Far Eastern University

Institute of Nursing

Introduction

Intracranial hemorrhage is the escape of blood within the cranium due to the loss of

integrity of vascular channels and frequently leading to formation of a hematoma.

Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It

can result from physical trauma (as occurs in head injury) or non-traumatic causes (as occurs in

hemorrhagic stroke) such as a ruptured aneurysm. Anticoagulant therapy, as well as disorders

with blood clotting can heighten the risk that an intracranial hemorrhage will occur.

Objectives

• Define the Intracranial hemorrhage.

• Know the case of ICH, its possible signs and symptoms, risk factors, and diagnostic and

laboratory exams.

• Determine the treatment and to apply appropriate nursing interventions.

• Lastly, to use the case as a tool in the improvement of one’s profession in applying

nursing interventions.
I. Biographic Data

Name: A.T.
Address: Blk11 L3 SSDM, Bulacan
Age: 48 y/o
Gender: Male
Religion: Roman Catholic
Admitting date/time: Sept. 04, 2009 8:08AM
Room and Bed No.: 200
Chief Complaint: left sided body weakness 3hr. prior to admission
Admitting Diagnosis: T/C CVA, infarct
Final diagnosis: ICH right basal ganglia score of 1, HCVD, CAD, T2DM
Attending Physician: Dr. Boy Saw

II. Nursing History

A. Past Health History

The patient had measles and chickenpox during childhood. He cannot recall his
immunization. There are no allergies in food and drugs. There are no foreign travels yet. He
is asthmatic since childhood and had his last attack when he was in high school. He also
has type 2 Diabetic Mellitus for 10 years and it is being maintained by Diamicron but after 7
years he stopped taking his medication because he assumed that his illness had been
already cured.

B. History of Present Illness

The patient has Type 2 Diabetes Mellitus and Hypertension. 3 hours prior to
admission, he experienced left sided body weakness. His friend noticed that he walked like
tipsy wherein he is not sober that time and his friend decided to accompany him home. In
their house, his son accompanied him to urinate when AT is about to fall. AT said to his son
“Nanghihina ako” and his son noticed that he has slurring of speech.

C. Family History

Hypertension, diabetes mellitus and asthma runs through the family of AT. There are
no other diseases noted.

III. Patterns of Functioning

A. Psychological Health

1. Coping Pattern
When asked about how the patient copes up with life’s problems, he verbalized,
“Naguusap-usap kami tungkol sa problema. Kapag gipit sa pera, tumatawag ako sa mga kapaid
ko, humihingi ng pera.”

Interpretation:
 The client and his children talk about their problems and if it is about financial
problems, they ask money from his sisters.

Analysis:
Coping may be described as dealing with problems or contending them successfully.
Short-term coping strategies can reduce stress to a tolerable limit temporarily but are in the
long-run ineffective ways to deal with reality. Fundamentals of Nursing research by Kozier 7th
edition p. 1020).

2. Interaction Pattern
AT’s sister verbalized that “Ayos naman ang pakikitungo niya sa ibang tao,
marami siyang kaibigan sa village namin dahil nga security guard siya ng subdivision eh
kilalang kilala siya doon at wala naman siyang kagalit.”
AT’s has slurring of speech during the interview. As verbalized by his son, “Hindi
masyadong maintindihan yung sinasabi ni Papa kapag nagsasalita siya.” He also has slow and
sluggish movements. He also showed appropritae hand movements.

Interpretation:
The client has barriers to effective communication.

Analysis:
Human communication is essential for learning, working, and social interaction.
Communication may affect every aspect of a person’s life based on a person’s cognitive level,
educational attainment, and health status such as speech, language or hearing problems and
disorders. (Fundamentals of Nursing by Taylor et al, 5th ed. Pp466-467)

3. Cognitive Pattern
When we asked about his education, AT said that he is a college graduate.
About his occupation he is an OIC of security guards in their village.

Interpretation:
The client finished tertiary education and is a college graduate.

Analysis:
COGNITVE DEVELOPMENT (PIAGET): Cognitive thinking culminates with the capacity
for abstract thinking. This stage, the period of formal operations, is Piaget’s fourth and last
stage. It is typical of the period of concrete thought. They now think beyond the present. Without
having to center attention on the immediate situation, they can imagine a sequence of events
that might occur, such as college and occupational possibilities; how things might change in the
future, such as relationships with parents; and the consequences of their actions. At this time
their thoughts can be influenced by logical principles rather than just their own perceptions and
experiences. (Wong’s Essentials of Pediatrics Nursing, by Donna Wong and Marilyn J.
Hockenberr-Eaton, 6th Edition, p. 525)

4. Self-Concept
AT said that he is happy and contented even though he had been
separated from his wife for how many years. He lives with his daughter and son. He is also
happy because of his job, as an OIC security guard.

Interpretation:
 The client does not see any problem with his self-concept and the way how he lives his
life with his two children.

Analysis:
The self-concept becomes more differentiated as adults acquire a more complex picture
of themselves, one that takes situational factors into account. The self-concept gradually
becomes more individualized and more distinct from the concepts of others. The advent of
chronic disease or a permanent physical disability has very special significance and creates
stress for the person. (Wong’s Essential of Pediatric Nursing by Wong and Eaton, 6 th edition, p.
525) Image of physical self or body image is how a person perceives the size, appearance and
functioning of boy and its parts. Body sensation describes “how one feels and experiences
oneself as physical being.” Fundamentals of Nursing by Kozier 6th edition p. 804)

5. Emotional Pattern
Regarding to the emotional pattern of the client, his sister verbalized that
“6 years na simula nung maghiwalay sila ng asawa niya, after 2 years nilang maghiwalay
nakapag-move na din siya na wala silang komunikasyon at hindi na rin nasusustentuhan yung
mga bata”. She also added that “Tinutuon na lang niya ang atensyon sa pagpapalaki sa mga
anak niya at sa trabaho”.

Interpretation:
The client’s emotional state is normal.

Analysis:
Emotional pattern is the ability to manage stress and to express emotions appropriately.
It also involves the ability to recognize, accept, and express feelings and to accept one’s
limitations. (Fundamentals of Nursing by Kozier 7th ed. P. 173)

6. Sexuality
AT acts appropriate to his gender. He is friendly in both male and female as
verbalized by his sister that he everyone in their village knows him.

Interpretation:
The client is able to express his own sexuality.

Analysis:
Sexual health is the integration of the somatic, emotional, intellectual, and social aspects
of sexual being, in ways that are positively enriching and that enhance personality,
communication and love. (Fundamentals of Nursing by Kozier 7th ed. P. 973)

7. Family coping pattern

When asked about his family, his son verbalized “Ako at si papa po magkasama
sa bahay tapos yung kapatid kong babae nakatira sa tita ko” he added “Close naman po kami
kay papa, minsan napapalo ako pag may nagawa akong kasalanan at yung ate ko nasisigawan
niya minsan”

Interpretation:
The client’s family is open whenever they have problems.

Analysis:
 Family roles are especially important to clients, since family relationships are
particularly close. All members of the family are empowered to maintain communication with
each other. When it comes to decisions, the family members are considered as a whole that
functions together and not individually. (Public Health Nursing-DOH book, pg, 118)
B. Socio-cultural Pattern
The client’s siblings and his children are considered as significant others as mentioned
by his son.

As for his recreational activities, his son mentioned that he often drinks with his friends
and neighbors in their village. He also loves to watch TV when at home.

The client lives in SSDM Bulacan wherein he is also the security guard of the said
village. Since they live inside the village, their environment is not exposed to air pollution.
Sometimes their house has cockroaches, mouse, and mosquitoes.

AT’s income is not enough for their basic needs and to the education of his children.
That’s why sometimes he asks money from his sister.

Interpretation:
The significant relationship pattern of the client is normal since the client is able
to regard people around her who are significant. The client’s recreational pattern is similar to
others of his age which is interesting and can provide independence. Drinking often is not
healthy. The client’s environment has no health hazards. The client’s source of income for their
basic needs and the education of his children are not enough for the family.

Analysis:
Significant other is an individual or group that takes on a special importance for
the development of self-esteem during a particular life stage. Significant others may include
parents, siblings, peers, teachers and the like. (Fundamentals of Nursing by Kozier 6th ed.
p.806)

Recreational activities are often determined by what is popular and what can provide
independence. It is a form of relaxation on the part of a person. It is also a time free of
obligations and formal duties of paid work, thus an opportunity to pursue at one’s own pace,
mental nourishment, enlivenment, pleasure and relief from fatigue of work. (Fundamentals of
Nursing by Kozier 7th ed. P. 201)

The environment is all the conditions, circumstances, and influences surrounding and
affecting the development of an organism or a person. It should provide physical and
psychological comfort. (Fundamentals of Nursing by Kozier 6th ed. p.250)

All individual’s standard of living (reflecting occupation, income, and education) is related
to health, morbidity, and mortality. Hygiene, food habits, and the propensity to seek health care
advice and follow health care regimens vary among high-income and low-income groups.
(Fundamentals of Nursing by Kozier, p. 178)

C. Spiritual Pattern
AT is a Roman Catholic. He believes in God and he goes to church once a month.

Interpretation:
The client has a positive outlook in life and has faith in God.
Analysis:
Spirituality refers to that part of human that seeks meaningfulness through intrapersonal,
interpersonal and transpersonal connection. It generally involves a belief with some higher
power, creative force, divine being, or infinite source of energy. Spiritual and religious beliefs are
important in many people’s lives. They can influence lifestyle, attitudes and feelings about
illness and death. (Fundamentals of Nursing by Kozier 6th ed. p.313)

IV. Activities of Daily Living

Before During Interpretation and Analysis

Hospitalization Hospitalization
Nutrition A.T. usually eats The client Interpretation:
thrice a day. He maintains a soft
eats all kind of low salt, low fat The client is fond of eating foods
foods. DM diet. with high cholesterol, softdrinks and
He is fond of eating alcoholic beverages that are bad to
pork liempo, his health.
barbeque, tokwa’t During hospitalization the client is
baboy and sisig. He following his diet regimen
always drink
softdrinks while Analysis:
eating lunch. He Nutrition is a basic human need that
has a good changes throughout the life cycle
appetite. He drinks and along the wellness-illness
more than 8 continuum. Carbohydrates,
glasses of water. commonly known as sugars and
He often drinks starches, are organic compounds
beer with his composed of carbon, hydrogen and
friends and he oxygen. Tissue growth and repair,
consumes 4-6 helps regulate fluid balance through
bottles of beer. He oncotic pressure, helps regulate
loves to eat pulutan acid-base balance, component of
such as body framework are the functions of
Dinakdakan and protein in our body system.
Sisig. (Fundamentals of Nursing by Kozier
6th ed. p.714)

Elimination The client usually The client Interpretation:

voids 6 times per urinates 4-5 times
day. His urine is and defecates patient has a normal elimination
light in color and once a day. pattern
aromatic in odor.
He defecates once Analysis:
a day. His stool is A properly functioning urinary
brownish in color system is essential to the body’s
and smooth. physical well-being, to life itself, and
to a person’s general sense of well-
being. Elimination from the urinary
 tract helps to rid the body of waste
products and materials that exceed
bodily needs. Elimination of the
waste products of digestion is a
natural process critical for human
functioning. Although most people
have experienced minor acute bouts
of diarrhea or constipation, some
patients experience severe or
chronic alterations in bowel
elimination that affect their fluid and
electrolyte balance, hydration,
nutritional status, skin integrity,
comfort and self-concept.
(Fundamentals of Nursing by Kozier
6th ed. p.918-920)

Exercise The client is always A.T. does bed Interpretation:

walking because of exercises every
his job morning by The client’s activities/ exercise are
(subdivision’s stretching. very limited due to his illness.
security guard). The client’s
Sometimes he activities/ Analysis:
plays basketball exercise are very Active exertion of muscles involving
with his neighbors. limited due to his the contraction and relaxation of
illness. muscle groups is termed “exercise”.
The human body was designed for
motion, and regular exercise is
necessary for its healthy functioning.
Individuals who choose inactive
lifestyles or who are forced into
inactivity by illness or injury place
themselves at high risk for serious
health problems.
(Fundamentals of Nursing by Kozier
6th ed. p.345)

Hygiene A.T. takes a bath 1- As for the client’s Interpretation:

2 times a day and hygiene, he The patient has a limited movement
brushes his teeth cannot do his that’s why he cannot do his daily
twice a day. He daily routine or hygienic practices.
always washes his hygienic
hands before and practices. Analysis:
after eating. Personal hygiene promotes physical
and psychological well-being.
Various studies have confirmed that
improved personal hygiene
practices reduce illness rates.
(Fundamentals of Nursing by Kozier
6th ed. p.117)
Sleep and The client usually The client has Interpretation:
Rest sleeps 6 hours per shorter periods of The patient has a disturbed sleep
day including his sleep unlike and rest pattern related to illness.
naps. before. There are
times that he will Analysis:
be awakened to Rest connotes a condition in which
take his meds, for the body is in decreased state of
vital signs activity with the consequent feeling
monitoring, of being refreshed. Sleep is a state
changing of IV of rest accompanied by altered
fluids. consciousness and relative
inactivity.

Illness that causes physical distress

can result in sleep problems, People
who are ill require more sleep than
normal and the normal rhythm of
sleep and wakefulness is often
disturbed.
(Fundamentals of Nursing by Kozier
6th ed. p.998)
V. Physical Assessment

VITAL SIGNS:
Temperature: 36.7º C
Pulse Rate: 65Beats per minute
Respiration Rate: 20 Breaths per minute
Blood Pressure: 140/90 mmHg (Abnormal BP client is experiencing hypertension)
GCS: 15

APPEARANCE AND MENTAL STATUS:

ASSESSMENT NORMS AND ACTUAL FINDINGS ANALYSIS
STANDARDS
Body Build: Proportionate, Varies Medium body build, Normal
with Lifestyle appropriate for height.
Posture and Gait Relaxed, Erect The client is relaxed and Asymmetry of movement, in
weak in appearance.He
Posture, Coordinated which only one side of the
has generalized body
Movement weakness with minimal body is affected, may occur
movement.
with disorders of the central
nervous system, principally
in those patients who had
cerebrovascular accidents.
(Medsurg 10th edi by
Brunners and Suddarths p.
68)
Hygiene and Neat and Clean Looks neat and clean; Normal
Grooming clothes are appropriate
for the current condition
Body and Breath No body or breath odor No body and breath odor Normal
Odors related to activity.
Signs of Distress No signs of distress. No sign of distress Normal
Attitude Cooperative Cooperative sometimes Normal
appropriate to the
situation
Affect/Mood, Client’s response is
The client has flat affect
Behavior changes after a
Appropriateness of the appropriate to the
and irritable. stroke.The client may exhibit
clients responses situation flat affect.
(medsurg by Black 7th edi.
p.2116)
Quantity, Quality, and Understandable, He can’t verbalize well Speech may be slurred
Organization of Moderate Pace, for NGT is present. because of CNS disease or
Speech Exhibits thought Slurred speech . because of damage to
association cranial nerves.
(Med-Surg 10th edi. by
Brunners p. 68)
Relevance and Logical Sequence, Answers appropriately Normal
organization of Makes sense, exhibits but seldom if he can’t
thoughts thought association answer the son or the
sister talk.
AREAS OR TECHNIQU NORMS AND ACTUAL ANALYSIS
THINGS TO BE E STANDARDS FINDINGS
ASSESSED
INTEGUMENT
Skin Inspect Varies from light to Varies from Normal
deep brown; ruddy light to
pink to light oink; deep
yellow overtones to brown;
olive ruddy pink
to light
oink; yellow
overtones
to olive
Skin color generally Skin color generally Normal
uniform except in uniform
areas exposed to
sun; areas of lighter
pigmentation (palms,
lips, nail beds) in
dark-skinned people
Observe Moisture in skin folds Moist Normal
and the axillae varies
with environmental
temperature, and
Palpate
activity
Skin temperature of Skin temperature of Normal
the two feet and two the two feet and
hands are uniform two hands are
and within the normal uniform and within
range the normal range.

Note Skin Turgor: Skin Turgor: Normal

When pinched, skin When pinched, skin
springs back to springs back to
previous state previous state

Hair Inspect The hair is evenly Thick and evenly Normal

distributed distributed hair. No
Thick hair alopecia and other
Silky, Resilient Hair infections.
No infection or
infestation
Nails Inspect Convex curvature; Convex curvature; Normal
VI. LABORATORY EXAMINATIONS

COMPLETE BLOOD COUNT

September 4, 2009

Result Normal Findings Interpretation and Analysis

RBC Count 5.50 x M: 5.5-6.5x1012/L Normal
10^12 /L

Hemoglobin 17.00 g/dL 14-16 g/dL High

May indicate Polycythemia,
Dehydration and COPD
Fundamentals of Nursing by
Kozier p.759
Hematocrit 0.50 L/L M:0.42-0.52L/L Normal
F:0.37-0.47L/L
WBC 7.84 x 10^9 /L 5-10 x10 ^ 9/L Normal

MCV (Mean 91.7 f 82-92 fl Normal

Corpuscular
Volume)
MCH (Mean 30.9 pg 27-33 pg Normal
Corpuscular
Hemoglobin)
MCHC (Mean 34.0 pg 32-38% Normal
Corpuscular
Hemoglobin
Concentration
)
Eosinophils 0.01 0.03-0.05 Low
With stress and certain
medications such as
epinephrine, thyroxine and
ACTH
Fundamentals of Nursing by
Kozier p.759
Segmenters 0.67 0.55-0.65 High
There might be an acute
infection, tissue necrosis,
leukemias and drug influences
such as aspirin, heparin,
digitalis, epinephrine, lithium,
histamine, antibiotics
Fundamentals of Nursing by
Kozier p.759
Lymphocytes 0.26 0.25-0.35 Normal
Monocytes 0.06 0.02-0.06 Normal

ROENTGENOGRAPHIC REPORT
September 4, 2009

Impression:
Atheromatous aorta

Chest:
No active lung infiltrate seen. Pulmonary vascular markings are within normal limits. Heart is not
enlarged. Aorta is calcified. Diaphragm and bony thorax are unremarkable.

URINALYSIS
September 4, 2009

Actual Findings Normal Findings Analysis

Color Light Yellow Light straw to dark Normal
amber
Sp. Gravity 1.010 1.005-1.030 Normal
Character Hazy Clear Bacteria,
Pus, tissue
RBCs
WBCs
Phosphates
Prostatic fluid
Urates, uric acid
Bilirubin Negative Negative Normal
Protein Negative Negative Normal
Glucose Negative Negative Normal
Blood Negative Negative Normal
Ketone +2 Negative Abnormal
Ketone bodies, a
product of the
breakdown of fatty
acids, normally are
not present in the
urine. They may,
however, be found
in the urine of
clients with poorly
controlled
diabetes.
 Fundamentals of
Nursing by Kozier
p.771
Nitrite Negative Negative Normal
Leukocytes Negative Negative Normal
Pus Cells Negative 0-2 hpf Normal

RBC Negative 0-3 hpf Normal

pH 6.0 4.6-8 Low
Urine is slightly
acidic with an
average pH of 6.
Fundamentals of
Nursing by Kozier
p.770
Casts None None Normal
Crystals None None Normal
Bacteria Moderate None Abnormal
Bacteria present in
stool indicate
infection.
Bacterial
gastroenteritis,
sometimes called
acute
gastroenteritis, is
an inflammation of
the stomach and
intestines caused
by the introduction
of certain types of
bacteria into the
digestive tract.

