AMA Computer Learning Center

St. Augustine School of Nursing

A Case Study Presented to the faculty of AMA

Computer Learning Center
Guagua, Pampanga

Cerebrovascular
Accident
Submitted to:
Mr. John Eric T. Salvador B.S.N, R.N

Submitted by:

Almario, Jeanette

Cayanan. Gemmalyn Joy

Quitaleg, Mary Jane

Santos, Cariza Joy M.

3k-PN
 October ‘09

Table of Content Page

Introduction 1

Personal History 2

Lifestyle and Diet 3

Complete Physical Assessment 4-9

Neurological Assessment 10-11

Laboratory Procedure 12-13

Diagnostic Procedure 14

Anatomy and Physiology 15-17

Pathophysiology of Cerebrovascular Accident 18-19

Drug Study 20-21

Diet and Activity 23

SOAPIE (actual) 24

SOAPIE (potential) 25

Conclusion 26

Recommendations 27

Bibliography 28

NCP (actual/ potential ) 29-33

Introduction
 A stroke is damage to part of the brain when its blood supply is suddenly reduced or
stopped. A stroke may also be called a cerebral vascular accident, or CVA. The part of the
brain deprived of blood dies and can no longer function. Blood is prevented from reaching
brain tissue when a blood vessel leading to the brain becomes blocked (ischemic) or
bursts (hemorrhagic). The symptoms of a stroke differ, depending on the part of the brain
affected and the extent of the damage. Symptoms following a stroke come on suddenly
and may include: weakness, numbness, or tingling in the face, arm, or leg, especially on
one side of the body trouble walking, dizziness, loss of balance, or coordination inability to
speak or difficulty speaking or understanding, trouble seeing with one or both eyes, or
double vision, confusion or personality changes, difficulty with muscle movements, such
as swallowing, moving arms and legs, loss of bowel and bladder control, severe headache
with no known cause, and loss of consciousness.

There are following metabolic disorder that may contribute to stroke, excess weight
around the waist (waist measurement of more than 40 inches for men and more than 35
inches for women) triglycerides blood level of 150 mg/dL or more, HDL cholesterol levels
below 40 mg/dL for men and below 50 mg/dL for women, blood pressure of 130/85 mm
HG or higher and prediabetes (a fasting blood sugar between 100 and 125) or diabetes (a
fasting blood sugar level over 125 mg/dL).

Latest Trend
(Medication for Cerebrovascular Accident)

Anti-platelet medicines like aspirin, clopidogrel, extended release dipyridamole and

aspirin in combination, and ticlopidine help prevent stroke because they keep the blood from
clotting. Like aspirin, these medicines keep your blood from clotting. They are available only
prescription. dipyridamole and aspirin combination (Aggrenoxl®), clopidogrel (Plavixl®),
ticlopidine (Ticlidl®).Anti-coagulant medicines keep you from getting blood clots. You may
hear people call these medicines "blood thinners." Warfarin (Coumadinl®) is often used in
patients who have heart problems or artificial heart valves. Tissue plasminogen activator (t-
PA or thrombolytic therapy) dissolves blood clots, but it may cause bleeding (including
bleeding into the brain).This medicine must be given within 3 hours of the start of stroke
symptoms. You will not be given t-PA if your blood pressure is too high, if changes on a CT
scan show it should not be given, or if the risk of bleeding is too great. Heparin / heparinoid
medicines slow the creating of blood clots. But there is little, if any, benefit in treating stroke.
The medicines also can cause bleeding.

1.

2. Personal History
 Name: Mr. D Address: San Rafael, Guagua

Age: 43 yrs. Old Work: Jeepney Driver

Chief Compliant: Impaired Verbal Communication

2.1 Family Health History

2.
2.2 Past Health History

Mr. D’s wife verbalized that Mr. D was already been confined on the hospital before
due to mild stroke last year December 2008 , while he is in their house he experienced
sudden headache, dizziness, numbness, blurred vision and that made his wife to bring him
into the hospital. Mr. D was confined for 4 days and after a week he was able to work again as
jeepney driver though the doctor said he need to take rest from work, avoid stress, smoking,
alcohol intake, and high fat/ salt food to avoid the stroke.

