CASE PRESENTATION on CVD ² Cerebrovascular Disease

BSN3Y2-6 GRP 463 A/B

INTRODUCTION

Cerebrovascular disease is a group of brain dysfunctions related to disease of blood vessels supplying the brain. Hypertension is the most important cause that damages the blood vessel lining endothelium exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow, stiff, deformed and uneven which are more vulnerable to fluctuations of blood pressure.

A fall in blood pressure during sleep can lead to m a r k e d r e d u c t i on i n b l o o d f lo w i n t h e n a r r o w e d b l o o d v e s s e l s ca u s i n g i s c h e m i c s t r o k e i n t h e morning whereas a sudden rise in blood pressure c a n c a u s e t e a r ing o f t h e b l o o d v e s s e l s c a u s i n g i n t r a c r a ni a l h em o r r h a g e d u r i n g e x c i t a t i on a t daytime. Primarily people who are elderly, d i a b e t i c , s m o k e r , o r h a v e i s c h e m ic h e a r t d i s e a s e , h a v e c e r e b r o v a s cu l a r d i s e a s e . A l l d i s e a s e s r e l a t e d t o a r t e r y d y s f u n c t i o n c a n b e c l as s i f i e d u n d e r a disease as known as macrovascular disease.

This is a simplistic study by which arteries are blocked by fatty deposits or by a blood clot. The results of cerebrovascular disease can include a stroke, or even sometimes a hemorrhagic stroke. Ischemia or other blood vessel dysfunctions can affect one during a cerebrovascular accident. CVD is the most disabling of all neurologic diseases. Approximately 50% of survivors have a residual neurologic deficit and greater than 25% require chronic care. Cardiovascular disease mortality in the philippines was studied from the existing vital statistics for 20002008. Death rates from cerebrovascular diseases increased enormously both in men and women.

0 in 2005. where disease rates are rapidly increasing.4 to 34.3 in 2000 to 78. The male to female ratios in the age-standardized death rates increased during this 9-year period. and that of women from 15.5. such as ours. The age-standardized mortality rate in men rose from 33. This excess mortality in males is mostly due to the increased cardiovascular disease death rate. Immediate preventive measures are needed in order to control cardiovascular diseases in countries. This is a clear example of how chronic non-communicable diseases are becoming major health problems in countries where they previously have not been prevalent. Agestandardized mortality increased clearly in the male population but decreased in the female population of the philippines. .This increase in mortality was seen in all age groups.

We chose this case as the main subject of this presentation because we were greatly alarmed with the sudden increase of the number of people having the said disease. We want to find out what makes it such a horrifying disease. . It is then through this case presentation that we will be able to apply the things we were taught to. We also wanted to come up with a thorough study so as to hasten and develop our critical thinking by utilizing the different nursing theories and principles that we learned from our discussion.

H e i s married with two (2) children. weakness . He is a f i l i pi n o c i ti z en r e s i d i n g i n c a vi t e.NURSING HEALTH HISTORY PERSONAL DATA: Patient A is a 49 years old male born on march 11. H i s r e l i g i o n i s r o m a n c a t h o l ic . CHIEF COMPLAINT: Left sided numbness. 1962 in leyte.

FINAL DIAGNOSIS: Cerebrovascular disease (CVD) completed probably 2o to thrombotic infarct right middle cerebral artery (MCA) with left hemiplegia deficit T/C low urinary tract symptoms (LUTS) . slurred speech.R with diagnosis of PUD and was discharged. patient noted weakness of left lower extremities. Five days prior to admission.HISTORY OF PRESENT ILLNESS: Eight days prior to admission. dizziness and epigastric pain consulted at E. persistent left sided weakness and developed numbness and positive (+) of difficulty in urinating.

