partial or complete occlusion of the carotid artery by atherosclerotic plaque and/or a thrombus;
a cerebral embolus associated with dislodgment of atherosclerotic plaque or a thrombus from the carotid artery.
The client will maintain adequate cerebral tissue perfusion as evidenced by:
mentally alert and oriented
absence of dizziness, visual disturbances, and speech impairments
normal motor and sensory function.
Nursing Actions and Selected Purposes/Rationales
Assess for and report signs and symptoms of carotid artery occlusion and/or cerebral embolization (e.g. agitation, lethargy, confusion, dizziness, diplopia, ipsilateral blindness, homonymous hemianopsia, slurred speech, expressive aphasia, paresthesias, hemiparesis, hemiplegia).
Implement measures to maintain adequate cerebral tissue perfusion:
administer anticoagulants (e.g. heparin, warfarin) or antiplatelet agents (e.g. low-dose aspirin, clopidogrel, ticlopidine) if ordered to prevent new or extended thrombus formation and further occlusion of the carotid artery (these medications might be discontinued before surgery to reduce the risk of intraoperative and postoperative hemorrhage)
caution client to avoid activities that create a Valsalva response (e.g. straining to have a bowel movement, holding breath while moving up in bed) in order to prevent dislodgment of existing thrombi
perform actions to prevent hypertension in order to reduce the risk of cerebral embolism: