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Cerebrovascular accident is the rapidly developing loss of the brain functions duet o disturbance in the blood vessels supplying blood to the brain causing brain tissue to die because of lack of nutrients and oxygen. This can be due to ischemia caused by thrombosis or embolism or due to a haemorrhage. CVA is the third leading cause of death in the United States and the leading cause of adult disability in the world. Three million Americans are currently permanent disabled from stroke. It is estimated that four of every four of every five families in the United states are affected by stroke in their lifetime and more than half a million of people in the United States experience a new or recurrent stroke each year. Our patient is a government employee and engineer who is a resident of Housing, Brgy. Canlanipa, Suriga0o City. He is a father of a kid and a hard working husband. He is 46 year old living together with his family in a cemented house. But unfortunately, he was confined at Surigao Medical Center last August 11, 2009 and was diagnosed of having Cerebrovascular accident Thrombosis secondary to hypertension. We have choosen this kind of case specially CVA- thrombosis or comonly known as stroke, for it is an interesting and challenging topic to learned. Especially most of us have family history of stroke that¶s why we are veruy crios about the cause, symptoms, complications, and how this disease could be treated.
Cerebrovascular accident (CVA) is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain causing brain tissue to die because of lack of nutrients and oxygen. . This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism or due to a hemorrhage. complications and how this disease could be treated. mentally.thrombosis or commonly known as stroke. It is estimated that four of every five families in the United States will be affected by stroke in their lifetime and more than half a million people in the United States experience a new or recurrent stroke each year Worldwide. stroke can occur at any age. Dysfunctions correspond to areas in the brain that have been damaged. emotionally. 95% of strokes occur in people age 45 and older. and etiology varies by age. Some risk factors for stroke apply only to women. or almost one out of three stroke victims. We have chosen this kind of case specifically CVA. symptoms. The incidence of stroke increases exponentially from 30 years of age. Stroke can affect patients physically. However.000 Americans each year. or a combination of the three.25 times more likely to suffer strokes than women. yet 60% of deaths from stroke occur in women.CVA is the third leading cause of death in the United States and the leading cause of adult disability in the world. Since women live longer. they are older on average when they have their strokes and thus more often killed. Especially most of us have family history of stroke that¶s why we are very curious about the causes. Men are 1. Stroke kills about 150. one-quarter of all strokes are fatal. Advanced age is one of the most significant stroke risk factors. Three million Americans are currently permanently disabled from stroke. for it is an interesting and a challenging topic to be learned. The results of stroke vary widely depending on size and location of the lesion. including in fetuses. and two-thirds of strokes occur in those over the age of 65.
and two-thirds twoof strokes occur in those over the gae of 65. Stroke can affect patients physically. yet 60 % of deaths from stroke occur in women. 95% of strokes occur in people age 45 and older. Stroke kills about 150. or a combination of the three. . The incidence of strokes increases exponentially from 30 years of age. The results of stroke vary widely depending on size and location of the lesion. Advanced age is one of the most significant stroke risk factors.23 times more likely to suffer strokes than women.Worldwide. Dysfunction correspond to areas in the brain that have been damage. stroke can occur at any age. or almost one out of three stroke victims. Men are 1. 000 Amrican each year. Some risk factors for stroke apply only to women. mentally. emotionally. and etiology varies by age. one quarter of all strokes are fatal. including in fetuses. Since in woman live longer. however. they are older on average when they have their strokes and thus more often killed.
most often on one side of the body. a stroke fit. dizziness.REVIEW OF RELATED LITERATURE The word stroke as a Synonym for apoplectic seizures as early as 1599. especially prior to a definitive diagnosis. leg. difficulty seeing with one or both eyes. or faint is sometimes referred to us an ictus (cerebri) from the Latin icere (to strike). This cuts off the supply of O2 and nutrients. fainting or unconscious. . arm. severe headache with no known cause. In medicine. difficulty in speaking or understanding speech. Other symptoms include: confusion. and is fairly literal translation of the Greek term. loss of balance or coordination. A stroke is caused by the interruption of the blood supply to the brain usually because a blood vessel bursts or is blocked by a clot. the most common symptom of stroke is sudden weakness or numbness of the face. causing damage to the brain tissue. difficulty walking.
cigarette smoking. This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose. which is related syndrome of stroke symptoms that resolve completelt with in 24 hours. devised by the World Health Organization in the 1970s. with the time frame of 24 hours being chosen arbitrarily. atrial fibrillation. Risk factors for stroke include. . Blood pressure is the most important modified risk factor of stroke. The traditional definition of stroke. migraine with aura. advanced age.Stroke is medical emergency and can cause permanent neurological damage complications and death if not promptly diagnosed and treated. hypertension. With the availability of treatments that when given early can reduce stroke severity. is a ³neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours´. It is the third leading cause of death and the leading cause of adult disability in the United States and Europe. diabetes. thrombophilia. many now prefer alternative concepts such as brain attack and acute ischemic cerebrovascular syndrome. TIA (transient ischemic attack). It is predicted that stroke will soon become the leading cause of death worldwide. that reflect the urgency of stroke symptoms and the need to act swiftly. It divide stroke from TIA. high cholesterol.
