NORTHEASTHERN COLLEGE

COLLEGE OF NURSING
Santiago City, Philippines

CASE STUDY

ON

CVA INFARCT

SUBMITTED BY:
GROUP 3
DUCOSIN, SHANIA
LOBO, PATRICK
MACAPILLAR, JOHN JUSTINE
MARCOS, JAIAH
MAYOR, MARIBHELLE
PALMA, CLARENCE

SUBMITTED TO:
REGANIT, JOHN PAUL, RN, LPT, MSN
CLINICAL INSTRUCTOR

NOVEMBER 25, 2022

Objectives:

General objectives:

This case study is intended to provide knowledge to the students about CVA or stroke,

together with its effect, develop their nursing skills and practice towards providing nursing

care, health teaching and management of the said disease.

Specific objectives:

● Define Cerebrovascular Accident

● Discuss the factors that affect the manifestation of CVA

● Discuss the signs and symptoms of CVA

● To provide an attainable Nursing care plan and apply the nursing process toi patient

care

● Discuss the different drugs; indications, mechanism of action, therapeutic effects,

adverse effects, and contraindications.

Overview of the disease

Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is when

blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood

vessel. There are two main types of cerebrovascular accident, or stroke: an ischemic stroke is

caused by a blockage; a hemorrhagic stroke is caused by the rupture of a blood vessel. Both

types of stroke deprive part of the brain of blood and oxygen, causing brain cells to die. CVA

infarct is an ischemic stroke which means, a blood clot blocks a blood vessel and prevents

blood and oxygen from getting to a part of the brain. There are two ways that this can happen.

One way is an embolic stroke, which occurs when a clot forms somewhere else in your body

and gets lodged in a blood vessel in the brain. The other way is a thrombotic stroke, which
occurs when the clot forms in a blood vessel within the brain. To treat an ischemic

stroke, you may be given a clot-dissolving drug or a blood thinner. You may also be given

aspirin to prevent a second stroke. Emergency treatment for this type of stroke may include

injecting medicine into the brain or removing a blockage with a procedure. There are many

risk factors for having a stroke, including diabetes, atrial fibrillation, and hypertension (high

blood pressure).

Signs and Symptoms:

● Difficulty walking

● Dizziness

● Loss of balance and coordination

● Difficulty speaking or understanding others who are speaking

● Numbness or paralysis in the face, leg, or arm, most likely on just one side of the

body

● Blurred or darkened vision

● A sudden headache, especially when accompanied by nausea, vomiting, or dizziness

Risk factors:

● Hypertension

● Heart disease

● Smoking

● Diabetes

● Lack of exercise

● Obesity

● Older age

● Gender
Other risk factors include:

● Temperature, season, and climate

● Social and economic factors

Complications:

Complications and resulting impairments become more serious depending on the

severity of the stroke. Complications can include the following:

● Blood clots (deep vein thrombosis or pulmonary embolism)

● Urinary tract infections, or UTI
● Bowel and bladder problems
● Risk of pneumonia
● Muscle weakness
● Bed sores
● Mobility problems and falls

Patient’s Profile:

Name: P.E

Age: 57

Sex: Male

Birthday: July 13, 1965

Religion: Roman Catholic

Address: San Mateo Isabela

Civil Status: Married

Dialect: Tagalog/Ilocano\

Occupation: Farmer

Height: 162.5cm

Weight: 70kg
Chef complaint: Numbness of left leg

Admitting Diagnosis: Stroke in evolution

Date of Admission: November 10, 2022

Time of Admission: 1:35 pm

PAST HEALTH HISTORY

Patient E.P. has no recorded or known past health disorders and was determined to

have negative hypertension and negative diabetes mellitus.

PRESENT HEALTH HISTORY

Patient E.P. was admitted to De Vera Medical Center with the chief complaint of

sudden onset of numbness of left leg, reported to have experienced left sided weakness,

headache, and dizziness upon admission. Patient was initially diagnosed with Stroke in

evolution.
 PHYSICAL ASSESSMENT
PARTS TECHNIQUE ASSESSMENT FINDINGS

Head Inspection Round in shape

Face is symmetrical in size NORMAL
No involuntary muscle movement

Scalp Inspection No presence of dandruff

No lesion distributed NORMAL

Hair Inspection Hair is well distributed

Oily NORMAL
No presence of lice
White hair due to aging

Face Inspection No lesions NORMAL

No scars

Eyebrows Inspection Hair is well distributed NORMAL

Eyelids Inspection No lesions NORMAL

Eyes Inspection Sclera are white NORMAL

Ears Inspection Presence of earwax

No lesions
Earlobes are bean like shaped NORMAL
Brown in color
No pain

Nose Inspection No tenderness NORMAL

Mouth Inspection Pink lips, smooth and moist NORMAL

Gums Inspection Pinkish gums ABNORMAL

due to smoking

Teeth Inspection Black teeth ABNORMAL

due to smoking

Tongue Inspection Pinkish in color with a whitish NORMAL

No pain reported

Neck Inspection Pain Free

Palpation No masses NORMAL
Trachea is aligned
Upper Extremities Inspection No masses ABNORMAL
Palpation Left arm is weak Affected part of
the body

Heart sounds Auscultation Heart rate and rhythm are normal NORMAL

Lung sounds Auscultation Clear Lung sounds NORMAL

No wheezing

Nails Inspection Short Nails NORMAL

Palpation Good CRT

Abdomen Inspection No visible scars or lesions NORMAL

Palpation

Lower extremities Inspection No scars, no lesions NORMAL

Palpation

Skin Inspection Warm skin NORMAL

Good turgor
No abnormal pigmentation

GORDON’S 11 FUNCTIONAL PATTERN

Date of interview: November 10, 2022

Days of confinement: 3 days

1. HEALTH PERCEPTION/HEALTH MANAGEMENT PATTERN

Before: According to the patient, “walang nag kakasakit sa aming pamilya”.

