I.

Introduction

Stroke, known medically as a cerebrovascular accident (CVA), is the rapidly developing loss oI brain Iunction(s) due to disturbance in the blood supply to
the brain. This can be due to ischemia (lack oI blood Ilow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage oI blood). As a result, the
aIIected area oI the brain is unable to Iunction, leading to inability to move one or more limbs on one side oI the body, inability to understand or Iormulate speech,
or an inability to see one side oI the visual Iield. The sudden death oI some brain cells due to lack oI oxygen when the blood Ilow to the brain is impaired by
blockage or rupture oI an artery to the brain.

The most important modiIiable risk Iactors Ior stroke are high blood pressure and atrial Iibrillation Other modiIiable risk Iactors include high blood
cholesterol levels, diabetes, cigarette smoking (active and passive), heavy alcohol consumption and drug use, lack oI physical mobility, obesity and unhealthy diet.

The maniIestations oI stroke includes sudden numbness or weakness oI Iace, arm, or leg, sudden conIusion or trouble speaking, and sudden trouble seeing
in one or both eyes. Stroke is diagnosed through several techniques: a neurological examination such as CT scans (most oIten without contrast enhancements)
or MRI scans, Doppler ultrasound, and arteriography. The diagnosis oI stroke itselI is clinical, with assistance Irom the imaging techniques. Imaging techniques also
assist in determining the subtypes and cause oI stroke. There is yet no commonly used blood test Ior the stroke diagnosis itselI, though blood tests may be oI help in
Iinding out the likely cause oI stroke.


Medical therapies are aimed at minimizing clot enlargement or preventing new clots Irom Iorming. To this end, treatment with medications such
as aspirin, clopidogrel and dipyridamote may be given to prevent platelets Irom aggregating. In addition to deIinitive therapies, management oI acute stroke includes
control oI blood sugars, ensuring the patient has adequate oxygenation and adequate intravenous Iluids. Patients may be positioned with their heads Ilat on the
stretcher, rather than sitting up, to increase blood Ilow to the brain.

Disability aIIects 75 oI stroke survivors enough to decrease their employability. Stroke can aIIect patients physically, mentally, emotionally, or a
combination oI the three. The results oI stroke vary widely depending on size and location oI the lesion. DysIunctions correspond to areas in the brain that have
been damaged. Some oI the physical disabilities that can result Irom stroke include muscle weakness, numbness, pressure sores, pneumonia, incontinence, apraxia
(inability to perIorm learned movements), diIIiculties carrying out daily activities, appetite loss, speech loss, vision loss, and pain. II the stroke is severe enough, or
in a certain location such as parts oI the brainstem, coma or death can result.

Cerebrovascular accident is the third leading cause oI death in the United States and aIIects more than 600,000 Americans annually with 160,000 deaths
per year. The incidence oI Iirst-time strokes is approximately 400,000 per year, but as the population ages, the incidence will increase to 1 million per year by 2050.

According to the Philippine Health Statistics (2004) stroke kills 61.8 per 100,000 populations. It is the second leading cause oI mortality in the Philippines
next to heart disease.

0n0ral Obj0ctiv08
To be able to obtain knowledge about the client`s disease condition together with the determination oI its causative Iactors and possible nursing intervention,
thus preventing Iurther complication oI the disease.
SpeciIic Objectives:

Knowledge Objectives:
1. To acquire knowledge about CVA.
2. To know the eIIects oI CVA to our patient and the right intervention speciIied Ior him.
3. To know the modiIiable Iactors that can be prevented to have a lesser risk oI recurring stroke.
4. To know the essentiality oI the case that would assist us student-nurses to build a holistic knowledge, skills and attitude approach to learning.
Skill Objective:

1. IdentiIy the risk Iactors that occur in the disease and make a pathophysiology about the disease.
2. Formulate signiIicant and prioritized nursing diagnoses Ior our patient that are attainable, Ilexible and time bound.
3. IdentiIy the medications administered to the client and the drugs indication, contraindication, side eIIects, and nurse`s responsibility.
4. Develop nursing interventions that promotes comIort and lessen the pain oI the patient.

Attitude Objective:

1. To build trust, rapport to the patient and gain cooperation.
2. To cultivate conIidence, independence and selI-reliance in rendering essential nursing care.
3. To expand the network oI communication oI the student-nurses with regards to the total concern oI the patient`s overall care.




PERSONAL HISTORY (ndi ko lam pano chi01 complaint)


Nam0 Patient JA
Birthday May 27, 1936
Ag0 74 y/o
Addr088 Benedicto Florida Blanca, Pampanga
Marital Statu8 Married
Nationality Filipino
Sourc0 o1 M0dical Car0 His children
Admitt0d Ho8pital Jose B. Lingad Hospital
Dat0 o1 Admi88ion December 13, 2010
Dat0 o1 Di8charg0
Typ0 o1 S0rvic0ard Medical ward
Chi01 Complaint ~Hindi ko na magalaw ang kanan katawan ko. as the client verbalized
Admi88ion diagno8i8 Cerebral inIarct leIt MCA Hypertension stage II uncontrolled

CHIEF COMPLAINT

Client JA chieI complaint since he was stroke was he can`t move the right side oI his body as he stated 'Hindi ko na magalaw ang kana katawan ko, and he
has diIIiculty in verbalizing words, some words that he said are hard to understand. He also stated that its like his whole body is numb and he Ieels dizzy.

