Professional Documents
Culture Documents
I. Introduction
I. Introduction
INTRODUCTION
A. Background of the study
Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden
paralysis. Apoplexy, from the Greek word meaning "struck down with violence,” first
appeared in Hippocratic writings to describe this phenomenon.
In 1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause
of hemorrhagic stroke when he suggested that people who had died of apoplexy had
bleeding in their brains. Wepfer also identified the main arteries supplying the brain, the
vertebral and carotid arteries, and identified the cause of ischemic stroke when he
suggested that apoplexy might be caused by a blockage to those vessels.
The word stroke was used as a synonym for apoplectic seizure as early as 1599,
and is a fairly literal translation of the Greek term.
A stroke happens when a blood vessel that feeds the brain becomes blocked or
bursts. When this happens, part of the brain does not get the oxygen and nutrients it needs
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and that area becomes damaged. The damaged area cannot work, and neither can the part
of the body it controls.
The actual disease case condition as such was studied by Jillianne M. Bertiz,
Siena College BSN-3A student. The study was conducted in Rizal Provincial Hospital at
Charity Ward Bed No. 03 Rm1. All the source of data was from the patient, his chart and
relatives which are entirely gathered during the patient’s hospitalization.
B. Objectives
General Objectives:
• To be able to gain knowledge about brain attack or stroke.
• To be able to prevent the occurrence of brain attack.
Specific Objectives:
• To be able to discuss what is brain attack, its causes and treatments.
• To be able to know the warning signs of and risk factors of stroke
• To explain the pathophysiology of the disease condition
The scope and limitations of this study is from the admission, assessment, and
history data gathering; discuss the Anatomy and physiology, Pathophysiology, make a
Nursing Care Plan, a Drug Study and do Discharge Planning.
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E. Theoretical framework
Within a health promotion context that views health as a resource for daily living,
self-care is seen as empowering. Through acquisition of self-care skills, people are able
to participate more actively in fostering their own health and in shaping conditions that
influence their own health.
Helping the patient improve self-care skills and move towards being as
independent as possible is the nurse's ultimate goal. The patient may need assistance after
leaving the hospital, but this can be achieved by assistance from the family members or a
home-health care giver.
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II. NURSING ASSESSMENT
A. Personal Data
B. Chief Complain
The patient’s principal complains was numbness in his left extremities together with
severe weakness that made them come to the hospital.
The patient had diagnosed to have tuberculosis in year 2004 and was treated for seven
months. His commonly experienced illness for the past 5 years was only cough and cold.
The patient self medicated by taking bio flu if they have money but if none, relaxation is
the choice of remedy.
The patient was unaware that he is hypertensive.He only knew this when he was
hospitalized. He do not know his average BP .He habitually drinks alcohol and have a
exhausting energy demanding workload.
E. Family History
Patient has no infectious or hereditary disease among his blood relations. None of
which he lives within the house has infectious disease like influenza or tuberculosis.
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F. Patient’s Concept of health illness and Hospitalization
G. Psychosocial History
The patient has only one sexual partner and eight siblings. No use of prohibited
drugs. Don’t use cigarette. However do drink alcoholic beverages with neighbors and
friends sometimes at home or after work two times a week wherein they share common
utensils and food. He was sixteen years of age when he first drink alcohol, until now that
his 45. He only stopped his drinking habit when he was hospitalized.
H. Physical Examination/Assessment
I. HEAD AND Method of NORMAL Actual findings ANALYSIS AND
NECK Assessment FINDINGS INTERPRETATI
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D. Eyebrows inspection Evenly hair Evenly hair Normal
distributed, distributed,
symmetrical symmetrical
E. Eyeball inspection No protrusion, No protrusion, Normal
scant amount of scant amount of
secretion. secretion.
F. Lip margins inspection No scaling, lips No scaling, lips Normal
close close
symmetrical, no symmetrical, no
charges. charges.
G Sclera inspection White, clear White, clear Normal
III. Ears/
Hearing
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K. Pupil inspection Constrict when Constrict when Normal
the light is the light is
pointed to eye pointed to eye
and dilates when and dilates when
the light is the light is
removed, removed,
constrict when constrict when
object is move object is move
closer to the eyes closer to the eyes
and dilates when and dilates when
moved away. moved away.
