ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

NCM 118 | CARE OF CLIENTS WITH LIFE-TREATENING CONDITIONS, ACUTELY

ILL / MULTI-ORGAN PROBLEMS HIGH ACUITY AND EMERGENCY SITUATION

A CASE STUDY ON:

STROKE INFARCT AT
RIGHT MIDDLE
CEREBRAL ARTERY
TERRITORY
Hypertensive Cardiovascular Disease
Diabetes Mellitus Type II
Acute Respiratory failure secondary to cerebrovascular events
Hospital acquired pneumonia

RLE GROUP 1

Ivan Christian Espulgar, SN

Jason Segovia, SN
Justine Mae Angeles, SN
Roshin Bonsato, SN
Shahanna Marie Buenafe, SN
Jannica Monique Dela Cruz, SN
Shania Fundal, SN
Estela Magallanes, SN
Shiela Mae Ombid, SN
Love Mae Roxas, SN
Nicole Villamor, SN

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Table of Contents

Acknowledgement ...........................................................................................................

Introduction .....................................................................................................................

Objectives: General and Specific .......................................................................................

Vital Information ............................................................................................................

Health Assessment ...........................................................................................................

Past Medical History ......................................................................................................

Present Medical History .................................................................................................

Review of Systems ...........................................................................................................

Diagnostic Test Result.....................................................................................................

Course in the Ward .........................................................................................................

Anatomy and Physiology ................................................................................................

Risk Factors (Modifiable and Non Modifiable) ...........................................................

Pathophysiology ...........................................................................................................

Clinical Manifestations (Textbook vs Patient) ............................................................

Diagnostic Tests ...........................................................................................................

Medical Management ................................................................................................

Surgical Management .................................................................................................

Nursing Management ..................................................................................................

Drug Tabulation..............................................................................................................

Nursing Care Plan ...........................................................................................................

Bibliography / References ...........................................................................................

RLE Journey ..................................................................................................................

ACKNOWLEDGEMENT

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

In the realm of nursing education, the journey from theory to practice is a dynamic
process that demands dedication, collaboration, and a steadfast commitment to the pursuit of
knowledge. As we present the findings of this case study, we recognize that our success is not
a solitary achievement but the result of a collective effort and the generous contributions of
numerous individuals and entities. In this acknowledgment, we extend our gratitude to those
who have been the pillars of support throughout our academic exploration. From educators
and clinical instructors to family and friends, each has played a vital role in shaping our
understanding of nursing and enriching our practical experience. This introduction serves as a
tribute to those whose guidance and encouragement have illuminated our path, ensuring that
our case study is a testament to the collaborative spirit that defines the nursing profession.

To St. Anthony College of Roxas City, Inc., thank you for providing us with a
conducive learning environment and the resources necessary for our academic pursuits.

To our Dean of the College Department, Mrs. Rubilyn B. Sumaylo, RN, MSN,
LPT, we express our gratitude for your guidance, support, and unwavering commitment to
the academic excellence of the College Department.

To our dearest Clinical Instructors, a special thanks to all of you for imparting
invaluable practical knowledge and real-world experiences that enriched our understanding of
the nursing profession.

To our ever-supportive Class Adviser, Mrs. Krystelle Therese Langurayan, your

mentorship, encouragement, and insightful guidance have been instrumental in shaping our
academic journey.

To our beloved families: To our families, who have been a constant source of love,
encouragement, and understanding throughout our academic endeavors, we extend our
deepest gratitude.

Fellow Classmates, our journey would not have been as fulfilling without the
camaraderie and shared experiences with our fellow classmates. Thank you for the
collaborative spirit that enriched our learning.

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San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Most of all, to our Heavenly Father, Jesus Christ, above all, we acknowledge Your
divine guidance and strength bestowed upon us. Your grace has been a source of inspiration
and resilience throughout our academic journey.

This case study stands as a collective effort, and we are grateful for the support and
encouragement received from each of you.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

INTRODUCTION
Stroke, a formidable adversary in the realm of neurological disorders, imposes a substantial
burden on individuals, families, and healthcare systems globally. Among the myriad presentations of
stroke, infarction within the right middle cerebral artery (RMCA) territory emerges as a critical and
challenging manifestation. The right middle cerebral artery, a major branch of the internal carotid
artery, plays a pivotal role in the blood supply to the lateral convexity of the cerebral hemisphere.
When compromised by ischemia or infarction, the consequences can be profound, affecting motor
function, sensory perception, language capabilities, and various higher-order cognitive functions.

