1

Maryhill College, Inc.

A CASE PRESENTATION ON CVA INFARCTION

CARDIOEMBOLIC

Represented By:

Idea, Pamela A.

Mendoza, Shazta Azalea L.

Olase, Jerick Gabriel G.

Nacawili, Maria Theresa Cecilia Z.

MC-BSN II D

COLLEGE OF NURSING

Presented to:

Sir Mark Ian Labay

 2

Maryhill College, Inc.

INTRODUCTION

BACKGROUND OF THE STUDY

A stroke, also referred to as a cerebral vascular accident (CVA) or a

brain attack, is an interruption in the flow of blood to cells in the brain. When the cells
in the brain are deprived of oxygen, they die. A stroke occurs when a blockage in an
artery prevents blood from reaching cells in the brain or an artery ruptures
inside/outside the brain, causing a hemorrhage.

Types of Stroke

• Ischemic

They are caused when blood vessels become clogged. Some ischemic strokes
are preceded by stroke-like symptoms called transient ischemic attacks (TIAs) that can
occur months before the stroke. Also called a warning stroke, a TIA is caused by a
temporary blockage of a blood vessel. TIA symptoms, which are similar to those of a
stroke, come on quickly and improve within 10 to 20 minutes. The loss of vision in a
TIA may be described as a feeling that a shade is being pulled down over your eyes.
TIAs typically do not cause long-lasting damage to the brain.

As the artery narrows, less blood is able to pass to the brain, and blood pressure
increases to meet the demands of the body. The normally smooth inner wall of the artery
is now roughed with plaque deposits, causing blood cells to build up and form clots.
Clot build-up usually occurs in large blood vessels of the neck and base of the brain.

• Hemorrhagic

Fewer strokes are categorized as hemorrhagic, which occur when weakened

blood vessels inside the brain rupture (such as a tangle of defective blood vessels and
capillaries called arteriovenous malformations (AVMs) or when an aneurysm (a thin
spot on an artery wall) at the base of the brain bursts. Every year, an estimated 30,000
people in the United States experience a ruptured cerebral aneurysm according to the
American Association of Neurological Surgeons. Symptoms more specific to
hemorrhagic stroke include headache, nausea and vomiting, neck stiffness, seizures,
 3

Maryhill College, Inc.

sudden changes in mental state and lethargy. Hemorrhagic strokes usually occur in the
daytime and during physical activity. The symptoms typically begin very suddenly and
evolve over several hours.

WHAT IS CVA INFARCTION CARDIOEMBOLIC?

• Twenty-six million people experience a stroke every year. There are many
different types of strokes, and cardioembolic stroke accounts for approximately
20% of all strokes.
• Cardioembolic stroke happens when the heart pumps rejected materials, such as
debris or a blood clot, into the brain. This can cause blockages in the blood
vessels, which may lead to a stroke.
• Causes of cardioembolic stroke: When debris, such as blood clots, moves from
the heart to the brain, this can cause a cardioembolic stroke, a type of ischemic
stroke.
• Ischemic strokes occur when there is a blockage in the blood vessels. This stops
blood flow to the brain, resulting in a stroke.
• Cardioembolic strokes can occur because of heart disease or following heart
surgery. They can also develop with little to no warning signs.
WHAT IS THE SIGNS AND SYMPTOMS?
• Numbness or weakness in the arm, leg, or face, often affecting one side of the
body
• Confusion
• Speaking difficulties or difficulty understanding speech
• Vision difficulties in one or both eyes
• Difficulties with walking, coordination, balance, and dizziness
• Severe headache

HOW IS CVA INFARCTION CARDIOEMBOLIC DIAGNOSED?

