VII.

CONCEPT MAP

Admitting Diagnosis: Cerebrovascular Left Middle Cerebral Artery large territory infarct, and left frontal, temporal, parietal
area probably cardioembolic, T/C Acute Coronary Syndrome NSTEMI Killip I, Coronary Artery Disease, Hypertensive
Cardiovascular Disease, S/P CVD 2013, Cardiogenic Shock Etiology
Predispositing Factors: Precipitating Factors:

Age: 69 y.o Diet: had Humba for a week prior to admission

Sex: Male (more common in male than female) Alcoholic
Diagnosed with Cardiomegaly (2002) Sedentary Lifestyle
Smoker (age of 14 year 2002)
Past history of CVD (2013)
History of hypertension (2013)

Sudden peripheral vascular resistance

Blood Pressure

Injury to arterial wall (endothelial injury)

Desquamation of endothelial injury

Lipids (LDL) & Platelet assimilate in the area

Oxidized LDL attracts monocytes &

macrophages to site

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 Plaques begin to form
Slightly palpable and weak
pulses noted on lower Lipids are engulfed by the cells & smooth
extremities muscle cell develops
Weakness
Disruption of plaques
Lethargic
Slow pulses on Continuous aggregation of platelets
extremities
Thrombus formation

Decreased cardiac output related

to change in myocardial Rapid increase in size of thrombus in coronary
contractility as evidences by weak artery wall
and slightly palpable pulses on
Coronary Artery Disease

Vasoconstriction

Decreased blood supply to the myocardium Hypertrophy and hyperplasia of arterial smooth
muscles

Acute Myocardial Ischemia: NSTEMI, Killip I Cardiomegaly

Ineffective blood flow

Myocardial cell necrosis

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 Inflammatory response stroke volume, cardiac output Lactic acid is secreted

Release of endogenous pyrogens Impaired tissue perfusion Stimulates pain receptor

Pyrogens will stimulate the cellular oxygen supply

release of prostaglandins
Impaired cellular metabolism

Cardiogenic Shock

Moved thrombus from the vessel Ineffective cerebral tissue perfusion related
to the middle cerebral artery to reduction of blood flow as evidenced by
prolonged capillary refill 21
 Occludes middle cerebral artery

Decreased level of consciousness

Decreased blood flow to the left FTP
GCS of 7
Not oriented to place
O2 supply on left frontal,
temporal, parietal area Weakness noted
Speech abnormalities (only moans at
Cerebrovascular Infarct times when talked to)
Lethargic
Slow pulses on extremities

Chest X-ray
Head CT Scan
Blood Coagulation Test
Blood Chemistry
Complete Blood Count
Electrocardiogram
Cardiac Monitor
Ineffective breathing pattern
related to neurologic damage
secondary to presence of
present condition
Impaired physical mobility related
to neuromuscular changes as
evidences by decreased level of
consciousness
Administered oxygen
therapy via non-
rebreather mask at
3mL/h
Inserted Foley Bag
Catheter
4.5 cc D5W + 250mg/5mL
Dobutamine @10cc/hr (90
mcg/kg/min)
uptitrate/downtitrate by 2
mcg/kg/min every 30 min to
maintain SBP > 110mmHg
Cholinerv 1 ampule IV
Midazolam 5mg IV
Totilac 100mL IV push

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Legends:

Predisposing Factors

Precipitating Factors

Disease Process

Diagnosis

Clinical Manifestations

Diagnostics / Laboratory Tests

Managements

Medical / Pharmacological Interventions

Nursing Diagnosis

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