Hearing acuity inspection Able to hear Able to hear Normal
whisper spoken 2 whisper spoken 2
feet away feet away
L. Nose inspection Nasal system Nasal system Normal
intact and in intact and in
midline, midline,
symmetrical, no symmetrical, no
discharges, discharges,
patent, no flaring. patent, no flaring.
IV. Mouth
M. Lips inspection Pinkish, smooth, Pinkish, chapped, Not normal, dry lips
moist well dry, well defined, maybe due to lack
defined, symmetrical of fluid intake and
symmetrical the lips is crack.
N. Gum inspection Pinkish, smooth, Pinkish, smooth, Normal
moist, no moist, no
swelling, no swelling, no
discharges, no discharges, no
retractions. retractions.
O. Teeth inspection Well aligned, free Staining; have Not normal,
from caries or missing tooth staining tooth may
filing, no halitosis due to lack of oral
care and have two
missing tooth
(molar tooth)
P. Tongue inspection Central position, Central position, Normal
large or rough on large or rough on
top, smooth, top, smooth,
along the lateral along the lateral
margin, moist, margin, moist,
shiny and freely shiny and freely
movable, no movable, no
lesions. lesions.
Q. Palate inspection Hard palate- Hard palate- Normal
lighter pink, more lighter pink, more
irregular texture irregular texture
soft palate-light soft palate-light
pink, smooth pink, smooth
uvulva in midline uvulva in midline
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R. Orophrynx/ inspection Pink, smooth, no Pink, smooth, no Normal
tonsils discharges, discharges,
behind tonsillar behind tonsillar
pillars, gag reflex pillars, gag reflex
present. present.
S. Neck inspection Pink, smooth, no Pink, smooth, no Normal
discharges, discharges,
behind tonsillar behind tonsillar
pillars, gag reflex pillars, gag reflex
present. present.
T. Posterior inspection Chest is Chest is Normal
thorax symmetric, symmetric,
vertically aligned vertically aligned
spine, spinal spine, spinal
column is column is
straight, right and straight, right and
left shoulders and left shoulders and
hips are at same hips are at same
height, skin height, skin
intact; uniform intact; uniform
temperature Chest temperature Chest
wall intact; no wall intact; no
tenderness; no tenderness; no
masses, full masses, full
symmetric and symmetric and
chest expansion chest expansion
bilateral bilateral
symmetry of symmetry of
vocal fremitus, vocal fremitus,
fremiyus is heard fremiyus is heard
most clearly at most clearly at
the apex of the the apex of the
lungs percussion lungs percussion
notes reasonate, notes reasonate,
except over except over
scapula, lowest scapula, lowest
point of point of
reasonance at the reasonance at the
diaphragm (8th diaphragm (8th
and 10th rib and 10th rib
posteriorly) posteriorly)
vesicular and vesicular and
bronchovesicular bronchovesicular
breath sounds. breath sounds.
U. Anterior inspection Thorax in greater Thorax in greater Normal
thorax diameter laterally diameter laterally
than than
anteroposteriorly. anteroposteriorly.
Skin color Skin color
matches the rest matches the rest
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complexion. complexion.
Quite, rhythmic, Quite, rhythmic,
and effortless and effortless
respiration full respiration full
symmetric symmetric
excursion; excursion;
thumbs normally thumbs normally
separate 3-5cm. separate 3-5cm.
Bilateral Bilateral
symmetry of symmetry of
vocal fremitus, vocal fremitus,
fremitus is heard fremitus is heard
most clearly at most clearly at
the apex of the the apex of the
lungs percussion lungs percussion
notes resonate notes resonate
down to the 6th down to the 6th
rib. rib.
V. Heart inspection No heave or No heave or Normal
abnormal abnormal
pulsation apical pulsation apical
pulse 60-80 beats pulse 60-80 beats
per-veins not per-veins not
visible visible
W. Breast inspection Symmetrical, Symmetrical, Normal
Nipple, Areola slightly slightly
pinkish/brown pinkish/brown
nipples (no nipples (no
dimpling and dimpling and
discharge) discharge)
uniform skin uniform skin
color, smooth and color, smooth and
intact, no lumps, intact, no lumps,
no masses, no masses,
tenderness tenderness
X. Abdomen inspection Unblemished Unblemished Normal
skin, uniform skin, uniform
color, symmetric color, symmetric
movement cause movement cause
by respiration by respiration
liver may not be liver may not be
palpable bladder palpable bladder
is not palpable is not palpable
Y. Upper inspection Symmetrical, Symmetrical, Normal
extremities equal in length, equal in length,
no lesions, no no lesions, no
deformities, able deformities, able
to do flexion, to do flexion,
extension and extension and
ROM 5 fingers ROM 5 fingers
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for both side the for both side the
hands, pinkish hands, pinkish
nail beds, clean, nail beds, clean,
can do ROM. can do ROM.
