Our discussion will focus on the fundamental difference of cerebrovascular accident (CVA) from transient ischemic attack (TIA). In a nutshell, CVA is the absence of oxygen, while TIA is low oxygen. And probably, the most significant difference between the two is the presence of blood clot inside the brain, which is presented by CVA clients.
To explain further, let us look into the pathophysiology of both conditions.
Cerebrovascular accident, also known by many as stroke, is caused lack of oxygen due to the interruption of blood that flows within. A stroke can lead to an aneurysm which is simply a blood vessel that burst inside the brain. Aneurysms can cause a huge leak that will lead to the following signs and symptoms:
- Increased bleeding
- Increased intracranial pressure
- Brain shifting to one side (seen in clients who underwent CAT scans)
Transient Ischemic Attack
On the other side of the spectrum is TIA. Here, there is just narrowing the blood vessels which then cause decreased oxygen going into the brain and various parts of the body. Take note: a transient ischemic attack is very self-limiting.
Plaque buildup is the most common cause of TIA. Plaque buildup around the walls of the blood vessels is caused by the following:
- Fried food
- Sedentary lifestyle
- Chronic smoking
- Family history of high cholesterol
Consequences of Plaque Buildup
If clients who have extensive plaque buildup suddenly exerted physical effort or gets stressed due to external factors, blood vessels will react by activating the fight and flight response, which will cause vasoconstriction. This shrinking of the blood vessels will force the plaques to come together, causing decreased blood flow and oxygen.
This scenario can be compared to a freeway accident that led to several cars blocking a couple of lanes; these blockages are the plaques situated in various areas of the blood vessels. Accumulation of plaques cause the shutdown of various lanes; therefore, there won’t be enough room for traffic (blood and oxygen) to pass through to get to vital areas in the body like the brain, heart, and lungs. Narrowing of blood vessels is the main cause of the transient ischemic attack.
TIA, which is self-limiting, goes away after management; clients start regaining function of their motor senses like smiling. TIA clients don’t have hemiparesis or weakness experienced on a particular side of the body or aphasia which is language impairment; they can talk and think again. On the other hand, CVA is permanent and detrimental, compromising movement and thinking.
Plan of Care
The plan of care for both CVA and TIA are similar, which are:
Constant neurological checks.
There are a couple of things that you want to check when doing a neurological assessment, which are:
- Check the grips
- Check the pushes
- Check the pulses
- Check the sensation
Aside from that, the medical team also has to ask their clients pertinent questions about their life, and at the same, asking them to identify what part of the body is being touched. Lastly, circulation is checked by looking at the capillary refill within two seconds.
After having a huge brain bleed or having doubts of constricting blood vessels in the brain that leads to low oxygen distribution, re-orientation of the client is essential to check the level of consciousness. Usually, four questions should be answered by the client, namely:
- What is your name?
- What is your date of birth?
- What date and month is it?
- General, easy questions about the client
Depending on how these questions are answered, the nurse can evaluate the neurological status of the client – whether the condition is getting better or worse.
Check the intracranial pressure.
Aneurysms, as established, cause hemorrhage inside the brain; therefore, it is essential that healthcare providers look for signs and symptoms of increased intracranial pressure.
For a CVA, since there is a clot, heparin is given to stabilize the clot. Heparin is not a clot buster but an anti-coagulant, which prevents further formation. Tissue plasminogen activator (TPA) is the only way to break or bust blood clots; however, this procedure is quite risky due to bleeding consequences.
Going back to intracranial pressure with clients who suffered from an aneurysm, how do nurses monitor ICP and what are the devices used? To answer this question and more, go to the Simple Nursing website and YouTube channel.