DMC COLLEGE FOUNDATION, INC. STA.

FILOMENA,
DIPOLOG CITY College of Nursing

A Case Study Presentation on Cerebrovascular Disease

NCM 117

Submiited to:
Ms. Eunice Marie M. Leal, RN, USRN
Ms. Ma. Lindy G. Jandug, RN
Ms. Marchie Galleposo, RN

Submitted by:

Trixzia Froyce Licayan

April 24, 2023

 TABLE OF CONTENTS

General Objectives
Specific Objectives
Patient’s profile
Physical Assessment
Gordon’s Functional Health Patterns
Introduction
• Risk Factors
• Signs and Symptoms
• Complications

• Medical management
• Nursing Intervention
Terminologies
Overview of the Case
Anatomy and Physiology
Pathophysiology
Laboratory Results & Interpretation
Drug Study
Nursing Care Plan
Related Readings w/ Summary
References
OBJECTIVES:

General Objectives:
This case study will serve as a guide for nursing students to provide information
about a patient having the disease which is Acute Cerebrovascular Disorder, presenting
its clinical manifestations, treatment and general health status for further knowledge.

Specific Objectives:
After the case presentation, the student nurses will be able to:
1. Widen and enhance the student nurses’ knowledge and skills through additional
research about the nature of disease, signs and symptoms and its
pathophysiology, its diagnosis and treatment.
2. Identify and analyze the etiology of the underlying cause of ACVD.
3. Establish essential nursing intervention to be implemented for the patients’
wellness.
4. To learn new clinical skills as well as sharpen our current clinical skills required in
the management of the patient with ACVD.
5. To support and guide the patient to be able to take forward on their own quality
improvement of health and work plan.
6. Formulate significant nursing diagnoses, with their significantly related nursing
care plan.
7. Student nurses will be able to discuss indications for and management of client
with ACVD.
8. Patient awareness as to what other complications may arise, if left untreated-
through patient teachings.
9. To describe effects of illness on individuals and family members’ roles and
function.
10. Interpret the results in the laboratory and diagnostic procedures done with the
patient including their purposes and specific nursing responsibilities.
PATIENT’S PROFILE
Hospital: Corazon C. Aquino Hospital Intravenous Fluids:

Patient’s Name: Patient X PNSS 1L at 30gtts/min

Age: 74 yrs. old Medications:

Sex: Male Clonidine 75 mcg once PRN

Blood Type: B+ Lactulose 30 cc PO HS

Birthdate: December 23, 1948 Atorvastatin 40mg tab HS

Birthplace: Dipolog City Omeprazole 40mg now

Address: Turno, Dipolog City Epirisone 1 tab q 8hrs

Civil Status: Married Ketorolac 30mg Now

Religion: Roman Catholic Patient Social History:

Nationality: Filipino Smoking, Alcohol

Date of Admission: April 16, 2023 History of Present Illness: 4 days

Time of Admission: 2:30 PM prior to admission, noted left sided

Accommodation: Male Surgical Ward weakness associated w/ nape pain

Attending Physician: Dr. Gahisan persistence prompted admission.

Chief Complaints: Left sided weakness Past Medical History:

w/ nape pain and back pain. Essential hypertension
VITAL SIGNS: Condition of patient upon arrival:
BP: 150/70 mmhg Conscious with complain of nape
Temperature: 35.9°C pain and dizziness.
Pulse Rate: 73 bpm
RR: 19 cpm
O2 Saturation: 96%
Weight: 59.5 kg
Admitting Diagnosis: Acute
Cerebrovascular Disorder Infarct VS
Bleed
PHYSICAL ASSESSMENT:

SKIN: No bruises present or observed.

The skin was warm, dry, and color brown.
Skin turgor returns to normal 1-3 secs.
HAIR: Hair is blond and evenly distributed.
Has no lesions.
No dryness or oiliness.
NAILS: Has capillary refill of <3 seconds;
nails are thick and yellowish due to aging.
EYES: Eyes are symmetrical and the sclera appears white.
Each pupil contracts when illuminated & dilates when
nonilluminated.
No swelling but with few tears.
EARS: No tenderness, swelling, or redness observed;
No pain and discharged present.
NOSE: External nose is symmetrical with no discoloration, swelling or
malformations;
No discharge/ bleeding present in nasal mucosa.
MOUTH: Lips appears moist & pinkish; Tongue in midline & moves freely.
No lesions, nodules, or swelling present.
NECK: No noticeable enlargement of lymph nodes or thyroid glands.
Able to speak clearly w/ no slurring or garbled words.
Symmetrical, able to move head w/out pain.
CHEST: No pain upon breathing; no lesions present.
No thorax deformities.
Clear lung sounds upon auscultation.
Nipple at the midline w/ no mass upon palpation.
ABDOMEN: Abdomen is soft, symmetrical, and non-tender w/out distention.
No masses/bulges palpated; No lesions or scars.
EXTREMITIES: Pain Scale of 5/10 upon moving the left shoulder.
No visible lesions or scars.
GORDON’S FUNCTIONAL HEALTH PATTERNS:
HEALTH PATTERN PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION
HEALTH PERCEPTION / HEALTH Pt. can’t able to do things on his own without Patient is conscious, pt. can’t able to move without assistance.
MANAGEMENT PATTERN assistance when pain in his body occurs.
NUTRITION / METABOLISM Patient’s appetite is poor. Patient is in loss of appetite.
No food restriction/allergy. Low salt, low fat diet is advised.
No skin problem.
ELIMINATION PATTERN Patient urinates three times a day and defecate Patient’s color of urine is in normal: dark yellow.
every day with no urinary problem. He is not using any laxative.
ACTIVITY / EXERCISE Patients movement is limited and complains of Patient can no longer do exercise or any activity pattern due
pain upon moving the left side of the body. to pain experiencing and hospitalization.
SEXUALITY / REPRODUCTIVE Patient is not sexually active Patient is not sexually active
COGNITIVE / PERCEPTUAL The patient is oriented to people, time, and place. The patient has no problem in his senses.
He is able to read, write, and understand word. He is able to respond when asked.
VALUE / BELIEF He has a strong faith in God. Prior to hospitalization there is no interference with their
religious practices.
SELF-PERCEPTION / SELF- The Patient is unable to groom himself. The Patient is not in a good state due to his condition but his
CONCEPT S.O is there to assist.
ROLES / RELATIONSHIP He is a husband. The Patient has his wife to be with him at the hospital.
COPING / STRESS The Patients’ way of coping stress is to sleep or Patients’ way to cope up with stress is sleeping.
take nap.
SLEEP / REST The Patient takes a nap every time the pain in his The Patient stated that he struggles sleeping due to pain and
body will occur. hospitalization.
 INTRODUCTION

