Nursing care of a patient with CVA: Hemorrhagic Stroke

Introduction
Cerebrovascular disease refers to a group of conditions that affect blood flow and the blood vessels in
the brain. Problems with blood flow may occur from blood vessels narrowing (stenosis), clot formation
(thrombosis), artery blockage (embolism), or blood vessel rupture (hemorrhage). Lack of sufficient
blood flow (also referred to as ischemia) affects brain tissue and may cause a stroke . Some of the
following symptoms may appear suddenly as danger indicators of an ischemic attack or stroke:
feeling dizzy, nauseated, vomiting,intense headache, confusion, memory loss, arm and leg numbness,
facial drooping, abnormal speech, vision loss, and loss of balance. Diabetes, high blood cholesterol
levels, smoking, obesity, and high blood pressure can cause cerebrovascular stenosis and aneurysms.

The term cerebrovascular is characterized by two parts: the "cerebro" which is the major region of the
brain, and "vascular" the arteries and veins wherein cerebrovascular means blood flow in the brain as a
whole.

According to the Centers for Disease Control and PreventionTrusted Source, 6.5 million people have
had some type of stroke 2015. In 2014, cerebrovascular disease or stroke was number 5.
For people who survive a stroke, the two most important outcomes are functional outcomes and life
expectancy. These are determined by the specific condition causing the stroke, the severity of the
stroke, and the individual’s response to rehabilitation therapy.
A cerebrovascular disease, especially a stroke, must receive immediate medical attention to have the
best outcomes.
Depending on the severity of your condition, you may be left with permanent mental disability, problems
with mobility, or weakness or paralysis in your arms, face, or legs.
However, with immediate medical attention, medications, surgery, interventional procedures, or a
combination of these, many people return to normal functionality

This case study presents a 63 year old female presented with extremities weakness, associated with
facial drop last status post intubation on September 1, 2022 at 1:55 pm, status post right
decompressive hemicraniectomy on August 30, 2022 at 11:38 pm with final diagnosed of
Cerebrovascular Disease Infarct with bleeding.

Significance of the study

This study aims to educate healthcare professionals to raise awareness of patients’ cases. This is to
help create an effective care plan for patients. This also contributes to improved patient care for
healthcare providers.

For nursing education, the conducted research will allow the nursing students to ponder and assess the
level of information regarding Cardiovascular Disease Infarct with Bleeding. As such, this research
offers assistance to health practitioners to be more mindful, understanding, and prepared to care for
patients with this disease.
For nursing practice, as an individual of a well-being care group, medical attendants frequently play a
major part in malady avoidance and wellbeing advancement and recuperation. This study can be
utilized as a premise for care. In this way, medical caretakers may utilize this research to customize
care plans for their patients. This broadens the concept of caring for patients with comparable cases.

For nursing research, knowledge gained from this research will offer assistance to prepare future
medical caretakers, healthcare laborers, and analysts to extend information on persistent cases, which
underpins progress in nursing practice. Families can take advantage of this research as medical
caretakers are equipped to teach them.

Objectives
● General Objectives Acquisition and application of
knowledge, skills and attitude (KSA) through the utilization of the nursing process in the care of
Cerebrovascular Disease with emphasis on health promotion and maintenance, and disease
prevention.
● Learning Objectives
1. Establish a nurse-patient relationship;
2. Understand the anatomy and physiology of the systems involved in the disease;
3. Review the patients past and present history of the patient thoroughly;
4. Conduct a drug study;
5. Analyze relevant trends, cues, or patterns of data;
6. Construct a nursing care plan for the patient;
7. Introduce the patient’s significant others to health teachings;
8. Develop nursing history, Gordon’s 11 Functional Health Patterns and Bates’ Physical Assessment
correctly and accurately;
9.Comprehensively conduct a review of patient’s laboratory tests, to differentiate normal from abnormal
results, and identify its clinical significance;
10. Evaluate accurately the nursing interventions rendered to the patient.
Anatomy and Physiology

● Frontal lobe. The largest lobe of the brain, located in the front of the head, the frontal
lobe is involved in personality characteristics, decision-making and movement.
Recognition of smell usually involves parts of the frontal lobe. The frontal lobe contains
Broca’s area, which is associated with speech ability.
● Parietal lobe. The middle part of the brain, the parietal lobe helps a person identify
objects and understand spatial relationships (where one’s body is compared with
objects around the person). The parietal lobe is also involved in interpreting pain and
touch in the body. The parietal lobe houses Wernicke’s area, which helps the brain
understand spoken language.
● Occipital lobe. The occipital lobe is the back part of the brain that is involved with
vision.
● Temporal lobe. The sides of the brain, temporal lobes are involved in short-term
memory, speech, musical rhythm and some degree of smell recognition.

Deeper Structures Within the Brain

Pituitary Gland

Sometimes called the “master gland,” the pituitary gland is a pea-sized structure found deep in
the brain behind the bridge of the nose. The pituitary gland governs the function of other
glands in the body, regulating the flow of hormones from the thyroid, adrenals, ovaries and
testicles. It receives chemical signals from the hypothalamus through its stalk and blood
supply.

Hypothalamus

The hypothalamus is located above the pituitary gland and sends it chemical messages that
control its function. It regulates body temperature, synchronizes sleep patterns, controls
hunger and thirst and also plays a role in some aspects of memory and emotion.

Amygdala

Small, almond-shaped structures, an amygdala is located under each half (hemisphere) of the
brain. Included in the limbic system, the amygdalae regulate emotion and memory and are
associated with the brain’s reward system, stress, and the “fight or flight” response when
someone perceives a threat.

Hippocampus

A curved seahorse-shaped organ on the underside of each temporal lobe, the hippocampus is
part of a larger structure called the hippocampal formation. It supports memory, learning,
navigation and perception of space. It receives information from the cerebral cortex and may
play a role in Alzheimer’s disease.

Pineal Gland

The pineal gland is located deep in the brain and attached by a stalk to the top of the third
ventricle. The pineal gland responds to light and dark and secretes melatonin, which regulates
circadian rhythms and the sleep-wake cycle.

Ventricles and Cerebrospinal Fluid

Deep in the brain are four open areas with passageways between them. They also open into
the central spinal canal and the area beneath the arachnoid layer of the meninges.

The ventricles manufacture cerebrospinal fluid, or CSF, a watery fluid that circulates in and
around the ventricles and the spinal cord, and between the meninges. CSF surrounds and
cushions the spinal cord and brain, washes out waste and impurities, and delivers nutrients.

Blood Supply to the Brain

Two sets of blood vessels supply blood and oxygen to the brain: the vertebral arteries and
the carotid arteries.