During: During hospitalization, the patient perception is to become healthier and stated “ag

watwat kanayon”

2. NUTRITIONAL - METABOLIC PATTERN

Before: According to the patient, he was able to eat 2 times a day. The patient also stated that

he regularly consumes vegetables, fatty foods, and coffee for breakfast.

During: According to the patient, he will regularly eat breakfast from now on after we

encourage and educate him the benefits of eating breakfast before going to proceed on his

daily work.

3. ELIMINATION PATTERN

Before: According to the patient, he eliminates stool 3 times a day and void2 times in night.

During: Patient was experiencing decreased bowel movement and void due to confinement.

4. ACTIVITY - EXERCISE PATTERN

Before: According to the patient, he was able to do ADLs, such as waking and cycling to go

to their farm. Patient also, says “magsibak ng kahoy, maki tangdan”

During: According to the patient, due to hospitalization, he is unable to do any kind of

exercise because he is scared that he might fall.

5. COGNITIVE - PERCEPTUAL PATTERN

Before: According to the patient, he is well oriented to people, and responds verbally and

physically. He is elementary graduate and a farmer.

During: Patient’s thought process and senses are intact/active.

6. SLEEP - REST PATTERN

Before: As stated by the patient, he normally sleeps around 9pm and wakes up at

5am, which is the desirable number of sleeping hours.

During: The patient sleeps around 7pm and wakes up 5am.

7. SELF - PERCEPTION/ SELF - CONCEPT PATTERN

Before: According to the patient, satisfied naman ako sa sarili ko.

During: Patient expressed dissatisfaction towards his body image and stated “mas payat sana”

8. ROLE - RELATIONSHIP PATTERN

Before: According to the patient, “marigatan kami ta rigat lang adda kanyami” but even

though he is struggling he was able to fulfill his duty as a good husband and father.

During: According to the patient’s wife, marigatan kami ngem naragsak latta kin pasaray ag

absent dagijay anak mi ta awan allowance. Ag titinnulong kami mit.

9. SEXUAL REPRODUCTIVE PATTERN

Before: According to the patient, they were sexually inactive and engage in coitus at least

once a week. 43 years old is his first sexual experience.

During: According to the patient’s wife, wala na ngayon kasi katabi na namin yung bunso

naming anak.

10. COPING/STRESS PATTERN

Before: Patient stated, nakiki kapit bahay lang sa pinsan ko, Nanunuod ng TV, walang

cellphone at hindi umiinom at yosi lang bisyo.

During: Patient stated, nag uusap lang kami ng asawa ko at nag bibiruhan.

11. VALUE - BELIEF PATTERN

Before: As stated by the patient’s wife, their religion is Roman Catholic and they’re going to

church every Sunday.

During: The patient stated that they are praying always and patient’s wife stated, duray ayan

mo nu malagip mo ag kararag.
COURSE IN THE WARD

Date/ Time Side Notes Doctor’s Order Interpretation

November 10, 2022 ▪ Diet: low salt, low fat ▪ Can help control

5:54 pm with strict aspiration blood pressure, body

precautions. weight, reduce a

Dr. Dannug person’s risk of

having another stroke.

▪ Monitor VS every 2 ▪ Can save someone’s

hours and record life and help them

avoid brain damage.

▪ IVF: PNSS 1L to run ▪ Implies infusing fluid,

at 8h electrolytes, and

buffers directly into

the extracellular fluid

volume. Maintain

hydration while

patient is unable to

drink and replace

losses.

Diagnostics:

1. CBC with Platelet A high platelet count can put

you at risk for harmful blood

clots or stroke.
2. PT, PTT, INF - Helps to diagnose the

cause of bleeding or clotting

disorders, measures how

long it takes blood to clot.

3. Urinalysis - A simple urine test can

help your doctor diagnose

conditions related to stroke

including blood clots,

kidney disease, other

metabolic diseases or

diabetes.

4. CXR (Posterio - done to assess the presence

anterio lateral) of cardiac failure,

intra-thoracic tumor, or to

detect

(aspiration)pneumonia.

5. FBS, Lipid profile, - to test the blood and

Na, K, BUN, platelet count and glucose

Creatinine, AST, (sugar) levels in the blood

ALT

6. 12 Lead ECG - To check the hearts'

electrical activity, can help

determine whether heart

problems caused the stroke.

 7. 2D Echo with - Echocardiograms are

doppler studies and ultrasound-based procedures

carotid duplex scan that are used to find out if

there is an abnormality of

the heart that could lead to

stroke.

- Done to assess occlusion

(blockage) or stenosis

(narrowing) of the carotid

arteries of the neck and/or

the branches of the carotid

artery.

Therapeutics:

1. Clopidogrel 1. To reduce rate of MI

25mg/tab 2 tabs AM and stroke in patients

the OD after meals. with established

peripheral arterial

disease or history of

recent MI or stroke

2. Atorvastatin 2. To reduce risk of

80mg/tab 1 tab MI, stroke, angina or

revascularization

procedures in

patients with
 multiple risk factors

for CAD but who

don’t yet have the

disease.

3. Betahistine 3. Treatment of

24mg/tab 1 tab OD symptoms of which

may include vertigo,

tinnitus, hearing loss

and nausea.

4. Omeprazole 4. To treat certain

40mg/IV OD conditions where

there is too much

acid in the stomach.

5. Paracetamol /IV q 4 5. For the short-term

hours as needed for treatment of

moderate pain,

especially following

surgery and for the

short term treatment

of fever.