Middle cerebral artery (MCA) stroke describes the sudden onset of a focal neurologic deficit resulting
from hemorrhagic or ischemic disruption of the MCA's blood supply. The MCA is by far the largest
cerebral artery and is the vessel most commonly affected by cerebrovascular accident (CVA). The
MCA supplies most of the outer convex brain surface, nearly all the basal ganglia, and the posterior
and anterior internal capsules. Infarcts that occur within the large distribution of this vessel lead to
diverse neurologic sequelae.

Stroke, a significant medical emergency, stands as a leading cause of disability and mortality
worldwide. Stroke is the leading cause of disability worldwide and the second leading cause of death.
The Global Stroke Factsheet released in 2022 reveals that lifetime risk of developing a stroke has
increased by 50% over the last 17 years and now 1 in 4 people is estimated to have a stroke in their
lifetime. From 1990 to 2019, there has been a 70% increase in stroke incidence, 43% increase in
deaths due to stroke, 102% increase in stroke prevalence and 143% increase in Disability Adjusted
Life Years (DALY). The most striking feature is that the bulk of the global stroke burden (86% of
deaths due to stroke and 89% of DALYs) occur in lower and lower-middle-income countries. This
disproportionate burden experienced by lower and lower-middle income countries has posed an
unprecedented problem to families with less resources.

The mortality from stroke during the last 10 years remains high with an average of 63,804 deaths per
year. In 2021, despite the COVID pandemic, the recorded annual Philippine stroke death was 68,180,
increased from 64,381 in 2020. Roxas City, situated in the heart of the Philippines, is not immune to
the impact of stroke. As the community grows and ages, the incidence of stroke has become a notable
health concern. Local health authorities and hospitals have reported a rising trend in stroke cases over.
According to the data gathered in St. Anthony College of Roxas City Inc., stroke took the number six
spot among the ten leading discharges as final diagnosis with 188 total cases and also a number six
spot on the ten leading causes of mortality with five cases.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

One of the main clinical risk factors for stroke is a high blood pressure. Other risk factors
include tobacco use, physical inactivity, unhealthy diet, use of alcohol, atrial fibrillation, raised blood
lipid levels, obesity, genetic disposition, stress, and depression. Stroke survivors may live with
impacts which include physical disability, communication difficulties, loss of work, income, and
social networks. Fast access to treatment saves lives and improves recovery.

Furthermore, the essence of this study embarks on a comprehensive exploration of stroke

infarct at the RMCA territory, seeking not only to elucidate the clinical intricacies but also to
underscore the broader implications on individuals, communities, and healthcare systems.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

OBJECTIVES: GENERAL AND SPECIFIC

General Objective:

At the end of conducting this study, the student nurses will be able to identify and
analyze the risk factors associated with Stroke Infarct at right middle cerebral artery territory,
HCVD, DM2, Pneumonia – Aspiration/Hospital associated Acute Respiratory Failure 2o
cerebrovascular; Hospital Acquired Pneumonia and to explore the therapeutic interventions
employed, addressing challenges arising from multiple coexisting medical issues. Through
this, the student nurses will be able to broaden their knowledge, skills, and attitude in giving
the appropriate nursing care for the patient.

Specific Objectives:

SKILLS
 Develop and demonstrate proficiency in conducting a comprehensive clinical
assessment, emphasizing neurological, cardiovascular, and respiratory evaluations in
a patient with multiple coexisting conditions.
 Acquire skills in planning and implementing rehabilitation strategies tailored to
address both neurological deficits and respiratory complications, fostering optimal
functional recovery.
 Implement patient-centered care approaches, ensuring that care plans consider the
individual needs, preferences, and values of the patient in the context of a complex
medical history.

KNOWLEDGE
 Deepen understanding of the pathophysiology of stroke, cardiovascular disease,
diabetes mellitus type 2, and their interconnections.
 Familiarize oneself with the pharmacological interventions employed in the
management of stroke, cardiovascular disease, diabetes, and pneumonia, considering
potential interactions and contraindications.

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San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

 Apply evidence-based practices for managing Stroke Infarct at right middle cerebral
artery territory, HCVD, DM2, Pneumonia – Aspiration/Hospital associated Acute
Respiratory Failure 2o cerebrovascular; Hospital Acquired Pneumonia.

