AMA Computer Learning CenterSt. Augustine School of Nursing

A Case Study Presented to the faculty of AMA Computer Learning Center

Guagua, Pampanga

Cerebrovascular Accident

Submitted to:Mr. John Eric T. Salvador B.S.N, R.N

Submitted by:

Almario, Jeanette

Cayanan. Gemmalyn Joy

Quitaleg, Mary Jane

Santos, Cariza Joy M.

3k-PN

October ‘09

Table of Content Page

Introduction 1

Personal History 2

Lifestyle and Diet 3

Complete Physical Assessment 4-9

Neurological Assessment 10-11

Laboratory Procedure 12-13

Diagnostic Procedure 14

Anatomy and Physiology 15-17

Pathophysiology of Cerebrovascular Accident 18-19

Drug Study 20-21

Diet and Activity 23

SOAPIE (actual) 24

SOAPIE (potential) 25

Conclusion 26

Recommendations 27

Bibliography 28

NCP(actual/ potential ) 29-33

Introduction

A stroke is damage to part of the brain when its blood supply is suddenly reduced or stopped. A stroke may also be called a cerebral vascular accident, or CVA. The part of the brain deprived of blood dies and can no longer function. Blood is prevented from reaching brain tissue when a blood vessel leading to the brain becomes blocked (ischemic) or bursts (hemorrhagic). The symptoms of a stroke differ, depending on the part of the brain affected and the extent of the damage. Symptoms following a stroke come on suddenly and may include: weakness, numbness, or tingling in the face, arm, or leg, especially on one side of the body trouble walking, dizziness, loss of balance, or coordination inability to speak or difficulty speaking or understanding, trouble seeing with one or both eyes, or double vision, confusion or personality changes, difficulty with muscle movements, such as swallowing, moving arms and legs, loss of bowel and bladder control, severe headache with no known cause, and loss of consciousness.

There are following metabolic disorder that may contribute to stroke, excess weight around the waist (waist measurement of more than 40 inches for men and more than 35 inches for women) triglycerides blood level of 150 mg/dL or more, HDL cholesterol levels below 40 mg/dL for men and below 50 mg/dL for women, blood pressure of 130/85 mm HG or higher and prediabetes (a fasting blood sugar between 100 and 125) or diabetes (a fasting blood sugar level over 125 mg/dL).

Latest Trend(Medication for Cerebrovascular Accident)

Anti-platelet medicines like aspirin, clopidogrel, extended release dipyridamole and aspirin in combination, and ticlopidine help prevent stroke because they keep the blood from clotting. Like aspirin, these medicines keep your blood from clotting. They are available only prescription. dipyridamole and aspirin combination (Aggrenoxl®), clopidogrel (Plavixl®), ticlopidine (Ticlidl®).Anti-coagulant medicines keep you from getting blood clots. You may hear people call these medicines "blood thinners." Warfarin (Coumadinl®) is often used in patients who have heart problems or artificial heart valves. Tissue plasminogen activator (t-PA or thrombolytic therapy) dissolves blood clots, but it may cause bleeding (including bleeding into the brain).This medicine must be given within 3 hours of the start of stroke symptoms. You will not be given t-PA if your blood pressure is too high, if changes on a CT scan show it should not be given, or if the risk of bleeding is too great. Heparin / heparinoid medicines slow the creating of blood clots. But there is little, if any, benefit in treating stroke. The medicines also can cause bleeding.

1.

2. Personal History

Name: Mr. D Address: San Rafael, Guagua

Age: 43 yrs. Old Work: Jeepney Driver

Chief Compliant: Impaired Verbal Communication

2.1 Family Health History

2.

2.2 Past Health History

Mr. D’s wife verbalized that Mr. D was already been confined on the hospital before due to mild stroke last year December 2008 , while he is in their house he experienced sudden headache, dizziness, numbness, blurred vision and that made his wife to bring him into the hospital. Mr. D was confined for 4 days and after a week he was able to work again as jeepney driver though the doctor said he need to take rest from work, avoid stress, smoking, alcohol intake, and high fat/ salt food to avoid the stroke.