The following factors may put you at a higher risk of having a CVA: Cigarette smoking. The plaque blocks an artery which causes as stroke. Heart disease. This is called embolic stroke. or drinking too much alcohol. Atherosclerosis (hardening of the arteries) or fatty cholesterol deposits on artery walls. A torn artery in the brain. Causes A CVA may be caused by any of the following: A piece of fatty plaque (debris) that is formed in a blood vessel breaks away and flows through the bloodstream going to the brain. such as coronary artery disease. This is called a thrombotic stroke. . This is called a cerebral hemorrhage or hemorrhagic stroke. High blood cholesterol (fat) and high blood pressure. Diabetes (high blood sugar) You or a close family member has had a stroke. A thrombus (blood clot) formed in an artery (blood vessel) and blocked blood flow the brain. blood pressure. stroke. It often results from high stroke. causing blood to spill out.The effects of a stroke depend on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death. Blockage of certain small blood vessels inside the brain. cocaine use.
even if the exact cause is not yet known. which part of the brain is affected). The symptoms of a stroke are related to the anatomical location of the damage. Hemorrhagic strokes can affect local areas. as well as the presence of risk factors. a examination.e. but often can also cause more global symptoms due to bleeding and increased intracranial pressure. Ischemic strokes usually only affect regional areas of the brain perfused by the blocked artery.Signs and Sypmtoms Stroke symptoms typically develop rapidly (seconds to minutes). nature and severity of the symptoms can therefore vary widely. doctor can rapidly diagnose the anatomical nature of the stroke (i. . On the basis of the history and neurological examination.
listen to see if you can hear any slurring of the speech not otherwise explained (e. alcohol) and see if they can answer simple questions (where are you?. what day of the week is it?) .g. what's your name?.ask the patient to close their eyes and hold both arms out straight for 30 seconds .look to see if there is any drooping or loss of muscle tone on the face Arm .Pre-hospital care professionals in the United Kingdom will typically want to identify stroke risk very rapidly. If they suspect a stroke.in a patient with a stroke. you might see one arm tending to slowly move down Speech . they will typically use the Face Arm Speech Test (FAST) to assess likelihood: Face .
However. since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms. corticospinal tract. the symptoms affect only one side of the body (unilateral). symptoms may include: hemiplegia and muscle weakness of the face numbness reduction in sensory or vibratory sensation In most cases. The defect in the brain is usually on the opposite side of the body (depending on which part of the brain is affected). and dorsal column (medial lemniscus). the presence of any one of these symptoms does not necessarily suggest a stroke.If the area of the brain affected contains one of the three prominent Central nervous system pathways²the spinothalamic tract. .
In addition to the above CNS pathways. or vision (total or partial) drooping of eyelid (ptosis) and weakness of ocular muscles decreased reflexes: gag. taste. pupil reactivity to light decreased sensation and muscle weakness of the face balance problems and nystagmus altered breathing and heart rate weakness in sternocleidomastoid muscle with inability to turn head to one side weakness in tongue (inability to protrude and/or move from side to side) . hearing. swallow. A stroke affecting the brainstem therefore can produce symptoms relating to deficits in these cranial nerves: altered smell. the brainstem also consists of the 12 cranial nerves.
hypersexual gestures (with involvement of frontal lobe) anosognosia (persistent denial of the existence of a. confusion. headache. deficit) If the cerebellum is involved. . often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing on the brain. the CNS pathways can again be affected. but also can produce the following symptoms: aphasia (inability to speak or understand language from involvement of Broca's or Wernicke's area) area) apraxia (altered voluntary movements) visual field defect memory deficits (involvement of temporal lobe) lobe) hemineglect (involvement of parietal lobe) lobe) disorganized thinking. If symptoms are maximal at onset. the patient may have the following: trouble walking altered movement coordination vertigo and or disequilibrium Loss of consciousness.If the cerebral cortex is involved. usually strokestrokerelated. the cause is more likely to be a subarachnoid hemorrhage or an embolic stroke. and vomiting usually occurs more consciousness.
The following tests may be done: lab tests of your blood electrocardiogram (ECG) to see how well your heart is working x-ray of your chest brain scans (CT or MRI) to try to identify a stroke and determine whether it is from a clot or from bleeding into the brain from a leaking artery (hemorrhage). . someone should call an ambulance or take you to an emergency room right away.How is it diagnosed? If symptoms of a stroke occur. Your health care provider will know from your symptoms and physical exam whether you are having a stroke.
