MISSION

“MABINI COLLEGES provides quality

instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate a CULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 

Earth caring
Productive, and
Email: mabinicollege@hotmail.com  Locally and Globally
competitive persons

CHAPTER I

Case Scenario

Patient C.P., widowed, 63 years of age, residing in Barangay Alawihao Purok 7, was
admitted at Camarines Norte Provincial Hospital (CNPH). Upon admission, she was
unconscious. The Doctor diagnosed her with cerebrovascular disease (CVA) secondary to
hypertension stage 2 and type 2 diabetes mellitus.

Patient’s Data
● Chief Complaint: 4 days hx of body weakness immobility on the left side body
● Past Medical History: (+)Heart Disease , (+)DM
● V/S: RR = 21, CR = 84, BP = 160/70, Temp. = 36.3

Overview (Cerebrovascular Disease, Hypertension Stage 2, Type 2 Diabetes Mellitus)

I. Cerebrovascular Disease
The primary cerebrovascular disease is Cerebrovascular Accident (CVA). CVA is an
ischemic stroke or “brain attack,” is a sudden loss of brain function resulting from a disruption
of the blood supply to a part of the brain. It is a functional abnormality of the central nervous
system; causing temporary or permanent loss of movement, thought, memory, speech, or
sensation. There is a type of stroke that has an unknown cause and it is cryptogenic. Other
strokes result from causes such as illicit drug use, coagulopathies, migraine, and spontaneous
dissection of the carotid or vertebral arteries.

A. Classification
Strokes can be divided into 2 classifications.

1. Ischemic stroke. This is the loss of function in the brain as a result of a disrupted

blood supply.
2. Hemorrhagic stroke. Hemorrhagic strokes are caused by bleeding into the brain
tissue, the ventricles, or the subarachnoid space.
 MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate a CULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 

Earth caring
Productive, and
Email: mabinicollege@hotmail.com  Locally and Globally
competitive persons

B. Risk Factors
The following are the nonmodifiable and modifiable risk factors of Cerebrovascular
accident:
.
- Nonmodifiable: Advanced age (older than 55 years), Gender (Male), & Race (African
American,
Asian).

- Modifiable: Hypertension, Atrial fibrillation, Hyperlipidemia, Obesity, Smoking,

Diabetes, Asymptomatic carotid stenosis and valvular heart
disease (eg, endocarditis, prosthetic heart valves), & Periodontal disease

II. Hypertension Stage 2

Hypertension is defined as a systolic blood pressure greater than 140 mmHg and

a diastolic pressure of more than 90 mmHg. This is based on the average of two or more
accurate blood pressure measurements during two or more consultations with the healthcare
provider.
Stage 2 hypertension starts when the systolic pressure is already more than or equal
than 140 mmHg and the diastolic is more than or equal than 90 mmHg.

III. Type 2 Diabetes Mellitus

 Type 2 diabetes mellitus has major problems of insulin resistance and impaired insulin

secretion.
 Insulin could not bind with the special receptors so insulin becomes less effective at
stimulating glucose uptake and at regulating the glucose release.
 There must be increased amounts of insulin to maintain glucose level at a normal or
slightly elevated level.
 However, there is enough insulin to prevent the breakdown of fats and production of
ketones.
 Uncontrolled type 2 diabetes could lead to hyperglycemic, hyperosmolar nonketotic
syndrome.
 The usual symptoms that the patient may feel are polyuria, polydipsia,
polyphagia, fatigue, irritability, poorly healing skin wounds, vaginal infections, or blurred
vision.

VISION
“MABINI COLLEGES shall
cultivate a CULTURE of
EXCELLENCE in Education.”
MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
growth and development.
College of Nursing and Midwifery Specifically, it transforms
students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 

Earth caring
Productive, and
Email: mabinicollege@hotmail.com  Locally and Globally
competitive persons

CHAPTER II
Anatomy of the Brain

 Overview
The brain is an amazing three-pound organ that controls all functions of the body,
interprets information from the outside world, and embodies the essence of the mind and soul.
Intelligence, creativity, emotion, and memory are a few of the many things governed by the
brain. Protected within the skull, the brain is composed of the cerebrum, cerebellum, and
brainstem.
The brain receives information through our five senses: sight, smell, touch, taste, and
hearing - often many at one time. It assembles the messages in a way that has meaning for us,
and can store that information in our memory. The brain controls our thoughts, memory and
speech, movement of the arms and legs, and the function of many organs within our body.
The central nervous system (CNS) is composed of the brain and spinal cord. The
peripheral nervous system (PNS) is composed of spinal nerves that branch from the spinal cord
and cranial nerves that branch from the brain.