2.3 Present Health History

Mr. D was been confined again in the hospital of DPMMH last August 27, 2009 and he spent more than 7 days in the hospital. Mr. D’s wife said that while Mr. D is talking with his friend and drinking alcohol he experienced severe headache, sudden dizziness, paralysis in the right part of his body, numbness, blurred vision and loss of consciousness. And made his family to bring him into the hospital.

3. Lifestyle and Diet

Mrs. D said that his husband was a smoke, he consumed more than 30-40 pieces a day (1 1/2 pack) since 20 years old and he also drink 1 bottle of alcohol since 23 years old. Mrs. D said that her husband likes to eat pork after a long day of handling his jeep.

3.

4. Complete Physical Assessment

Date assessed: September 4, 2009Time Assessed: 9:00 A.MInitial Vital Signs:

Temperature: 36.3 CPulse Rate: 77 cpmRespiratory Rate: 21 cpmBlood Pressure: 140/ 100mmHg

General Appearance: The pt. is awake, lying on bed, unconscious with an IVF of PNSS regulated @

10-15 gtts./min. (KVO) 200ml. level infusing well @ left hand. With Nasogastric Tube inserted. With Foley catheter inserted (2000 ml. urine bag)

Area Assessed Technique Used

Normal Findings

Actual Findings

Analysis

SKINcolor Inspection Tan Pale Due to

decrease oxygen supply.

Texture Palpation Smooth, soft Smooth, soft NormalTurgor Palpation Skin snaps

back immediatelyWhen pinched

Skin snaps back immediatelyWhen pinched

Normal

Hair Distribution Inspection Evenly distributed

Evenly distributed

Normal

Temperature Palpation Warm to touch Warm to touch NormalMoisture Palpation Dry, skin folds

are normally moist

Dry, skin folds are normally moist

Normal

NAILSColor of Nail bed Inspection Pink and clear Pink and clear NormalTexture Palpation Smooth Smooth NormalShape Inspection Convex

curvatureConvex curvature

Normal

Nail base Inspection Firm Firm NormalCapillary refill time

Blanch test 2-3 seconds 4 sec. Due to decrease oxygen supply.

HAIR Normal

Color Inspection Black (varies) Black (varies)Distribution Inspection Evenly

distributedEvenly distributed

Normal

Moisture Inspection Neither excessively dry nor oily

Neitherexcessively dry nor oily

Normal

Texture Inspection Silky, resilient Silky, resilient NormalHEAD

Scalp symmetry Inspection Symmetrical Symmetrical Normal

Skull size Inspection Normocephalic Normocephalic Normal Shape Inspection and

PalpationRound Round Normal

Nodules/ masses Palpation Absence of nodules and masses

Absence of nodules and masses

Normal

FACESymmetry Inspection

Symmetrical Symmetrical Normal

Facial movement Inspection Symmetrical Symmetrical Normal

Skin color Inspection Tan Pale Due to decrease oxygen supply.

EYESEyebrows Inspection

Symmetrically aligned, equal movement

Symmetrically aligned, equal movement

Normal

Eyelashes Inspection Slightly curved upward

Slightly curved upward

Normal

Eyelids Inspection Smooth, tan, do not cover pupil as sclera, close symmetrically

Smooth, tan, do not cover pupil as sclera, close symmetrically

Normal

Ability to blink Inspection Blinks voluntarily and bilaterally

Blinks involuntarily.

Due to damage of Broca’s area.

Frequency of blinking

Inspection 20 blinks per min.

To speech. Due to damage of Broca’s area.

Ocular movement Inspection Eye moves freely

Lack of eye movement

Due to damage of Broca’s area.

Position Inspection Drawn from lateral angel

Drawn from lateral angel

Normal

Size Inspection Medium Medium Normal Texture Palpation Mobile, firm and

non-tenderMobile, firm and non-tender

Normal

CONJUCTIVAColor Inspection Transparent

with light colorTransparent with light color

Normal

Texture Inspection Shiny and Shiny and Normal

smooth smoothPresence of lesions

Inspection No lesions No lesions Normal

APPARATUS

CorneaColor Inspection Black Black Normal Texture Inspection Shiny and

smoothShiny and smooth

Normal

PUPILSColor Inspection Black Black NormalReaction to light Inspection Pupils Equally

Round and React to Light Accommodation (PERRLA)

Pupils Equally Round and React to Light Accommodation (PERRLA)

Normal

Size Inspection Equal Equal NormalShape Inspection Round and

constrict brisklyRound and constrict briskly

Normal

Symmetry Inspection Equal in size Equal in size Normal Visual Acuity Inspection Able to real

news printCannot able to real news print.

