I.

INTRODUCTION

A stroke which is medically known as cerebrovascular accident (CVA) occurs when a blood
artery bursts or becomes blocked, cutting off blood supply to a portion of the brain.
Cerebrovascular accidents or strokes, come in two primary forms but both kinds of stroke cause
brain cells to die by depriving certain areas of the brain of blood and oxygen. First is the most
frequent type of stroke known as ischemic stroke which are brought on by blockages. It happens
when a blood clot obstructs a blood artery, preventing oxygen and blood from reaching a certain
area of the brain. Second is known as hemorrhagic strokes which are brought on by blood vessel
ruptures. According to American Stroke Association (2019) when a blood vessel bursts or
hemorrhages and stops the blood flow to a portion of the brain, it can result in a hemorrhagic
stroke. Therefore any blood artery in the brain or the membrane enclosing the brain could be the
site of the hemorrhage.

According to World Health Organization (2021) the most important behavioral risk factors
of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use and harmful use of
alcohol. In which the effects of behavioral risk factors may show up in individuals as raised blood
pressure, raised blood glucose, raised blood lipids, overweight and obesity. On the other common
signs and symptoms that both hemorrhagic and ischemic strokes manifest are dizziness, nausea,
loss of appetite, seizures, fainting, one sided weakness and slurred speech.

However, depending on the patient and the location of the stroke in the brain, different people
may experience different symptoms. Thus on United Kingdom in 1998 the acronym “FAST” was
first introduced and has been used by the National Stroke Association, American Heart Association
and others to educate the public on detecting symptoms of a stroke. In which the acronym FAST
stands for Facial drooping, Arm weakness, Speech difficulties and Time. Then the stroke experts
at Beaumont Health created an updated acronym: “FASTER” – which adds two additional, but
key, stroke symptom indicators.

To diagnose the patient of CVA, the doctor will require a cranial CT scan plain where it can
assist in identifying regions of the brain that exhibit anomalies and help decide if these regions are
brought on by a broken blood vessel which leads to hemorrhagic stroke or inadequate blood flow
leading to ischemic stroke, or some other problem entirely along with hematology and chemistry
 Alongside with this, the course of treatment for a stroke is contingent upon its nature. But as
for the medical management on the patient’s case, medication such as Tegretol, Baclofen,
Alprazolam, Vitamin B, NAC Calvin plus and treatment of EnPlus gold are prescribed. Other
medications include Citicoline, Metclopramide, Rosuvastatin, Piracetam, Felodipine, Clopidogrel,
and Diazepam. While immediate single order includes Metclopramide, Diazepam and Mannitol.

For nursing management, it often focus by allowing adequate time for the patient’s response
and providing opportunities for spontaneous conversation to improve the speech of the patient.
Furthermore, in improving the physical mobility related to dizziness, patient is encourage to
perform activity more slowly, in a longer time with more rest or pauses and with assistance if
necessary. In addition, when feeding a client, patience and allowing enough time to complete the
meal and encourage nutritional supplements and healthy snacks between meals are included

In accordance with the morbidity and mortality, according to Stroke Society of the
Philippines (2020) stroke is the primary cause of morbidity and the second major cause of mortality
in the country. Its prevalence of 0.9% comprises of ischemic stroke for 70% of cases, while
hemorrhagic stroke accounts for 30%. Leading to total stroke deaths in the Philippines of 87,402
in 2017, or 14.12% of all deaths according to the most recent WHO data released. Therefore
Philippines’ age-adjusted death rate of 134.74 per 100,000 people, places it #29 in the world.
II. ANATOMY AND PHYSIOLOGY
 A stroke is called a cerebrovascular disorder because it affects the brain (cerebro-) and the blood
vessels (vascular) that supply blood to the brain. Nervous system is your body’s decision and
communication center. The central nervous system (CNS) is made of the brain and the spinal cord
meanwhile the peripheral nervous system (PNS) are made up of nerves. Brain which is the most
powerful organ yet weighs only about three pounds and has a texture similar to firm jelly. The
brain has 3 main parts, the cerebrum, cerebellum and brain stem.

Cerebral Vascular Accident damages the brain stem and affects some of the cranial nerves.
Strokes that damage the brain stem can also affect both sides of the body. (The brain stem connects
the cerebrum, which is the largest part of the brain, with the spinal cord. Cranial nerves directly
connect the brain and the brain stem with the eyes, ears, nose, and throat and with various parts of
the head, neck, and trunk.) . Blood is supplied to the brain through two pairs of large arteries: the
internal carotid artery and vertebral carotid artery.