ATTITUDE
 Cultivate a patient-centered care attitude, prioritizing the patient's unique needs and
preferences in the development and implementation of treatment plans, rehabilitation
strategies, and long-term care planning.
 Demonstrate a commitment to interdisciplinary collaboration, recognizing the value
of each healthcare professional's expertise and actively engaging in collaborative
decision-making for comprehensive patient care.
 Foster a mindset of continuous learning, actively seeking opportunities for
professional development, staying informed about the latest advancements in stroke
management, respiratory care, and related fields.
 Apply the Vincentian-Anthonian Core Values in order to perform quality care.

 To apply the best care for the needs of the patient, cultivate a responsive and helpful
attitude.
 To guarantee optimum protection by providing a conducive environment for a high
quality patient experience.
 Value active collaboration with patient or folks the during planning, evaluation and
intervention

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

VITAL INFORMATION
CASE SCENARIO
Patient A. U, a 70 year-old male, presented into the ER with a chief complaint of
aphasia and slurred speech with an impression of CVD bleed vs infarct, HCVD, and DM2, a
GCS score of 12 (E4, V2, M6). Patient had a clinical history of acute onset – decrease in
sensorium and associated with slurring of speech. Patient was admitted to the ICU
under Dr. J. Admission vital signs were heart rate of 54 bpm, RR of 21 bpm, BP of 140/80
mmHg, O Sat of 99% and temperature of 36 C.
2
o

Lab works was requested as ordered by the attending physician, and it was discovered
that the patient has low calcium level of 1.9mmol/L. Laboratory also revealed for occasional
gram (+) cocci in singles and pairs, elevated eosinophil of 4%, RDW of 13.50%, chest AP x-
ray revealed right basal pneumonia, cranial CT scan revealed left periventricular infarct with
regression and replaced by small frontal periventricular calcification, Bilateral thalamo-
ganglionic and pontirelacunar infarct, unchanged. Bilateral parietal periventricular lacunar
infarct with progression in the left, and left ethmoid sinusitis.
Patient A. U was given citicoline 1g IV Q12h, omeprazole 4g IV OD, lactulose 30cc
OD HS, and other meds are to follow.

PERSONAL DATA:

Patient’s Name A. U.

Age 70 Sex: Male

Civil Status Married

Presenting weight: N/A Height: N/A

BMI N/A

Birth Date March 1, 1953

Address Cabugao, Ivisan, Capiz

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Nationality Filipino

Occupation N/A

Religion Roman Catholic

Attending Physician Dr. J

Chief Complaint Aphasia and slurred speech

Admitting Diagnosis CVD bleed vs Infarct, HCVD, DM2

Final Diagnosis Stroke Infarct at right middle cerebral artery

territory, HCVD, DM2, Pneumonia –
Aspiration/Hospital associated Acute Respiratory
Failure 2o cerebrovascular; Hospital Acquired
Pneumonia
Date of Admission August 21, 2023

Date of Discharge September 12, 2023

PAST MEDICAL HISTORY

Patient was diagnosed with Hypertension and Diabetes Mellitus type 2
PRESENT MEDICAL HISTORY
One hour prior to admission, patient was brought to the Emergency Department with
the manifestation of acute onset decrease sensorium associated with slurring of speech.
PERSONAL AND SOCIAL HISTORY
Patient records showed that he is a previos smoker. Years of smoking and sicks per
day were not noted.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

REVIEW OF SYSTEMS

Patient was brought to the ER with the chief complaint of Aphasia and slurred
General speech. Patient was seen and examined by ROD, VS was assessed, started IVF
Health and regulated, and began medication prescribed.
State
Upon admission, patient was Awake and Follows command, (+) Fine rales,
Bradycardic with regular rhythm, and (+) Hyperpigmentation lower
extremities was noted.

V/S:
Temp: 36°c
BP: 140/80
CR: 54bpm
RR: 21bpm
02sat: 99%

AREA ASSESSED SIGNIFICANT FINDINGS

INTEGUMENTARY SYSTEM:

A. SKIN FFF

Inspect the skin color and the uniformity of The patient color is fair, uniform in
skin color. Observe and palpate the skincolor, postal doc, positive for
moisture. Palpate skin temperature. Note
the skin turgor. hyperpigmentation noted.

B. NAILS

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Inspect the fingernails & toenails plate Nail bed color is normally pink with the
shape and color. Inspect tissues concave curvature of the nail plate.
surrounding nails. Palpate for texture and Translucent ,shiny and
perform capillary refill test. firm texture of nails are noted.

A. HAIR & SCALP

Inspect the evenness of growth over the

scalp, thickness or thinness, length
infestations and amount of body hair.
Palpate for texture.

