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A CASE ANALYSIS ON
CEREBROVASCULAR ACCIDENT

Prepared by: Francis Marcel Peteros

BSN
September 13, 2020
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TABLE OF CONTENTS

CHAPTER I
Introduction ...................................................................................................................3-4
Goals and Objectives........................................................................................................5
CHAPTER II
Discharge Planning……………………...........................................................................6-7
CHAPTER III
Related Nursing Theories………………........................................................................7-8
CHAPTER IV
Review of Related Literature………………..................................................................9-10
CHAPTER V
References…………………………………………………………………………………..…11

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I. INTRODUCTION

Geriatric nursing is the medical care of elderly patients, anywhere from ages 65yr
+, taking place either in an acute care, acute rehabilitation center, home health care, or
long term care facility. Geriatrics comes from the Greek words 'geras' meaning “old age”
hence why this branch of medicine deals particularly with the diseases & problems of
old age. The main role of Geriatric nurses is to care for elders with health problems, or
those in need of tertiary care. Considering that this branch of nursing deals with elder
patients, we must take into concern that our patient is a lot more, feeble, and prone to
injury & disease. So as nurse, our procedures must be done with extra care and
compassion, for any use of unnecessary force may potentially be harmful. Such forms
of care are highly dependent on which setting of care you are assigned. In this rotation
of geriatric nursing, we were assigned in a long-term facility, more specifically, a nursing
home. Nurses working in a nursing home are expected to monitor, care for, and
entertain the residents. Such examples of this can be monitoring of vital signs, or any
health deficits, caring for their basic needs such as food & water, as well as providing
entertainment whether it be an game or activity. In general, nurses should make the
residents time there pleasant, & enjoyable, as if they’re still living in the comfort of their
own home.
Within the realm of Geriatrics, is Gerontology, originating from the Greek work
“geron” meaning “old man”. Distinctively, Gerontology studies the process of aging, and
such problems that come with it. This may include biological, sociological,
psychological & economic aspects. In relation, Gerontological Nursing is separate
specialty of nursing that hones in on assessments & functional status of older adults.
So while Geriatric nurses focus on the actual care of the patient, gerontological nurses
plan, implement, & evaluate the health care & services needed for such patient.
Parallel to us student nurses, this can be exemplified by our Nursing Care Plans, where
we create the plan of care, whereas the foundation of actual care is set in geriatric
clinical practice.
Among the many illnesses due to the coming of age, this case analysis is
focused on Cerebral Vascular Accidents (CVA), commonly known as a Stroke.
According to EasyLiving.com (2018) Strokes are the 4 th leading causes of death in
adults 65+ yrs old. “A stroke occurs when part of your brain is deprived of oxygen and
nutrients, causing brain cells to die.” (High Blood Pressure Dangers, 2019). A lot of
what leads to a stroke are common health problems aging adults face, the main
contributor however is hypertension.
Hypertension leads to extensive alteration in endothelium and smooth muscle
function in the brain. This increased stress can increase permeability over the blood-
brain barrier. The endothelial damage & altered blood cell-endothelium interaction can
lead to local thrombus formation & ischemic lesions within the brain’s vascular region
(Johansson, n.d). Furthermore, hypertension accelerates the arteriosclerotic process,
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this is due to the added force against the artery walls, making it vulnerable to narrowing
& plaque buildup. The hardened surface of the artery can also encourage the formation
of small blood clots. All these cardio dysfunctions increase the risk of an Ischemic
stroke. Ischemic stroke is 1 of the 3 types of stroke that is caused by the blockage of a
blood vessel in your brain, normally due to fatty deposits or in this case, a blood clot.
(Khatri, 2019).
The weakening of the vessel walls, no only predispose them to clotting, but
rupturing as wells. This is less common, and connects with more extreme cases of
hypertension, but the rupturing of a blood vessel wall causes Hemorrhagic stroke. The
pathophysiology is quite the same, wherein the blood vessel walls continue to weaken,
and damage over. The main difference is the disease secondary to hypertension, brain
aneurysm. “Over time, the constant pressure of blood moving through a weakened
artery can cause a section of its wall to enlarge and form a bulge (aneurysm). An
aneurysm can potentially rupture and cause life-threatening internal bleeding.” (High
Blood Pressure Dangers, 2019).
The last type of stroke that may happen, is a Transient Ischemic Attack (TIA).
“When you have a TIA, the flow of blood to part of your brain gets cut off for a short time.
It's also called a ministroke, but don't let the "mini" part fool you. A TIA can be a sign that a
full-blown stroke is on the way. About 1 in 3 people who have a TIA go on to have a stroke,
often within a year.” (Beckerman, 2019). Just like an Ischemic Stroke it is caused by
occlusion of a blood vessel in the brain. The difference here is that “…TIA only lasts a few
minutes. The clot then gets pushed along, like a temporary clog in a pipe, or chemicals in
your body quickly break it down. Normal blood flow returns to your brain before any lasting
problems set in. Symptoms can last for up to 24 hours, but they're usually gone in an hour.”
(Beckerman, 2019).
A stroke may happen to anyone, and is generally a common cause of death, but
despite that fact, “Nearly three-quarters of all strokes occur in people over the age of 65.
The risk of having a stroke more than doubles each decade after the age of 55.” (Stroke
Statistic, n.d). This can be correlated to the higher prevalence in hypertension for the
elderly, as “After the age of 69, the prevalence of hypertension rises to 50%.” (Morley,
2015). With direct links to both, It is no surprise that “The overall weighted stroke
prevalence was 7.6%, among older adult residents aged 60 years and above. Weighted
stroke prevalence for those aged 65 years and above was 9.3%.” (Teh, 2018).
Tying into Geriatric nursing, as student nurses we have a vital role in handling
and providing care to our patients. In doing this case analysis, we commit to our role as
a nurse researcher, in order to stay updated in current clinical rotation and ensure
optimal care to the type of patients we’re met with. With our patients being 65+ yrs old,
stroke is prevalent in this age group, thorough research and understanding of this
disease will only be beneficial to our body of knowledge in Geriatric Nursing.
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OBJECTIVES