• A doctor will most likely diagnose a stroke at the hospital as soon as possible.
In order to get the correct treatment, doctors will need to identify the type of
 4

Maryhill College, Inc.

stroke a person has had. They may ask about the person’s medical history and
recent symptoms and conduct a physical examination.
• Doctors may also conduct imaging tests to observe the blood vessels in the
brain. These tests may include a computed tomography (CT) or a magnetic
resonance imaging (MRI) scan. They may also order blood tests.
• If they suspect the stroke may be cardioembolic, they may carry out tests to
look at the heart in closer detail. For example, a person may undergo an
electrocardiogram (EKG) or a coronary computed tomography angiogram
(CCTA).

FOCUS OF THE INCIDENT

RISK FACTOR

Non-modifiable

• Age
• Gender
• Family history
• Personal history cardiac disease
• Prior stroke

Modifiable

• Lifestyle: Assistive use of alcohol

• Stress
• Hypertension
• Physical Inactivity
• Diet
• Obesity
• Smoking
• High cholesterol

CLINICAL SUMMARY

• Demographic data of patient

 5

Maryhill College, Inc.

Biographical information patient X is 66 y/o male who lives in Sariaya, Quezon
and was born on June 6, 1957, a Filipino and Roman Catholic. Reason for
seeking health care:
-Unstable gait
A. PERSONAL DATA:
NAME: Patient X
ADDRESS: Sariaya, Quezon
AGE: 66 y/o
GENDER: Male
DATE OF BIRTH: June 6, 1957
Nationality: Filipino
RELIGION: Roman Catholic
DATE OF ADMISSION: November 8, 2023
ATTENDING PHYSICIAN: Dra. Grace Joy Arceo
ADMITTING DIAGNOSIS: CVA Infarction Cardioembolic

B. PAST HISTORY
The patients’ wife stated that it was the third time of his husband experienced
cerebrovascular accident. His first stroke happened about 6 years ago and
occurred after he ate “pusit”, and it was the worst stroke his husband
experienced because he is really unconscious that time as stated by his wife.
Meanwhile, his second stroke happened about months or a year ago and
occurred after he ate “katang” (crab) and demonstrated unstable gait. The
patient also had a pneumonia years ago and showed past hypertension.

C. HISTORY OF PRESENT ILLNESS

On the 8th day of Nov 2023, a 66 years old male has arrived and brought to the
emergency room, per stretcher. The patient relative stated, the patient has
demonstrated an unstable gait. The relative also said that this was his third time
 6

Maryhill College, Inc.

experiencing stroke. Adding to what the relative said, the patient is also has an
assistive use of alcohol.
D. FAMILY GENOGRAM
 7

Maryhill College, Inc.

E. PHYSICAL ASSESSMENT
 8

Maryhill College, Inc.

F. ANATOMY OF THE BRAIN

To understand stroke, it is helpful to know how blood circulates to the brain.

Blood is pumped from the heart and carried to the brain by two paired arteries,
the internal carotid arteries and the vertebral arteries.The internal carotid
arteries supply the anterior (front) areas and the vertebral arteries supply the
posterior (back) areas of the brain.After passing through the skull, the right and
left vertebral arteries join together to form a single basilar artery. The basilar
artery and the internal carotid arteries communicate with each other in a ring at
the base of the brain called the Circle of Willis. The middle cerebral artery is
the artery most often blocked during a stroke.
 9

Maryhill College, Inc.

G. PATHOPHYSIOLOGY
 10

Maryhill College, Inc.

H. DIAGNOSTIC TEST
 11

Maryhill College, Inc.

 12

Maryhill College, Inc.

 13

Maryhill College, Inc.

 14

Maryhill College, Inc.

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective data: “Risk for Short Term: Independent: -Gain a good After 2-4hours
“Wala naming Impaired After 2-4hours -Establish trust and patient-nurse shift, goal is
masakit na sakin, Physical shift, patient rapport. relationship. partially met.
pero nanghihina Mobility will be able to -Monitor vital signs -To establish Patient are able
pa din ang related to verbalize and and record. baseline data to understood
kaliwang Hemiparesis as demonstrate -Provide health observations. and verbalized
katawan ko” as evidenced by understanding teaching and -To promote about activities
verbalized by the left-sided about promote and improve and therapies
patient. weakness and activities or activities/therapies optimal level of that can
facial therapies that that can help in his function. increased
Objective data: asymmetry” can increase progression. strength of his
-Left-sided strength on affected area.
weakness his affected
-Facial area. Dependent:
Asymmetry -Administer After days of
Long Term: medications as nursing
After days of prescribed by the intervention,
nursing physician. goal is fully met.
intervention, Patient are able
patient will be to demonstrate
able to increased
manifest strength and
increase function on his
strength and affected body
function on his area and can
affected area perform
and will moderate range
further of motion.
perform
within
moderate
range of
motion.
 15