▪ Refer if SBP is more - to monitor elevation or

than 150mmHg or decrease of blood pressure

less than 120mmHg

 ▪ Request for Trop I - to measure the levels of

troponin T or I proteins in

blood. These proteins are

released when the heart

muscle has been damaged,

such as occurs with a heart

attack. The more damage

there is to the heart, the

greater the amount of

troponin T and I there will

be in the blood.

November 11, 2022 Neurology

5:16 pm ▪ Facilitate urinalysis ▪ Urinalysis may have

utility in the early

Dr. Dannug identification of the

CE stroke subtype in

patients with acute

ischemic stroke.

▪ Request for ▪ Can help your health

procalcitonin. care provider

diagnose if you have

sepsis from a

bacterial infection or

if you have a high

 risk of developing

sepsis.

▪ Start ceftriaxone ▪ Early antibiotic

1g/IV every 12 hour therapy (mostly

( ) Anst. within 24 hours)

leads to a reduced

rate of post-stroke

infections and

reduced fever spikes.

▪ treatment of

▪ Paracetamol moderate pain,

500mg/tab 1 tab especially following

every 4 hours as surgery and for the

needed for fever (T > short term treatment

37.8 C) of fever.

November 12, 2022 ▪ For repeat CBC now - to measure again the

5:14 am overall health of the blood

and helps diagnose

infection, anemia, clotting

problems, or other blood

problems.

November 12, 2022 ▪ D/C in ceftriaxone - treat bacterial infections. It

7:18 pm and shift to helps reduce the growth of

cefuroxime bacteria. Essential for

500mg/tab; 1 tab
 BID to complete for antimicrobial therapy of

7 days. brain infections.

▪ May go home any

time tomorrow.

▪ Home meds:

1. ASA 80mg/tab; 1 tab - Aspirin slows the blood's

OD after meals. clotting action by reducing

the clumping of platelets.

Platelets are cells that clump

together and help to form

blood clots. Aspirin keeps

platelets from clumping

together, thus helping to

prevent or reduce blood

clots. Most heart attacks and

strokes are caused by blood

clots.

2. Atorvastatin - 80 mg of atorvastatin per

80mg/tab; 1 tab OD day reduced the overall

HS incidence of strokes and of

cardiovascular events,

despite a small increase in

the incidence of

hemorrhagic stroke period.

 3. D/C betahistine the - Aspirin prevents blood

shift to ASA. clots from forming in the

arteries.

November 13, 2022 ▪ CVA infarct final DX

8:10 am ▪ FF after 2 weeks

LABORATORY AND DIAGNOSTIC FINDINGS

HEMATOLOGY
NOVEMBER 10, 2022
LABORATORY PATIENT NORMAL VALUE INTERPRETATION
READING
Hemoglobin 11.8 (L) 14.000 – 18.000 Cells are not getting
g/dL enough oxygen from
blood.
Hematocrit 36.9 (L) 42.000 – 51.000 % A low hematocrit
level may indicate
anemic.
White Blood Cell 25.29 (H) 5.000 – 10.000 x Risk of further
10^9/L ischemic stroke
Segmenters 92.6 (H) 50.000 – 80.000 % Risk for infections
Lymphocytes 3.6 (L) 25.000 – 50.000 % Higher risk of
infection
Eosinophils 0.0 0.000 – 5.000 % Normal
Monocytes 3.6 2.000 – 10.000 % Normal
Basophils 0.2 0.000 – 2.000 % Normal
Platelet Count 214 150 – 450 mm^3 Normal
Partial 22.6 (L) 27.000 - 42.000 Blood clotting factor
Thromboplastin seconds is decreased
Time
Mean Corpuscular 72.1 (L) 80 – 100 fL Low values of MCV
Volume may be caused by
anemia as it is
consistently present in
patients with acute
stroke.
Mean Corpuscular 23.0 (L) 26.000 – 32.000 pg Low MCH indicates
Hemoglobin insufficient
hemoglobin in the red
blood cells.
Mean Corpuscular 32.0 31.000 – 36.000 Normal
Hemoglobin g/dL
Concentration
Red Blood Cell 14.3 10.000 – 16.000 % Normal
Distribution - CV
NOVEMBER 12, 2022
LABORATORY PATIENT NORMAL VALUE INTREPRETATION
READING
Hemoglobin 13.0 (L) 14.000 – 18.000 Indicates that cells are
g/dL not getting enough
oxygen from your
blood.
Hematocrit 42.7 42.000 – 51.000 % Normal
White Blood Cell 9.1 5.000 – 10.000 x Normal
10^9/L
Segmenters 35.8 (L) 50.000 – 80.000 % Low segs indicates
risk for infections
Lymphocytes 42.5 25.000 – 50.000 % Normal
Eosinophils 1.3 0.000 – 5.000 % Normal
Monocytes 16.3 (H) 2.000 – 10.000 % High monocyte levels
indicate a risk for
developing
autoimmune diseases.
Basophils 4.1 (H) 0.000 – 2.000 % High monocyte levels
indicate a risk for
developing
autoimmune diseases.
Platelet Count 252 150 – 450 mm^3 Normal
Partial 28.3 27.000 - 42.000 Normal
Thromboplastin seconds
Time
Mean Corpuscular 74.5 (L) 80 – 100 fL Low values of MCV
Volume may be caused by
anemia as it is
consistently present in
patients with acute
stroke.
Mean Corpuscular 23.0 (L) 26.000 – 32.000 pg Low MCH indicates
Hemoglobin insufficient
hemoglobin in the red
blood cells.
Mean Corpuscular 30.4 (L) 31.000 – 36.000 Low MCH indicates
Hemoglobin g/dL insufficient
Concentration hemoglobin in the red
blood cells.
Red Blood Cell 14.3 10.000 – 16.000 % Normal
Distribution - CV
URINALYSIS
LABORATORY PATIENT NORMAL VALUE INTERPRETATION
READING

Color Light Yellow Pale Yellow Normal

Transparency Slightly cloudy Clear Cloudy urine may

indicate dehydration
or infection.