Family health history: Patient A family has known history of hypertension on his father side. Other than that they were no family history of any diseases. He is a roman catholic and tries to go to church whenever he had time before hospitalization. Socio-economic status: He is living with his family. by the year 2011 patient was been hospitalized at pnpgh and has been diagnosed with cerebrovascular disease.History of past illness: In a year 2009 the patient has been hospitalized in cavite and had been diagnosed with cerebrovascular disease. He is a police superintendent (PSUPT). .

Intelligence. At birth. while the brain of an adult male weighs about three pounds. The weight of the brain changes from birth through adulthood. the average brain weighs about one pound. memories are but a few of the many things the brain does. This mysterious three-pound squishy tissue controls all necessary functions of our physical body. receives information from the outside world and makes it understandable. .ANATOMY & PHYSIOLOGY There is nothing in the universe to compare with the human brain. creativity. The average weight of an adult female brain is about 2. love. and goes beyond that which is understandable to embody the essence of our mind and soul.7 pounds. emotion. and grows to about two pounds during childhood.

touch. taste. W r i t i n g o f a n e x am . . I t p u t s t o g e t h e r t h e messages in a way that has meaning for us. m e m o r y a n d s p e e c h . illness) by regulating our heart and breathing rate. l o s s o f a j o b . I t a l s o determines how we respond to stressful s i t u a t i o n s ( i . O u r b r a i n c on t r o l s o u r t h o u g h t s . and c a n s t o r e t h a t i nf o r m a t i o n in o u r m e m o r y . the movements of our arms and legs and the f u n c t i on o f m a n y o r g a n s w i t h i n o u r b o d y .T h e b r a i n r e c ei ve s i n f o r m a t i o n th r o u g h o u r f i v e senses: sight. e . and hearing o f t e n m a n y a t on e t i m e . smell. .

heart rate. which controls our vital internal functions such as respiration. . The PNS includes the autonomic nervous system. digestion.NERVOUS SYSTEM y Central nervous system (CNS) is composed of the brain and spinal cord y Peripheral nervous system (PNS) is composed of spinal nerves that branch from the spinal cord and cranial nerves that branch from the brain. and secretion of hormones.

BRAIN The brain is composed of the cerebrum. cerebellum. and brainstem .

Ten of the twelve cranial nerves originate in the brainstem. parietal. Many simple or primitive functions that are essential for survival are located here. It acts as a relay center connecting the cerebrum and cerebellum to the spinal cord. It serves as a relay station. The cerebrum is divided into four lobes: frontal. temporal. pons. vomiting. pons and medulla oblongata.The brain is composed of three parts: the brainstem. heart rate. and cerebrum.includes the midbrain. and swallowing. It consists of three structures: the midbrain. coughing. . and medulla. wake and sleep cycles. It performs many automatic functions such as breathing. The brainstem is the lower extension of the brain. digestion. and occipital. located in front of the cerebellum and connected to the spinal cord. sneezing. cerebellum. passing messages back and forth between various parts of the body and the cerebral cortex.  Brainstem . body temperature.

Originating in the brainstem are 10 of the 12 cranial nerves that control hearing." Without these key functions. Destruction of these regions of the brain will cause "brain death. Medulla oblongata . eye movement. swallowing and movements of the face. heart rhythms and swallowing. humans cannot survive. It controls levels of wakefulness.Midbrain . enables people to pay attention to their environments. shoulder and tongue muscles. hearing and balance. taste. neck.is an important center for ocular motion Pons . blood pressure. Messages from the cortex to the spinal cord and nerves that branch from the spinal cord are sent through the pons and the brainstem. medulla and part of the thalamus.is involved with coordinating eye and facial movements. Four pairs of cranial nerves originate from the pons: nerves 5 through 8. facial sensation. . and is involved in sleep patterns. The reticular activating system is found in the midbrain.controls breathing. facial sensations. The cranial nerves for smell and vision originate in the cerebrum. pons.

