CVA- cs.docx

7/25/2019 CVA- cs.docx

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TOMAS CLAUDIO MEMORIAL COLLEGE

College of Nursing

A CASE STUDY OF A

CLIENT WITHCEREBROVASCULARACCIDENTCVA!

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"resen#e$ #o'Mrs3 Ro--el&ne Ro%les* RN* MANClini,(l Ins#u,#or


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I3 INTODUCTION

A s#ro+e, previously known medically as a ,ere%ro)(s,ul(r

(,,i$en# CVA!, is the rapidly developing loss of brainfunction(s) due

to disturbance in the blood supplyto the brain. This can be dueto ischemia(lack of blood ow) caused by blockage

(thrombosis, arterial embolism), or a hemorrhage(leakage of

blood). As a result, the aected area of the brain is unable to function,

leading to inability to move one or more limbs on one side of the body,

inability to understandor formulatespeech, or an inability to see one

side of the visual eld.

!schemic stroke is the most common type of stroke and is caused

by a blockage of the blood vessels supplying the brain. This may be

due to "hardening# and narrowing of the arteries (atherosclerosis) or by

a blood clot blocking a blood vessel.

The most severe type of stroke is a hemorrhagic stroke. !t occurs

when a blood vessel in the brain bursts, allowing blood to leak and

cause damage to an area of the brain. There are $ types% subarachnoid

hemorrhage, which occurs in the space around the brain& and an

intracerebral hemorrhage, the more common type, which involvesbleeding within the brain tissue itself.

The symptoms of a stroke usually appear suddenly. !nitially the

person may feel sick, and look pale and unwell. They may complain of

a sudden headache. They may have sudden numbness in their face or

limbs, particularly down one side of their body. They may appear

confused and have trouble talking or understanding what is being said

to them. They may have vision problems, and trouble walking or

keeping their balance. 'ometimes a seiure (t) or loss of

consciousness occurs.

epending on what function the damaged part of the brain had,

a person may lose one or more of the following functions%
http://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Blood_supplyhttp://en.wikipedia.org/wiki/Ischemiahttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Arterial_embolismhttp://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Hemiplegiahttp://en.wikipedia.org/wiki/Receptive_aphasiahttp://en.wikipedia.org/wiki/Expressive_aphasiahttp://en.wikipedia.org/wiki/Homonymous_hemianopsiahttp://en.wikipedia.org/wiki/Homonymous_hemianopsiahttp://en.wikipedia.org/wiki/Blood_supplyhttp://en.wikipedia.org/wiki/Ischemiahttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Arterial_embolismhttp://en.wikipedia.org/wiki/Hemorrhagehttp://en.wikipedia.org/wiki/Hemiplegiahttp://en.wikipedia.org/wiki/Receptive_aphasiahttp://en.wikipedia.org/wiki/Expressive_aphasiahttp://en.wikipedia.org/wiki/Homonymous_hemianopsiahttp://en.wikipedia.org/wiki/Homonymous_hemianopsiahttp://en.wikipedia.org/wiki/Brain


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ability to perform movements * usually aecting one side

of the body&

speech&

part of vision&

co+ordination&

balance&

memory& and

perception

The warning signs are%

'udden weakness or numbness of the face, arm and leg on

one side of the body.

oss of speech, or di-culty talking.

imness or loss of vision.

ne/plained diiness, especially when associated with any

of the above signs.

nsteadiness or sudden falls.

0eadache (usually severe and of sudden onset).

1onfusion.

1onrmation of diagnosis and initial treatment of strokes usually

takes place in a hospital. A computeried 1T scan of the brain is done

which produces a two or three dimensional pictures of the part of the

brain. Another laboratory procedure done is (23!)or 2agnetic

3esonance !maging scan which uses a large magnet, low+energy radio

waves and a computer to produce a two or three dimensional pictures

of the body.

!f a stroke has occurred, treatment should begin as soon as the

stroke is diagnosed to ensure that no further damage to the brainoccurs. !nitially, the doctor may administer o/ygen and insert an

intravenous drip to provide the aected person with ade4uate

nutrients and uids.