The external carotid arteries extend up the sides of your neck, and are where you can feel your
pulse when you touch the area with your fingertips. The internal carotid arteries branch into the
skull and circulate blood to the front part of the brain.

The vertebral arteries follow the spinal column into the skull, where they join together at the
brainstem and form the basilar artery, which supplies blood to the rear portions of the brain.

The circle of Willis, a loop of blood vessels near the bottom of the brain that connects major
arteries, circulates blood from the front of the brain to the back and helps the arterial systems
communicate with one another.

Arterial Supply to the Brain

There are two paired arteries which are responsible for the blood supply to the brain; the
vertebral arteries, and the internal carotid arteries. These arteries arise in the neck, and
ascend to the cranium.
Within the cranial vault, the terminal branches of these arteries form an anastomotic circle,
called the Circle of Willis. From this circle, branches arise which supply the majority of the
cerebrum.

Other parts of the CNS, such as the pons and spinal cord, are supplied by smaller branches
from the vertebral arteries.

Internal Carotid Arteries

The internal carotid arteries (ICA) originate at the bifurcation of the left and right common
carotid arteries, at the level of the fourth cervical vertebrae (C4).

They move superiorly within the carotid sheath, and enter the brain via the carotid canal of the
temporal bone. They do not supply any branches to the face or neck.

Once in the cranial cavity, the internal carotids pass anteriorly through the cavernous sinus.
Distal to the cavernous sinus, each ICA gives rise to:

Ophthalmic artery – supplies the structures of the orbit.

Posterior communicating artery – acts as an anastomotic ‘connecting vessel’ in the Circle of

Willis (see ‘Circle of Willis’ below).

Anterior choroidal artery – supplies structures in the brain important for motor control and
vision.

Anterior cerebral artery – supplies part of the cerebrum.

The internal carotids then continue as the middle cerebral artery, which supplies the lateral
portions of the cerebrum.

Vertebral Arteries

The right and left vertebral arteries arise from the subclavian arteries, medial to the anterior
scalene muscle. They then ascend the posterior aspect of the neck, through holes in the
transverse processes of the cervical vertebrae, known as foramen transversarium.

The vertebral arteries enter the cranial cavity via the foramen magnum. Within the cranial
vault, some branches are given off:

Meningeal branch – supplies the falx cerebelli, a sheet of dura mater.

Anterior and posterior spinal arteries – supplies the spinal cord, spanning its entire length.

Posterior inferior cerebellar artery – supplies the cerebellum.

After this, the two vertebral arteries converge to form the basilar artery. Several branches from
the basilar artery originate here, and go onto supply the cerebellum and pons. The basilar
artery terminates by bifurcating into the posterior cerebral arteries.

Arterial Circle of Willis

The terminal branches of the vertebral and internal carotid arteries all anastomose to form a
circular blood vessel, called the Circle of Willis.

There are three main (paired) constituents of the Circle of Willis:

Anterior cerebral arteries – terminal branches of the internal carotid arteries.

Internal carotid arteries – located immediately proximal to the origin of the middle cerebral
arteries.

Posterior cerebral arteries – terminal branches of the basilar artery

To complete the circle, two ‘connecting vessels’ are also present:

Anterior communicating artery – connects the two anterior cerebral arteries.

Posterior communicating artery – branch of the internal carotid, this artery connects the ICA to
the posterior cerebral artery.

Regional Blood Supply to the Cerebrum

There are three cerebral arteries; anterior, middle and posterior. They each supply a different
portion of the cerebrum.

The anterior cerebral arteries supply the anteromedial portion of the cerebrum.
The middle cerebral arteries are situated laterally, supplying the majority of the lateral part of
the brain.
The posterior cerebral arteries supply both the medial and lateral parts of the posterior
cerebrum.

PATHOPHYSIOLOGY: Blood supply of the brain

To understand stroke, it is helpful to know how blood circulates to the brain (see Anatomy of
the Brain). Blood is pumped from the heart and carried to the brain by two paired arteries, the
internal carotid arteries and the vertebral arteries (Fig. 1). The internal carotid arteries supply
the anterior (front) areas and the vertebral arteries supply the posterior (back) areas of the
brain. After passing through the skull, the right and left vertebral arteries join together to form a
single basilar artery. The basilar artery and the internal carotid arteries communicate with each
other in a ring at the base of the brain called the Circle of Willis. The middle cerebral artery is
the artery most often blocked during a stroke.
Figure 1. A stroke is a sudden interruption of the blood supply to the brain. The middle cerebral
artery is most often blocked during a stroke. The internal carotid arteries form the anterior
(green) circulation and the vertebral / basilar arteries supply the posterior (red) circulation of
the brain. The two systems connect at the Circle of Willis (circle).

II- Nursing Process

A. Assessment
 ● Biographic Data
A. Name: D.H
B. Address: Building II Unit 05 Aplaya, Rio Hondo, Zamboanga City
C. Age: 63 years old
D. Birth Date: 11/10/1958
E. Sex: Female
F. Race: Filipino
G. Marital Status: Married
H. Occupation: N/A
I. Religious Orientation: Islam
J. Health Care Financing and usual source of medical care:

Comprehensive Nursing Health History

A. Chief Complaint and Reason of Visit:

Last August 27, 2022, at 11:48 am, the patient was brought to the emergency room at Ciudad Medical
Zamboanga (CMZ) with chief complaints of severe headache and weakness on one side of the body.

B. History of Present Illness

The patient is a 63 year old female presented with extremities weakness, associated with facial drop
last status post intubation on September 1, 2022 at 1:55 pm, status post right decompressive
hemicraniectomy on August 30, 2022 at 11:38 pm with final diagnosed of Cerebrovascular Disease
Infarct with bleeding.

C. Past History
N/A

D. Family History of Illness

N/A

Marjorie Gordon’s 11 Functional Health Problem

A. Health Perception and Health Management Pattern

Upon admission to the ICU, the patient was received in bed with a GCS score of 3 (E,V,M) with 4-5mm
pupil size, both non-reactive. Patient was with a tracheostomy tube hooked to a mechanical ventilator.

B. Nutritional and Metabolic Pattern

During the hospitalization, the patient is unable to eat and drink due to her being in a coma. A
nasogastric tube was placed on the right nostril of the patient in order for her to gain adequate nutrition.

C. Elimination Pattern

Patient is with a urinary catheter attached to the urobag.

D. Activity-Exercise Pattern

The patient is unable to maintain a normal respiratory pattern and is hooked to a mechanical ventilator.

E. Sleep-Rest Pattern

The patient is in a state of prolonged unconsciousness (coma).

F. Cognitive-Perception Pattern

The patient has an altered level of consciousness evidenced by increased intracranial pressure with a
glasgow coma scale of 3/15. There is no eye opening response, verbal response, and spontaneous
movement.

