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Far Eastern University Institute of Nursing

Introduction Intracranial hemorrhage is the escape of blood within the cranium due to the loss of integrity of vascular channels and frequently leading to formation of a hematoma. Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma (as occurs in head injury) or non-traumatic causes (as occurs in hemorrhagic stroke) such as a ruptured aneurysm. Anticoagulant therapy, as well as disorders with blood clotting can heighten the risk that an intracranial hemorrhage will occur.

Objectives

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Define the Intracranial hemorrhage. Know the case of ICH, its possible signs and symptoms, risk factors, and diagnostic and laboratory exams.

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Determine the treatment and to apply appropriate nursing interventions. Lastly, to use the case as a tool in the improvement of one’s profession in applying nursing interventions.

I. Biographic Data Name: Address: Age: Gender: Religion: Admitting date/time: Room and Bed No.: Chief Complaint: Admitting Diagnosis: Final diagnosis: Attending Physician: II. Nursing History A. Past Health History The patient had measles and chickenpox during childhood. He cannot recall his immunization. There are no allergies in food and drugs. There are no foreign travels yet. He is asthmatic since childhood and had his last attack when he was in high school. He also has type 2 Diabetic Mellitus for 10 years and it is being maintained by Diamicron but after 7 years he stopped taking his medication because he assumed that his illness had been already cured. B. History of Present Illness The patient has Type 2 Diabetes Mellitus and Hypertension. 3 hours prior to admission, he experienced left sided body weakness. His friend noticed that he walked like tipsy wherein he is not sober that time and his friend decided to accompany him home. In their house, his son accompanied him to urinate when AT is about to fall. AT said to his son “Nanghihina ako” and his son noticed that he has slurring of speech. C. Family History Hypertension, diabetes mellitus and asthma runs through the family of AT. There are no other diseases noted. A.T. Blk11 L3 SSDM, Bulacan 48 y/o Male Roman Catholic Sept. 04, 2009 8:08AM 200 left sided body weakness 3hr. prior to admission T/C CVA, infarct ICH right basal ganglia score of 1, HCVD, CAD, T2DM Dr. Boy Saw

III. Patterns of Functioning A. Psychological Health 1. Coping Pattern When asked about how the patient copes up with life’s problems, he verbalized, “Naguusap-usap kami tungkol sa problema. Kapag gipit sa pera, tumatawag ako sa mga kapaid ko, humihingi ng pera.” Interpretation:

The client and his children talk about their problems and if it is about financial problems, they ask money from his sisters. Analysis: Coping may be described as dealing with problems or contending them successfully. Short-term coping strategies can reduce stress to a tolerable limit temporarily but are in the long-run ineffective ways to deal with reality. Fundamentals of Nursing research by Kozier 7th edition p. 1020). 2. Interaction Pattern AT’s sister verbalized that “Ayos naman ang pakikitungo niya sa ibang tao, marami siyang kaibigan sa village namin dahil nga security guard siya ng subdivision eh kilalang kilala siya doon at wala naman siyang kagalit.” AT’s has slurring of speech during the interview. As verbalized by his son, “Hindi masyadong maintindihan yung sinasabi ni Papa kapag nagsasalita siya.” He also has slow and sluggish movements. He also showed appropritae hand movements. Interpretation: The client has barriers to effective communication. Analysis: Human communication is essential for learning, working, and social interaction. Communication may affect every aspect of a person’s life based on a person’s cognitive level, educational attainment, and health status such as speech, language or hearing problems and disorders. (Fundamentals of Nursing by Taylor et al, 5th ed. Pp466-467) 3. Cognitive Pattern When we asked about his education, AT said that he is a college graduate. About his occupation he is an OIC of security guards in their village. Interpretation: The client finished tertiary education and is a college graduate. Analysis: COGNITVE DEVELOPMENT (PIAGET): Cognitive thinking culminates with the capacity for abstract thinking. This stage, the period of formal operations, is Piaget’s fourth and last stage. It is typical of the period of concrete thought. They now think beyond the present. Without having to center attention on the immediate situation, they can imagine a sequence of events that might occur, such as college and occupational possibilities; how things might change in the future, such as relationships with parents; and the consequences of their actions. At this time their thoughts can be influenced by logical principles rather than just their own perceptions and experiences. (Wong’s Essentials of Pediatrics Nursing, by Donna Wong and Marilyn J. Hockenberr-Eaton, 6th Edition, p. 525) 4. Self-Concept AT said that he is happy and contented even though he had been separated from his wife for how many years. He lives with his daughter and son. He is also happy because of his job, as an OIC security guard. Interpretation:

