CARDIOVASCULAR ACCIDENT (HEMORRHAGIC STROKE)

A Case Study Presented to the Faculty of College of Health Sciences Education In

Partial Fulfillment of the Requirements in NCM 121N/L

Code: 9071

Submitted by:

Sheila Mae C. Saclot BSN-4

Submitted to:

Majella Gonzales, RN, MAN

February 2022
DEFINITION

Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is when
blood flow to a part of your brain is stopped either by a blockage or the rupture of a blood
vessel. A hemorrhagic stroke occurs when a blood vessel ruptures, or hemorrhages, and then
prevents blood from getting to part of the brain. The hemorrhage may occur in any blood
vessel in the brain, or it may occur in the membrane surrounding the brain.

SIGNS AND SYMPTOMS

Common symptoms of stroke:
✓ Face: Does one side of the face droop?
✓ Arm: If a person holds both arms out, does one drift downward?
✓ Speech: Is their speech abnormal or slurred?
✓ Time: It’s time to call 911 and get to the hospital if any of these symptoms are
present.
The quicker you can get a diagnosis and treatment for a stroke, the better your prognosis will
be. For this reason, it’s important to understand and recognize the symptoms of a stroke.
Stroke symptoms include:
✓ difficulty walking
✓ dizziness
✓ loss of balance and coordination
✓ difficulty speaking or understanding others who are speaking
✓ numbness or paralysis in the face, leg, or arm, most likely on just one side of the body
✓ blurred or darkened vision
✓ a sudden headache, especially when accompanied by nausea, vomiting, or dizziness

ETIOLOGY (RISK FACTOR)

Lifestyle risk factors
▪ Being overweight or obese
▪ Physical inactivity
▪ Heavy or binge drinking
▪ Use of illegal drugs such as cocaine and methamphetamine
Medical risk factors
▪ High blood pressure
▪ Cigarette smoking or secondhand smoke exposure
▪ High cholesterol
▪ Diabetes
▪ Obstructive sleep apnea
▪ Cardiovascular disease, including heart failure, heart defects, heart infection or
irregular heart rhythm, such as atrial fibrillation
▪ Personal or family history of stroke, heart attack or transient ischemic attack
Other factors associated with a higher risk of stroke include:
▪ Age. People age 55 or older have a higher risk of stroke than do younger people.
▪ Race or ethnicity. African Americans and Hispanics have a higher risk of stroke than
do people of other races or ethnicities.
▪ Sex. Men have a higher risk of stroke than do women. Women are usually older when
they have strokes, and they're more likely to die of strokes than are men.
▪ Hormones. Use of birth control pills or hormone therapies that include estrogen
increases risk.

MEDICAL MANAGEMENT
• Recombinant tissue plasminogen activator would be prescribed unless
contraindicated, and there should be monitoring for bleeding.
• Increased ICP. Management of increased ICP includes osmotic diuretics,
maintenance of PaCO2 at 30-35 mmHg, and positioning to avoid hypoxia through
elevation of the head of the bed.
• Endotracheal Tube. There is a possibility of intubation to establish patent airway if
necessary.
• Hemodynamic monitoring. Continuous hemodynamic monitoring should be
implemented to avoid an increase in blood pressure.
• Neurologic assessment to determine if the stroke is evolving and if other acute
complications are developing
Surgical Management
• Carotid endarterectomy. This is the removal of atherosclerotic plaque or thrombus
from the carotid artery to prevent stroke in patients with occlusive disease of the
extracranial cerebral arteries.
• Hemicraniectomy. Hemicraniectomy may be performed for increased ICP from brain
edema in severe cases of stroke.