DIFFUSION WEIGHTED MRI OF THE BRAIN

September 4, 2009

Indication:
The patient presents left-sided body weakness and slurring of speech.

Pertinent MR findings:
There is 2.8 x 2.5 x 3.9 cm (APxTxH) abnormal signal, which is ointense on T1W1 slightly
hyperintense on T2W1 and shows blooming artifact on GRE, in the R basal ganglia and
surrounding capsules extending superiorly into the R corona radiate. These findings are
indicative of intracerebral hemorrhage in hyperacute stage. There is an associated perilesional
edema with apparent mild compression effect to the right lateral ventricle producing some mild
bowing of the midline structures leftwardly. There is also 1.0 x 0.4 (APxT) focal hemorrhage in
subacute stage in the left lentiform nucleus and left external capsule. Minimal perilesional
edema is likewise present. In addition, there is a probable petechial hemorrhage in the right
occipital region.

Other worth mentioning findings include chronic small vessel ischemic changes in the centrum
semiovale/coron radiate, left frontal subcorticalwhite matter and both forceps major. There are
old lacunar infarcts in the left external capsule and probably also in the anterior portion of both
corona radiata.

Remarks:
There are finding of bilateral intracerebral hemorrhage of differing ages as described.

SEROLOGY
September 5, 2009

Actual Findings Normal Findings Analysis

HgbA1c 10.7% 4-7% % Abnormal
Indicates Diabetes.
http://diabetes_basics/what/high_bloo
d_sugar.html

BLOOD CHEMISTRY

Septem Septem Septem Normal Interpretation and Analysis

ber 4, ber 7, ber Findings
2009 2009 8,2009
RBS 358 --- --- 70-100 High
mg/dL mg/dL
Greater than normal levels
(hyperglycemia) may indicate:

• Acromegaly (very rare)

• Cushing syndrome (rare)
• Diabetes mellitus
• Impaired fasting glucose
(also called "prediabetes")
• Hyperthyroidism
• Pancreatic cancer
• Pancreatitis
• Pheochromocytoma (very
rare)
• Too little insulin
• Too much food

http://www.nlm.nih.gov/medlineplus/en
 cy/article/003482.htm
Crea 92 --- --- M: 62-115 Normal
mmol/L mmol/L
F: 53-97
mmol/L
SGPT 166 U/L --- --- 0-55 U/L High
Elevations of SGPT, an enzyme
found within the liver cells,
indicate that the liver cells are
either leaky (internal contents
are entering the blood) or
damaged. A wide array of
conditions can cause this
problem. For example, viral
hepatitis or alcohol can cause
elevated SGPT. We know that
patients can have elevated liver
tests as a result of fatty liver, a
condition that does not
necessarily mean generalized
obesity. Usually fatty liver is not
a cause for significant liver
problems.http://www.valdezlink.co
m/pages/SGPT.htm

Na 131.70 --- 147.60 135-148 Normal

mmol/L mmol/L mmol/L
K 4.29 3.20 2.83 3.50-5.30 Normal
mmol/L mmol/L mmol/L mmol/L
Glucose 12.71 --- --- 3.90-6.00 High
mmol/L mmol/L Indicates diabetes mellitus.

CLINICAL CHEMISTRY RESULT

Capillary Blood Glucose

Actual Findings Normal Interpretation and Analysis

Findings
September @ 1pm 277 mg/dL 70-110 mg/dL High
4, 2009 @ 2pm 271 mg/dL *Indicates Diabetes.
@6pm 369 mg/dL Having too much sugar in the blood
@ 7pm 237 mg/dL for long periods of time can cause
@ 10pm 346 mg/dL serious health problems if it's not
treated. Hyperglycemia can cause
damage to the vessels that supply
blood to vital organs, which can
increase the risk of heart disease
and stroke, kidney disease, vision
problems, and nerve problems in
people with diabetes. These
problems don't usually show up in
 kids or teens with diabetes who
have had the disease for only a few
years. However, these health
problems can occur in adulthood in
some people with diabetes,
particularly if they haven't managed
or controlled their diabetes
properly.
http://diabetes_basics/what/high_bloo
d_sugar.html
September @ 2mn 242 mg/dL 70-110 mg/dL High
5, 2009 @ 6am 190 mg/dL *
@11pm 150 mg/dL
@ 12nn 397 mg/dL
@ 1pm 377 mg/dL
@ 3pm 382 mg/dL
@ 4pm 283 mg/dL
@ 5pm 256 mg/dL
September @ 5am 207 mg/dL 70-110 mg/dL High
6, 2009 @ 11am 167mg/dL *
@ 5pm 125 mg/dL
September @ 5am 106 mg/dL 70-110 mg/dL High
7, 2009 @ 5pm 163 mg/dL *

