STUDENT’S NAME: ARCAYAN TRIXIE BSN 3-A1

Name of the Patient: Christian Santos Nadela Age: 87

Chief Complaint/s: Vomiting, Elevated BP, Weakness, Cough Diagnosis: CVD Infarct
I. Brief Description of the Disease
A. Definition
Cerebrovascular disease can develop from a variety of causes, including
atherosclerosis, where the arteries become narrow; thrombosis, or embolic arterial
blood clot, which is a blood clot in an artery of the brain; or cerebral venous
thrombosis, which is a blood clot in a vein of the brain.

Cerebrovascular diseases include stroke, transient ischemic attack (TIA), aneurysm,

and vascular malformation.

In the United States, cerebrovascular disease is the fifth most commonTrusted

Source cause of death. In 2017, it caused 44.9 fatalities per 100,000 people or
146,383 deaths in total.

However, people can take steps to reduce their chances of developing

cerebrovascular disease. In this article, we explain the symptoms, types, and
treatments for these serious health problems and how to prevent them.

B. Risk factors
Stroke is the most common type of cerebrovascular event.

The risk of stroke increases with age, especially if an individual or their close
relative have previously had a cerebrovascular attack. This risk doubles every 10
years, between 55 and 85 years of age.

However, a stroke can occur at any age, even during infancy.

Factors that increase the risk of stroke and other types of cerebrovascular disease
include:

 hypertension, which the American College of Cardiology define as blood

pressure of 130/80 mm Hg or higher
 smoking
 obesity
 poor diet, and lack of exercise
 diabetes
 blood cholesterol levels of 240 milligrams per deciliter (mg/dl) or higher
The same factors increase a person’s chances of a cerebral aneurysm. However,
people with a congenital anomaly or have experienced head trauma may also
be at higher risk of a cerebral aneurysm.

C. Signs and Symptoms or Clinical Manifestation

The symptoms of cerebrovascular disease depend on the location of the
blockage and its impact on brain tissue.
 Different events may have different effects, but common symptoms include:

 a severe and sudden headache

 paralysis of one side of the body, or hemiplegia
 weakness on one side, also known as hemiparesis
 confusion
 difficulty communicating, including slurred speech
 losing vision on one side
 loss of balance
 becoming unconscious

Stroke can cause a wide variety of neurologic deficits, depending on the location of the lesion,
the size of the area of inadequate perfusion, and the amount of the collateral blood flow.
General signs and symptoms include numbness or weakness of face, arm, or leg (especially on
one side of the body); confusion or change in mental status; trouble speaking or understanding
speech; visual disturbances; loss of balance, dizziness, difficulty walking; or sudden severe
headache.

D. Management/Nursing Interventions
After the stroke is complete, management focuses on the prompt initiation of
rehabilitation for any deficits.

Nursing care has a significant impact on the patient’s recovery. In summary, here
are some nursing interventions for patients with stroke:
 Improving Mobility and Preventing Deformities
 Establishing an Exercise Program
 Preparing for Ambulation
 Preventing Shoulder Pain
 Enhancing Self Care
 Managing Sensory-Perceptual Difficulties
 Assisting with Nutrition
 Attaining Bowel and Bladder Control
 Improving Thought Processes
 Improving Communication
 Maintaining Skin Integrity
 Improving Family Coping
 Helping the Patient Cope with Sexual Dysfunction

II. Patient’s Signs and Symptoms or Clinical manifestations

• Elevated BP- 150/100 mmhg

• Elevated RR- 24bpm
• Serum electrolytes (sodium)- 131 mmol/L
• CRP 20.70 mg/L
• CT SCAN: Chronic Lacunar Infarct in the right corona radiata, Moderate
Microvascular Ischemic changes in both centrum semiovale and periventricular white
matter.
• Weakness
• Vomiting
• Cough