Z. Lower inspection Symmetrical, Symmetrical, Normal
extremities equal in length, equal in length,
no lesions, no no lesions, no
deformities, able deformities, able
to do flexion, to do flexion,
extension and extension and
ROM 5 fingers ROM 5 fingers
for both side the for both side the
hands, pinkish hands, pinkish
nail beds, clean, nail beds, clean,
can do ROM. can do ROM.
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4:00pm on bed
4:45pm coherent & coherent
with IVF of PNSS 1L + 2
amps Trivimin @ 100cc regulated @
31gtts/min
on ↓ Salt & ↓ Fat diet
V/S taken & recorded:
T-36.5 PR-81 RR-20 BP
-150/90
Above IVF consume &
followed with PNSS 1L + 2 amps
Trivimin @ same rate
Due meds given
Still for urinalysis FSB, FBS,
Lipid profile, Crea, Na+, K+
Advised to ↑ fiber intake
Encouraged to verbalize
concern
Watched out for internal
Kept comfortable
Needs attended
10pm-6am on bed with same IVF on @
800 level
afebrile
meds prescribed
LS & LF
Oral
Nov.20.2007 6am-2pm >Piracetam 400 Received lying on bed asleep
2caps BID, follow up On going IVF of PNSS 1L +
10:20am official request of CT 2 amps of Trivimin reg @ 31gtts/min
scan; B-Complex @ 200cc level infusing well
V/S taken & recorded:
Above IVF & consumed
followed with PNSS 1L + 2 amps of
Trivimin reg @ 31gtts/min
Needs attended
2pm-10pm Received pt. lying on bed
with 1L + 2 amps Trivimin @
31gtts/min on & infusing well
V/S taken & recorded
Conscious & coherent
Health teachings instructed as
follows:
*Increase fluid intake
*Continuously assume active
Rom exercises
Due meds given
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Maintained low fat & low salt
diet
10pm-6am On bed with same IVF going
on @150cc level
Afebrile
BP 150/90
Conscious
Coherent
On LSLF
PNSS + amp B-complex
Nov.21.2007 6am-2pm Follow up received pt. on bed with on
official CT scan IVF of PNSS 1L + 2 amps Trivimin
request @ 800cc level
11:05am BP-120/90 on moderate high back rest
Follow up V/S taken & recorded:
blood chem. Referrals Due meds given
Continue meds S/E by Dra.Alcantar with new
Refer orders made & carried out
accordingly On LSLF
May give high Referred FBS result to
sugar diet Dra.Ocampo with new orders made
& carried out
Advised pt. to eat sweet foods
Still for lab compliance
Needs attended
2pm-10pm Received pt. sitting on bed
with PNSS + 1L + 2 amp Trivimin x
8hrs regulated @ 31gtts/min @ 300cc
level
Initial V/s taken & recorded:
Health teachings as follows:
Due meds given *Advised to eat high
glucose foods
*Continuously assume active
ROM exercises
On low Salt & low Fat diet
Able t ambulate on the ward
Encourage to turn side to side
q2
Needs attended
Still on lab compliance
Endorsed
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I. ANATOMY AND PHYSIOLOGY
The back of the brain controls
vision.
The front of the brain deals with reasoning and the ability to control emotions. Strokes
here may cause changes in personality.
Right-Brain Stroke
Be on the lookout for the following symptoms of a Right-brain stroke. If you have any
signs, call 911 right away!
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II. PATHOPHYSIOLOGY
(Schematic Diagram)
ors
Predisposing Fact Precip
itating
Factor
s
Excessive
Alcohol
Age
Intake
Hypertension
Male
Atherosclerosis
BRAIN ATTACK
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Left sided Numbness & Paresthesia
V. DRUG STUDY
Medication & Indication Drug Classification Nursing
Dosage & Consideration
Action
Adverse Reactions:
Headache,
hypotension,
dizziness & flushing
of the skin.
