Cerebrovascular accident is the rapidly developing loss of the brain functions duet o disturbance in the blood vessels supplying blood to the brain causing brain tissue to die because of lack of nutrients and oxygen. This can be due to ischemia caused by thrombosis or embolism or due to a haemorrhage. CVA is the third leading cause of death in the United States and the leading cause of adult disability in the world. Three million Americans are currently permanent disabled from stroke. It is estimated that four of every four of every five families in the United states are affected by stroke in their lifetime and more than half a million of people in the United States experience a new or recurrent stroke each year. Our patient is a government employee and engineer who is a resident of Housing, Brgy. Canlanipa, Suriga0o City. He is a father of a kid and a hard working husband. He is 46 year old living together with his family in a cemented house. But unfortunately, he was confined at Surigao Medical Center last August 11, 2009 and was diagnosed of having Cerebrovascular accident Thrombosis secondary to hypertension. We have choosen this kind of case specially CVA- thrombosis or comonly known as stroke, for it is an interesting and challenging topic to learned. Especially most of us have family history of stroke that¶s why we are veruy crios about the cause, symptoms, complications, and how this disease could be treated.

for it is an interesting and a challenging topic to be learned. complications and how this disease could be treated. Advanced age is one of the most significant stroke risk factors. mentally.000 Americans each year.25 times more likely to suffer strokes than women.thrombosis or commonly known as stroke. emotionally. Cerebrovascular accident (CVA) is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain causing brain tissue to die because of lack of nutrients and oxygen. Especially most of us have family history of stroke that¶s why we are very curious about the causes. or a combination of the three. . they are older on average when they have their strokes and thus more often killed. one-quarter of all strokes are fatal. Dysfunctions correspond to areas in the brain that have been damaged. or almost one out of three stroke victims. stroke can occur at any age. Stroke kills about 150. Stroke can affect patients physically. including in fetuses. It is estimated that four of every five families in the United States will be affected by stroke in their lifetime and more than half a million people in the United States experience a new or recurrent stroke each year Worldwide. and etiology varies by age. Since women live longer. 95% of strokes occur in people age 45 and older.CVA is the third leading cause of death in the United States and the leading cause of adult disability in the world. The results of stroke vary widely depending on size and location of the lesion. Men are 1. Three million Americans are currently permanently disabled from stroke. yet 60% of deaths from stroke occur in women. symptoms. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism or due to a hemorrhage. and two-thirds of strokes occur in those over the age of 65. Some risk factors for stroke apply only to women. We have chosen this kind of case specifically CVA. However. The incidence of stroke increases exponentially from 30 years of age.

Some risk factors for stroke apply only to women. . stroke can occur at any age. Men are 1. Stroke kills about 150. or almost one out of three stroke victims. 95% of strokes occur in people age 45 and older. or a combination of the three. 000 Amrican each year. they are older on average when they have their strokes and thus more often killed. Since in woman live longer. and two-thirds twoof strokes occur in those over the gae of 65. Advanced age is one of the most significant stroke risk factors. The incidence of strokes increases exponentially from 30 years of age. Stroke can affect patients physically. including in fetuses.23 times more likely to suffer strokes than women. emotionally. and etiology varies by age. The results of stroke vary widely depending on size and location of the lesion. one quarter of all strokes are fatal. Dysfunction correspond to areas in the brain that have been damage. yet 60 % of deaths from stroke occur in women.Worldwide. however. mentally.


dizziness. especially prior to a definitive diagnosis. loss of balance or coordination. leg. a stroke fit. In medicine. . A stroke is caused by the interruption of the blood supply to the brain usually because a blood vessel bursts or is blocked by a clot. most often on one side of the body. severe headache with no known cause.REVIEW OF RELATED LITERATURE The word stroke as a Synonym for apoplectic seizures as early as 1599. causing damage to the brain tissue. This cuts off the supply of O2 and nutrients. difficulty seeing with one or both eyes. fainting or unconscious. difficulty in speaking or understanding speech. or faint is sometimes referred to us an ictus (cerebri) from the Latin icere (to strike). Other symptoms include: confusion. difficulty walking. the most common symptom of stroke is sudden weakness or numbness of the face. and is fairly literal translation of the Greek term. arm.

It divide stroke from TIA. TIA (transient ischemic attack). cigarette smoking. that reflect the urgency of stroke symptoms and the need to act swiftly. devised by the World Health Organization in the 1970s. This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose. migraine with aura. hypertension. Blood pressure is the most important modified risk factor of stroke.Stroke is medical emergency and can cause permanent neurological damage complications and death if not promptly diagnosed and treated. The traditional definition of stroke. advanced age. It is predicted that stroke will soon become the leading cause of death worldwide. Risk factors for stroke include. . It is the third leading cause of death and the leading cause of adult disability in the United States and Europe. with the time frame of 24 hours being chosen arbitrarily. is a ³neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours´. which is related syndrome of stroke symptoms that resolve completelt with in 24 hours. With the availability of treatments that when given early can reduce stroke severity. many now prefer alternative concepts such as brain attack and acute ischemic cerebrovascular syndrome. diabetes. high cholesterol. atrial fibrillation. thrombophilia.