The cerebrum is a term often used to describe the entire brain. is divided into two major parts: the right and left cerebral hemispheres. which forms the major portion of the brain.the largest part of the brain and is composed of right and left hemispheres. It is separated from the cerebrum by the tentorium (fold of dura). The corpus callosum connects the two halves of the brain and delivers messages from one half of the brain to the other. A fissure or groove that separates the two hemispheres is called the great longitudinal fissure. The surface of the cerebrum contains billions of neurons and glia that together form the cerebral cortex . The two sides of the brain are joined at the bottom by the corpus callosum.Cerebrum . The cerebrum.

located under the cerebrum.Cerebellum . The cerebellum fine tunes motor activity or movement. reasoning. and fine control of movement. It performs higher functions like interpreting touch. and balance. by controlling the tone of muscles and the position of limbs. It helps one maintain posture.G. . e. vision and hearing. Its function is to coordinate muscle movements. sense of balance or equilibrium. The cerebellum is important in one's ability to perform rapid and repetitive actions such as playing a video game. maintain posture. The fine movements of fingers as they perform surgery or paint a picture. as well as speech. emotions. learning.

it can effectively be divided into pairs of "lobes. fissures (larger grooves) and bulges between the grooves called gyri. connecting fibers between neurons form a whitecolored area called the "white matter. once again. temporal. into areas that serve very specific functions." Lobes are simply broad regions of the brain.The cerebral cortex appears grayish brown in color and is called the "gray matter. parietal and occipital lobes. temporal. Each hemisphere has a frontal. ." The surface of the brain appears wrinkled. The cerebral cortex has sulci (small grooves). Beneath the cerebral cortex or surface of the brain. By locating these landmarks on the surface of the brain. Each lobe may be divided. The cerebrum or brain can be divided into pairs of frontal. The lobes of the brain do not function alone they function through very complex relationships with one another. parietal and occipital lobe." The cerebral hemispheres have several distinct fissures.

temperature (sensory strip) Interprets signals from vision. concentration. y solving Speech: speaking and writing (Broca¶s area) Body movement (motor strip) Intelligence. self awareness Parietal lobe Interprets language. behavior. sensory and memory Spatial and visual perception light. pain. motor. movement)  Temporal lobe y Understanding language (Wernicke¶s area) y Memory y Hearing y Sequencing and organization . planning. hearing.Lobes of the brain  Frontal lobe y Personality. words Sense of touch. emotions y Judgment. problem y y y  y y y  Occipital lobe y Interprets vision (color.

The result will be a loss of function such as speech. Any destruction of brain tissue by a tumor can disrupt the communication between different parts of the brain. or from the deep structures of the brain to another region in the central nervous system.y Messages within the brain are delivered in many ways. . from one lobe of the brain to structures that are found deep in the brain. The signals are transported along routes called pathways.G. the ability to read. from one side of the brain to the other. Thalamus. Messages can travel from one bulge on the brain to another (gyri to gyri). from one lobe to another. e. or the ability to follow simple spoken commands.

Deep structures .

and secretion of hormones. sleep.the thalamus serves as a relay station for almost all information that comes and goes to the cortex. y Thalamus . It plays a role in controlling behaviors such as hunger. It plays a role in pain sensation.the hypothalamus is located in the floor of the third ventricle and is the master control of the autonomic system. . attention. blood pressure. emotions. alertness and memory. It also regulates body temperature. thirst. and sexual response.Deep structures y Hypothalamus .

hypothalamus. putamen and globus pallidus. . and memory.The basal ganglia include the caudate. These nuclei work with the cerebellum to coordinate fine motions. learning. y Limbic system . such as fingertip movements. Included in this system are the cingulate gyri. amygdala (emotional reactions) and hippocampus (memory).Deep structures y Basal ganglia .The limbic system is the center of our emotions.

eye movement. neck. taste.Cranial nerves The brain communicates with the body through the spinal cord and twelve pairs of cranial nerves ten of the twelve pairs of cranial nerves that control hearing. . facial sensations. swallowing and movement of the face. shoulder and tongue muscles originate in the brainstem. The cranial nerves for smell and vision originate in the cerebrum.