2.3 Present Health History

Mr. D was been confined again in the hospital of DPMMH last August 27, 2009 and he
spent more than 7 days in the hospital. Mr. D’s wife said that while Mr. D is talking with his
friend and drinking alcohol he experienced severe headache, sudden dizziness, paralysis in
the right part of his body, numbness, blurred vision and loss of consciousness. And made his
family to bring him into the hospital.

3. Lifestyle and Diet

Mrs. D said that his husband was a smoke, he consumed more than 30-40 pieces a
day (1 1/2 pack) since 20 years old and he also drink 1 bottle of alcohol since 23 years old.
Mrs. D said that her husband likes to eat pork after a long day of handling his jeep.

3.
 4. Complete Physical Assessment

Date assessed: September 4, 2009

Time Assessed: 9:00 A.M
Initial Vital Signs:
Temperature: 36.3 C
Pulse Rate: 77 cpm
Respiratory Rate: 21 cpm
Blood Pressure: 140/ 100mmHg

General Appearance:
• The pt. is awake, lying on bed, unconscious with an IVF of PNSS regulated @
10-15 gtts./min. (KVO) 200ml. level infusing well @ left hand.
• With Nasogastric Tube inserted.
• With Foley catheter inserted (2000 ml. urine bag)

Area Assessed Technique Normal Actual Analysis

Used Findings Findings
SKIN
color Inspection Tan Pale Due to
decrease
oxygen supply.
Texture Palpation Smooth, soft Smooth, soft Normal
Turgor Palpation Skin snaps Skin snaps Normal
back back
immediately immediately
When pinched When pinched
Hair Distribution Inspection Evenly Evenly Normal
distributed distributed
Temperature Palpation Warm to touch Warm to touch Normal
Moisture Palpation Dry, skin folds Dry, skin folds Normal
are normally are normally
moist moist
NAILS
Color of Nail bed Inspection Pink and clear Pink and clear Normal
Texture Palpation Smooth Smooth Normal
Shape Inspection Convex Convex Normal
curvature curvature
Nail base Inspection Firm Firm Normal
Capillary refill Blanch test 2-3 seconds 4 sec. Due to
time decrease
oxygen supply.
HAIR Normal
Color Inspection Black (varies) Black (varies)
Distribution Inspection Evenly Evenly Normal
distributed distributed
Moisture Inspection Neither Neither Normal
excessively dry excessively dry
nor oily nor oily
Texture Inspection Silky, resilient Silky, resilient Normal
HEAD

Scalp symmetry Inspection Symmetrical Symmetrical Normal

Skull size Inspection Normocephalic Normocephalic Normal

Shape Inspection and Round Round Normal
Palpation
Nodules/ masses Palpation Absence of Absence of Normal
nodules and nodules and
masses masses
FACE
Symmetry Inspection Symmetrical Symmetrical Normal

Facial movement Inspection Symmetrical Symmetrical Normal

Skin color Inspection Tan Pale Due to

decrease
oxygen supply.
EYES Symmetrically Symmetrically Normal
Eyebrows Inspection aligned, equal aligned, equal
movement movement
Eyelashes Inspection Slightly curved Slightly curved Normal
upward upward
Eyelids Inspection Smooth, tan, do Smooth, tan, do Normal
not cover pupil not cover pupil
as sclera, close as sclera, close
symmetrically symmetrically
Ability to blink Inspection Blinks Blinks Due to damage
voluntarily and involuntarily. of Broca’s area.
bilaterally
Frequency of Inspection 20 blinks per To speech. Due to damage
blinking min. of Broca’s area.
Ocular movement Inspection Eye moves Lack of eye Due to damage
freely movement of Broca’s area.
Position Inspection Drawn from Drawn from Normal
lateral angel lateral angel
Size Inspection Medium Medium Normal
Texture Palpation Mobile, firm and Mobile, firm and Normal
non-tender non-tender
CONJUCTIVA
Color Inspection Transparent Transparent Normal
with light color with light color
Texture Inspection Shiny and Shiny and Normal
smooth smooth
Presence of Inspection No lesions No lesions Normal
lesions
APPARATUS