General Objectives

At the end of the 4-week rotation, the student nurses of BSN 3J, Group 3, will be
able to achieve a comprehensive, online learning experience about geriatric nursing and
their given related illnesses. All throughout, maintaining SPC nursing discipline, and
proper netiquette. In order to achieve the most studious, and interactive, online RLE
experience possible.

Specific Objectives

A.) Continue to maintain nursing discipline throughout the use of online classes;

- Attendance
- Proper attire
- Participation

B.) Have real time simulated learning experiences through asynchronous &
synchronous learning via:

- Synchronous; Virtual demo of “Planned Structure of Activities” (PSA)

- Asynchronous; Taking of vital signs
- Asynchronous; Physical Examination
- Asynchronous; Neurological Assessment

C.) Choose a related disease for case analysis

D.) Collect, analyze, and comprehend, data regarding the chosen disease
E.) Create a comprehensive, & sound case analysis with the data given
F.) Present a Nursing Care Plans based on the chosen disease
G.) Relate applicable nursing theories to Geriatric Nursing
H.) Supply the online resources used for the formulation of the case study following
APA format
I.) Present the case study in a comprehensive manner
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II. DISCHARGE PLANNING

In the discharging plan we considered the changes in daily living, the diet, tips for taking
the medicines and the warning signs and symptoms of a stroke.

Changes in Daily Living

 Resident may be at risk of falling. Make or buy assistive devices such as cane or
walker so that he or she can walk or go around the house safely of course with
the assistance of the watcher.
 When it comes to bathing, the temperature of the water must be tested first at the
hand or foot of the patient that was not affected by stroke and as always assist
him or her with care while taking a bath.
 Dress the resident while sitting for safety purposes. While dressing, start with the
affected side or limb. Let him or her wear shirts and pants or skirts with elastic
waistbands so that it can be easily pulled over the head.
 Take medicine religiously.
 Limit or if possible never drink alcoholic beverages
 If the resident is a smoker, he or she should quit smoking.