Head, Eyes, Ears, Nose and Throat

(HEENT)

B. HEAD

Observe the skull for size, shape and Head is normocephalic. No inflammation,
symmetry. Note any deformities or lesions. deformities, depression, lumps, or
tenderness were noted.

C. FACE

Inspect and observe for facial features, Symmetric facial features, facial grimacing
abnormal facial expression, and are noted. No swelling, lumps, or masses
involuntary movement. Palpate for were noted.
swelling, lumps, masses and temporal
pulses.

D. EYES

Inspect both eyes for position and
alignment. Assess pupil response. Observe
for redness, swelling, watery discharges,
and any deformities.
The eyes exhibit symmetry, with
responsive pupils to both light and
accommodation, and a positive corneal
reflex. The sclerae were anicteric, and the
conjunctivae have a pinkish hue. The
pupils are equal in size at 2mm, with
sluggish reactions, and nystagmus is
present. There is a lack of eye opening, and
the doll's eyes are observed in the left eye.
Additionally, there is a reduction in the
right preferential eye, and pinpoint pupils
are evident.

E. EAR

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San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Inspect for alignment, shape and size of the
ear. Note any lumps, lesions, abnormal
discharges, and tenderness. Inspect the
tympanic membrane for color and gloss.
Ears are of equal size and have a similar
appearance. Aligned with the outer canthus
of the eyes. The color is consistent with
facial skin color. No lumps, lesions,
abnormal discharges, or tenderness were
noted. Able to hear in both ears.

F. NOSE

Inspect the location, size and symmetry of
nostrils and note any discharges, tenderness
and lesions.
The nose is symmetrical. The nasal septum
is intact and in the middle. No discharge,
lesions, or tenderness were noted. Able to
sniff through each nostril, and no nasal
discharges were noted.

G. MOUTH AND THROAT

Inspect the location, texture and color of
the lips and oral mucosa. Check the
mucous membrane if there are nodules.
Check for inflammation of tonsils, bleeding
gums, missing tooth and dental caries.
Inspect for tongue movement.
Lips are symmetrical in contour, pink, and
moist. with no nodules noted. Buccal
mucosa is moist and pink in color. No
bleeding gums were noted. The tongue
moves freely.

I. NECK

Inspect for masses, enlargement of thyroid There are no masses, congenital goiters, or
gland or distended jugular vein. scars noted. Jugular veins are not
distended. The thyroid gland is not
enlarged.

J. LYMPH NODES

Check for any enlargement of the lymph Lymph nodes are nonpalpable, and no
nodes. tenderness is felt when palpated.

K. BREAST AND AXILLA

Inspect for color, discharge of the nipples. Dark pinkish brown areola with nipples, no
Palpate for masses, tenderness or nodules. discharges noted. Presence of hair in the
axilla. No masses, nodules, or tenderness
were noted.

L. ALLERGIES

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Inspect for any signs of allergies like hives, The patient has no signs of allergies.
swelling of the lips or tongue, hay fever,
asthma, eczema, and other sensitivity to
drugs, foods, pollen, or dander.

RESPIRATORY SYSTEM

A. CHEST AND LUNGS

Inspect for shape, size and symmetry.

Palpate for chest expansion, lumps,
tenderness and depression. Auscultate for
any abnormal breath sounds.
No past medical or family history of
respiratory disease. Both lungs have equal
expansion;no lumps, tenderness or
depression noted. Irregular respiratory rate,
(+) fine rales Bibasal, (+) occasional
rhonchi, (+) hypopnea, and (+) crackles
bibasal was noted.

CARDIOVASCULAR SYSTEM

A. HEART & CENTRAL VESSELS

Inspect for enlargement of neck veins and

assess blood pressure. Auscultate for
cardiac rate, clarity and regularity of heart
sounds.
The patient’s cardiac rate is 54 bpm.
No enlargement of neck veins. Blood
pressure of 140/80 mmHg. Normal heart
sounds and regular rhythm noted upon
auscultation.

PERIPHERAL VASCULAR SYSTEM

A. PERIPHERAL PULSES

Inspect the peripheral veins and assess the The palms and soles are pale and cold to
signs of phlebitis. Inspect the skin of the touch. Capillary refill <2 secs. Presence of
hands and feet for color, temperature and Edema both upper and lower extremities
edema. Perform a Capillary Refill Test. and Pedal edema gr.1 was noted.

GASTROINTESTINAL SYSTEM

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San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

No episode of nausea and vomiting.

Note the appetite, food intolerance, other (-) bowel movement for 5 days.
abdominal pain, episodes of nausea,
characteristics of vomit, history of
abdominal disease, frequency of bowel
movement, and stool characteristics.