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!n cases of ischemic stroke, it is common to give aspirin to

reduce the risk of death or of a second stroke.

!f the cause of the stroke was a clot, it is possible that the 4uick

administration of certain clot+dissolving drugs, such as alteplase, willprevent some symptoms such as paralysis. 0owever, this is not a

suitable treatment for all strokes, and can increase the risk of

hemorrhagic stroke, so there are strict guidelines determining the

circumstances in which it should be used.

5nce a stroke has permanently damaged the brain, the damage

cannot be undone. 0owever, many symptoms can improve

considerably in the days following a stroke, because the areas of brain

on the periphery of the stroke can recover. !n addition, your doctor willsuggest ways to prevent a future stroke, including modifying your

lifestyle to minimie your risks of stroke, and taking medications.

epending on the type and cause of the stroke, anticoagulant

drugs ("blood thinners#) may be prescribed to help prevent new blood

clots from forming, in order to prevent a future stroke. 6/amples

include aspirin, aspirin plus dipyridamole (Asasantin), clopidogrel (e.g.

7lavi/) and warfarin (1oumadin or 2arevan).

8here there is a blockage in a neck artery, surgery may be

performed to remove the build+up of pla4ue in order to prevent a

future stroke. This operation is called a carotid endarterectomy.

2en are $9: more likely to suer strokes than women, yet ;< years of

age, and etiologyvaries by age. Advanced age is one of the most

signicant stroke risk factors. ?9: of strokes occur in people age @9
http://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)http://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Exponential_growthhttp://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)http://en.wikipedia.org/wiki/Incidence_(epidemiology)http://en.wikipedia.org/wiki/Exponential_growthhttp://en.wikipedia.org/wiki/Etiology


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and older, and two+thirds of strokes occur in those over the age of

;9. A persons risk of dying if he or she does have a stroke also

increases with age. 0owever, stroke can occur at any age, including in

childhood.

II3 OB/ECTIVES

GENERAL OB/ECTIVES

This study aims to present information that discussed the

1erebrovascular Accident (1BA) and possible complications that may

arise and interface with regards to the condition of the client. And to

develop, implement and evaluate plans for health promotion, using

professional eective nursing care with direct nursing activities. To

arrive at this point at which decision can be made. And to help client in

terms of physical adaptation.

S"ECIFIC OB/ECTIVES

6stablish rapport and gain the trust and cooperation of the

patient and immediate family members.


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7erform and obtain thorough and complete physical

assessment using the assessment techni4ues following the

cephalocaudal approach& obtain complete medical, socio+

cultural, and family history related to the patient#s current

health condition. Analye and prioritie problems based from the gathered

pertinent data to come up with the correct nursing diagnoses.

7lan the appropriate nursing interventions to address the

patient#s health needs. The interventions should address not

only the physical well being of the patient but also her

emotional, social, and mental welfare.

!mplement the planned nursing interventions to meet the

desired outcomes and help improve patient#s condition. !mpart useful health teachings to the patient and immediate

family members to prevent further development of the

patient#s condition and other related complications, and for

the patient to be able to adCust well and continue with her

normal life after being discharged from the hospital

III3 DATA BASE

A3 "(#ien#s "ro4le=ame % 2r. 2Age % 9? years oldAddress % 7. 'ta. 2aria 't. Drgy. Dalibago, 1ardona,

3ialEender % 2ale1ivil 'tatus % 2arriedate of Dirth % February G, H?9H=ationality % Filipino3eligion % 3oman 1atholic

B3 A$-ission D(#(ate of Admission % February H, $


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0ospital % Jueen 2ary 0elp of 1hristian 0ospital

!nc.1hief 1omplaint % 3ight sided body weaknessAdmitting iagnosis % 01B(0emorrhagic 1erebrovascular

isease)Attending 7hysician % Ale/ander Abe

IV3 HISTORY OF "AST AND "RESENT ILLNESS

"AST HEALTH HISTORY

0is right eye was hit by a bamboo streaks that leads intoblindness during his adolescence. The patient underwent

herniorrhaphy and her wife stated that the patient is not hypertensive

or diabetic.

