OPINION ARTICLE
The role of nursing in the management of cerebrovascular diseases
El rol de la enfermería en el manejo de enfermedades cerebrovasculares
Luisa María Leonard Pérez 1*, https://orcid.org/0009-0006-7709-7121
Teresa Vega Montalvo 1, https://orcid.org/0000-0002-7795-3446
Yuleisis Pérez Díaz 2, https://orcid.org/0009-0005-7923-5586
1 Faustino Pérez Provincial Clinical-Surgical-Teaching Hospital. Matanzas, Cuba.
2 Dr. Mario Muñoz Monroy Military Hospital "Carlos Juan Finlay Order." Matanzas, Cuba.
* Corresponding author: luisamatanzas@gmail.com
Received: 05/01/2025
Accepted: 22/03/2025
How to cite this article: Leonard-Pérez LM, Vega-Montalvo T, Pérez-Díaz Y. The role of nursing in the management of cerebrovascular diseases. MedEst. [Internet]. 2025 [cited access date]; 5:e325. Available in: https://revmedest.sld.cu/index.php/medest/article/view/325
ABSTRACT
Cerebrovascular diseases represent one of the leading causes of mortality and disability worldwide. Among them, stroke is the most common and devastating entity, with a significant impact on the quality of life of patients and their families. In this context, the role of nursing is fundamental, as nursing professionals are involved not only in direct patient care but also in prevention, education, and rehabilitation. This article analyzes the role of nursing in the management of CVD, highlighting its importance in prevention, acute care, and rehabilitation, as well as its impact on clinical outcomes.
Keywords: Stroke; Multidisciplinary care; Cerebrovascular diseases; Nursing; Prevention; Rehabilitation
RESUMEN
Las enfermedades cerebrovasculares representan una de las principales causas de mortalidad y discapacidad a nivel mundial. Entre ellas, el accidente cerebrovascular es la entidad más común y devastadora, con un impacto significativo en la calidad de vida de los pacientes y sus familias. En este contexto, el papel de la enfermería es fundamental, ya que los profesionales de enfermería no solo participan en la atención directa del paciente, sino también en la prevención, educación y rehabilitación. Este artículo analiza el rol de la enfermería en el manejo de las ECV, destacando su importancia en la prevención, atención aguda y rehabilitación, así como su impacto en los resultados clínicos.
Palabras clave: Accidente cerebrovascular; Atención multidisciplinaria; Enfermedades cerebrovasculares; Enfermería; Prevención; Rehabilitación
Cerebrovascular Diseases (CVD) are disorders that affect the blood vessels of the brain, causing an interruption in blood flow and brain damage. Stroke, which can be ischemic (blockage of a vessel) or hemorrhagic (rupture of a vessel), is the most common manifestation of these diseases. (1) According to the World Health Organization (WHO), stroke is the second leading cause of death globally and one of the main causes of disability in adults. (2) Given the complexity of these diseases, their management requires a multidisciplinary approach, in which nursing plays a fundamental role at every stage of the process.
The management of CVD requires a multidisciplinary approach, with nursing playing a crucial role. From prevention to rehabilitation, nursing professionals are present at every stage, providing comprehensive and personalized care. Although prevention is crucial, when CVD occurs, the acute phase requires rapid and effective intervention, where nurses also play a key role. (3)
For the authors, prevention is one of the fundamental pillars in the management of CVD. As frontline professionals, nurses play a key role in identifying risk factors, both modifiable and non-modifiable, and in promoting healthy lifestyles that can significantly reduce the incidence of these diseases.
Nursing professionals are trained to identify risk factors, both modifiable and non-modifiable, associated with CVD. Among the modifiable factors are hypertension, diabetes mellitus, hyperlipidemia, smoking, obesity, and sedentary lifestyle. They conduct comprehensive assessments, including measuring blood pressure, monitoring blood glucose and lipid levels, and evaluating body mass index (BMI). (4)
Health education is a powerful tool in the prevention of CVD. Nurses educate patients and their families about the importance of maintaining a healthy lifestyle, including a balanced diet, regular physical exercise, smoking cessation, and moderate alcohol consumption. Additionally, they provide information on the signs and symptoms of a stroke, enabling early detection and prompt medical attention. (4)
Nurses also actively participate in community prevention programs, such as hypertension and diabetes screening campaigns, and in promoting physical activities in the community. (4) In the authors' opinion, these initiatives not only help reduce the incidence of CVD but also improve the overall health of the population.
