Case Presentation on Cerebrovascular Cerebrovascular Disease I.
Introduction
The patient’s initial is R.V. R.V., a 55 year old, male. His civil status is married, and he is a Roman Catholic (TSG). He resides at Tanay, Rial. The patient !as admitted "or the second time at #$%&C last &arch ', **+, !ith the dianosis o" CV- in"arction proaly le"t &C# in distriution ('++5) T/C rein"arction HT0 stae 1 -& type . 2ith reards to his history o" present illness, the patient has a 3no!n hypertension and he is diaetic since '++5 !ith poor compliance to medication. He !as apparently asymptomatic. 4t !as ' days !hen the patient suddenly noted diiness anrciated !ith nape pain and riht sided ody !ea3ness. He !as immediately admitted at Camp 6vanelista Station Hospital, !here he !as suse7uently admitted. Therea"ter, his diiness !ith nape pain !as resolved e8cept "or the rih rihtt side sided d ody ody !ea3 !ea3ne ness ss.. He !as !as iven iven Citi Citical calin inee tal talet et and and anti anti9hy 9hyper perte tens nsiv ivee and and Gli Glier erel elami amide de.. #nd #nd then then CT scan scan !as !as cont contem empl plate ated, d, ho!ev ho!ever er it !as !as not not done done due to unavailaility. #"ter!ards, he trans"erred to #$%&C "or "urther evaluation and manaement. #out the patient’s past medical history, he has a H ypertension and -iaetes &ellitus. He is a non9smo3er and a occasional occ asional alcohol drin3er. The acute phase o" an ischemic stro3e or cereral in"arction may last ' to days, ut onoin monitorin o" all ody systems is essential as lon as the patient re7uires care. Objectives: • • •
4denti"y the anatomy and physioloy o" the ischemic stro3e. 4denti"y the ris3 "actors "or cererovascular disease and related measures "or prevention. Relate the principles o" nursin manaement to the care o" a patient in the acute stae o" an ischemic manaement.
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68plain the pathophysioloy o" ischemic stro3e.
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-iscuss the pharmacoloic interventions in CV-.
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:se the nursin process as a "rame!or3 "or care o" a patient !ith a cererovascular disease.
A. II.
Theoretical Framework Activities of Dail !ivin"
1. Nutrition
Before Hospitalization mixed mostly fsh and vegetables
During Hospitalization
2. Elimination 3. Hygiene 4. Sleep !aborator and Dia"nostic Procedures Course in the wards:
;n the admission the patient is <<<<. His vital sins !ere as "ollo!s=<<<< . The patient had a (appearance)<<<<. ;n the "irst day hospital day, the patient had<<<<<<<. ;n the second day hospital day, the patient had<<<<<<<. ;n the third day hospital day, the patient had<<<<<<<. III.
#ursin" Assessment
Findings 1.
Posture
2.
Skin
Norms Flexed with good muscle tone Sot smooth good turgor !ossible !eeling and dryness o hands and eet lanugo may be !resent on ace" brow" shoders vernix # in olds acrocyanosis erythema toxicum" $ongolian s!ots and harle%uin sign
Interpretation Deviated rom normal Deviated rom normal
&.
'olor
ital Signs 1. )es!iratory )ate 2. ,eart )ate
Findings
&. -em!erature
I$.