Anticoagulant medicine: treatment for an ischemic stroke includes anticoagulant medicines which are also called blood thinners. Hemorrhagic (bleed) stroke: this type of stroke may require surgery. Platelets are type of blood cell that joins to form clots. . . . Thrombolytics break apart clot and restore blood flow.Antiplatelet aggregating medicine: these medicines interact with platelets to prevent blood clots from forming. This medicinegroup keeps clots from forming in the blood.Treatment Treatment of CVA depends upon the type of stroke: Ischemic stroke: An ischemic stroke includes stokes caused by a blockage in a blood vessel.Thrombolytic medicine: this medicine group is used in a stroke caused by a clot ion a blood vessel. .
tests on key functions like swallowing and movement checks on oxygen. AntiAnti-clotting medication is not given in strokes caused by haemorrhaging because it will make the bleeding worse. If a blood clot is the cause. glucose and blood pressure levels. brain scans are needed to find out what type of stroke you've had. . Anti-clotting medication such as Antiaspirin may also be given to stop the stroke from getting worse. but this must be given within three hours of the stroke. Other treatment includes: If swallowing is affected. you may be fed by a tube or given fluids into a vein (intravenously) to avoid food going into the lungs.Immediate treatment In hospital. 'clot busting' medication may be used to dissolve the clot.
occupational therapists. nurses and doctors. . speech therapists. The next phase of treatment is recovery through rehabilitation. then taking a low-dose aspirin (eg Nu-seals 75mg) once a day may help make the blood less sticky and less likely to cause clots. If a stroke is caused by a blood clot.After a stroke In the first few days after a stroke. treatment concentrates on making sure you are well hydrated and nourished. This involves a team of health professionals including physiotherapists.
If you have hyperlipidemia (high blood cholesterol level. These medications include the following categories of drugs: Beta blockers are used to reduce the force and speed of the heartheartbeat. This lowers fat levels in the bloodstream. like vodka or whiskey. liquor. you may need to take antithrombotic medicine. in a normal. a physician may also order medication to lower blood pressure. Vasodilators are used to dilate the blood vessels. talk to your caregiver about ways to lower it. It is important as how much you drink. Different people have different ideas about what too much means. Lipid-lowering drugs increase the loss of cholesterol from the body or Lipidprevent the conversion of fatty acids to cholesterol. Keep your blood cholesterol level. Monitor and control your blood sugar level if you have diabetes.Prevention Take your high blood pressure medicine regularly. Don not smoke or drink too much alcohol. wine. and other adult drinks. range. Alcohol is found in beer. Diuretics reduce the total volume of circulating blood and thus the heart's work by removing fluid from the body. Having a recent heart attack may also require you to take antithrombotics. . If necessary. If you have atrial fibrillation (an irregular of fast heart beat). Eat foods low in fat to decrease the risk of developing plaque (fatty deposits) in your blood vessels.
or a combination of the three. mentally. Stroke can affect patients physically. Of the Europeanremaining 55% of people who have strokes. while 20% die within three months after the stroke. The results of stroke vary widely depending on size and location of the lesion. . rehabilitative and longrestorative services will be necessary in order for them to regain as much of their former capabilities as possible. Stroke is fatal for nearly twice as many people of AfricanAfricanAmerican heritage as it is for European-Americans. 5% will require long-term (nursing home) care. For the rest.Prognosis The National Institute of Neurological Disorders and Stroke reports that 25% of people who suffer a stroke recover completely. emotionally. Dysfunctions correspond to areas in the brain that have been damaged. Disability affects 75% of stroke survivors enough to decrease their employability.
NURSING HEALTH HISTORY Biographic Data: Name of Patient: Mr.E. 1962 Religion: Roman Catholic Highest Educational Attainment: College Graduate Degree: Bachelor of Science in Civil Engineering Occupation: Government Employee Health care financing and usual source of medical care: Phil Health Source and reliability of data gathered: Primary source (patient¶s wife) and secondary sources (chart and the SOs) . V. Surigao City Age: 46 years old Sex: Male Civil Status: Married Date of Birth: November 21. Address: Canlanipa Housing.
Roy N.160/100 mmHg Weight: Height: 5¶10 Admitting Physician: Dr.: Room: Date Admitted: Time Admitted: Arrived via: Admitting vital signs: Surigao Medical Center 39558 PR . Impression: CVA Thrombosis seconday to Hypertension Final Diagnosis: Cerebrovascular Accident ± thrombosis with Right Paralysis.Admission Data: Hospital: Case No. HPN .8°C RR. Ycong Chief Complaint:Left side weakness and semi-unconscious and slurred speech.36. Barcenas Attending Physician: Dr.22 cpm PR.25 August 11. Gilberto A. 2009 7:45 pm per stretcher T.92 bpm BP.
hemiparesis and hemiplegia were noted on the left side of the body.HISTORY OF PRESENT ILLNESS A 46 year-old patient was admitted in Surigao Medial Center last August 11. The next day. he woke up early in the morning and prepared insisted to go to wok. lechon. While doiung his duty in office he got collapsed. Furthermore. . The patient was semiconscious and he had difficulty in speaking and responding to verbal commands. As day before hospitalization. and got drunk. This prompted his co-officemate to seek medical attention at SMC. 2009 at exactly 7:45 pm because of left side weakness and semiconscious with slurred speech. etc. he attended a wedding of his brother. an anti-hypertensive drug as his maintenance for his hypertension. patient is taking Captopril 75 mg 1 tab daily. It was his 1sy time to be diagnosed with CVA. the patient had eaten too much fatty foods such as homba. Upon admission his BP was high (160/100mmHg). According to the SO.