But due to the building up thrombosis, the blood can no longer flow normally to the blood
vessel which may cause a rupture of blood vessel or it puts pressure against the blood vessel leading
to lack of blood supply in brain which may result to a hemorrhagic stroke. In some instances like
in ischemic stroke, the blood will be block by the building up of thrombosis and the blood supply
is cut off leading to a stroke.
III. PATHOPHYSIOLOGY
 There are several risk factors of CVA. The modifiable risk factors or what we call the
predisposing factors are high blood pressure, high cholesterol, irregular rhythm changes, diabetes,
smoking, previous TIA and excessive alcohol intake. When it comes to the precipitating factors or
non-modifiable risk factors are older age, gender, race ethnicity and genetics or hereditary.

There are 2 types of CVA, the ischemic and hemorrhagic. In ischemic, there is a building up of
thrombosis, because of this growing thrombosis, it will blocks the flow of the blood which may
cause a lack of blood supply and makes the tissue/cells dies leading to a stroke or, there is a
building up of thrombosis, sooner or later, other parts of thrombosis will breaks off and it will
travel to the bloodstream, this is now called an embolus. When this embolus blocks or stucks at
the blood vessel, this is now called embolism. Because of the blockage, the blood supply will cut
off and this makes the tissue/cells dies, there will be a necrosis leading to a stroke.

Another type of CVA is hemorrhagic stroke. In hemorrhagic, there is also a building up of

thrombosis which may grow in the blood vessels that’s why the blood goes to the smaller opening
of the vessels. Just like the ischemic stroke, the thrombosis will also breaks off and travels to the
bloodstream (embolus) and blocks or stucks in the blood vessel (embolism), because of the
blockages, the blood puts pressure against the blood vessels and then it will form a little bubble
inside or what we call aneurysm. And then the aneurysm may break and blood comes out of the
bloodstream (leaking) which may cause the nerves on the brain dies or necrosis leading to a
hemorrhagic stroke.
 IV. NURSING HISTORY

1. Present Health History

1 month PTA, patient noticed that she has a sudden dizziness but she ignored it since she
thought that she was just tired after cleaning the backyard in the middle of the day. No other
associated signs and symptoms are reported.

3 weeks PTA, there is still presence of dizziness but she ignored it and she thought that it
was just because of the warm temperature.

2 weeks PTA, dizziness has become frequent even in small activities but all she did was
drink lots of water and rest. No check-up nor medication was taken.

1 week PTA, patient was advised by her daughter for check-up because she finally told
them about what she feels but the patient did not comply for the reason that she has an event
that needs to be attended.

2 days PTA, patient experienced loss of appetite as well as dizziness and the patient was
advised by her daughter to have a check-up first thing in the morning and the patient finally
complied.

1 day PTA around 7:00 PM, patient experienced dizziness associated by loss of appetite.

6 hours PTA around 2:00 AM, patient is still experiencing dizziness now associated
w/slurred of speech persistence and was admitted to The Lord’s Hospital at exactly 8:30 AM.

2. Past Health History

Patient R.A has known Hypertension for approximately 27 years and intake of Amlodipine
for 3 years but is non-compliant with the medication. For hospitalizations, patient has been
hospitalized twice for Caesarean Section. Aside from this, no known allergies to food and
medications nor diseases are reported
 V. REVIEW OF SYSTEM