Anatom and Phsiolo"
(risk ca!illaty refll with !ink to ruddy color Norms &* # +* breaths !er minute 12* # 1+* !er minute &+. # &/. 0'
Deviated rom normal
Interpretation Deviated rom normal Deviated rom normal Deviated rom normal
%iddle Cerebral Arter&coronal 'lane( ISCHEMIC/EMBOLIC STROKE
'. Carotid #rtery distriution9carotid arteries per"use the ma>ority o" the
cererum
Common Carotid #rtery99?splits into the Carotid #rtery and the 68ternal Carotid #rtery, 4nternal Carotid #rtery99?divides into #nterior Cereral #rtery (#C#) and Cereral #rtery (&C#)1 oth a le"t and riht side are present a. #C#9supplies the medial sur"ace o" parietal loe and occipital loe . &C#9the larest ranch o" the internal carotid
4nternal then the the the &iddle
the "rontal loe,
artery . Verteroasilar #rtery distriution9per"uses ase o" cererum and ma>ority o" cereellum Verteral #rteries99?>oin to "orm the @asilar #rtery99?ranchin "rom the @asilar #rtery are the %osterior Cereral #rteries (%C#) a. @asilar #rtery and %C#9supply the occipital loe, rain stem and cereellum Dru" )tud $.
Patho'hsiolo"
Hypertension Heart -isease T4#s, prior stro3e, carotid ruits 4ncreased hematocrit, increased "irinoen Sic3le Cell -isease Ai"estyle $actors -iaetes &ellitus &iraine H#’s Retinal emoli @R#40
;struction o" lood vessel
-isruption o" the cereral lood "lo!
Cereral @lood $lo!
4rreversile neuronal damae
Ischemic Cascade
&echanism o" ischemia Thromosis, • 6molism • Systemic • hypoper"usion #rterial luminal • oliteration Venous conestion •
Cereral venous thromosis
Vascular conestion
4mpairment o" "or!ard "lo!
4n"arction into the penumra enlares
)i"ns * )m'toms: 0umness or !ea3ness o" • the "ace, arm, or le, especially on one side o" the ody (riht ody) Con"usion or chane in • mental status Troule spea3in or • understandin speech Visual disturances • -i""iculty !al3in, • diiness, or loss o" alance or coordination Sudden severe headache •
Dia"nostic +,am: %hysical and • 0euroloical 68amination CT Scan • 6CG • Carotid :ltrasound • Cereral • anioraphy Transcranial • -oppler "lo! studies Transesophaeal • echocardioraphy &R4 (rain, nec3 r • oth) Sinle photon • emission (S%6CT)
Dia"nostic +,am b the 'atient: •
Cell Injur and death
Cerebrovascular Disease / Ischemic )troke
$I.
#ursin" Care Plan Assessment
)-
O•
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Plannin" #"ter the end o" the shi"t the patient !ill e ale to maintain position and "unction (B) Riht ody and s3in interity. !ea3ness Tremors noted on le"t arms and hands
Intervention
-etermine dianosis that contriutes to immoility - To identi"y
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+valuation #"ter the end o" shi"t the patient !as ale to maintain position and "unction and s3in interity as evidenced y asence o" contractures, "oot drop, decuitus and so "orth.
4naility to per"orm ross/"ine motor s3ills $unctional • level scale (doesn’t participate in activity) #ursin" Dia"nosis: 4mpaired physical moility r/t hemiparesis, loss o" alance and coordinaton •
causative/contriutin "actors •
#ssess nutritional status and S/; report o" enery level. - To identi"y causative/contriutin "actors
-etermine deree o" immoility in relation to "unctional level scale - To assess "unctional aility
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#ssist or have sini"icant other reposition client on a reular schedule (turn the patient to side every hours) as ordered y the physician - To prevent complication
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%rovides sa"ety measures (side rails up, usin pillo!s to support ody part) - To provide sa"ety 6ncourae patient’s • S/;’s involvement in decision ma3in as much as possile - 6nhances commitment to plan optimiin outcomes •
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4nvolve S/; in care, assistin them to learn !ays o"
manain prolems o" immoility - To impart health teachin
$II.
Pro"nosis
Dischar"e Plan %edications
Chec3 !ith the physician e"ore ta3in any ne! medications
+,ercise Treatment
Ta3e medications as prescried
0ealth Teachin"
S3in care 0eed to !eih the patient daily and !atch "or and report sins and symptoms o" complications
Out'atient Follow/u' Diet )e,ual Activities
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