Family coping pattern When asked about his family. and social aspects of sexual being. P. Analysis: The self-concept becomes more differentiated as adults acquire a more complex picture of themselves. The self-concept gradually becomes more individualized and more distinct from the concepts of others. He is friendly in both male and female as verbalized by his sister that he everyone in their village knows him. (Fundamentals of Nursing by Kozier 7th ed. She also added that “Tinutuon na lang niya ang atensyon sa pagpapalaki sa mga anak niya at sa trabaho”. (Wong’s Essential of Pediatric Nursing by Wong and Eaton. after 2 years nilang maghiwalay nakapag-move na din siya na wala silang komunikasyon at hindi na rin nasusustentuhan yung mga bata”.The client does not see any problem with his self-concept and the way how he lives his life with his two children. emotional. 525) Image of physical self or body image is how a person perceives the size. Emotional Pattern Regarding to the emotional pattern of the client. It also involves the ability to recognize. Sexuality AT acts appropriate to his gender. (Fundamentals of Nursing by Kozier 7th ed. Analysis: Sexual health is the integration of the somatic. P. and express feelings and to accept one’s limitations. intellectual. 6 th edition. Interpretation: The client’s emotional state is normal. minsan napapalo ako pag may nagawa akong kasalanan at yung ate ko nasisigawan niya minsan” Interpretation: The client’s family is open whenever they have problems. p. communication and love. appearance and functioning of boy and its parts. The advent of chronic disease or a permanent physical disability has very special significance and creates stress for the person. accept. one that takes situational factors into account. 804) 5. his sister verbalized that “6 years na simula nung maghiwalay sila ng asawa niya. Interpretation: The client is able to express his own sexuality. Analysis: Emotional pattern is the ability to manage stress and to express emotions appropriately. 973) 7. in ways that are positively enriching and that enhance personality. 173) 6. Analysis: . Body sensation describes “how one feels and experiences oneself as physical being. his son verbalized “Ako at si papa po magkasama sa bahay tapos yung kapatid kong babae nakatira sa tita ko” he added “Close naman po kami kay papa.” Fundamentals of Nursing by Kozier 6th edition p.

Since they live inside the village. the family members are considered as a whole that functions together and not individually. 178) C. p. He also loves to watch TV when at home. (Fundamentals of Nursing by Kozier 7th ed. teachers and the like. Interpretation: The client has a positive outlook in life and has faith in God. pg. (Fundamentals of Nursing by Kozier 6th ed. That’s why sometimes he asks money from his sister. It is a form of relaxation on the part of a person. (Fundamentals of Nursing by Kozier 6th ed. As for his recreational activities. The client lives in SSDM Bulacan wherein he is also the security guard of the said village. p. Interpretation: The significant relationship pattern of the client is normal since the client is able to regard people around her who are significant. Analysis: Significant other is an individual or group that takes on a special importance for the development of self-esteem during a particular life stage. mouse. (Fundamentals of Nursing by Kozier. When it comes to decisions. peers. income. his son mentioned that he often drinks with his friends and neighbors in their village. Spiritual Pattern AT is a Roman Catholic.250) All individual’s standard of living (reflecting occupation. . since family relationships are particularly close. The client’s environment has no health hazards. siblings. circumstances.806) Recreational activities are often determined by what is popular and what can provide independence. thus an opportunity to pursue at one’s own pace. It should provide physical and psychological comfort. Significant others may include parents. mental nourishment. It is also a time free of obligations and formal duties of paid work. p. and influences surrounding and affecting the development of an organism or a person. and education) is related to health. Drinking often is not healthy. morbidity. The client’s recreational pattern is similar to others of his age which is interesting and can provide independence. pleasure and relief from fatigue of work. (Public Health Nursing-DOH book. 118) B. The client’s source of income for their basic needs and the education of his children are not enough for the family. Sometimes their house has cockroaches. AT’s income is not enough for their basic needs and to the education of his children. Socio-cultural Pattern The client’s siblings and his children are considered as significant others as mentioned by his son. and mosquitoes. 201) The environment is all the conditions. P. food habits. enlivenment. and the propensity to seek health care advice and follow health care regimens vary among high-income and low-income groups. their environment is not exposed to air pollution.Family roles are especially important to clients. He believes in God and he goes to church once a month. and mortality. All members of the family are empowered to maintain communication with each other. Hygiene.

