CHAPTER 1 : INTRODUCTION

We, the students of the University of Baguio - School of Nursing, Group NCB 1, went for

our duty last September 29-30, October 1, 6 and 7 of 2019, 3-11 shift, at the Baguio General

Hospital and Medical Center. We were assigned to Medical 3 – Neuroscience Ward to experience

hands on care to Neuroscience Disorders or diseases. We were under the keen guidance and

supervision of their clinical instructor, Mr. Roniefhel N. Apsay. We decided to record this case of a

patient who is diagnosed as CVD ICH LEFT PUTAMEN. He has been confined at Med 3 since

September 11, 2019.

The brain is one of the largest and most complex organs in the body that is made up of

billions of nerves that controls the body. A problem in the brain may lead to a problem of the whole

body. A cerebrovascular disease refers to a group of conditions, diseases, and disorders that affect

the blood vessels and blood supply of the brain. If a blockage, malformation, or hemorrhage

prevents the brain cells from getting enough oxygen, brain damage can result. Aneurysms and

hemorrhages might cause severe health problems. Blood clots can form in the brain or travel there

from other parts of the body, causing a blockage.

Hemorrhagic stroke: This occurs when a blood vessel in part of the brain weakens and

bursts open, causing blood to leak into the brain. The leaking blood puts pressure on the brain

tissue, leading to edema, which damages brain tissue. The hemorrhage can also cause nearby

parts of the brain to lose their supply of oxygen rich blood. Intracranial hemorrhage may occur

within brain parenchyma or the surrounding meningeal spaces. Hemorrhage within the meninges

or the associated potential spaces, including epidural hematoma, subdural hematoma, and

subarachnoid hemorrhage.

Intracranial hemorrhage (ICH) refers to acute bleeding inside your skull or brain. There are

four types of ICH: (1) epidural hematoma; (2) subdural hematoma; (3) subarachnoid hemorrhage;

(4) intracerebral hemorrhage. The patient manifests intracerebral hemorrhage. It is a bleeding

inside the brain. This is the most common type of ICH that occurs with a stroke. The patient

manifested a 20cc putamen in the brain. This blood can crush delicate brain tissue or limit blood
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supply. The brain is compact. A blood clot can move parts of the brain and compresses them. This

leads to constriction and it prevents parts of the brain to function properly. The transmission of

nephrons will either be delayed or prevented to going to the different parts of the body.

In the United States, cerebrovascular disease is the fifth most common cause of death. In

2017, it caused 44.9 fatalities per 100,000 people or 146,383 deaths in total. (Moawad, 2019)

Intracranial hemorrhage accounts for 8-13% of all strokes and results from a wide spectrum of

disorders. Intracerebral hemorrhage is more likely to result in death or major disability than

ischemic stroke or subarachnoid hemorrhage. Intracranial hemorrhage and accompanying edema

may disrupt or compress adjacent brain tissue, leading to neurological dysfunction.

In 2013, 25 persons in every 100,000 persons are affected worldwide. There is a 30-day

mortality rate of 35-52% with only 20% of survivors fully recover (Caceres and Joshua, 2015).

Since 2007 to 2017, Stroke became the second leading cause of death following ischemic heart

disease; it is 27.8% in average in the Philippines (IHME, 2017). In 2015, the Cordillera Region had

registered 7,909 deaths and 4.5% of which is caused by ICH (PSA, 2018).

People can take steps to reduce their chances of developing cerebrovascular disease.
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Goals:

 To apply the knowledge and skills gained in our concept of Medical-Surgical Nursing and

to further expand our knowledge regarding these cases;

Specific Objectives:

 To be familiarized with the role of a nurse in patients who has CVD ICH

 To be able to gain trust with the patient and watcher comfortably interact with each other

 To understand the intricacies of the disease

 To determine appropriate therapies in the application of the nursing process

 To study the drugs appropriate for the disease

 To apply appropriate nursing interventions for a patient suffering from CVD ICH

 To improve condition by cooperating in the management of the condition