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Introduction
To begin with, it should be stated that cardio vascular accidents, which are usually called strokes is regarded to be rather dangerous pathology, which may cause irreversible consequences, and even death. The fact, that there are several types of cardio vascular make it difficult to diagnose and treat. The same should be stated of the rehabilitation period. Nevertheless, the recommendations for avoiding cardio vascular difficulties are simple.
Originally, stroke is regarded to be the emergent medical case, which requires urgent curing. The fact is that, the sooner assistance is provided, the higher are the chances for the successful treatment, and the higher the chances for recovery are. The treatment is generally aimed at breaking up the blood clot, which is the key reason of a stroke, and, it should be started within the nearest three hours after the stroke for being effective. In spite of the fact that medical progress helped to decrease the death rates, caused by the stroke, up to two thirds of all the survivors suffer serious consequences, ranging from moderate to severe.
The fact is that, Cardio Vascular Accident becomes fatal for 27% of males, and 23% of females. Originally, two thirds of the victims are the Afro Americans. The survivors may be left with serious disabilities and essential deficits of the everyday life, as some skills may be lost, and should be regained. Nevertheless, emergency treatment and properly managed rehabilitation can essentially improve and speed up the survival process and recovery in general.
Proration
As for the proration and the equipment which is used in the treatment process, it should be stated that the necessary equipment is aimed at decreasing the blood pressure and breaking the blots of blood, which cause the thrombosis of blood vessels. When thrombosis is suspected, or cardio vascular attack has already occurred, non-contrast head CT scan is the only way to define and locate the hemorrhagic stroke. Scanning will help to reveal the location bleeding in or around the brain. If no bleeding can be located, it is one of the most evident reasons of ischemic stroke.
Saladin (2001, p, 256), in the review, aimed at describing the CVAs states the following fact: In increasing numbers of primary stroke centers, pharmacologic thrombolysis with the drug tissue plasminogen activator (tPA), is used to dissolve the clot and unblock the artery. Nevertheless the use of tPA in acute stroke is controversial. On one hand, it is endorsed by the American Heart Association and the American Academy of Neurology as the recommended treatment for acute stroke within three hours of onset of symptoms as long as there are not other . As for the matter of statistics, it should be stated that mortality rates are higher among those patients who received tPA, in comparison with those who did not.
Managing a patient
As for the issues of patients management and treatment, it should be stated that patients are required to be subjected to neurosurgical evaluation and thorough examination for detecting the reasons and sources of bleeding. Surely, not everyone needs surgical invasion. Kalva and Mueller (2008) emphasizes that anticoagulants and antithrombotics, which are used for curing the consequences of ischemic stroke, can not be used for intracerebral hemorrhage, as they make bleeding more extensive. Patients require thorough monitoring, for the life indicators like blood pressure, blood sugar, and oxygenation could be maintained at the required levels, compatible with life.
Managing a patient during the rehabilitation is even more important than Cardio Vascular Accident treatment. Originally, the attack causes serious consequences, thus, minimization of the risk of these consequences is much more important for the future life and health of the patient. The rehabilitation period presupposes the relearning of some skills, which are necessary for the everyday life. On the other hand, the rehabilitation period is crucial for helping the patient realize the consequences of Cardio Vascular Accident and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role. (Kalva and Mueller, 2008).
The best way of proper management of the patient is the good nursing care, which is fundamental in managing various deceases, including CVA. Performing feeding, hydration, skin care, and monitoring vital signs such as temperature, pulse, and blood pressure should be managed for the treatment and rehabilitation. Stroke rehabilitation should be started immediately, otherwise, the more it is delayed, the more serious consequences may be.
Hofer (2007, p. 294) in his research states the following: Emergency treatment of hemorrhagic stroke is aimed at controlling intracranial pressure. Intravenous urea or mannitol plus hyperventilation is the most common treatment. Corticosteroids also may be used. Patients with reversible bleeding disorders, such as those due to anticoagulant treatment, should have these bleeding disorders reversed, if possible.
Due to the fact that hemorrhage may cause aneurysm, surgery may be performed if the aneurysm is close enough to the surface of the cranium, so the access is not complicated. If a vessel is ruptured, originally, it is impossible to prevent rebleeding, consequently, surgical invasion is impossible. If the aneurysm is difficult to access surgically, endovascular treatment is generally resorted to. This procedure entails the guidance of a catheter into a brain from a larger artery. Thus, reaching the aneurysm, catheter blocks the bleeding by discharging small coils of wire into his aneurysm. It becomes plugged, and the bleeding is blocked. (Kalva and Mueller, 2008)
As for the matters of managing a patient, it is also should be stated that a study by Perry (2001) helped to reveal that antidepressants are able to increase the chances of people to live longer and get back to comparatively normal life sooner. People, who received such treatment, even those who were not in depression, revealed lesser rates of death, caused by cardio vascular accidents, in comparison with those, who did not gain the antidepressants.
