I.

INTRODUCTION
A cerebrovascular accident is the medical term for a stroke. A stroke is when
blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood
vessel. There are important signs of a stroke that you should be aware of and watch out
for. A left-side stroke happens when the blood supply to the left side of the brain is
interrupted. Without oxygen and nutrients from blood, the brain tissue quickly dies. The
cerebrum is the largest part of the brain. It is made of a left and a right hemisphere. In
most people, the left hemisphere is in charge of the functions on the right-side of the
body. It is also involved in abilities such as the ability to speak, or use language. There
are two main types of stroke: ischemic and hemorrhagic.
Hemorrhagic stroke accounts for about 13 percent of stroke cases. It results from
a weakened vessel that ruptures and bleeds into the surrounding brain. The blood
accumulates and compresses the surrounding brain tissue. The two types of
hemorrhagic strokes are intracerebral (within the brain) hemorrhage or subarachnoid
hemorrhage.
Globally, measurements undertaken by the WHO revealed an up to ten-fold
difference in age-adjusted and sex-adjusted mortality rates and burden (measured in
disability-adjusted life year loss rates (DALYs)) among countries. Both were
considerably higher in low-income countries (North Asia, Eastern Europe, Central Africa,
and South Pacific) compared to high-income countries (Western Europe, North
America). 795,000 new or recurrent strokes occur per year in the US, accounting for
approximately 1 in 18 deaths. In Europe, the incidence of stroke varies from 101.1 to
1

239.3 per 100,000 in men and 63.0 to 158.7 per 100,000 in women. Within 5 years of a
stroke, over half of patients aged 45 years will die: 52% of men and 56% of women.
Stroke is the second leading cause of death above the age of 60 years, and the
fifth leading cause of death in people aged 15 to 59 years old. Every year, 15 million
people worldwide suffer a stroke. Nearly six million die and another five million are left
permanently disabled. Stroke is the second leading cause of disability, after dementia.
Disability may include loss of vision and / or speech, paralysis and confusion. Stroke is
less common in people under 40 years, although it does happen. In young people the
most common causes are high blood pressure or sickle cell disease. In many developed
countries the incidence of stroke is declining even though the actual number of strokes
is increasing because of the ageing population. In the developing world, however, the
incidence of stroke is increasing. In China, 1.3 million people have a stroke each year
and 75% live with varying degrees of disability as a result of stroke. The predictions for
the next two decades suggest a tripling in stroke mortality in Latin America, the Middle
East, and sub-Saharan Africa.
Nationally, according to the latest WHO data published in April 2011 Stroke
Deaths in Philippines reached 40,245 or 9.55% of total deaths. The age adjusted Death
Rate is 82.77 per 100,000 of population ranks Philippines #106 in the world.
Locally, there are no records of incidence of stroke published online for Davao
Del Norte. However, in Davao City, Councilor Rene Elias Lopez said stroke is now the
top cause of morbidity in the city, with 1,800 people dying from the disease in 2008.

OBJECTIVES
The study aims to present all the information we have gathered about the case of
our patient who has an admitting diagnosis of T/C Cerebrovascular accident; CAP-MR.
Moreover, this intends to share the knowledge based on information gathered to the
patient, the significant others and to our fellow nursing students.
Specifically, this study intends to:

Obtain sufficient and relevant information regarding our patients condition.

Present personal data of our patient.
Trace the past medical history affecting the patients present health condition.
Present factual information by conducting a thorough head-to-toe assessment

with our chosen subject serving as our baseline data.

Show and discuss the anatomy and physiology of the involved organ and system

basing from our patients diagnosis.

List down the actual laboratory results of our patient.
Present the medical interventions done to the patient including the different drugs

ordered with their action in alleviating the underlying causes of present condition.
Identify the needs of the patient and formulate effective nursing care plans

appropriate for the patients case.

Impart suitable and realistic health teachings to the patient himself and to his

significant others (watcher).

Evaluate the outcome of the condition of the patient.

II. ASSESSMENT
A Biographical Data
Name: Patient Kowowo
Age: 65 years old
Birthdate: July 10, 1949
3

Birthplace: Bohol
Sex: Male
Status: Married
Address: Purok 02A, Magdum, Tagum City
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: December 7, 2014
Time admitted: 6:25 pm
Attending Physician: Dr. Kintanar
B Chief Complaint
Right Sided Weakness
C History of present illness
Patient Kowowo was admitted on December 7, 2014 at Bishop Joseph
Regan Memorial Hospital. Few minutes PTA, had sudden onset of Right Sided
Weakness associated with Chest pain, (+) cough.

D Past Medical History

It is the first time for the patient to be admitted due to cerebrovascular
accident. He has not done a regular BP check-up even though hes aware that he
has a high BP especially that he has family history of hypertension. He did not seek
any medical attention therefore he has no maintenance medications.
E Personal, Family and Socio-Economic History
Patient Kowowo belongs to the middle class family. He is currently a
pensioner. The patients father was hypertensive and died because of it. The patient
has ten siblings and they also died due to hypertension and CVA. The client himself
was a smoker during his young age and stopped when he was older. However, hes
a habitual alcoholic drinker and has no limit in eating foods that are not good for him.
He has also a sedentary lifestyle and not doing regular exercises.
F Patient Need Assessment
Date: December 9, 2014
4

Name of patient: Patient Kowowo

Age: 65 years old

Sex: M

Status: Married

Date/ Admission Time: December 7, 2014/ 6:25 PM

Arrived on Unit by: Stretcher From: Emergency Room
Admitting weight/VS: Weight: 70kg.Temp: 35.7 C BP: 260/130 mmHg
RR: 22cpm PR: 88 bpm
Clients Reason for Admission: Nikalit ra pagnaog niya sa motor namurag
nawad-an na og kusog og dili na kalihok ang right side sa iyang lawas as
verbalized by the watcher.
How was problem been managed by client at home? Patient was immediately
brought to the hospital.
Allergies: No known allergies
Medication (at home): No medications at home

Physiologic Needs
I.

Oxygenation: BP = 140/100 mmHg; PR = 85bpm; RR = 20cpm (regular

respiration).
Lungs (per auscultation: sound, character, chest pain): With symmetrical
chest expansion upon inhalation and distress not noted upon assessment.
With crackles heard upon lung auscultation.
Cardiac Status (per auscultation: sound, character, chest pain): With
normal cardiac sound of Lubb dubb heard upon auscultation and no
complains of chest pain upon assessment.
Capillary Refill: With capillary refill of 2 seconds upon blanching.

Skin Character and Color: Brownish skin complexion, warm to touch.

Good skin turgor noted.
Life Supporting Apparatus: With O 2 inhalation @ 2LPM via nasal cannula.

II.
III.

IV.

V.

VI.

VII.

With IVF #2 PNSS 1L @ KVO rate infusing well @ L metacarpal vein.

Other Observations: No other observations
Temperature Maintenance
Temperature: 37.1o C
Skin Character: Brownish, warm to touch and with good skin turgor.
Nutritional Fluid
Height: 57
Weight: 70 kg.
Amount of Food Consumed: Able to consume meal served.
Prescribed diet: DAT
Eating pattern: 3x a day
Eating problems: Needs assistance and aspiration precaution should be
considered.
IVF/Fluid Intake: IVF- 200cc, Water 300 cc
Elimination
Last bowel movement: Unable to defecate within the shift.
Normal pattern: once a day
Urination: Able to urinate 400 cc, yellow in color, within the shift.
Other observations: With Foley catheter attached to urobag
Rest and Sleep
Bed time: 7:00 P.M
Waking up: 8:00 A.M
Sleep (pattern, amount of sleep): Able to sleep at long intervals and only
wakes up to attend needs.
Pain Avoidance
Rate of pain (using scale 0-10): No complains of pain upon assessment.
Character: N/A
Location: N/A
Frequency: N/A
Duration: N/A
Behavior: N/A
Other Observations: None
Stimulation/ Activity
Work: He was once a laborer in a Banana Plantation before and is
currently retired, a pensioner.
Recreation or past time: Hes doing household chores.
Hobbies or vices: Stopped smoking several years from now but is still and
alcoholic drinker.
6

VIII.