Cranial nerves .

and the underside of the cerebrum. the two vertebral arteries join together to form a single basilar artery. The vertebral arteries supply the cerebellum. The basilar artery and the internal carotid arteries ³communicate´ with each other at the base of the brain called the circle of willis. If one of the major vessels becomes blocked. it is possible for collateral blood flow to come across the circle of willis and prevent brain damage. brainstem. . After passing through the skull. The communication between the internal carotid and vertebral-basilar systems is an important safety feature of the brain. The internal carotid arteries supply most of the cerebrum.Blood supply Blood is carried to the brain by two paired arteries. the internal carotid arteries and the vertebral arteries.

middle. and posterior cerebral arteries.The Circle of Willis y The Circle of Willis or the Circulus Arteriosus is an arterial polygon where the blood carried by the two internal carotid arteries and the basilar system comes together and then is redistributed by the anterior. . The posterior cerebral artery is connected to the internal carotid artery by the posterior communicating artery.

the internal carotid artery gives rise to the anterior communicating artery and the posterior communicating artery. Before this divide. . The anterior cerebral artery supplies blood to the frontal lobes and medial aspects of the parietal and occipital lobes. The middle cerebral artery supplies blood to the frontoparietal somatosensory cortex.Internal Carotid System y The internal carotid artery divides into two main branches called the middle cerebral artery and the anterior cerebral artery.

each vertebral artery gives rise to the posterior spinal artery. the anterior spinal artery.y Vertebral Artery y The two vertebral arteries run along the medulla and fuse at the pontomedullary junction to form the midline basilar artery. the basilar artery divides into the two posterior cerebral arteries. also called the vertebro-basilar artery. it gives rise to numerous paramedian. Before forming the basilar artery. y Basilar Artery y At the ponto-midbrain junction. the posterior inferior cerebellar artery (PICA) and branches to the medulla. short and long circumferential penetrators and two other branches known as the anterior inferior cerebellar artery and the superior cerebellar artery. Before this divide. .

The membfrane pumps that maintain electrolyte balanaces begin to fail. there is disruption of the cerebral blood flow due to obstruction of the cerebral blood flowdue to obstruction of a blood flow. causing a change in the pH. neurons are no longer able to maintain aerobic respiration. This switch to less efficient anaerobic respiration also renders the neuron incapable of producing sufficient quantities of adenosine triphospate (ATP) to fuel the depolirazation processes. The mitochondria must then switch to anaerobic respiration.PATHOGENESIS y In an ischemic brain attack. y The ischemic cascade begins when cerebral blood flow decreases to less that 25 ml per 100 g of blood per minute. At this point. . which generates large amounts of lactic acid. This disruption in a blood flow flow initiates a complex series of cellular metabolic events reffered to as the ischemic cascade. and the cells cease to function.

an area of low cerebral blood flo. the release of more calcium and glutamate. if continued.9 million neurons each minute that a stroke is not treated. exist around the area of infraction. and the generation of the free radicals. A person experiencing as stroke typically loses 1. activate a number of damaging pathways that result in the destruction of the cell membrane. The influx of calcium and the release of glutamate. reffered to as the penumbre region. The penumbra region is ischemic brain tisuue that may be salvaged with timely intervention. vasoconstriction. The ischemic cascade treathens cells in the penumbre because membrane depolarization of the cell wall leads to an increase in intracellular calcium and the release of glutamate. . extending stroke.6 years each hour without treatment. and the ischemic brain ages 3. These processes enlarge the area of infarction into the penumbra.y Early in the cascade.