ANATOMY AND PHYISOLOGY

Name of the Affected Organ

Brain

Draw and label the affected organ

Clots form in the brain and interrupt blood flow, clogging arteries and causing blood vessels to
break, leading to bleeding. Rupture of the arteries leading to the brain during stroke results in the
sudden death of brain cells owing to a lack of oxygen. Stroke can also lead to depression and
dementia.
FRONTAL PARIETAL OCCIPITAL

• Personality/Behaviour

• Planning

• Decision making

• Concentration

• Voluntary motor functions

• Primary motor cortex (precentral gyrus)

TEMPORAL

• Understanding speech

• Interpretation and storage of auditory and olfactory sensations

BRAINSTEM

• Breathing

• Swallowing

• Heart rate

• Arousal and wakefulness

PARIETAL

• Comprehension and language

• Sensory functions (pain, heat and other sensations)

• Primary somatosensory cortex (postcentral gyrus)

OCCIPITAL

• Primary visual cortex

• Processing visual information

• Storing visual memories

CEREBELLUM

• Coordination

• Balance

• Stores memories of previously learned movement patterns

Reference/Source:

https://www.physio-pedia.com/Stroke

https://www.england.nhs.uk/london/wp-content/uploads/sites/8/2019/09/Brain-Anatomy-
Physiology-Stroke-Neurological-Assessment.pdf
 Non-modifiable risk factors
 History of prior stroke
Stroke  Genetics
Affected Organ
Etiology/Causative agent:  Old age
Brain
 Large artery  Gender
 Race or ethnicity
atherosclerosis
Modifiable risk factors
 Small artery
 High blood pressure
atherosclerosis Disruption of cerebral blood flow due to
 Heart disease
 Cardioembolism obstruction of a blood vessel  Diabetes
 Cryptogenetic  Smoking
 High red blood cell
count
Unsteady supply of glucose and oxygen  High cholesterol and
lipids
 Lack of exercise
 Obesity
Cellular metabolic events: ischemic cascade  Excessive alcohol use
 Illegal drugs
 Abnormal heart
rhythm

Cerebral blood flow decreases than 25 mL per 100 g of blood per minute.

Neurons no longer able to maintain aerobic respiration

Anaerobic respiration. Large amounts of lactic acid

Neuron incapable of producing sufficient quantities of ATP to fuel the depolarization

processes.

Membrane pumps that maintain electrolyte balance begin to fail

 Increased intracellular calcium

Release of glutamate

Release of apoptosis inducing factors & Degradative enzymes

Inflammation: damages blood brain barrier

Vasogenic edema

Necrosis

S/Sx: _________________________________________________________________________

change in mental status Sudden severe headache Vomiting

Weakness Difficulty walking, or loss of balance or coordination

Reference/Source: Osmosis. Ischemic stroke- causes, symptoms, diagnosis, treatments, pathology.

(2018). https://www.youtube.com/watch?v=2IgFri0B85Q
 LABORATORY/DIAGNOSTIC STUDIES

Date/Exam Patient’s Results Normal Values Significance/Interpretation

Complete Blood Count Patient’s hgb and hct are below normal range. Low
RBC hgb evels can affect cortical brain integrity and lead
WBC 4.08x10⁶/mm³ 4.5 – 5.90x10⁶/mm³ to cortical brain atrophy. Low hct indicates insufficient
Eosinophil 13.4x10³/mm³ 4.4-11.0x10³/mm³ supply of healthy red blood cells
Basophil 0.8 % 0.0-7.0%
Neutrophil 0.2% 0.0-2.5% An increase in WBCs and in neutrophils. It suggests a
Platelet 87.7 % 37.0-80.0% wide variety of infections, inflammations and the like.
Hemoglobin 281x10³/mm³ 150-450x10³/mm³ Elevated WBC could be associated with stroke
Hematocrit 13.0 g/dl 14.0-17.5 g/dl severity on admission and poor functional outcome.
39.4% 41.5-50.4%

Coagulation Studies within normal range

Prothrombin time (PT) 11.8 sec 9.2-13.2 sec

INR 1.05 0.84-1.11
Activated Partial Thromboplastiin Time 35.3 sec 25.4-38.4
(APPT)
Electrolytes Decreased amount of sodium. Patient manifest
Sodium 131 mmol/L 136-145 mmol/L hyponatremia
Potassium 4.50 mmol/L 3.5-5.1 mmol/L

Blood Glucose Increase level of blood glucose. Patient is

HGT 119 mg/dl 72-99 mg/dL hyperglycemic.

