Chapter 1 PDF

CEBU TECHNOLOGICAL UNIVERSITY
in consortium with
CEBU CITY MEDICAL CENTER - COLLEGE OF NURSING
Dinisio Jakosalem St., Bgy. Sto. Nińo, Cebu City 6000
Tel Nos. (032)316-5128; (032)418-6105
Email: ctuccmc_cn@ymail.com
Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Chapter 1
Introduction
The words "cerebro" and "vascular," which refer to the arteries and veins, are combined to form
the phrase cerebrovascular. The phrase cerebrovascular refers to the movement of blood
throughout the brain. Any conditions when one or more cerebral blood arteries are involved in
the diseased process and a region of the brain is temporarily or permanently impacted by
ischemia or bleeding are referred to as cerebrovascular diseases. Stroke, carotid stenosis,
vertebral stenosis, intracranial stenosis, aneurysms, and vascular abnormalities are all examples
of cerebral vascular disease. Blood flow restrictions can result from blood vessel rupture,
thrombosis, embolism, or vascular narrowing (stenosis) (hemorrhage). Brain tissue is impacted
by inadequate blood flow (ischemia), which can result in a stroke. A stroke happens when a
portion of the brain's blood supply is cut off or when a blood artery in the brain bursts, allowing
blood to enter the brain tissue. A basal ganglia stroke is when one of those take place in the basal
ganglia, a region of the brain. A stroke that affects the basal ganglia is referred to as a basal
ganglia stroke. This area of the brain is essential for communicating, regulating movement, and
controlling emotions. The most common type of stroke is the hemorrhagic stroke, a stroke
happens when blood spreads into the brain tissue from a ruptured, torn, or unstable blood artery.
Blood accumulation can cause swelling and pressure, which can harm the brain. Hemorrhagic
strokes, which are more common in basal ganglia strokes, are brought on by excessive blood
pressure. Some risk factors are: a personal or family history of stroke, having anxiety,
depression, or high stress level, high blood pressure, heart and blood vessel diseases, such
as atrial fibrillation or high LDL cholesterol and diabetes. According to the Stroke Society of
the Philippines (2023), is that the second leading cause of death and the first leading cause of
morbidity in the Philippines is stroke. Hemorrhagic stroke accounts for 30% of the prevalence,
while ischemic stroke makes up 70%. According to the most recent WHO data, 87,402 stroke
deaths—or 14.12% of all deaths—occurred in the Philippines in 2017. Philippines is ranked #29
in the world with a death rate of 134.74 per 100,000 people when adjusted for age. In 109
million Filipinos in the Philippines as of August 2021, the epidemiologic findings , stroke
continues to be the second greatest cause of death and one of the top five leading causes of
disability from 2009 to 2019. The actual prevalence of stroke is unknown, however reported
estimates range from 0.9% of the population in 2005(4) to 2.6% of the population in 2017. Seven
out of ten stroke cases are determined to be ischemic, with the remaining three being
hemorrhagic strokes. 36 percent (36%) of all stroke deaths happen without any medical
assistance. For the recent breakthroughs of the managements, patient is given medications that
manage blood pressure, clotting supports (Vitamin K therapy), Surgeries (Surgical AVM
removal, Surgical clipping, Angioplasty and stents), Stroke Rehabilitation: Speech, Cognitive
and Physical Therapy.
Prepared by: CTU-CCMC CN Faculty 1

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Tel Nos. (032)316-5128; (032)418-6105

References:
Collantes, M. V., Zuñiga, Y. H., Granada, C. N., Uezono, D. R., De Castillo, L. C., Enriquez, C.
G., Ignacio, K. D., Ignacio, S. D., & Jamora, R. D. (2021). Current state of stroke care in
the Philippines. Frontiers in Neurology, 12, 665086.
https://doi.org/10.3389/fneur.2021.665086
Fletcher, J. (2022, November 11). Basal ganglia stroke: Symptoms, causes, and treatment.
Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/313596
prevalence rate of hemorrhagic stroke in philippines - Yahoo Search Results. (n.d.). Yahoo.com.
Retrieved March 2, 2023, from
https://ph.search.yahoo.com/search;_ylt=AwrKDoqhKABkWP4H.pSzRwx.;_ylc=X1MD
MjExNDczNDAwMwRfcgMyBGZyA21jYWZlZQRmcjIDc2ItdG9wBGdwcmlkA3IwM
UpMZlQ1UWVlZHpxS2o4TG1EMkEEbl9yc2x0AzAEbl9zdWdnAzAEb3JpZ2luA3BoL
nNlYXJjaC55YWhvby5jb20EcG9zAzAEcHFzdHIDBHBxc3RybAMwBHFzdHJsAzUy
BHF1ZXJ5A3ByZXZhbGVuY2UlMjByYXRlJTIwb2YlMjBoZW1vcnJoYWdpYyUyM
HN0cm9rZSUyMGluJTIwcGhpbGlwcGluZXMEdF9zdG1wAzE2Nzc3MzIwOTE-
?p=prevalence+rate+of+hemorrhagic+stroke+in+philippines&fr2=sb-
top&fr=mcafee&type=E210PH91215G0