IX.

Safety Security needs

Neuro VS: score of 15 out of 15
Mental status: Conscious; Slurred speech.
Emotional Problems: None
Other objective cues: R hand grip and R leg movement is absent
Love and belonging
He feels very secure and happy living with his wife, they were gifted with
four loving children. He feels grateful toward his familys loving and caring

X.

support, especially in terms of his current condition.

Self- esteem
The client has a low self-esteem at present because of his current
condition that would really limit or make him unable to perform ADL and
total assistance of significant others is highly needed.

XI.

Self-actualization
The client was able to raise their four children successfully with the help of
his loving wife. He was successful in his previous job as hes now
receiving his pension every month. However, the client has no limit in
eating foods and is continuously drinking alcoholic beverages that

aggravated his current condition.

Ericksons Developmental Task
Erickson envisions life as a sequence of levels of achievement. Each stage
signals a task that must be achieved. The resolution of the task can be complete,
partial, or unsuccessful. Erickson believes that the greater the task achievement, the
healthier the personality of the person: failure to achieve a task influences the persons
ability to achieve the next task. These developmental tasks can be viewed as a series of
crises, and successful resolution of these crises is supportive to the persons ego.
Failure to resolve the crises is damaging the ego.

Generativity vs. Stagnation

Patient Kowowo, 65 years old, falls under the Mid Adulthood from 35-65 years
old which has the central task of Generativity versus Stagnation. This stages major task
is creativity, productivity and concern for others. Self-indulgence, self-concern, lack of
interests and commitments are the indicators of negative resolution. In the case of our
patient, Patient Kowowo, he attained the Generativity for he was able to achieve and
realize the major task successfully by showing concern to his family especially to his
wife and children despite of the condition he has. He always thinks of whats best for his
family, willing to give the excellent care and love that he can.

PHYSICAL ASSESSMENT
General Survey
Patient Kowowo, 65 years old, male, stands 5 feet and 7 inches tall and weighs
70kg. With the following VS as monitored and recorded upon admission Temp = 35.7 o C;
BP= 260/130 mmHg; PR = 88 bpm; RR = 22cpm. With IVF bottle # 1 PNSS 1L @ KVO
rate infusing well. He is conscious and his words were hard to understand due to slurred
speech.
Vital Signs Monitoring Sheet
Name: Patient Kowowo

Sex: M

Ward: St. Francis

Room/Bed: 405-2

Date/Shift

Time

Temperatur

Blood

Age: 65 Y.O

Respirator

Cardiac
8

12/07/201

6:25 PM

e
35.7

Pressure
260/130

y Rate
22

Rate
88

39.3
36.8

180/100
180/190
200/140

21
22

87
96

200/110
180/100
150/80
150/100
150/80
150/100

25
28
25
25
24
20

98
96
97
98
86
90

19

89

21

86

4
311
12/08/201

6:30 PM
8:00 PM
12:00 AM

4
117

12/08/201

1:00
2:00
2:30
3:00
4:00
8:00

AM
AM
AM
AM
AM
AM

36.7
36
37
37

4
73

12/08/201

10:00 AM
12:00 NN
1:00 PM
4:00 PM

37.3

140/90
150/100
170/100
140/90

6:00 PM
8:00 PM
12:00 MN

37.4
36.5
36.7

150/90
150/90
150/90

21
22
22

87
83
88

4:00 AM
6:00 AM
8:00 AM

37.1
36.8

160/100
180/90
150/80

22
22
20

80
89
86

10:00 AM
12:00 NN
2:00 PM
4:00 PM

36.6
37.1
37.3
37

180/100
140/100
190/90
160/90

21
20
20
22

84
85
81
76

37.1

4
311
12/09/201
4
117
12/09/201
4
73

12/09/201
4

311
12/10/201

8:00 PM
12:00 MN

37.4
37

160/80
180/100

20
20

75
76

4:00 AM
8:00 AM

37
36.9

160/90
160/100

20
21

78
90

10:00 AM
12:00 NN
2:00 PM

36.8
37.2
37.1

170/100
130/100
160/90

20
20
21

91
88
89

4
117
12/10/201
4
73

REVIEW OF SYSTEMS
Integumentary System
Generally, patient Kowow has brownish skin that is warm to touch, with the
presence of hair, with good skin turgor and capillary refill of 2 seconds.
HEENT
HEAD

Head is normocephalic, can lift head fully and turn them from side to side. Hair is
short, thick and evenly distributed. No dandruff, head and scalp lesions not
noted.

EYES

10

Eyes are symmetrical and black in color; No eye discharges noted. The pupil is
brisk and constricted at 2mm when diverted to light and dilated when the patient
looks into the distance; Pale and palpebral conjunctivae not noted, with white and
anicteric sclera. Eyelashes are equally distributed.

EARS

Both symmetrical; with no discharges noted within both ears. There were no
lesions, wounds or discoloration noted upon inspection, and there were no
problems in hearing.

NECK

Short and mobile. Able to perform the different neck ROM exercises or
maneuvers. No tracheal deviations felt upon placing a finger along one side of
the trachea, noting the space and comparing with the opposite side. No swollen
lymph nodes upon palpation.

THROAT

Gums are in good condition. Tongue midline and mobile with visible papillae.
Tonsils are not inflamed. Pinkish hard and soft palate. Gag reflex is present.

Pulmonary System

With crackles heard upon auscultation; regular breathing pattern and symmetrical
chest expansion. Theres an equal rise and fall of the chest with normal depth of
respiration.
11

Cardiovascular System

Normal lubbdubb heard upon auscultation and apical pulse heard per
auscultation. No heaves and thrills heard. No murmurs, regular cardiac rate and
rhythm heard upon auscultation.

Gastrointestinal System

Abdomen is distended, and has the same color as the rest of the body. 5-15 clicks
per minute heard upon auscultation.
Musculoskeletal System

Unable to perform ADL alone and assistance is really needed. Right Hand grip and
Right Leg movement is absent.
Genito-urinary System
Was able to urinate 400 cc, yellow in color. With Foley catheter attached to
urobag.

III. LABORATORY AND DIAGNOSTIC EXAMINATION

HEMATOLOGY
12

Date: 12/07/2014
LABORATORY

RESULT

NORMAL

EXAMINATIONS/

VALUE

DETERMINATION
Hemoglobin
137

134.00-

Hematocrit
Leukocytes No. of

0.41
8.9

160.00
0.40-0.54
5-

Concen.
Segmenters

0.32

10x10^9
0.40-0.60

UNIT

IMPLICATION

g/L

Normal

Normal
Normal
Low. It may indicate
Viral infections;

Lymphocytes
Monocytes
Eosinophils

0.52
0.08
0.06

0.25-0.40

autoimmune diseases.
High. It may indicate

0.01-0.12
0.01-0.05

Acute infection.
Normal
High. It may indicate
Allergy; asthma;
parasitic infections.