Elimination from the urinary Nutrition Elimination . The client usually voids 6 times per day. component of body framework are the functions of protein in our body system. barbeque. attitudes and feelings about illness and death. or infinite source of energy. He loves to eat pulutan such as Dinakdakan and Sisig. He often drinks beer with his friends and he consumes 4-6 bottles of beer. Tissue growth and repair. Carbohydrates. interpersonal and transpersonal connection. helps regulate acid-base balance. He always drink softdrinks while eating lunch.714) The client urinates 4-5 times and defecates once a day. He is fond of eating pork liempo. Interpretation: patient has a normal elimination pattern Analysis: A properly functioning urinary system is essential to the body’s physical well-being.313) IV. It generally involves a belief with some higher power. softdrinks and alcoholic beverages that are bad to his health. During Hospitalization The client maintains a soft low salt. His urine is light in color and aromatic in odor. He drinks more than 8 glasses of water. He eats all kind of foods. commonly known as sugars and starches. Spiritual and religious beliefs are important in many people’s lives.Analysis: Spirituality refers to that part of human that seeks meaningfulness through intrapersonal. (Fundamentals of Nursing by Kozier 6th ed. p. They can influence lifestyle. Activities of Daily Living Before Hospitalization A. divine being. and to a person’s general sense of wellbeing. During hospitalization the client is following his diet regimen Analysis: Nutrition is a basic human need that changes throughout the life cycle and along the wellness-illness continuum. usually eats thrice a day. creative force. p. tokwa’t baboy and sisig. His stool is brownish in color and smooth. to life itself.T. He defecates once a day. are organic compounds composed of carbon. hydrogen and oxygen. helps regulate fluid balance through oncotic pressure. He has a good appetite. low fat DM diet. (Fundamentals of Nursing by Kozier 6th ed. Interpretation and Analysis Interpretation: The client is fond of eating foods with high cholesterol.

hydration. nutritional status. As for the client’s hygiene. p.T. he cannot do his daily routine or hygienic practices. takes a bath 12 times a day and brushes his teeth twice a day.tract helps to rid the body of waste products and materials that exceed bodily needs. comfort and self-concept.117) Hygiene A. (Fundamentals of Nursing by Kozier 6th ed. p. some patients experience severe or chronic alterations in bowel elimination that affect their fluid and electrolyte balance. Sometimes he plays basketball with his neighbors. (Fundamentals of Nursing by Kozier 6th ed. A. (Fundamentals of Nursing by Kozier 6th ed. Analysis: Personal hygiene promotes physical and psychological well-being. Various studies have confirmed that improved personal hygiene practices reduce illness rates. Although most people have experienced minor acute bouts of diarrhea or constipation. does bed exercises every morning by stretching.T. Interpretation: The client’s activities/ exercise are very limited due to his illness.918-920) Exercise The client is always walking because of his job (subdivision’s security guard). Analysis: Active exertion of muscles involving the contraction and relaxation of muscle groups is termed “exercise”. The client’s activities/ exercise are very limited due to his illness. . He always washes his hands before and after eating. Individuals who choose inactive lifestyles or who are forced into inactivity by illness or injury place themselves at high risk for serious health problems. and regular exercise is necessary for its healthy functioning. The human body was designed for motion. p. Elimination of the waste products of digestion is a natural process critical for human functioning. skin integrity.345) Interpretation: The patient has a limited movement that’s why he cannot do his daily hygienic practices.

Analysis: Rest connotes a condition in which the body is in decreased state of activity with the consequent feeling of being refreshed. Illness that causes physical distress can result in sleep problems. There are times that he will be awakened to take his meds. (Fundamentals of Nursing by Kozier 6th ed. Interpretation: The patient has a disturbed sleep and rest pattern related to illness. changing of IV fluids. The client has shorter periods of sleep unlike before.Sleep Rest and The client usually sleeps 6 hours per day including his naps. for vital signs monitoring. p. Sleep is a state of rest accompanied by altered consciousness and relative inactivity. People who are ill require more sleep than normal and the normal rhythm of sleep and wakefulness is often disturbed.998) .

7º C Pulse Rate: 65Beats per minute Respiration Rate: 20 Breaths per minute Blood Pressure: 140/90 mmHg (Abnormal BP client is experiencing hypertension) GCS: 15 APPEARANCE AND MENTAL STATUS: .V. Physical Assessment VITAL SIGNS: Temperature: 36.