HISTORY OF PAST ILLNESS

Client JA as he recalled had a complete immunization, we observed that he had an immunization oI BCG because he had a scar on his right deltoid but he
doesn`t have any immunization Ior adults. According to him, he had chicken pox when he was 13 years old and experienced common illness like cough, Iever and
headache. He takes over-the-counter drugs like biogesic or paracetamol and herbal remedies like guava leaves when he had diarrhea. Client JA had no history oI
allergy.


HISTORY OF PRESENT ILLNESS

Last December 13, 2010, client JA was working in their backyard he was cleaning it by uprooting the grass and chopping the woods which they use Ior
cooking. He suddenly Ielt dizziness and weakness and Irom then he became unconscious. He Iainted and was rushed to Jose B. Lingad Memorial Regional Hospital.
This is the Iirst time he was hospitalized, as her wiIe stated beIore they went to Jose B. Lingad Memorial Regional Hospital they Iirst went to a quack doctor to
consult his condition. The doctor diagnoses that client JA was experiencing Hypertension Stage II uncontrolled and Cerebral InIarction a problem to his leIt Middle
Cerebral Artery. The client is in a nasogastric tube Ior his Ieeding and a diaper Ior his toileting.

- Female
- Male
- Client
- CVA

- DM

- Pneumonia

- Deceased

FAMILY HEALTH ILLNESS HISTORY





























As the genogram shows that his grandmother Irom his Iather has a CVA and her mother has a DM, one oI her siblings already died and one oI her sister is
also experiencing CVA as well as him. He acquires his pneumonia through his hospitalization.





KJ
75




MG
63

PL
52









SC
71




EDC
59
LEGEND:




OJ
75


MJ
78




MC
72







RC
76




MG
56










AS
49
C
PHYSICAL ASSESSMENT
Name: Mr. JA Vital signs:
Birthday: Blood Pressure: 160/90 mmHg
Age: 74 y/o Temp: 36.5 C
Date oI Assessment: December 16, 2010 RR: 24cpm
Weight: 54 kg. PR: 64 bpm
Height: 5`1 inches

Part8 to b0 Examin0d T0chniqu0 Normal Finding8 Actual Finding8 Int0rpr0tation
ENERAL SURVEY
Client`s posture and gait,
standing, sitting and walking
Inspection Relaxed, erect
posture; coordinated
movement
Can`t walk without
wheelchair.
Deviation Irom
normal due to
neurologic illness.
Body and breath odor Inspection No body odor or
minor body odor
relative to work or
exercise; no breath
odor
He have bad breath
odor.
Deviation Irom
normal due to poor
hygiene.
Clinical Measurements
Height
Weight

Inspection
Underweight 18.5
Normal weight 18.5-
24.9
Overweight 25-29.9
Obesity BMI oI 30 or
greater

5`1 inches
54 kg.
BMI 22.5
Normal
BEHAVIOR
Signs oI distress, in posture or
Iacial expression
Inspection No distress noted In distress, Facial
grimace noted
Deviation Irom
normal due to
disease process
Signs oI health or illness Inspection Healthy appearance Positive signs oI
illness
Deviation Irom
normal due to
neurologic illness.
Client`s attitude Inspection Cooperative, able to
Iollow instructions
He is uncooperative
and un-able to Iollow
my instructions
Deviation to normal
due to physical
condition.
Client`s aIIect/mood;
appropriateness oI client`s
response
Inspection Appropriate to
situation
He responds
inappropriately to
questions, blunted
aIIect is observed,
incoherent to time,
place and events.
Deviation to normal
due to neurologic
illness.
Quantity oI speech, quality Inspection Understandable,
moderate pace; clear
tone and inIlection;
exhibit thought
association
His speech is
moderately
understandable, not
clear and has
disassociation oI
thoughts
Deviation Irom
normal due to
neurologic illness
Relevance and organization oI
thoughts
Inspection Logical sequence;
makes sense; has
sense oI reality
Can give relevant
answers though has
poor sense oI reality