Cornea
Color Inspection Black Black Normal
Texture Inspection Shiny and Shiny and Normal
smooth smooth
PUPILS
Color Inspection Black Black Normal
Reaction to light Inspection Pupils Equally Pupils Equally Normal
Round and Round and
React to Light React to Light
Accommodation Accommodation
(PERRLA) (PERRLA)
Size Inspection Equal Equal Normal
Shape Inspection Round and Round and Normal
constrict briskly constrict briskly
Symmetry Inspection Equal in size Equal in size Normal
Visual Acuity Inspection Able to real Cannot able to Due to damage
news print real news print. of the left
hemisphere of
the brain.
Visual Fields Inspection When looking With blurred Due to damage
straight ahead, vision and of the left
client can see cannot classify hemisphere of
objects in objects in the brain.
periphery periphery.
Ocular Inspection Eyes move Eyes move Normal
freely freely
NOSE
Symmetry, shape, Inspection Symmetrical, Symmetrical, Normal
size and color smooth and tan smooth and tan
Mucosa color Inspection Reddish to Reddish to Normal
pinkish pinkish
NASAL SEPTUM
Nares
Inspection Oval, Oval, Normal
symmetrical symmetrical
Nasal discharge Inspection No discharge No discharge Normal
Sinuses Inspection Not tender Not tender Normal
MOUTH
Secretion Inspection (neutral in without mucus Normal
color) without production
mucus
production

Lips Inspection Pinkish to Dark and brown Due to

Color slightly brown and cracking decrease
lips oxygen level
Symmetry Palpation Symmetrical Symmetrical Normal
Texture Palpation Soft, moist, Crack, rough s Normal
 smooth
Moisture Palpation Soft and moist Dry Due to
decrease
oxygen.
GUMS
Color Inspection Pinkish Pale Due to
decrease
oxygen.
Moisture Palpation Moist Moist Normal
BUCCAL
MUCOSA
Color Inspection Glistening pink Slightly pale Due to
decrease
oxygen.
Texture Palpation Soft Soft Normal
Moisture Palpation Moist Moist Normal
TOUNGE
Color Inspection Pinkish Slightly pinkish Due to
decrease
oxygen.
Size Inspection Medium Medium Normal
Symmetry Inspection Symmetrical Symmetrical Normal
Mobility Inspection Moves freely Moves freely Normal
UVULA
Location Inspection At the midline At the midline Normal
Symmetry Inspection Symmetrical Symmetrical Normal
TONSILS
Color Inspection Pinkish Pinkish Normal
Discharges Inspection No discharges No discharges Normal
TEETH
Color Inspection Ivory/yellowish Yellowish Normal
Number of teeth Inspection 32 28 Due to tooth
decay (teeth
extraction)
NECK
Position Inspection Head-centered Head-centered Normal
Movement Inspection Moves freely Moves freely Normal
Range of motion Inspection Full range No ROM Abnormal due
to
neuromuscular
impairement.
Consistency Inspection No enlargement No enlargement Normal
HEART
Heart rate Auscultation 60-100bpm 77 bpm Normal
Heart sounds Auscultation Clear, without Clear Normal
crackles
Lung field Auscultation Resonant Resonant Normal
THORAX &
LUNGS
POSTERIOR
THORAX
Symmetry Inspection Symmetrical Symmetrical Normal

Respiratory rate Inspection 12-20cpm 21 cpm Normal

Spinal Alignment Inspection Spine vertically Spine vertically Normal
align align
Skin integrity Inspection Skin intact Skin intact Normal
ANTERIOR
THORAX
Breathing pattern Auscultation Breathing is Breathing is Normal
automatic and automatic and
effortless, effortless,
regular and regular and
even and even and
produces no produces no
noise noise
Lung/ breath Auscultation Bronchia- Bronchia- Normal
sounds vesicular vesicular
ABDOMEN
Contour Inspection Flat Flat Normal
Texture Palpation Smooth Smooth Normal
Frequency and Auscultation Audible; soft Audible; soft Normal
character gurgling sound gurgling sound
occur irregularly occur irregularly
and rages from and rages from
5-30 mins 5-30 mins
UPPER
EXTREMITY
Skin color Inspection Tan Pale Due to
decrease
oxygen

Movement Inspection With ROM and With no ROM Due to

sensation and sensation neuromuscular
impairment
Size (arms) Inspection Equal Equal Normal
Symmetry Inspection Symmetrical Symmetrical Normal
Hair distribution Inspection Evenly Evenly Normal
distributed distributed
LOWER
EXTREMITY

