is approved for Category A credit by the ASRT/ Expiration October 1, 2010.

This activity may be available in multiple formats or from different sponsors. The ARRT does not allow CE activities such as internet courses, home study programs or directed readings to be repeated for CE credit in the same or any subsequent biennium.

Author

Isabelita Duncan, RN, MSN, ACNS-BC, CNRN

Ms. Duncan has over thirty years of nursing experience in neuroscience nursing and more than twenty years in the academic setting. She is a professor of nursing at Sinclair Community College’s Associate Degree Program (Dayton, Ohio) and faculty member in the college’s Center for Nursing Continuing Education. In addition to her faculty responsibilities and committee activities, she regularly teaches three continuing education courses for registered nurses and other allied health personnel: Traumatic Brain Injury, Stroke Management Continuum, and Movement Disorders. She incorporates educational activities in her international travels and volunteers with Sinclair’s Speakers Bureau in providing information to the community on global nursing perspectives.
Ms. Duncan received her Bachelor of Science in Nursing from the University of Santo Tomas, the Catholic University of the Philippines, Manila, Philippines in 1972 and her Master of Science in Nursing degree from Indiana University, Indianapolis, Indiana in 1984. She was licensed as a Registered Nurse in Indiana in 1973 and in Ohio in 1985. She currently maintains two specialty certifications: CNRN, certified Neuroscience Nurse by the American Board of Neuroscience Nursing and Clinical Specialist in Medical- Surgical Nursing by the American Nurses’ Credentialing Center. She is board-certified in Ohio as a clinical nurse specialist (ACNS-BC). She also held certification as a critical care nurse (CCRN), credentialed by the American Association of Critical-Care Nurses Certification Corporation from 1986 until 1995 while actively providing care to patients in the intensive care areas.
Prior to becoming a college professor, her interest in the neuroscience specialty was developed and nurtured during her years of clinical practice in the Neurosurgical Intensive Care Unit at Indiana University Hospital. She has conducted research on tactile stimulation of brain-injured patients. She was involved with the Health Impact Profile tool development, studying its content validity and construct validity as health promotion attitudinal measure. She is a member of the National League for Nurses, American Association of Neuroscience Nurses, American Stroke Association/American Heart Association, National Stroke Association and Intravenous Nurses Society.

Objectives

Upon completion of the learning modules, the learner will be able to:

Demonstrate an awareness of stroke mortality and morbidity statistics as call to action for health promotion and disease prevention initiatives.
Identify the various etiologies and pathophysiological basis for various clinical presentations of stroke syndromes.
Correlate the assessment findings in stroke with the brain’s anatomical locations and functions.
Discuss the healthcare provider’s role in the care of patients undergoing imaging studies for diagnosis of stroke and cerebrovascular disease.
Identify the modifiable and non-modifiable risk factors for stroke and cerebrovascular disease.
Apply the guidelines for primary and secondary prevention of stroke based on evidence-based studies.
Discuss the current treatment guidelines for ischemic and hemorrhagic stroke.

Resources

Bibliography
Adams HP, ed. Handbook of Cerebrovascular Diseases, 2nd ed. New York: Marcel Dekker, Inc.; 2005.

Aminoff MJ, Greenberg DA, Simon RP. Clinical Neurology. 6th ed. New York: McGraw Hill; 2005.

Caplan LR. Stroke. New York: American Academy of Neurology Press; 2005.

Hankey GJ. Stroke Treatment and Prevention: An Evidenced-based Approach. 1st ed. New York: Cambridge University Press; 2005.

Hickey JV. The Clinical Practice of Neurological and Neurosurgical Nursing, 5th Ed. Philadelphia: Lippincott Williams and Wilkins; 2003.

Lewis SL, Heitkemper MM, Dirksen SR, O’Brien PG, Bucher L. Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 7th ed. (Chapter 56: Nursing Assessment, Nervous System & Chapter 58: Stroke). St Louis, Missouri: Mosby, Inc.; 2007.

Smith SW, Johnston SC, Easton JD. Cerebrovascular Disease. In: Kasper DL, Braunwald E, Fauci AS, et al Eds. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw Hill; 2005.

Zivin JA. Ischemic Cerebrovascular Disease. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia: W.B. Saunders Co.; 2004.

Zivin JA. Hemorrhagic Cerebrovascular Disease. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia: W.B. Saunders Co.; 2004.

Webliography
Adams H, Adams R, Del Zoppo G et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the stroke council of the American Stroke Association. Stroke. 2005; 1(36), 916-923 Available at: http://stroke.ahajournals.org/cgi/content/full/36/4/916. Accessed April 13, 2008.

Adams, RJ, Albers G, Alberts, MJ et al. Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Available at: http://stroke.ahajournals.org/cgi/reprint/STROKEAHA.107.189063. Accessed April 13, 2008.

American Heart Association. Heart Disease and Stroke Statistics. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200026. Accessed April 13, 2008.

American Heart Association. Stroke. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3004586. Accessed April 13, 2008.

Goldstein LB, Alberts MJ, Brass LM, et al. Primary Prevention of Ischemic Stroke. A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. The American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37:1583.© 2006 American Heart Association, Inc. and Circulation, Jun 2006; 113: e873 - e923. Available at: http://stroke.ahajournals.org/cgi/content/full/36/4/916. Accessed April 13, 2008.

Latchaw RE, Yonas H, Hunter GJ et al. Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia. A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association. Stroke. 2003; 34:1084. Available at: http://stroke.ahajournals.org/cgi/content/full/34/4/1084. Accessed April 13, 2008.

National Heart Blood and Lung Institute, National Institutes of Health, Department of Health and Human Services. The 7th Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of Hypertension. 2003. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/. Accessed April 2, 2008.

Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke:Co-sponsored by theCouncil of Cardiovascular Radiology and Intervention Circulation: The American Academy of Neurology affirms the value of this guideline. 2006;113:e409–e449. Available at: http://stroke.ahajournals.org/cgi/content/full/37/2/577. Accessed on April 13, 2008.

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