Reaction 6.0 pH 4.800-7.800 Normal

Specific Gravity 1.020 1.015-1.025 Normal

Glucose NEGATIVE Normal

Protein NEGATIVE Normal

Pus cells 0-2/hpf 0-5/hpf Normal

Red Blood Cell 0-2/hpf 0-2/hpf Normal

Epithelial Cell Few Few Normal

Bacteria Few None Indicates risk for UTI

Mucus thread Few Few Normal

Amorphous Urates Few Few Normal

Uric Acid None None Normal

 RESULT

PATIENT NORMAL VALUE

LABORATORY INTERPRETATION
READING

PROCALCITONIN 33.75 (H) 0.000 - 0.50ng/mL High procalcitonin

D-Dimer 0.000 - 500.00 ng/mL may indicate a risk or
a sign for infection.

RESULT

PATIENT NORMAL VALUE

LABORATORY INTERPRETATION
READING

Troponin I <0.01ng/mL 0.01 - 15.00 ng/mL This indicates that the

Quantitative patient has not
experienced a heart
attack.

RESULT

PATIENT NORMAL VALUE

LABORATORY INTERPRETATION
READING

HDL Cholesterol 43.34 (L) M:>55 : F:>65 mg/dL Low HDL cholesterol
can indicate risk of
developing heart
disease.
X-RAY Examination November 10, 2022
Chest PA:
● Film taken with suboptimal inspiration shows crowding of the pulmonary vascular
markings.
● There are no active lung parenchymal infiltrates.
● The heart is magnified.
● The trachea is midline.
● The costophrenic angles and hemidiaphragms are intact.
● The osseous structures and soft tissues are unremarkable.

IMPRESSION:
No evidence of pulmonary infiltrates.
Consider cardiomegaly.

Carotid Artery Duplex Scan November 11, 2022

IMT Measurement
Right: 0.8
Left: 0.7
Plaque Morphology

Type I Uniformly Echolucent with thin echogenic cap (homogenous

hypoechoic) *High risk for plaque rupture and embolism regardless of %
stenosis.

Type II Substantially echolucent with small areas (<50%) of echogenicity

(heterogenous hypoechoic)

Type III Dominantly echogenic with small areas (<50%) of echolucency

(heterogenous hyperechoic)

Type IV Uniformly echogenic (homogenous hyperechoic)

Type V Calcified
 Doppler

RIGHT LEFT RIGHT LEFT

CCA(prox) 100 81 IC/CCA Ratio

(mid) 89 86 ECA 118 106

Bulb 84 100 Vertebral (V0) 43 49

ICA(prox) 89 100 Artery (VI)

(middle) 95 123 Diameter 5.1 4.7

(distal) 106 106

Interpretation:
No plaques in the bilateral Common Carotid Artery, external carotid and internal carotid
arteries.
Increased intima-media-thickness in the bilateral Common Carotid Artery.
Normal antegrade flow in the bilateral vertebral arteries.

Echocardiography and Color flow doppler November 11, 2022

Interpretation:
Normal left ventricular dimensions with normal systolic function.
Normal right ventricular dimensions with adequate contraction.
Dilated left atrium.
Normal right atrial size.
Structurally normal mitral, aortic, tricuspid and pulmonic waves with good opening and
closing motion.
Normal main pulmonary artery and aortic root dimensions.

Doppler:
Normal
ANATOMY AND PHYSIOLOGY

Anatomy

The brain is a complex organ that controls thought, memory, emotion, touch, motor

skills, vision, breathing, temperature, hunger and every process that regulates our body.

Together, the brain and spinal cord that extends from it make up the central nervous system,

or CNS. Weighing about 3 pounds in the average adult, the brain is about 60% fat. The

remaining 40% is a combination of water, protein, carbohydrates and salts. The brain itself is

not a muscle. It contains blood vessels and nerves, including neurons and glial cells.

Main Parts of the Brain and Their Functions

At a high level, the brain can be divided into the cerebrum, brainstem and cerebellum.

Cerebrum

The cerebrum (front of brain) comprises gray matter (the cerebral cortex) and white matter at

its center. The largest part of the brain, the cerebrum initiates and coordinates movement and

regulates temperature. Other areas of the cerebrum enable speech, judgment, thinking and
reasoning, problem-solving, emotions and learning. Other functions relate to vision, hearing,

touch and other senses.

Cerebral Cortex

Cortex is Latin for “bark,” and describes the outer gray matter covering of the cerebrum. The

cortex has a large surface area due to its folds, and comprises about half of the brain’s weight.

The cerebral cortex is divided into two halves, or hemispheres. It is covered with ridges (gyri)

and folds (sulci). The two halves join at a large, deep sulcus (the interhemispheric fissure,

AKA the medial longitudinal fissure) that runs from the front of the head to the back. The

right hemisphere controls the left side of the body, and the left half controls the right side of

the body. The two halves communicate with one another through a large, C-shaped structure

of white matter and nerve pathways called the corpus callosum. The corpus callosum is in the

center of the cerebrum.

Brainstem

The brainstem (middle of brain) connects the cerebrum with the spinal cord. The brainstem

includes the midbrain, the pons and the medulla.

● Midbrain. The midbrain (or mesencephalon) is a very complex structure with a range

of different neuron clusters (nuclei and colliculi), neural pathways and other

structures. These features facilitate various functions, from hearing and movement to

calculating responses and environmental changes. The midbrain also contains the

substantia nigra, an area affected by Parkinson’s disease that is rich in dopamine

neurons and part of the basal ganglia, which enables movement and coordination.