Skin color Inspection Tan Pale Due to

decrease
oxygen

Movement Inspection With ROM and With no ROM Due to

sensation and sensation neuromuscular
impairment and
(+) weakness
 on right lower
extremities.
Size (legs) Inspection Equal Equal Normal
Symmetry Inspection Symmetrical Symmetrical Normal
Hair distribution Inspection Evenly Evenly Normal
distributed distributed
NEUROLOGICAL Due to
Level of Interview Can follow Unconscious decrease level
consciousness instructions and of
commands consciousness.
Behavioral and Interview Makes eye Does not make Due to
appearance contact with the eye contact with decrease level
examiner the examiner. of
consciousness
Mood Interview Expresses Expresses Normal
feelings which feelings which
corresponds to corresponds to
the examiner the examiner
MANNERISMS &
ACTIONS
LANGUAGE
Voice inflection Interview Clear and Aphasia Due to damage
strong of Broca’s area
in the brain and
muscle tone.
Tone Interview Fluent and Aphasia Due to damage
articulated of Broca’s area
in the brain and
muscle tone.
Manner and Interview Can give Cannot give Due to damage
speech appropriate answer or talk. of Broca’s area
answer to in the brain and
questions muscle tone.
MENTAL
STATUS
Orientation Interview Oriented with Disoriented with Due to
time time decrease level
of
consciousness
TIME
Recall recent and Interview Recall events Cannot recall Due to aphasia.
remote memory readily, events readily,
immediate immediate
recall of remote recall of remote
information information
Judgments and Interview Can make Cannot make Due to
thoughts logical logical decrease level
decisions decisions of
consciousness
Neurological Assessment (September 4, 2009)
Gloscow Normal Result Total GCS Interpretation
Coma Scale Values
Eyes Spontaneous- 4 To speech- 3 Total GCS= 8/15 8/15 pts., good
To speech- 3 points. prognosis
To pain- 2
None-1 (15 pts. Pt is
Verbal Oriental- 5 None- 1 alert, can follow
Confused- 4 simple
Inappropriate commands and
word- 3 is completely
None- 1 oriented to time,
Motor Obeys Flexion pain- 4 person and
command- 6 place.)
Localized pain-
5 (7 or less= pt is
Flexion pain- 4 comatose.)
Abnormal
flexion- 3 (3= indicates
Abnormal deep coma and
extension- 2 poor prognosis.z
Flaccid- 1

10.
 Cranial Nerve Date Done Normal Actual Result Interpretation
Result
Olfactory Nerve September 04. Can smell on Cannot able to Due to decrease
2009 both nostrils. extinguish smell LOC.
Optic Nerve With 20/20 Without 20/20 Due to the
vision vision. damage of left
hemisphere and
decrease LOC.
Occulomotor PERRLA PERRLA Normal
Nerve
Abducens Nerve Lateral Cannot move Due to the
movement. eyes in lateral damage of left
direction. hemisphere and
decrease LOC.
Trochlear Nerve Up and down Pt. cannot move Due to the
movement. eyes up and damage of left
down. hemisphere and
decrease LOC.
Trigeminal Nerve For touch and Pt. cannot Due to the
pain sensation. localize damage of left
sensation. hemisphere and
decrease LOC.
Facial Nerve Can smile, Cannot follow Due to the
frown, puff the specific damage of left
cheek and can command. hemisphere and
feel the cotton. decrease LOC.
Acoustic Nerve Can hear on Cannot follow Due to the
both ears. specific damage of left
command. hemisphere and
decrease LOC.
Glossopharengeal Can swallow. Inability to Due to the
swallow due to damage of left
presence of hemisphere and
NGT. decrease LOC.
Vagus Nerve Check for gag With NGT Due to the
reflex inserted. damage of left
hemisphere and
decrease LOC.
Accessory Nerve With strength on With no muscle Due to the
both shoulder. strength. damage of left
hemisphere and
decrease LOC.
Hypoglossal Sense of taste. Cannot localize Due to the
Nerve taste. damage of left
hemisphere and
decrease LOC.
 5. Laboratory Procedures
Laboratory Date Normal Result Nursing Nursing
Procedure Done Values Interpretatio Responsibilities
n
Creatine August 28, 53-115.0 63.6 Normal Pretest:
2009 Explain the
procedure to the
patient.

