I.

INTRODUCTION:

Cerebrovascular accident  or stroke (also called  brain attack) results from sudden interruption of
blood supply to the brain, which precipitates neurologic dysfunction lasting longer than 24 hours. Stroke
are either ischemic, caused by partial or complete occlusions of a cerebral blood vessel by cerebral
thrombosis or embolism or hemorrhage (leakage of blood from a vessel causes compression of brain
tissue and spasm of adjacent vessels). Hemorrhage may occur outside the dura (extradural), beneath the
dura mater (subdural), in the subarachnoid space (subarachnoid), or within the brain substance itself
(intracerebral).

Risk factors for stroke include transient ischemic attacks (TIAs) – warning sign of impending
stroke – hypertension, arteriosclerosis, heart disease, elevated cholesterol, diabetes mellitus, obesity,
carotid stenosis, polycythemia, hormonal use, I.V., drug use, arrhythmias, and cigarette smoking.
Complications of stroke include aspiration pneumonia, dysphagia, constractures, deep vein thrombosis,
pulmonary embolism, depression and brain stem herniation.

Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden paralysis that is

often associated with ischemia. Apoplexy, from the Greek word meaning "struck down with violence,”
first appeared in Hippocratic writings to describe this phenomenon. The word stroke was used as a
synonym for apoplectic seizure as early as 1599, and is a fairly literal translation of the Greek term. In
1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause of hemorrhagic stroke
when he suggested that people who had died of apoplexy had bleeding in their brains.  Wepfer also
identified the main arteries supplying the brain, the vertebral and carotid arteries, and identified the
cause of ischemic stroke [also known as cerebral infarction] when he suggested that apoplexy might be
caused by a blockage to those vessels. Rudolf Virchow first described the mechanism
of thromboembolism as a major factor.

The traditional definition of stroke, devised by the World Health Organization in the 1970s, is a
"neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death
within 24 hours". This definition was supposed to reflect the reversibility of tissue damage and was
devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24-hour limit
divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that
resolve completely within 24 hours. With the availability of treatments that, when given early, can
reduce stroke severity, many now prefer alternative concepts, such as brain attack and acute ischemic
cerebrovascular syndrome that reflect the urgency of stroke symptoms and the need to act swiftly.

Strokes can be classified into two major categories: ischemic and hemorrhagic.  Ischemic strokes
are those that are caused by interruption of the blood supply either caused by thrombosis, embolism,
systemic hypoperfusion, venous thrombosis, while hemorrhagic strokes are the ones which result from
rupture of a blood vessel or an abnormal vascular structure. 87% of strokes are caused by ischemia and
the remainder by hemorrhage. Some hemorrhages develop inside areas of ischemia ("hemorrhagic
transformation"). It is unknown how many hemorrhages actually start off as ischemic stroke.

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 Stroke could soon be the most common cause of death worldwide.  Stroke is currently the
second leading cause of death in the Western world, ranking after heart disease and before cancer, and
causes 10% of deaths worldwide.  Geographic disparities in stroke incidence have been observed,
including the existence of a "stroke belt" in the southeastern United States, but causes of these
disparities have not been explained.

The incidence of stroke increases exponentially from 30 years of age, and etiology varies by age.

Advanced age is one of the most significant stroke risk factors. 95% of strokes occur in people age 45
and older, and two-thirds of strokes occur in those over the age of 65. A person's risk of dying if he or
she does have a stroke also increases with age. However, stroke can occur at any age, including in
fetuses. Family members may have a genetic tendency for stroke or share a lifestyle that contributes to
stroke. Higher levels of Von Willebrand factor are more common amongst people who have had
ischemic stroke for the first time. The results of this study found that the only significant genetic factor
was the person's blood type. Having had a stroke in the past greatly increases one's risk of future
strokes.

Men are 25% more likely to suffer strokes than women, yet 60% of deaths from stroke occur in
women. Since women live longer, they are older on average when they have their strokes and thus
more often killed (NIMH 2002).[20] Some risk factors for stroke apply only to women. Primary among
these are pregnancy, childbirth, menopause and the treatment thereof (HRT).

II. PATHOPHYSIOLOGY:

Increased level of Decreased/

Atherosclerosis/
cholesterol & Disrupted blood
Thrombosis/
Increased Blood supply in Brain
Embolism
pressure Tissue

Exhibit Signs and Sudden loss of

Symptoms Neurofunction

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 As evidenced by client’s Lipid profile and taken vital signs, the client has an increased levels of
cholesterol and LDL and is also having an elevated blood pressure which are both risk factors in
developing CVA/ Cerebral Infarction. As these cholesterol deposits within the walls of blood vessels in
the brain blood supply is disrupted as it narrows the lumen from which blood flows by forming clots.
Brain tissue ceases to function if deprived of oxygen for more than 60-90 seconds and approximately 3
hours which could possible lead to death of tissue (necrosis). As brain tissue ceases to function the client
will experience neurologic dysfunctions such as numbness or loss of sensation of one side of the body
muscle weakness on face and altered speech which are among the symptoms the patient experiences
prior to admission.

III. HISTORY:

Mr. Francisco Villegas retired from his last job have never been hospitalized and his first
admission to a hospital. He is 65 years old, admitted at around 3:00 pm in the afternoon of August 27,
Friday. Mr. Villegas complains of numbness in left side of his body, and experiences difficulty of speech.
He stated that he was in good health and has never experienced any discomfort few days prior to
admission.

He is living in Bicol Province but currently residing at Dalandanan, Valenzuela City with a
relative. He has four children and stated that his eldest daughter has hypertension which he assumed to
be inherited from him after he discovers that he has hypertension, too. According to him, he never
remembered his parents having hypertension or any cardiovascular disease. He stated that he is an
occasional drinker with an average intake of 4-8 bottles of beer. Fish and vegetables are what are
commonly served during mealtime and meat is served once a week. He also stated that he often eat at
fast-food chains every time he goes out to a mall with his family. He does not have prescribed
medications prior to admission nor known allergy.