Due to damage of the left hemisphere of the brain.

Visual Fields Inspection When looking straight ahead, client can see objects in periphery

With blurred vision and cannot classify objects in periphery.

Due to damage of the left hemisphere of the brain.

Ocular Inspection Eyes move freely

Eyes move freely

Normal

NOSESymmetry, shape, size and color

Inspection Symmetrical, smooth and tan

Symmetrical, smooth and tan

Normal

Mucosa color Inspection Reddish to pinkish

Reddish to pinkish

Normal

NASAL SEPTUMNares

Inspection Oval, symmetrical

Oval, symmetrical

Normal

Nasal discharge Inspection No discharge No discharge Normal Sinuses Inspection Not tender Not tender Normal MOUTHSecretion Inspection (neutral in

color) without mucus production

without mucus production

Normal

LipsColor

Inspection Pinkish to slightly brown

Dark and brown and cracking

Due to decrease

lips oxygen level Symmetry Palpation Symmetrical Symmetrical Normal Texture Palpation Soft, moist,

smoothCrack, rough s Normal

Moisture Palpation Soft and moist Dry Due to decrease oxygen.

GUMSColor Inspection Pinkish Pale Due to

decrease oxygen.

Moisture Palpation Moist Moist Normal BUCCAL MUCOSAColor Inspection Glistening pink Slightly pale Due to

decrease oxygen.

Texture Palpation Soft Soft Normal Moisture Palpation Moist Moist Normal TOUNGEColor Inspection Pinkish Slightly pinkish Due to

decrease oxygen.

Size Inspection Medium Medium Normal Symmetry Inspection Symmetrical Symmetrical Normal Mobility Inspection Moves freely Moves freely NormalUVULALocation Inspection At the midline At the midline Normal Symmetry Inspection Symmetrical Symmetrical Normal TONSILSColor Inspection Pinkish Pinkish NormalDischarges Inspection No discharges No discharges Normal TEETHColor Inspection Ivory/yellowish Yellowish NormalNumber of teeth Inspection 32 28 Due to tooth

decay (teeth extraction)

NECKPosition Inspection Head-centered Head-centered Normal Movement Inspection Moves freely Moves freely Normal Range of motion Inspection Full range No ROM Abnormal due

to neuromuscular impairement.

Consistency Inspection No enlargement No enlargement Normal HEARTHeart rate Auscultation 60-100bpm 77 bpm Normal Heart sounds Auscultation Clear, without

cracklesClear Normal

Lung field Auscultation Resonant Resonant Normal

THORAX & LUNGS POSTERIOR THORAXSymmetry Inspection Symmetrical Symmetrical Normal

Respiratory rate Inspection 12-20cpm 21 cpm Normal Spinal Alignment Inspection Spine vertically

alignSpine vertically align

Normal

Skin integrity Inspection Skin intact Skin intact Normal ANTERIOR THORAXBreathing pattern Auscultation Breathing is

automatic and effortless, regular and even and produces no noise

Breathing is automatic and effortless, regular and even and produces nonoise

Normal

Lung/ breath sounds

Auscultation Bronchia-vesicular

Bronchia-vesicular

Normal

ABDOMENContour Inspection Flat Flat NormalTexture Palpation Smooth Smooth Normal Frequency and character

Auscultation Audible; soft gurgling sound occur irregularly and rages from 5-30 mins

Audible; soft gurgling sound occur irregularly and rages from 5-30 mins

Normal

UPPER EXTREMITY Skin color

Movement

Inspection

Inspection

Tan

With ROM and sensation

Pale

With no ROM and sensation

Due to decrease oxygen

Due to neuromuscular impairment

Size (arms) Inspection Equal Equal Normal Symmetry Inspection Symmetrical Symmetrical Normal Hair distribution Inspection Evenly

distributedEvenly distributed

Normal

LOWER EXTREMITY

Skin color

Movement

Inspection

Inspection

Tan

With ROM and

Pale

With no ROM

Due to decrease oxygen

Due to

sensation and sensation neuromuscular impairment and (+) weakness on right lower extremities.

