Case Based Presentation

By
Wilson

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 Objectives

• By the end of my case study presentation, listeners will be

able to,
• Discuss the significance of this case study presentation
• Discuss patient's data
• Discuss evidence based Nursing diagnosis and
interventions
• Develop a teaching plan.

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 Cont…

• Conclude the case study

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 Significance of the Case Study

I selected this patient for case study because of the

following reasons:
• Her case was interesting in relation to disease process.
• The case was important from Nursing Care point of view.
• Moreover the prevalence of stroke in South Asia and
particularly Pakistan is vey high.

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 Significance…..

• Stroke is the third most common cause of death and the

first leading cause of disability in developed and
developing countries.
• According to World Health Organization estimates, 5.5
million people died of stroke in 2002, and roughly 20% of
these deaths occurred in South Asia.

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 Incidence of stroke in Pakistan

• Estimated annual incidence is 250/100,000, translating to

350,000 new cases every year.
• At a major University hospital with a busy Neurology
service in Karachi, 519 patients with stroke were admitted
over a 22 month period.
• In a retrospective analysis of patients admitted with stroke
in two major hospitals over an 8 years period, 796/12,454
(6.4%) of consecutive cases admitted in medical units had
stroke.

• Bhojo A. Khealani ( Department of Medicine, Aga Khan University Hospital, Karachi, )

Bilal Hameed,Uzma U. Mapari ( Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. ) ,
Stroke in Pakistan.
http://www.jpma.org.pk/full_article_text.php?article_id=1444

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 Scenario

• My pt was 50 year old female.

• GCS
E:4, M:5, V:1 = 10/15
• She was house wife . She had history of DM and HTN.
She came to hospital with chief complain of right side
stroke and was not able to eat , speak ,difficulty in
chewing and to do other activities.
• Family history she had a family history of DM and HTN.

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 Genral Survey

• Pt lying on bed in Rt. lateral position, was looking lethargic

with hemiplegia. Overall skin was pinkish and physically
looking overweight.

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 A-G assesment

• A- air way clear

• B- breathing spontaneously at room air
• C- capillary refill 2/sec
• D- on soft diet
• E- Foleys catheter implaced
• F- aminovel @ 30 drops/mint
• G- pt looks lethargic and uncomfortable

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 Stroke?

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 WHO defined stroke as ‘rapidly developed clinical
signs of disturbance of cerebral (brain) function,
lasting more than 24 hrs or leading to death, with no
apparent cause other than vascular origin.

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 causes

• Artery blockage
• HTN
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Embolism

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 S/S

• Weakness
• Confusion
• Walking trouble
• Lack of coordination
• Lack of swallowing
• Severe headache
• G.I disturbance
• Urine incontinence

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 Diagnosis and labs…

• CT scan
Shows the right hemiplegic stroke and damage left
temporal region of the brain.
• BSR <200mg/dl
(blood sugar was high)
• BSF 312
(Normal =60-100)

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 Nursing Diagnosis And
Nursing Care

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 N. Diagnose and Interventions

• Self care deficit related to lack of coordination secondary

to stroke.

• Interventions
• Provide sponge bath
• Provide hand and foot care
• Provide back care
• Provide bed pan and urinal
• Provide N/g feed as prescribed

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 N. Diagnose and Interventions

• Impaired physical Mobility r/t Deceased muscle

strength and endurance s/t Paralysis
• Interventions
• Perform ROM
• Change position every 1 or 2 hrly

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 N. Diagnose and Interventions

• Impaired skin integrity r/t immobility s/t Comatose

state
• Interventions
• Teach family members to provide back care and massage the
vulnerable sites
• Increase fluid intake
• Change position every 2-3 hrly
• Provide air mattress beneath the bed sheet
• Put water filled gloves at the bony prominences of limbs

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 Teaching plan

• Stroke rehabilitation program.

-ROM (active and passive)
-Assist in daily life activity
-Foot drop prevention
• Control of HTN.
-Diet
-Exercise

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 Cont…

• Diabetic diet chart.

Teach about glucose monitoring and normal ranges.
• Speech therapy

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 Conclusion

In conclusion stroke is one of the most debilitating issues

of the older people. Being nurses we should have the
knowledge and skills to handle a patient with stroke. My
patient suffered stroke because of diabetes and
hypertension. These are the most commonest causes. In
order to prevent stroke the prevention of theses diseases
is essential.

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 Refrences:

• http://www.medicinenet.com/stroke/page3.htm
• http://www.ajmc.com/publications/supplement/2008/2008-06-vol14-
n7suppl/jun08-3376ps204-s211
• Bhojo A. Khealani ( Department of Medicine, Aga Khan University
Hospital, Karachi, )
Bilal Hameed,Uzma U. Mapari ( Department of Medicine, University of
Alberta, Edmonton, Alberta, Canada. ) , Stroke in Pakistan.
http://www.jpma.org.pk/full_article_text.php?article_id=1444

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