Instruct the
patient to wear
easily
manipulated
clothing to get
blood samples
easily.
HDL 0.78-2.21 1.30 Normal Tell the pt. to
relax because
the procedure is
painless.
Hematocrit 0.44 Normal Intra-test:
0.37-0.54 g/l Instruct the
g/l patient to look
away when the
needle is being
inserted.
Leucocytes 12.4 x Abnormal due Post-test:
5-10 x 10 10 g/l to infection Put cotton balls
g/l weakened on the puncture
immune site to avoid
response. bleeding.
Platelets 648 x Abnormal due Tell the patient to
150-450 x 10/l to blood clot rest after the
10/l formation. test.

12.
Laboratory Date Normal Values Result Nursing Nursing
Procedure Done Interpretation Responsibilities
August Color Yellow Normal Pre-test:
URINALYSIS 29, 2009 Straw/ yellow Explain the
amber procedure to the
pt. and how he
can cooperate.

Transparency Turbid Due to Provide privacy.

Clear infection
Reaction 6.0 Normal Intra-test:
4.5-8.0 Instruct the pt.
on how to get
urine samples (it
should be
midstream/
sterile
technique).

Specific 1.030 Normal Tell the pt. that

Gravity the procedure is
1.010-1.025 painless.
Sugar Negative Normal Post-test:
Negative Bring the urine
samples in the
laboratory.

Albumin Positive Due to nearly

Negative kidney
damage and
hypertension.

13.
6. Diagnostic Procedure
Diagnostic Date Done Result Interpretation Nursing
Procedure Responsibilities
Electrocardiogram September 1, Rhythm: Sinus Post-test:
Report 09 Sinus tachycardia Explain the
procedure to the
pt.and how he
can cooperate.
AL: Tell him to
120/m remove all
jewelry and
coins.
PR: Tell him to relax
0.20 sec. and lie still.
QRS: Intra-test:
0.40 sec. Monitor for the
result.
QT: Post-test:
0.32 sec. Assist the pt.
when he will
stand.
Axis: Remind him
+250 about his jewelry
and coins or any
metal he remove
will he is doing
the procedure.
 14.

7. Anatomy and Physiology

Cerebellum

The cerebellum is involved in the coordination of voluntary motor movement,

balance and equilibrium and muscle tone. It is located just above the brain stem and
toward the back of the brain. It is relatively well protected from trauma compared to
the frontal and temporal lobes and brain stem.

Cerebellar injury results in movements that are slow and uncoordinated.

Individuals with cerebellar lesions tend to sway and stagger when walking.

Damage to the cerebellum can lead to: 1) loss of coordination of motor

movement (asynergia), 2) the inability to judge distance and when to stop (dysmetria),
3) the inability to perform rapid alternating movements (adiadochokinesia), 4)
movement tremors (intention tremor), 5) staggering, wide based walking (ataxic gait),
6) tendency toward falling, 7) weak muscles (hypotonia), 8) slurred speech (ataxic
dysarthria), and 9) abnormal eye movements (nystagmus).

Cerebellum

The cerebrum is the part of the brain that occupies the top and front portions of
the skull. It is responsible for control of such abilities as movement and sensation,
speech, thinking, reasoning, memory, sexual function, and regulation of emotions. The
cerebrum is divided into the right and left sides, or hemispheres.

Depending on the area and side of the cerebrum affected by the stroke, any, or all, of
the following body functions may be impaired:

• movement and sensation

• speech and language
• eating and swallowing
• vision
• cognitive (thinking, reasoning, judgment and memory) ability
• perception and orientation to surroundings
• self-care ability
• bowel and bladder control
• emotional control
• sexual ability
 15.

Limbic System

The limbic system is a set of evolutionarily primitive brain structures located on

top of the brainstem and buried under the cortex. Limbic system structures are
involved in many of our emotions and motivations, particularly those that are related to
survival. Such emotions include fear, anger, and emotions related to sexual behavior.
The limbic system is also involved in feelings of pleasure that are related to our
survival, such as those experienced from eating and sex.

Broca's Area

An area located in the frontal lobe usually of the left cerebral hemisphere and
associated with the motor control of speech. Also called Broca's center.

Temporal Lobe

The temporal lobes are involved in the primary organization of sensory input
(Read, 1981). Individuals with temporal lobes lesions have difficulty placing words or
pictures into categories.

Language can be effected by temporal lobe damage. Left temporal lesions disturb
recognition of words. Right temporal damage can cause a loss of inhibition of talking.

The temporal lobes are highly associated with memory skills. Left temporal lesions
result in impaired memory for verbal material. Right side lesions result in recall of non-
verbal material, such as music and drawings.