LIPID PROFILE:

Cholesterol 7.66 mmol/L 3.66-5.20 mmol/L

Triglycerides 1.28 mmol/ L 0,68-1.70 mmol/L
HDL 0.81 mmol/ L 0.78- 1.55 mmol/L
LDL 6.60 mmol/L 1.70-4.59 mmol/L
VLDL 0.25 mmol/L 0.25- 0.79 mmol/L

IV. NURSING PHYSICAL ASSESSMENT:

Mr. Villegas appears alert, oriented and cooperative. Patient has no complaints of headache
change in vision, nose or ear problems, or sore throat. No complaints of dysphagia, nausea, vomiting, or
change in stool pattern, consistency, or color. He has no complains of epigastric pain. No complaints of
dysuria, nocturia, polyuria, or hematuria. No complains of muscle weakness or numbness and have
regain normal neurologic function and ability to resume daily activities after admission. He complains of

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no other arthralgias, muscle aches, or pain. Vital signs taken as follows: Blood Pressure: 150/100, Pulse:
62, Respirations: 21, Temperature: 36.2.

V. RELATED TREATMENTS:

Prescribed medications are as follows:

Captopril 25 mg (1 tab q 12°)

Citicholine 100 mg/ml (2 ml q 12°)
Simvastatin 40 mg (1 tab OD at bedtime)
Intravenous solution inserted Plain NSS KVO.
VI. NURSING CARE PLAN:

“Anu-ano ang dapat kong gawin para hindi na maulit ang nangyari sa akin?” & “Anung mga
pagkain ang dapat kong kainin?”, as verbalized by the patient. The nursing diagnosis would be Health-
Seeking behaviors related to current perceive health status as manifested by frequent asking of
questions of foods to be avoided. A major focus of nursing care is to promote effective health-seeking
behaviors in clients. Activities that do so include nurturing, encouraging, teaching, communicating, and
providing. According to Nyamathi (1989), “The health goals of the client and desired goals of the nurse
are mutually concerned with enhancing the individual’s motivation to attain and maintain health and
function, to avoid disease and disability, and to attain or retain the highest possible level of health,
function or productivity.”

Expression of eagerness to change lifestyle and participation in planning for change are the goals
of the nursing interventions to be implemented. Finding out client’s current health status, lifestyle,
behavior and precipitating factors that might have caused the problem is the first nursing intervention
to provide baseline information and detects improper or poor health practices that might have caused
the problem. Determine potential available resources beneficial to the plan of care this is to provide
accessible way and familiar ways in which the patient is going to switch and modify behaviors. Discuss
with the client the possible options in changing behaviors that are conducive to his health into that is
advantageous and could prevent worsening of disease condition. Print materials have been used to
inform client about their rights of information, for example the International Planned Parenthood
Federation (IPPF) poster on the “Rights of the Client” encourages clients to claim their rights to
information, confidentiality, and privacy during consultations. It has been translated into more than 20
languages and displayed in thousands of clinics worldwide. Information sheets or brochures listing
sample questions are another approach. They can encourage clients to formulate their own questions
for providers and remember to ask them during the consultation. Let the client choose the best options
he thinks that is more appropriate for him to facilitate patient’s participation in plan of care. Instruct
client to carry out general wellness behaviors such as exercise and healthy diet for the enhancement
and improvement of health. "Clearly the biomedical as well as the social science community now
acknowledges, theoretically, if not empirically, the multifaceted and complex nature of health and
well-being." (Schuster T, Dobson M, Jauregui M, Blanks R. "Wellness Lifestyles II: Modeling the Dynamic
of Wellness, Health Lifestyle Practices and Network Spinal Analysis." Journal of Alternative and

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Complementary Medicine 2004;10:357-367)
Moreover, Schuster et al note that a consensus is developing, in which health includes several domains
embracing the physical, psychological, mental, emotional, intellectual, social, and spiritual. The life a
person is living, the choices that must be made for the point in the individual's path, stresses to be
negotiated; human resources available at that moment in time, the person's structural capacity, and his
or her personal beliefs -- all do more to influence symptoms, illness, or wellness under most
circumstances than "abnormalities" found in a medical examination. From this expanded perspective,
treatment of a condition is very limited in its potential outcome.  Ask for the cooperation of other family
members and encourage them to guide and participate in client’s behavior modification this is to ensure
that the patient will adhere to the planned care and higher chance of success in the implemented
nursing intervention. Using therapeutic communication skills will further encourage the client to comply
and follow suggested management.

VII. RECOMMENDATIONS:

It is highly recommended that patient comply with the suggested and planned care for early
rehabilitation, recovery and positive changes and improvement of client’s condition. Patient’s family
must participate as well as a form of encouragement and increased tolerance of the client towards the
activities that requires client’s adjustment.

VIII. REFERENCES:

"The American Journal of Medicine;" Outcomes after Stroke: Risk of Recurrent Ischemic Stroke
and Other Events; Elkind, M. Volume 122, April 2009.

Brunner and Suddarth's Textbook on Medical-Surgical Nursing, 11th Edition

Fabrega, H., Disease and Social Behaviour: An Interdisciplinary Perspective Cambridge, MIT
Press. 1974.

J. Olenja, PhD, Associate Professor, Department of Community Health, College of Health

Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

Kozier, Erb, Berman, Snyder, Kozier & Erb’ s Fundamental of Nursing 8 th Edition Volume 1 & 2,
Pearson Education South Asia Pte. Ltd. 2007

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