Each step in the ischemic cascade represents an opportunity for intervention to limit the exrent of secondary brain damage caused by a stoke the penumbra area mayn be revitalize by a administration of tissue plasminogen activator. Mediaction that protects the brain from secondary injury are called neuroprotectants. A number of ongoing clinical trials focus on neuroprotective medication and strategies to improve stroke recovery and survival. .

bronchospasm -CV: Bradycardia. -Administer Metoprolol with meals or directly eating Brand Name: Betaloc Durules. drowsiness. Decrease rate of cardiovascular mortality and hospitalization in patients with heart failure. Therapeutic Effects: Decrease blood pressure and heart rate . urinary frequency. pulmonary edeme. Beloc Generic Name: Metoprolol Classification: Therapeutic Antianginals.I -Management of stable symptomatic (class II & III) heart failure due to ischemic. depression. and hypoglycemia. flatulence. -Derm: rashes Endo: hyperglycemia. & Antihypertensives Pharmacologic: Beta blockers -Block stimulation of beta1 (myocardial) adrenergic receptors. Anxiety. diuretics and digoxin). -Resp: wheezing. Angina Pectoris -Prevention of M. hypotension. uterine) adrenergic receptor sites. NURSING CONSIDERATION -Monitor BP and pulse -Monitor VS q15 during and for several hours -Monitor I & O ratio and daily weight -Assees routinely for s/sx of CHF (dyspnia. Does not usually affect beta2 (pulmonary vascular. snuff nose. dry mouth. CHF. Hepatic impairment ADVERSE REACTION -CNS: fatigue. insomnia. weakness. peripheral vasoconstriction -GI: constipation.O take apical pulse before administering. dizziness. weigh gain. Decrease frequency of attacks of Angina Pectoris. nervousness -EENT: blurred vision. -Hypertension. gastric pain. hypertensive or cardiomyopathic origin (may be used with ACE inhibitors. diarrhea. pheriperal edema -P. .DRUG NAME ACTION INDICATION CONTRAINDICATI ON Containdicated in: uncompensated CHF: Pulamonary edema: Cardiogenic shock: Bradycardia or Heart attack -Used cautiously in Renal Impairment. crackles. nausea and vomiting -GU: Erectile dysfunction.I Decrease mortality in patient with recent M.

neurologic findings . edema. to notify health care professional promptly if fever chills . INDICATION -Reduction of atherosclerotic events (MI. rash HEMAT: bleeding. or unusual bleeding or bruising occurs. METAB: hypercholesterolemi a MS: arthralgia. hypertension GI: GI bleeding. renal dysfunction. pathologic bleeding (peptic ulcer. sore throat . neutropenia. acute coronary syndrome (angina/ non-Q. headache EENT: epistaxis RESP: cough CV: chest pain. thrombotic thrombocytopenic purpura. for signs of thrombotic thrombocytic purpura (thrombocytopenia. or MI periodically during therapy. fatigue. microangiopathic hemolytic anemia . for symptoms of stroke peripheral vascular disease. back pain MISC: fever. fever) -PO: Administer once daily w/o regard to food -Instruct pt. stroke.DRUG NAME Brand Name: Plavix Generic Name: Clopidogrel Classification: -Therapeutic -anti platelet agent Pharmacologic: -Platelet aggregation inhibitors. purpura. ACTION -Inhibitors aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. dyspepsia. -Advise pt. intracranial hemorrhage) ADVERSE EFFECT CNS: depression. abdominal pain. -monitor pt. diarrhea. to take medication exactly as directed. gastritis DERM: pruritus. dizziness. CONTRAINDICATI ON hypersensitivity. hypersensitivity reactions NURSING CONSIDERATION -assess pt.wave MI) stoke or peripheral vascular disease. vascular death) in patients at risk for such events including recent MI. .