"RESENT HISTORYast February H,$


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uring assessment, the patient#s wife stated that his husband#s

two brothers have history of hypertension and diabetes mellitus.

0owever, he was not diagnosed having even the two diseases.

V3 56 AREAS OF ASSESSMENT

I3 So,i(l S#(#us

2r. 2 is a 9? years old, married and was born on February G,H?9H. 0e is currently residing at 7. 'ta. 2aria 't. Drgy. Dalibago,1ardona, 3ial. 0e is a high school graduate, a sherman and theyowned a sh pen. 0e is a-liated in the 3oman 1atholic 3eligion

and has one child. 0e is a smoker& he can consume one pack ofcigarette every day and he drinks occasionally.According to 6rik 6rikson#s stages of 7sychosocial

evelopment, the patient was in the stage of Eenerativity vs.'tagnation, wherein the patient was in positive development, hiswife said that his husband has mentioned in one of theirconversation that he is happy and contented with what he and hisfamily have.

II3 Men#(l S#(#us

uring assessment, we have observed that the patient isalert, and oriented to the persons around him. 0e was also awarethat he is in the hospital. The patient was cooperative andevidenced by answering 4uestions through sign language(e/amples of 4uestions are% 0ow manyM oes it hurtM And those4uestions answerable by yes or no.)& he was also able to maintainan eye+to+eye contact and could follow simple directions such asplacing his hands above his head and holding the nurse# hand.

0is eyes opens spontaneously, oriented and obeys command.0is neurovital sign was 6@B92;with a total score of H9 in Elasgow1oma 'cale.

0e was not also able to speak. N0indi n siya mkapag salitamula nung inatake syaO as stated by his wife.

III3 E-o#ion(l S#(#us

8henever 2r. 2 had problems, he consulted to his wife andother relatives to seek for some advices. 0e is optimistic and does


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not show any signs of hopelessness and helplessness. 0e is willingto ght for his recovery.

IV3 Sensor& "er,e.#ion

Vision

6yes are black and are almond in shape. 0e was able tofollow the si/ cardinal gaes. eft eye was reactive to light andaccommodating well and his pupil was round. 7633A assessmentwas not applicable on right eye because it is blind, reported by hiswife. =o discharges found during inspection.S-ell

2r. 2#s nose is symmetrical in shape. 0e can identify smell.=o further assessment was done due to o/ygen therapy via nasal

cannula.

He(ring

6ars are symmetrical in terms of sie and shape. There is nopresence of earwa/ and no discharges found during inspection. 8eassessed his hearing ability by asking him to close his eyes andidentify the sound made by tapping of a ball pen and a coin in theside rails of his bed and by making a sound of a crumpled paper.0e was able to hear the sounds made at a specic distance. 0ewas able to identify the sound that he hears by asking him to point

out which of the two (ball pen or paper) he hears rst and last.

T(s#e

0e had pale, dry and cracked lips. 8hen we inspect his teeth,he had no cavities and had dentures on the upper part of his teeth.=o further assessment was done due to having an =ET.

Tou,1

0e reacted through facial mask of pain when his skin was

tested intradermally on his left arm. 8hen we asked him if he feelsany pain, he pointed his head and rates it as one from a pain scaleof H+H


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0e cannot move his right upper and lower e/tremities, buthis left upper and lower e/tremities can move fully. 0ave propersymmetry between left and right upper and lower e/tremities.There is no presence of deformities. 0e cannot turn to his left sidebecause he cannot move his right upper and lower e/tremities. 0e

also feels numbness on the aected part.5n assessment last February


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During hospitalization:

N0irap syang makakain, hindi nya kayang lumunokO as stated byhis wife.

0e has an =ET and has a diet of have a low salt low fat diet. Asof February G,$


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7III3 S#(#e of S+in (n$ A..en$(ges2r. 2 has dry, dark and warm skin. The skin turgor is poor.