● Pons. The pons is the origin for four of the 12 cranial nerves, which enable a range of

activities such as tear production, chewing, blinking, focusing vision, balance, hearing
 and facial expression. Named for the Latin word for “bridge,” the pons is the

connection between the midbrain and the medulla.

● Medulla. At the bottom of the brainstem, the medulla is where the brain meets the

spinal cord. The medulla is essential to survival. Functions of the medulla regulate

many bodily activities, including heart rhythm, breathing, blood flow, and oxygen and

carbon dioxide levels. The medulla produces reflexive activities such as sneezing,

vomiting, coughing and swallowing.

The spinal cord extends from the bottom of the medulla and through a large opening in the

bottom of the skull. Supported by the vertebrae, the spinal cord carries messages to and from

the brain and the rest of the body.

Cerebellum

The cerebellum (“little brain”) is a fist-sized portion of the brain located at the back of the

head, below the temporal and occipital lobes and above the brainstem. Like the cerebral

cortex, it has two hemispheres. The outer portion contains neurons, and the inner area

communicates with the cerebral cortex. Its function is to coordinate voluntary muscle

movements and to maintain posture, balance and equilibrium. New studies are exploring the

cerebellum’s roles in thought, emotions and social behavior, as well as its possible

involvement in addiction, autism and schizophrenia.

Brain Coverings: Meninges

Three layers of protective covering called meninges surround the brain and the spinal cord.

● The outermost layer, the dura mater, is thick and tough. It includes two layers: The

periosteal layer of the dura mater lines the inner dome of the skull (cranium) and the

meningeal layer is below that. Spaces between the layers allow for the passage of

veins and arteries that supply blood flow to the brain.

 ● The arachnoid mater is a thin, weblike layer of connective tissue that does not contain

nerves or blood vessels. Below the arachnoid mater is the cerebrospinal fluid, or CSF.

This fluid cushions the entire central nervous system (brain and spinal cord) and

continually circulates around these structures to remove impurities.

● The pia mater is a thin membrane that hugs the surface of the brain and follows its

contours. The pia mater is rich with veins and arteries.

Lobes of the brain and what they control

Each brain hemisphere (parts of the cerebrum) has four sections, called lobes: frontal,

parietal, temporal and occipital. Each lobe controls specific functions.

● 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.
Cranial Nerves

Inside the cranium (the dome of the skull), there are 12 nerves, called cranial nerves:

▪ Cranial nerve 1: The first is the olfactory nerve, which allows for your sense of smell.

▪ Cranial nerve 2: The optic nerve governs eyesight.

▪ Cranial nerve 3: The oculomotor nerve controls pupil response and other motions of the

eye, and branches out from the area in the brainstem where the midbrain meets the pons.

▪ Cranial nerve 4: The trochlear nerve controls muscles in the eye. It emerges from the

back of the midbrain part of the brainstem.

▪ Cranial nerve 5: The trigeminal nerve is the largest and most complex of the cranial

nerves, with both sensory and motor function. It originates from the pons and conveys

sensation from the scalp, teeth, jaw, sinuses, parts of the mouth and face to the brain,

allows the function of chewing muscles, and much more.

▪ Cranial nerve 6: The abducens nerve innervates some of the muscles in the eye.

▪ Cranial nerve 7: The facial nerve supports face movement, taste, glandular and other

functions.

▪ Cranial nerve 8: The vestibulocochlear nerve facilitates balance and hearing.

▪ Cranial nerve 9: The glossopharyngeal nerve allows taste, ear and throat movement, and

has many more functions.

▪ Cranial nerve 10: The vagus nerve allows sensation around the ear and the digestive

system and controls motor activity in the heart, throat and digestive system.

▪ Cranial nerve 11: The accessory nerve innervates specific muscles in the head, neck and

shoulder.

▪ Cranial nerve 12: The hypoglossal nerve supplies motor activity to the tongue.

The first two nerves originate in the cerebrum, and the remaining 10 cranial nerves emerge

from the brainstem, which has three parts: the midbrain, the pons and the medulla.
PATHOPHYSIOLOGY
Signs and symptoms Medical Surgical Management
● Difficulty walking ● Pharmacologic managements:
- administer platelet - inhibiting
● Dizziness
medications( aspirin, dipyridamole santint),
● Loss of balance and coordination clopidogrel, and ticlopidine
● Numbness ● Ordering significant lab tests:
- Blood culture, CBC, Platelet count,
● Body weakness
Urinalysis, CT scan, X-ray, Carotid Artery
Duplex Scan

Nursing Management
● Frequent monitoring of Vital signs
● Instruct patient to do passive ROM
activities
● Administer prescribed meds at given
time intervals

Complications Medical Surgical Management

● Blood clots (deep vein
thrombosis or pulmonary
embolism)
● Urinary tract infections, or UTI
● Bowel and bladder problems
● Risk of pneumonia
● Pharmacologic managements:
- administer platelet - inhibiting
medications( aspirin, dipyridamole santint),
clopidogrel, and ticlopidine
● Administer antibiotics
● Administer antidiarrheal medications
● Chest X-ray, blood tests, sputum test
and administer analgesics,
antibiotics, cough medications.