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He can urinate and defecate without any discomfort.No discomfort in elimination pattern. .Because of his illness.He can take 5 to 6 hours of sleep and take a nap at PM.He quit in smoking and drinking alcohols. he limit taking fatty and salty foods. and read. .Before Hospitalization . comprehends. Cognitive Perception Pattern . . .He is vegetarian. especially in ambulating and stair climbing.Sexually active Sexuality Reproductive Pattern . . .He takes a less than a pack of cigarette . During Hospitalization .He is alert. .Because of his condition. . Nutrition ± Metabolic Pattern . Health Maintained Perception Pattern Activity ± Exercise Pattern .He takes more salty and fatty foods.He able to read. he was restricted in smoking and taking an alcohol.He is independent in doing his daily activities. comprehends. Interpretation . .Not sexually active . Elimination Pattern . he was restricted on fatty and salty foods.He can sleep takes 5 to 6 hours of sleep and sometimes he takes a nap at PM.He can urinate and defecate without any discomfort. .He was still able to communicates.The patient was able to communicate effectively to others.He drinks alcohol occasionally . . he can¶t do by himself some of his daily activities.Because of his condition.Because of his condition. . . and communicates to others.He used to read news papers and answering word search. reaction to him are rashes. Sleep ± Rest Pattern . he is not sexually active now.He needs assistance from other in doing his daily activities.He has an allergy on peanuts.The patient can sleep well because he has no work. .

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evenly distributed .same as skin color .rounded -Proportionate to body size .thick and short hair .normal findings Face -symmetric or slightly asymmetrical facial features -same as skin color .Body Parts General appearance Mental status - Normal Findings Medium frame with upright posture Well groomed No odor Conscious and cooperative Use of simple words - Actual Findings Medium frame with upright posture Well groomed No odor Conscious and cooperative Use of simple words - Interpretation Normal findings - normal findings Skull -absence of nodules and masses .no lices and infection . client can see objects periphery - - normal findings .asymmetrical .Proportional to body size -rounded -absence of mass and nodules .abnormal findings Eyes When looking straight ahead.asymmetrical facial movement straight normal eye brows hair are normally distributed frequent blink response symmetric eyeballs pink conjunctiva reddish sclera .normal finding Hair -evenly distributed -Thick hair -no infection .

firm texture -no retraction -light pink.normal findings . not tender -able to hear on both side -uniform pink in color -soft. smooth. white shiny tooth enamel -normal findings Gums -pink gums -moist. white shiny tooth enamel -pink gums -moist. firm. moist smooth texture -normal findings Teeth -32 adult teeth -smoothy. firm. not tender -able to hear on both side -normal findings Lips -uniform pink in color -soft. soft palate -uvula is positioned in the midline of soft palate . moist smooth texture -32 adult teeth -smoothy.normal findings Ears -symmetrical -aligned with the outer canthus of eye -mobile. soft palate -uvula is positioned in the midline of soft palate Interpretation .Body Parts Nose Normal Findings -no discharge or flaring -Uniform in color -no tenderness and lesions -color same as facial skin -both patent Actual Findings -no discharge or flaring -Uniform in color -no tenderness and lesions -color same as facial skin -both patent -symmetrical -aligned with the outer canthus of eye -mobile. smooth. firm texture -no retraction -normal findings Palates and uvula -light pink.

normal findings Heart -RR: 12-20 -no shortness of breath -no chest pain or tightness -RR: 12-20 -no shortness of breath -no chest pain or tightness . rhythmic and effortless respiration .normal findings Chest -full and symmetric chest expansion -bilateral symmetry of vocal fremitus -full and symmetric chest expansion -bilateral symmetry of vocal fremitus .normal findings Neck -complete range of motion -no pain at any movement -uniform in color -complete range of motion -no pain at any movement -uniform in color .Body Parts Tongue Normal Findings -tongue in central positioned Actual Findings -tongue in central positioned Interpretation . rhythmic and effortless respiration -color should be consistent with the color of the face -quiet.normal findings Thorax -color should be consistent with the color of the face -quiet.normal findings Oropharynx and tonsils -pink and smooth posterior wall -pink and smooth tonsils -no discharges in tonsils -pink and smooth posterior wall -pink and smooth tonsils -no discharges in tonsils .normal findings .

