Hemorrhagic Stroke

Neurologic Case pres

 Objectives
During the four hours of case presentation, the student nurses of Johnson B
aims to achieve the following objectives:
1. Review the anatomy and physiology of the cranium.
2. Identify the summary of the patient’s history and general appearance of the
patient.
3. Interpret abnormal findings with significant deviations in the diagnostic
examination.
4. Trace the pathophysiology of Increased ICP.
5. Formulate the appropriate nursing care plans using a nursing process as the
framework of care.
6. Tabulate the drugs according to the name, content, mechanism of action,
indication, contraindications, adverse or side effects per system and nursing
responsibilities or considerations.
7. Formulate a specific health teaching plan for the continuity of care of the
patient.
 Anatomy & Physiology
Cranium
 The brain is housed inside of a bony covering called the cranium
wherein it protects the brain from injury and along with the bones
that protect the face. The cranium is a rigid structure in our head
and has three components: brain, cerebrospinal fluid, and blood.

Meninges
c
The meninges are the second layer of protection located between
the skull and brain. It has three membranes that surround the
brain and spinal cord to keep it from being damaged by contact
with the inside of the skull. These are the dura mater, arachnoid
mater and pia mater.

Cerebral volume consists of 3 components. These are cerebral

tissue, blood, and cerebral spinal fluid (CSF).
 Assessment
a.)   Demographic Data
Patient’s Name Mr. Clean b.)   Chief complaint/s
Chief complaint(s): stroke
Age 28 years old

Sex Male

c.)   History or Present Illness

On the day of admission, the patient was brought
to the emergency department via ambulance
intubated as a Level 1 Trauma activation. He was
unconscious after he had lost control of his
motorcycle and went off the road. 
 Assessment
a.)   Baseline Data:

Vital sign/s: Initial Blood pressure 172/118 mmHg upon admission

221/105 mmHg after 30 mins after his arrival

b.)   Overall appearance of the Client

Mr. Clean was unconscious and unresponsive upon admission.

c.) Cephalocaudal Assessment

1. Neurologic Assessment

GCS of 3T, bilateral fixed pupil, cephalohematoma, cerebral spinal fluid

otorrhea, subarachnoid hemorrhage, subdural hemorrhage, effacement of the
suprasellar cistern, effacement of the ventricles , fracture in temporal bone,
cerebral edema  frontal/temporal and parietal hematoma
 Lab Results
CT scan result prior to operation CT scan result post op

 Subarachnoid hemorrhage  Improvement of midline shift 

 Left frontal and temporal subdural  Ventriculostomy catheter tip was found to
hemorrhage be in the proper location in the frontal horn
 Effacement of the suprasellar cistern of the right lateral ventricle
 Effacement of the 3rd and 4th ventricles
 Left frontal/temporal and parietal
hematoma with mass effect 
 Cerebral edema causing a 5.38-mm left to
right midline shift
 Frontal skull base fracture
 Complex nondisplaced comminuted
fracture of the right temporal bone
 Lab Results
  Normal values Results

initial intracranial 0-15 mmHg 14 mmHg.

pressure (ICP)

CP and cerebral 0-15mmhg 3–4 and 70–75 mm Hg

perfusion pressure
(CPP)
 
Pathophysiology
 Nursing Care Plan

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 Nursing Care Plan

Mercury is Mercury is
the closest the closest
planet to planet to
the Sun and the Sun and
the smallest the smallest
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System, it’s System, it’s
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Nursing Care Plan
Nursing Care Plan
Nursing Care Plan
Nursing Care Plan
Drug Tabulation
 Drug Tabulation

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the closest the closest the closest
planet to planet to planet to
the Sun and the Sun and the Sun and
the smallest the smallest the smallest
one in the one in the one in the
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System, it’s System, it’s System, it’s
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Drug Tabulation
 Discharge Summary
•Encourage personal hygiene activities as soon as the patient can sit up;
Hygiene select suitable self-care activities that can be carried out with one hand.
•Keep wounds clean and dry.
•Do not let skin remain wet, as this gives rise to sores and skin infections.
•Apply water barrier cream to protect the skin around buttock/sacrum to
prevent formation of sores and skin infections.
•Keep nails short as dirt particles collect easily beneath them.
•Use aseptic technique when handling any part of the intracranial
monitoring device or changing a dressing applied after surgery. 
 

•Straining activities AVOIDED: vomiting, coughing, sneezing,

Activity Valsalva, agitation (keep environment calm), avoiding restraints as
necessary.
•Avoid vigorous activity until your doctor says it is safe to do so.
•Ask your doctor when you will be able to return to work.
•Ask your doctor when you will be able to resume sexual activity.
•Do not drive unless your doctor has said it is okay to do so.
 Discharge Summary
•Eat a healthy well-balanced diet. It should be rich in fruits and vegetables,
Diet and low in meat and dairy.
•Adequate fluid volume should be maintained. Maintain fluid restriction as
prescribed.
•If you are having trouble chewing or swallowing, your doctor will
recommend a therapy program. You may also work with a dietitian to help
you plan your meals.
•Advise family members of the patient to take smaller boluses of food, and
taught about types of foods that are easier to swallow (the patient may be
started on a thick liquid or pureed diet).

Instructions •Maintain head in midline position at above 30 degrees to improve cerebral

venous drainage
•Consider installing rails or assistive bars near the toilet or shower
•Instruct the family members to keep the environment organized and
uncluttered.
•Having a patient to sit upright, preferably out of bed in a chair. Instruct the
patient to tuck the chin toward the chest as he/she swallows. This would
help to prevent aspirations.
•Position to prevent contractures, relieve pressure, attain good body
alignment, and prevent compressive neuropathies.
•Apply splint at night to prevent flexion of the affected extremity.
 Thank You
JOHNSON B GROUP 1