AREA METHOD NORMAL ACTUAL CLINICAL

FINDINGS FINDINGS SIGNIFICANCE
November 12,
2023
Neurologic Inspection Level of The patient’s Slurred speech due to
awareness and level of weakness or
interaction with awareness and incoordination of the
the environment interaction with muscles involved in
should be good the environment speaking is called
without a slurred is good but with dysarthria and is a
speech and only a slurred physical, not a
dizziness. speech and language, problem. A
Sensation should dizziness. CVA can also change
be intact Sensation is the way your brain
bilaterally. intact bilaterally. controls balance, and
you could feel
unsteady or
uncoordinated.
Musculoskeletal Inspection Movement should Patient’s A CVA can change
be coordinated movement is the way your brain
and moderate, uncoordinated controls balance, and
there should be and slow, there you could feel
no tremors during are tremors unsteady or
movement, and during uncoordinated.
the muscles movement, and Uncoordinated
should be strong. the muscles are movement is due to a
weak. muscle control
problem that causes
 an inability to
Coordinate
movements
Gastrointestinal Inspection Abdomen should Abdomen is soft, Central causes of
and be soft, symmetric, and dysphagia in CVA
Palpation symmetric, and non-tender patients include
non-tender without damage to the cortex
without distention. There or brain stem, and
distention. There are visible scars peripheral causes
should be no in the lower include damage to the
visible lesions or abdomen. There nerves or muscles
scars. There is a presence of involved in
should be no difficulty swallowing
presence of swallowing
difficulty on (dysphagia).
swallowing
(dysphagia).
Cardiac Auscultatio Upon Upon A frequent irregular
n auscultation, there auscultation, rhythm may mean that
should a regular there is an your heart is not
rhythm. irregular rhythm pumping enough
changes. blood to your body. It
occurs when the atria
beat irregularly. This
irregular beating can
lead to blood pooling
within the atria and
the formation of clots.
If these clots travel to
the brain, they can
cause a CVA.
 VI. COURSE IN THE WARD

Upon admission on November 12, 2023, with the following vital signs: BP 180/100, HR:
74, RR: 22. Laboratories here requested and done such as CBC, platelet, Na, K, SGPT,
SGOT, creatinine, capillary blood glucose (CBG), antigen test, chest x-ray, and Cranial CT
Scan.

The patient was placed in nothing per orem then low salt, low fat, SAP diet (strict
aspiration precaution), started infusion of PNSS 1L x 16 hours.

Medications were started as follows: Citicoline 1 g thru IV q12, Rosuvastatin 10 mg/tab

HS, Piracetam 1.2 g/tab OD. Felodipine 5mg, Clopidrogel + Aspirin OD, Metoclopramide 1
amp thru IV now, Diapezam 5mg thru IV now. Mannitol 75 cc q6 thru IV, Tegretol 200 mg
TID, Baclofen 10mg ½ tab TID, Vitamin B OD, NAC 600mg/tab in ¼ glass of water TID,
Calvin plus/tab HS, Enplus Gold 4 scoops in 1 glass H20 TIB
 VII. LABORATORIES

Blood Chemistry was conducted to Patient R.A on November 12, 2023

BLOOD CHEMISTRY REPORT

PARAMETER NORMAL ACTUAL REMARKS CLINICAL
VALUES FINDINGS SIGNIFICANCE
NOVEMBER
12, 2023
CBG 70.00- 130.00 102 NORMAL
mg/dl
CREATININE 53.00-106.00 97.24 NORMAL
umol/l
SODIUM 135.00-145.00 135.1 NORMAL
POTASSIUM 3.50-5.30 mmol/l 3.42 DECREASED A low potassium
level can make
muscles feel
weak, cramp,
twitch, or even
become
paralyzed, and
abnormal heart
rhythms may
develop.
SGPT 5.00-40.00 U/L 35.2 NORMAL
SGOT 10.00-40.00 U/L 35.7 NORMAL
 Hematology was conducted to Patient R.A on November 12, 2023

HEMATOLOGY REPORT
PARAMETER NORMAL VALUES ACTUAL FINDINGS REMARKS CLINICAL
NOVEMBER 12, SIGNIFICANCE
2023
HEMOGLOBIN 125-160 g/L 150 NORMAL
HEMATOCRIT 0.38-0.50 0.45 NORMAL
LEUKOCYTE 5-10×10^9/L 6.5 NORMAL
NEUTROPHILE 0.40-0.60 0.77 INCREASED High neutrophils
means the body
is under stress.
The elevation
can be caused by
many different
conditions and
may be an
indicator of a
severe infection,
an inflammatory
disorder, or
cancer. High
levels of
neutrophils may
indicate a severe
infection or
stress on the
body.
LYMPHOCYTE 0.20-0.40 0.23 NORMAL
PLATELET 150-350 200 NORMAL
 VIII. DRUG STUDY

DRUG NAME MECHANISM OF ACTION INDICATION ADVERSE EFFECT NURSING

RESPONSIBILITIES
GENEREIC: The B-complex vitamins act To treat and prevent vitamin CNS: Headache, dizziness,
 Verify client’s identity.
Vitamin B complex as coenzyme and are essential deficiency insomnia, fatigue, tiredness
 Inform client of the purpose
for metabolism of proteins,
BRAND: Aduvit of the drug.
carbohydrates and fatty acids CONTRAINDICATI ON: Derma: Rash, pruritus,
CLINICAL:  Document all relevant data
Sensitivity to any of the sweating, dry MM,
Therapeutic anti-
ingredients included in the stomatitis
anemics, food sup-
medication
lements
Gl: dyspepsia, Gl pain,
DOSAGE: 350mg diarrhea, vomiting,
TAB OD
constipation

