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INTRODUCTION
Definition:
Cerebrovascular accident: The sudden death of some brain cells due to lack of
oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery
to the brain. A CVA is also referred to as a stroke.
It is characterized by a relatively abrupt onset of persisting neurological
symptoms due to the destruction of brain tissue (infarction) cause by ischemia
(thrombus or embolism) or hemorrhage resulting from disorders in blood vessels that
supply the brain. Also called stroke
Symptoms of a stroke depend on the area of the brain affected. The most
common symptom is weakness or paralysis of one side of the body with partial or
complete loss of voluntary movement or sensation in a leg or arm. There can be speech
problems and weak face muscles, causing drooling. Numbness or tingling is very
common. A stroke involving the base of the brain can affect balance, vision, swallowing,
breathing and even unconsciousness.

Stroke – any sudden – onset focal neurological deficit
Causes:
 Intracerebral hemmorhage (rupture of a blood vessel in the pia mater or
brain
 Emboli (blood clots)
 Atherosclerosis (formation of plaque) of the cerebral arteries.

Risk Factor:
1. Hypertension – leading risk factor for coronary heart disease and stroke
– treatable and can be controlled.
2. Modifiable by change in lifestyle
a. smoking
b. elevated serum cholesterol
c. obesity
d. heart disease
3. Modifiable by Medical mean
a. Transient Ischemic Attack
b. Asymptomatic carotid bruit
c. Diabetes Mellitus
d. Increased blood viscosity
e. HPN
4. Non – modifiable risk factors
a. age
b. sex
c. race
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2.d.etiology unknown .neurologic symptoms develop and disappear over several minutes and completely resolve in 24 hours .likely the result from small infarctions (Lacunes) of the deep subcortical gray and white matter resulting in only temporary impairment 3. Reversible Ischemic Neurologic Deficit . Subarachnoid (5%) – result from aneurismal rupture of a cerebral artery with blood loss into space surrounding the brain. Transient ischemic attack (TIA) .Once stable called Complete Stroke Statistics Stroke is the Philippines' second leading cause of death. Hemorrhage stroke (intracranial hemorrhage)  5% of all strokes  two division a. Intracerebral (10%) – due to rupture of weakened vessels within brain parenchyma as result of Hypertension. It has a prevalence of 0·9%. evolve over 1 –2 hours. 2 . Stroke in Evolution . arteriovenous malformation or tumor b. . -rapid or prolonged interval of onset and may lead last many hours  Cerebral embolism (20%) -usually a cardiac origin -frequently result of chronic ischemic cardiovascular disease with secondary ventricular wall hypokinessis or artial arrhythmia – both conditions increase risk of intracardiac thrombus formation -quick onset and fully develop in a matter of minutes Temporal Classification of Stroke 1. previous stroke Types of Stroke by Etilogy: 1.often associated with active occlusive thrombosis of a major cerebral artery. Ischemic Strokes (remaining 85%)  Large (40%) or small (20%) vessel thrombosis -most commonly occur in presence of atherosclerotic cerebrovascular disease -vascular changes or lipohyalinosis found in small deep penetrating arteries as associated with chronic hypertension can lead to small vessel thrombosis.most frequently associated with atherosclerotic carotid artery disease 2.describe an unstable ischemic event characterized by the progressive development of more severe neurologic impairment .

This condition generally develops several weeks after a stroke.  Changes in behavior and self-care ability. depending on how long the brain lacks blood flow and which part was affected. 3 . Complications may include:  Paralysis or loss of muscle movement.  Memory loss or thinking difficulties. You may become paralyzed on one side of your body. reading or writing. Many people who have had strokes experience some memory loss. making it difficult for you to talk clearly (dysarthria). and it may improve over time.  Pain. if a stroke causes you to lose feeling in your left arm.  Emotional problems. You also may have difficulty with language (aphasia). Therapy with a speech and language pathologist may help. diabetes 6·0%. Age-adjusted hypertension prevalence is 20·6%. Complication A stroke can sometimes cause temporary or permanent disabilities. such as walking. People who have had strokes may become more withdrawn and less social or more impulsive. such as those on one side of your face or one arm. For example. They may need help with grooming and daily chores. numbness or other strange sensations in parts of their bodies affected by stroke. People who have had strokes may have pain. or lose control of certain muscles. dyslipidemia 72·0%.  Difficulty talking or swallowing. reasoning and understanding concepts. People who have had strokes may have more difficulty controlling their emotions. swallow or eat (dysphagia). This complication is known as central stroke pain or central pain syndrome. including speaking or understanding speech. especially extreme cold after a stroke. A stroke may cause you to have less control over the way the muscles in your mouth and throat move. making judgments.ischemic stroke comprises 70% while hemorrhagic stroke comprises 30%. and obesity 4·9%. you may develop an uncomfortable tingling sensation in that arm. Physical therapy may help you return to activities hampered by paralysis. eating and dressing. People also may be sensitive to temperature changes. But because the pain is caused by a problem in your brain. or they may develop depression. rather than a physical injury. there are few treatments. Others may have difficulty thinking. smoking 31%.