Maryhill College, Inc.

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Subjective data: “Self Care Short Term: Independent: -Gain a good After 2-4hours
“Wala naming Deficit related After 2- -Establish trust and patient-nurse shift, goal is
masakit na sakin, to Impaired 4hours of rapport. relationship. partially met.
pero nanghihina Mobility patient nurse -Monitor vital signs -To establish Patient are able
pa din ang secondary to interaction, and record. baseline data to identified
kaliwang Prior Brain patient or - Assess client’s observations. personal
katawan ko” as Stroke” significant muscle - To identify/note resources that
verbalized by the others will be strength, gross and probable can provide
patient. able to fine motor management/plan assistance and
identify coordination5. of care, severity of be able to
Objective data: personal -Determine the condition. verbalized
-Left-sided resources individual -To identify plan knowledge of
weakness that can strengths and skills of health care
-Facial provide of the client. care; to know practices.
Asymmetry assistance client’s needs for
and be able assistance.
to verbalize Dependent: After days of
knowledge of -Administer nursing
health care medications as intervention,
practices. prescribed by the goal is fully met.
physician. Patient are able
Long Term: to
After days of demonstrated
nursing techniques/
intervention, lifestyle changes
patient or to meet self-
significant care needs or
others will be the significant
able to others will be
demonstrate able to perform
techniques/ the health care
lifestyle practices for the
changes to patient.
meet self-
care needs.

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
 16

Maryhill College, Inc.

Subjective data: “Disturbed Body Short Term: Independent: -Gain a good After 2-4hours
“Wala naming Image related to After 2- -Establish trust and patient-nurse shift, goal is
masakit na sakin, Brain Stroke 4hours of rapport. relationship. partially met.
pero nanghihina secondary to patient nurse -Monitor vital signs -To establish Patient are able
pa din ang left-sided interaction, and record. baseline data to recognized
kaliwang katawan weakness and patient will be - Assess the observations. the normalcy of
ko” as verbalized facial able to perceived impact of - Alteration in response to the
by the patient. asymmetry” recognize the change in ADLs, body image can actual or
normalcy of social participation, have an perceived
Objective data: response to personal effect on the change in body
-Left-sided the actual or relationships, and patient’s structure or
weakness perceived occupational ability to carry out function.
-Facial change in activities. daily roles and
Asymmetry body -Evaluate the responsibilities. After days of
structure or patient’s behavior -There is a broad nursing
function. regarding the actual range of behaviors intervention,
or perceived associated with goal is fully met.
Long Term: changed body part body image Patient are able
After days of or function. disturbance, to understood
nursing -Acknowledge and ranging from and has
intervention, accept expression totally ignoring accepted the
patient will be of feelings of the altered body changes
able to able to frustration, structure or that happened
understand dependency, anger, function to to him without
and accept grief, and hostility. preoccupation negating self-
the body Note withdrawn with it. esteem.
changes that behavior and use of -Acceptance of
happened to denial. these feelings as a
him without normal response
negating self- to what has
esteem. occurred
facilitates
resolution. It is not
helpful or possible
Dependent: to push patient
-Administer before ready to
medications as deal with.
prescribed by the
physician.
 17

Maryhill College, Inc.