Nursing Management
● Frequent monitoring of Vital signs
● Monitor patient for reports of severe
pain
● Administer prescribed meds at given
time intervals
 Name: Patient P.E Date/Time of Assessment: 11/ 10/22, 1:35pm
Age: 57 years old Sex: Male
Clinical Diagnosis:
Assessment Diagnosis Planning Intervention Rationale Evaluation

SUBJECTIVE: Absence or Short Term: - Ascertain level - To assess Short term:

Patient stated Deficiency of After an hour of of knowledge, readiness to Patient was able
that “Ano po ba cognitive nursing including learn and to to participate in
ang ibig sabihin information intervention, the anticipatory know the learning and was
neto, hindi ko po related to Lack patient will be needs. patient learning able to identify
kasi of Specific able to needs. interferences to
maintindihan”. information for participate in learning and has
He also stated the client to learning process - Determine - To identify known the
that “Pwede po make informed and be able to patient’s method teaching specific actions to
bang choices identify of assessing methods to be deal with them.
pakiliwanagan regarding the interferences to information and used.
po kami dahil condition, learning and include in Long term:
hindi po namin treatment and know the teaching plan. Patient was able
alam kung ano lifestyle specific actions to verbalize
ang mga dapat changes. to deal with - Begin with - To facilitate understanding of
na gawin”. them. informations that learning. condition or
the client already disease process
Long Term: knows and move and treatment.
After 3 hours of to what the client
nursing does not know, Goal met.
intervention the progressing from
patient will be simple to
able to verbalize complex.
understanding of
condition or
disease process
and treatment.
 Name: Patient P.E Date/Time of Assessment: 11/ 10/22, 1:35pm
Age: 57 years old Sex: Male
Clinical Diagnosis:
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Impaired Short term: Independent: 1. To determine Short Term:

“Bago ako Physical After 4 hours of 1 . Assess the strength and After 4 hours of
itinakbo sa Mobility related nursing functional ability weakness that nursing
hospital bumili to interventions, the by classify may provide interventions, the
ako ng paninda neuromuscular pt will verbalize according to a 0-4 information pt able to
namin ng asawa impairment as - He understand scale about recovery. verbalized he
ko ng mga evidenced by the situation 2. Alternate the 2. To decrease understood his
alauna ng weakness on the - He will pt position numbness and situation as well
tanghali, pag uwi left extremity. understand the (supine, side pain in the as the therapy and
ko naramdaman therapy lying) at least affected area. he is able to
ko nalang bigla - He able to every 2 hours. 3. To help ease participate in
na parang participate in the 3. Encourage the the pain and interventions
nangmanhid ang interventions patient to move numbness rendered by the
kaliwang paa ko rendered by the time to time the 4. To help nurses.
at sumakit yung nurses affected part. reduce fatigue
ulo ko” as 4. Give rest and O2 demand Long term:
verbalized by the periods to 5. promotes After 6 days of
patient Long term: activities. venous return nursing
After 6 days of 5. Elevate arm and helps to intervention the pt
nursing and hand. prevent edema. verbalized he able
Objective: intervention the 6. Provide full 6. To barely to increase the
- Limited ability pt will be able to ROM five times a flexed. strength and
and difficulty to maintain or day to maintain 7. This foods function of
perform gross possible increase joint mobility high in affected body
motor skills like the strength and 7. Instruct the saturated fats part.
extending and function of patient and family and can impact
lifting of the affected body to avoid eating the brain’s
right arm. part fatty foods ability to
- Dizziness strengthen and
- Body create a new
weakness and neural
slow movement pathways.
- Limited ROM .
 Name: Patient P.E Date/Time of Assessment: 11/ 10/22, 1:35pm
Age: 57 years old Sex: Male
Clinical Diagnosis:
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Risk for Short Term: Independent: Independent: Short term:

“Minsan ay injury related After the 5 hours 1 . Assess the 1. Reduced After the 5 hours
natatakot akong to neuromotor of nursing sensory sensory of nursing
tumayo kasi impairment as intervention the awareness. awareness and intervention the
naramdaman ko evidenced by patient will 2. Assess muscle kinesthetic patient able to
nalang na muscle interact strength, gross sense interact
nanghihina ang weakness of appropriately in and fine impairment appropriately in
kaliwang hita ko left lower his environment coordination. negatively his environment
at may oras na extremity. and will show no 3. Monitor the affect balance, and show no
namamanhid pa” signs of sensory environment for positioning, and injury happened.
as verbalized by deficit-related safety hazards appropriateness
the patient injury and remove of movement,
hazardous objects interfering with Long Term:
4. Provide ambulation and After 3 days of
Objective: Long Term: materials for increasing risk nursing
- Limited ability After 3 days of injury prevention. of trauma. intervention, the
and difficulty to nursing 5. Guide the pt to 2. To evaluate patient's
perform gross intervention, the their the degree of knowledge and
motor skills like patient's surroundings. Put risk. awareness of the
extending and knowledge and the call light 3. To lessen the presence and
lifting of the awareness of the within reach and possible possible
right arm. presence and teach how to call hazardous complications of
- Body possible for assistance. injury. his illness are
weakness and complications of 6. Ask the family 4. To lessen the expanded and
slow movement his illness will or relatives of the risk for injury able to verbalized
- Limited ROM expand by pt to be with him and promotes he learned a lot in
attending or to prevent the client comfort. rehabilitation, as
listening to the incidence of 5. To prevent well as he knows
rehabilitation of accidental falling. accidents from what he will do to
stroke. 7. Provide happening. increase his
wheelchair belt items that are strengths more to
for support as too far from the fight his illness.
necessary pt may cause
8. Encourage the hazards.
patient to attend 6. This is to
in rehabilitation prevent falling
of stroke. and accidental
injury.
7. To lessen
Dependent: injury and falls
1. Neurological of the pt.
Exam as 8. To expand
necessary his awareness
on his illness as
well as to
strengthen the
body, be
healthy and to
fight what
might happen to
him because of
his illness

