Old CVA

Post cardiac
arrest
 outline
 Patient data
 Diagnosis
 Physical Assessment
 Investigation
 Nurse care
 Goal of care
 Treatment
 Patient data
Name : ganema selem al-atawi
.Date of admission : 2/1/1430 H
Diagnosis : post cardiac arrest + old CVA
Age: 81 years old
Sex: f
Nationality: Saudi
Address: haqel
Department : ICU

:Post cardiac arrest

Post cardiac arrest means postive response to cpr

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

On Admission
* Patient came from ER to ICU 11:35 PM with AmboBag
Patient on mc/v with data SIMV ( T.V 300 – FIO 50% - RR 10 –P/S 5 )
Change data according to ABG'S results
↑↓ FIO until 30% now P/S 7 ) .
* ECG – Xray's – ABG'S – CT brain done
* inserted NGT – SILICON cath on urine bag – I.V. canula
* patient on muscle relaxant (sedation) : dormicam –fentanyle – tracurum )
* all blood investigation and culther was sent
 Physical Assessment
Name: ganema selem al-atawi
Date: 18/10/1431 H.

Vital Signs:
Stable naw
1. Temperature: 36.8 Site: axallry
2. BP: 136 /53 mmhg
3. Pulse: 56
4. Resp. Rate: 20
5. O2 Sat.: 100 %

Assessmet:
LOC : un conseous patient's
Attached with:
* EET : size : 7
Fixed : 9
*NGT : size ;16
Change every 10- 15 days
*silicon cath on urinary bag
Change every 30 days
*I.V. canula
Change every 3 days

Investigation
1. CT. brain after 2days from admission
2. Daily ABG every for 1.5 years
then ABG every 10-15 day (now)
3. ROTIEN investigation ( CBC – PT -PTT – INR – B.T & C.T …)
First year daily
Naw every 15 day
:Anthesesia Doctor
Plan of treatment
Continue mechanical ventilation with parameters

A.M. SIMV (T.V: 280 – P/S :7 – RR : 6/min – FIO : 30% ) 7:00

A.M. Shift to CPAP( FiO: 30% Ps: 7 RR: 6/min PEEP: 5 TV: 280 cc) 8:00

A.M.shift to T-piece 1L/ min WITH spontenous breathing 9:00

Oxygen countinue till 1:00 am or if PT get tired shift to SIMV
 ETT + mouth care
 Chest physiotherapy
 Change position Q 2 hrs
 ABG if needed

Goal of care
KEEP PT SAFE , CLEAN , CAMPFORTABLE …
Nursing care
 Ventilation

EET :
Change every 2-3 weeks
Suction

 Feeding
300ml/3hrs
High protein dait

 Suction
* Oral (airway)
* EET
Sucation cath. According to EET size

 Hygiene
Bed bath Every day at 4:00 am
… Clean face, hair, mouth , cut nails
Treatment

medication
Clexane 30 mg OD – S.C
It is used to stop blood clots forming within the blood vessels.
T. Amlor ( 10 )
mg
Amlodipine is in a group of drugs called calcium channel blockers. It is used to treat high blood
.pressure (hypertension) or chest pain (angina)
T.tenormin 50 mg
Tenormin is in a group of drugs called beta-blockers. it is used to treat angina (chest pain) and
.hypertension (high blood pressure). It is also used to treat or prevent heart attack
T. One alpha 100 mg
Pseudo-deficiency (D-dependent) rickets
:T. septrin
Antibiotic smoll dose 800 mg

T.iso mack :
Prophlatic dose 20 mg BD