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Chapter 2
Patient’s Profile
1. Objectives:
General
The general purpose of a case study is to contribute promotion of patient’s health who is
currently suffering CVD Bleed of Left Ganglia; Hypertensive Emergency.
Specific
Cognitive
Identify the numbers presented through handsignals and be able to respond accordingly
through eye blinking.
Affective
Display appropriate emotions received and be able to show interest in communicating to

people around the patient’s diameter.
Psychomotor
Follow basic movement commands and to gradually repeat the action demonstrated in
front of the patient.
2. Patient’s Profile
Patient M.P.C., 53 years old, female. Born on April 3, 1970 at Negros City. Patient is
4th birth order and is Married. They currently live at Sitio Kabulakan Banawa,
Guadalupe Cebu City. M.P.C. is Roman Catholic and a high school graduate. She is a
housewife and has no food, drug and cosmetic allergies. Her working or final diagnosis
is T/C CVD Bleed Left Basal Ganglia, Hypertensive Emergency.
Chapter 3
Patient’s History
This section is composed of four components, namely:
2.1 Hx of present illness Patient was hypertensive at the age of 30+. Patient always told
her children that her indicator that she has high blood pressure is when her nape
hurts, and felt sudden dizziness. It will take usually one hour and after she will take
her medication, symptoms subsides. The characteristics of her pain are when her
nape felt like it is being slashed and her head has a tingling or pumping pulsations

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2.2 inside. Aggravating factors was when she had a lot of work to do from home to their
farm. She lifts heavy weights under the heat of the sun and did laundry when arrived
at home. Alleviating factors is that when she took 2-3 hours rest either to sleep or do
nothing at home and took her maintenance antihypertensive medication-losartan.
Related symptoms were nausea & vomiting, dizziness and blurry vision. Her
treatment before admission was Losartan. Severity of pain 10/10 as per the
grimaces, phrases told by the patient to his son before admitted.
2.3 Past health hx (medical, surgical, dental, ob/gyne, maintenance meds taken)
The patient had no history of any surgical procedures, dental consultations. She is a
multipara mother and were all vaginal/normal delivery. She was diagnosed as
hypertensive back when she was 30+ years old and the took her maintenance
medication –Losartan. This is her first admission coming from emergency room.
2.4 Family health hx (to include genogram starting from the immediate grandparents)
Mother’s Side Father’s Side
LEGEND:
- Deceased
- Deceased

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- Female
- Male
- Hypertensive
- Patient Hypertensive
2.5 Environmental hx (place of residence from childhood until present)
Patient was born on rural areas at Negros City. The surroundings were free from pollutions
of cars, factories and garbage. Patient was used in eating vegetables, fried fish and ginamos
(anchioves). She used to farming, lifting weights and eating salty foods until she got
married. They currently lived in a sub-urban area at Sitio Kabukalan, Banawa Guadalupe,
Cebu City. They have a small garden in front of their house which has kamunggay, sili
espada, papaya and some others. They still eat buwad, meat and ginamos. Patient worked to
a farm filled with plant crops and that served as her daily exercise.
Chapter 4
Developmental task
Patient is 53 years old. Based in Psychosocial Development Theory of Erik Erikson., she
is in the 7th stage: Generativity vs. stagnation (40 and 65). In this stage, middle-aged adults
strive to create or nurture things that will outlast them. The patient applied this stage by
parenting her 5 children and fosters positive lectures and changes that are beneficial to her
children and to people in her community. Patient did her responsibility by joining the as one
of the sweepers in their community every morning, This contribution helps our society to
promote unity and encourage harmony to future generations. During her marriage up to
before she was admitted, she was committed to wake up early, according from his son,
whenever her mother felt stagnant. She always look for opportunities to learn and have
herself inspired in order to make their family to have atleast meal thrice a day. The
Generativity vs. stagnation developmental stage is halfway achieved because patient ‘s
responsibilities were cut due to her stroke and current admission.

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Chapter 5
Health Assessment
3. Health assessment
Health Perception- Health Management Pattern
Nursing Diagnosis: Ineffective Health Maintenance related to poor nutrition
Before admission, patient was hypertensive and has left sided body weakness. The family’s
general health was not really healthy because it was not balance due to excessive sodium
intake. Their family is engaged in strenuous work at farm and her husband as a driver.
Patient’s children are all students and the eldest is College level. The family’s way to stay
healthy by living as a hardworking individual, eating vegetables and fried fishes most of the
time. Walking and lifting weights act as an exercise of the patient. Patient seek her first
health care at their rural hospital back when she was 30+. The family had no history of
seeking actual consultation at the hospital because they prefer herbs and buying OTC
medications to treat common symptoms. Some members of their family also loves to eat
junkfoods which is considered unhealthy.
Upon admission, the SO rated her mother’s health as 2 (fair) because he compared the
situation from first admission is different to now because patient demonstrated
improvements. The effect of illness on ADL’S are poor. Patient is covid-19 vaccinated with
Pfizer. SO is compliant with the treatment.
Upon assessment, patient is lethargic, weakness, invalid. Patient is well-groomed. Posture is