Diet

 Eat fresh fruits and vegetables.

 Amount of cholesterol and fats should be reduced.
 Reduce amount of salt in the food especially if the resident is hypertensive
 Eat more lean proteins. Foods such as fish, legumes and poultry are rich of it.
 Processed meat or foods should not be considered in the diet.
 Limit sweets.
 Use low-fat dairy products

Taking Medicines

  Have the prescriptions filled before going home. Do not take any other drugs or
supplements without the prescription of the health care provider or physician.
 Antiplatelet medicines help to keep the blood from clotting.
  Beta blockers, diuretics, and ACE inhibitors controls the blood pressure of the
resident
 Statins will lower the patient’s cholesterol
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Warning Signs and Symptoms of a Stroke

 F – Face: The one side of the face droops.

 A – Arms: One arm starts to drop when both arms are raised.
 S – Speech: Sounds different than usual or slurred.
 T – Time: Stroke needs an immediate treatment. Person having a stroke must be
seen immediately
 Legs or arms feel warmer, tender and painful.
 Double vision
 Heavy bleeding
 High blood pressure or low blood pressure
 Loss of balance

If these warning signs and symptoms occur, immediate call 911, the doctor or go to the
nearest hospital as soon as possible because it may be fatal if not treated immediately.

III. RELATED NURSING THEORIES

Sr. Callista Roy

“Man is a biopsychosocial, spiritual being in
continuous interaction with a changing environment.”
as stated by Sr. Callista Roy in 1976. As one of the
prodigies, she created the theory of adaptation model
and was well known across the world. By her phrase,
she simply means that, man is holistic. Applying to the
case, the disease can be managed, treated, and
improved thoroughly by using Callista Roy’s theory. In
today’s generation, health care providers especially handling old patients oftentimes
neglect the spiritual needs because sometimes they forgot that it should also be a part
of their priority. That is why it is always important to satisfy all aspects of the life of the
patient for his own betterment. Not just physical, environmental, but also spiritual,
because we all know that even though Science can almost provide all types of
management, we cannot deny the fact that God is always there to help us.

Faye Glenn Abdellah

According to Faye Glenn Abdellah's theory,
“Nursing is based on an art and science that molds the
attitudes, intellectual competencies, and technical skills of
the individual nurse into the desire and ability to help
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people, sick or well, cope with their health needs.” This theory is also one of the
profound statements that can be applicable in geriatric rotation, because relating to the
first theory that was mentioned, health care providers nowadays especially nursing
students does not really know what the true essence of caring through empathy is. By
fitting yourself on other’s shoes, one can provide a satisfactory care. As today’s
workers, mostly thrive to finish their tasks without even knowing the inner aspect of the
patient. When it comes to nursing, it is understood that the care that will be applied
should be patient centered because this is the foundation and devotion of the nursing
profession.

Florence Nightingale
The lady with the lamp, Florence Nightingale.
Florence Nightingale is famous for changing the way
nurses were perceived during her time, raising the
standards for nursing, and educating nurses. First,
when she arrived in Turkey in 1854 during the
Crimean War, she found the conditions in the
hospital to be horrid. One thing for sure Nightingale
teaches us is aside from patient centered care, we
should also look out for the environment that the patient is resting in. One of the
geriatric rotation’s core values is the safety of the elderly. It is a major contributor on
how the patient will cope up to the alterations of his condition. By application of these
theories, health workers can promote and enhance their standards that can be helpful to
become globally competitive and professional nurse inside and out.

