SRI GURU RAM DAS NURSING INSTITUTE

PANDHER, AMRITSAR

CASE STUDY
ON
STROKE

SUBJECT: ADVANCED NURSING PRACTICE

SUBMITTED TO,

MISS ARPANDEEP KAUR

ASSOCIATE PROFESSOR
DEPT.OF COMMUNITY HEALTH NURSING
SUBMITTED BY,
MISS PAWANDEEP KAUR
MSC NURSING FIRST YEAR

MEDICAL SURGICAL NURSING

BASE LINE DATA:
Name of the patient - Mr.Anandh
Age - 58 years
Sex - Male
IP No - 1803830
Ward No - Emergency
Address - Amritsar
Date of admission -
Caste - Hindu
Education - Nil
Occupation - Shop keeper
Income - 8000/Month
Marital status - Married
No. of children - Three
Languages known - Hindi, Punjabi

Patient admitted Guru Nanak hospital with compliant of paralysis of Half side.
Patient was unconsciousness.

Personal History:
Appetite - Decreased
Sleep - Normal
Bowel & bladder - Normal & Regular
Diet - Vegetarian
Name Age Sex Relationship Occupation Remarks
Mr. Nagaraja 56 Male Patient Farmer Unhealthy
years
Mr. DINESH 20 Male Son 12th Std Healthy
years
Mrs. Geetha 13 Femal Daughter 7th Std Healthy
 years e
Ms. Rajeshwari 40 Femal Wife Nil Healthy
years e

Medical History:
Past History : Patient is not having any kind of disease.
Present History : Patient got paralysed and is unconsciousness.
Allergic History : There is no history of any allergic to 100 or days.
Ear:
Hearing - Normal
Nose:
External nose - No DNS
Nostrils - No discharge
Mouth :
Lips - Not cracked
Gums - No bleeding
Teeth - No dental caries
Tongue - Coated

Skin condition:
Colour - Black

Neck:
Lymph node - No enlargement
Thyroid gland - No enlargement
Range of motion Not possible.
Chest:
Heart - Abnormal heart sound
Abdomen - Pain not present
Physical examination:
General appearance
Nourishment - Moderate

Body built - Moderate

Activity - Dull

Healthy - Unhealthy

Mental status

Level of conscious - Conscious

Look - Anxious

Body postures

Body curves - No deformity

Movement - Possible

Head & Face

Scalp - No dandruff

Hair - Equally distributed

Face - No puffiness

Eye:
Eye - no infection
Conjunctiva - No discoloration.

Signs:
Date Time Vital Signs Patient Normal Remark
Value Value
1 Temperature 99°F 98.9°F Normal

2 Pulse 82b/mt 80b/mt Normal

3 Respiration 22b/mt 20b/mt Normal

4 Blood 140/90m 120/80m hypertensio

pressure n

Investigation
Investigation done Patient Value Normal Value
Random blood sugar 198 mgs% 70 -140 mgs%
Blood UREA 90 mgs% 10 - 50mgs%
Serum Creatinine 0-8 mgs 0 - 2mgs%

Medical Diagnosis: Stroke

Need of Patient:
Physiological need - Patient need fresh air and water to maintain life.
Comfort need - My patient need comfortable bed and position.
Nutritional used - My patient need nutrition diet to maintain health.
Hygienic need - My patient need hygienic environment to prevent infection.
Psychological need - Patient need psychological support to reduce fear and anxiety.

Anatomy and Physiology Human Brain

The anatomy of the brain is complex due its intricate structure and function. This amazing
organ acts as a control centre by receiving, interpreting, and directing sensory information
throughout the body. There are three major divisions of the brain. They are the forebrain, the
midbrain, and the hindbrain.

Anatomy of the Brain

The brain contains various structures that have a multitude of functions. Below is a list of
major structures of the brain and some of their functions. Basal Ganglia, Involved in
cognition and voluntary movement. This involves diseases related to damages of this area are
Parkinson's and Huntington's. Brain stem relays information between the peripheral nerves
and spinal cord to the upper parts of the brainy .Consists of the midbrain, medulla oblongata,
and the pons
Broca's Area , Speech production. Understanding language .Central Sulcus (Fissure of
Rolando) involves deep grove that separates the parietal and frontal lobes. Parts of the brain
explained below: 
Cerebellum
Controls movement coordination.
Maintains balance and equilibrium.
Cerebral Cortex

Outer portion (1.5mm to 5mm) of the cerebrum.

Receives and processes sensory information.
Divided into cerebral cortex lobes.

Cerebral Cortex Lobes

Frontal Lobes -involved with decision-making, problem solving, and planning

Occipital Lobes -involved with vision and color recognition

Parietal Lobes - receives and processes sensory information

Temporal Lobes - involved with emotional responses, memory, and speech.