G. Self-Perception and Self-Concept

N/A

H. Role-Relationship Pattern

The patient is married and is well supported and loved by her family with close relationships. The family
is considered as the most important social support for the patient.

I. Sexuality-Reproductive Pattern

N/A

J. Coping-Stress Tolerance

N/A

K. Value Belief Pattern

The patient’s religion is Islam. The family considers religion as an important aspect of their life.
 ● Physical Assessment

B. Diagnostic Test

1. Computed Tomography (CT Scan)

The aim of the procedure is to create a detailed image of features of the brain. It is a non-invasive
procedure that uses special X-rays measurements to produce horizontal, or axial, images (often called
slices) of the brain. Brain CT scans can provide more detailed information about brain tissue and brain
structures than standard X-rays of the head, thus providing more data related to injuries and/or
diseases of the brain, and can help diagnose conditions such as stroke. The diagnosis of stroke using a
CT scan is ideal for identifying whether the stroke is hemorrhagic or ischemic. A stroke CT scan can
immediately detect if there is blood in the skull due to a hemorrhage.

2. Complete Blood Count (CBC)

The aim of a clinical laboratory test is to provide information to the nurse on duty and the physician
of the current status of the patient and be able to create an accurate diagnosis and provide the
appropriate nursing interventions or nursing care plan as a holistic approach to the client. In this
case, the patient is subjected to a complete blood count, clinical chemistry test for BUN and
troponin and a molecular laboratory exam for COVID-19.

The aim of a Complete Blood Count (CBC) is a blood test used to evaluate the client’s circulation
health and detect a wide range of circulatory disorders and measures the characteristics of the
patient’s blood. A complete blood count test measures several components of the patient’s blood,
including: Red blood cell, Hemoglobin, Hematocrit and more. It measures the overall health of the
blood and helps diagnose infection, anemia, clotting problems, or other blood problems

C. Laboratory result

Complete blood count

RESULTS UNIT NORMAL CLINICAL SIGNIFICANCE

RANGE
Red Blood Cell 5.9 (High) x10^1 3.8-5.8 The results of an RBC count can be used to
help diagnose blood-related conditions.
2/L
high numbers of RBCs may indicate Low
oxygen tension in the blood or congenital heart
disease because the body may try to
compensate for any condition that results in
low oxygen levels

Hemoglobin 159 g/L 115-165 Hemoglobin is a protein in the red blood cells
that carries oxygen to the body's organs and
tissues and transports carbon dioxide from the
organs and tissues back to the lungs.

Hematocrit 0.48 (High) g/L 0.37-0.47 A hematocrit test is part of a complete blood
count (CBC). Measuring the proportion of red
blood cells in the blood can help the doctor
make a diagnosis or monitor the response to a
treatment.

High hematocrit may indicate low oxygen

tension (smoking, congenital heart disease,
living at high altitudes) or dehydration
MCV 81.60 fL 80.00-100.00 An MCV test may also be used with other tests
to help diagnose or monitor certain blood
disorders, including anemia. There are many
types of anemia. An MCV test can help
diagnose which type of anemia the patient will
have.

MCH 27.10 pg 27.00-32.00 Hemoglobin is a protein in red blood cells that

carries oxygen and carbon dioxide.

MCHC indicates the amount of hemoglobin per

unit volume. In contrast to MCH, MCHC
correlates the hemoglobin content with the
volume of the cell.

MCHC 33 g/Dl 30.0-35.0 The MCHC test can help a doctor determine
the cause and severity of anemia.

MCHC indicates the amount of hemoglobin per

unit volume.

RDW 12.90 % 11.50-14.50 RDW results help the provider understand how
much the patient’s red blood cells vary in size
and volume which can indicate the body is
having difficulty making red blood cells.
White Blood Cell 11.4 (High) x10^9 4.0-11.0 White blood cells are part of the immune
system. They help the body fight off infections
and other diseases. A high white blood cell
count usually indicates:

An increased production of white blood cells to

fight an infection. A reaction to a drug that
increases white blood cell production. A
disease of bone marrow, causing abnormally
high production of white blood cells.

Differential Count

Neutrophils 0.74 % 0.40-0.75 Neutrophils help the immune system fight

infections and heal injuries. Neutrophils are the
most common type of white blood cell in the
body. An absolute neutrophil count identifies
whether the body has enough neutrophils.

Lymphocytes 0.24 % 0.20-0.45 Lymphocytes are a type of white blood cell.

They play an essential role in the immune
system, helping your body fight infections.
 Monocyte 0.02 % 0.00-0.10 Monocytes are a critical component of the
innate immune system. They are the source of
many other vital elements of the immune
system, such as macrophages and dendritic
cells. Monocytes play a role in both the
inflammatory and anti-inflammatory processes
that take place during an immune response.

Eosinophil 0.00 % 0.00-0.06 Eosinophils are a type of disease-fighting

white blood cell. This condition most often
indicates a parasitic infection, an allergic
reaction or cancer.

Basophil 0.00 % 0.00-0.01 Basophils are one of the five white blood cell
types that protect the body from infections or
respond to intruders like parasites, fungi and
cancer cells. Basophils drive the body's
reaction to allergens.

Platelet Count 295 x10^6 150-400 A platelet count is most often used to monitor
or diagnose conditions that cause too much
bleeding or too much clotting. A platelet count
/L may be included in a complete blood count, a
test that is often done as part of a regular
checkup. Platelet function tests may be used
to: Help diagnose certain platelet diseases.
 MPV 9.20 fL 8.00-12.00 MPV stands for mean platelet volume.
Platelets are small blood cells that stick
together to make blood clots that stop or slow
bleeding when the patient will have a cut or
injury. Platelets are made in the bone marrow.
An MPV blood test measures the average size
of the platelets.

Clinical Chemistry

RESULT UNIT NORMAL CLINICAL SIGNIFICANCE

RANGE

Blood Urea Nitrogen 4.64 mmol/L <8.3 The blood urea nitrogen (BUN) test reveals important
information about how well your kidneys are working. A BUN
test measures the amount of urea nitrogen that's in the blood.

TROPONIN I 0.10 (Negative) 0.00-0.16 The troponins have a strong correlation with adverse
cardiovascular outcome whether coronary artery disease is
present or not.
 Molecular Laboratory

pH= 7.41 PC02 = 28 HC03= 18 Molecular lab tests offer a high level of reliability

and accuracy and are used to detect

Normal Normal Value: Normal Value:
microorganisms, look for genetic mutations
Value: 7.35- 35-45mmol/L
22 to 26 mEq/L associated with certain infectious diseases and
7.45
cancers, perform paternity tests, and much more.