Basophils
Stabs
Thrombocytes

333.5

0.005
0.01-0.05
150-

Normal

440x10^9
Blood type
Rh type

URINALYSIS
Date: 12/08/2014
LABORATORY

RESULT

NORMAL VALUE

UNIT

IMPLICATION

EXAMINATION
13

S/
DETERMINATI
ON
Color

Light

Light yellow to a -

Normal

Sugar

yellow
negative

dark amber color

0
to
trace -

Normal

Albumin
Reaction

negative
5.0

amounts.
Negative
4.5 - 7.2

Normal
Normal

Sp gravity
Crystlas

1.020
-

1.005 to 1.025
Few

Normal
-

Casts

Negative

Epithellial cells
Mucous threads
Pus cells

3-6

Few
0-2

Hpf

Normal
Abnormal:

hpf

Infection
Normal
-

Rbc
Bacteria
Pus in clumps

0-2
-

0-2
Negative
Negative

CT CRANIAL
Date: 12/08/2014
This report is based on radiographic findings and should be correlated with clinical and
laboratory data and other imaging modality.
Multiple plain axial tomographic sections of the head were taken and reveal the
following findings:

14

There is an irregular intraparenchymalhyperdensity focus in the left capsule-thalamic

area, extending up to the corona radiate with an approximate volume of 12.0 cc.
Surrounding hypodense edema noted. Hyperdense bleed extensions into the ventricular
system (lateral and 3rd ventricles). There is slight midline shift to the right with a distance
of 0.5cm from midline. No other abnormal density changes in the brainstem nor brain
parenchyma.
The ventricles, cortical sulci, tissues and cisterns are prominent.
The sella, orbits, petromastoids and the paranasal sinuses are not unusual.
Physiologic calcifications are seen in the pineal gland and basal ganglia.
No other significant findings.
IMPRESSION:
Acute bleed (12.0cc) in the left capsulo-thalamic areas with parenchymal and
intraventricular bleed extensions, edema and slight mass effect as described.
Cerebral atrophy, age related.

CHEST PA
Date: 12/08/2014
Hazy densities are seen in both areas.
The heart is enlarged with left ventricular prominence. Aortic knob is calcified
Hemidiaphragm and costophrenic sulci are intact.
15

Minimal spurrings are seen in the lateral edges of the thoracic spines.
No other significant interval chest findings
IMPRESSION:
Compatible with bibasal pneumonia.
Left ventricular cardiomegaly with atherosclerotic aorta.
Minimal hypertrophic degenerative spurs, thoracic spines.

ECG
Ecg no. 5285

A.R.: 75/min

Rhythm: Sinus

V.R.: 75/min

P.R.: .16sec.

Q.T.: .32sec.

Q.R.S.: .08sec.

QRS Axis: +15o

Impression:
Nonspecific ST segment. R/O myocardial ischemia

16

IV. REVIEW OF ANATOMY AND PHYSIOLOGY

NERVOUS SYSTEM

17

The brain is a spongy organ made up of nerve and supportive tissues. It is

located in the head and is protected by a bony covering called the skull. The base, or
lower part, of the brain is connected to the spinal cord. Together, the brain and spinal
18

cord are known as the central nervous system (CNS). The spinal cord contains nerves
that send information to and from the brain.

The CNS works with the peripheral nervous system (PNS). The PNS is made up
of nerves that branch out from the spinal cord to relay messages from the brain to
different parts of the body. Together, the CNS and PNS allow a person to walk, talk, and
throw a ball and so on.

The brain is the bodys control centre. It constantly receives and interprets nerve
signals from the body and responds based on this information. Different parts of the
brain control movement, speech, emotions, consciousness and internal body functions,
such as heart rate, breathing and body temperature.

The brain has 3 main parts: cerebrum, cerebellum and brain stem.

Cerebrum
The cerebrum is the largest part of the brain. It is divided into 2 parts (halves)
called the left and right cerebral hemispheres. The 2 hemispheres are connected by a
bridge of nerve fibres called the corpus callosum.

The right half of the cerebrum (right hemisphere) controls the left side of the
body. The left half of the cerebrum (left hemisphere) controls the right side of the body.
19

The outer surface of the cerebrum is called the cerebral cortex or grey matter. It
is the area of the brain where nerve cells make connections, called synapses, that
control brain activity. The inner area of the cerebrum contains the insulated (myelinated)
bodies of the nerve cells (axons) that relay information between the brain and spinal
cord. This inner area is called the white matter because the insulation around the axons
gives it a whitish appearance.

The cerebrum is further divided into 4 sections called lobes. These include the
frontal (front), parietal (top), temporal (side) and occipital (back) lobes.

Each lobe has different functions:

The frontal lobe controls movement, speech, behaviour, memory, emotions and
intellectual functioning, such as thought processes, reasoning, problem solving,
decision making and planning.

The parietal lobe controls sensations, such as touch, pressure, pain and
temperature. It also controls spatial orientation (understanding of size, shape and
direction).

The temporal lobe controls hearing, memory and emotions. The left temporal
lobe also controls speech.

The occipital lobe controls vision.

20

Cerebellum
The cerebellum is the next largest part of the brain. It is located under the
cerebrum at the back of the brain. It is divided into 2 parts or hemispheres and has grey
and white matter, much like the cerebrum.

The cerebellum is responsible for:

movement

posture

balance

reflexes

complex actions (walking, talking)

collecting sensory information from the body

Brain stem
The brain stem is a bundle of nerve tissue at the base of the brain. It connects
the cerebrum to the spinal cord and sends messages between different parts of the
body and the brain.

The brain stem has 3 areas:

midbrain

pons

21

medulla oblongata
The brain stem controls:

breathing

body temperature

blood pressure

heart rate

hunger and thirst

Cranial nerves emerge from the brainstem. These nerves control facial
sensation, eye movement, hearing, swallowing, taste and speech.

Other important parts of the brain

Cerebrospinal fluid (CSF)

The cerebrospinal fluid (CSF) is a clear, watery liquid that surrounds, cushions
and protects the brain and spinal cord. The CSF also carries nutrients from the blood to,
and removes waste products from, the brain. It circulates through chambers called
ventricles and over the surface of the brain and spinal cord. The brain controls the level
of CSF in the body.
Meninges

22

The brain and spinal cord are covered and protected by 3 thin layers of tissue
(membranes) called the meninges:

dura mater thickest outer layer

arachnoid layer middle, thin membrane

pia mater inner, thin membrane

CSF flows in the space between the arachnoid layer and the pia mater. This
space is called the subarachnoid space.

The tentorium is a flap made of a fold in the meninges. It separates the cerebrum
from the cerebellum.

The supratentorial area of the brain is the area above the tentorium. It contains
the cerebrum, the first and second (lateral) ventricles, the third ventricle, and glands and
structures in the centre of the brain.

The infratentorial area is located at the back of the brain below the tentorium. It
contains the cerebellum and brain stem. This area is also called the posterior fossa.
Corpus callosum
The corpus callosum is a bundle of nerve fibres between the 2 cerebral
hemispheres. It connects and allows communication between both hemispheres.
Thalamus

23

The thalamus is a structure in the middle of the brain that has 2 lobes or
sections. It acts as a relay station for almost all information that comes and goes
between the brain and the rest of the nervous system in the body.
Hypothalamus
The hypothalamus is a small structure in the middle of the brain below the
thalamus. It plays a part in controlling body temperature, hormone secretion, blood
pressure, emotions, appetite, and sleep patterns.

Pituitary gland
The pituitary gland is a small, pea-sized organ in the centre of the brain. It is
attached to the hypothalamus and makes a number of different hormones that affect
other glands of the bodys endocrine system. It receives messages from the
hypothalamus and releases hormones that control the thyroid and adrenal gland, as
well as growth and physical and sexual development.
Ventricles
The ventricles are fluid-filled spaces (cavities) within the brain. There are 4
ventricles:

The first and second ventricles are in the cerebral hemispheres. They are called
lateral ventricles.

The third ventricle is in the centre of the brain, surrounded by the thalamus and
hypothalamus.