limps or swelling -no rashes . limps or swelling -no rashes Interpretation .Body Parts Breast Normal Findings -no pain and tenderness -symmetrical -no swelling Actual Findings -no pain and tenderness -symmetrical -no swelling -no tenderness.normal findings Abdomen -skin is of normal racial tone which is brown -contour is flat -bowel sound is normal active and no bruits -no tenderness -liver is not palpable -skin is of normal racial tone which is brown -contour is flat -bowel sound is normal active and no bruits -no tenderness -liver is not palpable .abnormal findings .normal findings Axilla -no tenderness.normal findings Lower extremities -no lesions -peripheral pulses are equal -lymph nodes are not palpable .normal findings Upper extremities -peripheral pulses are equal -lymph nodes are not palpable -peripheral pulses are equal -lymph nodes are not palpable -no lesions -peripheral pulses are equal -lymph nodes are not palpable .numbness .

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52 Normal Lymphocytes 25 ± 40% 0.Microscopic Examination Hemoglobin Normal Findings Male: 140 ± 180 g/l Female: 120 ± 140 g/l Male: 0.0 ± 10.0 g/L Interpretation Normal Hematocrit 0.4 Stab 2 ± 5% None None Basophils 0 ± 1% 1% Normal .54 Female: 0.42 ± 0.41 Normal Monocytes 3 ± 9% 0.0 x 10 9/L 50 ± 60% 6.48 Result 163.2 Eosinophil 1 ± 3% 0.0 x 10 9/L Normal Segmenters 0.37 ± 0.48 Normal WBC Male / Female: 5.

025 Normal Sugar Negative Negative Normal Protein Negative Negative Normal .Microscopic Examination Normal Findings Result Interpretation Color Straw ± amber Yellow Normal Transparency Clear Slightly turbid Normal Reaction Acidic or alkaline Acidic Normal Specific gravity 1.025 1.005 ± 1.

Microscopic Examination Normal Findings Result Interpretation Red Blood Cells 0 ± 1hpf None None Pus Cells 0 ± 2hpf 1 ± 2hpf Normal Squamous Ephit Cells rare Normal Renal Ephit Cells None None Amorphous Phosphates Urates / None None Mucus Threads many .

80 mmol/L 3.24 mmol/L Normal LDL 2.86 mmol/L 1.Examination Fasting Blood Sugar Normal Findings 3.50 ± 6.21 mmol/L 5.63 ± 6.85 ± 5.1 umol/L 0.201 ± 0.6 umol/L 61.9 ± 121.40 ± 3.56 mmol/L 1.41 ± 1.68 mmol/L Normal HDL 1.6 ± 132.43 mmol/L Creatinine (male) (female) Blood Uric Acid (male) (female) Total cholesterol 79.23 mmol/L Normal .04 ± 1.413 mmol/L 0.142 ± 0.336 mmol/L 3.24 mmol/L Normal Triglycerides 0.80 mmol/L Result Interpretation Blood Urea Nitrogen 2.

95 5.1 ± 133.9 ± 511.42 Normal Creatinine 62.6 Normal .08 ± 6.45 4.0 432.Test Normal Value Result Interpret Glucose / Sugar 3.1 Normal Uric Acid 237.7 80.07 Normal Blood Urea Nitrogen 2.59 ± 5.

OPD Check-up: follow up check up after 1 week.DISCHARGE PLANNING y y y y y y y y y y y y y y y y y y y Medication: metoprolol 50mg 1tab BID Copidogrel 75mg. low fat diet. coffee. Avoid excessive intake of alcohol. tea or cola. OD Exercise: Early ambulation to avoid further complication Treatment: continue medication Health Teaching: medication must be taken daily as prescribed o ensure control. Diet: proper low salt. Always consult provider before interrupting therapy. low fat diet. Adhere to a low salt. Spirituality: just pray for guidance and safety. . Sexuality: avoid having intercourse.