Deviation Irom
normal due to
neurologic illness
SKIN
Fingernail and toenail bed
color
Inspection Highly vascular and
pink in light-skinned
people; dark-skinned
may have brown or
black pigmentation in
longitudinal streaks
Pale in Color Deviation Irom
normal due to poor
circulation and
hydration.
Blanch test oI capillary reIill Palpation Prompt return oI pink
or usual color;
Delayed 1-2 sec
There is a prompt
return oI blood
resulting to the usual
color, delayed Ior 3
sec.
Deviation Irom
Normal d/t poor
arterial circulation.
Skin temperature Palpation UniIorm; within
normal ranges
Cold to touch in the
side oI paralyzation
Deviation Irom
normal due to right
hemiplegia
HEAD
HAIR
Color Inspection Black gray Normal due to aging
ACE
Facial Ieatures, symmetry oI
Iacial movements
Inspection Symmetrical Iacial
Ieatures and
movements
he has asymmetrical
Iacial Ieatures which
has asymmetrical
movements
Deviation Irom
normal d/t
neurologic illness.
EYES
EYELIDS
SurIace characteristics,
position in relation to the
cornea, ability to blink and
Irequency oI blinking
Inspection Skin intact; no
discharge or
discoloration; Lids
closed symmetrically
approximately 15-20
involuntary blinks per
minute
Can`t blink right eye
when in pain
Deviation Irom
normal d/t
neurologic illness.
CONJUNCTIJA
Palpebral Conjunctiva Ior
color, texture and presence oI
lesions
Inspection Shiny, smooth and
pink or red
He has shiny, smooth
and pale palpebral
conjunctiva
Deviation Irom
normal due to poor
circulation
JISUAL ACUITY
Near Vision Inspection Able to read
newsprints
he has been able to
read newsprints with
the use oI eye glasses
Deviation Irom
normal due to the use
oI eye glasses
MOUTH
LIPS
Symmetry oI contour, color
and texture
Inspection UniIorm pink color,
soIt, moist, smooth
texture, symmetry oI
He has a pale in color
lips, slightly dry and
smooth; it has
Deviation Irom
normal d/t poor
circulation and
contour, ability to
purse lips
symmetry oI contour
and has the ability to
purse his lips
hydration.
%%
Color, number, condition and
presence oI dentures
Inspection 32 adult teeth;
smooth, white and
shiny tooth enamel
Yellowish teeth Deviation Irom
normal d/t poor
hygiene.
A. TONGUE
Presence oI nodules, lumps or
excoriated areas
Palpation Smooth with no
palpable nodules
asymmetry Deviation Irom
normal d/t
neurologic illness
MUSCULOSKELETAL
A. MUSCLES
Size, comparison on one side
to other side
Inspection Equal size on both
sides oI the body
Unequal, leIt is much
larger than right
Deviation to normal
due to hemiplegic
right side oI the
body.
Fasciculation and tremors Inspection No tremors He has tremors Deviation to normal
due to neurological
illness.
Muscle tonicity Palpation Normally Iirm Decreased muscle
tone on the right side
oI the body
Deviation Irom
normal due to
neurological illness.
Muscle strength Inspection and
Palpation
Smooth coordinated
movements
He has weak and
uncoordinated
movements.
Deviation Irom
normal due to
neurological illness.

. JOINTS
Tenderness, smoothness oI
movements, crepitation and
nodules
Palpation No swelling,
tenderness, crepitation
or nodules
Positive tenderness Deviation Irom
normal due to lack oI
exercise.
Joint range oI motion Inspection Varies to some degree
in accordance with
Limited range oI
motion
Deviation Irom
normal due to lack oI
person`s degree oI
physical ability.
exercise.


Signi1icant Finding8

- Based on our observation our client`s coordination is not good.
- He cannot speak clearly.
- His muscles are have limited ROM, decreased muscle tone especially on the right side.
- His eyes are aIIected because oI his medical condition.
- He has hemiplegia on the right side oI his body.
























ANATOMY AND PHYSIOLOY OF THE NERVOUS SYSTEM

Th0 C0ntral N0rvou8 Sy8t0m
C0r0brum

4 The c0r0brum -- which is just Latin Ior "brain" -- is the largest part oI the brain as a whole. It is here that things like perception, imagination,
thought, judgment, and decision occur.
4 The surIace oI the cerebrum -- the c0r0bral cort0x -- is composed oI six thin layers oI neurons, which sit on top oI a large collection oI white matter
pathways. The cortex is heavily convoluted, so that iI you were to spread it out, it would actually take up about 2 1/2 square Ieet (2500 sq cm). It
includes about 10 billion neurons, with about 50 trillion synapses.
4 The convolutions have "ridges" which are called gyri (singular: gyru8), and "valleys" which are called 8ulci (singular: 8ulcu8). Some oI the sulci are
quite pronounced and long, and serve as convenient boundaries between Iour areas oI the cerebrum called lob08.
4 The Iurthest Iorward is the 1rontal lob0 (Irom the Latin word Ior Iorehead). It seems to be particularly important: This lobe is responsible Ior
voluntary movement and planning and is thought to be the most signiIicant lobe Ior personality and intelligence.