NURSING MANAGEMENT
Improving Mobility and Preventing Deformities
▪ Position to prevent contractures; use measures to relieve pressure, assist in
maintaining good body alignment, and prevent compressive neuropathies.
▪ Apply a splint at night to prevent flexion of affected extremity.
▪ Prevent adduction of the affected shoulder with a pillow placed in the axilla.
▪ Elevate affected arm to prevent edema and fibrosis.
▪ Position fingers so that they are barely flexed; place hand in slight supination. If upper
extremity spasticity is noted, do not use a hand roll; dorsal wrist splint may be used.
▪ Change position every 2 hours; place patient in a prone position for 15 to 30 minutes
several times a day.
Establishing an Exercise Program
▪ Provide full range of motion four or five times a day to maintain joint mobility, regain
motor control, prevent contractures in the paralyzed extremity, prevent further
deterioration of the neuromuscular system, and enhance circulation. If tightness
occurs in any area, perform range of motion exercises more frequently.
▪ Exercise is helpful in preventing venous stasis, which may predispose the patient to
thrombosis and pulmonary embolus.
▪ Observe for signs of pulmonary embolus or excessive cardiac workload during
exercise period.
▪ Supervise and support patient during exercises; plan frequent short periods of
exercise, no longer periods; encourage patient to exercise unaffected side at intervals
throughout the day.
 NURSING
ASESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Objective Cues: Ineffective cerebral That within my 6-8 1. Establish rapport. 1. It helps to gain trust and Goal Met
tissue perfusion related hrs. of nursing cooperation towards nursing After my 6-8 hrs. of
• SpO2 89% to interruption of care the client will management. nursing care the
• GCS (5/15) blood flow secondary manifest effective 2. Monitor Glasgow Coma 2. Decreasing level of client manifested
• Ruptured Saccular to hemorrhage of tissue perfusion as Scale score and report consciousness (LOC) effective tissue
aneurysm at the cerebral vessel. evidenced by: worsening status promptly. may indicate increased perfusion as
Right Middle ICP and may necessitate evidenced by:
Cerebral Artery. a. Increased emergency intervention. a. Increased SpO2
• Intracranial bleeding SpO2 level of 3. Use pulse oximetry to 3. Pulse oximetry is a useful level of 95%.
95% from 89%. monitor oxygen saturation tool to detect changes in b. GCS score of
and pulse rate. oxygenation. 15/15.
b. Increased GCS 4. Monitor client’s ABG 4. PaO2 the client measures
Reference: score of 15/15 especially PaO2. the oxygen pressure in arterial
Vera, M. (2019). from 7/15 blood.
Cataract Nursing Care 5. Keep head of bed elevated 5. Head elevation reduces ICP
Plan. Nurse’s pocket 30 degrees unless in some patients.
guide: diagnoses, contraindicated.
prioritized 6. Perform assistive/ active 6. Alleviates the effects of
interventions, and range of motion exercises. the stroke.
rationales. Washington 7. Encourage client to have 7. Enough rest is needed to
DC: Sage Publications. adequate rest. conserve energy.
8. Instruct client to avoid any 8. To prevent further damage
strenuous action that may to the brain cells.
cause further increase in
intracranial pressure such as
coughing and sneezing.
DEPENDENT 9. Attach oxygen via
9. Attach oxygen via Simple Face Mask at
Simple Face Mask at 10Lpm as ordered.
10Lpm as ordered. 10. To reduce intracranial
10. Administer mannitol 20% pressure and brain mass of the
as ordered. client.
HEALTH TEACHINGS
Lifestyle Changes
✓ Take your medicines exactly as directed. Don’t skip doses.
✓ Begin an exercise program. Ask your provider how to get started. Ask how much activity
you should try to get every day or week. You can benefit from simple activities such as
walking or gardening.
✓ Limit how much alcohol you drink.
✓ Control your cholesterol level. Follow your provider’s advice about how to do this.
✓ If you are a smoker, quit now. Join a stop-smoking program to improve your chances of
success. Ask your provider about medicines or other methods to help you quit.
✓ Learn stress management methods. These can help you deal with stress in your home and
work life.
Diet
✓ Reducing the amount of fat and cholesterol you eat
✓ Reducing the amount of salt (sodium) in your diet, especially if you have high blood
pressure
✓ Eating more fresh vegetables and fruits
✓ Eating more lean proteins, such as fish, poultry, and beans and peas (legumes)
✓ Eating less red meat and processed meats
✓ Using low-fat dairy products
✓ Limiting vegetable oils and nut oils
✓ Limiting sweets and processed foods such as chips, cookies, and baked goods
✓ Not eating trans fats. These are often found in processed foods. Don't eat any food that has
hydrogenated listed in its ingredients.
REFERENCES

Belleza, M. (2021). Nurseslabs: Cerebrovascular Accident (Stroke). Retrieved from Retrieved from
https://nurseslabs.com/cerebrovascular-accident-stroke/.

Fairview. (2020). Discharge Instructions for Stroke. Retrieved from

https://www.fairview.org/PatientEducation/Articles/English/d/i/s/c/h/Discharge_Instructio
ns_for_Stroke_86467.

Mayo Clinic. (2022). Stroke Overview. Retrieved from https://www.mayoclinic.org/diseases-

conditions/stroke/symptoms-causes/syc-20350113.

Vera, M. (2019). Cataract Nursing Care Plan. Nurse’s pocket guide: diagnoses, prioritized
interventions, and rationales. Washington DC: Sage Publications.