There is no reported history of skin disease or allergy. 'he hadthick, black, curly hair and was fully distributed& he has a healthy

scalp as evidenced by absence of dandru and lice. 0is nails arefound to be properly trimmed and no traces of dirt are noted.

VI3 LABORATORIES

CLINICAL CHEMISTRY

DATE' FebruaryKHmmolK H>;+H@9mmolK !ndicates kidney

failure7otassium >.;mmolK >.9+9.HmmolK =ormal

URINALYSIS

DATE'FebruaryK


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7uss 1ell $+>hpf =one infection3D1 H


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withatherosclerosis

February


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RADIOLOGICAL RE"ORT

DATE' February


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VII3 CONCE"TUAL AND THEORETICAL FRAMEWOR0

Conser)(#ion T1eor&M&r( Le)ine9s

!t is focused in promoting adaptation and maintaining wholeness usingthe principles of conservation. The model guides the nurse to focus on theinuences and responses at the organismic level. The nurse accomplishesthe goals of the model through the conservation of energy, structure, andpersonal and social integrity

META"ARADIGM IN NURSING

"erson

a holistic being who constantly strives to preserve wholeness and

integrity and one Nwho is sentient, thinking, future+oriented, andpast+aware.O

En)iron-en#

1ompletes the wholeness of the individual. The individual hasboth an internal and e/ternal environment.

Internal Environment combines the physiological and pathophysiological aspects of

the individual and is constantly challenged by the e/ternalenvironment.

External Environment Perceptual environment + is that portion of the e/ternal

environment which individuals respond to with their senseorgans and includes light, sound, touch, temperature,chemical change that is smelled or tasted, and position senseand balance.

Operational environment + is that portion of the e/ternalenvironment which interacts with living tissue even thoughthe individual does not possess sensory organs that can


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record the presence of these factors and includes all forms ofradiation, microorganisms, and pollutants.

Conceptual environment - is that portion of the e/ternalenvironment that consists of language, ideas, symbols, andconcepts and inventions and encompasses the e/change of

language, the ability to think and e/perience emotion, valuesystems, religious beliefs, ethnic and cultural traditions, andindividual psychological patterns that come from lifee/periences.

He(l#1

implied to mean unity and integrity and Nis a wholeness andsuccessful adaptationO

Nursing

NThe nurse enters into a partnership of human e/perience wheresharing moments in time*some trivial, some dramatic*leavesits mark forever on each patientO

MAIN CONCE"TS'

ADA"TATION

!s the process of change, and conservation is the outcome ofadaptation. Adaptation is the process whereby the patientmaintains integrity within the realities of the environment

CONSERVATION

7roduct of adaptation. 1onservation describes the way comple/ systems are able to

continue to function even when severely challenged.O

WHOLENESS:INTEGRITY Nthe unceasing interaction of the individual organism with itsenvironment does represent an "open and uid# system, and acondition of health, wholeness, e/ists when the interaction orconstant adaptations to the environment, permit ease*theassurance of integrityWin all the dimensions of life.O

0EY CONCE"TS Conser)(#ion(l .rin,i.le!

Conservation of energy

3efers to balancing energy input and output to avoid e/cessivefatigue. !t includes ade4uate rest, nutrition and e/ercise.

Conservation of structural integrity

3efers to maintaining or restoring the structure of bodypreventing physical breakdown and promoting healing.

Conservation of personal integrity3ecognies the individual as one who strives for recognition,

respect, self awareness, selfhood and self determination.


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Conservation of social integrity

An individual is recognied as some one who resides with in afamily, a community, a religious group, an ethnic group, a politicalsystem and a nation.