The fourth ventricle is at the back of the brain between the brain stem and the
cerebellum.
24

The ventricles are connected to each other by a series of tubes. The fluid in the
ventricles is cerebrospinal fluid (CSF). The CSF flows through the ventricles, around the
brain in the space between the layers of the meninges (subarachnoid space) and down
the spinal cord.
Pineal gland
The pineal gland is a very small gland in the third ventricle of the brain. It
produces the hormone melatonin, which influences sleeping and waking patterns and
sexual development.
Choroid plexus
The choroid plexus is a small organ in the ventricles that makes CSF.
Cranial nerves
There are 12 pairs of cranial nerves that perform specific functions in the head
and neck area. The first pair starts in the cerebrum, while the other 11 pairs start in the
brain stem. Cranial nerves are indicated by number (Roman numeral) or name.
Types of cells in the brain
The brain is made up of neurons and glial cells:

neurons
These cells carry the signals that make the nervous system work.
They cannot be replaced or repaired if they are damaged.
glial cells (neuroglial cells)
These cells support, feed and protect the neurons.
The different types of glial cells are:
astrocytes
oligodendrocytes
ependymal cells
microglial cells

25

Structure and function of the spine

The spine is made up of:

vertebrae, sacrum and coccyx bony sections that house and protect the spinal

cord (commonly called the spine)

The vertebral body is the biggest part of a vertebra. It is the front part of the vertebra,

which means it faces into the body.

spinal cord a column of nerves inside the protective vertebrae that runs from the

brain to the bottom of the spine

disc a layer of cartilage between each vertebra that cushions and protects the
vertebrae and spinal cord

The spine is divided into 5 sections:

cervical the vertebrae from the base of the skull to the lowest part of the neck

thoracic the vertebrae from the shoulders to mid-back

lumbar the vertebrae from mid-back to the hips

sacrum the vertebrae at the base of the spine

The vertebrae in this section are fused and do not flex.

coccyx the tail bone at the end of the spine

The vertebrae in this section are fused and do not flex.

Spinal nerves
The spine relays messages between the body and the brain. These nerve
messages control body functions like movement, bladder and bowel control and
26

breathing. Each vertebra has a pair of spinal nerves that receive messages from the
body (sensory impulses) and send messages to the body (motor impulses). The spinal
nerves are numbered from the cervical spine to the sacral spine.

Stroke occurs when the

supply of blood to the brain is
either interrupted or reduced.
When this happens, the brain
does not get enough oxygen or
nutrients which cause brain
cells to die.
If the stroke occurs in the
left side of the brain, the right
side of the body will be affected, producing some or all of the following:Paralysis on the
right side of the body; Speech/language problems; Slow, cautious behavioral style and
Memory loss.

27

Hemorrhagic

stroke

accounts

for

about 13 percent of stroke cases. It results

from a weakened vessel that ruptures and
bleeds into the surrounding brain. The blood
accumulates

and

compresses

the

surrounding brain tissue.

V. ETIOLOGY OF THE DISEASE
Etiology
High blood
pressure

Actual

Rationale
Uncontrolled increase of blood pressure
can cause a vessel to explode or burst.
Thus,

causes

hemorrhagic

strokehttp://www.strokeassociation.org/S
TROKEORG/AboutStroke/UnderstandingRi
sk/Understanding-StrokeRisk_UCM_308539_SubHomePage.jsp#
Uncontrolled diabetes can cause increase
Uncontrolle
d diabetes

viscosity of blood in the blood stream

http://www.strokeassociation.org/STROKE
ORG/AboutStroke/UnderstandingRisk/Und
erstanding-StrokeRisk_UCM_308539_SubHomePage.jsp#
28

High

Having high Cholesterol contributes to

cholesterol

blood vessel disease, which often leads

to strokehttps://www.google.com.ph/?
gfe_rd=cr&ei=qKiOVMEBYSK8Qfw6oD4Bw&gws_rd=ssl#q=high
+cholesterol+in+CVA
Smoking

Smoking also nearly doubles the risk of

ischemic

stroke.3 Smoking

acts

synergistically with other risk factors,

substantially

increasing

the

risk

of

CHD.4Smokers are also at increased risk

for peripheral vascular disease, cancer,
chronic lung disease, and many other
chronic
diseaseshttp://circ.ahajournals.org/conte
nt/96/9/3243.full
Excessive alcohol
intake

The role of alcohol consumption as an

independent

risk

factor

for

ischemic

brain infarction has remained unclear.

Both

mortality

and

morbidity

from

ischemic brain infarction seem to be

increased

among

heavy

alcohol

drinkershttp://stroke.ahajournals.org/cont
29

ent/30/11/2307.full

Race

African-Americans

(opens

in

new

window) have a much higher risk of

death from a stroke than Caucasians
do. This is partly because blacks have
higher

risks

of high

blood

pressure, diabetes and

obesity.http://www.strokeassociation.org/
STROKEORG/AboutStroke/Understanding
Risk/Understanding-StrokeRisk_UCM_308539_SubHomePage.jsp#
Age (>65)

People aging 65 years old above are at

great risk for CVA. . atrial fibrillation is
the direct cause of one in four strokes.
https://www.google.com.ph/?
gfe_rd=cr&ei=9JOVLPoO8uL8QeCyoC4DA&gws_rd=ssl#q
=rationale+for+65+years+old+person+

Family
history of stroke

with+stroke
Your stroke risk may be greater if a parent,
grandparent, sister or brother has had a
stroke. Some strokes may be symptoms of
30

genetic disorders like CADASIL (Cerebral

Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy),
which is caused by a gene mutation that
leads to damage of blood vessel walls in the
brain, blocking blood flow. Most individuals
with CADASIL have a family history of the
disorder each child of a CADASIL parent
has

50%

chance

of

inheriting

the

disease.http://www.strokeassociation.org/ST
ROKEORG/AboutStroke/UnderstandingRisk/

VI. SYMPTOMATOLOGY
Symptoms
Weakness

Actual

Rationale
Numbness can occur from dysfunction

or numbness of

anywhere along the pathway from the

the face, arm, or

sensory receptors up to and including

leg on one side of

the

the body

cortexhttp://www.merckmanuals.com/pr

cerebral

ofessional/neurologic_disorders/approac
h_to_the_neurologic_patient/numbness.h
tml
Loss of speech,
difficulty talking,

communication deficits are

characterized by difficulty in
31

or understanding

understanding or producing speech

what others are

correctly (aphasia), slurred speech

saying

consequent to weak muscles

(dysarthria), and/or difficulty in
programming oral muscles for speech
production (apraxia). These deficits vary
in nature and severity depending on the
extent and location of the damage.
Some individuals may also have
difficulty in social communication, such
as difficulty taking turns in conversation
and problems maintaining a topic of
conversation.http://www.asha.org/public

Loss of vision or

/speech/disorders/Stroke/
Vision loss can be both a symptom and

dimming (like a

result of a stroke. Temporary vision loss

curtain falling) in

can be a sign of impending stroke and

one or both eyes

requires immediate medical attention.

Learn about how stroke may affect
vision and what to do about
ithttp://www.stroke.org/strokeresources/library/stroke-and-vision-loss

Sudden, severe
headache with no

Pain can also accompany a stroke.