Dorothea Orem
Orem developed the Self-Care Deficit Theory of Nursing
which is composed of three interrelated theories: self-
care theory, self-care deficit theory and theory of nursing
systems. Self-care is the performance or practice of
activities that individuals initiate and perform on their
own behalf to maintain life, health, and well-being. Self-
care agency is the human’s ability or power to engage in
self-care. Therapeutic self-care demand is the totality of
“self-care actions to be performed for some duration in
order to meet known self-care requisites by using valid methods and related sets of
operations and actions. Then there are three categories of self-care requisites:
universal, developmental, and health deviation. Self-care requisites are actions directed
toward the provision of self-care. In the second vital part of Orem’s theory is the self-
care deficit theory wherein nursing is needed when the self-care demands are greater
than the self-care abilities. The nursing system is based on the self-care needs and
abilities of the patient to perform self-care activities. Orem has identified three
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classifications of nursing systems to meet the self-care requisites of the patient and
these are: wholly compensatory system, the partly compensatory system, and the
supportive educative system. In geriatric rotation, stubbornness is one of the big
problems in the field, but as a nurse we encouraged our client to perform daily hygiene
and assisted her in task that she cannot do by herself alone.

Lydia Hall’s Care, Core, Cure theory

Lydia Hall’s theory is visually presented by
interlocking circles and each represents a particular
aspect of nursing. The three circles represent the
care, core and cure. The major aspect of care is to
achieve an interpersonal relationship with the health
care provider that will much more facilitate
development. This aspect provides motherly care
and comfort, provide teaching-learning activities and support the daily biological function
of the patient. The closeness of the nurse and patient promotes the sharing and
exploration of feelings with the nurse. The core aspect emphasized the therapeutic use
of self and usage of reflective technique. The patient become more aware of the feeling
being experienced as evidenced of making conscious decision, understand and accept
feeling. The cure circle is based on pathological and therapeutic sciences. The patient
has a negative perspective about the nurse as potential cause of pain rather than a
comforting being. These three aspects function independently but they are interrelated
and the circle’s size represents the progress in each aspect.

IV. REVIEW OF RELATED STUDIES / LITERATURE

Stroke; Studies from University of Ulm Reveal New Findings on Stroke (Risk of
osteoporotic fractures following stroke in older persons). (2015). Retrieved 09/11/2020,
fromhttps://www.proquest.com/docview/1673198344/D571946956C74D72PQ/2?
accountid=171161.
Stroke survivors have a high risk for having osteoporotic fractures due to
frequent falls and an increased risk to develop osteoporosis. But, according to the data
gathered by the journal, the ones who always suffered or most high risk for that is the
stroke survivors without any functional impairment. Compared to those who have
functional impairment, they have no significantly increased risk for any fractures site.
Therefore, stroke survivors who does not have functional impairment suffers from
osteoporotic fractures due to frequent falls more than those who have functional
impairment. Because those who have functional impairment may not carry out certain
functions of daily lives in short, they have limited mobility more likely less activity in their
respective homes which can be a result for lower risk to accidents and injuries.
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Meanwhile those who do not have impairment tends to move or go around their house
doing things they want then accidentally falls because of a certain reason like possibly
dizziness, weakness in arm or leg and chest pain.

Lipid-lowering drugs may be effective in the prevention of stroke in older people.

(2015). Retrieved 09/11/2020, from
https://www.proquest.com/docview/1784938724/abstract/D571946956C74D72PQ/20?
accountid=171161

Use of cholesterol-lowering drug is associated with a one third reduced risk of

stroke in older adults who do not have a known history of vascular events. The
researchers investigated statins or fibrates which are known as the cholesterol-lowering
drug. After an average follow-up time of nine years, these so-called drugs were
associated with a 30% decrease in the incidence of stroke.
Therefore, the residents must be reminded by us nursing students to take the
prescribed medicines religiously especially if the physician prescribed statins or fibrates.
This will help reduce the risk for those who do not suffer from stroke yet and also for
those who already experienced stroke. Lower cholesterol in the body, lower risk to
stroke.

