Throughout this assignment the anatomy and physiology of the central nervous will be examined in relation to the affects a stroke may cause. The causes and symptoms will also be identified along with the various affects a stroke may have on an individual such as physical, emotional, and social impact. Finally, the care and treatments provided will be highlighted and will be referenced throughout according to relevant literature and guidelines such as Infection control, Health and Safety, and various government policies.
According to the National Stroke Strategy 2007, a stroke is a condition in which the brain cells suddenly die due to a lack of oxygen. A stroke is often caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain (reference). The two main types of stroke which will be referred to throughout the text are hemorrhagic and Ischemic. National Stroke Strategy (2007) states that ‘an Ischemic stroke accounts for around 87% of all strokes and occurs when a blood clot (thrombus) forms that blocks the blood flow to a certain part of the brain’. When a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus (reference). This wandering clot may then be carried through the bloodstream and to the brain where it can then cause an ischemic stroke. A hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and then fills the space between the brain and skull with blood or when a malfunctioning artery in the brain bursts and fills the surrounding tissue with blood. Both Ischemic and Hemorrhagic strokes result in a lack of blood flow to the brain. The outcome of a stroke is dependent on where the stroke occurs. Major strokes may lead to paralysis or death. www.nhs.uk/stroke
It is evident that the main body disorder affected by a stroke is the central nervous system. The nervous system is responsible for sending, receiving, and processing nerve impulses through the body. All the organs and muscles inside the human body rely on these nerve impulses to function. The nervous is often considered to be the master control unit inside the body- McKissock, C. (2009). Sense organs provide the nervous system with information about the environment such as senses of sight, hearing, smell, taste, touch, pain, and pressure. Nerves are connected through the whole body to the brain, they carry the information throughout the body in the form of electrochemical signals called impulses. These impulses travel from the brain and spinal cord to the nerves located throughout the body. Unlike other cells in the body, most neurons in the central nervous system cannot renew or repair themselves. So, if and when some of the cells die through illness or damage, the nervous system can permanently lose some of its abilities. www.sciencemuseum.org.uk. The symptoms of disorders of the nervous system depend on which part is attacked for example Alzheimer's disease destroys cells in the memory area of the brain.
The signs and symptoms of a stroke are different for each individual but often start suddenly. Due to the fact that different parts of your brain control different parts of the human body, a person’s symptoms are dependent on which part of the brain is affected. This also determines the extent of the damage the stroke may cause. The most common signs of a stroke are visible on the face, arms, and may affect an individual’s speech-NHS 2009. According to the NHS, individuals that experience strokes have particular physical changes such as- the face may have drop on one side, the individual may find it difficult to smile or move their mouth and their eyes may drop. One or both of the arms are often difficult for the individual to lift due to the arms feeling weak or numb. The speech may be slurred or garbled or failing this the individual may not be able to speak at all. Other symptoms of a stroke include sudden loss of vision, communication problems-difficulty in understanding what others are saying, sudden and severe headache, neck stiffness, difficulty in swallowing, numbness and weakness resulting in complete paralysis of one side of the body, and blacking out in severe cases (NICE 2009). Although there are two different types of strokes that can occur they symptoms are quite similar and often only a healthcare professional can determine the type of stroke it is. According to the NHS, the symptoms of an ischemic are the same as a haemorrhagic stroke it can last from a few minutes to a few hours then suddenly disappear completely. However, it is important to never ignore an ischemic stroke as it is a serious warning sign there is a problem with the blood supply to an individual’s brain and can have a major impact on their health. There is around a one in ten chance that those who have an ischemic stroke experience a full stroke during the four weeks following the stroke. Mass media campaigns are used to raise awareness of the signs and symptoms of stroke more and more, and the need to immediately contact emergency medical services. Stroke awareness campaigns target the general public, including individuals who might experience stroke symptoms and those who might witness stroke. In England the Department of Health has recently rolled-out the first national stroke awareness raising campaign ‘Act FAST’ –(Stephan U Dombrowski) between February 2009 and March 2012. The campaign included television, press and radio advertisements targeting the general public, thus improving the chances of the affected individual’s mental and physical health. This included information of the physical signs to look for such as FACE: has their face dropped on one side, can they smile? Arms: can they lift their arms, and does one arm hang lower than the other? Speech: Can they speak and is their speech slurred? Time: Time to call for assistance, call 999 if you suspect any of these signs and symptoms. www.biomedcentral.com