not clearly demonstrated because patient is bed-reddened. Patient is unable to display
expressions. Height is 162 cm and Weight is 63 kg. Before medication given vital signs were:
BP: 140/90mmHg, P: 79, RR: 26, T: 35.5 and o2: 97%. After medication given, the vital
signs became BP: 110/80mmHg, P: 70, RR: 19, T: 35.5 and o2: 99%.
Nutritional Metabolic Pattern
Nursing Diagnosis: Impaired Swallowing related to brain injury
Before admission, patient’s family usually ate meal together at 5 am, ate lunch at 1pm and
dinner at 7-8pm. Patient drank water to satisfy thirst after a hard day of work. Family’s
general appetite is fair. Patient and family did not seek dental care. Patient and family had
history of rashes but cure it with fluococinonide. Patient is the one who prepares meal and do
shopping.
Upon admission, food intake is thru nasogastric feeding while fluid intake is thru IVF.
Breakfast is at 8am, lunch is 12nn, snacks 4pm and supper is 8pm. Patient’s current food
intolerance are hard foods because pt has dysphagia. Patient has no sore gums and tongue

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and no abdominal pains.
Upon assessment, skin color is brown, no lesions, normal skin turgor, cold and clammy to
touch and dry in texture. Hair color is black with some white strands, no scalp lesions and
dry, frizzy hair. Patient has yellowish teeth, darkened lips and tongue. No lesions gums but
seen some on tongue. Patient has 28 teeth left.
Elimination Pattern
Nursing Diagnosis: Altered Bowel Elimination
Before admission, patient has normal urination and bowel elimination. No laxatives were
used. When diarrhea occurs, they only took Diatabs and Lomotil as OTC treatment. They
don’t have problems in disposing garbages. Used bottles were used as a pot at home and grey
colored water were recycled and used as a flushing water at their comfort room. They don’t
have pets at home. Mosquitos and cockroaches are everywhere in the areas that’s why patient
is always cleaning the surroundings and that, lessens the presence of insects in their house.
Upon admission, patient eliminates waste once a day, yellow color same with the color of
feeding formula as stated by the SO. Consistency is not watery. Bladder urine elimination is
via FBC. As of 11am, 450ml of urine is noted at the urobag with an amber yellow color.
Patient has no history of UTI. Upon assessment, abdomen has no lesions and no masses
palpated. Rectum has small lesions, dry and pressure ulcers were noted.
Activity-Exercise Pattern
Nursing Diagnosis: Impaired Physical Mobility related to CVD
Before admission, patient took a bath two times a day. She woke up early in the morning to
prepare and cook foods for breakfast up to lunch. Patient does the shopping, and decision
making in the family. Household chores were patient’s job as well as the yard works that has
planted crops namely: kamunggay, papaya, alogbati, okra and flowers. Eating times were
5am, 1pm and 8pm. No dyspnea. Felt chest pain sometimes when overstressed. When attack
happened, patient had immediate problem in speaking.
Upon admission, patient became bed reddened for one month with presence of bed ulcers at
butt area. Right side of the body is immobile. NGT is attached to support body by absorbing
nutrients. Upon assessment, patient can’t stand, no swelling on legs, positioned in a semi
fowlers, and supine position. Body shape is symmetrical. No retractions and no adventitious
sound. No prominent pulsations noted. Pulses were noted.

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Sleep-Rest Pattern
Nursing Diagnosis: Risk for Disturbed Sleep Pattern
Before admission, patient and her family slept 8-9pm and woke up 5am in the morning.
Some members arose at different time depending on what time her children will go to school.
Patient is sleeping to rest from a tiring day. No family members in house has work at night.
Upon admission, patient is lethargic and always told to sleep. Body movements are
uncontrollable and it needs assistance. Patient had interrupted sleep whenever there is a loud
noise that may frightened her. Upon assessment, patient can’t yawn, not irritable and appears
weak and unresponsive to some questions. Patient is cannot be ask.
Sexuality-Reproduction Pattern
Nursing Diagnosis: Risk for Ineffective Sexuality Pattern
Before admission, patient and her husband had difficult time to be together. They slept beside
each other but no time for communication due to tiredness. Patient had miscarriage of their
first born. By the following deliveries, all were normal and no history of cesarian section.
She have 5 children with only one female- their youngest who is currently 11 years old.
Patient is fertile with no history of using contraceptives and no STI.
Upon admission, patient is catheterized using FBC. Her urine color is amber orange and
using diaper for bowel elimination. Upen assessment to her genital, abundant pubic hair is
noted, foul smelling, and has yellow discharges. Lesions, masses and inflammation were not
noted. Darkened labia majora is noted. Breast has no masses and lumps. Shape is sagging and
nipples are protruded.
Cognitive Pattern
Nursing Diagnosis: Impaired Verbal Communication related to impaired cerebral

circulation secondary to stroke
Before admission, patient is aware of her illness and she was taking her medication for
hypertension daily but not in uniform time. She was the one who made decisions most of the
time. The family member who has highest educational attainment is their eldest who is
currently a 3rd yr college. Patient and family bonding is by gathering together at home,
cooking meat foods and have an open communication to each one of them.
Upon admission, patient can’t be asked. Unable to respond, unable to express emotions and
decisions. Upon assessment, patient is behave, has aphasia, drowsy and no body

