Case Presentation

TRINITY UNIVERSITY OF ASIA
[CASE PRESENTATION: INTRACEREBRAL HEMORRHAGE]

ST. LUKE’S COLLEGE OF NURSING
I. OBJECTIVES
A. General:
The main purpose of this study is to have the knowledge about intracranial hemorrhage, its
causes and effects, signs and symptoms and treatment to be able to acquire and have hands on
experience on the appropriate skills in helping the patient manage and recover from the said disease.
B. Specific:
1. To have deeper understanding in:
 The causes and effects of intracranial hemorrhage
 The signs and symptoms and its corresponding treatment
 How to manage and prevent intracranial hemorrhage
2. To be able to improve our skills:
 In taking the accurate, thorough assessment to have appropriate nursing
interventions
 In providing complete and needed care of the patient
 As an educator, by coaching the patient as well as his support person regarding
home management of the disease of the patient, and the “do’s” and “don’ts” of
the patient.
3. To build a good nurse-patient relationship through therapeutic communication so that the
patient can express his thoughts and feelings for us to carry out the needed and
accurate interventions with care.
II. INTRODUCTION
A. Background of the study:
This case will focus on the condition of Mr. NC. He was diagnosed with intracranial hemorrhage
when he was admitted to Amang Rodriguez Memorial Medical Center last August 17, 2009 at 7:20 am
with the chief complaint of left sided weakness.
An intracranial hemorrhage is a severe condition requiring prompt medical attention. It may
develop quickly into a life threatening situation for the patient which made our group chose this case.
Another reason is that this study will give us deeper understanding and sufficient knowledge on the
disease which will help us in our hands on experience in giving the appropriate nursing interventions.
B. Definition of the case:

An Intracranial hemorrhage is bleeding in the brain caused by breaking (rapture) of a blood
vessel in the head. And this internal bleeding may occur any part of the brain. The blood may build up in
the brain tissues or in the spaces between the brain and membranes that cover it.
Hematomas (collections of blood) that develop within the cranial vault are most serious brain
injuries. A hematoma may be epidural (above the dura), subdural (below the dura), and intra-cerebral
(within the brain). Major symptoms are frequently delayed until the hematoma is large enough to cause
distortion of the brain and increase intracranial pressure. The signs and symptoms of cerebral ischemia
resulting from compression by a hematoma are variable and depend on the speed with which vital areas
are affected and the area that is injured. In general, a rapidly developing hematoma, even if small, may
be fatal whereas a larger but slowly developing one may allow compensation for the increase
intracranial pressure.
AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 1

C. General signs and symptoms:

Symptoms vary depending on the location of the bleed and the amount of the brain tissue
affected. The symptoms usually develop suddenly, without warning, often during activity. They may
occasionally develop in a step wise pattern, or they may get worse over time.
Signs and Symptoms include:
 Abnormal sense of taste
 Change in alertness (level of consciousness)
o Apathetic, withdrawn
o Sleepy, lethargic, stuporous
o Unconscious, comatose
 Difficulty speaking or understanding speech
 Difficulty swallowing
 Difficulty writing or reading
 Headache
o May occur when lay flat
o May awaken patient from sleep
o May increase with change in position
o May increase with bending, straining, and coughing
 Loss of coordination
 Loss of balance
 Movement changes
o Difficulty moving any body part
o Hand tremor
o Loss of fine motor skill
o Weakness of any body part
 Nausea, vomiting
 Seizure
 Sensation changes
o Abnormal sensations
o Decreased sensation
o Facial paralysis
o Numbness or tingling
 Vision changes
o Any change in vision
o Decreased vision, loss of all part of vision
o Double vision
o Eyelid drooping
o Pupils different size
o Uncontrollable eye movement
Signs and Symptoms seen in the patient:
 Left sided weakness
 Vomiting
 Slurring of speech
 Patient experienced blurring of vision

