LEVEL 4 . NCM 104 .

1 SEM SY 2011-2012
ST

P a g e | 12

XII. Comprehensive Pathophysiology

Predisposing Factors:
Dysilpe Non-modifiable Age (loss of blood vessel elasticity) Hypertensive Cardiovascular Disease Modifiable Lifestyle Diet

Precipitating Factors

Increased level of Low Density Lipoprotein (LDL) in the blood / Dyslipidemia High risk of atheroma formation which adheres to the inner lumen of the blood vessel Adherence of platelets

THROMBOEMBOLI FORMATION
Dislodgement of thrombi due to increased peripheral resistance due to hypertension

Embolus lodged to the brain artery

Presence of blockage increases ICP Nausea and Vomiting

Occlusion of the Artery leading to the right thalamus, right occipital lobe and left cerebellar area

Cerebral Hypoperfusion

Deficient Fluid Volume

Projectile Vomiting persisted for several hours

Ineffective Cerebral Tissue Perfusion

Impaired Distribution of oxygen and glucose

Tissue hypoxia and Cellular Starvation

Cerebral Ischemia

Failure of the ion pumps

Initiation of Ischemic Cascade Damage to the blood vessel endothelium Production of oxygen free radicals and other reactive agents Damage to the blood vessel

Potassium flows out of the cell into the extracellular space

Depolarization of neuronal membranes Increased intracellular calcium levels (influx)

Release of neurotransmitters into the synaptic space

Activation of destructive enzymes (proteases, lipases, endonucleases)

Glutamate is release, accumulates at excitatory synapses and in the extracellular space. Altered mitochondrial function Further energy depletion Cellular Death (Apoptosis)

Release of cytokines

Loss of cellular integrity

ISCHEMIC STROKE
S/Sx: Projectile Vomiting and Aphasia

Admission to Benguet General Hospital

Contralateral Hemiparesis

Apraxia

Global Aphasia Loss of Mental Acuity

Impaired Mobility Impaired Verbal Communication

Self-Care Deficit

Risk for Impaired Skin Integrity