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coordination. Patient can’t be asked.
Role Relationship Pattern
Nursing Diagnosis: Parental Role Conflict
Before admission, the patient is close to her family especially to her eldest son. They
expressed concerns and solved problems together. Their support system is only the salary the
patient and her husband have. They are a member of TAPAT program and she was active in
participating environmental cleaning. She is the mother of the family and the one who guide
her children. Dissemination of household chores responsibilities are not effective because the
patient usually does all the work. Upon admission, patient is unable to fulfill her
responsibility as a mother but she has a good and caring second born son who take care of
her actively in the ward. Upon assessment, her son is communicating with their family
members for clothes and other things needed in the hospital. They tend to have an open
communication and relationship with each other,
Self-Perception Pattern- Self-Concept Pattern
Nursing Diagnosis: Disturbed Body Image
Before admission, patient identified herself as a woman and a mother. She loved to take good
care of her hygiene and loved to dress clean. Upon admission, patient is well cleaned but hair
is frizzy. Her son always cleaned and wiped her with clean wet cloth to moisturize her dry
skin. Patient can’t be asked and unresponsive to questions.
Coping Stress Tolerance Pattern
Nursing Diagnosis: Risk for Ineffective Coping
Before admission, her stressors were disorganized areas and the quarrels of her children.
When there is a family problem, she opened it up to her husband and then tell it to their
children so that everyone will be aware of the problems. Their support system is only God
and each other. Coping methods was communication. Upon admission, patient can’t be ask.
SO answered that he always prayed silently and motivates her mother to fight and recover
fast.

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Tel Nos. (032)316-5128; (032)418-6105
Value-Belief Pattern
Nursing Diagnosis: Risk for Impaired Religiousity
Before admission, they went to church sometimes every Sunday. They prayed together
especially when there is an upcoming Patron Fiesta in their area. They don’t believe in any
superstitious beliefs because they only trust God and he is the hope they have now.

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Chapter 6
Physical Examination
4. Physical examination
General
Patient received unconscious and not coherent. Patient has NGT, O2 and FBC attachments.
IVF is PNSS 1L with KVO rate. Patient appears drowsy. Patient is aphasia and has
dysphagia.
Skin
Inspection:
 Brown skin  No signs of rashes
 Wrinkled  No eye bags noted
 Cold and Clammy to touch  Dry skin
 No lesions
 Has pressure ulcers on butt area.
Hematopoietic
Inspection:
 No blood transfusion performed
 No visible pumping pulsations
 No abnormal bleeding
Auscultation:
 BP before med: 140/90mmHg ; BP after med: 110/80 mmHg
 No abnormal heart sounds
Endocrine
Inspection:
 NGT attached

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Head
Inspection:
 Symmetrical and head shape is  Hair is black in color with some

normocephalic white strands
 Head is appropriate to body’s  Hair is dry and frizzy

size and shape.
Palpation:
 No masses and tenderness noted.  No lesions noted
Eyes
Inspection:
 Right eye is not able to open  Eyes is not following to moving

objects
 Symmetrical eyes
 Sclera is yellowish
 Thin eyelashes noted
 Conjunctiva are reddish
Ears
Inspection:
 Ears are symmetrical  Dry
 Bed Sores at upper pinna noted  Able to react to loud noises.
Palpation
 No lumps and masses noted
Nose and Sinuses
Inspection
 Symmetric and straight  No deformities noted
 No lesions noted  Oxygen mask is attached
 Dry  NGT is inserted at right nostril.

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Palpation:
 Sinuses are clear and felt no pain during palpation
Neck
Inspection:
 Immobile both sides  No sores and wound noted
 No discoloration noted
Palpation:
 Trachea is positioned midline  No tenderness and lump noted
Lungs
Inspection:
 RR: 19cpm  No cyanosis  CRT is 2

noted seconds
Auscultation:
 Vesicular sound noted.
Heart
Inspection:
 No visible pulsations
 Jugular veins not prominent
Auscultation:
 BP: 140/90 mmHg and 110/80 mmHg
 PR: 70 and 76 bpm
Peripheral Vascular
Inspection:
 No edema and cyanosis noted

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Gastrointestinal
Inspection:
 Flat  No lesions and swelling noted
Palpation:
 Abdomen is flat and soft  Not distended
 No lumps noted
Urinary
Inspection:
 FBC attached  Amber Orange in color
 1pm has 550 cc of urine
Genito-reproductive
Inspection:
 Dark labia majora  Yellow discharges noted
 Abundant pubic hair  No lesions seen
Palpation:
 No lumps and masses palpated.
Musculoskeletal
Inspection:
 Right side is immovable  Paralaysis noted
 Limited mobility  No edema noted

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Nervous System
Inspection:
 Right side paralysis  GCS: 10 E:3 M:6 V:1
 Aphasia
Chapter 7
Laboratory and Diagnostic Studies
Table 1 Sodium February 25, 2023 1:00pm
Component Patient’s Reference Values Interpretation Significance