This is called embolic stroke. such as coronary artery disease. The plaque blocks an artery which causes as stroke.  A torn artery in the brain.  A thrombus (blood clot) formed in an artery (blood vessel) and blocked blood flow the brain.  Diabetes (high blood sugar)  You or a close family member has had a stroke.  Atherosclerosis (hardening of the arteries) or fatty cholesterol deposits on artery walls. It often results from high stroke. . or drinking too much alcohol. causing blood to spill out.  High blood cholesterol (fat) and high blood pressure. The following factors may put you at a higher risk of having a CVA:  Cigarette smoking. A very severe stroke can cause sudden death. Causes A CVA may be caused by any of the following:  A piece of fatty plaque (debris) that is formed in a blood vessel breaks away and flows through the bloodstream going to the brain. cocaine use.  Blockage of certain small blood vessels inside the brain. This is called a thrombotic stroke.  Heart disease. stroke. blood pressure. This is called a cerebral hemorrhage or hemorrhagic stroke.The effects of a stroke depend on which part of the brain is injured and how severely it is affected.

Ischemic strokes usually only affect regional areas of the brain perfused by the blocked artery. even if the exact cause is not yet known. which part of the brain is affected). doctor can rapidly diagnose the anatomical nature of the stroke (i.Signs and Sypmtoms Stroke symptoms typically develop rapidly (seconds to minutes). The symptoms of a stroke are related to the anatomical location of the damage. a examination. . but often can also cause more global symptoms due to bleeding and increased intracranial pressure. On the basis of the history and neurological examination. Hemorrhagic strokes can affect local areas. as well as the presence of risk factors.e. nature and severity of the symptoms can therefore vary widely.

what's your name?.look to see if there is any drooping or loss of muscle tone on the face Arm . If they suspect a stroke.g. you might see one arm tending to slowly move down Speech .in a patient with a stroke.Pre-hospital care professionals in the United Kingdom will typically want to identify stroke risk very rapidly.ask the patient to close their eyes and hold both arms out straight for 30 seconds .listen to see if you can hear any slurring of the speech not otherwise explained (e. what day of the week is it?) . they will typically use the Face Arm Speech Test (FAST) to assess likelihood: Face . alcohol) and see if they can answer simple questions (where are you?.

However. . The defect in the brain is usually on the opposite side of the body (depending on which part of the brain is affected). the symptoms affect only one side of the body (unilateral). corticospinal tract. since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms. the presence of any one of these symptoms does not necessarily suggest a stroke. symptoms may include: ‡hemiplegia and muscle weakness of the face ‡numbness ‡reduction in sensory or vibratory sensation In most cases. and dorsal column (medial lemniscus).If the area of the brain affected contains one of the three prominent Central nervous system pathways²the spinothalamic tract.

pupil reactivity to light ‡decreased sensation and muscle weakness of the face balance problems and nystagmus ‡altered breathing and heart rate ‡weakness in sternocleidomastoid muscle with inability to turn head to one side ‡weakness in tongue (inability to protrude and/or move from side to side) . hearing. swallow. or vision (total or partial) ‡drooping of eyelid (ptosis) and weakness of ocular muscles ‡decreased reflexes: gag. A stroke affecting the brainstem therefore can produce symptoms relating to deficits in these cranial nerves: ‡altered smell. the brainstem also consists of the 12 cranial nerves.In addition to the above CNS pathways. taste.

. but also can produce the following symptoms:  aphasia (inability to speak or understand language from involvement of Broca's or Wernicke's area) area)  apraxia (altered voluntary movements)  visual field defect  memory deficits (involvement of temporal lobe) lobe)  hemineglect (involvement of parietal lobe) lobe)  disorganized thinking. the patient may have the following:  trouble walking  altered movement coordination  vertigo and or disequilibrium Loss of consciousness. the CNS pathways can again be affected.If the cerebral cortex is involved. If symptoms are maximal at onset. headache. deficit) If the cerebellum is involved. often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing on the brain. hypersexual gestures (with involvement of frontal lobe)  anosognosia (persistent denial of the existence of a. usually strokestrokerelated. confusion. the cause is more likely to be a subarachnoid hemorrhage or an embolic stroke. and vomiting usually occurs more consciousness.

. The following tests may be done:  lab tests of your blood  electrocardiogram (ECG) to see how well your heart is working  x-ray of your chest  brain scans (CT or MRI) to try to identify a stroke and determine whether it is from a clot or from bleeding into the brain from a leaking artery (hemorrhage). Your health care provider will know from your symptoms and physical exam whether you are having a stroke. someone should call an ambulance or take you to an emergency room right away.How is it diagnosed? If symptoms of a stroke occur.

. Platelets are type of blood cell that joins to form clots.Anticoagulant medicine: treatment for an ischemic stroke includes anticoagulant medicines which are also called blood thinners. . This medicinegroup keeps clots from forming in the blood.Thrombolytic medicine: this medicine group is used in a stroke caused by a clot ion a blood vessel. Thrombolytics break apart clot and restore blood flow.Antiplatelet aggregating medicine: these medicines interact with platelets to prevent blood clots from forming.  Hemorrhagic (bleed) stroke: this type of stroke may require surgery. . .Treatment Treatment of CVA depends upon the type of stroke:  Ischemic stroke: An ischemic stroke includes stokes caused by a blockage in a blood vessel.

