Department of Education

Region VI – Western Visayas

Schools Division of Iloilo
NICOMEDES R. TUBAR SR. NATIONAL HIGH SCHOOL
Pase, San Dionisio, Iloilo

CASE PRESENTATION

In Partial Fulfillment for the Requirement on

Caregiving NC II

Submitted to:

JONEM D. SANTUYO, RN
Subject Facilitator

Submitted by:

RUFINO B. SISON JR.

JUDY ANN L. ARTIZONA
RAIN AMOR BAYLON
KARLA-J C DABLEO
EVA GLORIA A. PET
JOY LYN M.VALLA
12-Macrophage

SY: 2018-2019
TABLE OF CONTENTS

I. Overview of the Disease 1

II. Introduction 2

III. Anatomy and Physiology 5

IV. Patient Assessment 6

V. Pathophysiology 7

VI. Diagnosis/Diagnostic Procedure 8

VII. Drug Study 9

VIII. Patient Care Plan 12

 I. Overview of the Disease

Stroke is the second leading cause of death in the Philippines. It has a prevalence of 0.9%;

ischemic stroke comprises 70% while hemorrhagic stroke comprises 30%. Age-adjusted

hypertension prevalence is 20.6%, diabetes 6.0%, dyslipidemia 72.0%, smoking 31% and obesity

4.9%. The neurologist-to-patient ratio is 1:330.000, with 67% of neurologist practicing in urban

centers.

Hemorrhagic strokes makes up about 13 percent of stroke cases. It caused by a weakened

vessel that ruptures and bleeds into the surrounding brain. The blood accumulates, and

compresses the surrounding brain tissue.

Ischemic stroke makes up about 80% of stroke cases. Ischemic stroke occur when the arteries

to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia).
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II. Introduction

The word cerebrovascular is made up of two parts “cerebro” which refers to the large part

of the brain, and “vascular” which means arteries and veins. Together, the word cerebrovascular

disease includes all disorders in which an area of the brain is temporarily or permanently affected

by ischemia or bleeding and one or more cerebral blood vessels are involve in the pathological

process.

An ischemic stroke, cerebrovascular accident (CVA), or what is now being termed “brain

attack” is a sudden loss of function resulting from disruption of the blood supply to a part of the

brain. This event is usually the result of long- standing cerebrovascular disease. The term “brain

attack” is being used to suggest to health care practitioners and the public that a stroke is an

urgent health care issue similar to a heart attack. This change in terms also reflects similar

management strategy in both diseases.

The most common ischemic strokes include:

• Thrombotic stroke. A thrombolytic stroke occurs when a blood clot (thrombus) forms in

one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits

(plaque) that built up in arteries and cause reduction of blood flow (atherosclerosis) or

other artery condition.

• Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away

from your brain-commonly in your heart-and is swept through your blood stream to lodge

in narrower brain arteries. This type of blood clot is called embolus.

 Ischemic stroke are subdivided into five different types according to their cause: Large

artery thrombosis (20%), Small penetrating artery thrombosis (25%), Cardiogenic embolic stroke

(20%), cryptogenic (30%) and other (5%).

Large artery thrombotic strokes are due to atherosclerotic plaques in the large blood

vessels of the brain. Thrombus formation and occlusion at the site of the atherosclerosis result in

ischemia and infarction.

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Small penetrating artery thrombotic stroke affect one or more vessels and are most

common type of ischemic stroke. Small artery thrombotic stroke are also called lacunar stroke

because of the cavity that is created once the brain tissue disintegrates.

Cardiogenic embolic stroke are associated with cardiac dysrhythmias, usually atrial

fibrillation. Embolic originates from the heart and circulate to the cerebral vasculature, most

commonly the middle cerebral artery, resulting stroke. Embolic strokes may be prevented by the

use of anticoagulation therapy in patients with atrial fibrillation.

The last two classifications of ischemic strokes are cryptogenic strokes, which have no

known cause, and other strokes, from causes such as cocaine use, coagulopathies, migraine, and

spontaneous dissection of the carotid or vertebral arteries.