GENITO-URINARY SYSTEM

Check for any deformities, lesions and No swelling in the inguinal area was noted.
abnormalities. Inspect the anus and There are no signs of irritation,
surrounding tissue for color, integrity, and hemorrhoids or cracks on the anus.
skin lesions.

Note the frequency, urgency, history of (+) Fluid retention

urinary disease or any problems with (+) concentrated urine was noted.
urination that can be noted, I/O = 1140/520

MUSCULOSKELETAL SYSTEM

Inspect the muscles for size, contracture, Muscle weakness at the left side of both
and deformities. Observe if there are upper and lower extremities. No swelling
difficulties in movement upon performing was noted, five fingers are present on
a range of motion exercises. Inspect the each hand and foot with no deformities.
joint for swelling and palpate for any
tenderness, smoothness of movement,
swelling and presence of nodules.

NEUROLOGIC SYSTEM

Assessment of Mental Status: Observe the Patient is unconscious and unresponsive,

patient’s ability to respond to verbal with no verbal commands GCS: 5
commands.

Observe patient’s LOC (level of the patient is disoriented to place, time,

consciousness) and situation. the patient is not able to
identify the present location and cannot
recognize significant others.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Observe facial expression and mood. Patient Facial features are symmetric with
Observe the ability to concentrate or movement. No appearance of pain and
maintain attention. facial grimacing upon assessment.

Assessment of Motor function and Balance: Patient was unable to perform motor
Observe the patient’s posture, gait, and function test and balance due to decreased
movement. sensorium.

HEMATOLOGIC SYSTEM

Patient reported no bleeding and clotting

Note if there are bleeding and clotting problems. There were no bruises, swelling
problems. Observe if there are bruises, of lymph nodes upon assessment.
swelling of lymph nodes, exposure to toxic
agents or radiation, blood transfusion and
reactions.

ENDOCRINE SYSTEM

Note any history of diabetes or diabetic Patient reported a family history of

symptoms, history of thyroid disease, diabetes. He added that his family had no
intolerance to heat and cold, change in skin history of thyroid disease.
pigmentation, excessive sweating and (+)hyperpigmentation at lower extremities
relationship between appetite and weight. was noted.

PSYCHIATRIC

Assess the orientation of the client, mood, N/A

appetite, troubles in sleeping, and memory
function.

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COLLEGE OF NURSING
AY 2022 – 2023

Temperature- 36°c

VITAL SIGNS Blood Pressure- 140/80 mmHg

Cardiac Rate- 54 bpm

Respiration- 21 bpm

O2 sat- 99%

DIAGNOSTIC TEST RESULTS

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

COURSE IN THE WARD

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ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

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ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

TEXTBOOK DISCUSSION

ANATOMY AND PHYSIOLOGY

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San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

RISK FACTORS:

Modifiable Non-
modifiable

 Hypertension  Age
 Smoking  Sex
 Obesity  Race
 Alcohol consumption  Genetics
 Diet
 Hyperlipidemia
 Physical inactivity
 Diabetes
 Cardiac causes such as cardiomyopathy, heart failure, and atrial
fibrillation

Clinical Manifestation ( TEXTBOOK VS. PATIENT) (Indi pa ni final hehe)

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

ISCHEMIC STROKE

Signs and Rationale Evident

Symptoms In
Patient

Ataxia Ataxia in ischemic stroke results from the

disruption of blood flow to brain regions
responsible for motor coordination, particularly
the cerebellum.

Headache / Sudden Headaches associated with ischemic stroke may

Severe Headache be due to increased pressure within the skull or
the involvement of blood vessels.

Numbness or weakness A blood clot blockage in a blood vessel

of the face, arm, or leg, supplying blood to the brain can cause
especially on one side damage to brain cells, causing numbness or
of the body. weakness on one side.

Confusion or change in Disruption in blood flow can result in various

Mental Status neurological symptoms, including confusion.

Trouble seeing in one or The impairment in vision occurs due to the

both eyes interruption of blood flow to the part of the
brain responsible for processing visual
information.

Dizziness The vestibular system, located in the inner ear

and connected to the brainstem, plays a crucial
role in maintaining balance and equilibrium. If
the blood supply to the brainstem or inner ear is
compromised during an ischemic stroke, it can
lead to dizziness.

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San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Loss of balance or The disruption in blood flow can affect various

coordination/ Difficulty areas of the brain responsible for motor control
walking and coordination.