The acute phase of a CVD, especially in the case of a stroke, is critical and requires rapid and effective intervention. Nurses play a key role in initial care, patient stabilization, and coordination with other healthcare professionals. (5)
When a patient with suspected stroke is admitted, nurses are the first to assess their condition. They perform a rapid evaluation, including assessing the level of consciousness, motor and sensory function, and the presence of neurological deficits. (5) According to the authors, this initial assessment is crucial to determine the severity of the condition and to guide therapeutic decisions.
In the case of an ischemic stroke, treatment with thrombolytics (such as tissue plasminogen activator, tPA) must be administered within the first few hours after symptom onset. Nurses are responsible for preparing and administering these medications, as well as monitoring the patient for potential complications, such as bleeding. In the case of a hemorrhagic stroke, nurses participate in stabilizing the patient, controlling blood pressure, and preparing for possible surgical interventions, such as hematoma evacuation. (6)
Continuous monitoring is essential in the acute phase of a CVD. Nurses constantly monitor vital signs, neurological status, and cardiorespiratory function. Additionally, they are alert to any signs of clinical deterioration, such as increased intracranial pressure or the onset of complications, such as aspiration pneumonia. (6)
The acute phase of a CVD is extremely stressful for both the patient and their family. Nurses provide emotional and psychological support, helping patients and their loved ones cope with the situation. This support is crucial to reduce anxiety and fear and to foster a positive attitude toward recovery. Once the acute phase is overcome, many patients require a rehabilitation process to regain lost functions and improve their quality of life, a stage in which nurses continue to play an essential role. (7)
Rehabilitation is a crucial component in the management of CVD, as many patients experience physical, cognitive, and emotional sequelae that affect their quality of life. Nurses play a key role in this process, working in collaboration with other professionals, such as physiotherapists, occupational therapists, and psychologists. (8)
In physical rehabilitation, nursing professionals help patients regain mobility and independence. This includes performing muscle-strengthening exercises, passive and active mobilization, and teaching techniques to prevent complications, such as pressure ulcers and contractures. (8)
Cognitive sequelae, such as aphasia (difficulty speaking) and apraxia (difficulty performing voluntary movements), are common after a stroke. Nurses work with patients to improve these functions, using cognitive stimulation techniques and relying on tools such as communication boards. (9)
Emotional and social recovery is equally important. Nurses help patients cope with changes in their daily lives and adapt to new limitations. Additionally, they encourage participation in support groups and community activities, which contributes to improving their emotional and social well-being. (9)
Self-care education is a key aspect in the rehabilitation phase. Nurses teach patients and their families how to manage the sequelae of CVD, how to prevent complications, and how to follow a home care plan. This includes administering medications, performing rehabilitation exercises, and identifying warning signs that require medical attention. (10)
Nurses also coordinate care with other healthcare professionals, such as physicians, physiotherapists, and social workers. This coordination is essential to ensure that the patient receives comprehensive care and that all their needs are addressed. Despite advances in the management of CVD and the crucial role of nursing, there are challenges that must be addressed to optimize care and ensure better outcomes for patients. Among these challenges are the lack of resources, workload overload, and the need for continuous training. (10)
Work overload in nursing affects both the quality of care and the well-being of professionals. It is necessary to implement strategies to distribute the workload equitably and to promote self-care among nurses. (11)
CVD is a field in constant evolution, with new treatments and technologies emerging regularly. Nurses must receive continuous training to stay updated and to provide evidence-based care. This includes participating in courses, workshops, and conferences, as well as accessing online educational resources. (11)
The role of nursing in the management of cerebrovascular diseases (CVD) is essential at all stages: prevention, acute care, and rehabilitation, improving the quality of life of patients. Nurses identify risk factors, promote healthy lifestyles, provide critical care in the acute phase, and support physical and emotional recovery. However, they face challenges such as lack of resources, work overload, and the need for continuous training. Investing in nursing not only benefits patients with CVD but also the healthcare system as a whole. Recognizing and supporting their work is key to achieving more comprehensive, efficient, and humane care.