Erect The client is relaxed and weak in appearance. (medsurg by Black 7th edi. with Lifestyle Relaxed. in which only one side of the body is affected. No signs of distress. p. .ASSESSMENT Body Build: Posture and Gait NORMS STANDARDS Proportionate.The client may exhibit flat affect. and Understandable. Brunners p. Organization Speech of Moderate Exhibits association Behavior changes after a stroke. appropriate for height. for thought Slurred speech . (Medsurg 10th edi by Brunners and Suddarths p. 68) appropriately Normal Pace. situation Client’s response to situation No sign of distress Cooperative sometimes Normal Normal Normal Odors Signs of Distress Attitude Affect/Mood. AND ACTUAL FINDINGS Varies Medium body ANALYSIS build. exhibits but seldom if he can’t thought association answer the son or the sister talk. Normal clothes are appropriate for the current condition Breath No body or breath odor No body and breath odor related to activity. Relevance organization thoughts and Logical Sequence. because of CNS disease or because (Med-Surg of damage 10th edi. principally in those patients who had cerebrovascular accidents. Quality.He Posture. Answers of Makes sense. Hygiene Grooming Body and and Neat and Clean 68) Looks neat and clean. may occur with disorders of the central nervous system. Cooperative appropriate to the is the The client has flat affect and irritable. Coordinated has generalized body Movement weakness with minimal movement. Normal Asymmetry of movement. clients responses Appropriateness of the appropriate Quantity. to by cranial nerves.2116) He can’t verbalize well Speech may be slurred NGT is present.

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Normal infestation Convex curvature. distributed hair. Observe nail beds) in Normal dark-skinned people Moisture in skin folds Moist and the axillae varies with Palpate environmental and temperature. activity Skin temperature of Skin temperature of Normal the two feet and two the two feet and hands range are uniform two hands are and within the normal uniform and within the normal range. to Normal to olive Skin color generally Skin color generally Normal uniform areas except exposed in uniform to sun. areas of lighter pigmentation (palms. No alopecia and other infections. skin previous state Hair Inspect previous state The hair is evenly Thick and evenly Normal distributed Thick hair Silky. skin When pinched. ruddy light pink olive to light oink. lips.AREAS THINGS TO ASSESSED INTEGUMENT Skin OR TECHNIQU BE E NORMS STANDARDS AND ACTUAL FINDINGS ANALYSIS Inspect Varies from light to Varies from deep brown. Nails Inspect . yellow overtones yellow overtones to brown. Note Skin Turgor: springs back Skin Turgor: to springs back to Normal When pinched. deep ruddy pink to light oink. Resilient Hair No infection or Convex curvature.

759 Normal Normal Normal Normal Normal RBC Count Hemoglobin Hematocrit WBC MCV (Mean Corpuscular Volume) MCH (Mean Corpuscular Hemoglobin) MCHC (Mean Corpuscular Hemoglobin Concentration ) Eosinophils 0. lithium.5x1012/L 14-16 g/dL Interpretation and Analysis Normal High May indicate Polycythemia.VI.47L/L 5-10 x10 ^ 9/L 82-92 fl 27-33 pg 32-38% 0.55-0. LABORATORY EXAMINATIONS COMPLETE BLOOD COUNT September 4.84 x 10^9 /L 91.759 High There might be an acute infection.50 L/L 7.65 Lymphocytes 0. histamine.9 pg 34.35 Low With stress and certain medications such as epinephrine.37-0. heparin.7 f 30.67 0.26 0.5-6.50 x 10^12 /L 17.03-0.00 g/dL Normal Findings M: 5. tissue necrosis.25-0.52L/L F:0. 2009 Result 5.05 Segmenters 0. epinephrine.42-0. Dehydration and COPD Fundamentals of Nursing by Kozier p.01 0. antibiotics Fundamentals of Nursing by Kozier p.0 pg M:0. digitalis.759 Normal . thyroxine and ACTH Fundamentals of Nursing by Kozier p. leukemias and drug influences such as aspirin.

a product of the breakdown of fatty acids. tissue RBCs WBCs Phosphates Prostatic fluid Urates. Color Sp.030 Clear Analysis Normal Normal Bacteria. Gravity Character Bilirubin Protein Glucose Blood Ketone Negative Negative Negative Negative +2 Negative Negative Negative Negative Negative . 2009 Actual Findings Light Yellow 1.06 Normal ROENTGENOGRAPHIC REPORT September 4. URINALYSIS September 4. Aorta is calcified.06 0. be found in the urine of clients with poorly controlled diabetes. Diaphragm and bony thorax are unremarkable.010 Hazy Normal Findings Light straw to dark amber 1.02-0.005-1. Pulmonary vascular markings are within normal limits. however.Monocytes 0. They may. uric acid Normal Normal Normal Normal Abnormal Ketone bodies. 2009 Impression: Atheromatous aorta Chest: No active lung infiltrate seen. Pus. Heart is not enlarged. normally are not present in the urine.

sometimes called acute gastroenteritis. which is ointense on T1W1 slightly hyperintense on T2W1 and shows blooming artifact on GRE. Pertinent MR findings: There is 2.771 Normal Normal Normal Normal Low Urine is slightly acidic with an average pH of 6. is an inflammation of the stomach and intestines caused by the introduction of certain types of bacteria into the digestive tract.9 cm (APxTxH) abnormal signal.Nitrite Leukocytes Pus Cells RBC pH Negative Negative Negative Negative 6.5 x 3. These findings are indicative of intracerebral hemorrhage in hyperacute stage.8 x 2. in the R basal ganglia and surrounding capsules extending superiorly into the R corona radiate. 2009 Indication: The patient presents left-sided body weakness and slurring of speech. Casts Crystals Bacteria None None Moderate None None None DIFFUSION WEIGHTED MRI OF THE BRAIN September 4. Bacterial gastroenteritis. Fundamentals of Nursing by Kozier p.770 Normal Normal Abnormal Bacteria present in stool indicate infection. There is an associated perilesional .6-8 Fundamentals of Nursing by Kozier p.0 Negative Negative 0-2 hpf 0-3 hpf 4.