September 8, @ 5am 110 mg/dL 70-110 mg/dL Normal

2009 @ 5pm 92 mg/dL
September @ 5am 204 mg/dL 70-110 mg/dL High
9, 2009 @ 5pm 141 mg/dL *
September @ 5am 105 mg/dL 70-110 mg/dL Normal
10, 2009
VII. Drug Study
Generic/Trade Dosage/ Classification Indication Contraindication Side Effects Nursing
Name Frequency Responsibilities
Citicholine 1g BID Nootropics & Parkinson's Contraindicated elevated body  Assess patient for
Neurotonics disease; to patients with temperature, any allergy of the
Cerebrovascular allergy with the restlessness, and drug.
disorders and head drug difficulty sleeping  Advise patient to
injury if the supplement seek emergency
is taken in the medical attention if
evening. he feels adverse
insomnia, effects of the drug.
headache,
diarrhea, low or
high blood
pressure, nausea,
blurred vision,
chest pains,
Omeprazole 2mg 1 CAP Antacids, Eradication of H. Contraindicated Diarrhoea,  Assess patient for
OD Antireflux pylori infection, in patients with nausea, fatigue, any allergy of the
Agents & Prophylaxis of acid known constipation, drug.
Antiulcerants aspiration, hypersensitivity vomiting,  Advise patient to
to treat symptoms to any flatulence, acid seek emergency
of component of the regurgitation, medical attention if
gastroesophageal formulation. taste perversion, he has chest pain
reflux disease arthralgia, or heavy feeling,
(GERD) and other myalgia, urticaria, dizziness, pain
conditions caused dry mouth, spreading to the
by excess stomach dizziness, arm or shoulder,
acid. Omeprazole headache, sweating, nausea
is also used to paraesthesia, or vomiting, and a
promote healing of abdominal pain, general ill feeling.
erosive esophagitis skin rashes,  Give each dose of
(damage to your weakness, back omeprazole with a
esophagus caused pain, upper full glass (8
by stomach acid). respiratory ounces) of water.
infection, cough.  Do not crush,
Potentially Fatal: break, or open a
Anaphylaxis. delayed-release
capsule. It is
specially made to
release medicine
slowly in the body.
Breaking or
opening the pill
would cause too
much of the drug
to be released at
one time.
 Store omeprazole
VIII. Pathophysiology
Aneurysm Severe Hypertension AV Malformation
Risk factors
• DM

Rupture of cerebral vessel • HPN

• Smoking

• Obesity
Bleeding in the Right Intracerebral bleeding occurs
basal ganglia • High cholesterol
levels

Sudden severe headache • Heart Disease

Contralateral hemiplegia,
with initial flaccidity
• Age
progressing to spasticity
Increased Decreased insulin production
Nausea and vomiting
ICP

Diminished insulin
Coma
Imbalance bet. The blood action
supply and the demand of
the heart for oxygenated DEATH Hyperglycemia

Limitations to coronary blood

S/Sx: Generalized weakness and malaise,
flow with vasospasm and
excessive urine production, excessive thirst,
thrombosis
blurred vision, unexplained weight loss

Increased metabolic demands

of the heart and everyday
activities Perfusion pressure may be insufficient to
provide adequate blood flow
X. Ecologic Model

A. Hypothesis

The condition of the client might have been resulted from the interrelationship of the risk
factors that the client gained overtime. Factors like diet, familial history, and the client’s lifestyle
aggravates the condition of the client.

B. Predisposing Factors

The host, male 48 years of age, with a nationality of Filipino and is residing at Barangay
San Manuel SSMD, Bulacan.Working as a security guard in the subdivision. With familial history
of hypertension and Diabetes Mellitus.He engages in drinking alcohol often with friends
consumes 4-6 bottles of beer. He is fond of eating pork foods which is high in cholesterol. Client
is known to be hypertensive and with DMT2

Last September 4, 2009 the client experienced left side body weakness 3 hours PTA.

C. Ecologic Model
,
HYPERTENSION

MALE HIGH-CHOLESTEROL
FAMILY HISTORY DIET
DMT2 HPN, DM
CVA

ENVIRONMENT
CAD DRINKING ALCOHOL

OCCUPATION
SECURITY GUARD
D. Analysis

There are several factors of CVA. The modifiable factors are hypertension, sedentary
lifestyle, obesity, increase salt, cholesterol, and fatty foods intake, smoking, stress,
diabetes mellitus. The non-modifiable factors are sex (women are more likely to die from
a stroke), age (two-thirds of strokes occur in people over age 65), race (affect blacks
more often than whites, and are more likely to be fatal among blacks) and heredity.
 In this case, factors contributing to the client’s attack are FAMILIAL
HISTORY,GENDER,HPN,DMT2,LIFESTYLE, DIET,AGE,OCCUPATION.GENDER As in all
diseases, a genetic predisposition increases one’s risk of having the disease. His advancing
age also cause a lot of physiologic changes in his body. As a person ages, his blood vessels
become less elastic and covered by atheroma or fat plaques which narrows or obstructs the
passage of blood causing an infarct to the area. Present illness HPN,DM2 aggreviates the
disease. Food habits and alcohol consumption, also intensified his risk because such acts
increase the deposition of fat in the vessels and its hardening. Lastly, the incidence of stroke is
higher in men than that of women.