He is the fourth from the eldest child. only hepatitis B vaccine. Although. the patient experienced sore eyes when she was 9 yrs. . His 52 years old sibling had Diabetes Mellitus. The usual sickness the patient¶s families often encountered are the common colds. old and mumps when she was 13 yrs. cough and headache. Both of his parents had a history of hypertension and died because of Stroke.PAST HEALTH HISTORY Childhood Illness According to the informant. He is married and blessed with one child. fever. sometimes he seeks for a medical check-up checkFamily Health History The patient has 5 siblings with 3 girls and 2 boys in the family. History of Hospitalization Patient doesn¶t have any history of hospitalization. old. The patient did not complete his immunization.
coSLEEP AND REST PATTERNS Before hospitalization. patient usually sleeps at 9 pm and wakes up at around 5 am. He is a person who loves to stay and have fun together with his friends and co-officemate. usually 8 hours of sleep . he never defecated during day and with a dwelling Folley bag catheter. But during his hospitalization. his sleeping pattern was in interrupted due to his condition. But during our assessment in the hospital. He had irregular sleep and wake up pattern as stated by the SO.And an active smoker as his past time in which he can consume 3 packs of cigarette per day as stated by the SO.Personal Health History LIFESTYLE The patient was indulged in drinking alcohol if there are occasions with San Miguel Beer about a minimum of 1 liter or sometimes 1 case of beer with his colleges and during high school days. . ELIMINATION PATTERN The patient defecated twice a day and urinated 4-6 times a day 4and he don¶t have any difficulties in urination and defecation before his hospitalization.
He also goes to church every Sunday to attend the mass as stated. go on duty in a government office every weekday as claimed by the SO. Environmental Data The patient¶s house is situated near the basketball court in Canlanipa Housing wherein the houses are closed to each other. he loves to play with his 1 child and listen to radio.ACTIVITIES OF DAILY LIVING Before hospitalization. clean and green environment as described by the SO. according to his wife. Currently he is a government employee. . Patient doesn¶t have experience any history of accidents on the job. he is so devoted on his work. Social Data Our patient is a college graduate of Bachelor of Science in Civil Engineering as stated by the SO. our patient takes a bath every day. Patient¶s support systems are her family and friends. RECREATION AND HOBBIES As claimed. Their house is made up of cemented materials and they live in a peaceful. Oftentimes. he makes use of his vacant time hanging out with his family and sometimes goes on gimmick with his friends. he strolls on a Sunday night riding his motorcycle. Oftentimes.
Aside from that. fish and vegetables.Psychologic Data Before hospitalization. Patient¶s don¶t have any food allergies. he ate snack 3 times a day. There are times that the patient felt upset if something will happen to his family. Patterns of Health Care The patient did not consult any annual check-ups nor checkvisited even a dentist. patient¶s typical on a normal day was consists of meat. The patient and his family used herbal plants as alternative medicine such as ³carabo´ for cough and ³helbas´ for abdominal pain as verbalized by the SO. as claimed by the SO. the patient was an energetic and fun to be with husband as stated by his wife. . Nutritional Pattern Before hospitalization.
weak.36. agitated and irritable. with a signs of cardiac or respiratory distress. Vital Signs: Date of Assessment: August 12. He appears weak.PHYSICAL ASSESSMENT General Survey Patient lies on bed conscious.160/100 mmHg . Patient is afebrile and has an IVF of PNSS infusing well at the right metacarpal vein at the level 620 cc with a drop rate of 20 gtts/min. Patient has an O2 inhalation at 3L/min via nasal .3 oC RR.26 cpm PR.96 bpm BP. restless. 2009 T.
Thick and black hair with a few streaks of graying hair upon inspection but not that prominent yet Uncombed hair noted upon inspection With no infestation of dandruffs or flaking upon inspection. Perspiration noted Hair Hair is evenly distributed on the scalp upon inspection. smooth and moist skin upon palpation Good skin turgor noted No tenderness upon palpation both in right and left part of the body No edema noted upon inspection.INTEGUMENTARY: Skin Patient has brown complexion and uniform in color Negative in pigmentation Warm. Variable amount of body hair with beard noted upon inspection .
Lids close symmetrically upon inspection. No edema or tenderness noted over periorbital area upon inspection and palpation. Slightly rough in texture upon palpation. Pupils are black and equal in size upon inspection (5 mm) Blurred vision. Absence of nodules or masses upon palpation. Drowsy eyes noted . Smooth.Nails Convex curvature of nail in shape and dirty upon inspection. uniform consistency of the skull upon palpation. Intact epidermis surrounding the fingernails and toe nails upon inspection. Sclera appears white upon inspection. Right Flaccidity faced note Eyes and Vision Thick eyebrows and lashes are noted upon inspection No abnormal discharges of the eyes upon inspection. HEENT: Skull and Face Rounded and normocephalic skull contour and no scars upon inspection. Capillary refill test of less than 3 seconds unaffected side and more than 3 seconds at affected side and more than 3 seconds on toes. cant read with ( RANGED) 8 involuntary blink reflexes noted in 1 minute.