Results
Sodium 137.40 135.0-148.0mmol/L Normal No significant findings
BUN 12.6 7.94-20.1 mg/dL Normal No significant findings
Creatinine 0.86 0.7-1.3 mg/dL Normal No significant findings
Potassium 3.37 0.37-0.43%mmol/L Low Hypokalemia. Indicates that patient is

lack of foods rich in potassium and it
can be done to taking diuretics for
treating HBP.
Low potassium (hypokalemia). (2022,

June 23). Mayo Clinic.
https://r.search.yahoo.com/_
ylt=AwrKAvVdwP9jXjIAj
D.zRwx.;_ylu=Y29sbwNzZ
zMEcG9zAzIEdnRpZAME
c2VjA3Ny/RV=2/RE=1677
734110/RO=10/RU=https%
3a%2f%2fwww.mayoclinic.
org%2fsymptoms%2flow-
potassium%2fbasics%2fdefi
nition%2fsym-
20050632/RK=2/RS=AkmI
xQ6HMrvbimds_.5mwAFA
VpE-

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Tel Nos. (032)316-5128; (032)418-6105
Table 2. Complete Blood Count February 25, 2023
Component Patient’s Reference Values Interpretation Significance

Results
RBCs 3.8 4.5-6.210^12/L Low May indicate iron deficiency and

low haemoglobin levels.
Reference:
Low hemoglobin count. (2022,

May 24). Mayo Clinic.
https://www.mayoclinic.
org/symptoms/low-
hemoglobin/basics/cause
s/sym-20050760
WBCs 11.2 4.0-10.010^9/L High Leukocytsis. May indicate

presence of infection and immune
system is fighting with infections.
Reference:
Miller, F. P., Vandome, A. F., &

McBrewster, J. (Eds.).
(2010). Complete Blood
Count. Alphascript
Publishing.
Hemoglobin 123 130-180 g/L Low Indicates that there is lack of blood
that carries oxygen all thoughtout
the body.
Reference:
Miller, F. P., Vandome, A. F., &

McBrewster, J. (Eds.).
(2010). Complete Blood
Count. Alphascript
Publishing.
Hematocrit 0.39 0.40-0.50% Low May indicate insufficient supply of

oxygen. Patient may also lack
B12, folate, or iron in their diet.

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Reference:
Martin, L. (2022, November

24). Hematocrit test:
What it is, levels, high
and low range.
Medicalnewstoday.com.
https://www.medicalnew
stoday.com/articles/hem
atocrit-levels
MCV 104.5 80-100 fL High Macrocytosis, Indicates the RBC is

larger that the average size. Patient
may also have Vitamin B-12
deficiency. Folate deficiency.
Reference:
Macrocytosis: What causes

it? (2023, January 25).
Mayo Clinic.
https://www.mayoclinic.
org/macrocytosis/expert-
answers/faq-20058234
MCH 32.6 27-31pg High Indicates that patient has low

vitamin B12 or folate intake and
may also due to intake of
antidiabetic medications.
Reference:
MCH levels. (n.d.). MedicineNet.

Retrieved March 1,
2023, from
https://www.medicinenet
.com/mch_levels/article.
htm
MCHC 31.2 31-36 g/dL Normal No significant findings
RDW 0.125 0.115-0.150 Normal No significant findings
Platelet 240 150-450x10^9L Normal No significant findings

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Differential
Count
Segmenters 0.83 0.55-0.65% High Neutrophilia. Indicates that the

body is fighting an infection.
Reference:
Neutrophils. (n.d.). Cleveland

Clinic. Retrieved March
1, 2023, from
https://my.clevelandclini
c.org/health/body/22313-
neutrophils
Lymphocytes 0.09 0.25-0.35% Low Lymphocytopenia. May indicate

that the patient is malnutrition and
lack of protein production happens
due to too much fighting of
immune system to infection.
Reference:
Iftikhar, N. (2022, October

19). Lymphocytopenia:
Causes, symptoms, and
treatment. Healthline.
https://www.healthline.c
om/health/lymphocytope
nia
Monocytes 0.06 0.03-0.06% Normal No significant findings
No significant findings
Eosinophils 0.02 0.02-.04% Normal
Basophils 0.00 0.00-0..01 Normal

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Table 3. Potassium test February 22, 2023
Component Patient’s Results Reference Values Interpretation Significance
Potassium 3.45 3.5-5.0 mmol/L Low

Hypokalemia. Indicates that
patient is lack of foods rich
in potassium and it can be
done to taking diuretics for
treating HBP.
Reference:
Low potassium
(hypokalemia).
(2022, June 23).
Mayo Clinic.
https://r.search.yah
oo.com/_ylt=Awr
KAvVdwP9jXjIAj
D.zRwx.;_ylu=Y2
9sbwNzZzMEcG9
zAzIEdnRpZAME
c2VjA3Ny/RV=2/
RE=1677734110/
RO=10/RU=https
%3a%2f%2fwww.
mayoclinic.org%2f
symptoms%2flow-
potassium%2fbasic
s%2fdefinition%2f
sym-
20050632/RK=2/R
S=AkmIxQ6HMrv
bimds_.5mwAFA
VpE-

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Table 4. Procalcitonin February 19, 2023 8:09pm
Procalcitonin 1.01 0-0.5ng/mL High Indicates that the body is

fighting a serious infection
this may due to necrotizing
bed sore. This must be
treated immediately to
prevent further tissue death.
Reference:
Procalcitonin test. (n.d.).