Other treatment includes:   If swallowing is affected. brain scans are needed to find out what type of stroke you've had. glucose and blood pressure levels. you may be fed by a tube or given fluids into a vein (intravenously) to avoid food going into the lungs. Anti-clotting medication such as Antiaspirin may also be given to stop the stroke from getting worse. tests on key functions like swallowing and movement checks on oxygen. but this must be given within three hours of the stroke. 'clot busting' medication may be used to dissolve the clot. AntiAnti-clotting medication is not given in strokes caused by haemorrhaging because it will make the bleeding worse.Immediate treatment In hospital.   If a blood clot is the cause. .

. nurses and doctors. The next phase of treatment is recovery through rehabilitation. If a stroke is caused by a blood clot.After a stroke In the first few days after a stroke. speech therapists. treatment concentrates on making sure you are well hydrated and nourished. then taking a low-dose aspirin (eg Nu-seals 75mg) once a day may help make the blood less sticky and less likely to cause clots. occupational therapists. This involves a team of health professionals including physiotherapists.

talk to your caregiver about ways to lower it. Different people have different ideas about what too much means.  If you have atrial fibrillation (an irregular of fast heart beat). If you have hyperlipidemia (high blood cholesterol level. Having a recent heart attack may also require you to take antithrombotics. Alcohol is found in beer. you may need to take antithrombotic medicine.  Vasodilators are used to dilate the blood vessels. range. If necessary. It is important as how much you drink.  Don not smoke or drink too much alcohol. a physician may also order medication to lower blood pressure. These medications include the following categories of drugs:  Beta blockers are used to reduce the force and speed of the heartheartbeat.  Diuretics reduce the total volume of circulating blood and thus the heart's work by removing fluid from the body.  Keep your blood cholesterol level. . wine.  Lipid-lowering drugs increase the loss of cholesterol from the body or Lipidprevent the conversion of fatty acids to cholesterol. liquor. This lowers fat levels in the bloodstream. Eat foods low in fat to decrease the risk of developing plaque (fatty deposits) in your blood vessels.Prevention  Take your high blood pressure medicine regularly.  Monitor and control your blood sugar level if you have diabetes. like vodka or whiskey. and other adult drinks. in a normal.

5% will require long-term (nursing home) care.Prognosis The National Institute of Neurological Disorders and Stroke reports that 25% of people who suffer a stroke recover completely. while 20% die within three months after the stroke. Disability affects 75% of stroke survivors enough to decrease their employability. Stroke is fatal for nearly twice as many people of AfricanAfricanAmerican heritage as it is for European-Americans. emotionally. The results of stroke vary widely depending on size and location of the lesion. . Stroke can affect patients physically. rehabilitative and longrestorative services will be necessary in order for them to regain as much of their former capabilities as possible. Of the Europeanremaining 55% of people who have strokes. For the rest. Dysfunctions correspond to areas in the brain that have been damaged. or a combination of the three. mentally.

V.NURSING HEALTH HISTORY Biographic Data: Name of Patient: Mr. 1962 Religion: Roman Catholic Highest Educational Attainment: College Graduate Degree: Bachelor of Science in Civil Engineering Occupation: Government Employee Health care financing and usual source of medical care: Phil Health Source and reliability of data gathered: Primary source (patient¶s wife) and secondary sources (chart and the SOs) . Address: Canlanipa Housing.E. Surigao City Age: 46 years old Sex: Male Civil Status: Married Date of Birth: November 21.

: Room: Date Admitted: Time Admitted: Arrived via: Admitting vital signs: Surigao Medical Center 39558 PR .92 bpm BP.36. Roy N.22 cpm PR. Ycong Chief Complaint:Left side weakness and semi-unconscious and slurred speech. Impression: CVA Thrombosis seconday to Hypertension Final Diagnosis: Cerebrovascular Accident ± thrombosis with Right Paralysis. HPN . Gilberto A.25 August 11.160/100 mmHg Weight: Height: 5¶10 Admitting Physician: Dr.8°C RR. Barcenas Attending Physician: Dr.Admission Data: Hospital: Case No. 2009 7:45 pm per stretcher T.

the patient had eaten too much fatty foods such as homba. It was his 1sy time to be diagnosed with CVA. 2009 at exactly 7:45 pm because of left side weakness and semiconscious with slurred speech. The next day. etc.HISTORY OF PRESENT ILLNESS A 46 year-old patient was admitted in Surigao Medial Center last August 11. As day before hospitalization. While doiung his duty in office he got collapsed. he woke up early in the morning and prepared insisted to go to wok. The patient was semiconscious and he had difficulty in speaking and responding to verbal commands. hemiparesis and hemiplegia were noted on the left side of the body. he attended a wedding of his brother. patient is taking Captopril 75 mg 1 tab daily. and got drunk. Furthermore. . According to the SO. an anti-hypertensive drug as his maintenance for his hypertension. Upon admission his BP was high (160/100mmHg). This prompted his co-officemate to seek medical attention at SMC. lechon.