No abnormal discharges noted Auricles are of the same color with the facial skin upon inspection. firm. No tenderness and lesions on both nose and sinuses noted upon palpation. Difficulty in hearing on the left ear Nose and Sinuses Nose is symmetrical and straight upon inspection. NGT attached Oxygen attached (3L/min) . External nose has same color as facial skin Right mole noted on the upper part of the nose Nasal septum is intact and in midline upon inspection. and not tender upon palpation. No discharges or flaring noted upon inspection.Ears and Hearing Symmetric ear position that lines with outer canthus of the eye upon inspection. Pinna recoils after it is folded. Auricles are mobile.
Thyroid gland is not visible upon inspection. With head centered upon inspection. Slightly dark gums and plaque noted on the enamel upon inspection. . Coordinated smooth movements of the head upon inspection. uniform and brownish in color. No presence of dentures upon inspection. Lymph nodes are not evident/palpable upon palpation. Has ability to purse lips upon inspection.Oropharynx (mouth and throat) Lips has symmetric contour. Lacking 2 lower molars upon inspection Halitosis noted With NGT attached Negative gag and swallowing reflexes noted Neck Neck muscles are equal in size upon inspection. Slightly enlarged neck noted upon inspection Can hyperextend and flex neck but in a slower pace upon inspection. soft and slightly dry upon inspection and palpation. Able to move tongue and positioned centrally upon inspection. No jugular vein distention was noted upon inspection.
Chest wall intact and no tenderness noted upon palpation Antero-posterior diameter is 2:1 Antero Respiratory rate 26 cpm O2 inhalation attach and no respiratory distress noted Spinal column is vertically aligned and intact with no tenderness or masses noted upon palpation. CARDIOVASCULAR SYSTEM and PERIPHERAL VASCULAR SYSTEM . No abdominal aortic pulsations upon auscultation.THORAX AND LUNGS Chest is symmetrical upon inspection. Apical pulse palpable and no edema noted . Pulse rate of 96 bpm Blood pressure of 160/100 mmHg Positive tactile fremitus upon palpation Capillary refill test of less than 3 seconds unaffected side and more than 3 seconds at affected side and more than 3 seconds on toes. Skin is intact and uniform in color both anterior and posterior upon inspection and palpation.
No evidence of enlargement of liver or spleen upon inspection and palpation. or tenderness noted upon palpation. Same color as the skin of abdomen/back upon inspection. nodules. No discharges in the nipple noted upon inspection. Uniform in color upon inspection.BREAST AND AXILLAE No masses. ABDOMEN Small brown pigments on the abdominal skin noted upon inspection. Easy fatigability noted Patient unable to do ADL¶s . Symmetric abdominal contour upon inspection. No rebound tenderness felt upon palpation MUSCULOSKELETAL SYSTEM Pulse is palpable on distal part of the extremities when palpated Slow coordinated movements noted Muscle strength is 4/5 Paresthesia and paresis noted in the left side of the body No edema noted upon inspection.
to voice on request = 2 OpeningMotor Response. converses = 3 ResponseScore: 8/15 ± slightly coma .oriented. Memory He was able to recognize the people who surround him.MENTAL STATUS Language During the first day of assessment the patient has difficulty in speaking as evidenced by slurred speech but able to comprehend spoken words. recognize persons in his room and but not specifically in date and time upon assessment. He wasn¶t able to explain that the reason for seeking healthcare service.to verbal command = 3 ResponseVerbal Response. As to long term events. Orientation Patient is not oriented to time but he knows who¶s his talking to and where he was. he was able to recall where he grew up by asking some question and he nags his head if correct. but identify present location. Glasgow Coma Scale Eye Opening.
Patient uses eyeglasses because he is unable to read small written words or phrases. of PNSS infusing well at the right metacarpal vein at the level 620 cc running with a drop rate of 20. . Nose. restless. Patient has no history of ear infection. Head. Patient is afebrile and has an IVF. dizziness and light headedness which are usually aggravated by heavy work. curling/ straightening preparations were used. Patient has an O2 inhalation via nasal cannula at 3 L/min Integumentary System: As what the so verbalized. agitated and irritable. Ears. the patient had no history of skin itchiness. 2009 General Data: Patient lies on bed conscious. Throat (HEENT): Patient has no history of head trauma. He appears weak. and responsive with signs of cardiac or respiratory distress.REVIEW OF SYSTEMS (ROS) Date of assessment: August 14. No hair dyes. and no pigmented spots on the upper and lower extremities. Patient also claimed that at times he experienced headache. Eyes. moist skin and oftentimes experience sweating. He has a warm. coherent.
Gastrointestinal System: Patient claimed that there were few times when he finds it difficult to manage his food intake especially when he was still working. Thorax and Lungs: Patient verbalized that he did not have any major lung diseases experienced. like lung cancer and PTB. He sometimes experienced incidence of diarrhea. He also stated that he experienced fatigue every time he is over worked or under some emotional stress. Patient stated that he experienced numbness. He has no known allergies in terms of foods. His usual bowel habit is every day usually in the morning. ³Salonpas´ ³hilot´ Breast and Axillae: Patient did not experience any pain on his breast area. . he observed an increase appetite but tries so hard to curtail it for fear of Hypertension complications and it resulted in increase weight and increase blood pressure.Neck: Patient said that when he works too much he sometimes experienced neck and back pain and were relieved through using ³Salonpas´ and ³hilot´ or massage. Cardiovascular System: He said his usual BP is 160/100 mmHg and experiences palpitations. He is a smoker and drinks alcoholic beverages. tingling sensation and observed poor wound healing. Lately. However he still drinks alcohol occasionally when he finds it difficult to decline when his friends cajole him whenever they get together but he insisted that on moderation only.