C-reactive protein 20.70 mg/L 0-5 mg/L Increased CRP. May indicate inflammatory reaction
or tissue damage.

Reference/Source: LabTestsOnline. (2020). Stroke. https://labtestsonline.org/conditions/stroke Office on Women’s Health. (2018). How is Stroke
diagnosaed?. https://www.womenshealth.gov/heart-disease-and-stroke/stroke/stroke-treatment-and-recovery/how-stroke-diagnosed

CT SACN/MRI/CHEST X-RAY/KUB RESULT:

Chronic Lacunar Infarct in the right corona radiata. Moderate Microvascular Ischemic changes in both centrum semiovale and
periventricular white matter. Age-compatible cerebro-cerebellar volume loss. Right maxillary sinusitis
 DRUG STUDY

Name of the Drug Mechanism of Indications Contraindications Side effects Nursing Responsibilities
Action
Generic Name: Inhibits platelet Secondary Hypersensitivity to Body as a Whole: Before:
Clopidogrel aggregation by prevention of MI, clopidogrel; Flu-like syndrome,  Assess vital signs.
bisulfate selectively stroke, and vascular intracranial fatigue, pain,  Patient Education
preventing the death in patients hemorrhage, peptic arthralgia, back pain.
Brand Name: binding of with recent MI, ulcer, or any other During:
Plavix adenosine stroke, unstable active pathologic CV: Chest pain,  Carefully monitor for and
diphosphate to its angina or bleeding; pregnancy edema, hypertension, immediately report S&S of GI
Classification: platelet receptor. established (category B). thrombocytic bleeding,especially when co
Blood formers, It is an analog of peripheral arterial Discontinue purpura. administered with NSAIDs,
coagulators, and ticlopidine. The disease. clopidogrel 7 d aspirin, heparin, or warfarin.
anticoagulants; drug's effect on before surgery and GI: Abdominal pain,  Lab tests: Periodic platelet
antiplatelet the during lactation. dyspepsia, diarrhea, count and lipid profile
agent adenosine Safety and efficacy nausea,
diphosphate not established in hypercholesterolemia. After:
Route: receptor children.  Evaluate patients with
PO of a platelet is Hematologic: unexplained fever or infection
irreversible. Thrombotic for myelotoxicity.
Frequency: Therapeutic Effects thrombocytopenic  Patient & Family Education
OD Consequently, purpura, epistaxis.
clopidrogrel
Timing: prolongs CNS: Headache,
You can choose dizziness, depression.
to take
it at any time, as Respiratory: URI,
long as dyspnea, rhinitis,
you stick to the bronchitis, cough.
same time every
day. Skin: Rash, pruritus.