There are old lacunar infarcts in the left external capsule and probably also in the anterior portion of both corona radiata. left frontal subcorticalwhite matter and both forceps major. There is also 1.html HgbA1c BLOOD CHEMISTRY Septem ber 4.7% Normal Findings 4-7% % Analysis Abnormal Indicates Diabetes.edema with apparent mild compression effect to the right lateral ventricle producing some mild bowing of the midline structures leftwardly.2009 --Normal Findings 70-100 mg/dL Interpretation and Analysis High Greater than normal levels (hyperglycemia) may indicate: • • • • • • • • • • RBS Acromegaly (very rare) Cushing syndrome (rare) Diabetes mellitus Impaired fasting glucose (also called "prediabetes") Hyperthyroidism Pancreatic cancer Pancreatitis Pheochromocytoma (very rare) Too little insulin Too much food http://www.gov/medlineplus/en . 2009 Actual Findings 10. http://diabetes_basics/what/high_bloo d_sugar. Other worth mentioning findings include chronic small vessel ischemic changes in the centrum semiovale/coron radiate. 2009 358 mg/dL Septem ber 7. 2009 --Septem ber 8.0 x 0. Minimal perilesional edema is likewise present.4 (APxT) focal hemorrhage in subacute stage in the left lentiform nucleus and left external capsule. In addition.nlm.nih. Remarks: There are finding of bilateral intracerebral hemorrhage of differing ages as described. there is a probable petechial hemorrhage in the right occipital region. SEROLOGY September 5.

viral hepatitis or alcohol can cause elevated SGPT.90-6. A wide array of conditions can cause this problem. which can increase the risk of heart disease and stroke.50-5. and nerve problems in people with diabetes. These problems don't usually show up in .00 mmol/L Normal Normal High Indicates diabetes mellitus.71 mmol/L --3.60 mmol/L 2. vision problems.70 mmol/L 4. an enzyme found within the liver cells. Having too much sugar in the blood for long periods of time can cause serious health problems if it's not treated.co m/pages/SGPT.htm Na K Glucose 131.29 mmol/L 12. 2009 @ 1pm 277 mg/dL @ 2pm 271 mg/dL @6pm 369 mg/dL @ 7pm 237 mg/dL @ 10pm 346 mg/dL Normal Findings 70-110 mg/dL Interpretation and Analysis High *Indicates Diabetes. Usually fatty liver is not a cause for significant liver problems.20 mmol/L --- 147. For example. indicate that the liver cells are either leaky (internal contents are entering the blood) or damaged. a condition that does not necessarily mean generalized obesity. Hyperglycemia can cause damage to the vessels that supply blood to vital organs.htm Normal High Elevations of SGPT.30 mmol/L 3. kidney disease. We know that patients can have elevated liver tests as a result of fatty liver. CLINICAL CHEMISTRY RESULT Capillary Blood Glucose Actual Findings September 4.83 mmol/L --- 135-148 mmol/L 3.Crea 92 mmol/L 166 U/L --- --- SGPT --- --- M: 62-115 mmol/L F: 53-97 mmol/L 0-55 U/L cy/article/003482.http://www.valdezlink.

these health problems can occur in adulthood in some people with diabetes.html High * 70-110 mg/dL 70-110 mg/dL 70-110 mg/dL 70-110 mg/dL 70-110 mg/dL High * High * Normal High * Normal . 2009 September 9. 2009 September 7. 2009 September 8.September 5. 2009 September 10. particularly if they haven't managed or controlled their diabetes properly. http://diabetes_basics/what/high_bloo d_sugar. 2009 @ 2mn 242 mg/dL @ 6am 190 mg/dL @11pm 150 mg/dL @ 12nn 397 mg/dL @ 1pm 377 mg/dL @ 3pm 382 mg/dL @ 4pm 283 mg/dL @ 5pm 256 mg/dL @ 5am 207 mg/dL @ 11am 167mg/dL @ 5pm 125 mg/dL @ 5am 106 mg/dL @ 5pm 163 mg/dL @ 5am 110 mg/dL @ 5pm 92 mg/dL @ 5am 204 mg/dL @ 5pm 141 mg/dL @ 5am 105 mg/dL 70-110 mg/dL kids or teens with diabetes who have had the disease for only a few years. 2009 September 6. However.