His 52 years old sibling had Diabetes Mellitus. Although. He is married and blessed with one child. sometimes he seeks for a medical check-up checkFamily Health History The patient has 5 siblings with 3 girls and 2 boys in the family.PAST HEALTH HISTORY Childhood Illness According to the informant. old. . He is the fourth from the eldest child. The usual sickness the patient¶s families often encountered are the common colds. the patient experienced sore eyes when she was 9 yrs. History of Hospitalization Patient doesn¶t have any history of hospitalization. The patient did not complete his immunization. Both of his parents had a history of hypertension and died because of Stroke. only hepatitis B vaccine. cough and headache. old and mumps when she was 13 yrs. fever.

He is a person who loves to stay and have fun together with his friends and co-officemate. patient usually sleeps at 9 pm and wakes up at around 5 am. coSLEEP AND REST PATTERNS Before hospitalization. . his sleeping pattern was in interrupted due to his condition. But during our assessment in the hospital. But during his hospitalization. he never defecated during day and with a dwelling Folley bag catheter. He had irregular sleep and wake up pattern as stated by the SO. usually 8 hours of sleep .And an active smoker as his past time in which he can consume 3 packs of cigarette per day as stated by the SO. ELIMINATION PATTERN The patient defecated twice a day and urinated 4-6 times a day 4and he don¶t have any difficulties in urination and defecation before his hospitalization.Personal Health History LIFESTYLE The patient was indulged in drinking alcohol if there are occasions with San Miguel Beer about a minimum of 1 liter or sometimes 1 case of beer with his colleges and during high school days.

he makes use of his vacant time hanging out with his family and sometimes goes on gimmick with his friends. Environmental Data The patient¶s house is situated near the basketball court in Canlanipa Housing wherein the houses are closed to each other. RECREATION AND HOBBIES As claimed. . Oftentimes. Patient doesn¶t have experience any history of accidents on the job. He also goes to church every Sunday to attend the mass as stated. our patient takes a bath every day. Patient¶s support systems are her family and friends. according to his wife. he loves to play with his 1 child and listen to radio. go on duty in a government office every weekday as claimed by the SO. clean and green environment as described by the SO. Oftentimes. he is so devoted on his work. Social Data Our patient is a college graduate of Bachelor of Science in Civil Engineering as stated by the SO.ACTIVITIES OF DAILY LIVING Before hospitalization. Their house is made up of cemented materials and they live in a peaceful. he strolls on a Sunday night riding his motorcycle. Currently he is a government employee.

as claimed by the SO. Patient¶s don¶t have any food allergies.Psychologic Data Before hospitalization. The patient and his family used herbal plants as alternative medicine such as ³carabo´ for cough and ³helbas´ for abdominal pain as verbalized by the SO. Nutritional Pattern Before hospitalization. Aside from that. . he ate snack 3 times a day. Patterns of Health Care The patient did not consult any annual check-ups nor checkvisited even a dentist. patient¶s typical on a normal day was consists of meat. There are times that the patient felt upset if something will happen to his family. the patient was an energetic and fun to be with husband as stated by his wife. fish and vegetables.

PHYSICAL ASSESSMENT General Survey Patient lies on bed conscious.26 cpm PR. Patient is afebrile and has an IVF of PNSS infusing well at the right metacarpal vein at the level 620 cc with a drop rate of 20 gtts/min.160/100 mmHg . Patient has an O2 inhalation at 3L/min via nasal . Vital Signs: Date of Assessment: August 12. restless.3 oC RR.36. 2009 T. agitated and irritable. with a signs of cardiac or respiratory distress.96 bpm BP. He appears weak. weak.

smooth and moist skin upon palpation Good skin turgor noted No tenderness upon palpation both in right and left part of the body No edema noted upon inspection. Perspiration noted Hair Hair is evenly distributed on the scalp upon inspection.INTEGUMENTARY: Skin Patient has brown complexion and uniform in color Negative in pigmentation Warm. Variable amount of body hair with beard noted upon inspection . Thick and black hair with a few streaks of graying hair upon inspection but not that prominent yet Uncombed hair noted upon inspection With no infestation of dandruffs or flaking upon inspection.

uniform consistency of the skull upon palpation. Smooth. Capillary refill test of less than 3 seconds unaffected side and more than 3 seconds at affected side and more than 3 seconds on toes. Pupils are black and equal in size upon inspection (5 mm) Blurred vision. cant read with ( RANGED) 8 involuntary blink reflexes noted in 1 minute. No edema or tenderness noted over periorbital area upon inspection and palpation. Drowsy eyes noted .Nails     Convex curvature of nail in shape and dirty upon inspection. Lids close symmetrically upon inspection. Sclera appears white upon inspection. Right Flaccidity faced note Eyes and Vision          Thick eyebrows and lashes are noted upon inspection No abnormal discharges of the eyes upon inspection. HEENT: Skull and Face     Rounded and normocephalic skull contour and no scars upon inspection. Absence of nodules or masses upon palpation. Slightly rough in texture upon palpation. Intact epidermis surrounding the fingernails and toe nails upon inspection.

and not tender upon palpation. firm. No abnormal discharges noted Auricles are of the same color with the facial skin upon inspection. Difficulty in hearing on the left ear Nose and Sinuses         Nose is symmetrical and straight upon inspection. No discharges or flaring noted upon inspection. External nose has same color as facial skin Right mole noted on the upper part of the nose Nasal septum is intact and in midline upon inspection.Ears and Hearing       Symmetric ear position that lines with outer canthus of the eye upon inspection. Auricles are mobile. Pinna recoils after it is folded. NGT attached Oxygen attached (3L/min) . No tenderness and lesions on both nose and sinuses noted upon palpation.