Self;C(re De4,i# T1eor&

Doro#1e( Ore-

Doro#1e( E3 Ore- identied three theories of self+care, self+caredecit, and nursing systems. The ability of the person to meet dailyre4uirements is known as self+care, and carrying out those activities is self+care agency. 7arents serve as dependent care agents for their children. Theability to provide self+care is inuenced by basic conditioning factorsincluding but not limited to age, gender, and developmental state. 'elf+careneeds are partially determined by the self+care re4uisites, which arecategoried as universal (air, water, food, elimination, activity and rest,solitude and social interaction, haard prevention, function with social

groups), developmental, and health deviation (needs arising from inCury orillness and from eorts to treat the inCury or illness).

The total demands created by the self care re4uisites are identied astherapeutic self+care demand. 8hen the therapeutic self+care demande/ceeds self+care agency, a self+care decit e/ists and nursing is needed.Dased on the needs, the nurse designs nursing systems that are whollycompensatory (the nurse provides all needed care), partly compensatory(the nurse and the patient provide care together), or supportive+educative(the nurse provides needed support and education for the patient to e/erciseself+care).

CONCE"TS

Nursing ,lien# A human being who has Xhealth related Khealth derived limitations that

render him incapable of continuous self care or dependent care orlimitations that result in ineective K incomplete care.

A human being is the focus of nursing only when a self Vcare re4uisitese/ceeds self care capabilities


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Nursing .ro%le- decits in universal, developmental, and health derived or health

related conditionsNursing .ro,ess

a system to determine (H)why a person is under care ($)a plan for

care ,(>)the implementation of careNursing #1er(.eu#i,s deliberate, systematic and purposeful action

OREM categories of self

care re4uisites are niversal niversal self+care re4uisites evelopmental self+care re4uisites

B3 T1eor& of self;,(re $e4,i# 'pecies when nursing is needed =ursing is re4uired when an adult (or in the case of a dependent,

the parent) is incapable or limited in the provision of continuouseective self+care.

5rem identies 9 methods of helping%H. Acting for and doing for others$. Euiding others>. 'upporting another


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@. 7roviding an environment promoting personal developmentin relation to meet future demands

9. Teaching anotherC3 T1eor& of Nursing S&s#e-s

escribes how the patient#s self care needs will be met by the

nurse , the patient, or both !denties > classications of nursing system to meet the self care

re4uisites of the patient%+o 8holly compensatory systemo 7artly compensatory systemo 'upportive V educative system

VIII3 ANATOMY AND "HYSIOLOGY

The supply of freshly o/ygenated blood from the heart to thebrain is delivered via the carotid and basilar arteries.

C(ro#i$ Ar#eries

The carotid arteries run up both sides of the neck, and supplyo/ygen to the Xcarotid territoryX of the brain. The carotid territoryincludes the frontal and temporal lobes. 'trokes in the carotid territory,the XfrontX of the brain, are referred to as anterior stroes. Anteriorstrokes produce the most common stroke symptoms. Anterior strokescan be caused by blood clots or narrowing in the carotid arteries as


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well as in smaller arteries within the brain. 'peech di-culties, visionproblems, tingling, and paralysis may result from an anterior stroke.

B(sil(r Ar#eries

The basilar arteries are part of the vertebrobasilar circulationsystem, located at the base of the skull. The two vertebral arteriesconnect to form a single basilar artery that provides theXvertebrobasilar territoryX of the brain with o/ygen. This territoryincludes the brain stem, cerebellum, and occipital lobes. A stoke in thisregion of the brain is referred to as a posterior stroe (meaning thestroke aects the back of the brain). 7osterior strokes cause some ofthe less common stroke. 'trokes in the basilar territory can sometimesaect both sides of the body. 7osterior strokes may also causeheadaches, visual disturbances, speech problems, nausea, di-culty

swallowing, and weakness in the legs or arms.

Cir,le of Willis

The 1ircle of 8illis (also called 8illis 1ircle, cerebral arterialcircle, arterial 1ircle of 8illis, and 8illis 7olygon) is a circleof arteriesthat supply bloodto the brain.