GU: Dysuria, renal

impairment

MS: arthralgia, back, limp

or neck pain

DRUG NAME MECHANISM OF ACTION INDICATION ADVERSE EFFECT NURSING

RESPONSIBILITIES
GENEREIC: Citicoline is derivative of CVA acute and recovery phase  Headache  Monitor blood pressure,
Citicoline choline and cytidine involved and S/SX cerebral insufficiency  Dizziness pulse rate and heart rate.
BRAND: Nicholin in the biosynthesis of lecithin. It e.g. dizziness headache, poor  Monitor for adverse effect;
 Shaking hands or feet
is claimed to increase blood concentration, memory loss, instruct patient to report
CLINICAL: Noo-  Sleepiness
tropic agent flow and oxygen consumption disorientation, recent cranial immediately if she develops
 Change in pulse rate
in the brain. trauma and their sequence chest tightness, tingling in
 Change blood pressure
mouth and throat, headache,
 Diarrhea
CONTRAINDICATI ON: diarrhea, and blurring vision.
DOSAGE: 1g IV  Nausea
Hypertonia of parasympathetic
Q12H
 Stomach pain
nervous system.
 Blurred vision

DRUG NAME MECHANISM OF ACTION INDICATION ADVERSE EFFECT NURSING

RESPONSIBILITIES
GENEREIC: Interferes with cholesterol Adjunct to diet therapy in  Potential for ocular lens  Monitor serum cholesterol,
Rosuvastatin biosynthesis by inhibiting patients w/primary hyper- opacities. HDL, LDL, triglycerides for
conversion of the enzyme lipidemia & mixed dysli-  Hypersensitivity reaction therapeutic response. Lipid
BRAND: Crestor
HMG-CoA to mevalonate, a pidemia; To decrease elevated  Hepatitis levels should be monitored
CLINICAL: Anti-
hyperlipidemic precursor to cholesterol. total, LDL cholesterol, serum  Rhabdomyolysis within 2–4 weeks of
triglyceride levels; increases initiation of therapy or
Therapeutic Effect: Decreases HDL. change in dosage
LDL, VLDL, plasma, trigly-  Monitor daily pattern of
DOSAGE: 10mg ceride levels; increases HDL CONTRAINDICATI ON: bowel activity, stool
TAB OD HS
concentration. Hypertonia of statin drugs consistency.
 Assess for headache, sore
throat. Be alert for myalgia,
 weakness

DRUG NAME MECHANISM OF ACTION INDICATION ADVERSE EFFECT NURSING

RESPONSIBILITIES
GENEREIC: Inhibits calcium movement Hypertension  Overdose produces  Assist with ambulation
Felodipine across cardiac, vascular smooth nausea, drowsiness, if dizziness occurs.

BRAND: Plendil
muscle cell membranes. CONTRAINDICATI ON: confusion, slurred  WOF peripheral edema
Hypersensitivity to Felodipine speech, hypotension, and bradycardia, flushing
CLINICAL: Anti-
hypertensive Therapeutic Effect: Relaxes or other calcium channel bradycardia.  Monitor hepatic
coronary vascular smooth blocker. function.
muscle and causes vasodilation.  Question for headache,
Increases myocardial oxygen asthenia.
DOSAGE: 5mg delivery. Reduces B/P
TAB OD

DRUG NAME MECHANISM OF ACTION INDICATION ADVERSE EFFECT NURSING

RESPONSIBILITIES
GENEREIC: Active metabolite irreversibly Reduce risk of stroke, Ml, or  Agranulocytosis, aplastic  Monitor PLT count for
Clopidogrel blocks P2Y12 component of vascular death in patients with anemia/pancytopenia thrombocytopenia.