4 At the back portion oI the Irontal lobe, along the sulcus that separates it Irom the parietal lobe, is an area called the motor cort0x. In studies with
brain surgery patients, stimulating areas oI the motor cortex with tiny electrical probes caused movements. It has been possible Ior researchers to
actually map out the motor cortex quite precisely. The lowest portions oI the motor cortex, closest to the temples, control the muscles oI the mouth
and Iace. The portions oI the motor cortex near the top oI the head control the legs and Ieet.


4 Behind the Irontal lobe is the pari0tal lob0 (Irom a Latin word meaning wall). It includes an area called the 8omato80n8ory cort0x, just behind the
sulcus separating this lobe Irom the Irontal lobe. Again, doctors stimulating points oI this area Iound their patients describing sensations oI being
touched at various parts oI their bodies. Just like the motor cortex, the somatosensory cortex can be mapped, with the mouth and Iace closest to the
temples and the legs and Ieet at the top oI the head.

4
4 At the side oI the head is the t0mporal lob0 (Irom the Latin word Ior temple). The special area oI the temporal lobe is the auditory cort0x. As the
name says, this area is intimately connected with the ears and specializes in hearing. It is located near to the temporal lobe's connections with the
parietal and Irontal lobes.
4 At the back oI the head is the occipital lob0. At the very back oI the occipital lobe is the vi8ual cort0x, which receives inIormation Irom the eyes
and specializes, oI course, in vision.
4 The areas oI the lobes that are not specialized are called a88ociation cort0x. Besides connecting the various sensory and motor cortices, this is also
believed to be where our thought processes occur and many oI our memories are ultimately stored.

Brain Stem
4 The lower extension oI the brain where it connects to the spinal cord. Neurological Iunctions located in the brainstem include those necessary Ior
survival (breathing, digestion, heart rate, blood pressure) and Ior arousal (being awake and alert).
4 Most oI the cranial nerves come Irom the brainstem. The brainstem is the pathway Ior all Iiber tracts passing up and down Irom peripheral nerves and
spinal cord to the highest parts oI the brain.









O M0dulla Oblongata - The medulla oblongata Iunctions primarily as a relay station Ior the crossing oI motor tracts between the spinal cord and the brain. It
also contains the respiratory, vasomotor and cardiac centers, as well as many mechanisms Ior controlling reIlex activities such as coughing, gagging,
swallowing and vomiting.
O Midbrain - The midbrain serves as the nerve pathway oI the cerebral hemispheres and contains auditory and visual reIlex centers.
O Pon8 - The pons is a bridge-like structure which links diIIerent parts oI the brain and serves as a relay station Irom the medulla to the higher cortical
structures oI the brain. It contains the respiratory center
C0r0b0llum
O Th0 c0r0b0llum i8 involv0d in th0 coordination o1 voluntary motor mov0m0nt, balanc0 and 0quilibrium and mu8cl0 ton0. It i8 locat0d
ju8t abov0 th0 brain 8t0m and toward th0 back o1 th0 brain. It i8 r0lativ0ly w0ll prot0ct0d 1rom trauma compar0d to th0 1rontal and
t0mporal lob08 and brain 8t0m.
O C0r0b0llar injury r08ult8 in mov0m0nt8 that ar0 8low and uncoordinat0d. Individual8 with c0r0b0llar l08ion8 t0nd to 8way and 8tagg0r
wh0n walking.
O Damag0 to th0 c0r0b0llum can l0ad to 1) lo88 o1 coordination o1 motor mov0m0nt (a8yn0rgia), 2) th0 inability to judg0 di8tanc0 and
wh0n to 8top (dy8m0tria), 3) th0 inability to p0r1orm rapid alt0rnating mov0m0nt8 (adiadochokin08ia), 4) mov0m0nt tr0mor8
(int0ntion tr0mor), 5) 8tagg0ring, wid0 ba80d walking (ataxic gait), 6) t0nd0ncy toward 1alling, 7) w0ak mu8cl08 (hypotonia), 8) 8lurr0d
8p00ch (ataxic dy8arthria), and 9) abnormal 0y0 mov0m0nt8 (ny8tagmu8).
Th0 Limbic Sy8t0m
A set oI evolutionarily primitive brain structures located on top oI the brainstem and buried under the cortex. Limbic system structures are involved
in many oI our emotions and motivations, particularly those that are related to survival. Such emotions include Iear, anger, and emotions related to sexual
behavior. The limbic system is also involved in Ieelings oI pleasure that are related to our survival, such as those experienced Irom eating and sex.

Certain structures oI the limbic system are involved in memory as well. Two large limbic system structures, the amygdala and hippocampus play important
roles in memory. The amygdala is responsible Ior determining what memories are stored and where the memories are stored in the brain. It is thought that
this determination is based on how huge an emotional response an event invokes. The hippocampus sends memories out to the appropriate part oI the
cerebral hemisphere Ior long-term storage and retrieves them when necessary. Damage to this area oI the brain may result in an inability to Iorm new
memories.