MEDICINE CLASSFICATIO ACTION CONTRAINDICATI ADVERSE NURSING
NAME N INDICATIO ONS EFFECTS RESPONSIBILIT
NS IES
Brand Name: Antioxidants/ It is used to Contraindicated in -Chest pain -Before giving
RADICAVA Anticoagulant prevent patients with: -Change in drugs, assess
s stroke and -History of walking and first patient’s
Generic Name: blood clots hypersensitivity to balance name.
EDAVARONE in the edaravone or any -Cough -Ask for any
patient of the other -Cracked, allergies to
with certain ingredients in the dry, scaly medication.
heart product. skin -Do not exceed
rhythm -Difficult or the dosage
problems. troubled prescribed.
It also breathing -Discontinue if
treats deep -Dizziness hypersensitivit
venous -Headache y occurs.
thrombosis
Brand Name: Angiotensin II It works by Irbesartan Tablets -Confusion -Before giving
AVAPRO receptor blocking a are -dizziness drugs, assess
blocker (ARB) substance contraindicated in -faintness first patient’s
Generic Name: in the body patients who are -chest pain name.
INBERSARTAN that causes hypersensitive to -difficult, -Ask for any
blood any component of fast, allergies to
vessels to this product. pounding, or medication.
tighten. As irregular -Do not exceed
a result, Do not co- heartbeat or the dosage
irbesartan administrate pulse prescribed.
relaxes the aliskiren with -headache -Discontinue if
blood Irbesartan Tablets -fever hypersensitivit
vessels. in patients with y occurs.
This lowers diabetes.
blood
pressure
and
increases
the supply
of blood
and oxygen
to the
heart.

Brand Name: Vasodilators It is used to Contraindicated in -Burning of -Before giving

TRIMETAZIDINE (fatty acid treat angin patients with: the stomach drugs, assess
oxidation a or chest -Cardiac disorders - or throat first patient’s
Generic Name: inhibitors) pain that Rarely, -Muscle name.
TMZ occurs cramps
 18

Maryhill College, Inc.

when the palpitations, -Dizziness -Ask for any
heart tachycardia. -Drowsiness allergies to
doesn’t get -Gastrointestinal -Heart medication.
enough disorders: palpitations -Do not exceed
oxygenated Nausea, vomiting, -Changes in the dosage
blood. abdominal pain, vision prescribed.
It is also diarrhea, -Changes in -Discontinue if
used to dyspepsia. appetite hypersensitivit
treat heart -stomach y occurs.
failure pain
when the -diarrhea
heart -nausea,
doesn’t vomiting
pump as -headache
well as it -skin rash
should. and itching
Brand Name: Mineralocortic It is a Contraindicated in -Stomach -Before giving
ADALCTONE oid receptor medication patients with: pain drugs, assess
antagonist used in the -Anuria -confusion first patient’s
Generic Name: manageme -Acute renal -difficulty name.
SPIRONOLACTO nt and insufficiency with -Ask for any
NE treatment -Significant breathing allergies to
of impairment of -irregular medication.
hypertensio renal excretory heartbeat -Do not exceed
n and heart function -nausea or the dosage
failure with -Hyperkalemia. vomiting prescribed.
some -numbness -Discontinue if
indications or tingling in hypersensitivit
aside from the hands, y occurs.
cardiovascu feet, or lip,
lar disease. or weakness
or heaviness
of the legs.
.

Brand Name: Antiarrhythmi It is used Contraindicated in -Dizziness -Before giving

LANOXIN c for the patients with: -Vomiting drugs, assess
treatment -Acute myocardial -Diarrhea first patient’s
Generic Name: of heart infarction. -Blurred or name.
DIGOXIN failure in -Hypersensitivity loss of vision -Ask for any
combinatio to the drug. -Abdominal allergies to
n with -Ventricular pain medication.
other fibrillation.
medicines. -Myocarditis.
 19

Maryhill College, Inc.