Parietal Lobe

Damage to the left parietal lobe can result in what is called "Gerstmann's
Syndrome." It includes right-left confusion, difficulty with writing (agraphia) and
difficulty with mathematics (acalculia). It can also produce disorders of language
(aphasia) and the inability to perceive objects normally (agnosia).

Damage to the right parietal lobe can result in neglecting part of the body or
space (contralateral neglect), which can impair many self-care skills such as dressing
and washing. Right side damage can also cause difficulty in making things
(constructional apraxia), denial of deficits (anosagnosia) and drawing ability.

16.
Occipital Lobe

The occipital lobes are the center of our visual perception system. They are not
particularly vulnerable to injury because of their location at the back of the brain,
although any significant trauma to the brain could produce subtle changes to our
visual-perceptual system, such as visual field defects and scotomas. The Peristriate
region of the occipital lobe is involved in visuospatial processing, discrimination of
movement and color discrimination (Westmoreland et al., 1994). Damage to one side
of the occipital lobe causes homonomous loss of vision with exactly the same "field
cut" in both eyes.

Frontal Lobe

The frontal lobes are considered our emotional control center and home to our
personality. There is no other part of the brain where lesions can cause such a wide
variety of symptoms. The frontal lobes are involved in motor function, problem solving,
spontaneity, memory, language, initiation, judgement, impulse control, and social and
sexual behavior. The frontal lobes are extremely vulnerable to injury due to their
location at the front of the cranium, proximity to the sphenoid wing and their large size.

17.
8. Pathophysiology (Patient Base)
Pathophysiology (Book Base)
9. Drug Study

Drugs Classification Indication Side Nursing

Effect Responsibilities
Generic Diuretic Reduction of Pulmonary • Monitor blood
Name: intracranial congestion, pressure.
Mannitol pressure and fluid and
brain mass. electrolyte • Check for
Brand imbalance, hypervolemia,
Name: electrolyte urinary tract
Osmitrol loss, dryness obstruction
of mouth, and signs of
thirst, marked fluid
diuresis, imbalance.
urinary
retention,
edema,
headache,
blurred vision,
convulsions,
nausea,
vomiting,
rhinitis, arm
pain, skin
necrosis,
chills,
dizziness,
dehydration,
hypotension,
tachycardia,
fever and
angina-like
chest pains.
Generic Anti-hypertensive Severe essential Difficulty of • Patient must
Name: drug hypertension breathing, avoid
Hydralazine when the drug swelling of orthostatic
cannot be given face, lips, position.
Brand Name: orally or when tongue or
Apresoline there is an throat, fast • Pt. must get
urgent need to pounding up slowly to
lower blood heart beats, avoid fall.
pressure. numbness, • Monitor Bp.
joint pain and
loss of
appetite.
Generic Anti-hypertensive Metoprolol Tiredness and • Metoprolol
Name: drug tartrate tablets dizziness, should be
Metropolol are indicated for Shortness of used with
the treatment of breath, caution in
Brand Name: hypertension. diarrhea and patients with
Neobloc They may be alopecia. impaired
used alone or in hepatic
combination function.
with other • Should not be
antihypertensive given in
agents. breast
feeding
mother.
Generic Anti-thrombosis Treatment of Nausea, • Take Aspirin
Name: mild to vomiting, by mouth with
Aspirin moderate pain; tinnitus, or without
fever; various dizziness, food. If
Brand Name: inflammatory respiratory stomach
Zorprin conditions; alkalosis, upset occurs,
reduction of risk metabolic take with food
of death or MI in acidosis, to reduce
patients with hemorrhage, stomach
previous convulsions. irritation.
infarction or
unstable angina • Swallow
pectoris or Aspirin whole.
recurrent Do not break,
transient crush, or
ischemia attacks chew before
or stroke in men swallowing.
who have had
transient brain • Take Aspirin
ischemia with a full
caused by glass of water
platelet emboli. (8 oz/240
mL).
Generic Cerebral Disturbances of Dropped • Monitor blood
circulation consciousness blood pressure.
Name:
stimulant associated with pressure, • Check for the
Nicholin head and brain chest correct site
injury. discomfort, for injection.
Brand Name:
dyspnea,
Citicoline nausea,
headache and
dizziness.
21.
 10. Diet and Activity

Activity Date Ordered Indication Nursing

Responsibilities
Turn side to side August 28, 2009 To prevent bed Accompany the
(every 2 hrs.) sores and relative whenever
pneumonia. mobility is done
(q2 hrs.)