Medlineplus.gov. Retrieved
March 1, 2023, from
https://medlineplus.gov/lab-
tests/procalcitonin-test/
Table 5. C-REACTIVE PROTEIN TEST QUANTITATIVE February 19, 2023
CRP Quantitative 125.58 0-5mg/dL High Indicates inflammation due

to acute infection or tissue
injury.
Reference:
Huizen, J., & Villines, Z.

(2022, July 29). C-
reactive protein
(CRP) test: High
and low levels, and
normal range.
Medicalnewstoday
.com.
https://www.medic
alnewstoday.com/a
rticles/322138

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Table 6. Urinalysis February 7, 2023

Physical Properties
Color Yellow Not normal Indicates slight dehydration.
Tranparency Slightly Cloudy Not normal Indicates dehydration
Chemical Properties
pH 6.0 3.5-7.2 Normal No Significant findings
Specific Gravity 1.025 1.005-1.020 High Indicates that patient have extra
substances in urine: RBC
Reference:
Nall, R., MSN, & CRNA. (2018,

August 7). Urine specific gravity
test. Healthline.
https://www.healthline.com/heal
th/urine-specific-gravity
Protein Negative Negative Normal No Significant Findings

Glucose Negative Negative Normal No Significant findings
Microscopic Exam
Indicates that there might be irritation of

RBC 5-10 0-2/hpf High
the tissues in urinary tract.
Reference:
Faculty By Department, & Find a

Physician. (n.d.). Microscopic
urinalysis. Rochester.edu.
https://www.urmc.rochester.edu/
encyclopedia/content.aspx?conte
nttypeid=167&contentid=urinan
alysis_microscopic_exam
WBC
0-2 0-2/hpf Normal
Epithelial cells
Moderate Few Normal
Bacteria Few Negative Not normal Indicates infection

in consortium with
Tel Nos. (032)316-5128; (032)418-6105

Reference:
Faculty By Department, & Find a

Physician. (n.d.). Microscopic
urinalysis. Rochester.edu.
https://www.urmc.rochester.edu/
encyclopedia/content.aspx?conte
nttypeid=167&contentid=urinan
alysis_microscopic_exam
Mucus Thread
Few Small amount Not normal
May indicate UTI or kidney problem to
patient
Reference:
Leonard, J. (2021, May 4). Mucus in

urine: Causes, tests, and
treatment.
Medicalnewstoday.com.
https://www.medicalnewstoday.
com/articles/321112
Table 7. Culture and Sensitivity February 4, 2023
Sample: Blood
Site of Collection: Left arm
Result/Conclusion:
No growth after 5 days of incubation – 2/9/23
Significance:
This means that the probability that a person has a blood infection caused by bacteria or
fungi is low.
Reference:
Blood C/S (Aerobic and Anaerobic -ARD). (n.d.). Gov.Ph. Retrieved March 2, 2023, from
https://www.phc.gov.ph/services/vtour/lab/bacteriology/Blood%20Culture%20and%20Sensitivity%2
0(Aerobic%20and%20Anaerobic-ARD).pdf

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Table 8. X-Ray February 1, 2023
Conclusion:
X-ray lungs are clear
Heart is not enlarged
Both hemidiaphgram are sharp and distinct
The trachea lies in the midline
The visualized osseous and soft tissue sheets are unremarkable.
Impression: Normal Chest
Significance:
The result indicates that there is no cardiomegaly, collapsed lung, pneumonia, broken ribs, emphysema,
cancer that may cause complications to current patient condition.
Reference:
Chest X-rays. (2022, March 5). Mayoclinic.org. https://www.mayoclinic.org/tests-procedures/chest-x-

rays/about/pac-20393494
Table 9.. CT SCAN Brain Plain (SPC) January 1, 2023

Conclusion:
There is an intra parenchymal hemorrhage at the pons extending to the left midbrain and Left cerebral
pecluride measuring all in volume with edema. there are small well defined hypondensitus at the subcortical
Right frontoparietal lobe use. age periventricular region both ventrium semi ovale and both basal ganglia.
The cortical sulci and gyri are present. The ventricles and basal cistern are within normal limits; the midline
structures are not displaced; there is no extra axial fluid collection seen. There are calcified plaques outlining
the wall of the internal carotid arteries. the orbital structures are unremarkable. There are mucoid densities at
both maxillary intra ethmoid air cell and left frontal sinus. there is decreased aeration of the left mastoid. The
air cell was partly replaced with soft tissue debris and sclerotic bone. the right mastoid air cell and the rest of
the visualized paranasal sinuses are well aerated.