Part oI the Iorebrain known as the diencephalon is also included in the limbic system. The diencephalon is located beneath the cerebral hemispheres and
contains the thalamus and hypothalamus. The thalamus is involved in sensory perception and regulation oI motor Iunctions (i.e., movement). It connects
areas oI the cerebral cortex that are involved in sensory perception and movement with other parts oI the brain and spinal cord that also have a role in
sensation and movement. The hypothalamus is a very small but important component oI the diencephalon. It plays a major role in regulating hormones, the
pituitary gland, body temperature, the adrenal glands, and many other vital activities.
Limbic Sy8t0m Structur08

Amygdala - almond shaped mass oI nuclei involved in emotional responses, hormonal secretions, and memory.

Cingulate Gyrus - a Iold in the brain involved with sensory input concerning emotions and the regulation oI aggressive behavior.

Fornix - an arching, Iibrous band oI nerve Iibers that connect the hippocampus to the hypothalamus.

Hippocampus - a tiny nub that acts as a memory indexer -- sending memories out to the appropriate part oI the cerebral hemisphere Ior long-term storage and
retrieving them when necessary.

Hypothalamus - about the size oI a pearl, this structure directs a multitude oI important Iunctions. It wakes you up in the morning, and gets the adrenaline
Ilowing. The hypothalamus is also an important emotional center, controlling the molecules that make you Ieel exhilarated, angry, or unhappy.

OlIactory Cortex - receives sensory inIormation Irom the olIactory bulb and is involved in the identiIication oI odors.

Thalamus - a large, dual lobed mass oI grey matter cells that relay sensory signals to and Irom the spinal cord and the cerebrum.
Motor Function8
The motor system oI the brain and spinal cord is responsible Ior maintaining the body`s posture and balance; as well as moving the trunk, head, limbs, tongue, and
eyes: and communicating through Iacial expressions and speech. ReIlexes mediated through the spinal cord and brainstem is responsible Ior some body movements.
They occur without conscious thought. Voluntary movements, on the other hand, are movements consciously activated to achieve a speciIic goal, such as walking or
typing. Although consciously activated, the details oI most voluntary movements occur automatically. AIter walking begins, it is not necessary to think about the
moment-to-moment control oI every muscle because neural circuits in the reticular Iormation automatically control the limbs. AIter learning how to perIorm
complex tasks, such as typing, they can be perIormed relatively automatic.
Voluntary movements result Irom the stimulation oI upper and lower motor neurons. Upper motor neurons have cell bodies in the cerebral cortex. The Axons oI
upper motor neurons Irom descending tracts that connects to lower motor neurons. Lower motor neurons have cell bodies in the anterior horn oI the spinal cord gray
matter or in cranial nerve nuclei. Their axons leave the central nervous system and extend through spinal or cranial nerves to skeletal muscles. Lower motor neurons
are the neurons Iorming the motor units.
Motor ar0a8 o1 th0 c0r0bral cort0x
The motor areas are located in both hemispheres oI the cortex. They are shaped like a pair oI headphones stretching Irom ear to ear. The motor areas are very closely
related to the control oI voluntary movements, especially Iine Iragmented movements perIormed by the hand. The right halI oI the motor area controls the leIt side
oI the body, and vice versa.
Th0 cortico8pinal 8y8t0m (pyramidal 8y8t0m)
The corticospinal tract supplies impulses to most oI the voluntary muscles. It originates in the precentral gyrus oI the cerebral cortex (area 4). The axons
pass through the internal capsule and descend to the mid-brain where they Iorm the crus cerebri (basis pedunculi). In the medulla oblongata, 80 to 90 percent oI the
Iibers decussate to the opposite side and descend in the spinal cord where they Iorm the lateral corticospinal tract. In the spinal cord, the axons oI the lateral
corticospinal tract are located internal to the posterior spinocerebellar tract and posterior to the lateral spinothalamic tract.
The lateral corticospinal tract irradiates branches at all levels oI the spinal cord. TheIibers enter the gray matter where they synapse in the ventral horn with
second- orderneurons. The latter emerge Irom the spinal cord in the ventral spinal roots and supply the voluntary muscles through the peripheral nerves.
The remainder oI the corticospinal tract which does not cross over in the medulla oblongata divides into two separate tracts: the anterior corticospinal tract
and the anterolateral corticospinal tract. The axons oI the anterior corticospinal tract descend uncrossed into the spinal cord. They occupy an antero-medial position
in the anterior white commissure and are contiguous to the anterior median Iissure. Most oI the Iibers oI the anterior corticospinal tract descend to the upper cervical
spine where they cross in the anterior white commissure. The Iibers enter the gray matter where they synapse in the ventral horn with second-order neurons.
The anterolateral corticospinal tract is the smallest oI the three descending tracts. The Iibers descend in the lateral Iuniculus and remain uncrossed in the entire
course oI the tract. The axons oI the anterolateral corticospinal tract synapse in the ventral horn with second-order neurons. It should be emphasized that the
pyramidal or voluntary muscle system is made oI a two-neuron system. The neurons oI the corticospinal tracts leaving the precentral gyrus and descending in the
spinal cord to terminate their course in the ventral horn are called upper motor neurons. The second-order neurons leaving the spinal cord to supply the voluntary
muscles are called lower motor neurons. The distinction between upper and lower motor neurons paralysis is important in clinical neurology.