Size (legs) Inspection Equal Equal Normal Symmetry Inspection Symmetrical Symmetrical NormalHair distribution Inspection Evenly

distributedEvenly distributed

Normal

NEUROLOGICALLevel of consciousness

Interview Can follow instructions and commands

UnconsciousDue to decrease level of consciousness.

Behavioral and appearance

Interview Makes eye contact with the examiner

Does not make eye contact with the examiner.

Due to decrease level of consciousness

Mood Interview Expresses feelings which corresponds to the examiner

Expresses feelings which corresponds to the examiner

Normal

MANNERISMS & ACTIONS LANGUAGEVoice inflection Interview Clear and

strongAphasia Due to damage

of Broca’s area in the brain and muscle tone.

Tone Interview Fluent and articulated

Aphasia Due to damage of Broca’s area in the brain and muscle tone.

Manner and speech

Interview Can give appropriate answer to questions

Cannot give answer or talk.

Due to damage of Broca’s area in the brain and muscle tone.

MENTAL STATUSOrientation Interview Oriented with

timeDisoriented with time

Due to decrease level of consciousness

TIMERecall recent and remote memory

Interview Recall events readily, immediate recall of remote information

Cannot recall events readily, immediate recall of remote information

Due to aphasia.

Judgments and thoughts

Interview Can make logical

Cannot make logical

Due to decrease level

decisions decisions of consciousness

Neurological Assessment (September 4, 2009)

Gloscow Coma Scale

Normal Values

Result Total GCS Interpretation

Eyes Spontaneous- 4To speech- 3To pain- 2None-1

To speech- 3 Total GCS= 8/15 points.

8/15 pts., good prognosis

(15 pts. Pt is alert, can follow simple commands and is completely oriented to time, person and place.)

(7 or less= pt is comatose.)

(3= indicates deep coma and poor prognosis.z

Verbal Oriental- 5Confused- 4Inappropriate word- 3None- 1

None- 1

Motor Obeys command- 6Localized pain- 5Flexion pain- 4Abnormal flexion- 3Abnormal extension- 2Flaccid- 1

Flexion pain- 4

10.

Cranial Nerve Date Done Normal Result Actual Result Interpretation

Olfactory Nerve September 04. 2009

Can smell on both nostrils.

Cannot able to extinguish smell

Due to decrease LOC.

Optic Nerve With 20/20 vision

Without 20/20 vision.

Due to the damage of left hemisphere and decrease LOC.

Occulomotor Nerve

PERRLA PERRLA Normal

Abducens Nerve Lateral movement.

Cannot move eyes in lateral direction.

Due to the damage of left hemisphere and decrease LOC.

Trochlear Nerve Up and down movement.

Pt. cannot move eyes up and down.

Due to the damage of left hemisphere and decrease LOC.

Trigeminal Nerve For touch and pain sensation.

Pt. cannot localize sensation.

Due to the damage of left hemisphere and decrease LOC.

Facial Nerve Can smile, frown, puff the cheek and can feel the cotton.

Cannot follow specific command.

Due to the damage of left hemisphere and decrease LOC.

Acoustic Nerve Can hear on both ears.

Cannot follow specific command.

Due to the damage of left hemisphere and decrease LOC.

Glossopharengeal Can swallow. Inability to swallow due to presence of

Due to the damage of left hemisphere and

NGT. decrease LOC.

Vagus Nerve Check for gag reflex

With NGT inserted.

Due to the damage of left hemisphere and decrease LOC.

Accessory Nerve With strength on both shoulder.

With no muscle strength.

Due to the damage of left hemisphere and decrease LOC.

Hypoglossal Nerve

Sense of taste. Cannot localize taste.

Due to the damage of left hemisphere and decrease LOC.