Diet Date Ordered Indication Nursing

Responsibilities
Osteorize August 30, 2009 To prevent Make sure that the
feeding aspiration (NGT). NGT is intact
whenever feeding is to
be made.

Check for stomach

content to prevent
overfeeding.

23.
 11. SOAPIE (actual)

Subjective
“Nahihirapan siyang magsalita, kung minsan umuungol din siya, as verbalized
by Mr. D’s wife.”

Objective

Received pt. on lying position on bed, unconscious , with ongoing PNSS 1L

regulated @ 10-15 gtts./min. (KVO) 200 ml. level infusing well @ left hand.
(+) difficulty in speaking
(+) weakness
(+) headache
(+) dizziness
(+) blurred vision
(+)Paralysis on right part of the body
With NGT inserted
With Foley catheter inserted

Assessment
Impaired verbal communication related to impaired cerebral circulation possibly
evidence by impaired articulation.

Planning
After 4-6 hrs. of N.I the patient will learn techniques on how to communicate
with others.

Interventions
 Established rapport.
 Monitored and recorded vital signs.
 Maintained good verbal/ non-verbal means of communication.
 Thought the patient that loss of ability to talk does not mean loss of
intelligence.
 Provided time for the patient to respond.
 Conversation should be continue to practical and concrete matter,
supplemented with gestures, pictures, and object.
 Medications compliance on time (with the doctor’s permission).

Evaluation
Goal met as evidence by the patient learn techniques on how to communicate non-
verbal cues and in which needs are can be expressed.
24.
11. SOAPIE (potential)

Subjective:

Objective

Received pt. on lying position on bed, unconscious , with ongoing PNSS 1L

regulated @ 10-15 gtts./min. (KVO) 200 ml. level infusing well @ left hand.

(+) difficulty in speaking

(+) weakness
(+) headache
(+) dizziness
(+) blurred vision
(+)Paralysis on right part of the body
With NGT inserted
With Foley catheter inserted

Assessment
Risk for aspiration related to decreased level of consciousness.

Planning
After 2-4 hrs. of N.I the client/ SO shall be able to identify causative factor that
may lead to aspiration.

Interventions
 Established rapport.
 Monitored and recorded vital signs.
 Monitored administration of NGT feeding.
 Checked for the NGT if intact in the stomach.
 Provided information about the effect of aspiration in the lung.
 Always keep the bed elevated whenever feeding.
 Keep wire cutter or scissor at bedside all the time.

Evaluation
 Goal partially met as evidence by the pt./SO was able to avoid factors that may
cause aspiration.

25.

13. Conclusion

We therefore conclude that CVA or stroke may lead to permanent brain

damage or death to individuals with sedentary lifestyle. People who consumed large
amount of food high in cholesterol, alcohol, cigarette smoking, obesity, and high blood
pressure can increase the possibility of stroke. This may also lead to heart disease
and maybe worsen if we don’t prevent the common factors that cause Stroke. Self
discipline is very important for us not to acquire this feared or killing disease.
 26.
14. Recommendations

For the Patient and Family Members

Patient and family members should be given proper instruction and knowledge
on how to help the patient to cope in his condition. Dealing with emotional stress and
changing his sedentary lifestyle can reduce the risk of stroke. Patient way of living
should be carefully understand to limit the anxiety and self-pity. Showing emotional
and moral support can aid the anxiety and self-pity. If family members adjusted to this
kind of treatment to the patient, a fast recovery can be possibly.

For Health Care Provider/ Institutions

Cerebrovascular accident is one of the most common disease that cause dead
in the world. It can happen to anyone, especially to those of people who have
sedentary lifestyle and most commonly to people who acquired it through genes.
Though we don’t know when it will come, we have to be aware of the main factors that
bring our lives into danger. Maintaining good lifestyle and avoiding smoking, alcohol
intake, high fat and salty food, exercise, and low sugar food can decrease the possible
stroke. Health care provider and Institutions should give the enough knowledge to
everyone. Dealing with this kind of condition is one of the healthy processes of fast
recovery. It helps the patient and family members to adapt this knowledge and
behavior for the sake of the wellness of their love ones.
 27.