BIBLIOGRAPHIC REFERENCES
1. Kalaria R, Englund E. Neuropathological features of cerebrovascular diseases. Pathology. [Internet] 2025 [cited 02/01/2025]; 57(2):207-219. Available in: https://pubmed.ncbi.nlm.nih.gov/39718486/
2. Organización Mundial de la Salud (OPS). Las diez causas principales de defunción. [Internet] 2024. Available in: https://www.who.int/es/news-room/fact-sheets/detail/the-top-10-causes-of-death
3. Chuga Guaman JG, Valarezo Guaman TM, Irazabal Viscaino EM, Chuga Guaman NR. Abordaje de Enfermería en el Cuidado Integral de un Paciente con Enfermedad Cerebrovascular Isquémico y Probable Encefalitis Infecciosa Viral. Ciencia Latina [Internet]. 2024 [cited 02/01/2025]; 8(4):6713-32. Available in: https://ciencialatina.org/index.php/cienciala/article/view/12861
4. Fundación Española del Corazón. Cómo prevenir un accidente cerebrovascular. Blog Impulso Vital. [Internet] 2023 [cited 02/01/2025]. Available in: https://fundaciondelcorazon.com/blog-impulso-vital/3936-como-prevenir-un-accidente-cerebrovascular.html
5. Andjelkovic AV, Keep RF, Wang MM. Molecular Mechanisms of Cerebrovascular Diseases. Int J Mol Sci. [Internet] 2022 [cited 02/01/2025]; 23(13):7161. Available in: https://pubmed.ncbi.nlm.nih.gov/35806164/
6. American Heart Association (AHA). Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke [Internet] 2020 [cited 02/01/2025]; 51(7):e1-e31. Available in: https://www.ahajournals.org/doi/10.1161/STR.0000000000000211
7. Kumar V, Bishayee K, Park S, Lee U, Kim J. Oxidative stress in cerebrovascular disease and associated diseases. Front Endocrinol (Lausanne). [Internet] 2023 [cited 02/01/2025]; 14:1124419. Available in: https://pubmed.ncbi.nlm.nih.gov/36875474/
8. Alessandro L, Olmos LE, Bonamico L, Muzio DM, Ahumada MH, Russo MJ et al. Rehabilitación multidisciplinaria para pacientes adultos con accidente cerebrovascular. Medicina (B.Aires) [Internet]. 2020 [cited 03/01/2025]; 80(1):54-68. Available in: https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802020000100008
9. Kwakkel G, Stinear C, Essers B, Munoz-Novoa M, Branscheidt M, Cabanas-Valdés R, et al. Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework. Eur Stroke J. [Internet] 2023 [cited 03/01/2025]; 8(4):880-94. Available in: https://pubmed.ncbi.nlm.nih.gov/37548025/
10. Barthels D, Das H. Current advances in ischemic stroke research and therapies. Biochim Biophys Acta Mol Basis Dis. [Internet] 2020 [cited 03/01/2025]; 1866(4):165260. Available in: https://pubmed.ncbi.nlm.nih.gov/31699365/
11. Mead GE, Sposato LA, Sampaio Silva G, Yperzeele L, Wu S, Kutlubaev M, et al. A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization. Int J Stroke. [Internet] 2023 [cited 03/01/2025]; 18(5):499-531. Available in: https://pubmed.ncbi.nlm.nih.gov/36725717/
CONFLICTS OF INTEREST
The authors declare that there are no conflicts of interest.
FUNDING SOURCES
The authors declare that they received no funding for this article.