5. Laboratory Procedures

LaboratoryProcedure

Date Done

Normal Values

Result Nursing Interpretatio

n

NursingResponsibilities

Creatine August 28, 2009

53-115.0 63.6 Normal Pretest:Explain the procedure to the patient.

Instruct the patient to wear easily manipulated clothing to get blood samples easily.

HDL 0.78-2.21 1.30 Normal Tell the pt. to relax because the procedure is painless.

Hematocrit0.37-0.54

g/l

0.44 g/l

Normal Intra-test:Instruct the patient to look away when the needle is being inserted.

Leucocytes5-10 x 10

12.4 x 10 g/l

Abnormal due to infection

Post-test:Put cotton balls

g/l weakened immune response.

on the puncture site to avoid bleeding.

Platelets150-450 x

10/l

648 x 10/l

Abnormal due to blood clot formation.

Tell the patient to rest after the test.

12.

LaboratoryProcedure

Date Done

Normal Values Result Nursing Interpretation

NursingResponsibilities

URINALYSISAugust 29, 2009

ColorStraw/ yellow amber

Yellow Normal Pre-test:Explain the procedure to the pt. and how he can cooperate.

TransparencyClear

Turbid Due to infection

Provide privacy.

Reaction4.5-8.0

6.0 Normal Intra-test:Instruct the pt. on how to get urine samples (it should be midstream/ sterile technique).

Specific Gravity1.010-1.025

1.030 Normal Tell the pt. that the procedure is painless.

SugarNegative

Albumin Negative

Negative

Positive

Normal

Due to nearly kidney damage and hypertension.

Post-test:Bring the urine samples in the

laboratory.

13.

6. Diagnostic Procedure

Diagnostic Procedure

Date Done Result Interpretation Nursing Responsibilities

Electrocardiogram Report

September 1, 09

Rhythm:Sinus

Sinus tachycardia

Post-test:Explain the procedure to the pt.and how he can cooperate.

AL:120/m

Tell him to remove all jewelry and coins.

PR:0.20 sec.

Tell him to relax and lie still.

QRS:0.40 sec.

Intra-test:Monitor for the result.

QT:0.32 sec.

Post-test:Assist the pt. when he will stand.

Axis:+250

Remind him about his jewelry

and coins or any metal he remove will he is doing the procedure.

14.

7. Anatomy and Physiology

Cerebellum

The cerebellum is involved in the coordination of voluntary motor movement, balance and equilibrium and muscle tone. It is located just above the brain stem and toward the back of the brain. It is relatively well protected from trauma compared to the frontal and temporal lobes and brain stem.

Cerebellar injury results in movements that are slow and uncoordinated. Individuals with cerebellar lesions tend to sway and stagger when walking.

Damage to the cerebellum can lead to: 1) loss of coordination of motor movement (asynergia), 2) the inability to judge distance and when to stop (dysmetria), 3) the inability to perform rapid alternating movements (adiadochokinesia), 4) movement tremors (intention tremor), 5) staggering, wide based walking (ataxic gait), 6) tendency toward falling, 7) weak muscles (hypotonia), 8) slurred speech (ataxic dysarthria), and 9) abnormal eye movements (nystagmus).

Cerebellum

The cerebrum is the part of the brain that occupies the top and front portions of the skull. It is responsible for control of such abilities as movement and sensation, speech, thinking, reasoning, memory, sexual function, and regulation of emotions. The cerebrum is divided into the right and left sides, or hemispheres.

Depending on the area and side of the cerebrum affected by the stroke, any, or all, of the following body functions may be impaired:

movement and sensation speech and language eating and swallowing vision cognitive (thinking, reasoning, judgment and memory) ability perception and orientation to surroundings self-care ability bowel and bladder control emotional control sexual ability

15.

Limbic System

The limbic system is a set of evolutionarily primitive brain structures located on top of the brainstem and buried under the cortex. Limbic system structures are involved in many of our emotions and motivations, particularly those that are related to survival. Such emotions include fear, anger, and emotions related to sexual behavior. The limbic system is also involved in feelings of pleasure that are related to our survival, such as those experienced from eating and sex.

Broca's Area 

An area located in the frontal lobe usually of the left cerebral hemisphere and associated with the motor control of speech. Also called Broca's center.