afebrile. with no signs of inflammation or infiltration on IV site. receiving oxygen inhalation at 2L/min via nasal cannula. 4 . 2016/ 8:40AM Source of History: Daughter 80%. BP. Slurring of Speech Date of Confinement: February 9. with patent IVF of PNSS @ 10gtts/min.Vital Information Name: DJ Room Number: 258-2 Age: 63 Gender: Male Civil Status: Married Date of Birth: February 20. 1953 Birthplace: Iligan City Cultural group: Iliganon Primary Language: Cebuan/Bisaya Religion: UCCP Highest Educational Attainment: Elementary Level Occupation: Farmer Usual Health Care Provider: Physician Reason for Seeking Health Care: Body Weakness. Nestor Estrada Impression/Final Diagnosis/Chief Complaints: To Consider Cerebrovascular Accident Description of Patient: asleep in supine position. with NGT on right nare. Chart 10% Attending Physician: Dr. indwelling urinary catheter with dark yellow urine output. skin warm to touch. Wife 10%.130/90. right sided body weakness. lethargic but can follow simple commands.

The patient opted for admission at Kolambugan Hospital. the patient is allergic to eggplant and squid. The patient is completely immunized as claimed by the wife. He does not take any medications for his DM 5 . He was diagnosed to have hypertension in the year 2000 and Diabetes Mellitus in year 2013. patient had onset of headache. He has not undergone any major or minor surgeries. and Cardiocyl. Right sided Body Weakness History of Present Illness One day prior to admission. Hours prior to admission. Mipraz. with dropping of facial features and slurring of speech. with pain and numbness all over the body especially on the right side of the body. He takes Citicoline. patient transferred to AMC-Iligan upon request hence the admission. History of Past Illness According to the patients wife. Estudgeron.Nursing History Chief Complaints Slurring of Speech.

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chicken). tocino. Stool Characteristics Color brownish Consistency Formed stool Smell Foul odor Frequency and amount Once a day Urine Characteristics Color Yellowish. He used a lot fish sauce. pito-pito (7 different kinds of leaves). guava leaves. DURING HOSPITALIZATION The client still has right sided body weakness that is progressive NUTRITIONAL AND METABOLIC PATTERN PRIOR TO HOSPITALIZATION The client’s typical food intake is composed of rice.orange Frequency and Amount 6 times a 1000ml/day day at least DURING HOSPITALIZATION Client has not defecated and has an indwelling urinary catheter with dark yellow color of the urine output. exercises. When signs and symptoms arise they sought medical consultation. Client urinates 6x a day which is yellowish. He cannot perform the things he likes and usually do. anything with preservatives. Client believed that proper diet.orange color w/out any discomfort. chicharon and fried dish (porkchop. MSG when cooking. with discomfort or difficulties and experienced excessive sweating. ELIMINATION PATTERN BEFORE HOSPITALIZATION Client usually defecates at least 1-2 times of soft and brownish stool. Occasionally he eats vegetables and fruits. meat. The client also believed in “albularyo” and use herbal medicines such as lagundi. He’s fond of eating processed food like corned beef.HEALTH PERCEPTION PATTERN BEFORE HOSPITALIZATION The client experienced weakness on the right side of his body when he does some household task like gardening. and fish. He does not perform testicular examination. He manages it by having a period of rest in bed. He is still uncomfortable with his state of health because it greatly affects his daily activities. His appetite was good and drinks 6 glasses of water daily. and adequate financial support are the things needed to maintain proper health diet and no vices are factors of having a healthy body. 7 .