Dependent:
1. To detect
neurological
deterioration in
recently
hospitalized
stroke patients
so that
appropriate
treatment can
be instituted as
soon as
possible.
 DRUG STUDY
DRUG CLASSIFIC MECHANISMS INDICATION AND ADVERSE NURSING
NAME ATION OF ACTION CONTRAINDICAT REACTION RESPONSIBILITI
ION ES
DRUG THERAPEUT Inhibits proton Indication: CNS: - Monitor other
NAME: IC CLASS: pump activity by To lower the risk of - Asthenia CNS side effects
Omeprazol Antiulcer binding to recurrent stroke in pt - Dizziness (Drowsiness,
e Drugs hydrogen – who has an ischemic - Headache Fatigue, Weakness,
potassium stroke or transient Headache), and
BRAND PHARMACO adenosine ischemic attack. GI: report severe or
NAME: LOGIC triphosphatase, Omeprazole us - Abdominal prolonged effects.
Losec CLASS: located at proton pump pain
PPIs secretory surface inhibitor - Constipation - Monitor any chest
ACTUAL of gastric parietal - Diarrhea pain and attempt to
DOSAGE: cells, to suppress CONTRAINDIC - Flatulence determine if pain is
40 mg gastric acid ATION: - Nausea drug induced or
secretion Contraindicate d in - Vomiting caused by
ROUTE: patients hypertensive - Acid cardiovascular
IV OD to drug or its regurgitation dysfunction.
components and in
patients receiving MUSCULOSKE
rilpivirine containing LE TAL:
products - Back pain
- Weakness

SKIN:
- Rush
DRUG THERAPEUT Ceftriaxone works Indication: GI: - Monitor signs of
NAME: IC CLASS: by inhibiting the To improve the PSEUDOMEM pseudomembranous
Ceftriaxone Antibiotics mucopeptide functional outcome BRANOUS colitis, including
synthesis in the in IVT-treated patient COLITIS, diarrhea, abdominal
BRAND PHARMACO bacterial cell wall. with acute stroke diarrhea, pain, fever, pus or
NAME: LOGIC The beta-lactam cholelithiasis, mucus in stools, and
Rocephin CLASS: moiety of Contraindication: sludging in the other severe or
Third-Generati ceftriaxone binds Pt with known gallbladder. prolonged GI
ACTUAL on to allergy to the problems (nausea,
DOSAGE: cephalosporins carboxypeptidases cephalosporin group Derm: vomiting,
2g , endopeptidases, of antibiotic. rashes, urticaria. heartburn).
and - Monitor signs of
ROUTE: transpeptidases in Hemat: bleeding, allergic reactions
IV the bacterial eosinophilia, and anaphylaxis,
cytoplasmic hemolytic including
membrane. These anemia, pulmonary
enzymes are leukopenia, symptoms (tightness
involved in thrombocytosis. in the throat and
cell-wall synthesis chest, wheezing,
and cell division Local: pain at cough dyspnea) or
IM site, phlebitis skin reactions (rash,
at IV site. pruritus, urticaria).
Notify physician or
Misc: nursing staff
ALLERGIC immediately if these
REACTIONS, reactions occur.
INCLUDING
 ANAPHYLAXI - Monitor injection
S, site for pain,
superinfection. swelling, and
irritation. Report
prolonged or
excessive injection
site reactions to the
physician.
DRUG THERAPEUT Paracetamol has a INDICATION: An allergic - Alcohol increases
NAME: IC CLASS: central analgesic Temperature reaction, which the risk of liver
Paracetamo Analgesic effect that is management with can cause a damage that can
l mediated through paracetamol in acute - rash occur if an overdose
PHARMACO activation of stroke patients. - swelling of paracetamol is
BRAND LOGIC descending Prescribed for pain - flushing taken. The hazards
NAME: CLASS: serotonergic and fever. and low blood of paracetamol
Perfalgen Acetaminophe pathways. Debate pressure and fast overdose are greater
n exists about its CONTRAINDICATI heartbeat in persistent heavy
ACTUAL primary site of ON: drinkers and in
DOSAGE: action, which may Paracetamol does not people with
30 mg be inhibition of appear to affect alcoholic liver
prostaglandin long-term mortality disease.
ROUTE: (PG) synthesis or and functional
IV PRN through an active recovery. - Evaluate
FOR metabolite therapeutic
HEADAC influencing Acute liver failure. response.
HE cannabinoid liver problems. a
receptors. condition where the
body is unable to
maintain adequate
blood flow called
shock.
acetaminophen
overdose.
DRUG THERAPEUT The active INDICATION: EENT: epistaxis. - Monitor signs of
NAME: IC CLASS: metabolite of Antiplatelet action, it Resp: cough, hypersensitivity
Clopidogrel Antiplatelet clopidogrel also has pleiotropic dyspnea. reactions, including
drug selectively effects, reducing the pulmonary
BRAND inhibits the inflammatory CV: chest pain, symptoms (tightness
NAME: PHARMACO binding of mechanisms that edema, in the throat and
Plavix LOGIC adenosine occur during hypertension. chest, wheezing,
CLASS: diphosphate ischemia. cough, dyspnea) or
ACTUAL Platelet (ADP) to its Clopidogrel has GI: abdominal skin reactions (rash,
DOSAGE: aggregation platelet P2Y12 demonstrated a pain, diarrhea, pruritus, urticaria).
75 mg inhibitors receptor and the benefit over aspirin dyspepsia, Notify physician or
subsequent ADP- in preventing gastritis. nursing staff
ROUTE mediated vascular events, immediately if these
2 TABS activation of the especially in patients Derm: pruritus, reactions occur.
2AM glycoprotein at high purpura, rash.
GPIIb/IIIa cardiovascular risk. - Assess peripheral
complex, thereby edema using girth
inhibiting platelet CONTRAINDICATI measurements,
aggregation. This ON: volume
action is Pt with a known displacement, and
irreversible hypersensitivity to
 clopidogrel or any measurement of
component of the pitting edema
product. Clopidogrel
increases the risk of
bleeding and is
contraindicated in
patients with active
pathological bleeding
including GI
bleeding and
intracranial bleeding.
DRUG HMG-CoA Atorvastatin INDICATION: CNS: dizziness, - Assess for
NAME: reductase competitively In patients with headache, allergies to
Atorvastati inhibitors(stati inhibits recent stroke or TIA insomnia, HMG-CoA
n ns) 3-hydroxy-3-meth and without known weakness. reductase inhibitors
ylglutaryl-coenzy coronary heart
Brand me A disease, 80 mg of . CV: chest pain, - Obtain baseline
Name: (HMG-CoA) atorvastatin per day peripheral cholesterol,
Caduet, reductase. [2] By reduced the overall edema. triglycerides, and
preventing the incidence of strokes liver function tests
ACTUAL conversion of and of cardiovascular
DOSAGE: HMG-CoA to events, despite a GI:,constipation, - Monitor liver
80 mg mevalonate, statin small increase in the diarrhea, flatus, function and
medications incidence of heartburn, creatine kinase
ROUTE: decrease hemorrhagic stroke. altered taste, level.
Oral cholesterol drug-induced
2 TABS production in the CONTRAINDICATI hepatitis, - Determine the goal
AM liver. ON: dyspepsia, of therapy in
Pt with active hepatic elevated liver starting atorvastatin
disease (including enzymes,
cholestasis, hepatic nausea. - Monitor serum
encephalopathy, GU: erectile lipid levels regularly
hepatitis, and dysfunction.
jaundice) or Derm: rashes, - Evaluate the
unexplained pruritus patient’s response to
persistent elevations atorvastatin
in serum
aminotransferase - Implement safety
concentrations. and fall precautions
as atorvastatin may
affect concentration,
alertness, and
vision.
DRUG Histamine-like Direct stimulating INDICATION: - Urticaria The nurse must to
NAME: antivertigo (agonistic) effect Betahistine is - Pruritus tell and instruct the
Betahistine drug on H1 receptors indicated for the - Mild gastric patient:
located on blood reduction of complaints
BRAND vessels in the recurrent vertigo - False heartbeat - This drug should
NAME: inner ear. It episodes associated - Insomnia be taken with food
Serc appears to act on with Ménière's - Advise relatives to
the precapillary disease in patients 18 support the patient's
ACTUAL sphincter in the years old and above. ambulation.
DOSAGE: stria vascularis of - Protect medication
24 mg the inner ear, thus CONTRAINDICATI from moisture.
reducing the ON: - Do not give this
ROUTE: pressure in the Pheochromocytoma, medication to
Oral endolymphatic active or history of children.
1 TAB OD space. peptic ulcer. - Swallow the tablet
whole with one full
glass of water.
- Never take a
double dose if you
missed one
medication.
- If you missed one,
take medication
immediately.
DRUG THERAPEU MECHANISM INDICATION: ADVERSE NURSING
NAME: TIC CLASS: OF ACTION: acute bacterial REACTION: RESPONSIBILITI
Cefuroxim cephalospori Cefuroxime is a otitis media, ES
e n antibiotics bactericidal several upper CNS: Monitor for
agent that acts respiratory tract dizziness, manifestations of
BRAND PHARMAC by inhibition of infections, skin chills, fever, hypersensitivity
NAME: OLOGIC bacterial cell infections, urinary headache, (see Appendix F).
Ceftin CLASS: wall synthesis. tract infections, seizures Discontinue drug
quinolone Cefuroxime has gonorrhea, early and report their
antibiotics activity in the Lyme disease, and CV: Edema appearance
ACTUAL presence of impetigo. promptly.
DOSAGE: some EENT: Hearing
500 mg beta-lactamases, CONTRAINDICA Loss, oral Monitor I&O rates
both TION: candidiasis and pattern:
ROUTE: penicillinases patients with Especially
1 TAB and cephalosporin important in
BID 7 cephalosporinas hypersensitivity or severely ill
DAYS es, of cephamycin patients receiving
Gram-negative hypersensitivity. high doses. Report
and Cefuroxime should any significant
Gram-positive be used cautiously changes.
bacteria. in patients with
hypersensitivity to
penicillin.
DISCHARGE PLANNING
Medication ▪ Instruct the patient and family to take medicines exactly as