Cerebrovascular disorders is an umbrella term that refers to functional

abnormality of the central nervous system (CNS) that occurs when the blood supply to
the brain is disrupted. Stroke primary cerebrovascular disorders in the US and while it
dropped from the fourth to the fifth leading cause of death, it is still a leading cause of
serious, long-term disability. Approximately 795,000 people experience a stroke each
year. Approximately 6,000 of this are new strokes, and 185 000 are recurrent strokes.
Strokes can be divided into two major categories; these are ischemic and hemorrhagic
strokes. Although there are some similarities between the two types of strokes,
differences exist in etiology, pathophysiology, medical management, surgical
management, and nursing care.

In hemorrhagic stroke, it is primarily caused by intracerebral and subarachnoid

hemorrhage and are caused by bleeding into the brain tissue, the ventricles, or the
subarachnoid space. the patient with a hemorrhagic stroke can present with a wide
variety of neurologic deficits, similar to the patient with ischemic stroke and should
undergo a CT scan or MRI scan (to determine the type of stroke, the size and location
of the hematoma, and the presence or absence of ventricular blood and
hydrocephalus). Group B recognizes their partial knowledge about the cerebrovascular
disorder and making the case a good avenue to broaden the proponents’ knowledge
about the disorder involved.

Risk Factors:

Modifiable
 Lifestyle
 Hypertension
 Obesity
 Smoking
 Excessive alcohol intake
 CVD
 OCP
Non- modifiable
 Age
 Race
  Family History
 Gender
Signs and Symptoms:
 Numbness or weakness of the face, arm, or leg, especially on 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

Complications:
Complications of cerebrovascular disease that may develop include:

 permanent disability
 loss of cognitive functions
 partial paralysis in some limbs
 speech difficulties
 memory loss

MEDICAL MANAGEMENT
Non-pharmacologic:
Diet: low salt and fat intake

Pharmacologic:
- Atorvastatin 5mg PO OD
- Amlodipine 5mg PO OD
- Clopidogrel 75mg PC OD
- Omeprazole 4mg TW OD

NURSING MANAGEMENT
1. Preventive education
2. The nurse helps the patient select a healthy diet (nutritional counseling).
3. Encourage the patient to continue iron therapy for as long as it prescribes
even though the patient may no longer feel fatigue.
4. Instruct the patient to take supplements an hour before meals.
5. The nurse needs to be aware of the type of parenteral formulation of iron
ordered so that the risk of anaphylaxis may be determined.
 6. The nurse need to assist patients in understanding the need for repeated
dosing to replenish iron stores or to maintain iron stores in the setting of
chronic blood loss such as dialysis, or chronic GI bleeding.
TERMINOLOGIES:

Ataxia - poor muscle control that causes clumsy voluntary movements. It may cause
difficulty with walking and balance, hand coordination, speech and swallowing, and eye
movements.

Arachnoid - a thin membrane of the brain and spinal cord that lies between the dura
mater and the pia mater.

Cerebrum- consists of two hemispheres that are incompletely separated by the great
longitudinal fissure.

Cerebellum- is separated from the cerebral hemispheres by a fold of dura mater, the
tentorium cerebelli. Has both excitatory and inhibitory actions and is largely responsible
for coordination of movement.

Embolism - A block in an artery caused by blood clots or other substances, such as fat
globules, infected tissue, or cancer cells.

Hemorrhage - loss of blood from damaged blood vessels. A hemorrhage may be

internal or external, and usually involves a lot of bleeding in a short time.

Hemiparesis - is weakness or the inability to move on one side of the body, making it
hard to perform everyday activities like eating or dressing.

Hemiplegia - is a condition caused by a brain injury, that results in a varying degree of

weakness, stiffness (spasticity) and lack of control in one side of the body.

Ischemic – ischemic stroke is when there is a blocked artery that reduces blood flow to
brain.

Thrombosis - A blood clot that forms on the wall of a blood vessel or in the heart when
blood platelets, proteins, and cells stick together. A thrombus may block the flow of
blood.
 OVERVIEW OF THE CASE

A case of patient "X", 74-year-old male a Roman Catholic Christian, Born in

Dipolog City on December 23, 1948, and currently residing in Turno, Dipolog City,
Zamboanga del Norte. The patient was diagnosed with Cerebrovascular Disease and
admitted to the hospital of Corazon C. Aquino hospital last April 16, 2023 at 2:30 PM.