Drug Study .VII.

 Advise patient to seek emergency medical attention if he feels adverse effects of the drug. abdominal pain.  Do not crush. chest pains. and a general ill feeling. Breaking or opening the pill would cause too much of the drug to be released at one time. pylori infection. dizziness. restlessness.  Advise patient to seek emergency medical attention if he has chest pain or heavy feeling. myalgia. sweating. Contraindicated in patients with known hypersensitivity to any component of the formulation.  Give each dose of omeprazole with a full glass (8 ounces) of water. dizziness. Cerebrovascular disorders and head injury Contraindication Contraindicated to patients with allergy with the drug Side Effects elevated body temperature. constipation. upper respiratory infection. Omeprazole 2mg 1 CAP OD Antacids. low or high blood pressure. blurred vision. paraesthesia. nausea or vomiting. dry mouth. break. and difficulty sleeping if the supplement is taken in the evening. nausea. arthralgia. vomiting.  Assess patient for any allergy of the drug. nausea. Antireflux Agents & Antiulcerants Eradication of H. skin rashes. headache. or open a delayed-release capsule. Prophylaxis of acid aspiration. insomnia. Diarrhoea. urticaria. It is specially made to release medicine slowly in the body. diarrhea. Nursing Responsibilities  Assess patient for any allergy of the drug.Generic/Trade Name Citicholine Dosage/ Frequency 1g BID Classification Nootropics & Neurotonics Indication Parkinson's disease. pain spreading to the arm or shoulder. Omeprazole is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid). Potentially Fatal: Anaphylaxis. weakness. headache. fatigue. to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions caused by excess stomach acid. acid regurgitation. taste perversion. back pain. flatulence.  Store omeprazole . cough.

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excessive urine production. blurred vision.VIII. unexplained weight loss DEATH Increased metabolic demands of the heart and everyday activities Perfusion pressure may be insufficient to provide adequate blood flow . The blood supply and the demand of the heart for oxygenated Limitations to coronary blood flow with vasospasm and thrombosis Diminished insulin action Hyperglycemia S/Sx: Generalized weakness and malaise. Pathophysiology Aneurysm Severe Hypertension AV Malformation Risk factors • DM • • • HPN Smoking Obesity High cholesterol levels Heart Disease Age Rupture of cerebral vessel Bleeding in the Right basal ganglia Intracerebral bleeding occurs • • • Contralateral hemiplegia. excessive thirst. with initial flaccidity progressing to spasticity Sudden severe headache Nausea and vomiting Coma Increased ICP Decreased insulin production Imbalance bet.

male 48 years of age. . and are more likely to be fatal among blacks) and heredity. DM HIGH-CHOLESTEROL DIET CVA ENVIRONMENT DRINKING ALCOHOL CAD OCCUPATION SECURITY GUARD D. age (two-thirds of strokes occur in people over age 65). The non-modifiable factors are sex (women are more likely to die from a stroke).Working as a security guard in the subdivision. 2009 the client experienced left side body weakness 3 hours PTA. increase salt. Predisposing Factors The host. Bulacan. The modifiable factors are hypertension. sedentary lifestyle. Factors like diet.X. smoking. race (affect blacks more often than whites. diabetes mellitus. HYPERTENSION MALE DMT2 FAMILY HISTORY HPN. with a nationality of Filipino and is residing at Barangay San Manuel SSMD. C.He engages in drinking alcohol often with friends consumes 4-6 bottles of beer. and fatty foods intake. Hypothesis The condition of the client might have been resulted from the interrelationship of the risk factors that the client gained overtime. Client is known to be hypertensive and with DMT2 Last September 4. Ecologic Model . Ecologic Model A. and the client’s lifestyle aggravates the condition of the client. obesity. With familial history of hypertension and Diabetes Mellitus. stress. . familial history. B. Analysis There are several factors of CVA. cholesterol. He is fond of eating pork foods which is high in cholesterol.