ACTIVITY-EXERCISE PATTERN BEFORE HOSPITALIZATION His activities are gardening and going to their land in one of the barangays of Kauswagan. Financial problems and health condition usually makes him worried. When this things are encountered the client diverts his attention through talking to a family member and praying. When things are not so well. ROLE-RELATIONSHIP PATTERN The client lives in extended family. By means of good conversation they can easily fixed family problems. DURING HOSPITALIZATION The client usually sleeps the whole day. When family experienced difficulty of caring for the client they just take it as trials given by God. They live peacefully even there are hardship and difficulties that arrives to their lives. When big problems are encountered. He also does take naps during afternoon. COGNITIVE-PERCEPTUAL PATTERN The client does not have any hearing difficulty and can remember past events. he is confined to bed because of his present situation. SLEEP-REST PATTERN BEFORE HOSPITALIZATION The client sleeps for 8-9 hours usually from 8pm-5am. They have harmonious relationships with the family and their neighbors. SELF PERCEPTION AND SELF CONCEPT PATTERN The client said that his condition has not improved. he looks for his wife to be the most helpful person in talking things over. SEXUALITY-REPRODUCTIVE PATTERN There is no sexual activity. COPING STRESS TOLERANCE PATTERN The client was observed to be withdrawn but the behavior improved as evidenced by his socialization with other people. According to the wife the patient lose some weight. VALUE-BELIEF PATTERN The client is a member of the United Church of Christ in the Philippines (UCCP) usually 8 . Through demonstration he could easily learn things. DURING HOSPITALIZATION The client cannot do any activities during the hospital stay. he still experience right sided body weakness and high blood pressure. he always prays and ask assistance with the Lord. The client sleeps adequately at night. Some of the time they failed to attain what they want and try other alternatives in solving it. They spent most of their time by taking care of each other and with that they are showing their love for one another.

(-) cyanosis  HEAD .HEENT: (-) colds  Chest/Lung: CBS  Musculoskeletal: (+) weakness  ADMITTING IMPRESSION: To consider Cerebrovascular Accident Review of systems:  General: No at loss  Skin: (-) rash  HEENT: (-) colds  Musculoskeletal: (+) weakness.go to the church to attend religious activities. (-) edema  Respiratory: (-) cough  Cardiovascular: (-) chest pain  GI: (-) LBM SKULL AND FACE  normocephalic shape skull with absence of nodules or masses upon palpation  symmetrical facial features and facial movements HAIR AND SCALP hair is short. Physical Examination (IPPA-Cephalocaudal Approach) Physical Examination:  General : conscious. coherent  Skin: (-) pallor. black and kinkyt upon inspection evenly distributed with no lice and dandruff noted SKIN AND NAILS  warm and moist skin with absence of edema and nodules  fair skin complexion  no presence of lesions  has short fingernails and toenails  no presence of pallor 9 .

no tenderness noted and moves freely 10 . shiny and smooth with visible details of iris  pupils are equally round and reactive to light accommodation  no discharges noted upon inspection EARS AND HEARING  no tenderness behind the ears  auricles are same as the color of facial skin  aligned with outer canthus of eyes  not tender and recoil after being folded  left and right ear can hear clearly a normal voice tones NOSE AND SINUSES  symmetrical and straight  no discharges or flaring  has uniform color and not tender  nasal septum is intact and in midline  facial sinuses are not tender  no lesions MOUTH AND OROPHARYNX  dry and pale lips  with dental caries  tongue is at the center and pinkish in color with no lesions.EYES AND VISION  dark eyebrows are evenly distributed and symmetrically aligned with equal movements  black pupil  eyelashes are also equally distributed and curled slightly outward and upward  eyelids close symmetrically with skin intact and no discharge or discoloration  bulbar conjunctiva is transparent and sclera appears white  without pale palpebral conjunctiva  lacrimal ducts have no edema or tearing upon palpation  cornea is transparent.

soft non-tender and no masses UPPER EXTREMITIES and LOWER EXTREMITIES muscles are equal in size no contractures no tremors no bone deformities no tenderness palpated 11 . flat.NECK muscles equal in size head centered can move his head smoothly and with no discomfort lymph nodes are not palpable trachea is in the midline of the neck thyroid gland is not visible upon inspection and ascends during swallowing upon palpation carotid artery and jugular veins are not distended or visible THORAX AND LUNGS chest symmetric volume no tenderness noted no masses noted full and symmetric chest expansion breathing is rhythmic. quiet and effortless  no adventitious breath sounds upon auscultation  spine is vertically aligned HEART normal heart rate regular in rhythm peripheral pulses are symmetrical with that of the apical pulse ABDOMEN uniform in color.

can sense sharp and blunt objects 12 .