Reference/Source: Nursing 2020 Drug Handbook

 Name of the Drug Mechanism of Indications Contraindications Side effects Nursing Responsibilities
Action
Generic Name: It is a Potent Treatment of ✓ None known. CNS: dizziness, Before:
Losartan vasodilator. hypertension. Used ✓ Use with cautions in insomnia, 1. Obtain B/P, apical pulse
Blocks alone or in Renal/hepatic depression immediately before each dose, in
Brand Name: vasoconstrictor, combination with impairment, EENT: nasal congestion, addition to regular monitoring (be
Cozaar other unstented renal sinusitis alert to fluctuations).
aldosterone
antihypertensives. arterial Respiratory: upper 2. Question for possibility of
Classification:
secreting effects Treatment of respiratory tract pregnancy (see
stenosis, significant
Antihypertensive of angiotensin II, diabetic infection, cough Pregnancy/Lactation).
aortic/
inhibiting binding nephropathy, mitral stenosis GI: diarrhea, dyspepsia, 3. Assess medication history (esp.
Dosage: of angiotensin II prevention of stroke heartburn diuretic).
50 mg/tab 1 tab to in pts with Musculoskeletal:
AT1 receptor hypertension and myalgia, During:
Route: left ventricular muscle cramp 1. Maintain hydration (offer fluids
PO hypertrophy. frequently).
Adverse Effects: 2. Assess for evidence of upper
Frequency: CV: hypotension, respiratory infection, cough.
OD tachycardia, 3. Monitor B/P, pulse. If excessive
bradycardia reduction in B/P occurs, place pt in
Timing: supine position, feet slightly elevated.
8 am 4. Assist with ambulation if dizziness
occurs.
5. Monitor daily pattern of bowel
activity, stool consistency.

After:
1. Tell patient to avoid tasks that
require alertness, motor skills until
response to drug is established
(possible dizziness effect).
2. Report any sign of infection (sore
throat, fever), chest pain.
3. Advise patient not to take OTC
cold preparations, nasal
decongestants.
4. Tell patient not to stop taking
medication.
5. Encourage patient to limit salt
intake

Reference/Source: Nursing 2020 Drug Handbook

 NURSING CARE PLAN

Defining Nursing Scientific Goal of Care Nursing Interventions Rationale

Characteristics Diagnosis Analysis (short term)
Independent: Independent:
Subjective Cues: Impaired Patient shows After 6-8
N/A Physical weakness hours of 1. Assess extent of impairment 1. Identifies strengths and deficiencies
Mobility as Inability to appropriate initially and on a regular that may provide information regarding
evidenced by purposefully nursing basis. Classify according to recovery. Assists in choice of
Objective Cues: Neuromuscular move within intervention, 0–4 scale. interventions, because different
• Elevated BP- involvement: the physical the patient techniques are used for flaccid and
150/100 mmhg weakness environment; will spastic paralysis.
• Elevated RR- impaired maintain/incr
24bpm coordination; ease strength 2. Reduces risk of tissue injury. Affected
• Serum limited range and function 2. Change positions at least side has poorer circulation and reduced
electrolytes (sodium)- of motion; of affected every 2 hr (supine, side lying) sensation and is more predisposed to
131 mmol/L decreased or and possibly more often if skin breakdown.
• CRP 20.70 muscle compensator placed on affected side.
mg/L strength/contr y body part.
• CT SCAN: ol 3. Elevate arm and hand
Chronic Lacunar 3. Promotes venous return and helps
Infarct in the right prevent edema formation.
corona radiata,
Moderate Dependent:
Microvascular 1. Use arm sling when patient is in Dependent:
Ischemic changes in upright position, as indicated.
both centrum 1. During flaccid paralysis, use of sling
semiovale and may reduce risk of shoulder subluxation
periventricular white and shoulder-hand syndrome.
matter. 2. Begin active or passive ROM to all
• Weakness extremities (including splinted) on 2. Minimizes muscle atrophy, promotes
• Vomiting admission. Encourage exercises circulation, helps prevent contractures.
• Cough such as quadriceps/gluteal Reduces risk of hypercalciuria and
exercise, squeezing rubber ball, osteoporosis if underlying problem is
extension of fingers and legs/feet. hemorrhage. Note: Excessive stimulation
can predispose to rebleeding.

3. Set goals with patient and SO for 3. Promotes sense of expectation of

participation in activities and improvement, and provides some sense
position changes. of control and independence.

Reference/Source: https://nurseslabs.com/8-cerebrovascular-accident-stroke-nursing-care-plans/2/