15. Bibliography

Website source:

http://www.lancastergeneral.org/content/search.htm?
inCtx9txtKeyword=CVA&inCtx9cmdKeywordSearch=search&inCtx9txtMode=site

http://www.lancastergeneral.org/content/stroke_2008_physician_chronicles.htm

http://ww2.allina.com/ac/pharmacy.nsf/

http://www.supportafterstroke.com/whatisahemorrhagicstroke.html

http://adam.about.com/reports/Stroke.htm

http://www.sciencedaily.com/releases/2008/06/080625123002.htm

http://brainmind.com/LeftHemisphere.html

http://psychology.wikia.com/wiki/Cerebrovascular_accident

http://answers.yahoo.com/question/index?qid=20070902172810AApbHou

http://healthlibrary.epnet.com/GetContent.aspx?token=af362d97-4f80-4453-a175-
02cc6220a387&chunkiid=30616

http://www.neuroskills.com/search/search.php

http://dictionary.reference.com/browse/broca%27s+area?qsrc=2446

http://biology.about.com/sitesearch.htm?terms=frontal%20lobe&SUName=biology&TopNode=99

Book Source:

NANDA Book

Medical-Surgical Nursing

Anatomy and Physiology

Mims Annual
 28.

The objective of the information in past and future anatomy articles is about
generalizations. My intent is not to address specifics. The objective is to provide
information and education. The left brain hemisphere, or logic brain, acts as a feature
combiner and comprehends spoken language by performing phonetic analysis of the
sounds, as opposed to the right brain method of comprehending language by matching
acoustic sound patterns. The left brain has the ability to extract isolated details from
spoken words or sentences, can generate correct spelling from scratch and can learn
from reading by reading for meaning even if the topic is dull. Where the right brain lacks
the short-term memory capabilities to be able to follow long sentences and extract their
meanings, the left hemisphere can. If a sentence is long and complex grammatically, it
falls into the realm of the left hemisphere for comprehension and de-coding for meaning.
The left hemisphere is able to work with both slow and rapid speech where the right brain
can only deal effectively with slow speech. Complex syntax, semantics, phonics, sight
words, new vocabulary (read or heard) are all shuttled to the left brain for comprehension.
The left brain is also where re-worded sentences or explanations, even if redundant, are
processed. The information processing that one hemisphere isn’t capable of processing is
switched to the other via the corpus callosum. The left hemisphere’s speaking and
listening vocabulary is almost as large as that for reading and sight and allows it to be
able to equally extract meaning from written or spoken words. When we read and hear
the words in our head, they’re formed (sub-vocalized) in the left brain because it, and not
the right hemisphere, has the ability to de-code written words acoustically. The left brain
doesn’t have the ability to handle ambiguity (needs absolutes, clear cut patterns and
predictability), doesn’t handle receiving input from changing sources, doesn’t do well if
required to make changes in solution strategies or changes in timing of responses. Left is
the logical and analytical side and processes information in a sequential manner. It works
best with life and projects when they’re presented in a planned and structured manner.
It’s the side that works best with multiple choice questions, prefers authority structuring,
controls feelings, is future oriented and time conscious, sees distinct right or wrong
according to the prevailing cultural/beliefs system and discerns sharp perceptual and
conceptual boundaries. This makes the left brain more involved in seeing differences
when dealing with others who are felt to be of lower caste or intelligence. Even though the
left brain prefers talking and writing it’s also the hemisphere that’s more likely to suspect
everyone and alienate friends. Those who are left brain dominant are more likely to buy,
buy, buy, test the limits of credit cards (and their ability to pay) clean everything, buy
everything and stock up for suspected or unknown eventualities, reorganize shelves,
cupboards, retrace their steps and reorganize shelves, etc. perpetually. They’re also
more likely to quit their job before being fired. If we go back and review the information on
all aspects of the brain it’s easy to see why we have differences and difficulties.
Fortunately, few of us are totally dominated by one hemisphere or the other. If that were
the case it would be a world of, “In this corner are the right brainers and in this corner the
lefties. Prepare your agendas and come out fighting.” Which, by the way, is how we seem
to handle most difficult problems anyway? All of us are endowed with two sides of the
brain and a way for the information to travel from one hemisphere to the other. The brain
is the area that heredity can be the largest or smallest factor in the way we interpret life
around us. If we don’t like our life and our health, the brain gives us the means with which
to change. The choices are also up to one of the brain’s functions but the mind and the
brain aren’t the same.