BE= 5.3 Pa02= 235 Sa02 = 99.8%

Normal Normal Value: Normal Value:

Value:
(80-100mmHg) (90-100%)
(x2mmol/L)

D. Drug study (Format form)

Drug Mechanism of Action & Side Indication and Nursing Responsibilities

effects Contraindication

Brand name: Lovenox MOA: Indication: ● Assess the injection

Generic name: Enoxaparin works by blocking a protein in Enoxaparin is indicated for the site for pain, swelling,
your body that causes clotting. This keeps prevention of ischemic
Enoxaparin blood clots from forming. If you have a blood irritation, or bruising.
complications in unstable angina
Classification: clot, it will stop it from getting worse while
and in non-Q-wave myocardial Report prolonged or
your body breaks down the clot on its own. It excessive injection-site
low molecular weight has an immediate onset of action when given infarction; it is indicated in
heparin in the intravenous form. It binds to and conjunction with percutaneous reactions to the
potentiates antithrombin III, a serine protease intervention and other treatment for physician
Route: inhibitor, to form a complex that irreversibly the management of acute ST
Subcutaneous inactivates factor Xa. elevation myocardial infarction.
● Assess for signs of
Dosage: bleeding and
Side effects: Contraindication:
40 mg/pfs ● Nausea
hemorrhage, including
You should not use this
Frequency: ● Fever bleeding gums,
medicine if you have had an
Once daily every 2pm ● Swelling extremities allergic reaction to enoxaparin, nosebleeds, unusual
● Diarrhea
heparin, benzyl alcohol, or bruising, black/tarry
● Anemia stools, hematuria, and
● Pain, bruising, redness, or products made from pork. You
irritation where the medicine should not use enoxaparin if a fall in hematocrit or
was injected. you have bleeding disorders or blood pressure. Notify
any active bleeding. physician or nursing
staff immediately if
enoxaparin causes
excessive
anticoagulation.
● Monitor signs of
anemia, including
unusual fatigue,
shortness of breath
with exertion, bruising,
and pale skin. Notify
physician or nursing
staff immediately if
these signs occur.
● Monitor signs of high
plasma potassium
levels (hyperkalemia),
including bradycardia,
fatigue, weakness,
numbness, and
tingling. Notify
physician or nursing
staff because severe
cases can lead to life-
threatening
arrhythmias and
paralysis.

Drug Mechanism of Action & Side Indication and Nursing Responsibilities

effects Contraindication

Brand name: Omexac- MOA: Indication: ● Monitor improvements in GI

40 Omexac-40: Omeprazole, a racemic
Generic name: mixture of two enantiomers reduces
gastric acid secretion through a highly
Omeprazole targeted mechanism of action. It is a
Classification:
specific inhibitor of the acid pump in the
Antiulcer agent parietal cell. It is rapidly acting and
provides control through reversible
proton-pump inhibitors
inhibition of gastric acid secretion with
Used in benign gastric and symptoms (gastritis, heartburn,
duodenal ulcers, Zollinger- and so forth) to help determine if
Ellison syndrome, gastric acid
drug therapy is successful.
reduction, gastroesophageal
reflux disease, acid reflux ● Monitor any chest pain and
disease, acid-related dyspepsia. attempt to determine if pain is
Contraindication: drug induced or caused by
cardiovascular dysfunction
Route: once-daily dosing. Omeprazole is contraindicated
IV in patients with a history of
Side effects: hypersensitivity to the drug or
Dosage: ● Headaches
40 mg/vial ● Abdominal pain
any excipients from the dosage
form.
Frequency: ● Constipation
● Diarrhea omeprazole is contraindicated
Q8 in patients taking dosage forms
● Flatulence
● Vomiting containing rilpivirine.
● nausea

Drug Mechanism of Action & Indication and Nursing Responsibilities

Side effects Contraindication

Brand name: MOA: Indication: ● Document the drugs+

Bactidol Hexetidine is an topical antiseptic Hexetidine is an topical dosage+ time+route+
Generic name: agent used for disinfection and antiseptic agent used for client.
prevention of bacterial, fungal and disinfection and prevention of ● Note the side effects o
Hexetidine yeast infections of the oral and bacterial, fungal and yeast the drugs
Classification: vaginal mucosa. A bactericidal and
infections of the oral and vaginal ● Do not swallow
local antiinfective and fungicidal antiseptic. It is used as a
antiseptic preparations 0.1% mouthwash for local infections mucosa.
Route: and oral hygiene. Contraindication:
This medicine is not
Oral toilette Side effects: recommended under six years
Dosage: ● Irritation of the tongue of age without doctor's advise.
N/A ● Taste disturbances Adult supervision is needed for
Frequency: ● Dry mouth children 6-12 years of age. Use
TID as directed to rinse the mouth. It
should be spat out not
swallowed.

Drug Mechanism of Action & Side Indication and Nursing Responsibilities

effects Contraindication

Brand name: MOA: Indication: ● Administer drug

Avamax Atorvastatin lowers plasma cholesterol Atorvastatin is indicated without regard to
and lipoprotein serum concentrations
Generic name: by inhibiting HMG-CoA reductase and as an adjunct to diet for food, but at same
Atorvastatin subsequently cholesterol biosynthesis in reduction of elevated time each day.
the liver and increases the number of
Classification: hepatic LDL receptors on the cell surface total cholesterol (total- ● Alert any health care
HMG-CoA reductase for enhanced uptake and catabolism of provider that you are
C), LDL-cholesterol
inhibitors (statins) LDL. on this drug; it will
Route: Atorvastatin competitively inhibits 3- (LDL-C), apolipoprotein need to be
hydroxy-3-methylglutaryl-coenzyme A B, and triglycerides in
NGT (HMG-CoA) reductase. [2] By preventing discontinued if acute
Dosage: the conversion of HMG-CoA to adults injury or illness
80 mg/tab
mevalonate, statin medications decrease Contraindication: occurs.
cholesterol production in the liver.
Frequency: Side effects: Hypersensitivity to ● Report muscle pain,
OD every 8pm ● Constipation atorvastatin. Active liver weakness,
● Flatulence disease or unexplained tenderness; malaise;
● Dyspepsia transaminase elevation. Your fever; changes in
● abdominal pain doctor should not prescribe
● Headache color of urine or
this medication if you are a
● Nausea patient with liver problems. stool; swelling.
● muscle aches
● Diarrhea
● insomnia