Aphasia Aphasia in ischemic stroke is primarily caused

by damage to specific regions of the brain
responsible for language processing.

Dysarthria It may occur when the part of the brain

responsible for controlling the muscles involved
in speech is affected by the lack of blood flow.

DIAGNOSTIC TEST

To diagnose ischemic stroke, your doctor will talk with you about your medical history and
perform a physical exam. In most cases, strokes are discovered incidentally when diagnosing another
medical condition. The doctor may recommend the following tests to confirm a diagnosis:

A. Hematology

Hematology tests include laboratory assessments of blood formation and blood disorders. A
count of the total number of red blood cells, white blood cells and platelets present in blood.
Hematological tests can help diagnose anemia, infection, hemophilia, blood-clotting disorders, and
leukemia.

B. Microbiology

A type of test through diagnosis and analysis of microbiological images obtained on samples.
These results will help doctors to find the cause of the disease in the patient's body, to diagnose and
propose the most effective treatment. It is define how some microorganisms cause diseases, discover
treatments for such diseases and even use a few microbes for industrial applications.

C. Clinical Microscopy

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COLLEGE OF NURSING
AY 2022 – 2023

It performs scientific analysis of non-blood body fluids such as urine, semen and stool. The
macroscopic, chemical and microscopic examinations of urine provide initial valuable diagnostic
information concerning metabolic dysfunctions of both renal and non-renal origin.

D. Clinical chemistry

A test that measures the levels of several substances in the blood (such as electrolytes). A
chemistry screen tells your doctor about your general health, helps look for certain problems, and
finds out whether treatment for a specific problem is working. Testing in this specialty utilizes
chemical reactions to identify or quantify levels of chemical compounds in bodily fluids.

E. Imaging Test

Imaging helps doctors diagnose a disorder, determine how severe the disease is, and monitor
people after the disease is diagnosed. Provide a picture of the body’s interior—of the whole body or
part of it. Most imaging tests are painless, relatively safe, and noninvasive (that is, they do not require
an incision in the skin or the insertion of an instrument into the body).

1. AP Portable Chest X - Ray- The anteroposterior (AP) portable chest radiograph is routinely
performed to evaluate cardiopulmonary status, however heart size can be misrepresented by
inherent technical factors. This type of X-rays pass from the anterior to the posterior of the
patient - hence Anterior-Posterior (AP) projection. The AP shows magnification of the heart
and widening of the mediastinum, it also views and examines the lungs, bony thoracic cavity,
mediastinum, and great vessels.

2. CT Scan - A head computed tomography (CT) scan uses many x-rays to create pictures of
the head, including the skull, brain, eye sockets, and sinuses. A stroke diagnosis using a CT
scan is ideal for identifying whether the stroke is hemorrhagic or ischemic. If there is blood in
the skull due to a hemorrhage, a stroke CT scan can detect it immediately, ensuring this
condition is treated the right way. CT scans can show areas of abnormalities in the brain, and
can help determine if these areas are caused by insufficient blood flow (ischemic stroke), a
ruptured blood vessel (hemorrhage), or another issue entirely.

MEDICAL MANAGEMENT

Analgesic/Antipyretic- medications commonly used to relieve pain and reduce fever.

Drug Dosage/Route/Frequency Rationale

Paracetamol 300mg IVTT then Q4H Used to lower elevated body temperature in the
PRN case of fever.
500 mg 1 tab PRN

Angiotensin II Receptor Blocker- a class of medications used to relax blood vessels,

reduce blood pressure, and improve blood flow.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Drug Dosage/Route/Frequency Rationale

Irbesartan 150 mg 1 tab PO OD Used in patients with type 2 diabetes who have
(Viirbez) proteinuria and hypertension. .

Antibiotic- Antibiotic therapy is initiated for the treatment of the following infections
when caused by susceptible isolates of the designated microorganisms. Also used to penetrate
bacterial cells readily and interfere with the synthesis of vital cell wall components, which leads
to cell death.

Drug Dosage/Route/Frequency Rationale

Piperacillin- 4.5 g / IV ANST Used to treat serious bacterial infections,

tazobactam including lower respiratory tract
(Kenzolin) infections.

Azithromycin 500mg 1tab OD PC X 5days Used for the treatment of various bacterial
(Zemith) then D/C infections, including both Gram-positive
and Gram-negative organisms.

Clindamycin 600mg IV Q8H ANST Used to treat respiratory tract infections

including pneumonia.

Meropenem 1 gram IV Q8 ANST infuse Used for the treatment of various bacterial
for 2hrs infections including pneumonia.