An ischemic stroke can cause a wide variety of neurologic deficits, depending on the

location of the lesion (which vessels are obstructed), the size of the area of inadequate perfusion,

and the amount of collateral blood flow. The patient may present with any of the following signs

or symptoms:

• Numbness or weakness of the face, arm, or leg, especially one side of the body.
• Confusion or change in mental status.
• Trouble speaking or understanding speech.
• Visual disturbances.
• Difficulty walking, dizziness, or loss of balance or coordination.
• Sudden severe headache.

DIAGNOSTIC IMAGING TEST

 The majority of cerebrovascular problems can be identified through diagnostic imaging

tests. These tests allow neurosurgeons to view the arteries and vessels in and around the brain

and the brain itself.

• Cerebral angiography (also called vertebral angiogram, carotid angiogram)

• Carotid duplex (also called carotid ultrasound)
• Computed tomography (CT or CAT scan)
• Doppler ultrasound
• Electroencephalogram (EEG) 3
• Lumbar puncture (spinal tap)
• Magnetic Resonance Imaging (MRI)
• Magnetic Resonance Angiogram (MRA)

RISK FACTORS

Many of the risk factors for CBVD are linked, which means if you have one, you’re
likely to have others as well.
The eight major risk factors for CBVD are described below.
• High blood pressure
• Smoking
• Diet
• High blood cholesterol
• Lack of exercise
• Being overweight or obese
• Sex

PREVENTION
Ways to reduce the risk of cerebrovascular disease include:
• Not smoking
• Getting regular physical exercise
• Eating a low-fat diet
• Maintaining a healthy weight
• Controlling blood pressure
• Lowering blood cholesterol with diet and medications if necessary.

 Medical Management
• Thrombolytic Therapy
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III. Anatomy and Physiology

CARDIOVASCULAR SYSTEM

NERVOUS SYSTEM
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IV. Patient Assessment

PATIENT HISTORY

Patient GG a 67 years old from Lonoy, Estancia, Iloilo came to ER (Emergency

Room) accompanied by his wife and daughter with a major complaint of unresponsiveness and

vomiting due to CVD (Cerebrovascular Disease ICH vs. infarction). He was then given medical

attention and nurses took his vital signs. He has a temperature of 36ᴼC, pulse of 64 bpm,

respiration of 24 cpm, and a blood pressure of 220/110 mmHg. When the doctor checked him, he

has a pinpoint pupil, drowsy and has a Status Post CVD.

The wife of the patient said “Mataas guid ang BP niya pirmi, hindi mo man siya

mahambalan nga magpaymuyong kay ginawahig niya ang catheter”. According to them, the

patient found out that he didn’t feel he urinated already. He had seizures while he was at home.

They brought him in the hospital and admitted.

CLIENT ASSESSMENT AND DATABASE

Patient GG a 67 years old, male and a Filipino citizen of the Philippines. He is happily

married to his wife, sexually active for 20 years until now. They have three daughters and they
do not use any contraceptives, he works as a plastic and metal scrapper in Lonoy, Estancia,

Iloilo. He has no vices and the way he handles stress is through social interaction with friends

and baking. He loves to eat salad or what we call “kinilaw”. He rarely eats foods like vegetables

frankly. He has no restrictions on what he wanted to eat because his religion id “Born Again”. He

doesn’t take any vitamins. He has a family history of hypertension in both mother and father.

Also he has a family history of bronchial asthma in his father’s medical history. He suffered

hypertension last year, taking Losartan as his medicine but he stopped taking it. Now, he has

uncontrolled hypertension. He had paralysis in left parts of his body, irritable, restless and unable

to communicate, understand, speak and respond.

VI. Diagnosis/Diagnostic Procedure

 CLINICAL CHEMISTRY

Normal values

-Glucose__11.6 mmol/L = 6.6-8.8 mmol/L

 HEMATOLOGY

Normal values

-LEUKOCYTE No. Concentration

___11.3x10/L = 5.0-10.0x10 /L

-MONOCYTE ___ 0.01:1 = .04-.08:1

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