D. Etiology:
The bleeding can occur in any part of the brain. It may be in one hemisphere (lobar intra-
cerebral hemorrhage), in other brain structures, such as the thalamus, basal ganglia, pons, or
cerebellum (deep intra-cerebral hemorrhage).
Hemorrhage can be caused by:
 Abnormalities of the blood vessels (aneurysm or vascular malformation)
 High blood pressure (hypertensive intra-cerebral hemorrhage)
 Protein deposits along blood vessels (amyloid angiopathy)
 Traumatic brain injury
In some cases, no cause could be found.
Blood irritates brain tissues, causing swelling (cerebral edema). In can collect into a mass called
hematoma. Either a hematoma or swelling will increase pressure on nearby tissues and can quickly
destroy them.
Other factors that raise the risk of ICH include the following:
 Blood and bleeding disorders
o Decreased levels of blood platelets
o Disseminated intravascular coagulation
o Hemophilia
o Leukemia
o Sickle cell anemia
 Cerebral amlyloid or brain tumors
 Liver disease ( associated with increased bleeding risk in general
 Use of aspirin or blood thinners (anticoagulant medications such as warfarin)
For the premature infants (born earlier than 35 weeks) will sometimes have bleeding into fluid-
filled spaces (ventricles) in the brain. This type of bleed is called intra-ventricular hemorrhage (IVH). This
occurs in the first day of life and is usually not preventable.
E. Incidence:
United States
Each year, intracerebral hemorrhage affects approximately 12-15 per 100,000 individuals,
including 350 hypertensive hemorrhages per 100,000 elderly individuals. The overall incidence of
intracerebral hemorrhage has declined since the 1950s.
International
Asian countries have a higher incidence of intracerebral hemorrhage than other regions of the
world.
Mortality/Morbidity
 Annually, more than 20,000 individuals in the United States die of intracerebral hemorrhage.
 Intracerebral hemorrhage has a 30-day mortality rate of 44%.
 Pontine or other brainstem intracerebral hemorrhage has a mortality rate of 75% at 24 hours.
 Hallevi et al reviewed the charts and CT scans of patients with intraventricular hemorrhage (IVH)
to determine if the extension of the hemorrhage could be measured. Clinical outcome was
determined by the modified Rankin Scale (mRS). IVH was also classified with an IVH score. The
IVH score allowed rapid estimate of IVH volume by the practitioner and increased predictability
for outcome.
Race
Intracerebral hemorrhage has a higher incidence among populations with a higher frequency of
hypertension, including African Americans. A higher incidence of intracerebral hemorrhage has been

noted in Chinese, Japanese, and other Asian populations, possibly due to environmental factors (eg, a
diet rich in fish oils) and/or genetic factors.
Sex
 Intracerebral hemorrhage has a slight male predominance, though study results have been
conflicting.
 Cerebral amyloid angiopathy may be more common among women.
 Phenylpropanolamine use has been associated with intracerebral hemorrhage in young women.
Age
 Incidence of intracerebral hemorrhage increases in individuals older than 55 years and doubles
with each decade until age 80 years.
 The relative risk of intracerebral hemorrhage is greater than 7 in individuals older than 70 years.
 In individuals younger than 45 years, lobar hemorrhage is the most common site of and
frequently is associated with AVMs.
 Subependymal hemorrhage or germinal matrix hemorrhage is primarily seen in premature
infants.
III. PATIENT PROFILE

A. Demographic data:
Name: Mr. NC
Address: Blk. 22 Bagong Nayon, AC
Birthday: August 23, 1952
Age: 57
Sex: Male
Occupation: (retired shoemaker)
Nationality: Filipino
Religious orientation: Roman Catholic
Admission date and time: August 17, 2009
Attending physician: Dr. Dela Cruz
B. Chief Complaint:
The patient is complained of having a left sided weakness 10 hours prior to his admission,
associated with slurring of speech and vomiting of previously eaten food.
C. Physical Examination:
 Health- Perception-Health –Management Pattern

In the past Mr. NC is doing well according to his wife. He used to be a shoemaker (retired at
the age of 49 y/o). Usually he exercises as apart of keeping his body fit. During his young adult
life, he was a smoker (more or less a pack per day as verbalized by his wife), and drinks alcohol
often, for example while cooking or doing other household works sited by his behalf. Never he had
accidents encountered or falls experienced.
His wife believed that Mr. NC’s condition was due to his vices (smoking and drinking). Mr. NC
often eats fatty and some salty food which could be a contributing factor in the development of
the disease as perceived by his wife.
 Nutritional and Metabolic Pattern

Mr. NC likes to eat foods that are fatty and salty. But aside from that he also eats vegetables
and fruits, and there’s nothing wrong with his appetite. Although he is drinks alcohol, he’s water
intake is not affected, he drinks enough water as verbalized by his wife. He is not also experiencing
any difficulty in eating (pain, swallowing, and diet restrictions). Also there are n o dental problems.
For his skin, some portion of his lower extremities has whitish spots near the bony
prominences, and a slight dryness.
 Elimination Pattern
For his bowel elimination, he has no difficulties or problems as to the frequency, discomfort or
in control. But as to the characteristics his wife described it as fatty (steatoreic).
For his urinary pattern, all are fine, no discomforts, increased in the frequency and other
problems.
 Activity- Exercise Pattern