Slightly enlarged neck noted upon inspection Can hyperextend and flex neck but in a slower pace upon inspection.Oropharynx (mouth and throat)  Lips has symmetric contour.  Able to move tongue and positioned centrally upon inspection. No jugular vein distention was noted upon inspection. Thyroid gland is not visible upon inspection. uniform and brownish in color.  No presence of dentures upon inspection.  Has ability to purse lips upon inspection. Coordinated smooth movements of the head upon inspection. soft and slightly dry upon inspection and palpation.  Slightly dark gums and plaque noted on the enamel upon inspection. Lymph nodes are not evident/palpable upon palpation. . With head centered upon inspection.  Lacking 2 lower molars upon inspection  Halitosis noted  With NGT attached  Negative gag and swallowing reflexes noted Neck         Neck muscles are equal in size upon inspection.

CARDIOVASCULAR SYSTEM and PERIPHERAL VASCULAR SYSTEM .THORAX AND LUNGS  Chest is symmetrical upon inspection.  No abdominal aortic pulsations upon auscultation.  Pulse rate of 96 bpm  Blood pressure of 160/100 mmHg  Positive tactile fremitus upon palpation  Capillary refill test of less than 3 seconds unaffected side and more than 3 seconds at affected side and more than 3 seconds on toes.  Chest wall intact and no tenderness noted upon palpation  Antero-posterior diameter is 2:1 Antero Respiratory rate 26 cpm  O2 inhalation attach and no respiratory distress noted  Spinal column is vertically aligned and intact with no tenderness or masses noted upon palpation.  Skin is intact and uniform in color both anterior and posterior upon inspection and palpation.  Apical pulse palpable and no edema noted .

Easy fatigability noted Patient unable to do ADL¶s .  Same color as the skin of abdomen/back upon inspection.  No discharges in the nipple noted upon inspection. ABDOMEN Small brown pigments on the abdominal skin noted upon inspection.BREAST AND AXILLAE  No masses.  No rebound tenderness felt upon palpation MUSCULOSKELETAL SYSTEM         Pulse is palpable on distal part of the extremities when palpated Slow coordinated movements noted Muscle strength is 4/5 Paresthesia and paresis noted in the left side of the body No edema noted upon inspection. nodules. or tenderness noted upon palpation.  Symmetric abdominal contour upon inspection.  Uniform in color upon inspection.  No evidence of enlargement of liver or spleen upon inspection and palpation.

He wasn¶t able to explain that the reason for seeking healthcare service. Orientation  Patient is not oriented to time but he knows who¶s his talking to and where he was. he was able to recall where he grew up by asking some question and he nags his head if correct. but identify present voice on request = 2 OpeningMotor verbal command = 3 ResponseVerbal Response. As to long term events. converses = 3 ResponseScore: 8/15 ± slightly coma .oriented. Glasgow Coma Scale Eye Opening. Memory  He was able to recognize the people who surround him. recognize persons in his room and but not specifically in date and time upon assessment.MENTAL STATUS Language  During the first day of assessment the patient has difficulty in speaking as evidenced by slurred speech but able to comprehend spoken words.


Ears. moist skin and oftentimes experience sweating. Nose. No hair dyes. restless. agitated and irritable. He appears weak. Patient also claimed that at times he experienced headache. Patient has no history of ear infection. Throat (HEENT): Patient has no history of head trauma. Patient has an O2 inhalation via nasal cannula at 3 L/min Integumentary System: As what the so verbalized. and responsive with signs of cardiac or respiratory distress. the patient had no history of skin itchiness. curling/ straightening preparations were used. coherent. Patient is afebrile and has an IVF.REVIEW OF SYSTEMS (ROS) Date of assessment: August 14. Eyes. dizziness and light headedness which are usually aggravated by heavy work. He has a warm. Head. Patient uses eyeglasses because he is unable to read small written words or phrases. of PNSS infusing well at the right metacarpal vein at the level 620 cc running with a drop rate of 20. . 2009 General Data: Patient lies on bed conscious. and no pigmented spots on the upper and lower extremities.

. Patient stated that he experienced numbness. He is a smoker and drinks alcoholic beverages. like lung cancer and PTB. Cardiovascular System: He said his usual BP is 160/100 mmHg and experiences palpitations. tingling sensation and observed poor wound healing. ³Salonpas´ ³hilot´ Breast and Axillae: Patient did not experience any pain on his breast area.Neck: Patient said that when he works too much he sometimes experienced neck and back pain and were relieved through using ³Salonpas´ and ³hilot´ or massage. Thorax and Lungs: Patient verbalized that he did not have any major lung diseases experienced. However he still drinks alcohol occasionally when he finds it difficult to decline when his friends cajole him whenever they get together but he insisted that on moderation only. He sometimes experienced incidence of diarrhea. Lately. he observed an increase appetite but tries so hard to curtail it for fear of Hypertension complications and it resulted in increase weight and increase blood pressure. He has no known allergies in terms of foods. He also stated that he experienced fatigue every time he is over worked or under some emotional stress. Gastrointestinal System: Patient claimed that there were few times when he finds it difficult to manage his food intake especially when he was still working. His usual bowel habit is every day usually in the morning.