Vancomycin 500mg IV ANST Q8 infuse Used to treat pneumonia caused by Gram-

for 3 hrs positive bacteria caused by
MRSA/MRSH.

Ciprofloxacin 500 mg 1 tab PO Q8H Used to treat respiratory tract infections,

400 mg IV Q12H including bacterial pneumonia.

Levofloxacin 750mg 1 tab OD Used to treat certain infections such as

(Levox) pneumonia.

Antidiabetic- drugs used to manage diabetes, stabilizing and controlling blood glucose
levels.

Drug Dosage/Route/Frequency Rationale

Glimepiride + Metformin 2/500 PO BID Used to treat type 2 diabetes.

+ Pioglitazone
(Estapride)

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Empagliflozin + 12.5mg/500 mg 1/2 tab PO Used to treat high blood sugar

Metformin HCI OD levels caused by type 2 diabetes.
(Jardiance Duo)

Glargine (podesta) 100u/ml 16 u SQ OD pre- Used to help control their blood

supper OTF sugar levels in management of type
1 and 2 diabetes.

Antiepileptic- medications primarily used for the prevention and control of seizures in
individuals with epilepsy and for the management of other neurological and psychiatric
conditions.

Drug Dosage/Route/Frequency Rationale

Phenytoi 100 mg IV/1cap Q8H Used for the management of seizures and certain
n cardiac arrhythmias.

Benzodiazepines- a group of central nervous system (CNS) depressants that are

commonly used for their sedative, anxiolytic (anxiety-reducing), muscle relaxant, and
anticonvulsant properties.

Drug Dosage/Route/Frequency Rationale

Midazolam 5 mg slow IV STAT Used for sedation of critically ill patients who require
mechanical ventilation, and helps control anxiety and
agitation.

Calcium Channel Blockers- class of medications that primarily affect the movement of
calcium ions across cell membranes, particularly in the cells of the heart and blood vessels.

Drug Dosage/Route/Frequency Rationale

Amlodipine 1 tab PO OD Used to treat hypertension (high blood pressure).

Nicardipine 1mg IV STAT Used for the management of hypertension and

certain cardiovascular conditions.

Diuretics- medications that increase the excretion of sodium and water from the body
through the urine. These drugs are used to treat a variety of medical conditions related to fluid
retention and high blood pressure.

Drug Dosage/Route/Frequency Rationale

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Furosemide 20mg IV STAT Used to treat edema, hypertension, and renal

impairment.

Mannitol 150 cc IV Q4H Used in the management of stroke patients,

specifically in the context of cerebral edema.

Laxatives- medications or substances that promote bowel movements and relieve

constipation. These are used to treat various conditions associated with difficulty in passing stools
or infrequent bowel movements.

Drug Dosage/Route/Frequency Rationale

Bisacodyl Suppository 2 per rectum Used to treat constipation.

Lactulose 30cc OD HS, hold for BM ≥ 1 Used to soften the stool and increase frequency of
day bowel movements.

Mucolytic agent- medications that help loosen and thin mucus in the respiratory tract.
They are often used to manage conditions characterized by thick and sticky mucus, making it
easier for individuals to cough up and clear the airways.

Drug Dosage/Route/Frequency Rationale

NAC 600mg 1tab in 1/2 glass of Used to help manage respiratory conditions
(Fluimucil) H20 OD characterized by increased mucus production.

Nootropics- often referred to as "smart drugs" or "cognitive enhancers," a class of

substances to improve cognitive functions, such as memory, creativity, motivation, and overall
mental performance.

Drug Dosage/Route/Frequency Rationale

Citicoline 500 mg IV Q12H Used to aid in the recovery of neurological

(Citifar) function after a stroke.

Opioids- a class of drugs used to relieve pain. While opioids can be effective for
managing pain, they also carry a risk of dependence, addiction, and overdose.

Drug Dosage/Route/Frequency Rationale

Fentanyl 100 mcg slow IV STAT Used for the management of severe pain.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

Proton Pump Inhibitor- class of medications that reduce the production of stomach acid. It
works by inhibiting the activity of the proton pump, an enzyme in the stomach lining that plays a
key role in the secretion of gastric acid.

Drug Dosage/Route/Frequency Rationale

Omeprazole (Prosec) 40 mg IV OD Used to reduce stomach acid production.

20 mg 1 tab PO Pre Am OTF

Statins- class of medications primarily used to lower blood cholesterol levels. These
medications are widely prescribed to reduce the risk of cardiovascular events, such as heart
attacks and strokes.