E. Conclusion and Recommendations

The factors contributing to the disease are Familial history, Lifestyle, DM2, HPN,
Occupation. Such factors that are not modifiable; thus, care must be focused on ensuring client
comfort and wellness and decreasing further complications and worsening of the disease. The
body becomes weaker and vulnerable to a lot of diseases as it matures. Remind the family to be
in constant monitor of the client in case of an attack. Also, always be in assistance with the
client because with this disease, the client becomes too weak with sensory and motor
impairments

Lifestyle should also be modified. His food habits must be corrected. His alcohol
consumption . Though this may not reverse the problem, such actions may prevent worsening
of the disease.

XI. Prioritization

NURSING PROBLEM CUES JUSTIFICATION

Impaired Tissue  Subjective: “Nanghihina Cerebral perfusion of the

Perfusion (cerebral)
related to bleeding
ako.”
 Changes in BP
(BP): 140/90 mmHg
 slurring of speech
 left sided body weakness
 flat affect and irritable
cerebrum is critical for survival
and long term outcome;
therefore it should be the first
priority in the care of the client.
Decrease in cerebral blood flow
may be secondary to thrombus,
embolus, hemorrhage, edema or
spasm

(p.1858 Medical Surgical

Nursing by Joyce Black)

Impaired physical  left sided body weakness Almost all clients have some
mobility related to  slow and sluggish degree of immobility after a
neuromuscular movements stroke.
impairment
Pressure ulcers are common
problem for anyone with a lower
than normal level of activity. It
can be deadly for a patient who
can’t turn or move by
him/herself. Infected pressure
ulcers are one of the primary
causes of death in a patient with
neurological diagnosis, even
when not infected, pressure
ulcer still cause prolonged
distress and adversely affect the
patient’s ability to function and
his/her quality of life.

(p.1859 Medical Surgical

Nursing by Joyce Black;
p. 122 Medical Surgical Nursing
by Lippincott Williams & Wilkins)

Impaired verbal  “Hindi masyadong The inability to speak is

communication related to maintindihan yung frustrating for clients. Early
decrease in circulation to sinasabi ni Papa kapag recognition of this problem
brain nagsasalita siya.” decreases some of the
 slurred speech frustration in meeting everyday
 showing of hand needs and the ability to
movements effectively communicate and
express feelings and sensations
to other people.

(p.1860 Medical Surgical

Nursing by Joyce Black)
XII. Nursing Care Plan

NURSING ANALYSIS GOAL AND INTERVENTIONS RATIONALE EVALUATION

PROBLEM OBJECTIVES

Impaired Tissue Immediate Cause: Goal: Goal met as the

Perfusion Ineffective tissue After 5 hours of client had
(cerebral) related perfusion nursing adequate and
to intracranial interventions, the improved cerebral
hemorrhage as Intermmediate client will have no perfusion as
evidenced by left Cause: further deterioration evidenced by
sided body Intracranial as mainifested by stable vital signs,
weakness hemorrhage improved cerebral improved
tissue perfusion cognition, motor
Root Cause: and stabilized and sensory
Cerebrovascular neurological function, and
Cues: Accident deficits. appropriate affect
Subjective: (stroke) and mood.
“Nanghihina ako, ” Objectives:
as verbalized by The cerebral
the client. hemisphere of our Independent
bicameral (two- After 1 hour of
Objectives: chambered) brain is nursing intervention
 slurring of known as the seat of the client will be Administer oxygen O2 therapy may be
speech thought, memory, able to: therapy required to maintain
 left sided awareness, motor adequate airway and to
body function, sensory a. maintain improve cerebral tissue
weakness function, and speech adequate perfusion.
 flat affect -- i.e., the higher oxygenation
and irritable brain. When a Assess heart rate Changes in rate,
hemorrhage and rhythm; especially bradycardia,
(bleeding from auscultate for can occur
Measurement: traumatic injury or b. maximize murmurs; because of the brain
VITAL SIGNS: arterial damage) tissue damage. Dysrhythmias
Temp: 36.7º C occurs inside the perfusion and murmurs
PR: 65 BPM brain in one or both may reflect cardiac
RR: 20 BPM of the hemispheres, disease, which may have
precipitated
BP: 140/90 mmHg CVA.
Symptoms depend
on distribution of the Assess Irregularities can suggest
cerebral vessel(s) respirations, noting location of cerebral
involved. patterns and insult/increasing ICP and
rhythm need for further
Hypertension intervention, including
(High Blood possible respiratory
Pressure) is one of support.
the prime causes. It
is also suspected that Evaluate pupils, Response to light reflects
the underlying blood noting size, shape, combined function
vessels of the brain equality, light of the optic (II) and
may be abnormal reactivity. oculomotor (III) cranial
with microaneurysms nerves and is useful in
(i.e., tiny determining whether the
outpouchings of the brainstem is intact.
arterial walls which
are weak and subject Assess higher Changes in cognition and
to bursting). functions, including speech content are an
speech, if patient is indicator of location/
Bleeding commonly alert. degree of cerebral
occurs in the basal involvement and may
ganglia, and less indicate deterioration/
commonly in the increased ICP.
pons, thalamus,
cerebellum, and Frequently monitor To maintain perfusion
cerebral white matter. b. maintain blood pressure without promoting
The hemorrhage blood cerebral edema.
(bleeding) may pressure
extend into the within normal
ventricular system or range
subarachnoid space Position with head Reduces arterial pressure
of the brain. The c. main slightly elevated by promoting venous
bleeding, in some tain head/ and in neutral drainage
cases, may neck in position. and may improve cerebral
compress the brain neutral circulation/perfusion.
position.
 Monitor client’s Normo- thermia reduces
stem (lower part of temperature. cerebral glucose and
the brain). If brain d. maintain normo- oxygen consumption.
stem compression thermia.
occurs, the death
rate is very high.
Collaborative
After 1 hour of
intervention the
client will be able
to:
Administer Will aid in the recovery of
a. Engage in medications (eg. the patient and help
pharmacologic anticoagulants, prevent further
therapy. antihypertensives, complications
stool softeners) as
prescribed by the
physician.