 Brain
The brain is composed of the cerebrum, cerebellum, and brainstem (Fig. 1).
Cerebrum: is the largest part of the brain and is composed of right
and left hemispheres. It performs higher functions like interpreting
touch, vision and hearing, as well as speech, reasoning, emotions,
learning, and fine control of movement.

Cerebellum: is located under the cerebrum. Its function is to

coordinate muscle movements, maintain posture, and balance.
Figure 1
Brainstem: acts as a relay center connecting the cerebrum and
cerebellum to the spinal cord. It performs many automatic functions
such as breathing, heart rate, body temperature, wake and sleep
cycles, digestion, sneezing, coughing, vomiting, and swallowing.

Right brain – left brain

The cerebrum is divided into two halves: the right and left
hemispheres (Fig. 2) They are joined by a bundle of fibers
called the corpus callosum that transmits messages from one
side to the other. Each hemisphere controls the opposite side
of the body. If a stroke occurs on the right side of the brain,
your left arm or leg may be weak or paralyzed.

Not all functions of the hemispheres are shared. In general,

the left hemisphere controls speech, comprehension,
Figure 2
arithmetic, and writing. The right hemisphere controls
creativity, spatial ability, artistic, and musical skills. The left
hemisphere is dominant in hand use and language in about
92% of people.
 MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate a CULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 

Earth caring
Productive, and
Email: mabinicollege@hotmail.com  Locally and Globally
competitive persons

Lobes of the brain

The cerebral hemispheres have distinct fissures, which divide the brain into lobes. Each
hemisphere has 4 lobes: frontal, temporal, parietal, and occipital (Fig. 3). Each lobe may be
divided, once again, into areas that serve very specific functions. It’s important to understand
that each lobe of the brain does not function alone. There are very complex relationships between
the lobes of the brain and between the right and left hemispheres.

Frontal lobe

 Personality, behavior, emotions

 Judgment, planning, problem solving
 Speech: speaking and writing (Broca’s area)
 Body movement (motor strip)

 Intelligence, concentration, self awareness

Parietal lobe Figure 3

 Interprets language, words

 Sense of touch, pain, temperature (sensory strip)
 Interprets signals from vision, hearing, motor, sensory and memory
 Spatial and visual perception

Occipital lobe

 Interprets vision (color, light, movement)

Temporal lobe

 Understanding language (Wernicke’s area)

 Memory
 Hearing
 Sequencing and organization
 MISSION
“MABINI COLLEGES provides quality
instruction, research and extension service
VISION MABINI COLLEGES, INC.
programs at all educational levels as its
monumental contribution to national and global
“MABINI COLLEGES shall growth and development.
cultivate a CULTURE of College of Nursing and Midwifery Specifically, it transforms
EXCELLENCE in Education.” students into:
Governor Panotes Avenue,  God – fearing
 Nation – loving
Daet, Camarines Norte  Law abiding
Tel. no. (054) 721-1281 local 109 

Earth caring
Productive, and
Email: mabinicollege@hotmail.com  Locally and Globally
competitive persons

Chapter III

Pathophysiology of Cerebrovascular Accident (CVA)

PREDIPOSING FACTORS:
> Advanced age (older than 55 years),
> Gender (Male), &
> Race (African American, Asian)
> Heredity (hx of hypertension)
Atherosclerosis

PRECIPITATING FACTORS:
> Hypertension,
> Atrial fibrillation, Build up of
Transient Patient’s
> Hyperlipidemia, plaque deposits
Ischemic Medical
in walls of History:
> Obesity, Attack
blood vessels
> Smoking,
(+)Heart
> Diabetes Mellitus (DM)
Disease
> Asymptomatic carotid stenosis and “Hypertension
valvular heart disease (eg, endocarditis, Thrombosis Stage 2”
prosthetic heart valves), &
> Periodontal disease (+)DM
“Type 2 DM”
> Sedentary lifestyle/Physical inactivity Blocked blood
> Poor diet (high fat, high cholesterol) vessel

Cerebral hypoperfusion

Impaired O2 & Nutrient

Delivery to Brain

Aspiration Tissue Hypoxia and

Pneumonia cellular starvation