Cerebrum

Largest portion of the brain and consists off olded bulges called gyri that create deep furrows.

Corpus Callosum
Thick band of fibers that connects the left and right brain hemispheres.

Cranial Nerves

Twelve pairs of nerves that originate in the brain, exit the skull, and lead to the head, neck
and torso.

Fissure of Sylvia’s (Lateral Sulcus)

Deep grove that separates the parietal and temporal lobes.
Limbic System Structures

 Amygdala
Involved in emotional responses, hormonal secretions, and memory

Cingulate Gyrus
A fold in the brain involved with sensory input concerning motions and the regulation of
aggressive behavior 

Fornix -
An arching, fibrous band of nerve fibers that connect the hippocampus to the hypothalamus

Hippocampus -
Sends memories out to the appropriate part of the cerebral hemisphere for long-term storage
and retrievs them when necessary

Hypothalamus
Directs a multitude of important functions such as body temperature, hunger, and
homeostasis
 
Olfactory Cortex
Receives sensory information from the olfactory bulb and is involved in the identification of
odors
 
Thalamus -
Mass of grey matter cells that relay sensory signals to and from the spinal cord and the
cerebrum

 
 Medulla Oblongata
 Lower part of the brainstem that helps to control autonomic functions meninges.
 Membranes that cover and protect the brain and spinal cord.
Olfactory Bulb
 Bulb-shaped end of the olfactory lobe.
 Involved in the sense of smell.

Pineal Gland
Endocrine gland involved in biological rhythms. Secretes the hormone melatonin

Pituitary Gland
 Endocrine gland involved in homeostasis.
 Regulates other endocrine glands.

Pons
 Relays sensory information between the cerebrum and cerebellum reticular Formation
 Nerve fibers located inside the brainstem. Regulates awareness and sleep.

Substantia Nigra
Helps to control voluntary movement and regualtes mood

egmentum
The ventral region of the mesencephalon (mid brain).Ventricular System - connecting system
of internal brain cavities filled with

Cerebrospinal fluid
Aqueduct of Sylvius - canal that is located between the third ventricle and the fourth ventricle
Choroid Plexus - produces cerebrospinal fluid
Fourth Ventricle - canal that runs between the pons, medulla oblongata, and the cerebellum
Lateral Ventricle - largest of the ventricles and located in both brain hemispheres.
Third Ventricle - provides a pathway for cerebrospinal fluid to flow.

Wernicke's Area
Region of the brain where spoken language is understood.

 
  Functions
The motor system of the brain and spinal cord is responsible for maintaining the body posture
and balance; as well as moving the trunk, head, limbs, tongue, and eyes: and communicating
through facial expressions and speech. Reflexes mediated through the spinal cord and
brainstem is responsible for some body movements. They occur without conscious thought.
Voluntary movements, on the other hand, are movements consciously activated to achieve a
specific goal, such as walking or typing. Although consciously activated, the details of most
voluntary movements occur automatically. After walking begins, it is not necessary to think
about the moment-to-moment control of every muscle because neural circuits in the reticular
formation automatically control the limbs. After learning how to perform complex tasks, such
as typing, they can be performed relatively automatic. Voluntary movements result from the
stimulation of upper and lower motor-neurons. Upper motor neurons have cell bodies in the
cerebral cortex. The Axons of upper motor neurons from descending tracts that connects to
lower motor neurons. Lower motor neurons have cell bodies in the anterior horn of the spinal
cord gray matter or in cranial nerve nuclei. Their axons leave the central nervous system and
extend through spinal or cranial nerves to skeletal muscles. Lower motor neurons are the
neurons forming the motor units.
STROKE
Introduction:
⮚ Stroke or cerebrovascular accident is the one and persistence of neurologic
dysfunction lasting lodger than 24 hrs and resulting from disruption of blood
supply to the brain and indicate infraction.
Definition:
- Stroke is defined as sudden loss of brain function caused by an interruption in
the blood supply to a pact of the brain.
Etiology
Book picture Patient picture

Cerebral thrombosis Cerebral thrombosis

- Embolism

- Cardiac disease

- Metabolic disease

- Hemorrhage

- Cigaratte smoking

Pathophysiology:
Due to thrombosis some neurons die because of lack of oxygen and nutrients
Tissue injury triggers an inflammatory response which increases intracranial pressure
The injury disrupts metabolism leading to changes in ionic transport, localised
acidosis Continued cell injury and swelling both occurs resulting to further cell
damage. Leads to brain damage.