Numbness and pain can also alternate in
32

known cause

the same area as the brain is having

difficulty communicating with nerves in
a

certain

area.http://www.healthline.com/health/st
roke/complications

of

Problems with balance are common

or

after stroke. If your balance has been

unstable walking,

affected, you may feel dizzy or unsteady

usually combined

which could lead to a fall or loss of

with

confidence when walking and moving

Loss
balance

another

around. Loss of balance can be a result

symptom

especially if certain part of the brain is

affected.
http://www.stroke.org.uk/factsheet/balan
ce-problems-after-stroke

VII. PATHOPHYSIOLOGY
A Written Pathophysiology
Strokes are divided into two main categories: Ischaemic and Haemorrhagic.
Haemorrhagic strokes are due to the rupture of a blood vessels leading to compression
of brain tissue from an expanding haematoma. In addition, the pressure may lead to a
loss of blood supply to affected tissue with resulting infarction.Intracerebral
SIGNS AND SYMPTOMS:
-

33

haemorrhage is the accumulation of blood anywhere within the brain, i.e.

intraparenchymal haemorrhage, intraventricular haemorrhage. This will form a gradually
enlarging haematoma (blood pool). Intracerebral Haemorrhages can be caused by local
vessel abnormalities (hypertension, vasculitis, vascular malformation) or systemic
factors (drugs, trauma, tumours and sickle cell anaemia/leukaemia). Haemorrhaging
directly damages brain tissue and raises intracranial pressure giving headaches,
vomiting nausea and eventually coma and death.Subarachnoid haemorrhage is the
gradual collection of blood in the subarachnoid space of the Dura. These can be
traumatic or spontaneous. Spontaneous haemorrhages occur through saccular (berry)
aneurysms and through extensions of intracranial haemorrhaging or due to similar
causes. Approximately one third of those who suffer a subarachnoid haemorrhage die.it
is the subarachnoid space which can pathologically fill with blood.

B Diagram of Pathophysiology
Predisposing Factors:

Precipitating Factors:

- Age
Age of 65 years old
- Family History of Stroke
- Sedentary Lifestyle

- Excessive alcohol intake; had been

drinking in the past days.
- History of smoking

Hemorrhagic- Impaired tissue

perfusion

34

Infarction of cerebral vessels

known as stroke
Space-occupying blood clots
put more pressure on the brain
tissues

The regulatory mechanisms of

the brain attempt to maintain
equilibrium by increasing BP
and ICP

The ruptured cerebral vessels

may constrict to limit blood loss
however, the vasospasm will
result to further ischemia and
necrosis of brain tissues.
Nursing Management:
1.
Reposition client q2
SIGNS
AND SYMPTOMS:
2.
Support
dependent body

Complications

Loss of Muscle
parts
with pillows
-Loss
of Balance
- Sudden or severe headache - Loss of vision
Pharmacological
Management
-Loss Provide
of Speech
of face and extremities
3.
safety
measures -Weakness or Numbness Control/Paralysis
including environmental
Furosemide
management
Ceftriaxone
4.
Encourage SOs
Citicoline
involvement in activities &
Omeprazole
decision making
5.
Peroform passive range
Amlodipine
of motion exercises daily
Losartan
6.
Increase functional
Mannitol
activities as strength
improves
GOOD PROGNOSIS

Speech Problems
Swallowing Difficulties
Cognitive Impairments
Personality and Mood
Changes
Depression
BAD PROGNOSIS

35

VIII. PLANNING
A NURSING CARE PLAN
Date /
Time
Decem
ber 10,
2014
7-3
shift

Assessment

Need

Subjective cues:
Gi-ubo sya sir,
dili sya
kaginhawa kaau
as verbalized by
the watcher.

P
H
Y
S
I
O
L
O
G
I
C
A
L

Objective cues:
-VS: BP- 160/100
PR- 90
RR- 27
Temp- 36.9
O2 sat= 97%

Need

-productive
cough
-crackles heard
upon
auscultation.
-(+) use of
accessory
muscle when

Nursing
Diagnosis
Ineffective
Breathing Pattern
r/t
tracheobronchial
inflammation and
increased sputum
production
secondary to
CAP-MR

Rationale:

Pneumonia is infl
ammation of the
terminal airways
Oxyg and alveoli
enatio caused by acute
n
infection by
patter various agents.
n
Community
Acquired

Objective
of Care
Within the
shift, will
be able to:
a. Identify
or
demonstra
te
behaviors
to achieve
airway
clearance.
b. Display
patent
airway
with
breath
sounds
clearing.

Nursing
Interventions
-Monitored VS.
R: To monitor
patients condition
and compared with
baseline data.
-Placed on MHBR
position.
R: It promotes
relaxation and helps
in promoting
effective airway
clearance.
-Assisted in turning
to sides every 30
minutes.
R: To promote
circulation as well
as to prevent
further
complications in the
pulmonary system.
-Encouraged to
increase OFI.

Evaluation
Within the
shift, GOAL
PARTIALLY
MET, as
evidenced
by:
a. being able
to
identify/demo
nstrate
behaviors to
achieve
airway
clearance
such as deep
breathing
and coughing
exercises.
b. crackles
lung sound
still heard
36

breathing
- with O2
inhalation @
2LPM via nasal
cannula
-lying flat on bed

Pneumonia
(CAP) is a
disease in which
individuals who
have not recently
been hospitalized
develop an
infection of the
lungs. It is an
acute
inflammatory
condition thats
result from
aspiration of
oropharyngealse
cretions or
stomach contents
in the lungs.
Therefore, airway
clearance is not
effective.

Reference:
http://nursingcrib.
com/

R: It helps to soften
and expectoration
of secretions.
-Encouraged to do
deep breathing and
coughing exercises.
R: Deep breathing
exercises facilitate
maximum
expansion of the
lungs and smaller
airways. Coughing
is a reflex and a
natural self-cleaning
mechanism that
assists the cilia to
maintain patent
airways.
-Demonstrated
proper back and
chest tapping to
watchers.
R: It can aid to
mobilization and
expectoration of
secretions.

upon
auscultation.

Dependent:
-Administer meds as
37

prescribed.
R: To continuously
treat underlying
causes and
symptoms.

Date Retrieved:
December 11,
2014

Collaborative:
-Encouraged
watchers to assist
patient in turning to
sides as well as in
performing ADL.
R: To prevent
further
complications and
to prevent accidents
that may lead to
injury.

Date /
Time
Decem
ber 10,
2014
7-3
shift

Assessment

Need

Subjective
cues:
Wala baya jud
kusog iyang
tuo nga parte
sa lawas sir

P
H
Y
S
I
O

Nursing
Diagnosis
Self-care
deficit r/t right
sided body
weakness
secondary to
Cerebrovascul
ar accident

Objective
of Care
Within the
shift, there
will be
demonstrati
on of selfcare, as

Nursing
Interventions
-Established rapport.
R: To gain trust and
cooperation.
-Monitored VS.
R: To have a baseline
data.

Evaluation
Within the shift,
GOAL
PARTIALLY
MET, as
evidenced by:
a. Being
38

as verbalized
by the
watcher.

L
O
G
I
C

Rationale:

Motor deficit
are the most
Objective
obvious effect
cues:
of stroke.
-VS: BPN
Symptoms are
160/100
E
caused by
PR- 90
E
destruction of
RR- 27
D
motor neurons
Temp36.9
Nutrition, in the
-hand grip and clothing pyramidal
pathways
leg movement
and
at the right
eliminati (nerve fibers
in the brain
side of the
on
and passing
body are
through the
absent
spinal cord to
- Inability to
the motor
feed self
tract.) When
independently
this happens,
-Inability to
activities of
dress self
daily living can
independently
be impaired
-Inability to
and even selfperform
care.
toileting task
independently
-total

evidenced
by:

-Assured that the

consistency of the
diet is appropriate for
patients ability to
chew and swallow.
R: Mechanical
problem may prohibit
the patient from
eating.
-Assisted during bed
bath.
R: To give comfort.
-Maintained privacy
during bathing.
R: The need for
privacy is
fundamental for most
patients.
-Assisted in changing
the clothes.
R: To give comfort
and to assess for the
parts which cannot
be move frequently.
-Provided frequent
encouragement and
assistance as needed
with dressing.
R: To reduce energy

unable to
place the
unnecessar
y things at
bedside on
his own.
b. Being able
to change
clothes
with
minimal
assistance.
c. Being
unable
to take a
bath
without
total
assistan
ce.