Temporal Lobe

The temporal lobes are involved in the primary organization of sensory input (Read, 1981). Individuals with temporal lobes lesions have difficulty placing words or pictures into categories.

Language can be effected by temporal lobe damage. Left temporal lesions disturb recognition of words. Right temporal damage can cause a loss of inhibition of talking.

The temporal lobes are highly associated with memory skills. Left temporal lesions result in impaired memory for verbal material. Right side lesions result in recall of non-verbal material, such as music and drawings.

Parietal Lobe

Damage to the left parietal lobe can result in what is called "Gerstmann's Syndrome." It includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects normally (agnosia).

Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosagnosia) and drawing ability.

16.

Occipital Lobe

The occipital lobes are the center of our visual perception system. They are not particularly vulnerable to injury because of their location at the back of the brain, although any significant trauma to the brain could produce subtle changes to our visual-perceptual system, such as visual field defects and scotomas. The Peristriate region of the occipital lobe is involved in visuospatial processing, discrimination of movement and color discrimination (Westmoreland et al., 1994). Damage to one side of the occipital lobe causes homonomous loss of vision with exactly the same "field cut" in both eyes.

Frontal Lobe

The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms. The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium, proximity to the sphenoid wing and their large size.

17.

8. Pathophysiology (Patient Base)

Pathophysiology (Book Base)

9. Drug Study

Drugs Classification

Indication Side Effect Nursing Responsibilities

Generic Name: Mannitol

Brand Name:Osmitrol

Diuretic Reduction of intracranial pressure and brain mass.

Pulmonary congestion, fluid and electrolyte imbalance, electrolyte loss, dryness of mouth, thirst, marked diuresis, urinary retention, edema, headache, blurred vision, convulsions, nausea, vomiting, rhinitis, arm pain, skin necrosis, chills, dizziness, dehydration, hypotension, tachycardia, fever and angina-like chest pains.

Monitor blood pressure.

Check for hypervolemia, urinary tract obstruction and signs of fluid imbalance.

Generic Name:Hydralazine

Brand Name:Apresoline

Anti-hypertensive drug

Severe essential hypertension when the drug cannot be given orally or when there is an urgent need to lower blood pressure.

Difficulty of breathing, swelling of face, lips, tongue or throat, fast pounding heart beats, numbness, joint pain and loss of appetite.

Patient must avoid orthostatic position.

Pt. must get up slowly to avoid fall.

Monitor Bp.

Generic Name: Metropolol

Brand Name:Neobloc

Anti-hypertensive drug

Metoprolol tartrate tablets are indicated for the treatment of hypertension. They may be used alone or in combination with

Tiredness and dizziness, Shortness of breath, diarrhea and alopecia.

Metoprolol should be used with caution in patients with impaired hepatic function.

other antihypertensive agents.

Should not be given in breast feeding mother.

Generic Name: Aspirin

Brand Name:Zorprin

Anti-thrombosis Treatment of mild to moderate pain; fever; various inflammatory conditions; reduction of risk of death or MI in patients with previous infarction or unstable angina pectoris or recurrent transient ischemia attacks or stroke in men who have had transient brain ischemia caused by platelet emboli.

Nausea, vomiting, tinnitus, dizziness, respiratory alkalosis, metabolic acidosis, hemorrhage, convulsions.

Take Aspirin by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.

Swallow Aspirin whole. Do not break, crush, or chew before swallowing.

Take Aspirin with a full glass of water (8 oz/240 mL).

Generic Name:

Nicholin

Brand Name:

Citicoline

Cerebral circulation stimulant

Disturbances of consciousness associated with head and brain injury.

Dropped blood pressure, chest discomfort, dyspnea, nausea, headache and dizziness.

Monitor blood pressure.

Check for the correct site for injection.

21.

10. Diet and Activity

Activity Date Ordered Indication Nursing Responsibilities

Turn side to side (every 2 hrs.)

August 28, 2009 To prevent bed sores and

pneumonia.

Accompany the relative whenever mobility is done

(q2 hrs.)

Diet Date Ordered Indication Nursing Responsibilities

Osteorize feeding

August 30, 2009 To prevent aspiration (NGT).