It helps to - -Breast -Do not exceed
provide Hypomagnesemia. swelling or the dosage
symptomati -Hypokalemia tenderness prescribed.
c relief by -Wolf-Parkinson- -Headache -Discontinue if
making the White syndrome. -Slow hypersensitivit
heart pump heartbeat y occurs.
blood more -Confusion
efficiently. -Weakness
It is also -Drowsiness
used to -Chest pain
treat or
abnormal discomfort
heart -Double
rhythm vision
(arrhythmia
).
Brand Name: Analgesics and Tramadol is Contraindicated in -Headaches -Before giving
TRAMADOL + Antipyretics used to patients who have: -Feeling drugs, assess
PARACETAMOL treat -hypersensitivity sleepy, tired, first patient’s
moderate reaction to any dizzy or name.
to severe opioid. "spaced out" -Ask for any
Generic Name: pain. -Patients under the -nausea or allergies to
CETADOL Paracetam age of twelve vomiting medication.
ol is used to -History of - -Do not exceed
treat fever. tonsillectomy or Constipation the dosage
adenoidectomy. -Dry mouth prescribed.
-Sweating -Discontinue if
hypersensitivit
y occurs.

Brand Name: Alpha and It is used to Contraindicated in -Dizziness, -Before giving

COREG PR beta blockers. treat high patients with: lightheadedn drugs, assess
blood -Hypersensitivity ess first patient’s
Generic Name: pressure -Pulmonary -Drowsiness, name.
CARVEDILOL and heart edema -Diarrhea -Ask for any
failure. It is -Cardiogenic shock -Impotence, allergies to
also used -Bradycardia, heart or tiredness medication.
after a block, or sick sinus may occur -Do not exceed
heart syndrome (unless a the dosage
attack to pacemaker is in prescribed.
improve place) -Discontinue if
the chance hypersensitivit
of survival y occurs.
 20

Maryhill College, Inc.

if your -Asthma or other
heart is not bronchospastic
pumping disorders.
well.
Lowering
high blood
pressure
helps
prevent
strokes,
heart
attacks,
and kidney
problems.
Brand Name: Anti- It is used to Contraindicated in -Skin rash. -Before giving
SAVAYSA Coagulants prevent patients with: -Anemia drugs, assess
stroke and -Hypersensitivity, -Shortness of first patient’s
Generic Name: blood clots and allergic breath name.
EDOXABAN in patients reactions -Fast heart -Ask for any
with a -Prohibited for rate allergies to
certain pregnant medication.
heart -Do not exceed
rhythm the dosage
problem . prescribed.
-Discontinue if
hypersensitivit
y occurs.
 21

Maryhill College, Inc.

DISCHARGE PLANNING
Medication The patient will continue his medication like Lanoxin for the
treatment of heart failure, Edoxaban as it is a blood-thinner, and
Irbesartan as it decreased high blood pressure.

Exercise Since the patient is on bed and it is recovery phase, it is

necessary to include exercise to your daily regime which could
include:
ROM exercise to prevent the muscular atrophy
Treatment Rehabilitation like:
Speech therapy
Physical therapy
Occupational therapy
Health Teachings Lifestyle change:
-Instruct patient to avoid foods that are high in cholesterol that
can elevate his blood pressure.
-Promote ROM exercises.
-Instruct patient to avoid assistive drinking of alcohol.
-Provide general health measures.
Outpatient The patient will advised to attend follow up check up and
attend therapies that can further help his condition after
discharge.

Diet Advised to eat foods that includes at least five portions of fruit
and vegetables per day, fish, pulses and wholegrains and
instruct to limit sweets, processed foods and fatty meats.

Spiritual Provide presence when in need: Emotional Support

Supporting in religious practices.
 22

Maryhill College, Inc.

References:

1. Understanding Stroke (CVA)

https://www.gwhospital.com/conditions-services/neurosciences-
institute/understanding-
stroke#:~:text=A%20stroke%2C%20also%20referred%20to,deprived%20of%
20oxygen%2C%20they%20die.
2. About Stroke: 2 Types of Stroke
https://www.cdc.gov/stroke/about.htm#:~:text=What%20are%20the%20types
%20of,Hemorrhagic%20stroke.