Pathology
Cardio Vascular Accidents often cause essential pathologies. It is closely linked with the notion, that thrombosis blocks vital organs: thrombus tears of, and blocks the blood vessel, thus, restricting the access of oxygen to brain, or blocking the heart valve. Blocking of the vessels in a brain may cause bleeding within the brain (cerebro vascular accident), and cause partial paralysis of the body and partial malfunction of the brain.
In accordance with the research by Haaga, Lanzieri and Sartoris (1994, p. 271), strokes may be classified the following way: ischemic and hemorrhagic. Ischemia is due to interruption of the blood supply, while hemorrhage is due to rupture of a blood vessel or an abnormal vascular structure. 80% of strokes are due to ischemia; the remainder are due to hemorrhage. Some hemorrhages develop inside areas of ischemia ( hemorrhagic transformation ). It is unknown how many hemorrhages actually start off as ischemic stroke.
The fact is that, the hemorrhagic strokes result the injury of brain and not only brain tissues by causing a compression within the blood vessel. Hematomas, which appear as a result of vessel injury, cause the injury of the tissues. Moreover, the increased pressure may cause the loss of blood supply to injured tissue, thus, resulting in infarction. Thus, the blood within the tissues of the brain may become a reason of direct toxic effects on the tissues of brain and cause vascular difficulties.
When the ischemic accident has happened, Kowalczyk and Mace (2009) emphasize that oxygen and glucose become depleted in the injured brain tissue, the production of adenosine triphosphate (ATP), which is the high energy component, vital for brain and muscular activity, fails. Thus, the energy dependent processes stop. One of such process is pumping: it is vital for cell survival. These sequence of injuries and failures may cause cellular injury and death.
According to Kowalczyk and Mace (2009, p. 301): A major cause of neuronal injury is release of the excitatory neurotransmitter glutamate. The concentration of glutamate outside the cells of the nervous system is kept low by uptake carriers, which are powered by the concentration gradients of ions (mainly Na+) across the cell membrane. However, stroke cuts off the supply of oxygen and glucose which powers the ion pumps maintaining these gradients. As a result the transmembrane ion gradients run down, and glutamate transporters reverse their direction, releasing glutamate into the extracellular space.
Basing on these consideration, it should be added that glutamate acts on the receptors of the nerve cells. This originates the influx of calcium, which, in its turn, activates the digestion of cells proteins, lipids and various nuclear materials by the enzymes. Calcium influx, in its turn, may also cause the failure of mitochondria, and then originate energy depletion, and trigger the apoptosis process.
Diagnosis
As for the matters of diagnosis, it should be stated that stroke is often diagnosed by the means of several techniques: a neurological examination, CT scans (most often without contrast enhancements) or MRI scans, Doppler ultrasound, and arteriography. (Kowalczyk and Mace, 2009). Hofer (2007), in his turn, emphasized the fact that diagnosis process itself is strictly clinical, and it is performed with the assistance of the imaging techniques. These techniques are also used for defining the subtypes and the reasons of the stroke. Originally, there is no common blood test exists for diagnosing the stroke, nevertheless, the blood test may be used for defining the most likely cause of the stroke.
Conclusion
Finally, it should be stated that Cardio Vascular Accident is the serious difficulty, which may cause either serious deficit in brain functioning and lead to death, if vital areas of brain are injured. Anyway, emergent treatment as well as properly managed along with thoroughly controlled management of the patient increases his or her chances to survive.
References
Kowalczyk, N., and J.D. Mace. 2009. Radiographic Pathology for Technologists. Missouri: Mosby Elsevier.
Saladin, K.S. 2001. Anatomy and Physiology: The unity of form and function. New York: McGraw-Hill.
Haaga, J.R., C.F. Lanzieri, D.J. Sartoris, and E.A. Zerhouni. 1994. Computed Tomography and Magnetic Resonance Imaging of the Whole Body. Missouri: Mosby.
Perry, C. 2001. Anatomica: The Complete Home Medical Reference. Hong Kong: Global Book Publishing.
Kalva, S. P., and P. R. Mueller. 2008. Vascular Imaging in the Elderly. Radiologic Clinics of North America 46 (4): 663-683.
Hofer, M. 2007. CT Teaching Manual: A Systematic Approach to CT Reading. Germany: Georg Thieme Verlag.
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