Drug Dosage/Route/ Rationale

Frequency

Atorvastatin 80 mg 1 tab OD HS Used in the prevention and management of

cardiovascular diseases, reducing the risk of events
such as heart attacks and strokes.

Supplements- enhances regular diet to provide essential nutrients. These supplements

come in various forms, including vitamins, minerals, amino acids, fatty acids, and herbal
extracts.

Drug Dosage/Route/Frequency Rationale

Beneprotein 4 scoops in 200 cc H20 PO Used to increase protein intake to patients with
Milk OD difficulty meeting their nutritional needs through
regular food sources.

Liverprime 1 tab PO OD Used to help maintain liver health.

NURSING MANAGEMNET

Nursing management for patients who have experienced a stroke is a multifaceted and
integral aspect of healthcare that encompasses a wide range of responsibilities aimed at
optimizing patient outcomes. Stroke, a sudden disruption of blood supply to the brain,
requires diligent and comprehensive nursing care to address the complex challenges faced by

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

affected individuals. In this context, nursing management plays a pivotal role in early
intervention, holistic assessment, rehabilitation support, and the prevention of complications.

During the acute phase, a neurologic flow sheet is maintained to provide data about the
following important measures of the patient’s clinical status:

 Change in level of consciousness or responsiveness.

 Presence or absence of voluntary or involuntary movements of extremities.

 Stiffness or flaccidity of the neck.

 Eye opening, comparative size of pupils, and pupillary reaction to light.

 Color of the face and extremities; temperature and moisture of the skin.

 Ability to speak.

 Presence of bleeding.

 Maintenance of blood pressure.

During the postacute phase, assess the following functions:

 Mental status (memory, attention span, perception, orientation, affect,

speech/language).

 Sensation and perception (usually the patient has decreased awareness of pain and
temperature).

 Motor control (upper and lower extremity movement); swallowing ability, nutritional
and hydration status, skin integrity, activity tolerance, and bowel
and bladder function.

 Continue focusing nursing assessment on impairment of function in patient’s daily

activities.

Nursing management for stroke patients involves a comprehensive approach to care,

addressing various aspects to promote recovery and prevent complications:

 Assessment

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

 Conduct thorough neurological assessments to monitor changes in level of

consciousness, motor function, and vital signs.
 Assess the patient's ability to swallow, communicate, and perform
activities of daily living.
 Monitoring
 Continuously monitor vital signs, including blood pressure, heart rate,
respiratory rate, and oxygen saturation.
 Regularly check neurological signs such as pupil response, motor strength,
and reflexes.
 Medication Management
 Administer medications as prescribed, including thrombolytics, antiplatelet
agents, anticoagulants, and medications to control blood pressure or
seizures.
 Nutritional Support
 Evaluate swallowing function and implement appropriate dietary
modifications, which may include texture modifications or enteral feeding.
 Monitor nutritional status and ensure adequate intake of fluids and
nutrients.
 Mobility and Rehabilitation
 Initiate early mobilization and rehabilitation exercises to prevent
complications such as muscle atrophy and joint contractures.
 Collaborate with physical and occupational therapists to facilitate the
patient's independence in daily activities.
 Pain Management
 Assess and manage pain, which may arise from various sources, including
muscle spasticity or positioning-related discomfort.
 Prevention of Complications
 Implement measures to prevent complications such as pressure ulcers,
deep vein thrombosis, and urinary tract infections.
 Monitor for signs of respiratory compromise and implement interventions
to prevent pneumonia.
 Communication and Education
 Provide clear communication to the patient and their family about the
patient's condition, treatment plan, and expectations for recovery.
 Educate on lifestyle modifications and risk factor management to prevent
recurrent strokes.
 Psychosocial Support
 Address psychological and emotional needs, as stroke patients may
experience depression, anxiety, or cognitive changes.
 Involve social workers or counselors to provide additional support.
 Discharge Planning
 Collaborate with the healthcare team to plan for the patient's discharge, considering
ongoing rehabilitation needs, home modifications, and community support services.

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 ST. ANTHONY COLLEGE OF ROXAS CITY, INC.
San Roque Extension, Roxas City, Capiz 5800

COLLEGE OF NURSING
AY 2022 – 2023

By addressing these aspects, nursing management aims to optimize the recovery and quality
of life for stroke patients while minimizing complications and promoting independence.

DRUG TABULATION

NURSING CARE PLAN

DISCHARGE PLANNING

REFERENCES

RLE JOURNAL

2023