The NICE guidelines state that life after a stroke varies for each individual some may go through a stroke and recover so that they are able to continue with their daily tasks with no hindrance and/or prevention as a result of the stroke. However, others may be left with various changes which impact how they live their day to day life. These include communication problems such as aphasia which affects an individual’s ability to speak and comprehend words, depression-this can occur for some people as a result of the unfortunate changes to their life which can cause them to feel less dependent and able thus causing depression, Memory loss- this is common after a stroke but is different for every individual. Various ways in which a an individual’s memory can be affected by a stroke include verbal memory, this includes remembering names and stories visual memory can also be affected and so the ability to remember people’s faces, different shapes, and remembering routes from place to place becomes difficult, mobility- many people often experience paralysis and/or balance problems, and neglect- some people may be affected by their stroke on the part/side of the brain which was affected and can cause neglect to the affected side. For example, the individual with left sided neglect may ignore the left side of the face when washing or may not eat food on the left side of the plate. www.nice.org.uk/stroke.
It is important for healthcare professionals to follow guidelines carefully and thoroughly to ensure the appropriate care, treatment and monitoring is given to the individual who has experienced any type of stroke. This is done through following relevant guidelines given such as National Institute of Health and Care Excellence (NICE guidelines), Infection Control, Health and Safety, and National Service Framework. The National Stroke Service published in December 2007, provides a guide to high quality health and social care for individuals that have been affected by a stroke. Experts have set out standards which define appropriate stroke care that can help in preventing lifelong disability and/or permanent illnesses including a quick response to a 999 call for suspected stroke, prompt transfer to a hospital providing special care, an urgent brain scan (for example, computerized tomography [CT] or magnetic resonance imaging [MRI]) undertaken as soon as possible, immediate access to a high quality stroke unit, early multidisciplinary assessment, including swallowing screening, stroke specialized rehabilitation, and planned transfer of care from hospital to community and longer term support (NSS 2007).
According to NICE guidelines, the NHS works towards providing high quality care to patients who suffer from strokes and have published in 2010 a guide quality standards of care to which professionals must adhere to when caring for stroke patients. The quality standard for stroke requires that services should be commissioned from and coordinated across all relevant agencies including the whole stroke care pathway. A combined approach to provision of services is fundamental to the delivery of high quality care to people with stroke. These are given as statements and include guidelines for aftercare such as what type of care people may need as each stroke can cause a variety of illnesses depending on what part of the brain has been affected. Therefore different tests, care, treatment, and aftercare must be given in accordance with what type of stroke the individual has had. For example, Ischaemic strokes can be treated using a 'clot-busting' medicine which is known as alteplase, this dissolves blood clots. However, alteplase is only effective if started during the first four and a half hours after the start of the stroke. According to relevant health studies conducted by Health and Safety officials, if this is given after that time, the medicine has not been shown to have beneficial effects. Even within this narrow time frame, the quicker alteplase can be started the better the chance of recovery. However, not all patients are suitable for thrombolysis treatment. A dose of aspirin is usually given to be taken as a regular dose (an anti-platelet medication), as this makes the cells in your blood, known as platelets, less sticky, thus reducing the chances of further blood clots occurring. However, some may be allergic to aspirin and in this event other anti-platelet medicines are available known as anticoagulants, these prevent blood clots and are often given to patients with an irregular heartbeat. These are most commonly given in the form of heparin, warfarin, and more recently rivaroxaban. Also, if the blood pressure is too high, medicine is given to lower it. Medicines most commonly used include alpha blockers, beta-blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, and thiazide diuretics. www.nhs/stroke/treatments