easy bruising and bleeding. He also feels guilt for maybe his condition now is a repercussion of his behavior a few years ago.Musculoskeletal System: Patient claimed that he experienced neck and back pain when his at work especially when having an over time. Urinary System: Patient claimed that he has no major complication in his kidney. Neurologic System: Patient said that he often have mood swings that sometimes lead to an argument with his wife over minute details which irate him. . He is anxious about his condition and its effects to his wife and children. He felt depressed when he was admitted. He felt nervous and tense for his recent condition since he had relatives who died from stroke. Hematologic: Patient had no history of anemia. This is because he knows that stroke is an illness that requires a long time to recuperate. sitting on a chair while watching television and frequents breaks while working. It was relieved through relaxation techniques like taking sleep.








block.Phenytoin (Dilantin) Classification: Anticonvulsants Dosage: 100 mg 1 cap BID Mechanism of Action: May stabilized neuronal membranes and limit seizure activity either by increasing efflux or decreasing influx of Sodium oins across cell membranes in the motor cortex during generation of nerve impulses. . SA. or Adams-strokes syndrome. Indications: To control tonic ± clonic and complex partial seizures. Elderly patients tend to metabolize drug slowly and may need reduced dosage. To prevent and treat seizures occurring during neurosurgery Contraindication: Contraindicated in patients hypersensitive to hydantoin and in those with sinus bradycardia.

toxic epidermal necrolysis Nursing consideration: ‡ Don¶t give IM unless dosage adjustments are made. thrombocytopenia HEPATIC: toxic hepatitis METABOLIC: hyperglycemia MUSCULOSKELETAL: osteomalacia SKIN: Stevens-johnson syndrome. nystagmus. nausea. pancytopenia. CV: periarteritis nodosa EENT: diplopia. ‡ Don¶t stop drug suddenly because this may be worsen seizures. drug may precipitate at injection site. Watch for increase seizures. ‡ Divided doses given with or after meals may decrease adverse GI reaction. constipatio HEMATOLOGIC: agranulocytosis. blurred vision GI: gingival hyperplasia. ‡ Allow at least 7 to 10 days to elapse between dosage changes. decreased coordination. mental confusion. slurred speech.Adverse Effect: CNS: ataxia. leucopenia. vomiting. . dizziness and headache. ‡ Mononucleosis may decrease level.

.Tramadol (Milador) Classification: Opioid Analgesic Dosage: 1 cap TID / NGT Mechanism of action: Unknown. Thought to bind to opioid receptors and inhibit reuptake to norepinephrine and serotonin. Indication: Moderate to moderately severe pain. or history of drug or alcohol abuse. Patient with history of anaphylactic reaction to codeine and other opioids may be at increased risk. Contraindications: Contraindicated in patients hypersensitivity to drug Use cautiously in patients with hepatic or renal disease. A centrally acting synthetic analgesic compound no chemically to opioids.

proteinuria. ‡Monitor patient at risk of seizure. headache. somnolence. asthenia CV: vasodilation EENT: visual disturbance GI: constipation. urinary frequency SKIN: diaphoresis. anorexia. . diarrhea GU: menopausal symptoms. ‡Monitor CV and respiratory status ‡Monitor bladder and bowel function ‡For better analgesic effect. anxiety. give drug before onset of intense pain. abdominal pain. nausea and vomiting. seizure.Adverse effect: CNS: dizziness. vertigo. pruritus Nursing Consideration: ‡Reassess patient¶s level of pain at least 30 minutes after administration.

increasing water flow into rxtracellular fluid. frank pulmonary edema . Oliguria To prevent oliguria or acute renal failure. To reduce intraocular or intracranial pressure Diureses in drug intoxication Contraindication: Contraindicated in patients hypersensitive to drug.severe pulmonary congestion. Indication: test dose for maked oliguria or suspected inadequate renal function.Mannitol (Osmitrol) Classification: Osmotic Diuretic Dosage: 2 % 100 cc IV bolus q 120 starting in AM Mechanism of action: Increases osmotic pressure of glomerular filtrate. inhibiting tubular reabsorption of water and electrolytes. Contraindicated to patient with anuria. drug elevates plasma osmolality.