Clinical Manifestation
Book picture Patient picture
- Visual disturbance Visual disturbance
- Hemiplegia Hemiplegia

- Dysarthria

- Impairment / touch

- Head ache Head ache

- Unconsciousness Unconsciousness

Diagnostic evaluation

Book picture Patient picture

- History Collection - History collection

- Physical examination - Physical examination

- CT Scan - CT Scan

- Cerebral angiography - Cerebral angiography

- Magnetic Resonance imaging during

acute phase
- Assess for voluntary on involuntary
movement tone of muscle
- Monitor effectiveness of anti
coagulation therapy
IDENTIFICATION OF PROBLEMS ACCORDING TO PRIORITY:
THEORY APPLICATION

According to Lydia E Hall nursing is a profession that involves nurturing

and comforting a patient who should receive care only from professional nurses
who can take complete responsibility for the care. It involves interacting with a
patient in a complex process of teaching and learning. It strives to form a
relationship that helps the patient to develop self identity and combines
knowledge of medical procedures and diseases with teaching and learning skills
to provide the patient with individualised care.

Major concepts

⮚ The Core circle

It is based on social sciences and involves the therapeutic use of self and
is shared with other members of the health team.

The patient is encouraged to express her feelings regarding the disease

condition. Her doubts are cleared and she is worried whether she will be able to
have an uncomplicated delivery. She is worried about her baby in the womb and
also about the precautions that she should take to avoid complications.

⮚ The Care circle

It refers to the patient’s body, and represents the nurturing aspect of

nursing care. It involves intimate body care. The nurse uses the knowledge of
natural and biological sciences as a basis for this care. It is exclusive to nursing
and the nurse is in charge of care. It involves teaching which improves the
patient care.
 ⮚ The Cure circle

It refers to the pathological process or the disease. It involves helping a

patient and family members through medical, surgical and rehabilitative
measures instituted by the physician. It involves an active role as patient
advocate. From the patients view point the nurse’s role in the cure circle may
take on the negative quality of avoiding pain rather than the positive quality of
providing comfort. It is a collaborative practice.

Here the physician is assisted to do the physical examination, blood is

collected for investigations. The client is prepared for a normal delivery and risk
consent was taken. The mother was administered with antibiotics to prevent
infection.
APPLICATION OF HALL’S CARE, CURE, AND CORE MODEL IN
THE CARE OF Mr.ANAND

THE CORE

● Clears the doubts

● Encourage to ventilate the
feelings
● Explained the patient’s
condition to the family
● Explained regarding the
medication and
investigations

THE CARE THE CURE

a) Prepared the ● Physician is assisted to
perineal area do the physical
and provided examination.
enema ● Blood is collected for
b) Changed the investigations.
wet clothes and ● The client is prepared for
provided a normal delivery and
hospital gown risk consent was taken.
c) Provided clean ● Administered antibiotics
Nursing Diagnosis

1) Ineffective cerebral tissue perfusion related to interruption of blood flow.

2) Impaired physical mobility related to motor neuromuscular abnormality.

3) Disturbed sensory perception related to disturbed sensory reception and

neuromuscular dysfunction.

4) Self care deficit related to neuromuscular impairment and decrease strength and
endurance.
 NURSING CARE PLAN
Assessment Nursing Diagnosis Objective Implementation Evaluation
Subjective Risk for injury To prevent injury Maintain bed rest
data; related to during acute phase
Patient neurologic deficit
complaint on
feeling
giddiness.
Objective
data:

24-48 Hrs with Risk for injury

head of bed slightly prevented
elevated with side
rails
Administer Oxygen
as order to
maximize cerebral
oxygenation
Assess the patient
risk
Impaired physical To improve physical Apply splint and
mobility related to mobility braces
motor deficit
Apply trochanter Physical
roll from crest of mobility
ileum maintained
Place the effected
upper extremities
slightly flexed on
 pillow with support
Alter thought Be aware of the Use picture of Though process
process related to patients cognitive family members, is improved
brain damage abilities and get it clock, post
optimizing improved schedule o
cognitive abilities. of daily activities.
Be aware of
patients cognitive
participate in
retraining
programme.
Health Education:
- Educated the patient & family members about disease condition.
- Educated the patient to take medication at correct time.
- Educated the patient to do exercise
- Educated the patient about follow up care.
Summary:
My patient was admitted in the mAx Hospital with the complaints of Paralysis and
unconsciousness.

Conclusion:
By this case study I could understand about the treatment and manage the case in
future.

Bibliography:
1) Brunner & Siddarth, Text Book of Medical Surgical Nursing, Vol No: I, PgNo: 165-
166.
2) Joyce M Black, Text Book of Medical Surgical Nursing, Vol No. II, Pg. No: 962-970.