39

assistance
during ADL like
bathing and
clothing
-

Reference:
http://nursesla
bs.com/cerebr
ovascularaccidentnursing-careplans/.
Date
Retrieved:
December 11,
2014

expenditure and
frustration.
- Provided privacy
while patient is
toileting.
R: Lack of privacy
may inhibit the
patients ability to
evaluate their bowel
& bladder.
-Stretched and
tucked properly the
linens.
R: To prevent the
feeling of being
uncomfortable when
lying in bed.
Dependent:
-Administer meds as
prescribed.
R: To continuously
treat underlying
causes and
symptoms.
Collaborative:
-Encouraged
watchers to assist
40

patient in ADL like

daily bed bathing and
oral hygiene.
R: To help patient
maintain a proper
hygiene and prevent
accidents.

Date/Ti
me
Decembe
r 11,
2014
7-3 shift

Assessmen Need
Nursing
t
Diagnosis
Subjective
S
Activity
cues:
A
Intolerance r/t
Dili kalihok
F
right sided
akong tuo na
E
body
kamot og
T
weakness
tiil, as
Y
secondary to
verbalized.
Cerebrovascul
A
ar accident
Objective
N
cues:
D
Rationale:

Objective of
Care
Long Term Goal:
a Participate
willingly in
necessary/de
sired
activities.
b Use identified
techniques to
enhance
activity

Nursing
Interventions
-Monitored VS.
R: To monitor
patients condition
and compared
with baseline data.
- Ascertained
ability to stand
and move about,
and degree of
assistance

Evaluatio
n
GOAL MET,
as
evidenced
by:
a. Able to
participate
willingly in
necessary/
desired
41

- hand grip
and leg
movement
at the right
side of the
body are
absent
- turns to
sides with
assistance
-needs total
assistance in
ambulation
-unable to
perform ADL
alone

S
E
C
U
R
I
T
Y

The sudden
death of some
brain cells due
to lack of
oxygen when
the blood flow
to the brain is
impaired by
blockage or
rupture of an
artery to the
brain, this can
cause body
weakness or
paralysis of
the one side of
the body,
depending on
the area of the
brain that is
affected. This
will lead the
patient to
have
intolerance to
some
activities.
Reference:

intolerance.

necessary or use
of equipment
R: To determined
current status and
needs associated
with participation
in needed/desired
activities.
- Assessed
emotional and
psychological
factors affecting
the current
situation.
R: Stress or
depression maybe
increasing the
effects of an
illness, or
depression might
be the result of
forced inactivity.
- Increased
exercise or activity
levels gradually.
R: To conserve
energy
- Planned care to
carefully balance

activities.
b. Able to
use
identified
techniques
to enhance
activity
intolerance
.

42

http://www.me
dicinenet.com/
script/main/art
.asp?
articlekey=26
76. Date
Retrieved:
December 11,
2014

rest periods with

activities
R: to reduce
fatigue.
- Assisted with
activities and
provided/monitore
d clients use of
assistive
devices(e.g.,
crutches,
wheelchair)
R: To protect client
from injury.
- Promoted
comfort measures
and provided for
relief of pain.
R: To enhance
ability to
participate in
activities.
- Planned for
maximal activity
within the clients
ability.
R: Promote the
idea of normalcy
of progressive
43

abilities in this
area.
- Planned for
progressive
increase of activity
level/participation
in exercise
training, as
tolerated by the
client.
R: Both activity
intolerance and
health status may
improve with
progressive
training.
- Assisted client in
learning and
demonstrating
appropriate safety
measures.
R: To prevent
injuries
Dependent:
-Administered
meds as
prescribed.
R: For continuous
44

treatment of
underlying cause
and symptoms.
Collaborative:
-Encouraged
watchers to
support the
patient by
assisting in
performing ADL.
R: To provide
safety and avoid
accidents that
may cause injury.

45

B DISCHARGE PLAN
Areas

Objective

Activities
1 Encourage the patient to comply
with the prescribed medication.
This prevents further

Medication

100 % compliance to home

medicines

development of the disease

process and other possible
complication.
2 Encourage the client to take the
medicine into the right time,
right dose, right amount, and
right frequency and take note
the side effects of the medicine.
This would enable them to
know what are the drugs and its
desired dosage. The exact
dosage and time are important
46

to ensure the drugs

effectiveness.
3 Instruct patient to notify
physician if there is any
abnormalities after taking the
medicine.
4 Instruct patient to do not buy
any drugs that does not
prescribed by the physician.
To avoid the ineffectiveness of
the drug prescribed, and to
ensure the safety of the client.
1 Avoid strenuous activities.
2 Encourage patient to have
Exercise

To stabilize the condition of the

activities of daily living.

3 Encourage client to have

patient. Encourage to do light

adequate rest periods

exercise and understands its

between activities.

important.
1. Explain the purpose of

47

the medication that is

Treatment

Understanding the recommended

treatment or lessen underlying
illness.

prescribed by the
physician.
2. Inform the significant of
the treatment others that
they should be involved
in the treatment of the
client.
3. Encourage to take
medications religiously.
1 Instruct to take extra care in
doing daily ADL especially in
ambulation.
2 Instruct the client to have a

Health teachings

To prevent the risk of any

complications that may lead to
death.

proper diet and hygiene.

3 Encourage client to wash hands
before and after doing things.
4 Patient is advised to avoid
strenuous activities until full
recovery is achieved
48

5 Encourage significant others to

give total supportive care.
1 Continue prescribed medicines
and its right dosage.
To attain the therapeutic
Out - patient

To maintain quality health and

independence towards self - care.

effect of each medicines

towards the client.
2 Follow up with appointments
with physician.
To evaluate the progress of
the treatment and condition.
3 Encourage the patient to have
adequate rest and sleep
periods.
These aid faster recovery
from the illness and to have
enough strength in performing
activities of daily living and
range of motion exercises.
4 Encourage him to comply with

49

all the modifications and

instructions given to her
In order to have a fast
recovery.
1 Emphasize intake of
nutritious foods.
2 Encourage foods that are
Diet

Decrease intake of fatty and salty

foods as well as those foods that
can irritate the GI tract including
spicy and acidic foods. Include a
variety of vegetables and fruits in

less fatty and salty.

3 Observe proper handling of
foods.
4 Instruct to include variety of
fruits and vegetables in the
diet.

the diet.

50

IX. PHARMACOLOGICAL MANAGEMENT

51

Gener
ic
Name
Furose
mide

Bran
d
Nam
e
Lasix

Classificati
on

Mechanism of
action

Indication

Loop diuretic Furosemide

-Edema
inhibits
associated
reabsorption of with CHF,
Na and chloride cirrhosis,
Gene Brand Classificati mainly
Indication
in the
renal
Action
ric
Name on
medullary
disease
Name
portion of the
-Acute
ascending Loop pulmonary
Ceftri Forgra Cephalospori ofIndicated
Works by
Henle. in
edema
axone m
ns
patients of
with
inhibiting
Excretion
neurologicand
the
potassium
complications,
mucopepti
ammonia
is
carditis
and
de
also
increased
arthritis.
It is
synthesis
while
uric acid
also effective
in in the
excretion
is
Gram negative
bacterial
reduced.
It
infections;
cell wall.
increases
Meningitis,
The betaplasma-renin
Gonorrhea.
levels
and It is lactam
also for Bone
moiety of
secondary
and joint
Ceftriaxone
hyperaldostero
infections,
binds to
nism
may
Lower
carboxypep
result.
respiratory tract tidases,end
Furosemide
infections,
opeptidase
reduces
BP in
middle ear
s, and
hypertensives
transpeptid
asinfection,
well as inPID,
Septicemia and ases in the
normotensives.
Tract
bacterialcyt
ItUrinary
also reduces
pulmonary
oedema before
diuresis has set
in.

