I.

ITRODUCTION
The BSN4Y2-1 Group C was given the opportunity to have a hospital last June 20-25, June 27-30 and July 1-2 2016 at 7am-3pm shift and
on the said dates found a commendable case reasonable to be presented for the case study as agreed by the group.
This study hopefully would become one of the bases for innovation of the Philippine health care system especially in the Emergency
Room setting. The same study aims to be a means of research practice for the studied profession. Readers of the study are expectedly to be
educated in the case of taking care of patients. This is also targets to document the event which by the demand of time can be used for review or
recall about the subject event. In our part, this is essential for our realization of the said experience and which would make us a subject of
ourselves for improvement.
A Cerebrovascular Accident or stroke is infraction of a specific portion of the brain due to insufficient blood supply. It can occur fron an
occlusion of one of the major vessels feeding the brain, a partial or complete obstruction of a major intracranial vessel, or it can also be a
hemorrhage within the brain. The blood vessels affected dermines the area and extent of infarction.
There are risk factors prior to the recurrence of CVA such as hypertension, hypercholesterolemia, smoking, oral contraceptives use,
emotional stress, obesity, family history of stroke and age. This condition may alter the original circulation of blood, then leads to stroke. In line
with this, as we all know almost of the illicit drugs, alcohol and nicotine found in cigarettes are one of the potent vasoconstrictor.
Stroke depends primarilly on the lession or infracted tissue. If the brain stem is affected, blood pressure fluctuations altered respiratory
patterns and cardiac dysrythmias are all possible.
Coma can follow stroke fron various causes; strokes due to occusal disease (thrombus, embolus) rarely caused sudden death. When sudden
death thus occurs it is usually due to heart failure. Respiratory infection and brain stem failure are two primary causes of death with stroke.
According to the Philippine Nurses Association, the top 5 of the clinical diseases entities frequently studied were Cerebrovascular Disease,
infectious disease, neuromuscular diseases, epilepsy and demyelinating disease. For the past10 years, there has been an increasing trend in the
number of studies dealing with Cerebrovascualar Disease.
The group chose Ptient XX as our subject primarily because his case posed a very intricate case requiring due understanding and
knowledge. The group recognizes partial knowledge about CVA and the surgical procedures involved in such condition, thus making this case a
good avenue to broaden the proponents' knowledge about the disease.
Having awareness and gaining more knowledge about CVA would enchance our skills and attitudes in handling patients suffering from
this disease.

This case serves as a challenge for us student-nurses to be committed and dedicated health professionals for the next days, we will take
care of the health of the citizens.

II. STATEMENT OF OBJECTIVES

A. General Objectives
The main goal of the group is to be able to present the case study of our chosen client that would provide a comprehensive discussion of
the pathological mechanism of the disease to yield
significant information for the case study.
B. Specific Objectives
This case analysis aims to:
a.) Illustrate the pathophysiology of CVA.
b.) Discuss the medical intervention for the management of CVA.
c.) Formulate appropriate nursing care plan suited for the client based on the assessmant findings.
d.) Identify care measyres to be given to the patient and family to promote continuity of care and independence after discharge.

Drug Name

Classification

Action

Indication

Consideration

Works by inhibiting the

mucopeptide synthesis in
the bacterial cell wall. The
beta-lactam moiety of
Ceftriaxone binds to
carboxypeptidases,
endopeptidases, and
transpeptidases in the
bacterial cytoplasmic
membrane. These
enzymes are involved in
cell-wall synthesis and cell
division. By binding to
these enzymes,
Ceftriaxone results in the
formation of defective cell
walls and cell death.

Indicated in patients with

neurologic complications,
carditis and arthritis. It is
also effective in
Gramnegative infections;
Meningitis, Gonorrhea. It is
also for Bone and joint
infections, Lower
respiratory tract
infections ,middle ear
infection, PID ,Septicemia
and Urinary Tract infections.

Hypersensitive to
cephalosporin ,
penicillin and related
antibiotics.

Side Effect

Nursing Consideration

Genenricname:
Ceftriazone

3rd generation
cephalosporin.

Pain
Induration
Phlebitis
Rash
Diarrhea
Thrombocytosis
Leucopenia
Glossitis
Respiratory
super infections

Assess patients
previous sensitivity
reaction to penicillin or
other
cephalosphorins.
Assess patient for
signs and symptoms of
infection before and
during the treatment
Obtain C&S before
beginning drug
therapy to identify
if correct treatment
has been initiated.
Report signs such as
petechiae, ecchymotic
areas, epistaxis or
other forms
of unexplainedble
eding.
Monitor hematologic,
electrolytes, renal and
hepatic function.
Assess for possible
supper
infection :itching
fever, malise,
redness

Drug Name

Genenricname:
Furosemide
(Lasix)

Classification

Diuretic

Action

Indication

Edema and
hypertension

Consideration

Contra indicated in
patients hyper
sensitive to drug and
those with anuria Use
cautious lyin patients
with hepatic cirrhosis
and in those allergic to
sulfonamides. Use
during pregnancy only
if potential benefits to
mother clearly
outweigh risksto fetus.