Make sure that the NGT is intact whenever feeding is to be made.

Check for stomach content to prevent overfeeding.

23.

11. SOAPIE (actual)

Subjective“Nahihirapan siyang magsalita, kung minsan umuungol din siya, as verbalized

by Mr. D’s wife.”

Objective

Received pt. on lying position on bed, unconscious , with ongoing PNSS 1L regulated @ 10-15 gtts./min. (KVO) 200 ml. level infusing well @ left hand. (+) difficulty in speaking (+) weakness (+) headache (+) dizziness (+) blurred vision (+)Paralysis on right part of the body With NGT inserted With Foley catheter inserted

Assessment Impaired verbal communication related to impaired cerebral circulation possibly

evidence by impaired articulation.

PlanningAfter 4-6 hrs. of N.I the patient will learn techniques on how to communicate

with others.

Interventions Established rapport. Monitored and recorded vital signs. Maintained good verbal/ non-verbal means of communication. Thought the patient that loss of ability to talk does not mean loss of

intelligence. Provided time for the patient to respond. Conversation should be continue to practical and concrete matter,

supplemented with gestures, pictures, and object. Medications compliance on time (with the doctor’s permission).

Evaluation Goal met as evidence by the patient learn techniques on how to communicate non-verbal cues and in which needs are can be expressed.

24.

11. SOAPIE (potential)

Subjective:

Objective

Received pt. on lying position on bed, unconscious , with ongoing PNSS 1L regulated @ 10-15 gtts./min. (KVO) 200 ml. level infusing well @ left hand.

(+) difficulty in speaking (+) weakness (+) headache (+) dizziness (+) blurred vision (+)Paralysis on right part of the body With NGT inserted With Foley catheter inserted

Assessment Risk for aspiration related to decreased level of consciousness.

PlanningAfter 2-4 hrs. of N.I the client/ SO shall be able to identify causative factor that

may lead to aspiration.

Interventions Established rapport. Monitored and recorded vital signs. Monitored administration of NGT feeding. Checked for the NGT if intact in the stomach. Provided information about the effect of aspiration in the lung. Always keep the bed elevated whenever feeding. Keep wire cutter or scissor at bedside all the time.

Evaluation Goal partially met as evidence by the pt./SO was able to avoid factors that may

cause aspiration.

25.

13. Conclusion

We therefore conclude that CVA or stroke may lead to permanent brain

damage or death to individuals with sedentary lifestyle. People who consumed large

amount of food high in cholesterol, alcohol, cigarette smoking, obesity, and high blood

pressure can increase the possibility of stroke. This may also lead to heart disease

and maybe worsen if we don’t prevent the common factors that cause Stroke. Self

discipline is very important for us not to acquire this feared or killing disease.

26.

14. Recommendations

For the Patient and Family Members

Patient and family members should be given proper instruction and knowledge

on how to help the patient to cope in his condition. Dealing with emotional stress and

changing his sedentary lifestyle can reduce the risk of stroke. Patient way of living

should be carefully understand to limit the anxiety and self-pity. Showing emotional

and moral support can aid the anxiety and self-pity. If family members adjusted to this

kind of treatment to the patient, a fast recovery can be possibly.

For Health Care Provider/ Institutions

Cerebrovascular accident is one of the most common disease that cause dead

in the world. It can happen to anyone, especially to those of people who have

sedentary lifestyle and most commonly to people who acquired it through genes.

Though we don’t know when it will come, we have to be aware of the main factors that

bring our lives into danger. Maintaining good lifestyle and avoiding smoking, alcohol

intake, high fat and salty food, exercise, and low sugar food can decrease the possible

stroke. Health care provider and Institutions should give the enough knowledge to

everyone. Dealing with this kind of condition is one of the healthy processes of fast

recovery. It helps the patient and family members to adapt this knowledge and

behavior for the sake of the wellness of their love ones.

27.