In the event that a hemorrhagic stroke occurs, emergency surgery is often needed to repair any burst blood vessels and to remove any blood from the brain, this is done through a surgical procedure known as craniotomy. A small section of the skull is cut away during this procedure to allow the surgeon access to the cause of the bleeding. The surgeon then repairs any damaged blood vessels and ensures there are no blood clots present that may restrict the blood flow to the brain. Once the bleeding has been stopped, the piece of bone removed from the skull is then replaced. Following a craniotomy, the patient may have to be placed on a ventilator that assists with their breathing. By taking over the body’s responsibilities such as breathing, this gives the body time to recover and also helps to control any possible swelling on the brain. The patient is also be given medicines, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring. www.nhs.com/stroke/treatments
The damage caused from a stroke can often be long lasting. Most people need a long period of rehabilitation before they can fully recover. The process of recovery is dependent on what type of stroke the individual has had and type of damage it has done to specific parts of the brain. Professional help is vital in the process of recovery and is given by various healthcare professionals such as including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors. The damage that a stroke can causes to the brain can impact on many aspects of an individual’s life and wellbeing, and depending on personal circumstances, professional help may be requires by a number of different treatment and rehabilitation methods. For example, a physiotherapist may help with the damage to the arms or legs using relevant techniques and may advice the patient to do some at home exercises that will improve the use of his or her body parts. Also, many individuals may require speech therapy depending on the damage done as a result of the stroke. This is usually done by a speech therapist that helps to enable the individual to speak again through use of various techniques. There are various organizations that specialize in the treatment and aftercare for individuals who have suffered from different types of illnesses and conditions. The National Service Framework for Older People (NSFOP) which launched in 2001, designed as a 10-year programme, the NSF contains standards specific to different types of illnesses or conditions which relate to older people’s services covering the full range of care older people need. NSFOP 2001, set up standard 5 with the aim to reduce the incidence of stroke in the population and ensure that those who have had a stroke have prompt access to integrated stroke care services. This also made the improvement of intermediate care a priority. Intermediate care speeds up helps people get better in their own homes or in supported community settings (NSFOP 2001)

In conclusion a stroke is a condition that can potentially cause much harm to an individual. However through the use of correct observation, treatment, and aftercare many illnesses and long term disabilities that may come about as a result of having a stroke can be addressed and improved which then enables the effected individual to continue with their lives with minimal hindrance.

Bibliography

http://www.sciencemuseum.org.uk/whoami/findoutmore/yourbrain/howcanillnessaffectthebrain/howcanthenervoussystembedamaged.aspx http://www.nervous-system-diseases.com/stroke.html http://www.nice.org.uk/ http://www.medicalnewstoday.com/articles http://www.nhs.uk/conditions/Stroke/Pages/Introduction.aspx https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198033/National_Service_Framework_for_Older_People.pdf Scott, W.N (2011) Anatomy and Physiology made incredibly easy! London: Lippincott Williams and Williams McKissock, C. (2009) Great ways to learn anatomy and physiology. Basingstoke: Palgrave Macmillan
Waugh, A, Grant, A, & Ross, J 2001, Ross And Wilson Anatomy And Physiology In Health And Illness, [N.p.]: Churchill Livingstone, eBook Collection (EBSCOhost), EBSCOhost, viewed 26 June 2014
Wilhelm, P, Rhees, R, & Van De Graaff, K 2001, Human Anatomy And Physiology : Based On Schaum's Outline Of Theory And Problems Of Human Anatomy And Physiology, New York: McGraw-Hill, eBook Collection (EBSCOhost), EBSCOhost, viewed 26 June 2014.