Drug Mechanism of Indication and Nursing

Action & Side Contraindication Responsibilities
effects

Brand name: MOA: Indication: ● Observe for signs of

Decadron, It relieves inflammation adverse reactions.
Dexamethasone is a (swelling, heat, ● Monitor blood
Dexamethasone
potent glucocorticoid redness, and pain) and pressure 2 - 3 times
Intensol, Dexasone,
with very little, if any, is used to treat certain daily.
Solurex, and
mineralocorticoid forms of arthritis; skin, ● Test for glycosuria
Baycadron. daily. If urine is
activity. blood, kidney, eye,
Generic name: thyroid, and intestinal positive for sugar,
Dexamethasone's
Dexamethasone disorders (e.g., colitis); check each urine.
effect on the body
Classification: severe allergies; and ● Observe gastric
occurs in a variety of
corticosteroids asthma. aspirates and stools
ways. It works by for bleeding.
Route: Dexamethasone is also
suppressing the used to treat certain ● Observe closely for
IV
migration of types of cancer. signs of infection.
Dosage:
neutrophils and ● Report unusual weight
4mg/vial 1 vial
decreasing Contraindication:
gain, swelling of the
Frequency: extremities, muscle
lymphocyte colony Contraindications to
Q12 every 10am- weakness, black or
proliferation. corticosteroids include tarry stools, fever,
10pm
hypersensitivity to any prolonged sore throat,
Side effects: component of the colds or other
formulation, concurrent infections, worsening
● upset stomach. administration of live or of this disorder.
● stomach irritation. live-attenuated ● Check history for
vaccines (when using systemic
● vomiting.
immunosuppressive administration: Active
● headache. infections; renal or
● dizziness. dosages), systemic
hepatic disease;
fungal infection,
● insomnia. hypothyroidism,
osteoporosis, ulcerative colitis;
● restlessness. uncontrolled diverticulitis; active or
● depression. hyperglycemia, latent peptic ulcer;
diabetes mellitus, inflammatory bowel
glaucoma, joint disease; CHF,
infection hypertension,
thromboembolic
disorders;
osteoporosis; seizure
disorders; diabetes
 mellitus; lactation.

Drug Mechanism of Indication and Nursing

Action & Side Contraindication Responsibilities
effects

Brand name: MOA: Indication: ● Watch for seizures;

Vactasol, Zosyn It works by killing Piperacillin and notify physician
bacteria that cause tazobactam injection is immediately if patient
Generic name: develops or increases
piperacillin infection. Tazobactam used to treat seizure activity.
tazobactam is in a class called beta- pneumonia and skin,
lactamase inhibitor. It gynecological, and ● Monitor signs of
Classification:
works by preventing abdominal (stomach pseudomembranous
penicillins and beta- bacteria from area) infections caused colitis, including
lactamase inhibitors destroying piperacillin. by bacteria. Piperacillin diarrhea, abdominal
Route: Antibiotics such as is in a class of pain, fever, pus or
IV piperacillin and medications called mucus in stools, and
tazobactam injection penicillin antibiotics. It other severe or
Dosage: prolonged GI problems
4.5 grams/vial; 1vial will not work for colds, works by killing bacteria (nausea, vomiting,
Frequency: flu, or other viral that cause infection. heartburn). Notify
infections. physician or nursing
Q8
Contraindication: staff immediately of
Side effects: Contraindicated in these signs.
● diarrhea patients with a history
● constipation ● Monitor signs of
of allergic reactions to allergic reactions and
● nausea any of the penicillins, anaphylaxis, including
● vomiting
cephalosporins, or pulmonary symptoms
● heartburn (tightness in the throat
beta-lactamase
● stomach pain and chest, wheezing,
● fever
inhibitors. cough dyspnea) or skin
● headache reactions (rash,
● mouth sores pruritus, urticaria).
Notify physician or
● difficulty falling nursing staff
asleep or staying immediately if these
asleep reactions occur.
● rash
● itching
● hives
● difficulty breathing or
swallowing
● wheezing
● severe diarrhea
 Drug Mechanism of Indication and Nursing
Action & Side Contraindication Responsibilities
effects

Brand name: MOA: Indication: ● .Monitor the client’s

Sodium Bicarbonate The main therapeutic .Sodium bicarbonate is serum calcium,
Generic name: effect of sodium indicated in the sodium, potassium,
Sodium Bicarbonate bicarbonate treatment of metabolic bicarbonate
acidosis which may concentrations,
Classification: administration is
occur in severe renal serum osmolarity,
Alkalinizing Agents increasing plasma acid-base balance
disease, uncontrolled
Route: bicarbonate levels, diabetes, circulatory and renal function
NGT which are known to insufficiency due to before and
Dosage: buffer excess shock or severe throughout the
650 mg/tab hydrogen ion dehydration, therapy.
Frequency: concentration, extracorporeal ● Assess for alkalosis
TID - 8am, 1pm, 6pm thereby raising circulation of blood, by monitoring the
solution pH to combat cardiac arrest and client for confusion,
clinical manifestations severe primary lactic irritability,
acidosis. paresthesia, tetany
of acidosis.
and altered
Contraindication: breathing pattern.
Side effects: ● Assess the client’s
● Hypersensitivity,
● Feeling more thirsty fluid balance
metabolic or
● Stomach cramps throughout the
respiratory alkalosis,
● Gas therapy. This
hypocalcemia,
● Severe headaches assessment includes
excessive chloride
● Loss of appetite intake and output,
(Cl-) loss from
● Nausea or vomiting daily weight, edema
vomiting or GI
● Irritability and lung sounds.
suctioning
● Weakness ● IV sites should be
● Patients at risk of
● Urge to urinate more observed closely.
developing diuretic-
frequently Extravasation should
induced
● Slowed breathing be avoided as tissue
hypochloremic
● Swelling in the feet irritation or cellulitis
alkalosis
or legs may occur when
● Hypercarbic acidosis
● Blood in the urine taking sodium
● Unknown abdominal
● Bloody or black bicarbonate.
pain
stools
 Drug Mechanism of Indication and Nursing
Action & Side Contraindication Responsibilities
effects

Brand name: MOA: Indication:. ● Monitor BP

Metoclopramide Metoclopramide is carefully during
Generic name: promotes gut motility used to treat the IV
Metoclopramide by the following three symptoms of slow administration.
Classification: mechanisms: stomach emptying ● Monitor for
Prokinetic agent inhibition of (gastroparesis) in extrapyramidal
Route: presynaptic and patients with reactions, and
IV postsynaptic D2 diabetes. It works by consult physician
Dosage: receptors, stimulation increasing the if they occur.
10 mg/amp of presynaptic movements or ● Monitor diabetic
Frequency: excitatory 5-HT4 contractions of the patients, arrange
Q8 receptors and stomach and for alteration in
antagonism of intestines. It relieves insulin dose or
presynaptic inhibition symptoms such as timing if diabetic
of muscarinic nausea, vomiting, control is
receptors (Figure 2A). heartburn, a feeling compromised by
of fullness after alterations in
Side effects: meals, and loss of timing of food
● Chills. appetite. absorption.
● clay colored ● Keep
stools. Contraindication: diphenhydramine
● difficulty with Metoclopramide is injection readily
breathing. contraindicated in available in case
● difficulty with patients with extrapyramidal
speaking or pheochromocytoma reactions occur
swallowing. because the drug (50 mg IM).
● dizziness or may cause a
fainting. hypertensive crisis,
● fast or irregular probably due to
heartbeat. release of
● general feeling of catecholamines from
tiredness or the tumor. Such
weakness. hypertensive crises
● headache (severe may be controlled by
or continuing) phentolamine.
 E. Nursing care plan
NURSING CARE PLAN #2