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Impression
1. Acute intraparenchymal hemorrhage at the pons extending to the left midbrain and left cerebral peduncle
measuring all in volume with surrounding edema.
2. Small chronic infarct at the subcortical right frontal parietal lobe right periventricular region both centrum
semi ovale and both basal ganglia.
3. Atheromas internal carotid arteries.
4. Bilateral maxillary ethmoid and left frontal sinusitis
5. Chronic left mastoiditis.
Significance:
Indicates that patient has 9cc of bleeding ate brain parenchyma, the functional tissue in the brain
consisting of neurons and glial cells. Subcortical structures found to have a necrotizing tissue which
affects the patient’s memory, emotion, pleasure and hormone production. Atheromas at carotid arteries
affects the patient by not receiving or their insufficient supply of oxygen-rich blood from the heart to the
brain and to distribute it to the rest of the body.. Blockage of atheroma leads to stroke at the left side of
the brain which results to a immobility at the right side part of patient’s body. Left mastoiditis indicates
that there is an sever infection at the prominent bone just behind and under the ear. Patient may have
swelling behind or under the ear, redness behind the ears, hearing problems, such as ringing in the ears.
References:
Fletcher, J. (2020, March 10). Carotid artery: Anatomy, function, disease, and more.
Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/carotid-artery
Mastoiditis: Symptoms, causes, and diagnosis. (2022, April 22). Medicalnewstoday.com.

https://www.medicalnewstoday.com/articles/324280
Vasković, J. (2023a, February 7). Hippocampus and fornix.

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Chapter 8
Anatomy & Physiology
Macro Anatomy
Physiology
The central nervous system (CNS) is a portion of the nervous system whose job it is to
assess, integrate, and produce a coordinated response to diverse intra- and extrapersonal inputs.
The CNS is the body's top command center, to put it simply.
The brain and spinal cord are the two continuous organs that make up the central nervous system
(CNS). Three layers of meninges surround and shield them, and the skull and vertebral column
are the two bone structures that house them. The cerebellum, brainstem, subcortical regions, and
cerebrum make up the brain. From the brainstem, the spinal cord continues inferiorly and travels
via the vertebral canal.
The various areas of the brain and spinal cord communicate with one another via a variety of
neural pathways as they process the information and plan appropriate bodily responses. The
peripheral nervous system (PNS), which arises directly from them, is used to transmit the final
output to the remainder of the body. More specifically, the spinal cord emits 31 pairs of spinal
nerves, while the brain emits 12 cranial nerves that innervate the head, neck, thoracic, and
abdominal viscera. The innervation of the viscera, as well as the rest of the body that is not
supplied by the cranial nerves, is completed by the spinal nerves (upper and lower limbs).
Reference:
Vasković, J. (2023, February 7). Nervous system.

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Micro Anatomy
Physiology
One of the parts of the brain network that regulates voluntary motor movement is the
basal ganglia. The cerebral cortex is the top link in this network. It generates the instructions that
specify how each skeletal muscle in the body moves. These instructions travel through the
pyramidal system's pathways and connect with the motor neurons in the spinal cord's cranial
nerve nuclei. The motor orders then proceed to the target muscles along the spinal and cranial
nerves from this point. The basal ganglia are responsible for fine-tuning voluntary movements.
They accomplish this by receiving the upcoming movement's impulses from the cerebral cortex,
which they then interpret and modify. They communicate their directives to the thalamus, which
transmits them back to the cortex. In the end, the pyramidal motor system's tracts communicate
the precise movement instructions to the skeletal muscles. The basal ganglia mediate several
higher cortical activities, including planning and controlling movement, memory, controlling eye
movements, processing rewards, and motivation.
Reference:
Mytilinaios, D. (2023, February 7). Basal ganglia.

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Chapter 9
Pathophysiology
Risk Factors Etiologic Factors Precipitating Factors
High blood pressure Elevated sodium and cortisol levels Family history at Maternal Side:
Excessive sodium intake Hypertensive
Too much stress

Stiffens and narrows the blood Sex: Women
vessels Accdg to CDC, Women are about
as likely as men to develop high
Increased blood pressure blood pressure at some point
during their lives.
Insufficient blood and oxygen
distribution to body.
Injury to artery walls of vessels due

to genetic and lifestyle factors.
Foam cells accumulates to the

injured vessels
Attracts fat and cholesterol leads to

growth of atheromas
Atheromas build up to internal

carotid artery
Blocks blood and oxygen flow to

brain
Hemorrhage with 9cc vol.