BRAND: Plavix
ADP receptors on platelet recent Ml, noncardioembolic  TTP  Assess Hgb, Hct, for
CLINICAL: Anti- surface, preventing activation stroke, peripheral artery  Hepatitis, hyper- evidence of bleeding;
PLT
of GPIIb/IIIa receptor complex. disease in non-STEMI/STEMI sensitivity, anaphylactoid serum ALT, AST,
bilirubin, BUN,
Therapeutic Effect: Inhibits CONTRAINDICATI ONS: creatinine for s/sx of
platelet aggregation. Hypersensitive to Clopidogrel, hepatic insufficiency
DOSAGE: 75mg
TAB AM active bleeding during therapy.
 IX. NURSING CARE PLAN

ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION

S: “Kailangan ko pa ng After 2 days of nursing 1. Passive ROM to all *Promotes circulation, The goal was met as
kasama bago ako interventions, the patient limbs and progress to muscle tone, joint evidenced by the patient
makagalaw” will be able to perform assistive and then active flexibility, prevents was able to able to perform
self-care activities within ROM in all joints four contractures and weakness. self-care activities within
O: level of own ability. times a day. level of own ability.

 Impaired capability to
put on or take off 2. Use assistive devices for *Provides safe support and
clothing ambulation and activities promote independence
 Inability to ambulate
autonomously 3. Review safety concerns *Reduce risks of injury

 Inability to bathe self and modify activities or

environment

Nursing Diagnosis:
Self-Care Deficit related to 4. Begin with familiar, *Encouraged client and
musculoskeletal impair- easily accomplished limit fatigue
ment secondary to CVA tasks.

ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION

S: “Nahihilo po ako‖ as After 3 hours of nursing 1. Establish guide- *Working with pt helps to The goal was met as
verbalized by the patient.” interventions, the patient lines and goals of activity incorporate therapy in the evidenced by the patient’s
will be able to verbalized with the patient. plan of patient’s ADL verbalized of effectiveness
O: the effectiveness and and improvement of
 Generalize d weakness. improvement of activity 2. Encourage to *Help pt become more activity intolerance by
intolerance by perform activity more tolerate of activity demonstrating the
 ADLs inability
demonstrating the slowly, in a longer time improvement of her
 VS: T=36.6°C, BP=
improvement of her with more rest or pauses or condition.
180/100, PR=74, RR=22
condition. with assistance PRN

Nursing Diagnosis:
3. Encourage to *Gradual escalation
Activity intolerance and
perform physical activity minimizes overexertion
impaired mobility related
consistent with the
to present condition
patient’s energy levels.

4. Encourage gradual *To improve tidal volume

increase activity with and boost circulation
active ROM in bed,
increasing to sitting and
then standing.

5. Encourage the *Enables healthcare

client to adhere importance practitioner to accurately
of treatment regimen. evaluate patient status

ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION

S: “Sa tuwing nagsasalita After 3 hours of nursing 1. Assess patient’s primary *Facilitate information The goal was met as
po ako parang hirap na intervention, the patient and secondary means of transfer evidenced by the
hirap ako o di kaya will be able to use effective communication. patient’s demonstrated
nahihirapan silang communication the effective comm-
intindihin ang sinasabi techniques. 2. Assess kind of aphasia *Help to tailor unication techniques.
ko.” that the patient has. interventions

O: 3. Allow adequate *Decreases

 Speaks too slowly than time for patient’s response. communication issues
intended.

 Sounding hoarse, harsh, 4. Provide oppor- *Allow patient to speak

and robotic. tunities for spontaneous without worrying of
conversation outcome
 Slurring

5. Teach techniques to *Encourages patient and

Nursing Diagnosis:
improve speech by initially boost confidence
Impaired verbal
asking questions that client
communication related
can answer with a: yes/no
to cerebral impairment
as evidenced by slurring.
 X. HEALTH TEACHING

MEDICATION  Educate the patient that it is important that the medications are takes as
prescribed by the physician. Once medications are ordered, it is essential for
the patient to comply.
 Advice patient to take medicines exactly as directed. Don’t skip doses.
 Provide information about benefits of medication, dosage, and the expiration.
 Instruct the patient to seek medical check-up right away if symptoms persist
after taking the medication
ENVIRONMENT  Advice the patient and the family that in order to avoid falls, remove loose
carpets and runners in hallways and stairwells or fasten them with non-skid
tape to improve traction
 Instruct the patient to Install a light switch near the bed
 Advice patient and the family to minimize environmental clutter and
distractions. Too much visual or auditory (sound) stimulation in the
environment may be dangerous and may be confusing. Providing calm and
quiet surroundings can help the patient to recover faster.
TREATMENT  Monitoring of vital signs and taking noted of any deviation from normal value.
Inform the physician of any abnormalities
 Instruct the patient to monitor their cholesterol level and blood pressure.
 Inform the patient about the possible risk of her condition.