Nursing Nursing Goals & Nursing Implementation Evaluation

Assessment Diagnosis Desired Interventions
outcome

SUBJECTIVE Ineffective SHORT INDEPENDENT: INDEPENDENT: After giving

CUES: cerebral tissue TERM: nursing
perfusion 1. Perform a 1. Performed intervention
Patient is related to Client’s vital comprehensive comprehensive the client's
comatose. obstruction of signs will be Neurological neurological cerebral
the cerebral maintained Assessment on the assessment on the perfusion
-Lack of response arteries by within normal client. client. was
to environmental thrombosis/ range. Rationale: to improved.
stimuli. emboli or 2. Monitor Vital identify the
hemorrhagic Client will signs regularly. neurologic Client’s
-Impaired motor lesions as maintain status of the vital signs
function evidenced by position of 3. Monitor the client and are
bleeding in the function and Intracranial initiate maintained
-Impaired cerebrum. skin integrity. Pressures. treatment. within
communication. normal
LONG 4. Administer 2. Monitored range.
OBJECTIVE TERM: oxygen therapy as patient’s vital signs.
CUES: needed. Rationale: To Client’s
Client’s assess the level of
-GCS SCORE: 3 cerebral blood DEPENDENT: hemodynamic consciousne
perfusion is 1. Administer status. ss, motor &
- Vital Signs improved and anticoagulants and 3. Monitored sensory
Monitoring shows client tissue plasminogen Intracranial Pressure. function has
respiratory distress demonstrates activator as Rationale: to improved.
signs of prescribed. identify
-Sensory function improved cerebral
impaired neuronal 2. Administer edema and
function. calcium channel hemorrhagic
-Absent reflexes blockers, stroke.
vasopressors & 4. Administered
osmotic diuretics as oxygen therapy as
prescribed. needed.
Rationale: to meet
3. Provide an the oxygen needs and
appropriate position aid in respiration.
for the clients.
Dependent:

1. Administer
 anticoagulants and
tissue plasminogen
activator as
prescribed.
Rationale: to relieve
cerebral artery
obstruction by
causing fibrinolysis.

2. Administer
calcium channel
blockers,
vasopressors &
osmotic diuretics as
prescribed.
Rationale: to relieve
cerebral edema &
decrease hemorrhage
thereby preventing
hematoma & nerve
compression.

3. Positioned client in
an appropriately
suitable for the
condition.
Rationale: to increase
cerebral blood flow
and improve venous
return.

NURSING CARE PLAN #2

NURSING NURSING GOALS & NURSING IMPLEMENTATIO EVALUATION

ASSESSMENT DIAGNOSIS DESIRED INTERVENTIONS N
OUTCOME

SUBJECTIVE Ineffective SHORT INDEPENDENT: 1. Assessed the After the

CUES: airway TERM: patient’s airway nursing
clearance 1. Assess airway patency. interventions
related to After the patency. Rationale: the patient will
Patient is neuromuscula nursing Maintaining open be able to;
comatose. r involvement interventions 2. Auscultate breath and clear airway is
secondary to the patient will sounds. vital to retain The patient is
CVA infarct be able to airway clearance. able to breathe
OBJECTIVE as evidenced breath 3. Assess vital signs. effectively.
CUES: by the effectively. 2. Auscultated
presence of 4. Assess the patient’s breath The patient’s
-Difficulty of abnormal LONG oxygenation status. sounds. SpO2 level is
breathing breath sounds TERM: Rationale: within normal
and dyspnea. 5. Assess the cause Abnormal breath range.
-Changes in After the and severity of the sounds such as
respiratory rate nursing obstruction. crackles, stridor, After the
and rhythm interventions and wheezes can nursing
the patient will 6. Prepare a suction signify ineffective intervention
-On endotracheal maintain an machine in the airway clearance. the patient is
tube attached to a open and clear. patient’s bedside. able to
mechanical 3. Assessed vital maintain an
ventilator. 7. Suction the signs. open and clear
secretions if the Rationale: the airway.
-Abnormal breath patient is unable to patient's vital signs
sounds. cough it out. can signify changes
in breathing status
-Dyspnea use of and oxygenation.
accessory DEPENDENT:
muscles. 8. Refer the patient 4. Assessed the
for chest oxygenation status.
physiotherapy. Rationale: Foreign
body obstruction
9. Administer can be serious and
supplemental oxygen severely cut off air
as prescribed. exchange.
Discontinue if SpO2
level is above the 5. Assess the cause
target range, or as and severity of the
ordered by the obstruction.
physician. Rationale:
Information
10. Administer regarding the cause
prescribed COPD of obstruction can
medications help direct medical
(bronchodilators, management.
steroids or
combination inhalers 6.Prepared suction
and antibiotic machine in the
medications. patient’s bedside.
Rationale: the
patient may not be
able to cough out
the build up of
secretions.
Suctioning will
prevent the
worsening of
obstruction.

7.Suctioned
patient’s airway.
Rationale: the
patient may not be
able to expel
secretions alone. In
this case, suctioning
of the copious
secretion is
necessary to
promote a clear
airway.

8. Administered
supplemental
oxygen as
needed/prescribed.
Rationale: to
increase the oxygen
level and achieve an
SpO2 value within
the target range.

9. Administered
prescribed
medications as
prescribed.
Rationale: to dilate
or relax the muscles
on the airways, to
reduce the
inflammation if
there is
inflammation and to
treat bacterial
infection if present.
 F. Discharge Instructions Plan/ Health Teachings or Teaching Plan
Discharge Instructions: (METHOD/S)
i. Medications
Taking medications as endorsed is significant. These are to be taken reliably as endorsed and dodge
changing it to other medicines which are not yet prescribed to be utilized as a substitute to the
endorsed drugs. Doing so might have other complications.

General guidelines:
I. Assess the guardian's capability to understand the instructions given.
II. Let the patient take her medication as prescribed and do not alter the dosage or time.
III. Do not give any other drugs, supplements, vitamins, or herbs without a physician's order.
IV. Do not share prescription medication.
V. Medications can be dangerous when mixed.

