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INTRODUCTION
Cerebrovascular disease is a group of brain dysfunctions related to disease
of the blood vessels supplying the brain. Hypertension is the most important
cause; it damages the blood vessel lining, endothelium, exposing the
underlying collagen where platelets aggregate to initiate a repairing process
which is not always complete and perfect. Sustained hypertension
permanently changes the architecture of the blood vessels making them
narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood
pressure.
A stroke is caused by the interruption of the blood supply to the brain, usually
because a blood vessel bursts or is blocked by a clot. This cuts off the supply
of oxygen and nutrients, causing damage to the brain tissue.
The most common symptom of a stroke is sudden weakness or numbness of
the face, arm or leg, most often on one side of the body. Other symptoms
include: confusion, difficulty speaking or understanding speech; difficulty
seeing with one or both eyes; difficulty walking, dizziness, loss of balance or
coordination; severe headache with no known cause; fainting or
unconsciousness.
The effects of a stroke depend on which part of the brain is injured and how
severely it is affected. A very severe stroke can cause sudden death.
The 1990 Global Burden of Disease (GBD) study provided the first global
estimate on the burden of 135 diseases, and cerebrovascular diseases
ranked as the second leading cause of death after ischemic heart disease.
During the past decade the quantity of especially routine mortality data has
increased, and is now covering approximately one-third of the
world’s population. The increase in data availability provides the possibility
for updating the estimated global burden of stroke.
Data on causes of death from the 1990s have shown that cerebrovascular
diseases remain a leading cause of death.
II. OBJECTIVES
GENERAL OBJECTIVES
1. To be able to discuss the effect, signs and symptoms of the disease,
Cerebrovascular Disease.
2. How to diagnose, prevent and the treatment should the nurse give for
the patient full recovery.
SPECIFIC OBJECTIVES
1. To be able to discuss patients background ( lifestyle, history of the
past illness, family health history) to show how may this effect on the
occurrence of this disease.
2. To be able to discuss the anatomy and the physiology of the heart, for
you to be able to understand where the infection takes place.
3. To be able to discuss the pathophysiology of cardiovascular diseases
and also to know and understand the etiology of the disease.
4. To be able to discuss the patient activities of daily living. To know if
there’s a factor that triggers the disease
5. To be able to discuss, nursing care plan for our patient.
6. To be able to discuss, the medication / drugs that the patient taken
and the diagnostic test that being perform for the patient.
7. Lastly, to be able to discuss our discharge plan for fully recovery of
our patient.
A. VITAL SIGNS
B. HEAD
Pink papillary conjunctiva, no nuchal rigidity and no carotid bruit.
C. NEUROLOGIC STATUS
-Oriented to time, person and place.
CN I- can smell
CN II- (2-3) ERTL
CN III, IV, VI- EDM, intact
CN V- (+) corneal reflex
CN VII- no facial asymmetry
CN IX- (+) gag reflex
CN XI- can shrug shoulder
CN XII- tongue at midline
D. PULMONARY SYSTEM
E. GASTROINTESTINAL SYSTEM
Flabby, NaBS, no abdominal bruit, (-) edema,(-) cyanosis.