HYGIENE  Encourage the family of the patient to assist the patient in bathing as a
fundamental aspect of maintaining the patient's hygiene.
 Advise the patient to use fluoride toothpaste: If possible, use fluoride
toothpaste or chlorhexidine gel to ensure the mouth is treated appropriately.
 Instruct the patient and/or the family of the patient to wash her face daily and
take a bath daily using a mild soap.
 Instruct the patient to brush her teeth every after eating
 Educate the patient to do hand washing before eating and after defecating
OUT PATIENT  Observe scheduled follow up and check-ups to monitor any notable changes
 Take physician prescribed medication as scheduled
 Instruct to monitor for sudden changes in blood pressure and other vital signs
 Instruct the family of the patient to help him to maintain a healthy body by
giving a healthy diet and encouraging the patient to do light exercise regularly.
 DIET  Instruct patient to perform exercises to evaluate range of motion, strength on
the affected and unaffected side, bed mobility,
 Advise the patient to follow Mediterranean diet wherein this diet has been
associated with a lower level of oxidized LDL
 Instruct the patient to limit foods high in saturated fat such as cakes, pastries,
pies, processed meats, commercial burgers, pizza, fried foods, potato chips,
crisps and other savory snacks.
 Encourage the patient to eat despite low appetite after a CVA
 Educate family to pay attention to what foods that the patient finds most
palatable at home
 Encourage eat higher calorie and more substantial, nutrient-dense foods.
SAFETY/SPIRIT  Advice the patient and the family that in order to avoid falls, remove loose
UAL/SEXUAL
carpets and runners in hallways and stairwells or fasten them with non-skid tape
to improve traction
 Instruct the patient to install a light switch near the bed
 Advice the patient and family to minimize environmental clutter and
distractions, too much visual or auditory (sound) stimulation in the
environment may be dangerous and may be confusing. Providing calm and
quiet surroundings can help the patient to recover faster.
 Encourage patient to pray to God, to strengthen their faith and believe in him.
 Create an open and non-judgmental environment where patients feel
comfortable sharing their spiritual or religious beliefs.
 Actively listen to the patient’s concerns and showing
 Empathy and understanding
 XI. EVALUATION (KSA)

At the end of the study, the objectives were achieved, and health education was performed and

verbalized to raise parental awareness and prevent recurrence. The student nurse was able to use the nursing

process to address the problem of the patient and was able to formulate nursing intervention and determine

the characteristics and risks factors of CVA. In addition, the nurse was able to apply nursing intervention

and promote health teaching to the patient’s daughter. Also, facilitate cooperation by establishing or

building a trust relationship between the student nurse, patient, and her daughter.

The daughter was able to enhance their knowledge by effectively increasing their awareness and

understanding about the long-term management of CVA. The daughter was able to apply all the learning’s

they learned upon the health teaching and was able to utilize lifestyle modification such as physical

activities and diet. Moreover, the daughter was able to collaborate with their health care provider and build

a therapeutic relationship.

The nursing theory that is related to this case study is the Self-Care Deficit Theory developed as a result

of Dorothea Orem working toward her goal of improving the quality of nursing in general hospitals in her

state. As a nurse, considering the scenario, assessing the client condition, taking care and providing holistic

care by utilizing the elements or components of Orem’s self-care deficit theory accordingly was intended.

The whole nursing care plan of care embedded in the Orem’s instruction to nurses to meet self-care needs

of instead, different approaches can be used to meet similar needs. Self- care abilities requires deliberate,

calculated action which is influenced by an individual’s knowledge and skills repertoire, and which is based

upon the premise that individuals know when they are in need of assistance and are aware of the specific

actions they therefore need to take. Individuals will inquire the ways to develop and meet known self-care

demands, when they overcome with realities, their self-care.

In addition, the health promotion model developed by Nola Pender is also related also in case study

which is designed to be a complementary counterpart to models of health protection. She emphasizes the

major role of the nurse in helping patients to prevent illness through nursing care and bold alternatives to

promote well-being and a healthy lifestyle. The model focuses on individual characteristics and

experiences, behavior-specific cognitions and affect, and behavioral outcomes. The nurse should assess the
personal factors and prior behaviors that may affect the management of his blood pressure. Using the health

promotion model, planning should be focused on activities that improve the patient's well-being and disease

prevention, such as providing health education about his hypertension, medication management, and

follow-up checkups.