He also feels guilt for maybe his condition now is a repercussion of his behavior a few years ago. He felt depressed when he was admitted. He is anxious about his condition and its effects to his wife and children. Hematologic: Patient had no history of anemia. This is because he knows that stroke is an illness that requires a long time to recuperate. Urinary System: Patient claimed that he has no major complication in his kidney. He felt nervous and tense for his recent condition since he had relatives who died from stroke. It was relieved through relaxation techniques like taking sleep. .Musculoskeletal System: Patient claimed that he experienced neck and back pain when his at work especially when having an over time. sitting on a chair while watching television and frequents breaks while working. easy bruising and bleeding. Neurologic System: Patient said that he often have mood swings that sometimes lead to an argument with his wife over minute details which irate him.
SA. or Adams-strokes syndrome. Elderly patients tend to metabolize drug slowly and may need reduced dosage. .Phenytoin (Dilantin) Classification: Anticonvulsants Dosage: 100 mg 1 cap BID Mechanism of Action: May stabilized neuronal membranes and limit seizure activity either by increasing efflux or decreasing influx of Sodium oins across cell membranes in the motor cortex during generation of nerve impulses. Indications: To control tonic ± clonic and complex partial seizures. To prevent and treat seizures occurring during neurosurgery Contraindication: Contraindicated in patients hypersensitive to hydantoin and in those with sinus bradycardia. block.
Allow at least 7 to 10 days to elapse between dosage changes. . drug may precipitate at injection site. Mononucleosis may decrease level. slurred speech. Don¶t stop drug suddenly because this may be worsen seizures. thrombocytopenia HEPATIC: toxic hepatitis METABOLIC: hyperglycemia MUSCULOSKELETAL: osteomalacia SKIN: Stevens-johnson syndrome. decreased coordination. Divided doses given with or after meals may decrease adverse GI reaction. constipatio HEMATOLOGIC: agranulocytosis.Adverse Effect: CNS: ataxia. dizziness and headache. nystagmus. toxic epidermal necrolysis Nursing consideration: Don¶t give IM unless dosage adjustments are made. pancytopenia. blurred vision GI: gingival hyperplasia. leucopenia. mental confusion. vomiting. nausea. CV: periarteritis nodosa EENT: diplopia. Watch for increase seizures.
A centrally acting synthetic analgesic compound no chemically to opioids.Tramadol (Milador) Classification: Opioid Analgesic Dosage: 1 cap TID / NGT Mechanism of action: Unknown. . Thought to bind to opioid receptors and inhibit reuptake to norepinephrine and serotonin. Indication: Moderate to moderately severe pain. Contraindications: Contraindicated in patients hypersensitivity to drug Use cautiously in patients with hepatic or renal disease. or history of drug or alcohol abuse. Patient with history of anaphylactic reaction to codeine and other opioids may be at increased risk.
headache. proteinuria. seizure. diarrhea GU: menopausal symptoms. Monitor patient at risk of seizure. . Monitor CV and respiratory status Monitor bladder and bowel function For better analgesic effect. asthenia CV: vasodilation EENT: visual disturbance GI: constipation. abdominal pain. urinary frequency SKIN: diaphoresis. give drug before onset of intense pain.Adverse effect: CNS: dizziness. pruritus Nursing Consideration: Reassess patient¶s level of pain at least 30 minutes after administration. anxiety. somnolence. vertigo. nausea and vomiting. anorexia.
inhibiting tubular reabsorption of water and electrolytes.Mannitol (Osmitrol) Classification: Osmotic Diuretic Dosage: 2 % 100 cc IV bolus q 120 starting in AM Mechanism of action: Increases osmotic pressure of glomerular filtrate. drug elevates plasma osmolality. Indication: test dose for maked oliguria or suspected inadequate renal function.severe pulmonary congestion. increasing water flow into rxtracellular fluid. frank pulmonary edema . To reduce intraocular or intracranial pressure Diureses in drug intoxication Contraindication: Contraindicated in patients hypersensitive to drug. Oliguria To prevent oliguria or acute renal failure. Contraindicated to patient with anuria.
Adverse reaction: CNS: dizziness. impotence HEMATOLOGIC: aplastic anemia. Monitor glucose level. . headache. and electrolyte levels. rash. fatigue. vertigo. leucopenia HEPATIC: jaundice. give drug in the morning. urticaria. vomiting. weight.anorexia. Monitor fluid intake and output. paresthesia CV: orthostatic hypotension. especially in diabetic patient. palpitations. vasculitis GI: pancreatitis. polyuria. hepatitis MUSKULOSKELETAL: muscle cramps SKIN: pruritus. Monitor blood pressure. blood pressure. nausea GU: nocturia. dermatitis Nursing consideration: To prevent nocturia.
