ICU CVD GroupCaseStudy

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A Case Study On Cerebrovascular Disease, HemorrhagicI.INTRODUCTIONCerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood pressure. A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the narrowed blood vessels causing hemorrhagic stroke in the morning. Conversely, a sudden rise in blood pressure due to excitation during the daytime can cause tearing of the blood vessels resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are elderly or have a history of diabetes, smoking, or ischemic heart disease. The results of cerebrovascular disease can include a stroke, or occasionally a hemorrhagic. Ischemia or other blood vessel dysfunctions can affect the person during a cerebrovascular accident. Hemorrhagic stroke is a condition that occurs mainly due to a rupture of a blood vessel in the brain. The blood vessel bursts and releases blood into the brain. Research shows that nearly 20 percent of the strokes that occur overall are hemorrhagic in nature. A systematic review of stroke incidence worldwide found that between 1970 and 2008, stroke incidence decreased 42% in high-income countries and increased more than 100% in low- to middle-income nations; between 2000 and 2008, the overall stroke incidence in low- to middle-income countries was 20% higher. (emedicine.com) Once the arteries rupture they are incapable of carrying blood and oxygen to the brain and it causes the cells to die. Another reason for hemorrhagic stroke is the blood that flows into the brain due to the rupture forms a clot inside the brain and damages the brain tissue. This could severely damage the brain functioning. A hemorrhagic stroke is the least common. However, it is more frequently fatal when compared to an ischemic stroke overall. Hemorrhagic stroke is of two types. Each one is named after the part of the brain that is affected by the bleeding. The subarachnoid hemorrhage is a condition that refers to the bleeding that takes place in the gap between the top of the brain and the skull. The most common cause of a subarachnoid hemorrhagic stroke is aneurysm. It is characterized by an abnormal

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A Case Study On Cerebrovascular Disease, Hemorrhagicswelling of a blood vessel within the brain followed by rupturing of that swollen blood vessel. We chose this case because we think that patients having Cerebrovascular disease needs full attention as to prevention of complications, which we think is our primordial responsibility as student nurses. Our concern is not only on the physical aspect but also on the emotions and feelings of our patient having this disease condition who may not be able to do the usual activities they used to deal on brought about by the condition. Hence we wanted to widen our knowledge on how to take good care of these particular patients so that we will be able to provide quality care and satisfaction to our future patients having the same disease condition. General Objective: This case presentation seeks to enhance the students knowledge with regards to the patients general health and disease condition, its pathophysiology, possible complications, treatment plan and medical regimen. This also seeks to assimilate the students skills through application of several nursing interventions and medical management. Furthermore, this case presentation intends to improve the students attitude by conveying open-mindedness and utilizing therapeutic communication all throughout the activity.

Scope and Limitation: The scope of this study is within the context of the patient's condition based on the assessment of the patient's present health condition and other precipitating and predisposing factors that influenced the course of the disease, the anatomy and physiology of the involved body systems, pathophysiology of the condition, patients diagnosis and diagnostic exams, nursing and medical management, drug study, discharge plan, prognosis and recommendation of the case study. The data presented in this case was primarily obtained from student nurse- patient interaction as well as with the significant other who partly served as informant. Further information is based on the patients chart.

The case study is limited to the available resources during the making of this study such as book sources, internet sources, and patients chart, information coming from the family and as well the observation of the patients during the span of duty.Page 2

A Case Study On Cerebrovascular Disease, HemorrhagicFurthermore, this case study will only show the changes of the patients condition from August 22, 2011 until August 24, 2011.