If the patient develops a problem while taking the prescribed medications, immediately alert the
physician.

ii. Exercise
Physical inactivity after stroke is profoundly predominant. The body vividly upholds the utilization of
work out prepared (both aerobic and strength) for stroke survivors. Exercise training makes the body
attain a functional capacity improvement, the capacity to perform day to day home activities, and
decreases possibility of subsequent cardiovascular events. The objective of Physical training for the
stroke survivors is to maximizes long-term adherence. The physician will suggest exercises to assist
the patient in re enforcing the patient’s strength. These are some of the exercises that can be done at
home:
● Wrist Curls
● Wrist and Hand Stretch
● Shoulder Openers
● Table Towel Slide
● Trunk Bends
● Knee Rotations
● Hip Abduction
● Standing Knee Raises
● Sit to Stands
● Hip thrust

iii. Treatment/Therapy
The patient may need to continue the cerebrovascular infarct rehabilitation program after she leaves
the hospital to help her adjust to some of the functions she may have lost. This may be done in an
intensive rehabilitation center or at home. Most rehabilitation programs include:
The patient may have to proceed with the cerebrovascular infarct restoration program after being
discharged to assist her in adjusting to a few capacities she may have lost. This may be done in a
recovery center or at home. Most restoration programs that incorporated are:
I. Physical therapy to help regain or maintain muscle strength and instruct ways to move safely
II. Occupational therapy to help refurbish ways to do tasks that are previously done
III. Speech therapy to help problems with swallowing, speaking, or understanding words

Therapy may incorporate skin care and preparing the patient to control bladder and bowels which by
then requires assistance with daily activities.

iv. Health teachings

The patient should remain feasibly active. Inactivity can be a hindrance to recovery. Physical and
occupational treatment will assist the patient to learn how to oversee any physical complications.
● Do not allow the patient to vigorously do activities
● Let the patient take her medicines exactly as directed and do not skip doses.
● Let the patient be engaged in an exercise program.
● Control the patient’s cholesterol level.
● Allow the patient to learn stress management methods.
● Loose fitting clothes and slip-on shoes.
● Keep distractions and noise down. Keep your voice lower and refrain from shouting.
● Allow plenty of time for the person to answer questions and understand instructions.
● Use simple words and sentences and speak slowly. Ask questions in a way that can be
answered with a yes or no. When possible, give clear choices. Do not give too many options.
● Break down instructions into small and simple steps.
● Repeat if needed. Use familiar names and places. Announce when you are going to change the
subject.
● Assist the patient to do exercises to keep elbows, shoulders, and other joints loose.
● Watching for joint tightening (contractures)
● Making sure arms and legs are in a good position when sitting or lying
● Check every day for pressure sores at the heels, ankles, knees, hips, tailbone, and elbows.
● Change positions in the wheelchair several times per hour during the day to prevent pressure
ulcers.

v. Outpatient consultation
Rigorously keep follow-up appointments to track progress, some require blood tests as ordered by the
physician.

vi. Diet
Healthcare providers will assist the patient's guardian regarding changes in diet. The changes can
improve cholesterol, blood pressure, and blood sugar. Changes may include:

I. Reducing the amount of fat and cholesterol being consumed

II. Reducing the amount of salt (sodium) in the diet
III. Eating more fresh vegetables and fruits
IV. Eating more lean proteins, such as fish, poultry, and beans and peas (legumes)
V. Eating less red meat and processed meats
VI. Use low-fat dairy products
VII. Limiting vegetable oils, nut oils, sweets and processed foods such as chips, cookies, and baked
goods

vii. Sex
Cerebrovascular Disease may have damaged the part of the brain that controls your sex drive. Patients
may feel emotionally overwhelmed and find it hard to focus on intimacy.
 G. Teaching Plan
Topic/s: Cerebrovascular Disease
Target Participant/s: Older Adults
General Objectives: At the end of the health teaching, the participants will be able to
verbalize understanding of condition, treatment, and disease management.

Learning Objectives Content Time Teaching References Evaluatio

Allotm Strategies n
ent

At the end of the

health teaching
the client will be
able to:

1. Define Kraft, S. (2022,

Cerebrovascular disease is 30 Discussion/ Q and A
Cerebrovas April 25). What
a heterogeneous disorder. mins Use of
cular brochures to know about
It comprises of a number of
Disease cerebrovascula
distinct pathologies,
r disease.
including transient ischemic Retrieved
attack, stroke pathological October 12,
types (ischemic stroke, 2022 from
intracerebral hemorrhage, https://
subarachnoid hemorrhage) www.medical
and etiological subtypes newstoday.
(e.g., cardioembolic, com/articles/
atherothrombotic, lacunar 184601
ischemic strokes,
aneurysmal subarachnoid Cerebrovascul
ar Disease –
hemorrhage), and other
Classifications,
intracranial vascular Symptoms,
disorders (e.g., vascular Diagnosis and
malformations, unruptured Treatments.
aneurysms), each of which (n.d.). Retrieved
has different October 12, 2022
epidemiological and https://www.aan
management features. s.org/en/Patient
Stroke is the most s/Neurosurgical-
important and devastating Conditions-and-
clinical manifestation of all Treatments/
Cerebrovascula
the cerebrovascular
r-Disease
disorders.
 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
2. Know the ● weakness on one
signs and side, also known as
symptoms hemiparesis
● confusion
● difficulty
communicating,
including slurred
speech
● losing vision on one
side
● loss of balance
● becoming
unconscious
3. Understand
the different Ischemic stroke is by far
types of the most common type of
stroke stroke, accounting for a
large majority of strokes.
There are two types of
ischemic stroke: thrombotic
and embolic. A thrombotic
stroke occurs when a blood
clot, called a thrombus,
blocks an artery to the
brain and stops blood flow.
An embolic stroke occurs
when a piece of plaque or
thrombus travels from its
original site and blocks an
artery downstream.

A hemorrhagic stroke can

 be caused by hypertension,
rupture of an aneurysm or
vascular malformation or as
a complication of
anticoagulation
medications. An
intracerebral hemorrhage
occurs when there is
bleeding directly into the
brain tissue, which often
forms a clot within the
brain. A subarachnoid
hemorrhage occurs when
the bleeding fills the
cerebrospinal fluid spaces
around the brain. Both
conditions are very serious.

A TIA is a temporary
cerebrovascular event that
leaves no permanent
damage. Most likely an
artery to the brain is
temporarily blocked,
causing stroke-like
symptoms, but the
blockage dislodges before
any permanent damage
occurs.