Cerebrovascular disease includes a range of conditions that affect the flow of

blood through the brain. This alteration of blood flow can sometimes impair the brain’s
functions on either a temporary or permanent basis. When such an event occurs
suddenly, it’s referred to as a cerebrovascular accident (CVA).
ANATOMY & PHYSIOLOGY

ANATOMY AND PHYSIOLOGY

The nervous system is the master controlling and communicating system of the body.
Every thought, action, and emotion reflect its activity. It’s signaling device, or means of
communicating with body cells, is electrical impulses, which are rapid and specific and cause
almost immediate responses. The nervous system has approximately 10 million sensory
neurons that send information about the internal and external environment to the brain and
500,000 motor neurons that control the muscles and glands. The brain itself contains more
than 20 billion nerve cells that link the motor and sensory pathways, monitor the body’s
processes, respond to the internal and external environment, maintain homeostasis, and direct
all psychological, biologic, and physical activity through complex chemical and electrical
messages.
ANATOMY
CONTAINS TWO MAJOR PARTS:
CENTRAL NERVOUS SYSTEM

PERIPHERAL NERVOUS SYSTEM

CELLS OF NERVOUS SYSTEM

 Dendrites
 Cell Bods
 Axon

NEUROTRANSMITTERS- it communicates messages

from one neuron to another or from a neuron to a
target cell, such as muscle or endocrine cells.

*CENTRAL NERVOUS SYSTEM*

 BRAIN

 is a complex organ that controls thought, memory, emotions, touch, motor skills,
vision, breathing, temperature, hunger and every process that regulates our body.
 Contains more than 100 billion cells.
 Brain weighs approximately 1,400 g (young adults) and 1,200 g (older adults)

3 MAJOR AREAS OF BRAIN

 Cerebellum- is separated from the cerebral hemispheres by a fold of dura mater, the
tentorium cerebelli.
- Has both excitatory and inhibitory actions and is largely responsible for
coordination of movement.
 Cerebrum- consists of two hemispheres that are incompletely separated by the great
longitudinal fissure
- The external or outer portion of the hemisphere that made up of gray
matter approximately 2 to 5 mm in depth
 Brain Stem- is about the size of a thumb in diameter and approximately 3 inches long.
- Its structures are the midbrain, pons, medulla oblongata.

CEREBRUM IS COMPOSED OF: TWO HEMISPHERE, THALAMUS, HYDROTHALAMUS AND BRAIN

STEM

 TWO HEMISPHERE- are joined at the lower portion of the fissure by the corpus
callosum
 THALAMUS- Lies on either side of the third ventricle and acts primarily as a relay
station for all sensation except smell.
 HYPOTHALAMUS- is located anterior and inferior to the thalamus
- Lies immediately beneath and lateral to the lower portion of
the wall of the third ventricle
 BASAL GANGLIA- are masses of nuclei located deep in the cerebral hemispheres that
are responsible for control of fine
motor movements, including those of
the hands and lower extremeties.
Cerebral Hemispheres are divided into pairs of:

 Frontal lobe- the largest lobe

- Are responsible in large part for an individual’s affect,
judgement, personality, and inhibitions.
 Parietal lobe- a predominantly sensory lobe
- The primary sensory cortex, which analyzes sensory
information and relays the interpretation of this information to
the thalamus and other cortical areas (located in the parietal
lobe)
- It is also essential to an individual’s awareness of the body in
space, as well as orientation in space and spatial relation.
 Temporal lobe- contains the auditory receptive areas.
- Contains a vital area called the interpretive area (that provides
integration of somatization, visual, and auditory areas and plays
the most dominant role of any area of the cortex in
cerebration)
 Occipital lobe- the posterior lobe of the cerebral hemisphere is responsible for visual
interpretation.

STRUCTURES PROTECTING THE BRAIN

 Duramater- the outermost layer; covers the brain and the spinal cord.
- Has three major extensions of the dura (falx cerebri,
tentorium, falx cerebelli)
 Arachnoid- the middle layer; an extremely thin, delicate membrane that closely
resembles a spider web
 Pia mater- innermost layer; thin, transparent layer that the brain closely and extends
into every fold of the brain’s surface.

CEREBROSPINAL FLUID- is a clear and colorless fluid that is produced in the choroid plexus of
the ventricles and circulates around the surface of the brain and the spinal cord.
CEREBRAL CIRCULATION- the brain does not store nutrients and requires a constant supply of
oxygen.
  ARTERIES- arterial blood supply to the anterior brain originates from the common
carotid artery.
- Vertebral artery branches from the subclavian arteries to
supply most of the posterior circulation of the brain.
 VEINS- the veins reach the brain’s surface, join larger veins, and then cross the
subarachnoid space and empty into dural sinuses, which are the vascular channels
embedded in the dura.
 BLOOD-BRAIN BARRIER- has a protective function but can be altered by trauma,
cerebral edema, and cerebral hypoxemia

SPINAL CORD
Is continuous with the medulla, extending from the cerebral hemispheres and serving as the
connection between the brain and the periphery.

 SPINAL TRACTS- spinal cord contains ascending and descending tracts. The primary
ascending tracts use three neurons to relay peripheral sensory information to the brain.
In contrast, the descending tracts transmit motor impulses from the cerebral cortex
throughout the body.
 VERTEBRAL COLUMN- surrounds and protects the spinal cord and normally consists of 7
cervical, 12 thoracic, and 5 lumbar vertebrae, as well as the sacrum and terminate in the
coccyx.