Anatomy o1 c0r0bral circulation
Art0rial 8upply o1 oxyg0nat0d blood

Four major arteries and their branches supply the brain with blood. The Iour arteries are composed oI two internal
carotid arteries (leIt and right) and two vertebral arteries that ultimately join on the underside (inIerior surIace) oI
the brain to Iorm the arterial circle oI Willis, or the circulus arteriosus.
The vertebral arteries actually join to Iorm a basilar artery. It is this basilar artery that joins with the two internal
carotid arteries and their branches to Iorm the circle oI Willis. Each vertebral artery arises Irom the Iirst part oI
the subclavian artery and initially passes into the skull via holes (Ioramina) in the upper cervical vertebrae and the
Ioramen magnum. Branches oI the vertebral artery include the anterior and posterior spinal arteries, the
meningeal branches, the posterior inIerior cerebellar artery, and the medullary arteries that supply the medulla
oblongata.
The basilar artery branches into the anterior inIerior cerebellar artery, the superior cerebellar artery, the posterior
cerebral artery, the potine arteries (that enter the pons), and the labyrinthine artery that supplies the internal ear.
The internal carotids arise Irom the common carotid arteries and pass into the skull via the carotid canal in the temporal bone. The internal carotid artery divides into
the middle and anterior cerebral arteries. Ultimate branches oI the internal carotid arteries include the ophthalmic artery that supplies the optic nerve and other
structures associated with the eye and ethmoid and Irontal sinuses. The internal carotid artery gives rise to a posterior communicating artery just beIore its Iinal
splitting or biIurcation. The posterior communicating artery joins the posterior cerebral artery to Iorm part oI the circle oI Willis. Just beIore it divides (biIurcates),
the internal carotid artery also gives rise to the choroidal artery (also supplies the eye, optic nerve, and surrounding structures). The internal carotid artery biIurcates
into a smaller anterior cerebral artery and a larger middlecerebral artery.
The anterior cerebral artery joins the other anterior cerebral artery Irom the opposite side to Iorm the anterior communicating artery. The cortical branches supply
blood to the cerebral cortex. Cortical branches oI the middle cerebral artery and the posterior cervical artery supply blood to their respective hemispheres oI the
brain.
The circle oI Willis is composed oI the right and leIt internal carotid arteries joined by the anterior communicating artery. The basilar artery (Iormed by the Iusion oI
the vertebral arteries) divides into leIt and right posterior cerebral arteries that are connected (anastomsed) to the corresponding leIt or right internal carotid artery
via the respective leIt or right posterior communicating artery. A number oI arteries that supply the brain originates at the circle oI Willis, including the anterior
cerebral arteries that originate
Irom the anterior communicating artery. In the embryo, the components oI the circle oI Willis develop Irom the embryonic dorsal aortae and the embryonic
intersegmental arteries.
The circle oI Willis provides multiple paths Ior oxygenated blood to supply the brain iI
any oI the principal suppliers oI oxygenated blood (i.e., the vertebral and internal carotid arteries) are constricted by physical pressure, occluded by disease, or
interrupted by injury.
This redundancy oI blood supply is generally termed collateral circulation. Arteries supply blood to speciIic areas oI the brain. However, more than one arterial
branch may support a region. For example, the cerebellum is supplied by the anterior inIerior cerebellar artery, the superior cerebellar artery, and the posterior
inIerior cerebellar arteries. Venous return oI deoxygenated blood Irom the brain Veins oI the cerebral circulatory system are valve-less and have very thin walls. The
veins pass through the subarachnoid space, through the arachnoid matter, the dura, and ultimately pool to Iorm the cranial venous sinus.
There are external cerebral veins and internal cerebral veins. As with arteries, speciIic areas oI the brain are drained by speciIic veins. For example, the cerebellum
is drained oI deoxygenated blood by veins that ultimately Iorm the great cerebral vein. External cerebral veins include veins Irom the lateral surIace oI the cerebral
hemispheres that join to Iorm the superIicial middle cerebral vein.

Pathophysiology
































Non-modiIiable
Factors
ModiIiable Factors

Age (59) Heredity oI
heart diseases
Blood vessels
lose
integrity
Cigarette
smoking
High cholesterol
diet
Vasoconstriction Fats deposit in the
blood vessel
Plague Iormation
Thrombosis
Atherosclerosis
Occlusion by major vessels
Hypertension

































Fat deposits dislodge Irom
the plaque
Emboli circulates in the body
Lodges unto the cerebral
arteries
Review of Systems


Nervous system
n the nervous system the affected part of the brain to a patient having a CVA is the ventricle. A hemorrhage or leakage of blood occurred in
the ventricle of the skull. As the result of the bleeding the part of the brain will not be able to function. t will lead to physical mobility of the limb/s of a
person, will be unable to understand and formulate speech, or an inability to see either one side of the eye.