. hepatitis MUSKULOSKELETAL: muscle cramps SKIN: pruritus. ‡Monitor glucose level. palpitations. impotence HEMATOLOGIC: aplastic anemia. give drug in the morning. leucopenia HEPATIC: jaundice. urticaria. rash. dermatitis Nursing consideration: ‡To prevent nocturia. especially in diabetic patient. polyuria. paresthesia CV: orthostatic hypotension. and electrolyte levels. ‡Monitor blood pressure. ‡Monitor fluid intake and output. vertigo.anorexia. headache. fatigue. blood pressure. vasculitis GI: pancreatitis. weight.Adverse reaction: CNS: dizziness. nausea GU: nocturia. vomiting.

neuroleptics. depressive states. increased motor activity.Piracetam (Nootropil) Classification: Neurovascular enhancer Dosage: 1. emotional lability. mental fatigue. aggreesively. to pregnant and lactated mother. Contraindication: Contraindicated to patient with hypersensitivity to drug. depressive states. troubled speech.2 gm IVTT Mechanism of action: CNS stimulants. . lack of concentration. Adverse effect: Sexual stimulation. impaired memory. somnolence. increase in weight. thyroid hormones Indication: Disturbances in cerebral activity due to advanced age.

nausea . Adverse effect: GI: abdominal pain. diarrhea. Indication: Short term treatment of active duodenal ulcer.PREVACID Classification:Anti ulcer Dosage: FGT 30 mg 1 cap once a day Mechanism of action: Inhibits activity of proton pump and binds to hydrogenpotassium adenosine triphosphate located at secretory surface of the gastric parietal cells to block secection of gastric acid. Contraindication: Contraindicated to patients hypersensitive to drug.

. shake gently and give any remaining contents. 4. Its unknown if drug appears in breast milk. but don¶t adjust the dosage for elderly patients or those with renal insufficiency. Breast feeding women should either stop breast-feeding or stop drug. 2. 3.Nursing consideration: 1. Patients with severe liver disease may need dosage adjustment. dissolve a 15 mg tablet in 4 ml water or a 30 mg tablet in 10 ml water and give within 15 minutes. The contents of capsule can be mixed 40 ml of apple juice in a syringe and given within 3-5 minutes via a nasogastric tube. To give ODT¶s through an NG tube 8 French or larger. Refill the syringe with about 5 ml of water. Flush with additional apple juice to give entire dose and maintain patency of the tube.

The 2 g regimen produces a high level that¶s more likely to reach fetal circulation. Indication: 1.Antibacterial Dosage: 500 mg IV infusion q 8 hours Mechanism of action: Direct-acting trichomonacide and amebicide that works inside and outside the intestines. . Bacterial infections caused by anaerobic microorganisms. Contraindication: 1. CNS disorder or retinal or visual field changes. 2. 2.Metronidazole (Zolmid) Classification: Antiprotozoal. use cautiously in patients with history of blood dyscrasias. 3. Contraindicated to patients hypersensitive to drug or to other nitroimidazole derivatives and in women in first trimester pregnancy. Intestinal amebiasis. Alert: If drug must be given to a pregnant women for trichomoniasis use the 7-day regimen not the 2 gm single dose regimen. Amebic liver abcess. 3.

Nursing consideration: 1. polyurea. sinusitis. 2. especially if he¶s receiving corticosteroids. Flagyl RTU may cause sodium retention. 4. Observe patients for edema. abdominal cramping or pain GU: vaginitis. Monitor liver function test results carefully in elderly patients. pharyngitis GI: nausea.Adverse effect: CNS: headache. flushing. vertigo CV: flattened T wave. Give oral forms with meals. duodenal ulcer. . Record number and character of stools when drug is used to treat amebiasis. seizures. 3. fever. dysuria RESPIRATORY: upper respiratory tract infection. edema. thrombophlebitis EENT: rhinitis.

as well as a fleeting and discrete hypotensor effect.CITICOLINE (Zynapse) Classification: Dose order/frequency/route: 500 mg IVTT q 6O Mechanism of action: It activates the bio-synthesis of structural phospholipids in the neuronal membrane. Furthermore. as well as improved learning and memory performance in animal models of the brain aging. Contraindications: Patients with hypertonia of the parasympathetic. increases cerebral metabolism and increases the level of various neurotransmitters. head trauma of varying severity. including acetylcholine and dopamine. Indications: Cerebrovascular diseases. cognitive disorders of various etiology. . Citicoline has shown nueroprotective effects in situation of hypoxia and ischemia. Adverse Reactions: May exert a stimulating action of the parasympathetic. it has been demonstrated that citicoline restores the activation of phospholipase A2 and accelerates the reabsorption of cerebral edema in various experimental models.

Indication. coma EENT: decreased intraocular pressure GI: nausea and vomiting. nephrotoxicity Nursing Considerations: check for medical history for hypersensitivity to anti-convulsant drugs don¶t discontinue abruptly unless provider approved be prepared in case of acute oral toxicity . Pain and cold sensation in chronic arterial occlusion Contraindication: Contraindicated in patient with hypersensitivity to drug. seizures.o. OD Classification: Anti-coagulant/anti-platelets Mechanism of Action: Therapeutic agent¶s can¶t cure convulsions disorder but do control seizures without impairing the normal function of the CNS. diarrhea. candidiasis GU: protienuria. anorexia. This is often accomplished by selective depression of hyperactive areas of the brain responsible for the convulsants.PLETAAL Dose ordered/ frequency/route: 50mg 1 tab p. Adverse Effect: CNS: headache.