PHYSIOLOGY

 MONITOR BODY PROCESSES

 RESPOND TO THE INTERNAL AND EXTERNAL ENVIRONMENT
 INTERPRETATION OF SENSORY INPUT
 EFFECTS RESPONSE
 MENTAL ACTIVITY
 MAINTAIN HOMEOSTATIS
 VOLUNTARY CONTROL OF MOVEMENT
PATHOPHYSIOLOGY

Modifiable Non- modifiable

 Lifestyle  Age
CLOT FORMATION
 Hypertension  Race
(Atheroma/blood clot)
 Obesity  Family History
 Smoking  Gender
 Excessive alcohol intake
OBSTRUCTION OF BLOOD
 CVD
VESSEL
 OCP

RESTRICT BLOOD FLOW

CEREBRAL BLOOD FLOW

NEURONS NO LONGER
MAINTAIN AEROBIC
RESPIRATION

Mitochondria switch to anaerobic

respiration that generates large
amount of lactic acid.
 Change in pH level

CELLS CEASE TO FUNCTION

DECREASE O2 SUPPLY IN
BRAIN

SX/S:

 Numbness or weakness of the

face, arm, or leg, especially
on 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
 MNGT:
DX:
PHARMA:
Serum and Electrolytes Test
- Atorvastatin 5mg PO OD
Hematology
Amlodipine 5mg PO OD
Ct- Scan
- Clopidogrel 75mg PC OD
- Omeprazole 4mg TW OD

NON-PHARMA:

DIET- decrease salt and fat intake

LIFESTYLE – do exercise
Take medication as prescribed
Monitor signs and symptoms of stroke

SURGICAL MNGT /TREATMENT:

ENDARTERECTOMY
A carotid endarterectomy is the removal of an atherosclerotic plaque or thrombus from the carotid artery to prevent stroke in patients with occlusive
disease of the extracranial cerebral arteries.
Nx Responsibility/post op
Close cardiac monitoring is necessary because these patients have a high incidence of coronary artery disease.
It is important to maintain adequate blood pressure levels in the immediate postoperative period.
THROMBOLYTIC THERAPY
Thrombolytic agents are used to treat ischemic stroke by dissolving the blood clot that is blocking blood flow to the brain. It works by binding to
fibrin and converting plasminogen to plasmin, which stimulates fibrinolysis of the atherosclerotic lesion.
Nx Responsibility/post op
- Should be given within 3 hours after stroke occurred.
- Delays make the patient ineligible for thrombolytic therapy because revascularization of necrotic tissue (which develops after 3 hours)
increases the risk for cerebral edema and hemorrhage.
GOOD OUTCOME: BAD OUTCOME:

• Controlled • Long-term disability

cerebrovascular disease • Aphasia
can lead normal lives • Loss of cognitive
with complete function
recovery. • Paralysis in some limbs
• Death
LABORATORY RESULTS:

Date ordered Specimen Patient Patient’s Normal

Date taken preparation Interpretation Significance
Result Values

4/16/23 4/16/23 BLOOD The nurse LOW To evaluate numerous

SPECIMEN will instruct RBC: 4.38 10^12/L 4.7-6.1 conditions involving the
the patient blood components.
prior to the HEMOGLOBIN: 13.6 g/dL 14.0-18.0 NORMAL
laboratory
test that HEMATOCRIT: 42.7 % 42.0-51.0 NORMAL
he/she will
undergo on WBC: 11.4 10^9/L 4.8-10.8 NORMAL
that
procedure. GRANULOCYTES: 72.8 % 51-67 HIGH

LYMPHOCYTES: 22.1 % 23-33 LOW

MONOCYTES: 5.1 % 4.8-10.8 NORMAL

PLATELET: 320 10^9/L 150-400 NORMAL

MCV: 97.5 fL 80-96 HIGH

MCH: 31.3 27-33 NORMAL

MCHC: 31.9 31-36 LOW

Date ordered Specimen Patient Patient’s Normal
Date taken preparation Interpretation Significance
Result Values

4/16/23 4/16/23 Urine Explain the NORMAL To determine

procedure to BUN: 15.27 mg/dL 6.000-20.00 if the kidneys
the patient are working
prior to the URIC ACID: 9.223 mg/dL 2.000-7.200 HIGH normally. To
test. diagnose
ALT/SGPT: 21.26 U/L 0.000-40.00 NORMAL acute or
chronic renal
CREATININE: 1.001 mg/dL 0.600-1.300 disease or
damage.

NORMAL
Date ordered Specimen Patient Patient’s Normal
Date taken preparation Interpretation Significance
Result Values

4/16/23 4/16/23 Urine Explain to the COLOR: DARK NORMAL To detect and
Pale yellow
Specimen patient how to YELLOW manage
obtain the disorders, such
specimen. TRANSPARENCY: Clear NORMAL as urinary tract
Instruct the HAZY infections and
patient the diabetes.
pH: 5.0 4.6-8.0 NORMAL
proper way of
cleaning the SPECIFIC GRAVITY: 1.001-1.030 NORMAL
genital area to 1.030
prevent
contamination GLUCOSE: (-) NONE NORMAL
. NEGATIVE

PROTEIN: (-) NONE NORMAL

LEUCOCYTES NONE NORMAL

ESTERASE: (-)

BLOOD: (-) NONE NORMAL

NITRITE: (-) NONE NORMAL

KETONE: (-) NONE NORMAL

BILIRUBIN: (-) NONE NORMAL

UROBILINOGEN: (-) NONE NORMAL

DRUG STUDY NO. 1:

 Drug Name Classification Mechanism of Indications Contraindications Adverse Reactions Nursing Responsibilities
Action
Generic: PHARMACO- Stimulates Hypertension, Epidural: Overdose produces BASELINE ASSESSMENT:
Clonidine THERAPEUTI alpha2- Acute Contraindicated in profound  Obtain B/P immediately before each
C: hypertension dose is administered, in addition to
adrenergic pts with bleeding hypotension,
Brand: Alpha2-adrenergic regular monitoring (be alert to B/P
receptors in the diathesis or infection irritability, fluctuations).
Catapres, agonist.
Kapvay brainstem, at the injection site; bradycardia, INTERVENTION/EVALUATION:
reducing pts receiving respiratory  Monitor B/P, pulse, mental status.
CLINICAL:  Monitor daily pattern of bowel
Antihypertensive sympathetic anticoagulation depression,
outflow from therapy. Cautions: hypothermia, activity, stool consistency.
 If Clonidine is to be withdrawn,
the CNS. Depression, elderly. miosis (pupillary discontinue concurrent beta-blocker
Epidural: Severe coronary constriction), therapy several days before
Prevents pain insufficiency, recent arrhythmias, apnea. discontinuing Clonidine (prevents
signal MI, cerebrovascular Abrupt withdrawal Clonidine withdrawal hypertensive
transmission to disease, chronic may result in crisis).
brain and renal impairment, rebound  Slowly reduce Clonidine dosage over
2–4 days.
produces preexisting hypertension PATIENT/FAMILY TEACHING:
analgesia at bradycardia, sinus associated with  Sugarless gum and sips of water may
pre- and post- node dysfunction, nervousness, relieve a dry mouth.
alpha- conduction agitation, anxiety,  Avoid tasks that require alertness and
adrenergic disturbances; insomnia, motor skills until response to drug is
receptors in concurrent use with paresthesia, tremor, established.
 To reduce hypotensive effect, rise
spinal cord. digoxin, diltiaZEM, flushing, slowly from lying to standing.
metoprolol, diaphoresis. May  Skipping doses or voluntarily
verapamil. produce sedation in discontinuing drug may produce
Therapeutic severe rebound hypertension.
pts with acute CVA.
Effect: Reduces  Avoid alcohol.
peripheral  If patch loosens during 7-day
resistance; application period, secure with
decreases B/P, adhesive cover
heart rate.
Produces
analgesia.
DRUG STUDY NO. 2:
 Drug Name Classification Mechanism Indications Contraindications Adverse Nursing
of Action Reaction Responsibilities
Generic PHARMACO- Inhibits Constipation, Pts requiring a Severe diarrhea BASELINE ASSESSMENT:
name: THERAPEUTIC: diffusion of NH3 Prevention of low-galactose may cause  Question usual stool pattern, frequency,
Lactulose dehydration and characteristics.
Lactose derivative. into blood by Portal-Systemic diet.
 Conduct neurological exam in pts with
converting NH3 Encephalopathy, electrolyte elevated serum ammonia levels,
Brand CLINICAL: to NH4 +; Treatment of Cautions: Diabetes, imbalance. symptoms of encephalopathy.
name: Hyperosmotic enhances Portal-Systemic hepatic impairment, Long-term use  Assess hydration status.
Constulose, laxative, ammonia diffusion of NH3 Encephalopathy, dehydration. may result in INTERVENTION/EVALUATION:
Enulose, detoxicant. from blood to Rectal laxative  Encourage adequate fluid intake.
Generlac,  Assess bowel sounds for peristalsis.
gut, where it is Administration (as dependence,
Kristalose  Monitor daily pattern of bowel activity,
converted to Retention Enema) chronic stool consistency; record time of
NH4 +; constipation, evacuation.
produces loss of normal  Assess for abdominal disturbances.
osmotic effect bowel function.  Monitor serum electrolytes in pts with
in colon, prolonged, frequent, excessive use of
medication.
resulting in  Monitor encephalopathic pts for
colon symptom improvement (alertness,
distention, orientation, ability to follow commands).
promoting PATIENT/FAMILY TEACHING:
peristalsis.  Evacuation occurs in 24–48 hrs of initial
dose.
 Institute measures to promote
Therapeutic Effect: defecation: increase fluid intake, exercise,
Promotes increased high-fiber diet.
 Drink plenty of fluids.
peristalsis, bowel
 If therapy was started to treat high
evacuation;
ammonia levels, notify physician if
decreases serum
worsening of confusion, lethargy,
ammonia
weakness occurs
concentration

DRUG STUDY NO. 3:

Drug Classification Mechanism Indications Contraindications Adverse Nursing Responsibilities
 Name of Reaction
Action
Generic: PHARMACO- Inhibits HMG-CoA Do not use in pts Active hepatic Potential for BASELINE ASSESSMENT:
Atorvastatin THERAPEUTIC: reductase, the with active hepatic disease, cataracts,  Obtain baseline cholesterol,
Hydroxy- enzyme that catalyzes disease. breastfeeding, photosensitivity, triglycerides, LFT.
Brand: methylglutaryl the early step in Dyslipidemias, pregnancy or myalgia,  Question for possibility of pregnancy
Lipitor CoA (HMG-CoA) cholesterol synthesis. Heterozygous women who may rhabdomyolysis. before initiating therapy.
reductase Results in an increase Hypercholesterolemia. become  Obtain dietary history.
inhibitor. of expression in LDL pregnant, INTERVENTION/EVALUATION:
receptors on unexplained  Monitor for headache.
hepatocyte elevated LFT  Assess for rash, pruritus, malaise.
CLINICAL: membranes and a  Monitor cholesterol, triglyceride lab
results.
Antihyperlipidemic stimulation of LDL values for therapeutic response.
Cautions:
catabolism.  Monitor LFTs, CPK.
Anticoagulant
Therapeutic Effect: PATIENT/FAMILY TEACHING:
therapy; history of
Decreases LDL and  Follow special diet (important part of
hepatic disease;
VLDL, plasma treatment).
substantial alcohol
triglyceride levels;  Periodic lab tests are essential part of
consumption; pts
increases HDL therapy.
with prior stroke/TIA;
concentration.  Do not take other medications
concomitant use of
without consulting physician.
potent CYP3A4
 Do not chew, crush, dissolve, or
inhibitors; elderly
divide tablets.
(predisposed to
 Report dark urine, muscle fatigue,
myopathy).
bone pain.
 Avoid excessive alcohol intake,
large quantities of grapefruit
products.