Musculoskeletal System
n musculoskeletal system the cerebrum is the affected part which is in the brain. f the ventricle inside of the brain loss its function it can
damage the musculoskeletal system. The musculoskeletal system will lose its function and can lead to paraplegia, hemiplegia or even quadriplegia.


Circulatory System
The heart and the blood vessels are also affected for patients having CVD. Hemorrhagic stroke is caused by a thrombosis or a blood clot or
blockage on the vessel. f the brain is unable to do its normal function and cannot have enough supply of oxygen in the body the heart will
compensate and will pump faster so that the brain can receive oxygen. The blockage can also be on the heart and can also cause stroke.






COURSE IN THE WARD
Dec ember 13, 2010(3pm-11pm SHIFT)

Patient was admitted accompanied by relatives with chieI complaint oI numbness oI the right side oI the body.Vital signs was taken.Diagnostics were also taken
includes CBC with platelet count ,Na, K, RBS,CREA,urinalysis ,CXR,ECG, and also plain cranial CT scan was advised and instructed.Lipid proIile also done.He
was hooked with IVF oI PNSS at 40-41 gtts/min plus Lysmix/ampule ,hooked with oxygen via nasal cannula at 2-3 LPM,inserted nasogastric tube at right
nostril.Also instructed and prescribed tube Ieeding at 1600 kcal/mg in 6 dided.Also instructed to monitor vital signs and complied medications as prescribed by the
physician .

Dec ember 13, 2010(11pm-7am SHIFT)

In Irom ER ,the patient transIerred accompanied by te hospital attendant and placed on bed.Still Ior cranial CtT scan advised

December 14,2010(7am-3pm SHIFT)

Patient was provided saIe and quiet environment ,monitored vital signs ,emphasized proper hygiene .Still Ior cranial CT scan.

December 14,2010(3pm-11pm SHIFT)

Provide arm care ,monitored vital signs ,due medication given and still Ior CT scan.



December 14,2010(7pm 3 am SHIFT)

Patient was provide adequate rest period,provided comIort and saIety measures ,perIormed tube Ieeding,elevated head oI the bed,Due medication given and still Ior
cranial CT scan .The patient also seen on rounds by the doctor with orders made and carried out


December 14,2010(3 am 7am SHIFT)

Patient`s back kept dry,daily hygiene advised ,monitored vital signs and still Ior cranial CT scan



December 15,2010(7am-3pm SHIFT)

Still have oxygen inhalation ,perIormed Ieeding and due medication given.

December 15,2010(3pm-11pm SHIFT)

Provided adequate sleep rest period ,rendered comIort and saIety measures ,still Ior cranial CT scan ,and seen on rounds by the doctors with orders made and carried
out








Laboratori08

Diagnostic
Laboratory
Procedure
Date
ordered
and Date
result
Indications or Purpose Results Normal Values Analysis and Interpretation
oI the results
Nursing
Responsibilities
Urinalysis August 25,
2010
The urinalysis is used as a
screening and/or
diagnostic tool because it
can :
O Help detect substances
or cellular material in

Components Actual Findings
Colour Yellow
Characteristic Turbid
Reaction

Normal Findings
Yellow to amber
Cleary to slightly
hazy


Analysis/Interpretation
Normal
Normal


the urine associated
with diIIerent metabolic
and kidney disorders.

O It is ordered widely and
routinely to detect any
abnormalities that
require Iollow up.
OIten, substances such
as protein or glucose
will begin to appear in
the urine beIore patients
are aware that they may
have a problem.

O It is used to
detect urinary tract
inIections (UTI) and
other disorders oI the
urinary tract.

O In patients with acute
or chronic conditions,
such as kidney diseases
the urinalysis may be
ordered at intervals as a
rapid method to help
monitor organ Iunction
status, and response to
treatment.

SpeciIic Gravity 1.010
Albumin
WBC 8-10
RBC
Too many to
count
Epithelial cells


1.003-1.030

5-7



Normal

Abnormal/ Decreased
Abnormal/ Elevated


Complete
Blood Count
August 24,
2010
The CBC provides valuable
inIormation about the blood
and to some extent the bone
marrow, which is the
blood-Iorming tissue. The

Components Actual Findings
WBC 14.9 10
4
/L
RBC 4.37 10
12
/L
HGB 129

Normal Findings
3.5 10.0
3.80 5.80
110 165

Analysis/Interpretation
Abnormal/Elevated
Normal
Normal

CBC is used Ior the
Iollowing purposes:
O as a preoperative test to
ensure both adequate
oxygen carrying capacity
and hemostasis
O to identiIy persons who
may have an inIection
O to diagnose anemia
O to identiIy acute and
chronic illness, bleeding
tendencies, and white
blood cell disorders such
as leukemia
O to monitor treatment Ior
anemia and other blood
diseases
O To determine the eIIects
oI chemotherapy and
radiation therapy on
blood cell production.