XIII. Discharge Plan

Medications Exercise Treatment/Therapy Health Teaching Outpatient Diet Support System

• Lowering of Get the
Medicines may Get Procedures may be Treatment • See the LDL support you
be needed in regular done to improve focuses on taking doctor for cholesterol need to
addition to exercise blood flow to the steps to manage regular by reducing succeed in
lifestyle on most, if heart. your symptoms follow-up saturated fat making
changes. not all, and reduce your appointme intake. lifestyle
days of the • Angioplasty is risk for heart nts. This • Lowering of changes. Ask
• Statins to week. used to open attack and stroke. lets the Triglyceride family or
help lower Your blocked doctor levels by friends to
choleste- doctor can arteries. It isn't Lifestyle changes keep track reducing share a
rol. suggest a major surgery. are the first step of the risk consumption healthy meal
safe level During for anyone with factors and of sugary and or join a stop-
• Beta- of exercise coronary artery adjust his
 processed smoking
blockers for you. angioplasty, the disease. These treatment foods. program with
or ACE Walking is doctor guides a changes may as needed. • Reduction of you. Or ask
inhibitors great thin tube stop or even Homocystein your doctor
to lower exercise (called a • Take
reverse coronary medicines e levels by about a
blood that most catheter) into artery disease. supplementat cardiac rehab
pressure. people can the narrowed exactly as
To improve your prescribed. ion with program. In
do. A good artery and heart health: Vitamins B6 cardiac rehab,
• Aspirin or goal is 30 inflates a small Do not
other stop or and B12, and a team of
minutes or balloon. This Don't smoke. folic acid. health
medicines more a widens the change
This may be the • Increased professionals
to reduce day. artery to help medicines
most important antioxidant provides
the risk of restore blood without
thing you can do. activity by education and
blood flow. Often a talking to
Quitting smoking higher support to
clots. small wire- the doctor.
can quickly consumption help you make
• Nitrates to mesh tube reduce the risk of • Instruct to of fruits and new, healthy
relieve called a stent is heart attack or keep vegetables. habits
chest placed to keep death. nitroglyceri • Lowering of
pain. the artery open. n with him fibrinogen
The doctor may Eat a heart-
healthy diet that at all times, and growth
use a stent that if the factors by
is coated with includes plenty of
fish, fruits, doctor cutting back
medicine, prescribed on foods
called a drug- vegetables,
beans, high-fiber it for chest such as red
eluting stent. pain. meat, dairy
When the stent grains and
breads, and olive products,
is in place, it 
poultry and
slowly releases oil. See a dietitian
if you need help eggs.
a medicine that
prevents the making better
growth of new food choices.
tissue. This Lower your stress
helps keep the level. Stress can
artery open. huzrt your heart.
• Bypass
Changing old
surgery, which
habits may not be
is major
easy, but it is
surgery, may very important to
be used if more help you live a
than one healthier and
coronary artery longer life.
is blocked. It Having a plan
uses healthy can help. Start
blood vessels with small steps.
to create For example,
detours around commit to eating
narrowed or five servings of
blocked fruits and
arteries. vegetables a day.
Instead of having
dessert, take a
short walk. When
feeling stressed,
stop and take
some deep
breaths
 Far Eastern University
Institute of Nursing

Case Study
Intracranial
Hemorrhage

Submitted to:
Pepito B. Ruzol JR., PT, RN, RM, MSN

Submitted by:

BSN117
Group 67

GALINATO, Maria Junelsia

GAMBOA, Jessedith Ann
GAMBOA, Michael Brian
GANCENIA, Bettina Rose
GARCIA, Janice
GARCIA, Kimberly Ann

BSN117
Group 68

MATULAC, Famela Jean

TEOVISIO, Jessely
 TUY, Barry
VASQUEZ, Neil