DRUG STUDY NO. 4

 Drug Classification Mechanism of Indications Contraindications Adverse Nursing Responsibilities
Name Action Reaction

Generic: PHARMACO- Inhibits hydrogen- Active Hypersensitivity Pancreatitis, INTERVENTION/EVALUATION:

Omeprazole THERAPEUTIC: potassium adenosine Duodenal to omeprazole, hepatotoxicity,  Evaluate for therapeutic
Benzimidazole triphosphatase Ulcer, other proton interstitial response (relief of GI
nephritis occur symptoms).
Brand: (H+/K+ ATP pump), Symptomatic pump inhibitors.
rarely. May  Question if GI discomfort,
Prilosec, an enzyme on the GERD, Concomitant use increase risk of nausea, diarrhea occurs.
and CLINICAL: surface of gastric Erosive with products C. difficile
Prilosec Proton pump parietal cells. esophagitis, containing infection. PATIENT/FAMILY TEACHING
inhibitor. Gastric Ulcer, rilpivirine.
OTC  Report headache, onset of
Frequent black, tarry stools, diarrhea,
Therapeutic Effect:
heartburn abdominal pain.
Increases gastric pH, Cautions: May increase  Avoid alcohol.
reduces gastric acid risk of fractures,  Swallow capsules whole; do
production. gastrointestinal not chew, crush, dissolve, or
infections. Hepatic divide.
impairment, pts of  Take before eating.
Asian descent.

DRUG STUDY NO. 5

 Drug Classification Mechanism Indications Contraindica- Adverse Nursing Responsibilities
Name of tions Reaction
Action
Generic centrally- Centrally acting Spastic Myasthenia Shock and anaphylactoid  Assess for mentioned
name: acting skeletal muscle paralysis, gravis, reactions (e.g. urticaria, contraindications and
Eperison muscle relaxant that Myotonic Lactation, pruritus, edema of the face or cautions (e.g., drug
e relaxants. decreases muscle symptoms Pregnancy, other parts, dyspnea), allergy, cardiac
spindle sensitivity Active hepatic Stevens-Johnson syndrome, depression, rheumatic
Brand through the disease. toxic epidermal necrolysis; disorder, pregnancy and
name: inhibition of weakness, dizziness, lactation, etc.) to prevent
Myonal spontaneous drowsiness. untoward complications.
discharge of γ- Gastrointestinal
motor neurons. It disorders: Nausea, vomiting,  Conduct thorough
also exhibits diarrhea, constipation, physical assessment
vasodilatory action stomach discomfort, (temperature, skin color
through abdominal pain. and lesion, CNS
antagonism of Ca General disorders and orientation, affect,
influx. administration site reflexes, bilateral grip
conditions: Fatigue. strength, spasticity
Metabolism and nutrition evaluation; bowel
disorders: Anorexia, sounds and urine output)
increased thirst. to obtain baseline data.
Nervous system
disorders: Headache,  Monitor liver and renal
numbness of the extremities. function tests to detect
Psychiatric potential adverse
disorders: Insomnia. effects.
Skin and subcutaneous
tissue disorders: Rash.
Vascular disorders: Hot
flushes.

DRUG STUDY NO. 6:

Drug Name Classification Mechanism Indications Contraindications Adverse Nursing Responsibilities
of Reaction
Action
Generic: PHARMACO- Inhibits COX-1 and Short- Intracranial bleeding, Peptic ulcer, GI BASELINE ASSESSMENT:
Ketorolac THERAPEUTIC: COX-2 enzymes, term hemorrhagic diathesis, bleeding,  Assess onset, type, location,
NSAID resulting in decreased relief of incomplete hemostasis, gastritis, duration of pain.
Brand name: prostaglandin moderate high risk of bleeding; severe hepatic  Obtain baseline renal/hepatic
Acular, CLINICAL: synthesis; reduces ly severe concomitant use of function tests.
reaction
Acular LS, Analgesic, prostaglandin levels pain. aspirin, NSAIDs, INTERVENTION/EVALUATION:
Allergic probenecid, or
(cholestasis,  Monitor renal function, LFT,
Acuvail Intraocular anti- in aqueous humor.
conjuncti pentoxifylline; labor and jaundice) urinary output.
inflammatory. occurs rarely.
vitis delivery, advanced renal  Monitor daily pattern of bowel
Therapeutic Effect: Nephrotoxicity
Cataract impairment or risk of activity, stool consistency.
Produces analgesic, extraction renal failure, active or (glomerular  Observe for occult blood loss.
antipyretic, anti- Corneal history of peptic ulcer nephritis,  Assess for therapeutic
inflammatory effect; Refractive disease, chronic interstitial response: relief of pain,
reduces intraocular Surgery inflammation of GI tract, nephritis, stiffness, swelling; increased
inflammation. recent or history of GI nephrotic joint mobility; reduced joint
bleeding/ ulceration. syndrome) may tenderness; improved grip
Perioperative pain in strength.
occur in pts
setting of CABG  Monitor for bleeding (may also
surgery. Prophylaxis
with preexisting occur with ophthalmic route due
before major surgery. renal to systemic absorption).
Cautions: Hepatic impairment. PATIENT/ FAMILY TEACHING:
impairment, history of Acute  Avoid aspirin, alcohol.
GI tract disease, hypersensitivity  Report abdominal pain, bloody
asthma, coagulation reaction (fever, stools, or vomiting blood.
disorders, receiving chills, joint  If GI upset occurs, take with
anticoagulants, fluid pain) occurs food, milk.
retention, HF, renal rarely.  Ophthalmic: Transient stinging,
impairment, burning may occur upon
inflammatory bowel instillation.
disease, smoking, use  Do not administer while
of alcohol, elderly, wearing soft contact lenses.
debilitated.
NURSING CARE PLAN
 Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
SUBJECTIVE: Acute pain r/t Within 8hrs of INDEPENDENT: INDEPENDENT: After the nursing
“Sakit akong tibuok hemiparesis nursing intervention, 1. Assess the patient for shoulder stiffness 1. It is a common & distressing intervention, the
and pain. complication r/t stroke and occurs in the
lawas ilihok samot na as evidenced the patient will be patient was able to;
paralytic side of the pt.
sa akong abaga ug by reports of able to; 2. Assist the pt when changing position. 2. Never lift pt by the flaccid shoulder or
tingkoy2 sa wala” as shoulder pain, pull on the affected arm or shoulder as • Demonstrate
verbalized by the nape pain, • Verbalize relief of this will cause pain. behaviors to
patient with the pain stiffness and pain. 3. When lifting arm, it should be moved 3. To avoid impingement. manage pain.
scale of 10/10. increased RR. slowly and be rotated outward.
4.Perform therapeutic technique of range 4. To produce a greater range of flexion
• Perform activities • Exhibit relieved/
of movement by holding the humerus at the hemiplegic shoulder.
OBJECTIVE: for recovery and under the axilla and maintaining external controlled pain.
• Upon reviewing rehabilitation. rotation.
patient's chart, the 5. Assist pt in performing ROM exercises. 5. To prevent shoulder stiffness. • Sleep/rest
chief complaint is left • Move without appropriately and
sided weakness with discomfort or pain. 6. Perform pain assessment every time 6. To determine improvement or appear relaxed.
pain occurs. Observe changes from worsening of underlying condition or
nape pain, back pain,
previous reports. complications.
and shoulder pain. 7. Provide non-pharmacological comfort 7. Promotes relaxation and helps refocus
measures (e.g., deep breathing exercises, attention.
•Weakness of massage, repositioning)
muscles and stiffness 8. Monitor vital signs, note nonverbal 8. May be useful in evaluating verbal
of left side of the cues, e.g., muscle, restlessness. comments and effectiveness of
interventions.
body was observed.
9. Provide a quiet environment and reduce 9. Promotes rest and enhances coping
stressful stimuli. abilities.
V/S: 10. Place in position of comfort and 10. May decrease associated joint
BP: 130/60 mmHg support joints, extremities with pillows or discomfort.
HR: 72 bpm padding.
RR: 24 cpm
DEPENDENT: DEPENDENT:
T: 37.8 °C Opioid analgesic agents (IV) To relieve the pain or provide rapid relief.
O2 Sat: 95 %
Assessment Nursing Planning Nursing Intervention Rationale Evaluation
Diagnosis
SUBJECTIVE: Risk for Within 8hrs of INDEPENDENT: INDEPENDENT: After the nursing
Patient decreased nursing 1. Monitor and record BP. 1. Comparison of pressures provides a complete picture intervention, the
of vascular involvement or the scope of the problem.
complains of cardiac intervention, the patient was able
Systolic hypertension is also an established risk factor for
shortness of workload as patient will be cerebrovascular disease. to;
breath. r/t Isolated able to; 2. Evaluate client reports or evidence of extreme 2. To assess for signs of poor ventricular function or
systolic fatigue, intolerance for activity, swelling of impending cardiac failure. • Maintain bp
OBJECTIVE: hypertension • Participate in extremities, and progressive shortness of breath. within acceptable
• Patient’s as evidenced activities that 3. Provide calm, restful surroundings, and minimize 3. It helps lessen sympathetic stimulation; promotes limits.
environmental activity and noise. relaxation.
Systolic blood by consistent reduce
4. Maintain activity restrictions (bedrest or chair 4. Lessens physical stress and tension that affect blood
pressure was elevated BP/Cardiac rest); schedule uninterrupted rest periods; assist pressure and the course of hypertension. • Initiate necessary
consistently systolic bp workload. patient with self-care activities as needed. lifestyle/behavioral
high, while and 5. Provide comfort measures (back and neck 5. Decreases discomfort and may reduce sympathetic change.
diastolic increased RR. • Maintain BP massage, the elevation of head). stimulation.
blood within 6. Monitor response to medications. 6. To control blood pressure. Because of side effects, • Prevent from
drug interactions, and patient’s motivation for taking
pressure is individually possible
antihypertensive medication, it is important to use the
less than acceptable smallest number and lowest dosage of medications. complications.
80mmHg. range. 7. Instruct in relaxation techniques, guided 7. Can reduce stressful stimuli, and produce a calming
imagery, and distractions. effect, thereby reducing BP.
• Muscle • Participate in 8. Observe skin color, moisture, temperature, and 8. Presence of pallor; cool, moist skin; and delayed
weakness was activities that will capillary refill time. capillary refill time may be due to peripheral
vasoconstriction or reflect cardiac decompensation and
noted prevent stress.
decreased output.
9. Advise pt to limit alcohol consumption and 9. Excessive alcohol intake and nicotine can increase
V/S: avoidance of tobacco. blood pressure.
BP: 150/70 10. Complete history should be obtained. 10. To assess for signs and symptoms that indicate target
mmHg organ damage.
HR: 73 bpm
DEPENDENT: DEPENDENT:
RR: 23 cpm 1. Administer medications, as indicated. 1. To keep blood pressure at a normal level.
T: 36.8 °C
O2 Sat: 96 %