The 1ircle of 8illis comprises the following arteries%

Anterior cerebral artery(left and right) Anterior communicating artery !nternal carotid artery(left and right) 7osterior cerebral artery(left and right) 7osterior communicating artery(left and right)

The basilar artery and middle cerebral arteries, though theysupply the brain, are not considered part of the circle

H. The (n#erior ,ere%r(l (r#eries(A1A) are a pair of arteries onthe brainthat supply o/ygento most medial portions of frontallobesand superior medial parietallobes. The $ anterior cerebralarteries arise from the internal carotid arteryand are part of the1ircle of 8illis.The left and right anterior cerebral arteries areconnected by the anterior communicating artery.
http://en.wikipedia.org/wiki/Circlehttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Anterior_cerebral_arteryhttp://en.wikipedia.org/wiki/Anterior_communicating_arteryhttp://en.wikipedia.org/wiki/Internal_carotid_arteryhttp://en.wikipedia.org/wiki/Posterior_cerebral_arteryhttp://en.wikipedia.org/wiki/Posterior_communicating_arteryhttp://en.wikipedia.org/wiki/Basilar_arteryhttp://en.wikipedia.org/wiki/Middle_cerebral_arterieshttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Frontal_lobehttp://en.wikipedia.org/wiki/Frontal_lobehttp://en.wikipedia.org/wiki/Superior_medial_parietalhttp://en.wikipedia.org/wiki/Internal_carotid_arteryhttp://en.wikipedia.org/wiki/Circle_of_Willishttp://en.wikipedia.org/wiki/Anterior_communicating_arteryhttp://en.wikipedia.org/wiki/Circlehttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Anterior_cerebral_arteryhttp://en.wikipedia.org/wiki/Anterior_communicating_arteryhttp://en.wikipedia.org/wiki/Internal_carotid_arteryhttp://en.wikipedia.org/wiki/Posterior_cerebral_arteryhttp://en.wikipedia.org/wiki/Posterior_communicating_arteryhttp://en.wikipedia.org/wiki/Basilar_arteryhttp://en.wikipedia.org/wiki/Middle_cerebral_arterieshttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Oxygenhttp://en.wikipedia.org/wiki/Frontal_lobehttp://en.wikipedia.org/wiki/Frontal_lobehttp://en.wikipedia.org/wiki/Superior_medial_parietalhttp://en.wikipedia.org/wiki/Internal_carotid_arteryhttp://en.wikipedia.org/wiki/Circle_of_Willishttp://en.wikipedia.org/wiki/Anterior_communicating_artery


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$. The (n#erior ,o--uni,(#ing (r#er& is a blood vesselof thebrainthat connects the left and right anterior cerebral arteries.

>. The internal carotid arteries are maCor arteriesof the head andneck that supply blood to the brain

@. The .os#erior ,ere%r(l (r#er&(71A) is one of a pair of bloodvesselsthat supplies o/ygenated bloodto the posterior aspect ofthe brain (occipital lobe) in human anatomy

9. The .os#erior ,o--uni,(#ing (r#er&is one of a pair of right+sided and left+sided blood vesselsin the circle of 8illis

I73 "ATHO"HYSIOLOGY CEREBROVASCULAR DISEASEHEMORRHAGIC STRO0E!

Sx:, headache,unconsciousness,nausea/vomiting, visualdisturbances

Mass of blood forms andgrows

Cerebral Hemorrhage

Vascular wall becomesweakened and fragile

Lysed or moved thrombusfrom the vessel

Leaking of blood from thefragile vessel wall

ormation of !la"ue de#osits

$hrombosis

Atherosclerosis

%cclusion by ma&or vessel

"re$is.osing F(,#ors'

Age 0eredity 'e/

"re,i.i#(#ing F(,#ors'

0ypertension 1igarette 'moking ndesirable levels of

cholesterol 7oor diet

Hy#ertension
http://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Anterior_cerebral_arteryhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Occipital_lobehttp://en.wikipedia.org/wiki/Human_anatomyhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Circle_of_Willishttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Anterior_cerebral_arteryhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Occipital_lobehttp://en.wikipedia.org/wiki/Human_anatomyhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Circle_of_Willis


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Vasos#asm oftissue and arteries

'ncreased 'C!