15. Bibliography

Website source:

http://www.lancastergeneral.org/content/search.htm?inCtx9txtKeyword=CVA&inCtx9cmdKeywordSearch=search&inCtx9txtMode=site

http://www.lancastergeneral.org/content/stroke_2008_physician_chronicles.htm

http://ww2.allina.com/ac/pharmacy.nsf/

http://www.supportafterstroke.com/whatisahemorrhagicstroke.html

http://adam.about.com/reports/Stroke.htm

http://www.sciencedaily.com/releases/2008/06/080625123002.htm

http://brainmind.com/LeftHemisphere.html

http://psychology.wikia.com/wiki/Cerebrovascular_accident

http://answers.yahoo.com/question/index?qid=20070902172810AApbHou

http://healthlibrary.epnet.com/GetContent.aspx?token=af362d97-4f80-4453-a175-02cc6220a387&chunkiid=30616

http://www.neuroskills.com/search/search.php

http://dictionary.reference.com/browse/broca%27s+area?qsrc=2446

http://biology.about.com/sitesearch.htm?terms=frontal%20lobe&SUName=biology&TopNode=99

Book Source:

NANDA Book

Medical-Surgical Nursing

Anatomy and Physiology

Mims Annual

28.

The objective of the information in past and future anatomy articles is about

generalizations. My intent is not to address specifics. The objective is to provide

information and education. The left brain hemisphere, or logic brain, acts as a feature

combiner and comprehends spoken language by performing phonetic analysis of the

sounds, as opposed to the right brain method of comprehending language by matching

acoustic sound patterns. The left brain has the ability to extract isolated details from

spoken words or sentences, can generate correct spelling from scratch and can learn

from reading by reading for meaning even if the topic is dull. Where the right brain lacks

the short-term memory capabilities to be able to follow long sentences and extract their

meanings, the left hemisphere can. If a sentence is long and complex grammatically, it

falls into the realm of the left hemisphere for comprehension and de-coding for meaning.

The left hemisphere is able to work with both slow and rapid speech where the right brain

can only deal effectively with slow speech. Complex syntax, semantics, phonics, sight

words, new vocabulary (read or heard) are all shuttled to the left brain for comprehension.

The left brain is also where re-worded sentences or explanations, even if redundant, are

processed. The information processing that one hemisphere isn’t capable of processing is

switched to the other via the corpus callosum. The left hemisphere’s speaking and

listening vocabulary is almost as large as that for reading and sight and allows it to be

able to equally extract meaning from written or spoken words. When we read and hear

the words in our head, they’re formed (sub-vocalized) in the left brain because it, and not

the right hemisphere, has the ability to de-code written words acoustically. The left brain

doesn’t have the ability to handle ambiguity (needs absolutes, clear cut patterns and

predictability), doesn’t handle receiving input from changing sources, doesn’t do well if

required to make changes in solution strategies or changes in timing of responses. Left is

the logical and analytical side and processes information in a sequential manner. It works

best with life and projects when they’re presented in a planned and structured manner.

It’s the side that works best with multiple choice questions, prefers authority structuring,

controls feelings, is future oriented and time conscious, sees distinct right or wrong

according to the prevailing cultural/beliefs system and discerns sharp perceptual and

conceptual boundaries. This makes the left brain more involved in seeing differences

when dealing with others who are felt to be of lower caste or intelligence. Even though the

left brain prefers talking and writing it’s also the hemisphere that’s more likely to suspect

everyone and alienate friends. Those who are left brain dominant are more likely to buy,

buy, buy, test the limits of credit cards (and their ability to pay) clean everything, buy

everything and stock up for suspected or unknown eventualities, reorganize shelves,

cupboards, retrace their steps and reorganize shelves, etc. perpetually. They’re also

more likely to quit their job before being fired. If we go back and review the information on

all aspects of the brain it’s easy to see why we have differences and difficulties.

Fortunately, few of us are totally dominated by one hemisphere or the other. If that were

the case it would be a world of, “In this corner are the right brainers and in this corner the

lefties. Prepare your agendas and come out fighting.” Which, by the way, is how we seem

to handle most difficult problems anyway? All of us are endowed with two sides of the

brain and a way for the information to travel from one hemisphere to the other. The brain

is the area that heredity can be the largest or smallest factor in the way we interpret life

around us. If we don’t like our life and our health, the brain gives us the means with which

to change. The choices are also up to one of the brain’s functions but the mind and the

brain aren’t the same.