HCT 0.403
PLT 2.56 10
4
/L
PCT 0.051 10
-2
/L
MCV 92
MCH 29.4
MCHC 320
RDW 13.1
MPJ 9.0
PDW 7.9
Lymphocytes 12.8
#Lymphocytes 0.6 10
4
/L
Monocytes 13.2
#Monocytes 0.6 10
7
/L
Granulocytes 74.0
#Granulocytes 3.7 10
4
/L

0.350 0.500
150 390
0.100 0.500
80 97
26.5 33.5
315 350
10.0 15.0
6.5 11.0
10.0 18.0
17.0-48
1.2-3.2
4.0-10.0
0.3-0.8
43.0-76.0
1.2-6.8

Normal
Abnormal/Elevated
Abnormal/Decreased
Normal
Normal
Normal
Normal
Normal
Abnormal/Decreased
Abnormal/Decreased
Abnormal/Decreased
Abnormal/Elevated
Abnormal/Elevated
Normal
Normal

Blood
Chemistry
August 25,
2010

Components Actual Findings
Creatinine 1.3 mg/dL
URE Nitrogen 16.0 mg/dL
Cholesterol 181.1 mg/dL
Triglyceride 54.5 mg/dL
HDL-C 40 mg/dL
LDL-C 130.2 mg/dL


Normal Findings
0.7 1,4 mg/dL
9 21 mg/dL
150 250 mg/dL
40 160 mg/dL
Greater than 35
4-38 mg/dL


Analysis/Impression
Normal
Normal
Normal
Normal
Normal
Normal



CT Scan August 25,
2010
CT scanning is a non-
invasive medical test that

Actual Findings

Normal Findings

Analysis/Impression

helps physician to diagnose
and treat medical
conditions.

O CT scanning combines
special x-ray equipment
with sophisticated
computers to produce
multiple images or
pictures oI the inside oI
the body. These cross-
sectional images oI the
area being studied can
then be examined on a
computer monitor or
printer or transIerred to
a CD.
O CT scans oI internal
organs, bones, soIt
tissue and blood vessels
provide greater clarity
and reveal more details
than regular x-ray
exams.
O Using specialized
equipment and
expertise to create and
interpret CT scans oI
the body,
radiologists can more
easily diagnose
problems such as
cancers, cardiovascular
disease, inIectious
disease, appendicitis,
trauma and
A high dense Iocus is noted in the
leIt basal ganglia. A peripheral
hypodensity is also seen eIIacing the
adjacent parenchyma. The ipsilateral
Irontal horn is unremarkable. Subtle
midline shiIt is noted. The posterior
Iossa is unremarkable.



Acute hemorrhagic inIarct
with peripheral edema, and
sign oI mass eIIect and
subtle midline shiIt.


















DISCHARE PLANNIN
0n0ral condition o1 th0 pati0nt upon di8charg0

M0dication
O Proper compliance with the medication prescribed to the patient will limit the progression oI his condition.
-Captopril 2mg/tab BID
-Provastatin 4mg/tab
musculoskeletal disorde
r.

-Metropolol 50 g tab/BID

Ex0rci808 and Activity
O Emphasize the need to maintain regular exercise and activity; to maintain muscle strength , prevent bone demineralization and to promote good circulation
oI the body system. Passive exercise like breathing can also help the patient to Ieel calm and comIortable.

Tr0atm0nt
O Comply with the medication
O Complete rest

Hom0 T0aching
O Teach the patient about the importance oI monitoring the progress and compliance with the treatment regimen.
O Emphasize the importance oI having a regular check up to know his condition.
O Encourage use oI relaxation techniques, exercise and establish regular exercise program.
O Teach about the actions oI the drugs to be taken.
O ReIer to a speciIic support groups, counseling as appropriate.
O Encourage healthy diet.

Out-pati0nt
O AIter discharge patient may go to clinic Ior Iollow up check up and continue the physical theraphy.

Di0t
O Eat a well-balanced diet with an emphasis on Iresh vegetables and Iruits; lean, clean protein Ioods; and whole grains
O Avoid saturated and hydrogenated Iats
Spiritual
O Encourage a closer relationship to GOD through praying and attending religious activities that they have.










oncIusion

e were able to conclude that the study portrayed its value and helped us know all about Cerebrovascular Accident. This study made us
aware of the right picture and characteristics of the disease. t also made us understood the cause and effects of the ailment that enabled us to find
out the predisposing and precipitating factors how the disorder was developed. This also had given us the knowledge to identify where and when it
had started and how the disease progressed, we were able to trace the pathophysiology of the disease and we had also interpreted the laboratory
and diagnostic exam results of the client and known the implications of the different procedures. e also had formulated Nursing Care Plans and
identified our appropriate and therapeutic nursing interventions that would help us arrive on our goal of care for our patient with this kind of disease.