Conclusion and Recommendations The factors contributing to the disease are Familial history. such actions may prevent worsening of the disease. factors contributing to the client’s attack are FAMILIAL HISTORY. Though this may not reverse the problem. edema or spasm (p. thus. hemorrhage. Prioritization NURSING PROBLEM Impaired Tissue Perfusion (cerebral) related to bleeding CUES JUSTIFICATION Cerebral perfusion of the cerebrum is critical for survival and long term outcome. HPN. His food habits must be corrected. Food habits and alcohol consumption. The body becomes weaker and vulnerable to a lot of diseases as it matures. his blood vessels become less elastic and covered by atheroma or fat plaques which narrows or obstructs the passage of blood causing an infarct to the area.In this case.1858 Medical Surgical Nursing by Joyce Black) Impaired physical mobility related to neuromuscular  left sided body weakness  slow and sluggish movements Almost all clients have some degree of immobility after a stroke. therefore it should be the first priority in the care of the client. Occupation.LIFESTYLE. the incidence of stroke is higher in men than that of women. Present illness HPN.”  Changes in BP (BP): 140/90 mmHg  slurring of speech  left sided body weakness  flat affect and irritable .  Subjective: “Nanghihina ako. E. Lifestyle. Such factors that are not modifiable. always be in assistance with the client because with this disease.GENDER As in all diseases. the client becomes too weak with sensory and motor impairments Lifestyle should also be modified. embolus. Decrease in cerebral blood flow may be secondary to thrombus. a genetic predisposition increases one’s risk of having the disease. care must be focused on ensuring client comfort and wellness and decreasing further complications and worsening of the disease.DMT2. XI.GENDER. DIET. Lastly. DM2.HPN.AGE. Also. His advancing age also cause a lot of physiologic changes in his body. Remind the family to be in constant monitor of the client in case of an attack. As a person ages. also intensified his risk because such acts increase the deposition of fat in the vessels and its hardening. His alcohol consumption .DM2 aggreviates the disease.OCCUPATION.

122 Medical Surgical Nursing by Lippincott Williams & Wilkins) Impaired verbal communication related to decrease in circulation to brain  “Hindi masyadong maintindihan yung sinasabi ni Papa kapag nagsasalita siya. p. Early recognition of this problem decreases some of the frustration in meeting everyday needs and the ability to effectively communicate and express feelings and sensations to other people.”  slurred speech  showing of hand movements The inability to speak is frustrating for clients.impairment Pressure ulcers are common problem for anyone with a lower than normal level of activity. pressure ulcer still cause prolonged distress and adversely affect the patient’s ability to function and his/her quality of life. (p. even when not infected.1860 Medical Surgical Nursing by Joyce Black) . Infected pressure ulcers are one of the primary causes of death in a patient with neurological diagnosis. It can be deadly for a patient who can’t turn or move by him/herself.1859 Medical Surgical Nursing by Joyce Black. (p.

Cues: Subjective: “Nanghihina ako.After 1 hour of chambered) brain is nursing intervention known as the seat of the client will be thought. (stroke) Objectives: The cerebral hemisphere of our Independent bicameral (two.. improved cognition.7º C PR: 65 BPM RR: 20 BPM Immediate Cause: Goal: Ineffective tissue After 5 hours of perfusion nursing interventions. maintain function. motor and sensory function. able to: awareness.i. Dysrhythmias and murmurs may reflect cardiac disease. which may have precipitated . the Intermmediate client will have no Cause: further deterioration Intracranial as mainifested by hemorrhage improved cerebral tissue perfusion Root Cause: and stabilized Cerebrovascular neurological Accident deficits. motor a.e. can occur because of the brain damage. ” as verbalized by the client. and appropriate affect and mood. sensory adequate function. and speech oxygenation -. When a hemorrhage (bleeding from b. Administer oxygen O2 therapy may be therapy required to maintain adequate airway and to improve cerebral tissue perfusion.XII. Objectives:  slurring of speech  left sided body weakness  flat affect and irritable Measurement: VITAL SIGNS: Temp: 36. maximize traumatic injury or tissue arterial damage) perfusion occurs inside the brain in one or both of the hemispheres. Assess heart rate and rhythm. auscultate for murmurs. Changes in rate. the higher brain. especially bradycardia. memory. Nursing Care Plan NURSING PROBLEM Impaired Tissue Perfusion (cerebral) related to intracranial hemorrhage as evidenced by left sided body weakness ANALYSIS GOAL AND OBJECTIVES INTERVENTIONS RATIONALE EVALUATION Goal met as the client had adequate and improved cerebral perfusion as evidenced by stable vital signs.