Side Effect
CNS: headache, vertigo,
dizziness, paresthesia,
weakness, restlessness,
fever
CV: orthostatic
hypotension, thrombo
phlebitis with
IV administration
EENT: transient deafness,
blurred or yellowed vision,
tinnitus GI: abdominal
discomfort and pain,
diarrhea, anorexia, nausea,
vomiting, constipation,
pancreatitis GU: nocturia,
polyuria, frequent urination,
oliguria HEMATOLOGIC:
agranulocytosis, aplastic
anemia, leucopenia,
thrombocytopenia,
azotemia, anemia
HEPATIC: hepatic
dysfunction, jaundice
METABOLIC: volume
depletion and dehydration,
asymptomatic
hyperuricemia, impaired
glucose tolerance,
hypokalemia,

Nursing Consideration
1.Observe 10
rights in giving
medication
2. Test if the
patient is allergic
to the drug. To
prevent nocturia,
give PO and IM
preparations in
the morning.
3.Give second
dose in early
afternoon.
4.Monitor
weight, blood
pressure, and
pulse rate
routinely with
long term use
and during rapid
dieresis.
5. Use can lead
to profound
water and
electrolyte
depletion. If
oliguria or
azotemia
develops or

hypochloremic alkalosis,
hyperglycemia, delusional
hyponatremia,
hypocalcaemia,
hypomagnesaemia
MUSCULOSKELETAL:
muscle spasm
SKIN: dermatitis, purpura,
photo sensitivity reactions,
transient pain at IM
injection site
Other: gout

increases, drug
may need to be
stopped.
6.Monitor fluid
intake and output
and electrolyte,
BUN, and carbon
dioxide levels.
7.Watch for signs
of hypokalemia,
such as muscle
weakness and
cramps. Consult
prescriber and
dietitian about a
high-potassium
diet or potassium
supplements.
Foods rich in
potassium
include citrus
fruits, tomatoes,
bananas, dates,
and apricots.
8.Monitor
glucose level in
diabetic patients.
Drug may not be
wellabsorbed
orally in patient
with severe heart
failure. Drug

may need to be
given IV even if
patient is
taking other oral
drugs.
9.Monitor uric
acid level,
especially in
patients with a
history of gout.
10.Monitor
elderly patients,
who are
especially
susceptible to
excessive
dieresis because
circulatory
collapse and
thromboembolic
complications
are possible.
11.Store tablets
in light-resistant
container to
prevent
discoloration.
11.Refrigerate
oral solution to
ensure drug
stability.

Drug Name

Genenricname:
Ketorolac
Tromethamine

Classification

Antipyretic NSAID

Action

Antiinflammatory and
analgesic
activity; inhibits
prostaglandins
and leukotriene
synthesis

Indication

Short-term
management of pain
(up to 5days)

Consideration

Contraindicated
with significant
renal impairment,
during
labor and delivery,
lactation, aspirin
allergy, recent GI
bleed or
perforation
Use cautiously
with impaired
hearing; allergies;
hepatic condition

Side Effect
CNS:
headache,
dizziness,
somnolence,
insomnia,
fatigue,
dizziness,
tinnitus,
ophthalmologic
effects

Nursing Consideration
Assessment:
1. History: renal
impairment, impaired
hearing, allergies,
hepatic, lactation,
pregnancy
2. Physical: skin color
and lesions, orientation,
reflexes, peripheral
sensation, clotting times,
CBC, adventitious
sounds
Interventions:
1. Be aware that patient
may be atrisk for CV
events, GI bleeding,
renal toxicity,
monitor accordingly.
2. Do not use during
labor, delivery, or while
nursing.

3. Keep emergency
equipment readily
available at time
of initial dose, in case of
severe hypersensitivity
reaction.
4. Protect drug vials from
light.
5. Administer every 6
hrs to maintain serum
levels and control pain.

Drug Name

Classification

Action

Indication

Consideration

Side Effect

Nursing Consideration

Genenricname:
Cefuroxime

Cephalosporin

Decrease or control
the infection.

Less susceptible to beta

lactamase and have
greater activity against
Haemophilus
influenzae, gonorrhea
and Lyme disease.

If the drug was

tolerated it can
cause diarrhea,
nausea, vomiting,
headache, or
migraines,
dizziness and
abdominal pain.

CV: phlebitis,
thrombo
phlebitis
GI: diarrhea,
anorexia,
vomiting
Hematologic:
hematologic
anemia,
thrombocytopen
ia, transient
neutropenia,
eosinophilia.

Should check the

patients name, the
correct route, dosage,
and medicine that should
be given.

Drug Name

Genenricname:

tramadol
hydrochloride

Classification

Analgesic
(centrallyacting)

Action

Centrally acting
opiate receptor
agonist that
inhibits the
uptake of
norepinephrine
and serotonin,
suggesting both
opiod and
nonopiod
mechanisms of
pain relief. May
produce opioidlike effects but,
causes less
respiratory
depression than
morphine.

Indication

Relief of moderate to
moderately severe pain

Consideration

Contraindicated
with allergy to
tramadol or opioids
or acute
intoxication with
alcohol, opioids,
or psychotropic
drugs.
Use cautiously
with pregnancy,
lactation, seizures,
concomitant use
of CNS
depressantsor
MAOIs, renal
or hepatic
impairment.

Side Effect

CNS:
Sedation, dizziness or
vertigo, headache,
confusion, dreaming,
sweating, anxiety, seizures
CV:
Hypotension,
tachycardia, bradycardia
Dermatologic:
Sweating,
pruritus, rash, pallor,
urticaria
GI:
Nausea, vomiting.

Nursing Consideration

Assessment
History:
Hypersensitivity to
tramadol; pregnancy;
acute in toxication with
alcohol, opioids, psycho
tropic drugs
or other centrally acting
analgesics; lactation;
seizures; concomitant use
of CNS depressants
or MAOIs; renal
or hepatic impairment;
past or present history
of opioid addiction
Physical: Skin color,
texture, lesions;
orientation,
reflexes, bilateral grip
strength, affect;
P, auscultation, BP;
bowel sounds, normal
output; liver and kidney
function tests
Interventions

Control
Environment
(temperature,

lighting) if sweating or
CNS effects occur.