Side Effects/
Adverse
Reaction
Fluid and
electrolyte
imbalance.
Rashes,
Side
photosensi
Effects/
tivity,
Adverse
nausea,
Reaction
diarrhoea,
Pain
blurred
Induration
vision,
Phlebitis
dizziness,
Rash
headache,
Diarrhea
hypotensio
Thrombocyt
n. Bone
osis
marrow
Leucopenia
depression
Glossitis
(rare),
Respiratory
hepatic
super
dysfunctio
infections
n.
Hyperglyca
emia,
glycosuria,
ototoxicity.
Potentially
Fatal:
Rarely,
sudden
death and
cardiac
arrest.
Hypokalae
mia and
magnesiu

Time
and
Dosag
e
40mg
OD
IVTT

Nursing
Responsibili
ties

-Reduce
dosage if
given with
other
Time & antihypertensi
Nursing
Dosage ves;
Responsibilit
readjust
dosage
ies
gradually as
1 gram BP
-Assess
responds.
every
patients
12 hours -Administer
Previous
ANST (-) with
sensitivity
food or
IVTT
reaction
milk
to to
penicillin
prevent
GIor
other
upset.
cephalosphori
-Give
early in
ns.
the day so
that increased
-Assess will
urination
patient
for
not
disturb
signs and
sleep.
symptoms
of infection
-Avoid
IV use
before
andis
if oral use
during
the
at
all possible.
treatment
-Obtain C&S
-WARNING:
Do
before
not mix
beginning
parenteral
solution with
highly acidic 52
solutions with
pH below 3.5.
-Do not

infections.

oplasmicm
embrane.
These
enzymes
are
involved in
cell-wall
synthesis
and cell
division. By
binding to
these
enzymes,
Ceftriaxone
results in
the
formation
of
of defective
cell walls
and cell
death.

drug therapy
to identify
if correct
treatment has
been initiated.
-Report signs
such as
petechiae,
ecchymotic
areas,
epistaxis or
other forms
of unexplaine
d bleeding.

53

Generi
c
Name
Citicoli
ne

Bran
d
Nam
e
Choli
nerv

Classificati Indication
on

Action

CNS
stimulant,
Peripheral
Vasolidlator

Citicoline
activates
the biosynthesis
of structural pho
spholipids in the
neuronal
membrane,
increases
cerebral
metabolism and
increases the
level of various
neurotransmitte
rs, including
acetylcholine
and dopamine.
Citicoline has
shown
neuroprotective
affects in
situations
of hypoxia and
ischemia.

Cerebrovasc
ular
Diseases,
accelerates
the recovery
of conscious
ness and
overcoming
motor deficit

Side
Effects/
Adverse
Reaction
citicoline
may exert
a
stimulating
action of
the parasy
mpathetic,
as well as a
fleeting
and
iscretehypo
tensor
effect.

Time & Nursing

Dosag Responsibiliti
e
es
500mg
1 cap
TID

-Watch out
for hypotensive
effects.
-Must not be
administered
along with
medicaments
containing

54

Generic
Brand Classi
Indication
SideSide
Time Time
Nursing
Generi Brand
Classificat
MechanismAction
Indication
Nursing
Name
Name
ficatio
Effects/
and
Responsibilities
c
Name
ion
of action
Effects/
and
Responsibiliti
n
Adverse
Dosag
Name
Adverse
Dosag es
Reaction
e
Reaction
e
Omepraz
Omep Proton
ShortInhibits
term
Suppresses
Diarrhea,
40 mg10mg
-Assess
other
Losarta Cozaar
AntiHypertensi
CNS1 -Monitor
ole
ron
pump
treatment
gastric
nausea,
patient
n
hypertensi
vasoconstricti
on,
dizziness,IVTT tab medications
OD patients
BP.
inhibito
of active
secretion
by fatigue,
maybe-Monitor
taking for
ve
ve and
Nephepatic
asthenia, OD
Generi Brand Classificati
Mechanism
Indication
Side
Time
Nursing
r
duodenalulcer,
constipatio
effectiveness
aldosterone-inhibiting
ally in type
fatigue,
patientsand
who
c Name Name on
of
action
Effects/
and
Responsibilities
gastroesopha
interaction.
secreting hydrogen/p
2 diabeticn, headache,
are also taking
Adverse
Dosag
gealreflux
otassium
vomiting,
-Monitor
therapeutic
action of
patients, to
insomia. CVdiuretics
for
Reaction
e
disease
ATP
as
flatulence,
effectiveness
and
angiotensin II
reduce risk edema,
symptomatic
Amlodip Norvas Calcium
Inhibits the
Alone or
10mg
(GERD),
enzyme
utycaria,
adverse
reaction at
by blocking
of
chest pain.
hypotension.
CNS:
-Monitor blood
ine
c
channel
transport
with other
1 tab
including
dry mouth,
the beginning
angiotensin system
II
CVAinin
EENT-nasal
-Assess
headache,
pressure
and pulse
blocker
of calcium into agents in
OD
erosive
the
gastric
dizziness,
of
therapy
and renal
receptor on
patients
congestion,
patients
dizziness,
before therapy,
myocardial
the
esophagitis
parietal
periodically
the surface of
withcell: headache
sinusitis,
function
during
dose titration,
and vascular
manageme fatigue CV:
and vascular
characterize
throughout
the
hypertensi pharyngitis,
-Tell
patient
to
peripheral
and periodically
smooth muscle nt
symptomatic
as
a
gastric
therapy
.
smooth
on and left sinus
avoid salt
during
cells, resulting of hyperten edema,
GERD.
Long
acid
pump
-Assess
GI system:
muscle and
ventricular disorder.
substitutes
angina, GItherapy.
Monitor EC
in the
sion,
term other tissue inhibitor,
bowel
sounds
8 hrly,
hypertroph Abdominal
bradycardia
G during prolonged
inhibition
angina
treatment
since yit block
abdomen
cells
pain,
nausea,
,
therapy.for pain
of excitation
pectoris
of pathologic
the final
and swelling,
diarrhea,
hypotensio
contraction
and
hypersecretor step of acid
appetite loss.
dyspepsia.M
coupling and
vasospastic n,
y condition: to production.
-Monitor hepatic
usculoskeleta
palpitations
subsequent
angina
maintain
enzymes.
-Monitor intake and
l-muscle
GI: gingival
contraction
healing of
Assess
output ratios and
cramps,
hyperplasia
erosive
knowledge/teach
daily
myalgia,
, nausea
esophagitis.
appropriate
use of this
weight. Assess
for
back
or leg
DERM:
Short term
medication,
signs of CHF
pain.
flushing
(peripheral edema,
treatment
interventions
to
Respiratoryrales/crackles,
of active
reduce
side effects, 55
cough, upper
weight
benign gastric
anddyspnea,
other symptoms
respiratory
gain and jugular
ulcer
to report
infection
venous distention

Generi Brand Classificati

c Name Name on

Mechanism
of action

Indication

Mannito
l

Increases
osmotic
pressure of
plasma in
glomerular
filtrate,
inhibiting
tubular
reabsorption
of water and
electrolytes
(including
sodium and
potassium).
These actions
enhance
water flow
from various
tissues and
ultimately
decrease
intracranial
and
intraocular
pressures

Test dose
for marked
oliguria or
suspected
inadequate
renal
function,
prevent
acute renal
failure
during
cardiovasc
ular and
other
surgeries,
acute renal
failure, to
reduce
intracranial
pressure
and brain
mass,
reduce
intraocular
pressure,
to promote
dieresis in
drug
toxicity,
irrigation
during
transurethr
al resection
of prostate.