Colin F. (2018). Aspirin a day is not OK. Retrieved 09/11/2020, from

https://www.proquest.com/docview/2104958828/325D9BF95FD24691PQ/5?
accountid=171161
The author of the journal said that those healthy older people who take aspirin to
prevent disease are just wasting their time. The research focused on aspirin’s effects on
healthy people or those who are free from heart diseases or free from stroke. It shows
that it does not have any effect to those who are healthy older people. A total of 19,114
people, mostly over the age of 70. Around half were told to take a low; 100mg dose of
aspirin every day and the other group given a placebo. The results were followed up
around five years later.
Treatment with aspirin did not help keep people free of dementia or disability, the
study found. Rates of cardiovascular problems, such as coronary heart disease, non-
fatal heart attacks and stroke, were also similar in both groups. Among the aspirin-
takers, 3.8% experienced serious bleeding compared with 2.8% in the placebo group.
The aspirin group was also at a slightly increased risk of dying within the five-year
period.

The study found that 5.9% died during the study, compared with 5.2% in the
placebo group. It means millions of healthy older people around the world who are
taking low-dose aspirin without a medical reason may be doing so unnecessarily. The
study showed no overall benefit to offset the risk of bleeding.
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IV.REFRENENCES:

Online Journal/Article:

Andrew, R. (2018). Intracerebral hemorrhage (ICH), hemorrhagic stroke, stroke:

Cincinnati, OH Mayfield Brain & Spine. Retrieved September 13, 2020, from
https://mayfieldclinic.com/pe-ich.htm

BB;, J. (n.d.). Hypertension mechanisms causing stroke. Retrieved September 13, 2020,
from https://pubmed.ncbi.nlm.nih.gov/10405790/

Beckerman, J. (2019, July 17). TIA (Transient Ischemic Attack): Causes & Risk Factors.
Retrieved September 13, 2020, from https://www.webmd.com/stroke/what-is-tia

Beckerman, J. (2020, August 24). Atherosclerosis Caused by High Blood Pressure:

Symptoms & Treatments. Retrieved September 13, 2020, from
https://www.webmd.com/hypertension-high-blood-pressure/guide/atherosclerosis

Discharge Instructions for stroke. (2020). Retrieved 09/11/2020, from

https://www.mountnittany.org/articles/healthsheets/2412

How high blood pressure can affect your body. (2019, November 19). Retrieved
September 13, 2020, from https://www.mayoclinic.org/diseases-conditions/high-
blood-pressure/in-depth/high-blood-pressure/art-20045868

Ischemic Stroke (Discharge Care) - What You Need to Know. (2020). Retrieved
09/11/2020, from https://www.drugs.com/cg/ischemic-stroke-discharge-care.html

Khatri, M. (2019, November 23). Top 10 Causes of Strokes - Risk Factors and How You
Can Lower Your Risks. Retrieved September 13, 2020, from
https://www.webmd.com/stroke/guide/stroke-causes-risks

Rigaud, A., & Forette, B. (2001, April 01). Hypertension in Older Adults. Retrieved
September 13, 2020, from
https://academic.oup.com/biomedgerontology/article/56/4/M217/619961

Stroke and hypertension. (2017). Retrieved September 13, 2020, from https://www.world-
heart-federation.org/resources/stroke-and-hypertension/

Stroke - discharge : MedlinePlus Medical Encyclopedia. (2020). Retrieved 09/11/2020,

from https://medlineplus.gov/ency/patientinstructions/000132.htm

The Internet Stroke Center. (n.d.). Retrieved September 13, 2020, from
http://www.strokecenter.org/patients/about-stroke/stroke-statistics/

The Leading Causes of Death for 65 year olds might surprise you. (2017, December 30).
Retrieved September 13, 2020, from https://easylivingfl.com/leading-causes-
death-65-year-olds/

Transient Ischemic Attack | TIA | Mini-stroke. (2020, July 27). Retrieved September 13,
2020, from https://medlineplus.gov/transientischemicattack.html

Gil W. (2020). Nursing Theories and theorists. Retrieved September 11 2020, from

https://nurseslabs.com/nursing-theories/