Piracetam (Nootropil) Classification: Neurovascular enhancer Dosage: 1. . neuroleptics. to pregnant and lactated mother.2 gm IVTT Mechanism of action: CNS stimulants. depressive states. somnolence. increase in weight. depressive states. Contraindication: Contraindicated to patient with hypersensitivity to drug. aggreesively. Adverse effect: Sexual stimulation. mental fatigue. impaired memory. troubled speech. thyroid hormones Indication: Disturbances in cerebral activity due to advanced age. increased motor activity. lack of concentration. emotional lability.
PREVACID Classification:Anti ulcer Dosage: FGT 30 mg 1 cap once a day Mechanism of action: Inhibits activity of proton pump and binds to hydrogenpotassium adenosine triphosphate located at secretory surface of the gastric parietal cells to block secection of gastric acid. diarrhea. Indication: Short term treatment of active duodenal ulcer. nausea . Adverse effect: GI: abdominal pain. Contraindication: Contraindicated to patients hypersensitive to drug.
shake gently and give any remaining contents. Refill the syringe with about 5 ml of water. Flush with additional apple juice to give entire dose and maintain patency of the tube. The contents of capsule can be mixed 40 ml of apple juice in a syringe and given within 3-5 minutes via a nasogastric tube. . 2. dissolve a 15 mg tablet in 4 ml water or a 30 mg tablet in 10 ml water and give within 15 minutes.Nursing consideration: 1. 4. Patients with severe liver disease may need dosage adjustment. but don¶t adjust the dosage for elderly patients or those with renal insufficiency. To give ODT¶s through an NG tube 8 French or larger. Its unknown if drug appears in breast milk. Breast feeding women should either stop breast-feeding or stop drug. 3.
CNS disorder or retinal or visual field changes. Bacterial infections caused by anaerobic microorganisms.Metronidazole (Zolmid) Classification: Antiprotozoal. Contraindicated to patients hypersensitive to drug or to other nitroimidazole derivatives and in women in first trimester pregnancy. use cautiously in patients with history of blood dyscrasias. 3. Indication: 1. Intestinal amebiasis. The 2 g regimen produces a high level that¶s more likely to reach fetal circulation. Alert: If drug must be given to a pregnant women for trichomoniasis use the 7-day regimen not the 2 gm single dose regimen. .Antibacterial Dosage: 500 mg IV infusion q 8 hours Mechanism of action: Direct-acting trichomonacide and amebicide that works inside and outside the intestines. Contraindication: 1. 2. Amebic liver abcess. 3. 2.
3. 4. seizures. especially if he¶s receiving corticosteroids.Adverse effect: CNS: headache. Give oral forms with meals. pharyngitis GI: nausea. duodenal ulcer. Flagyl RTU may cause sodium retention. Record number and character of stools when drug is used to treat amebiasis. thrombophlebitis EENT: rhinitis. Nursing consideration: 1. edema. abdominal cramping or pain GU: vaginitis. vertigo CV: flattened T wave. . Monitor liver function test results carefully in elderly patients. flushing. dysuria RESPIRATORY: upper respiratory tract infection. Observe patients for edema. 2. sinusitis. fever. polyurea.
increases cerebral metabolism and increases the level of various neurotransmitters. it has been demonstrated that citicoline restores the activation of phospholipase A2 and accelerates the reabsorption of cerebral edema in various experimental models. Adverse Reactions: May exert a stimulating action of the parasympathetic.CITICOLINE (Zynapse) Classification: Dose order/frequency/route: 500 mg IVTT q 6O Mechanism of action: It activates the bio-synthesis of structural phospholipids in the neuronal membrane. head trauma of varying severity. including acetylcholine and dopamine. cognitive disorders of various etiology. as well as improved learning and memory performance in animal models of the brain aging. Citicoline has shown nueroprotective effects in situation of hypoxia and ischemia. Furthermore. Contraindications: Patients with hypertonia of the parasympathetic. . Indications: Cerebrovascular diseases. as well as a fleeting and discrete hypotensor effect.
Adverse Effect: CNS: headache. seizures. OD Classification: Anti-coagulant/anti-platelets Mechanism of Action: Therapeutic agent¶s can¶t cure convulsions disorder but do control seizures without impairing the normal function of the CNS. anorexia. nephrotoxicity Nursing Considerations: check for medical history for hypersensitivity to anti-convulsant drugs don¶t discontinue abruptly unless provider approved be prepared in case of acute oral toxicity .o. coma EENT: decreased intraocular pressure GI: nausea and vomiting. Indication.PLETAAL Dose ordered/ frequency/route: 50mg 1 tab p. candidiasis GU: protienuria. This is often accomplished by selective depression of hyperactive areas of the brain responsible for the convulsants. diarrhea. Pain and cold sensation in chronic arterial occlusion Contraindication: Contraindicated in patient with hypersensitivity to drug.