Bleeding commonly occurs in the basal ganglia. shape. tiny outpouchings of the arterial walls which are weak and subject to bursting). Evaluate pupils. equality. maintain blood pressure within normal range Frequently monitor To maintain perfusion blood pressure without promoting cerebral edema. and cerebral white matter. noting size. noting location of cerebral patterns and insult/increasing ICP and rhythm need for further intervention. The hemorrhage (bleeding) may extend into the ventricular system or subarachnoid space of the brain. Hypertension (High Blood Pressure) is one of the prime causes. if patient is alert. neutral position.e. Position with head c. in some cases. b. Reduces arterial pressure by promoting venous drainage and may improve cerebral circulation/perfusion. light reactivity. . including speech. Assess higher functions. thalamus. Assess Irregularities can suggest respirations. and less commonly in the pons.BP: 140/90 mmHg Symptoms depend on distribution of the cerebral vessel(s) involved. Response to light reflects combined function of the optic (II) and oculomotor (III) cranial nerves and is useful in determining whether the brainstem is intact. cerebellum. The bleeding. main slightly elevated tain head/ and in neutral neck in position. including possible respiratory support. Changes in cognition and speech content are an indicator of location/ degree of cerebral involvement and may indicate deterioration/ increased ICP. may compress the brain CVA. It is also suspected that the underlying blood vessels of the brain may be abnormal with microaneurysms (i..

maintain normostem compression thermia. occurs. cerebral glucose and stem (lower part of oxygen consumption. antihypertensives. Lifestyle changes are the first step for anyone with coronary artery • Outpatient See the doctor for regular follow-up appointme nts. Discharge Plan Medications Medicines may be needed in addition to lifestyle changes. This lets the doctor keep track of the risk factors and adjust his • • Statins to help lower cholesterol. the death rate is very high. It isn't major surgery. Health Teaching Treatment focuses on taking steps to manage your symptoms and reduce your risk for heart attack and stroke. Your doctor can suggest a safe level of exercise Treatment/Therapy Procedures may be done to improve blood flow to the heart. complications stool softeners) as prescribed by the physician. Lowering of Triglyceride levels by reducing consumption of sugary and Support System Get the support you need to succeed in making lifestyle changes. XIII. Ask family or friends to share a healthy meal or join a stop- . Exercise Get regular exercise on most. Engage in medications (eg. Beta- • • Angioplasty is used to open blocked arteries.Monitor client’s Normo. If brain d. prevent further therapy. the brain). During • Diet Lowering of LDL cholesterol by reducing saturated fat intake. days of the week.thermia reduces temperature. Collaborative After 1 hour of intervention the client will be able to: Administer Will aid in the recovery of a. if not all. the patient and help pharmacologic anticoagulants.

These changes may stop or even reverse coronary artery disease. fruits. Nitrates to relieve chest pain. high-fiber grains and breads. and olive oil. Or ask your doctor about a cardiac rehab program. A good goal is 30 minutes or more a day. smoking program with you. Changing old habits may not be easy. Often a small wiremesh tube called a stent is placed to keep the artery open. This may be the most important thing you can do. • Aspirin or other medicines to reduce the risk of blood clots. Lower your stress level. To improve your heart health: Don't smoke. The doctor may use a stent that is coated with medicine. Increased antioxidant activity by higher consumption of fruits and vegetables. This widens the artery to help restore blood flow. vegetables. healthy habits • Bypass surgery. and folic acid. Eat a hearthealthy diet that includes plenty of fish. dairy products. but it is treatment as needed. Instruct to keep nitroglyceri n with him at all times. if the doctor prescribed it for chest pain. disease. • angioplasty. poultry and eggs. which is major . Walking is great exercise that most people can do.blockers or ACE inhibitors to lower blood pressure. it slowly releases a medicine that prevents the growth of new tissue. called a drugeluting stent. Lowering of fibrinogen and growth factors by cutting back on foods such as red meat. the doctor guides a thin tube (called a catheter) into the narrowed artery and inflates a small balloon. This helps keep the artery open. In cardiac rehab. Quitting smoking can quickly reduce the risk of heart attack or death. Do not stop or change medicines without talking to the doctor. • Take medicines exactly as prescribed. Stress can huzrt your heart. a team of health professionals provides education and support to help you make new. See a dietitian if you need help making better food choices. beans. When the stent is in place. Reduction of Homocystein e levels by supplementat ion with Vitamins B6 and B12. for you. • • • •  processed foods.

It uses healthy blood vessels to create detours around narrowed or blocked arteries. may be used if more than one coronary artery is blocked. Having a plan can help. Instead of having dessert.surgery. Start with small steps. take a short walk. very important to help you live a healthier and longer life. When feeling stressed. For example. commit to eating five servings of fruits and vegetables a day. stop and take some deep breaths .

Ruzol JR. Famela Jean TEOVISIO. Kimberly Ann BSN117 Group 68 MATULAC.. Jessely . Maria Junelsia GAMBOA. Bettina Rose GARCIA. RM. Jessedith Ann GAMBOA. PT.Far Eastern University Institute of Nursing Case Study Intracranial Hemorrhage Submitted to: Pepito B. Michael Brian GANCENIA. RN. Janice GARCIA. MSN Submitted by: BSN117 Group 67 GALINATO.

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