%bstruction of CS#assageway

ormation of smalland large clots

(lood see#s into theventricles

C)*)(*+LH,!%!)*-S'%.

Sx: dizziness,confusion,headache

Cerebral 'schemia

$issue hy#oxia andcellular starvation

'm#aired distribution ofoxygen and glucose

+ccumulation of CS inthe ventricles

Ventricles dilate behindthe #oint of obstruction

Lodges untoother cerebralarteries

ailure of energy de#endent

#rocess/ion #um#ing0

ailure #roduction ofadenosine tri#hos#hatase

Metabolic +cidosis

1enerates large amountsof lactic acid

!roduction of oxygen freeradicals and other reactiveoxygen s#ecies

+naerobic metabolism bymitochondria

'nitiation of ischemiccascade

urther energyde#letion

$ransient 'schemic +ttack

ailure ofmitochondria

+ctivates en2ymes thatdigest cell #roteins3 li#ids

and nuclear material

4amage to the bloodvessel endothelium

'nflux of calcium

*elease of excitatoryneurotransmitter glutamate


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*elease of metallo#rotrease/2inc and calcium5de#endent en2ymes0

(rain sustains an irreversiblecerebral damage

'm#aired #erfusion andfunction

'ncreased intracranial

Com#ression of tissue

Vascular Congestion

Cerebral edema

(reakdown of the #rotective(lood (rain (arrier

Structural integrity loss of braintissue and blood vessels

(reak down of collagen3 hyaluronic acid andother elements of connective tissue

Middle Cerebral+rtery

Sx:

hemiplegia,

unilateralneglect,

altered

consciousness

dysgra#hia

/inablity to write03

aphasia

(inability to

speech),

Lateral

hemis#here3frontal3 #arietaland tem#orallobes3 basalganglia


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7II3 DISCHARGE "LAN

MEDICATION

!nstruct pt to take prescribed medication and dosage religiously

to maintain health improvement.

a. Yynapse Hg H tab $ / a day

b. =eurobion H tab once a dayc. 7antoloc @?mg H tab once a dayd. actulose >


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HEALTH TEACHING

6ducated client about the dierent methods on how to improve

health and wellness. 'tress the importance of taking medications

regularly and report signs to octor such as increase in D7.

SCHEDULE OF NE7T VISIT

!nstruct patient to return on February H$, $


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'troke is a term used to describe the neurologic changes caused by aninterruption in the blood supply to a part of the brain. The incidence ofstroke and stroke mortalities has gradually declined in many industrialiedcountries in recent years as a result of increased recognition andtreatment of risk factors, which may include modiable risk factors such

as hypertension

7ublic education is focused on prevention, recognition ofmanifestations and early treatment of brain attack. As they sayprevention is better than cure. Therefore it is important for each andevery one of us to avoid these modiable risk factors and changesedentary lifestyles to healthy lifestyles. 1holesterol levels should bebrought to a normal level, diabetes should be controlled and reducingheavy alcohol consumption. The best intervention is to stop smokingcigarettes.

As nursing students, this study showed us the importance of earlydetection of diseases such as stroke since it may lead to more seriousconditions if it is not properly managed or treated. Znowledge of the riskfactors and preventive measures can help in reducing the incidence ofstroke. 7rompt recognition, which allows for early treatment of stroke isrecommended to lessen residual decits and decreased disability. Throughthis study, may we be able to help others to understand and know moreabout stroke and ways to prevent and treat its signs and symptoms.

The group was able to assess one patient having a case of 1erebralvascular accident and through the study of case the group was able to

identify of the causative factors that predisposes the patient in ac4uiringsuch disease condition. Furthermore the group was able to identify howwas it occurred and how it would be worse if left untreated, with severalcondition such as this case a lot of problems has occurred that wouldmight permanently aect the lifestyle of the patient.

!n this study the group was able to be familiaried to medicalmanagements and its benets and s side eect to patient during therapy

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