II.CLIENTS PROFILE This is a case of a 73 years old female Filipino, a resident of Poblacion 3, Villaneuva Misamis Oriental. Patient X was born on December 8, 1938. She is married and has 9 children all are in good health. Patient X was a high school graduate. She is a housewife. Patient X was admitted on August 20, 2011; 5:55pm at Capitol University Medical City Intensive Care Unit. A.VITAL SIGNS Upon assessment, the following data was obtained from Patient X: BP: 162/68mmHg, HR: 112 bpm, RR: 25 cpm, Temp.36.9c. Patient X weighs 40 kg and is 51 in height. B.CHIEF COMPLAINT Patient X has a chief complaint of altered level of consciousness. C. Family Health Illness History According to the significant others that the patient has known genetic disease that runs in the family which is hypertension. Patient is non-compliant with her medications. D.HISTORY OF PRESENT ILLNESS 2 days prior to admission patient had 2 episodes of LBM watery, non-mucoid, non-bloody stools associated with generalized body weakness. Sought consult at Tagoloan Polymedic General Hospital managed as a case of AGE however, noted change in sensorium, CT scan was done revealing acute hemorrhage involving the right frontal lobe extending to corpus callosum and partly to left side frontal lobe approximately 64ml, minimal subarachnoid hemorrhage. Started meds and referred for further management. With positive cough, masks yellowish phlegm. E.HISTORY OF PAST ILLNESS

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A Case Study On Cerebrovascular Disease, HemorrhagicAccording to the significant others the patient had several health conditions such as fever, common cough and cold but havent sought any medical consultation. F.STATEMENT OF THE PATIENTS GENERAL APPERANCE Patient X looked pale, weak, drowsy and responsive to verbal stimuli but seen to be inconsistent with her answers.

G. NUTRITIONAL AND METABOLIC PATTERN Pre-hospitalization: Patient X eats three times daily. She consumed 1/ 2 share of served food with good appetite. She drinks 8-10 glasses of water a day. During hospitalization: Patient X is in osteorized feeding of 166cc every 8am/12nn; 4pm/8pm; 12mn/4am. She was hooked to an Intravenous Fluid of IL PNSS regulated @ 20gtts/min infusing well on the left arm. H.ELIMINATION Pre hospitalization: Patient X defecates once a day, with yellowish to brownish stool and soft in consistency and no discomfort felt during defecation. She urinates three times daily with dark yellow colored urine in variable amount. During hospitalization: Patient X do not have a bowel movement for 2 days, she was inserted with Foley catheter attached to urobag draining with yellowish colored urine. I.ACTIVITY AND EXERCISE PATTERN Patient X doesnt any particular exercise regimen but she usually do brisk walking every morning at the seashore. ACTIVITIES OF DAILY LIVING Feeding 4 total dependence Bathing 4 total dependence DRESSING 4 total dependence Grooming 4 total dependence Meal preparation 4 total dependence Cleaning 4 total dependence Laundry 4 total dependence Toileting 4 total dependence Bed mobility 4 total dependence Chair/toilet transfer 4 total dependence Ambulation 4 total dependence R.O.M 2 assist with personPage 4

A Case Study On Cerebrovascular Disease, HemorrhagicJ.COGNITIVE AND PERCEPTUAL PATTERN Patient X speaks Cebuano and able to respond to some questions but she is inconsistent with her answers. K.SLEEP REST PATTERN Pre- hospitalization: Patient X sleeps 8 hours a day. During hospitalization: Patient X still sleeps 8 hours a day. L.SEXUALITY-REPRODUCTIVE PATTERN Patient X is already menopause since 60 years old. G9, P9 (9009) . PHYSICAL ASSESSMENT Together with medical history, the physical examination aids in determining the correct diagnoses and devising the treatment plan. This part of the study will present the normal and regressed health function of Patient X pointing out the salient, manifestations of the disease. I. Neurologic Assessment Drowsy Confused Calm Cooperative, responsive 12 (E-3;V-4;M-5)

Level of consciousness Orientation Emotional state Appropriate behavior Glassgow Coma Scale

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PHYSICAL ASSESSMENTComponent Head: August 21, 2011 Her head is normocephalic with symmetrical facial movements. Fontanels are closed. Hair is dry with normal/even distribution. Eyes: Scalp is clean. Eyelids are symmetrical. Conjunctiva is pale. Bilateral Pupil size is 2mm (constricted) with sluggish Ears: reaction to light. The external pinnae are normoset and there is no presence of any form of discharge from the external Nose: canal. There is no presence of alar flaring. Septum is midline, mucusa is pinkish and both Mouth: are patent. Her lips are pale in color and slightly dry and crack. Gums and mucosa are light pink in color. Tongue is located at midline. Has Pharynx: den