C. Adjunct lipid-lowering treatments such as LDL apheresis Heterozygous familial hypercholesterolemia To reduce the risk of MI. w/ multiple risk factor for CAD Contraindication: In pt. w/ history of liver dse. or revascularization procedures in pt. cholesterol. serious acutr condition that suggest myopathy. . hypersensitive to drug and in those w/ active liver disease or unexplained persistent elevation of transaminase levels. severe acute infection and severe metabolic disorders. an early step in cholesterol biosynthesis. Use cautiously in pt. angina. or heavy alcohol use. HDL. Indicaton: Adjunct diet to reduce LDL.Atorvastatin Calcium (Lipitor) Classification: HMG-CoA reductase inhibitor Dosage Order: 10 mg 7 tab P. Limit use in children to those older than age 9 w/ homozygous familial hypercholesterolemia. major surgery. supper Mechanism of Action: Inihibits HMG-CoA reductase. Withhold or stop drug in patients at risk for renal failure. stoke.

should follow a standard low-cholesterol diet before and during therapy. Obtain periodic liver function test results and lipid levels before starting treatment and at 6 and 12 wks. constipation. Drug may be given as a single dose at any time of day. Watch for signs of myositis . or after an increase in dosage and periodically thereafter. assess pt.Adverse Effect: CNS: headache. asthenia. diarrhea GU:UTI Musculoskeletal: rhabdomyolysis Respiratory: bronchitis Skin: rash Nursing Considerations: Use only after diet and other nondrug therapies prove ineffective. w/ or w/o food. insomnia CV: peripheral edema EENT: pharyngitis. rhinitis GI: abdominal pain. After initiation. Pt. for underlying causes for hypercholesterolemia and obtain a baseline a lipid profile. Before treatment.

easy bruising or bleeding. Nursing implications: Monitor BP closely following the 1st dose. A sudden exaggerated hypotensive response may occur with in 1-3 hr of 1st dose. photosensitivity and impaired renal function. slight increase in heart rate. Patient and Family Education Report to physician without delay the onset of unexplained fever. Indication: Hypertension Contraindication: Pregnancy lactation Adverse Reactions: Hypersensitivity reactions. . Report darkening or crumbling of nail beds. especially in those with high BP or on a diuretic. Advise bed rest and BP monitoring for the 1st 3 hr after initial dose. pruritis. fainting altered taste sensation. first dose hypotension. a potent endogenous vasoconstrictor. dizziness. This interrupts conversion sequences initiated by rennin that lead to formation of angiotensin II. cough.CAPTOPRIL (Capoten) Classification: Antihypertensive agent Dose order/frequency/route: 75 mg 1 tab q 12O Mechanism of Action: Lower blood pressure by specific inhibition of ACE. hyperkalemia. weight loss.

which lowers the pH colon contents. Indications: . Also decrease ammonia.Constipation Contraindication: . belching. nausea and vomiting . diarrhea.Use cautiously in patients with diabeted mellitus Adverse reaction: GI: abdominal crapms. probably as a result of bacterial degradation. gaseous distention.LACTULOSE (Lilac) Classification: Laxative Dose order: 30 cc 2 hs daily Mechanism of action: Produces an osmotic pressure effect in colon. flatulence.contraindicated in patient with low-galactulose diet . resulting distention promotes peristalsis.

especially when giving in higher doses to treat hepatic encephalopathy 3. 2.Nursing Consideration 1. Mental status and potassium levels when giving to pateints with hepatic encephalopathy 5. To minimize sweet taste. Monitor sodium level for hypernatremia. Monitor 4. Replace fluid loss . dilute with water or fruit juice or give with food.

The Human Brain


The Structure of Artery .

The Structure of Neuron .






o.Instructed the patient and SO. to turn the patient into a side-lying position every 2 hours . 2009 MEDICATIONS Advised the patient to take medication religiously as prescribed by the physician Phenytoin 100 mg 1 cap BID Prevacid 30 mg 1 cap once a day Pletaal 50mg 1 tab p.O.O. to have a calm and quite environment Instructed the patient¶s S. to have a well ventilated room and polluted free environment .Reminded the patient¶s S.O. the importance of the following recommendations to prevent further hemorrhagic stroke and keeping follow-up appointments for monitoring of risk factors .C.E.O. the importance of following treatment regimen to facilitate the healing process. supper EXERCISE/ENVIRONMENTAL CONCERNS . to undergo physical therapy . the importance of continuing health promotion and screening practices .Advised the patient to ambulate and perform only tolerable exercises TREATMENT .Name of the Patient: Mr.Reminded the patient¶s S.O.Encourage patient¶s S. V.Encouraged patient¶s S. .Reminded the patient¶s S.O. OD Atorvastatin Calcium (Lipitor) 10 mg 7 tab P. Date of Discharge: August 17.

to prevent aspiration in administering food. to maintain proper hygiene to avoid the risk for infection such as performing perineal care. to check the position in giving NGT. close monitoring of the patient). .Reminded the patient¶s S.Reminded the patient¶s S. to maintain sterility or used sterile technique in giving NGT feeding.O.O.O. .Reminded the patient¶s S. .O. the importance of interventions taken to prevent and detect complications (aneurysm precaution.Instructed the patient¶s S. . including surgical intervention if warranted.Instructed the patient¶s S.Reminded the patient¶s S.O.O.HEALTH TEACHINGS . with information about the medical treatment that are implemented. . . with information that will enable them to cooperate with the care and restrictions required during the acute phase of hemorrhagic stroke .Reminded the patient¶s S.O. .O. with information about the causes of hemorrhagic stroke and its possible consequences.Reminded the patient¶s S.

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