Assessment Nursing Planning Nursing Intervention Rationale Evaluation

Diagnosis
SUBJECTIVE: Impaired Within 8hrs of INDEPENDENT: INDEPENDENT: After the nursing
“Maglisod kog lihok physical nursing 1. Assess for subluxation of the shoulder (e.g., 1. Shoulder subluxation occurs when weight of intervention, the
sa ako kamot ug tiil” mobility r/t intervention, shoulder pain and tenderness, swelling, the affected arm is unable to be supported by patient was able to;
as verbalized by the neuromuscular the patient will decreased range of motion [ROM]). the weakened shoulder muscles, causing
patient and impairment be able to; separation of the shoulder joint. •Demonstrate
complains stiffness with limited use 2. Never pull on the affected arm. Guide the 2. To help prevent subluxation. techniques/behaviors
upon moving the of upper and •Demonstrate upper extremity movement. that enable
joints. lower limbs as techniques that 3. Gentle joint ROM exercises and proper arm 3. To avoid pain, edema, and skin and muscle resumption of
evidenced by promote positioning. Never place the arm under the body. atrophy caused by impairment of the circulatory activities.
OBJECTIVE: inability to ambulating. pumping action of the upper extremity.
• Upon assessing purposefully 4. Position the patient in correct alignment and 4. To help maintain anatomic position. •Maintain skin
the pt, decreased move, limited •Avoid shoulder provide a pillow or lapboard for support. integrity as evidence
muscle strength, range of motion. subluxation. Encourage passive ROM to improve muscle tone. by the absence of bed
struggle moving the 5. Assess the extent of impairment initially and 5. To Assists in choice of interventions because sore or pressure ulcer.
upper and lower •Remain free of functional ability. different techniques are used for flaccid and
limbs were contractures spastic paralysis. •Increase strength
observed. and decubitus 6. Elevate arm and hand. 6. To promote venous return and helps prevent and function of upper
ulcers from edema formation. and lower limbs.
V/S: impaired 7. Place knee and hip in an extended position. 7. Maintains functional position.
BP: 140/60 mmHg mobility. 8. Assist the patient with exercise and perform 8. Frequent repetition of activity helps form new
HR: 69 bpm ROM exercises for both the affected and neural pathways in the central nervous system,
RR: 23 cpm unaffected sides. encouraging new patterns of motion.
T: 37.8 °C 9. Position the patient and align his extremities 9. To prevent pressure ulcers.
O2 Sat:94 % correctly.
10. Encourage patient to assist with movement 10. To support and move the weaker side.
and exercises using unaffected extremity.

DEPENDENT: DEPENDENT:
1. Administer medications as prescribed like 1. To treat muscle stiffness.
eperisone.
RELATED READINGS W/ SUMMARY

The socio-economic impact of stroke is considerable world-wide. Stroke is

assuming an increasing impact in terms of media attention, patient and carer
knowledge, service developments and research. It is estimated that there are 4.5 million
deaths a year from stroke in the world and over 9 million stroke survivors. Almost one in
four men and nearly one in five women aged 45 years can expect to have a stroke if
they live to their 85th year. The overall incidence rate of stroke is around 2–25 per
thousand population.

The risk of recurrence over 5 years is 15–40%. It is estimated that by 2023

there will be an absolute increase in the number of patients experiencing a first ever
stroke of about 30% compared with 1983. There is a total prevalence rate of around 5
per thousand population. One year after a stroke, 65% of survivors are functionally
independent, stroke comprising the major cause of adult disability.
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• Wolfe, C. D. (2000). The impact of stroke. British Medical Bulletin, 56(2), 275–

286. https://doi.org/10.1258/0007142001903120

• Bsn, M. V., RN. (2023). 12 Stroke (Cerebrovascular Accident) Nursing Care

Plans. Nurseslabs. https://nurseslabs.com/cerebrovascular-accident-stroke-

nursing-care-plans/2/

• Team, C. B. M. (n.d.). Eperisone: Indication, Dosage, Side Effect, Precaution |

MIMS Philippines. www.mims.com.

https://www.mims.com/philippines/drug/info/eperisone?mtype=generic

• Wells, D. (2019, April 17). Cerebrovascular Disease. Healthline.

https://www.healthline.com/health/cerebrovascular-disease

• Brunner & Suddarth's textbook of Medical -Surgical Nursing 14th edition volume

1 and 2, page 672-673, page 902-999

• Swearingen, P. L., & Wright, J. D. (2019). All-in-one nursing care planning

resource: Medical-surgical, pediatric, maternity, and Psychiatric-Mental Health.

Elsevier.

• Kizior, R. J., & Hodgson, K. J. (2021). Saunders Nursing Drug Handbook 2021.

Elsevier.