Osmitr Osmotic
ol
Diuretic

Side
Effects/
Adverse
Reaction
CNS:
dizziness,
headache,
seizures
CV: chest
pain,
hypotension,
hypertension,
tachycardia,
thrombophlebi
tis, heart
failure,
vascular
overload
EENT: blurred
vision, rhinitis
GI: nausea,
vomiting,
diarrhea, dry
mouth
GU: polyuria,
urinary
retention,
osmotic
nephrosis
Metabolic:
dehydration,
water
intoxication,
hypernatremia
, hyponatremi
a,
hypovolemia,
hypokalemia,h

Time
and
Dosag
e
50ml
IVTT
every
6 hrs

Nursing
Responsibilities

-Monitor vital signs.

-Monitor intake and
output.
-Monitor central
venous pressure.
-Monitor pulmonary
artery pressure.
-Monitor signs and
symptoms of
dehydration.

-Monitor signs of
electrolyte
imbalance

56

57

X. SYNTHESES OF CLIENTS CONDITION/STATUS FROM ADMISSION TO

PRESENT
A. Conclusion
Therefore, after we had studied the case, our client has suffered from
Cerebrovascular Accident because of some possible factors that might have contributed
on the development of the condition. Cerebrovascular Accident refers to is the medical
term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by
a blockage or a rupture of a blood vessel. There are important signs of a stroke that you
should be aware of and watch out for. If you think that you or someone around you
might be having a stroke, it is important to seek medical attention immediately. The
more quickly you get treatment, the better the prognosis. When a stroke goes untreated
for too long, there can be permanent brain damage.
The certain condition that the patient is suffering is really considered dangerous.
It is a life-threatening condition especially if the patient will not follow the prescribed
meds and a healthy lifestyle as it would lead to many other complications that may
greatly affect his life as well as his family and eventually may lead to death. Despite of
all that facts, there are treatments and preventive measures that people should do in
order to stop or prevent this condition from getting worst. We conclude that the need for
medical consultations and abiding the medical orders regarding health condition and at
least preventing the worst to happen should be really observed and taken into
consideration by the patient himself and by the significant others as well. Doing right

58

things and sufficient knowledge about the patients conditions can be of great help and
they should know the preventive measures for prevention is always better than cure.

B. Patients Prognosis
Poor

Fair

Good

Duration

Justification
Patient has
been admitted
because of right
sided weakness

and still present

during our 4 day
exposure.
The patient still

Onset

experienced his
chief complaint

Willingnes

during our shift.

The patient has

the willingness
to take all

medications
after the
explanation of
the purpose of
the medicine.
59

Environme

The patient

nt

stayed in a ward

room and was

conducive for
healing and
recovery.
The patients

Diet

diet was more

on salty and
fatty foods.

Computation:
Poor-

1x0=0

Fair-

2x3=6

Good-

3x2=6
12/5 = 2.4 (Fair Prognosis)

C. RECOMMENDATIONS
Giving importance to the health of ourselves and maintaining a healthy lifestyle
as individuals, is highly required to maintain a good and healthy life. It is because
ignoring the health condition could greatly affect life especially when certain conditions
or diseases would develop.
60

It is very important that every person should give importance to his/her health. A
person should promote healthy lifestyle changes that include adequate nutrition, clean
environment, and free from stress. For our patient, it is important to eliminate those
factors that can trigger to his condition.
With this we recommend the following:
1.
2.
3.
4.
5.
6.
7.

Maintain proper hygiene all the time;

Deep breathing exercises to promote relaxation;
Adequate rest and sleep;
Strict compliance to the medical treatment and medical check-up;
Instructed watcher to assist patient in performing ADL;
Instructed watcher not to leave the patient alone;
Follow-up with appointment with the physician.

XI. EVALUATION OF THE OBJECTIVES OF THE STUDY

After days of collecting relevant information and sequence of analysis on related

61

topics of this case study, we are now presenting our evaluation related to our objectives
that have been presented. We have certified that we were able to complete the chosen
case with factual data gathered including the necessary information related to this case.
Within the span of at least of rendering care to Patient Kowowo, we have drawn
together the important and relevant information that serve as the baseline of our study
and were able to identify potential problems. By gaining the patients trust and
cooperation and with the help of the significant others, we were able to assess properly
every single data regarding the patients condition and thoroughly assessed every
system involved. We were able to obtain his past health history that contributed to the
occurrence of the condition. Additionally, we were able to get the complete diagnosis,
able to perform the cephalocaudal physical assessment of the patient, and discussed
firmly the anatomy and physiology of the systems involved. Besides, we were able to
present the pathogenesis of certain conditions included in the admitting diagnosis.
Moreover, we were able to present the factors that affect the patients condition,
comprehensively interpreted the laboratory results, discussed and enumerated the
medications prescribed including the nursing responsibilities and given the interventions
we have planned and implemented for our patient.

We were able to appreciate more the essence of utilizing the nursing process in
the care, service and management of our patient. This case study improves not only our
knowledge but also with our skills concerning on providing care for our patient with such
62

diseases and we can be able to share our learning regarding this study to the significant
people. In addition, it enhances our analysis, research, knowledge and skills on the field
of nursing. It was indeed a hard job on conducting this study yet, it gave a great impact
in our career regarding how useful it is in our chosen profession.

XII.

BIBLIOGRAPHY

Books

63

Brunner and Suddarth's Textbook of Med.-Surg. Nursing 12th ed Copyright

2010 by Lippincott Williams & Wilkins, a Wolter Kluwer business.

Medical - Surgical Nursing 7th ed. by Black Joyce M. and Jane Hokanson Hawks

PorthsEssentials of Pathophysiology 3rd EditionCopyright 2011 by Lippincott

Williams & Wilkins, a Wolter Kluwer business.

Fundamentals of Nursing, 7th ed. by Kozier, Barbara

Medical Surgical Nursing 7th ed. Copyright 2008 by Lewis, et.al. Nurses
pocket guide, 12th ed. by Doenges, Marilynn, et.al.

Nurses Handbook of Health Assessment 6th ed. by Weber, Janet

Daviss Drug Guide for Nurses. TENTH EDITION.
Daviss Nurses Pocket Guide. 12th edition
Internet

http://www.healthline.com/health/cerebrovascular-accident#Overview1 Date

of Retrieval: December 13, 2014

http://www.medicinenet.com/script/main/art.asp?articlekey=2676Date of

Retrieval: December 13, 2014

http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-

3e122a3f19e3&chunkiid=645095Date of Retrieval: December 13, 2014

http://www.world-heart-federation.org/cardiovascular-health/stroke/Date of

Retrieval: December 13, 2014

http://www.strokeforum.com/stroke-background/epidemiology.htmlDate of
Retrieval: December 13, 2014

64

http://www.worldlifeexpectancy.com/philippines-strokeDate of Retrieval:

December 13, 2014

http://emedicine.medscape.com Date of Retrieval: December 13, 2014
http://www.webmd.com/Date of Retrieval: December 13, 2014
http://www.healthline.com/health/Date of Retrieval: December 13, 2014
http://www.mayoclinic.org/Date of Retrieval: December 13, 2014
http://www.livestrong.com/Date of Retrieval: December 13, 2014
http://www.healthcommunities.com/ Date of Retrieval: December 13, 2014
http://emedicine.medscape.com/ Date of Retrieval: December 13, 2014
http://www.ncbi.nlm.nih.gov/Date of Retrieval: December 13, 2014

65