A CASE STUDY ON

ISCHEMIC STROKE

In Partial Fulfillment of the Requirement in

Related Learning Experience 112

Submitted to:

Mr. Park Roberto Abejuela, RN

Clinical Instructor

Submitted by:

Sophia Faith B. Gantuangco

Criza Jane C. Lanzaderas
Marianie Yien V. Legayada
RLE 112 Group 6
 CASE OVERVIEW

XX is a 65-year-old male and preparing his departure for the

meeting at his company. Upon walking his personal assistant notices
XX suddenly loses his balance, unable to walk, confused, and dizzy.
He developed right facial droop and right arm weakness. His personal
assistant asked if he is feeling okay and XX was having speech
difficulties. They let him take a seat and initiated calling 911 for help.

SIGNS AND SYMPTOMS

The majority of ischemic strokes happen suddenly, over minutes to

hours, and prompt medical attention is crucial. Do not delay to go and
get help if you observe one or more of these symptoms in a person
you know or in yourself. Dial 911 for help immediately.

 Sudden confusion and dizziness

 Loss of balance or coordination
 Facial drooping
 Arm weakness
 Speech difficulty
 Paralysis on one side of the body ( either arm, leg, or face)

IDEAL DIAGNOSTIC TESTS

 PHYSICAL EXAM
-Your doctor will do a variety of procedures you are already
familiar with, such hearing the heartbeat and taking your blood
pressure. To determine how a probable stroke may be
affecting your nervous system, you will also have a
neurological examination.
 BLOOD TESTS
- You might undergo a number of blood tests, such as those to
determine how quickly your blood clots, whether your blood
sugar is too high or low, and whether you are infected.
 ECHOCARDIOGRAM
-An echocardiography can identify the origin of any cardiac
clots that may have caused a stroke by moving from the heart
to the brain.
 CEREBRAL ANGIOGRAM
-In this test, sound waves produce precise images of the
interior of the necks carotid arteries. This test reveals blood
flow in the carotid arteries as well as the accumulation of fatty
deposits (plaques).
 COMPUTERIZED TOMOGRAPHY (CT) SCAN
- An accurate image of
your brain is produced
by a CT scan using a
sequence of X-rays. A
CT scan can detect
tumors, ischemic
strokes, brain tumors,
and other disorders.

 CAROTID ULTRASOUND
- In this test, sound
waves produce precise
images of the interior
of the necks carotid
arteries. This test
reveals blood flow in
the carotid arteries as
well as the
accumulation of fatty
deposits (plaques).

 MAGNETIC RESONANCE IMAGING (MRI)

- In this test, sound
waves produce precise
images of the interior
of the necks carotid
arteries. This test
reveals blood flow in
the carotid arteries as
well as the
accumulation of fatty
deposits (plaques).
PATHOPHYSIOLOGY
RISK FACTORS

Non-Modifiable Risk Factors Modifiable Risk Factors

 Age  Physical inactivity
 Low birth weight  Hypertension
 Race  Obesity
 Genetic factors  Diabetes mellitus
 Cigarette smoking
 Dyslipidemia
 Diet: high salt intake
 Carotid artery atherosclerosis.
 Atrial fibrillation
 Other cardiac diseases
 Other conditions that are also
related to stroke

Non- modifiable Risk Factors

a) Age: As one gets older, the risk increases.

b) Low birth weight: Individuals with low birth weight have a higher
risk of stroke later in life, as well as a higher stroke mortality rate.
c) Race: Blacks and Hispanic Americans were found to have a
higher risk of stroke. It is unclear whether this risk is due to
environmental, genetic, or both factors.
d) Genetic factors: Positive stroke family history, as well as stroke
history in parents before the age of 65, were found to increase
stroke risk. Younger stroke patients have a stronger family history.

Modifiable Risk Factors:

a) Physical inactivity: Physically active people have a 25-30%
lower risk of having a stroke. Physical activity is a well-established
stroke prevention strategy.
b) Hypertension: is a strong, continuous and independent risk
factor for stroke. A 10 mmHg increase in the systolic blood
pressure was found to increase the stroke risk to 8% in whites
and to 24% in African Americans.
c) Obesity and body fat distribution: abdominal obesity is a well-
established risk factor for stroke.
d) Diabetes mellitus: is another well-established risk factor for
stroke.
e) Cigarette smoking: is associated with a 2-fold increase in the
risk of stroke. Smoking cessation was found to be associated with
a reduction in the stroke risk but not to the levels of individuals
who never smoked.
f) Dyslipidemia: High levels of total cholesterol or low-density
lipoprotein (LDL) cholesterol in the blood are linked to ischemic
 stroke. The effect of low high-density lipoprotein (HDL) cholesterol
and high triglyceride levels is debatable; some studies found an
increased stroke risk, while others did not.
g) Diet: High salt intake, on the other hand, is linked to an increased
risk of stroke. Notably, observational studies addressing dietary
factors were associated with numerous methodological flaws,
particularly those related to difficulty in dietary assessment
methods and recall bias.
h) Carotid artery atherosclerosis.
i) Atrial fibrillation (AF): is associated with a 5-fold increase in the
risk of stroke (17). The risk of AF-related stroke was found to
increase dramatically with age; the risk is 1.5% at the age of 50-
59 years and reaches 25.5% at 80- 89 years (17). This risk is
usually related to the formation of thrombi in the left atrial
appendage as a result of disturbance of the laminar blood flow.
Paroxysmal and permanent AF are associated with the same risk.
j) Other cardiac diseases: acute myocardial infarction (MI),
cardiomyopathy, valvular heart disease, patent foramen ovale
(PFO), atrial septal aneurysm (ASA), cardiac tumors and aortic
atherosclerosis are all associated with increased risk of stroke.
k) Other conditions: sickle cell disease and hypercoagulopathy are
also related to stroke.

COMPLICATIONS

Complications of ischemic stroke may include:

 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

PREVENTIONS

 Exercise and healthy diet. Exercise helps people lose weight

and lower blood pressure, but it also acts as a precaution for
stroke or unwanted illness.
 Stop smoking. Smoking has a number of effects that speed up
clot development. Your blood becomes thicker, and the quantity
of arterial plaque accumulation rises. Smoking cessation is one
of the most effective lifestyle modifications that will greatly lower
your risk of stroke, along with a good diet and regular exercise.
  Track your blood sugar. Over time, elevated blood sugar
destroys blood arteries, increasing the risk of clot formation. It is
best to keep track of blood sugar as we age.
 Drink alcohol in moderation. It's acceptable to consume a
small amount of alcohol, such as one on average per day. Your
risk increases dramatically as soon as you start having more
than two drinks per day.
 Get checked for atrial fibrillation. Heart clots can occur as a
result of the irregular heartbeat known as atrial fibrillation.
Stroke risk increases roughly fivefold with atrial fibrillation, thus
it must be addressed carefully.

MANAGEMENT

Pharmacological
 Intravenous tissue plasminogen activator (IV tPA)
 Antiplatelet
 Aspirin

Non-pharmacological
 Healthy lifestyle
 Eating a balanced diet
 Getting regular physical
 Maintaining a healthy body weight can help with both high blood
pressure and high cholesterol, both of which increase a person's
chance of having another stroke.
 Smoking abstinence
 Moderate drinking alcohol

Surgical
 Thrombectomy
 The procedure involves inserting a catheter into an artery,
often in the groin. A small device is passed through the
catheter into the artery in the brain. The blood clot can then be
removed using the device, or through suction. The procedure
can be done under local anaesthetic or general anaesthetic.
 This removes blood clots and helps restore blood flow to
the brain.
 is only effective at treating ischaemic strokes caused by a
blood clot in a large artery in the brain.
 It's most effective when started as soon as possible after a
stroke.
PROGNOSIS

About 50% of patients with moderate or severe hemiplegia and most

with milder deficits have a clear sensorium and eventually can take
care of their basic needs and walk adequately. Complete neurologic
recovery occurs in about 10%. Use of the affected limb is usually
limited, and most deficits that remain after 12 months are permanent.
Patients who have had a stroke are at high risk of subsequent strokes
and each tends to worsen neurologic function. About 25% of patients
who recover from a first stroke have another stroke within 5 years.
After an ischemic stroke, about 20% of patients die in the hospital;
mortality rate increases with age.

REFERENCES

Risk factors of ischemic stroke (2, 4) - researchgate. (n.d.). Retrieved

November 18, 2022, from
https://www.researchgate.net/figure/Risk-factors-of-ischemic-
stroke-2-4_tbl1_337648577

Cleveland Clinic. (2018). Myocardial Ischemia | Cleveland Clinic.

Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17848-myocardial-
ischemia

NHS. (2019). Treatment - Stroke. NHS.

https://www.nhs.uk/conditions/stroke/treatment/

Planjar-Prvan, M. (2010). [Non-pharmacological methods of stroke

prevention]. Acta Medica Croatica: Casopis Hravatske
Akademije Medicinskih Znanosti, 64(1), 3–8.
https://pubmed.ncbi.nlm.nih.gov/20653119/