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Cva PPT Case Pres
Cva PPT Case Pres
Cva PPT Case Pres
Patients Profile
NAME: EDGARDO DIAZ ADDRESS: Batasan Hills Quezon City AGE: 50 years old BIRTHDAY: July 20, 1962 HEIGHT: 5 8 WEIGHT: 240 lbs. MARITAL STATUS: Married RELIGION: Roman Catholic OCCUPATION: Taxi Driver HOBBIES: Playing Basketball
FAMILY HISTORY:
In terms of Family History patient H.S stated that both of his Biological parents had a history of Hypertension, Diabetes, and Heart disease as well as the other family member has been diagnosed with that particular disease.
As initial action of patient H.S he took a nap thinking that he is tired with a long a long hour of duty. At around 8:30 in the morning patients H.S co-worker try to awake him up but unfortunately he doesnt wake at all. so they decided to rush him in the hospital. Patient H.S is admitted to Quezon City General Hospital last October 12, 2012 at around 9:15 am. He was admitted to the Emergency ward due to his condition the attending physician advised to have a CT-Scan.and some series of test such as CBC, LFT, SGPT, U/A, UTZ, BUN, and CREATININE to confirm the initial diagnose of Cerebro Vascular Accident (CVD).
SOCIAL HISTORY:
Based on the assessment conducted by the health care provider patient H.S loves to eat a fatty and salty food. Hes a social drinker, coffee lover, and a heavy smoker as part of his daily life for almost 30 years as a stated by his wife. As a taxi driver 4 hours of sleep is consider good enough for his next duty. He doesnt take any medication or vitamin to boost his immune system.
DISCHARGE PLANNING
MEDICATION:
Instruct patient to take Telmisartan once a day 40mg orally take it without meal Anti-hypertensive (Angiotensin II receptor antagonist) Blocks the binding of Angiotensin II to specific tissue receptor found in the vascular smooth muscle and adrenal gland. Instruct patient to take Atorvastatin once a day 80 mg oral at bedtime take it without meal. Anti-hyperlipidemia (Adjunct to diet in treatment of elevated total cholesterol) Instruct client to apply Mupirocin Ointment three times a day every 4 hours. (8am, 12noon, 4pm) It is an antibiotic that works by stopping the growth of certain bacteria.
EXERCISE:
Passive Range of Motion as prescribed by the physician.
TREATMENT:
Continue home medications as ordered by physician. Instruct patient to monitor blood sugar early in the morning before meal. Describe the importance of regular taking of prescribed medication.
HEALTH TEACHING:
Explain the underlying disorder and treatment plan. Lifestyle change such as stop smoking eats healthy foods and avoids drinking of alcohol. General health measures (adequate sleep, proper diet, and maintaining a clean surrounding). Instruct patient to have an adequate sleep atleast 8 hrs a day Monitor blood pressure as well as blood sugar regularly.
OUT PATIENT:
Continues follow up care schedule Return again after a month for follow up check up Consult the physician for any problem or any complication encountered
DIET:
Maintain low fat low protein, and low salt diet.
SPIRITUAL:
Supporting religious practice. Assisst client with prayer. Refer client for spiritual counselling.