F. MUSCULOSKELETAL SYSTEM
Laboratory Findings
1. GRAM STAIN
Specimen: Sputum
• Gram ( - ) cocci
singly:
• Gram ( + ) cocci
Short chain:
• Gram ( + ) cocci in Few
large chain:
• Pus cells:
• Epithelial cells: Few
2. URINALYSIS
Macroscopic
• Color: Few
• Transparency:
2-4/010
Microscopic
+1
• RBC:
• Pus cells:
• Bacteria:
• Epithelial cells:
• Mucus threads:
• Amonphous unates:
3. HbAlC: Light yellow
4. Glucose:
5. LIPID PROFILE SL. Turbid
• Cholesterol:
• Triglycerides:
• HDL cholesterol:
• LDL cholesterol:
4-6/HPF
• Na:
• K: 0-2/HPF
• Ca:
• Cl: Few
• SGPT:
Few
6. HEMATOLOGY Few
• PT:
• Control: Few
• INR: 12.2%
7. CHEMICAL ANALYSIS
• S.G: 7.36mmol/L 7.2– 6.2
• pH: 4.22 – 6.11
• nitri:
• protein:
• glucose:
5.10mmol/L
• ketone:
• urobilinogen: 0.70
• bilirubin:
1.24
• blood:
• leukocyte: 3.54
137
4.3
1.36
98
41U/L
Male: up to
40U/L
Female: up to
31U/L
15.31
12 – 15sec
14.1
1.35
1.010
6.5
(-)
(-)
(-)
(-)
(-)
(-)
+1
(-)
5:30 am
1. Capillary Blood
Glucose:
2. Head CT scan: 142 80 – 120mg/dl
-shows a low
attenuation focus
on the left occipital
lobe
Consistent with a
recent infarction
-midline structure
are in place
-mild cortical
atrophy is
demonstrated
100 96-110
The Brain
Three cavities, called the primary brain vesicles, form during the early
embryonic development of the brain. These are the forebrain
(prosencephalon), the midbrain (mesencephalon), and the hindbrain
(rhombencephalon).
The deeper fissures divide the cerebrum into five lobes (most
named after bordering skull bones)—the frontal lobe, the parietal
love, the temporal lobe, the occipital lobe, and the insula. All but
the insula are visible from the outside surface of the brain.
The cerebellum consists of a central region, the vermis, and two winglike
lobes, the cerebellar hemispheres. Like that of the cerebrum, the
surface of the cerebellum is convoluted, but the gyri, called folia,
are parallel and give a pleated appearance. The cerebellum
evaluates and coordinates motor movements by comparing actual
skeletal movements to the movement that was intended.
The brain stem connects the diencephalon to the spinal cord. The
brain stem resembles the spinal cord in that both consist of white
matter fiber tracts surrounding a core of gray matter. The brain
stem consists of the following four regions, all of which provide
connections between various parts of the brain and between the
brain and the spinal cord
Figure Prominent structures of the brain
2 stem.
The cerebellum consists of a central region, the vermis, and two winglike
lobes, the cerebellar hemispheres. Like that of the cerebrum, the
surface of the cerebellum is convoluted, but the gyri, called folia,
are parallel and give a pleated appearance. The cerebellum
evaluates and coordinates motor movements by comparing actual
skeletal movements to the movement that was intended.
Date/Shift Approach/Intervention
- Lab:
- UO drained- 1000cc
- endorsed
- urinalysis-TF as endorsed
Out
informed
TID given
- adequate UO
- no complaints
- needs attended
- endorsed
- assess; BP 170/100
- on CTscan-TF
- urinalysis, creatinine
- CBG monitoring q 12
- (-) BM
- needs attended
- endorsed
07/15/09
- endorsed
Addendum - start feeding AP order
- for SGOT
- (-)gag reflex
- with FC to urobag
- sputum GS/CS-TF
4ml q 6
- refer prn
- no BM, afebrile
- endorsed
- sputum GS/CS-TF
- CBG monitoring q 12
- no BM, afebrile
- refer prn
- needs attended
- endorsed
07/16/09
- for 2Decho
- needs attended
- endorsed
- for 2Decho
Carried out
- needs attended
- endorsed
07/17/09
- BP: 140/80mmHg
- endorsed
- for CTscan-TF
- refer prn
- endorsed
- for 2Decho
- (-)BM, afbrile
- needs attended
- endorsed
07/18/09
- 2Decho
- sputum GS/CS
-endorsed
-Encouraged her not to carry heavy loads and do not force herself too much
in doing household chores. Encouraged patient to limit number of hours in
playing domino.
D- advised patient to eat nutritional foods like fruits and vegetables. Eat a
well balanced diet. Instructed patient to limit eating foods high in fats and
with cholesterols. And also avoid salty foods.