Drug to drug
Interaction:
Concominant
administration of
substances which
interefere with the
cytochrome P-40
enzyme system may
affect plasma
concentration of
felodopine and
metoprolol
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Drug Classification Nursing
Medication & Indication & Consideration
Dosage Action
Contra Indication:
Sick sinus syndrome
Drug to drug
Interaction:
Enhanced anti-
hypertensive effects
by use of diuretics,
vasodilators & ß-
Blockers & cardiac
glycosides.
Reduction in BP-
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lowering effect with
tricyclic
antidepressants.
Adverse Reactions:
Hyperkenisea, wt
gain, anemia,
nervousness,
agitation, irritability,
anxiety & sleep
disturbances.
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VI. NUSING CARE PLAN
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VII. Evaluation
A. Prognosis
The patient condition will gain left sided stability. He must also follow what the
physician ordered and prescribed so that, there will be continuity of care. The patient will
able to do his activities of daily living independently. He will be able to do his work and
have a sound sleep at home.
(M.E.T.H.O.D.S)
M-EDICATIONS
Instruct the patient about the medical treatments that are implemented and take home
medication that are prescribed by the physician. Tell him the medication schedule and if
possible, explain the action of each drug.
E-XERCISE
Instruct the patient to make a regular exercise with emphasis on his left sided to promote
stability ant prevent atrophy. Having a walk around for 30 minutes to promote blood
circulation, stretching then walking or jogging as tolerated are encouraged and are
acceptable.
T-REATMENT
o Instruct about hygiene measures, including mouth care, covering mouth and
nose when coughing and sneezing, proper disposal of tissue.
o Instruct about medications, schedule, and side effects
o Assess patient’s ability to continue therapy at home.
H-EALTH TEACHINGS
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o Instruct the client to follow the drug regimen exactly as prescribed and always to
have a supply on hand.
o Discuss about the risk factors and of stroke prevention
1. primary prevention - the reduction of risk factors across the board, by public
health measures such as reducing smoking and the other behaviors that increase
risk;
2. secondary prevention - actions taken to reduce the risk in those who already have
disease or risk factors that may have been identified through screening; and
3. tertiary prevention - actions taken to reduce the risk of complications (including
further strokes) in people who have already had a stroke.
The most important modifiable risk factors for stroke are hypertension, heart disease,
diabetes, and cigarette smoking. Other risks include heavy alcohol consumption, high
blood cholesterol levels, illicit drug use, and genetic or congenital conditions. Family
members may have a genetic tendency for stroke or share a lifestyle that contributes to
stroke. Higher levels of Von Willebrand factor are more common amongst people who
have had ischemic stroke for the first time. The results of this study found that the only
significant genetic factor was the person's blood type. Having had a stroke in the past
greatly increases one's risk of future strokes.
One of the most significant stroke risk factors is advanced age. 95% of strokes occur in
people age 45 and older, and two-thirds of strokes occur in those over the age of 65. A
person's risk of dying if he or she does have a stroke also increases with age. However,
stroke can occur at any age, including in fetuses.
Sickle cell anemia, which can cause blood cells to clump up and block blood vessels, also
increases stroke risk. Stroke is the second leading killer of people under 20 who suffer
from sickle-cell anemia.
Men are 1.25 times more likely to suffer strokes than women, yet 60% of deaths from
stroke occur in women.[21] Since women live longer, they are older on average when they
have their strokes and thus more often killed (NIMH 2002). Some risk factors for stroke
apply only to women. Primary among these are pregnancy, childbirth, menopause and the
treatment thereof (HRT). Stroke seems to run in some families.
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drugs and excessive alcohol consumption are all recommended ways of reducing the risk
of stroke.
In patients who have strokes due to abnormalities of the heart, such as atrial fibrillation,
anticoagulation with medications such as warfarin is often necessary for stroke
prevention.
After discharge in the hospital refer patient to the nearest health center for BP check-ups
and consultation if any signs and symptoms of stroke occur. Patient was also advised to
slowly lessen alcohol intake and better stop it. It is important that patient should comply
with annual general check up to determine to have a baseline of his health state and if the
patient is recovering well.
D-IET
Advise the patient to eat low salty and low fatty foods.
S-PIRITUAL PRACTICES
o This stage is very crucial for the patient’s feeling and faith regarding our Lord.
So, this is the time where his faith is tested. So, it is the time to encourage the
patient to go to mass on Sunday, so he will be guided from the words of Gospel.
o Personal prayer is also advice because in his condition, for he was not able to go
to church.
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