4. Know the The American Stroke

emergency Association encourages
response of public knowledge of the
stroke F.A.S.T acronym as an aid
in recognizing the warning
signs of stroke and acting
on them quickly:
● Face drooping
● Arm weakness
● Speech difficulty
● Time to call 911

A neurosurgeon must
5. Understand evaluate an individual who
the has a brain hemorrhage.
treatment They may carry out surgery
and to reduce the increased
diagnosis pressure that a bleed
causes. Doctors usually
perform surgical
procedures, including
carotid endarterectomy,
carotid angioplasty, and
stenting.

● Cerebral
angiography
● MRI scan
● Magnetic resonance
angiogram (MRA)
● CAT scan
● CT angiography
(CTA)
● EKG or ECG
● Lumbar Puncture
(spinal tap)
 Topic/s: Coping Mechanism (Grief and Loss)
Target Participant/s: Client’s significant other/families
General Objectives: At the end of the health teaching, the participants will be able to be
informed about coping with suffering, grief, loss, dying, and bereavement, and provide them
with resources to adjust to loss/bereavement (e.g., individual counseling, support groups).

Learning Objectives Content Time Teaching References Evaluation

Allotm Strategies
ent

3o
At the end of the
health teaching
the client will be
able to: 330 Discussion (2022, August Q and A
mins 27). Grief and
Loss: NCLEX-
RN. Retrieved
1. Be able to Coping and coping
October 12,
know about mechanisms to grief can 2022 from
coping and vary greatly among https://
coping individuals. This coping can www.registere
mechanism be impacted by a number dnursing.org/
of factors and forces such nclex/grief-
as one's cultural loss/loss/
background, spiritual or
religious background, the
client's past experiences
with losses, the person's
level of growth and
development which
impacts on one's
perception of death and
loss such as a lack of
understanding about the
finality of death, one's level
of social supports and
interpersonal relationships,
socioeconomic status,
ethnicity, and the client's
perception of the gravity
and severity of the loss.

Coping mechanisms are

 strategies and techniques
used to help adjust to a
stressful event or situation.
There are two types of
coping mechanisms:

1. Adaptive Coping
Mechanisms -
generally considered
to be healthy
2. Maladaptive Coping
Mechanisms -
usually regarded as
negative coping and
often ineffective

The nurse assists in their

coping with grief and loss
2. Understand by encouraging them to
and learn about and employ
participate effective coping strategies,
in effective the nurse makes referrals
coping for the client so that
strategies
available community
resources are utilized.
Some of these referrals
may include psychological,
social, religious and
spiritual support, individual
counseling, group and
family therapy, and peer
support groups in the
community to promote
adaptive grieving and to
prevent complicated
grieving.

Clients who are

experiencing loss and
bereavement can often be
helped with resources such
as:
 ● individual therapy
● group therapy
● peer support groups
in the community

III- Evaluation

During the case study, the group identified the health problems and needs of the patient
diagnosed with a Cerebrovascular Disease infarct with bleeding. After determining patient’s
health problem, the group formulated goals and actions for treatment of the patient.Patient is
deceased due to cardiac arrest around august 31, 2022.

IV- Recommendations

Recommendations of the researchers who are at risk of experiencing cerebrovascular disease:

●Maintaining a healthy lifestyle, such as no tobacco use, healthful diet, and physical activity are
important strategies for both primary and secondary prevention of stroke.
● Controlling high blood pressure is also critically important in the general population and in the
acute stage of hemorrhagic stroke.
● People with stroke should accumulate at least 45 minutes of each appropriate therapy every
day, at a frequency that enables them to meet their rehabilitation goals, and for as long as they
are willing and capable of participating and showing measurable benefit from treatment.
Recommendations of the researchers in;
● In Nursing education helps us to teach our patients to discipline and maintain their good health,
and the researchers can educate the patients and give knowledge to improve their health status
outcomes.
● In nursing practice, it will help the nurse to showcase more of their roles with empathy while
ensuring the accurate data gathered, performing proper nursing intervention, and administering
right medication.
● This case study will help the future researchers as their reference data when conducting new
research that can provide background or an overview about Nursing care of a patient with CVA:
Hemorrhagic Stroke this will also be serve as a source of knowledge and information that would
help the future researchers.

V- References
https://www.healthline.com/health/cerebrovascular-disease#outlook-and-lifeexpectancy
https://my.clevelandclinic.org/health/diagnostics/4053-complete-blood-count#:~:text=A%20CBC
%20blood%20test%20can,disorders%2C%20such%20as%20myelodysplastic%20syndromes.

Lee, J. (2021, June 29). The Ultimate Guide to Stroke exercises. NEOFECT Blog. Retrieved October 5,
2022, from https://www.neofect.com/us/blog/the-ultimate-guide-to-stroke-exercises

Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., MacKay-Lyons, M.,
Macko, R. F., Mead, G. E., Roth, E. J., Shaughnessy, M., &amp; Tang, A. (2014). Physical activity and
exercise recommendations for stroke survivors. Stroke, 45(8), 2532–2553.
https://doi.org/10.1161/str.0000000000000022

Alexander, C. (2020, January 1). Stroke Discharge Instructions. Default. Retrieved October 05, 2022,
from https://www.mountnittany.org/wellness-article/stroke-discharge-instructions-for

Kraft, S. (2022, April 25). What to know about cerebrovascular disease. Retrieved October 12, 2022
from https://www.medical newstoday.com/articles/184601

(2022, August 27). Grief and Loss: NCLEX-RN. Retrieved October 12, 2022 from
https://www.registerednursing.org/nclex/grief-loss/loss/

National Clinical Guideline for Stroke, 5th edition from

https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/Key-Recommendations.aspx

Lijing L, Chaoyun L., Jie Chen,d. J. eNeurologicalSci. 2016 March from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818135/

Computed Tomography (CT or cat) scan of the brain. Johns Hopkins Medicine. (2021, August 8).
Retrieved October 15, 2022, from https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/computed-tomography-ct-or-cat-scan-of-the-brain#:~:text=A%20CT%20of%20the
%20brain%20may%20be%20performed%20to%20assess,a%20physical%20exam)%20are
%20inconclusive.

Developer. (2022, July 11). How CT scans & mris are used to diagnose strokes. Envision
Radiology. Retrieved October 15, 2022, from https://www.envrad.com/how-ct-scans-mris-used-to-
diagnose-strokes/#:~:text=A%20stroke%20diagnosis%20using%20a,is%20treated%20the
%20right%20way.

Pietrangelo, A. (2018, August 22). Cranial CT scan: Purpose, procedure, and precautions.
Healthline. Retrieved October 15, 2022, from https://www.healthline.com/health/cranial-ct-
scan#procedure

https://medicine.yale.edu/labmed/sections/molecular-diagnostics/#:~:text=The%20Molecular
%20Diagnostics%20Laboratory%20is,variety%20of%20settings%20in%20medicine.