surrounding edema at left midbrain
and left cerebral peduncle
Chronic infarcts at the right

subcortical frontoparietal lobe both
basal ganglia
CVD BLEED at LEFT BASAL Prepared by: CTU-CCMC CN Faculty 27
GANGLIA/ STROKE
in consortium with
Tel Nos. (032)316-5128; (032)418-6105
Signs and Symptoms
Balance problems Hemiplegia at the right Aphasia- trouble

side of the body speaking
Delirium.
Hemiparesis at left side Slurred speech
Dysphagia
of the body (dysarthria).
Fainting.
Unconscious Sensory changes in one
side of your body or
Loss of vision, visual
Sudden,
face.
field cut or double
severe headache.
vision.
Complications
Heart failure
Peripheral artery disease
Sudden cardiac arrest
Heart attack

in consortium with
Tel Nos. (032)316-5128; (032)418-6105
References:
Christiano, D. (2018, February 1). Atheroma: Causes, treatment, and more. Healthline.
https://www.healthline.com/health/atheroma
Kraft, S. (2022, April 25). Cerebrovascular disease: Causes, symptoms, and treatment.
Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/184601
Cerebrovascular disease. (n.d.). Cleveland Clinic. Retrieved March 2, 2023, from

https://my.clevelandclinic.org/health/diseases/24205-cerebrovascular-disease
Heart disease. (2022, August 25). Mayo Clinic. https://www.mayoclinic.org/diseases-

conditions/heart-disease/symptoms-causes/syc-20353118
Hypertension: What you need to know as you age. (2021, August 8). Hopkinsmedicine.org.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/high-blood-pressure-
hypertension/hypertension-what-you-need-to-know-as-you-age
CDC. (2022, December 13). Know your risk for high blood pressure. Centers for Disease
Control and Prevention. https://www.cdc.gov/bloodpressure/risk_factors.htm
Impaired physical mobility nursing diagnosis & care plan. (2021, October 25). NurseTogether.
https://www.nursetogether.com/impaired-physical-mobility-nursing-diagnosis-care-plan/
Low potassium (hypokalemia). (2022, June 23). Mayo Clinic.

https://r.search.yahoo.com/_ylt=AwrKAvVdwP9jXjIAjD.zRwx.;_ylu=Y29sbwNzZzMEc
G9zAzIEdnRpZAMEc2VjA3Ny/RV=2/RE=1677734110/RO=10/RU=https%3a%2f%2f
www.mayoclinic.org%2fsymptoms%2flow-potassium%2fbasics%2fdefinition%2fsym-
20050632/RK=2/RS=AkmIxQ6HMrvbimds_.5mwAFAVpE-
Mytilinaios, D. (2023, February 7). Basal ganglia.
Telmisartan side effects. (n.d.). Drugs.com. Retrieved March 1, 2023, from

https://www.drugs.com/sfx/telmisartan-side-effects.html
Vasković, J. (2023, February 7). Nervous system.
(N.d.). Nurseslabs.com. Retrieved March 1, 2023, from https://nurseslabs.com/cerebrovascular-

accident-stroke-nursing-care-plans/2/

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CEBU TECHNOLOGICAL UNIVERSITY

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Prepared by: CTU-CCMC CN Faculty 1

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Prepared by: CTU-CCMC CN Faculty 2

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Display appropriate emotions received and be able to show interest in communicating to

This section is composed of four components, namely:

Prepared by: CTU-CCMC CN Faculty 3

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Mother’s Side Father’s Side

Prepared by: CTU-CCMC CN Faculty 4

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

2.5 Environmental hx (place of residence from childhood until present)

Prepared by: CTU-CCMC CN Faculty 5

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Health Perception- Health Management Pattern

Nursing Diagnosis: Ineffective Health Maintenance related to poor nutrition

Upon assessment, patient is lethargic, weakness, invalid. Patient is well-groomed. Posture is

Nutritional Metabolic Pattern

Nursing Diagnosis: Impaired Swallowing related to brain injury

Prepared by: CTU-CCMC CN Faculty 6

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

and no abdominal pains.

Nursing Diagnosis: Altered Bowel Elimination

Nursing Diagnosis: Impaired Physical Mobility related to CVD

Prepared by: CTU-CCMC CN Faculty 7

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Nursing Diagnosis: Risk for Disturbed Sleep Pattern

Nursing Diagnosis: Risk for Ineffective Sexuality Pattern

Nursing Diagnosis: Impaired Verbal Communication related to impaired cerebral

Prepared by: CTU-CCMC CN Faculty 8

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

coordination. Patient can’t be asked.

Role Relationship Pattern

Nursing Diagnosis: Parental Role Conflict

Self-Perception Pattern- Self-Concept Pattern

Nursing Diagnosis: Disturbed Body Image

Coping Stress Tolerance Pattern

Nursing Diagnosis: Risk for Ineffective Coping

Prepared by: CTU-CCMC CN Faculty 9

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

Nursing Diagnosis: Risk for Impaired Religiousity

Prepared by: CTU-CCMC CN Faculty 10

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

 Brown skin  No signs of rashes

 Wrinkled  No eye bags noted

 Cold and Clammy to touch  Dry skin

 Has pressure ulcers on butt area.

 No blood transfusion performed

 No visible pumping pulsations

 BP before med: 140/90mmHg ; BP after med: 110/80 mmHg

 No abnormal heart sounds

Prepared by: CTU-CCMC CN Faculty 11

Name: Gellyfer Q. Leyson ID No.: 1204106 Section: B Date: March 3, 2023

 Symmetrical and head shape is  Hair is black in color with some

 Head is appropriate to body’s  Hair is dry and frizzy

 No masses and tenderness noted.  No lesions noted

 Right eye is not able to open  Eyes is not following to moving

 Thin eyelashes noted

 Conjunctiva are reddish

 Ears are symmetrical  Dry