C. Adjunct lipid-lowering treatments such as LDL apheresis Heterozygous familial hypercholesterolemia To reduce the risk of MI. angina. Indicaton: Adjunct diet to reduce LDL.Atorvastatin Calcium (Lipitor) Classification: HMG-CoA reductase inhibitor Dosage Order: 10 mg 7 tab P. or revascularization procedures in pt. severe acute infection and severe metabolic disorders. Use cautiously in pt. serious acutr condition that suggest myopathy. Limit use in children to those older than age 9 w/ homozygous familial hypercholesterolemia. w/ history of liver dse. hypersensitive to drug and in those w/ active liver disease or unexplained persistent elevation of transaminase levels. . stoke. major surgery. or heavy alcohol use. HDL. w/ multiple risk factor for CAD Contraindication: In pt. supper Mechanism of Action: Inihibits HMG-CoA reductase. an early step in cholesterol biosynthesis. cholesterol. Withhold or stop drug in patients at risk for renal failure.
Before treatment. Drug may be given as a single dose at any time of day. Obtain periodic liver function test results and lipid levels before starting treatment and at 6 and 12 wks. assess pt. Watch for signs of myositis . insomnia CV: peripheral edema EENT: pharyngitis. rhinitis GI: abdominal pain.Adverse Effect: CNS: headache. asthenia. diarrhea GU:UTI Musculoskeletal: rhabdomyolysis Respiratory: bronchitis Skin: rash Nursing Considerations: Use only after diet and other nondrug therapies prove ineffective. Pt. constipation. should follow a standard low-cholesterol diet before and during therapy. w/ or w/o food. or after an increase in dosage and periodically thereafter. After initiation. for underlying causes for hypercholesterolemia and obtain a baseline a lipid profile.
Patient and Family Education Report to physician without delay the onset of unexplained fever. This interrupts conversion sequences initiated by rennin that lead to formation of angiotensin II. A sudden exaggerated hypotensive response may occur with in 1-3 hr of 1st dose. Report darkening or crumbling of nail beds. cough. especially in those with high BP or on a diuretic. . Nursing implications: Monitor BP closely following the 1st dose. pruritis. fainting altered taste sensation. Advise bed rest and BP monitoring for the 1st 3 hr after initial dose. easy bruising or bleeding. first dose hypotension. photosensitivity and impaired renal function. weight loss.CAPTOPRIL (Capoten) Classification: Antihypertensive agent Dose order/frequency/route: 75 mg 1 tab q 12O Mechanism of Action: Lower blood pressure by specific inhibition of ACE. hyperkalemia. dizziness. slight increase in heart rate. a potent endogenous vasoconstrictor. Indication: Hypertension Contraindication: Pregnancy lactation Adverse Reactions: Hypersensitivity reactions.
belching. flatulence. probably as a result of bacterial degradation. diarrhea.Use cautiously in patients with diabeted mellitus Adverse reaction: GI: abdominal crapms. nausea and vomiting .Constipation Contraindication: . gaseous distention. which lowers the pH colon contents. resulting distention promotes peristalsis.contraindicated in patient with low-galactulose diet . Indications: . Also decrease ammonia.LACTULOSE (Lilac) Classification: Laxative Dose order: 30 cc 2 hs daily Mechanism of action: Produces an osmotic pressure effect in colon.
Replace fluid loss . Monitor 4. To minimize sweet taste. especially when giving in higher doses to treat hepatic encephalopathy 3.Nursing Consideration 1. dilute with water or fruit juice or give with food. Monitor sodium level for hypernatremia. Mental status and potassium levels when giving to pateints with hepatic encephalopathy 5. 2.
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Reminded the patient¶s S. Date of Discharge: August 17. to turn the patient into a side-lying position every 2 hours . to have a calm and quite environment Instructed the patient¶s S. OD Atorvastatin Calcium (Lipitor) 10 mg 7 tab P.C. the importance of the following recommendations to prevent further hemorrhagic stroke and keeping follow-up appointments for monitoring of risk factors . 2009 MEDICATIONS Advised the patient to take medication religiously as prescribed by the physician Phenytoin 100 mg 1 cap BID Prevacid 30 mg 1 cap once a day Pletaal 50mg 1 tab p. to have a well ventilated room and polluted free environment .O.Instructed the patient and SO.O.Reminded the patient¶s S.Reminded the patient¶s S. the importance of continuing health promotion and screening practices .O. .Advised the patient to ambulate and perform only tolerable exercises TREATMENT . supper EXERCISE/ENVIRONMENTAL CONCERNS .Encourage patient¶s S.Encouraged patient¶s S.Name of the Patient: Mr.O. to undergo physical therapy .O. V. the importance of following treatment regimen to facilitate the healing process.E.O.o.
Reminded the patient¶s S. close monitoring of the patient). .Reminded the patient¶s S.O.Instructed the patient¶s S. including surgical intervention if warranted. to check the position in giving NGT. with information about the causes of hemorrhagic stroke and its possible consequences. with information about the medical treatment that are implemented. to prevent aspiration in administering food. with information that will enable them to cooperate with the care and restrictions required during the acute phase of hemorrhagic stroke .O. . to maintain sterility or used sterile technique in giving NGT feeding.Reminded the patient¶s S.Reminded the patient¶s S.O. . .O.O.Reminded the patient¶s S. the importance of interventions taken to prevent and detect complications (aneurysm precaution. to maintain proper hygiene to avoid the risk for infection such as performing perineal care. .Instructed the patient¶s S.O.O. .Reminded the patient¶s S.O.HEALTH TEACHINGS . .
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