directed and on the right time.

▪ Instruct the patient and family the importance of medications

prescribed.

Exercises ▪ Instruct the patient to do ROM exercise at least 3 – 5 times a

day to prevent stiffness, helps with blood flow and improves

awareness of the arm.

▪ Encourage the patient to exercise such as walking outside,

wrist and hand stretch, and other passive exercise. This is to

maintain healthy weight of the patient because too much

weight increases your risk of high blood pressure, heart

disease, high cholesterol and type 2 diabetes which all

contribute to higher stroke risk.

Treatment ▪ Instruct the family to accompany and keep their eye to the

patient in his activities of daily living.

▪ Instruct the family to lookout for new stroke side effects

▪ Teach the patient and his family on how to manage risks for

stroke.

▪ Encourage the patient's family to be supportive especially on

the emotional healing of the patient after stroke.

Health Education ▪ Instruct the patient to quit smoking (join stop smoking

program)

▪ Instruct the patient how to learn stress management such as

watching tv, and bonding w/grandchildren.

 ▪ Encourage the patient to rest more and avoid workload

occupation

Out -patient ▪ Instruct the patient or family to continue follow up check up

to the doctor.

Diet ▪ Teach the patient and family to reduced the amount of fat and

cholesterol

▪ Instruct the patient eat more fresh vegetables and fruits

▪ Instruct the patient to eat lean protein such as fish, beans and

peas.

▪ Teach the patient to avoid drinking of coffee

Spiritual ▪ Advise the patient to pray everyday and maintain good health

and safety environment.