Mr. NC has sufficient energy in performing in performing his daily activities. He wakes up at
7:00 am and starts to do household works as his exercise, such as getting some fire woods,
cooking their food and sometimes he helps in cleaning the surroundings, and he can also perform
a full care to his self before he was admitted to the hospital.
Usually weekends is their leisure time and spends it with his family. Most of the time, they are
being entertained by their grandchildren and watch television shows together after lunch time
and in the afternoon.
 Sleep-Rest Pattern
After their supper, Mr. NC rest first for a while then goes to sleep. There a no known early
awakenings and nightmares shared by his wife. Rest and relaxation periods are usually during the
weekends with his family.
 Cognitive-Perceptual Pattern
At the age of 40, Mr. NC started to wear eyeglasses. And up to the present he had not
experienced any change in his memory. Regarding the decision making, when he cannot make a
right or he is not sure he usually refers it to his family first before putting on the final decision. He
is the main person that is involved in making decisions in the family.
 Self- Perception - Self- Concept Pattern

The patient’s self esteem, as observed by the wife, has noticeably decreased. It could be due
to that he usually earns for the living of the family and now he is the one being cared for his
recovery.
 Role –Relationship Pattern

Their family is composed of 9 people. Four of it is their children, three are their grandchildren.
His children who live with them are not totally dependent to him. One of his sons in law is seaman
who helps them sometimes in the expenses. And now that he has an illness, some of his family
members shared that they are hard up with what happened but what’s more important to them is
to have their head of the family to recover.
 Sexuality- Reproductive Pattern

(The wife did not manage to answer the question…)

 Coping-Stress –Tolerance Pattern

When he feels tired, most often that he does is to sit back and relax, but sometimes he drinks
alcohol and smokes. And during the times that he is out or sick, her wife or one of his sons in law
is taking over the family. If problems do come in along the way, and con not make decisions alone,
he refers it first to his family before laying out the final decision.
 Value- Belief Pattern

According to his wife they do not have other beliefs aside from what it is traditionally done
with their present orientation.
 Other
Other than those above mentioned, nothing else was shared by the family members.
D. Past History:
For the past days prior to the admission of the patient, there was no known signs and symptoms
related top the illness aside from him being diagnosed with hypertension and rheumatism years ago.
E. Present History of Illness:

Mr. NC was doing a household chore when he experienced sudden dizziness after he stood up.
Then followed by blurring of his vision, so he manage then to have some rest. Her wife applied a cold
compress on his nape thinking that it was due to his hypertension. Then after sometime the patient felt
a left sided weakness, hence for referring to Amang Rodriguez Memorial Medical Center at 7:20 am and
was diagnosed with intracranial hemorrhage.
F. Allergies:
The patient has no known allergies.
G. Course in the ward:
Date/ Time Remarks

August 17,2009 (Monday)  Referred for admission with PNSS 1L x
12 hr, started on OF at 1,200 kcal
(meds given and care requested)
August 20,2009 ( Thursday)
 12:00 noon  V/S taken and recorded
 Temp: 38⁰C, febrile
 Paracetamol 300 mg/ amp given
 Tepid sponge bath instructed
August 21,2009 (Friday)

 6:35 am  V/S taken and recorded
 Refer for neurosurgery for further
examination

August 22, 2009

 05:00 pm  V/S taken and recorded
 Temp: 38⁰C, febrile
 Paracetamol 150 mg/ amp given
 Tepid sponge bath instructed
IV. ANATOMY AND PHYSIOLOGY

THE CARDIOVASCULAR SYSTEM
The heart and circulatory system make up the cardiovascular system. The heart works as a
pump that pushes blood to the organs, tissues, and cells of the body. Blood delivers oxygen and
nutrients to every cell and removes the carbon dioxide and waste products made by those cells. Blood is
carried from the heart to the rest of the
body through a complex network of
arteries, arterioles, and capillaries. Blood is
returned to the heart through venules and
veins.
A. The Heart
Functions of the Heart:
1. Generating blood pressure
2. Routing blood
3. Ensuring one-way blood
flow
4. Regulating blood supply
The adult heart is shaped like a
blunt cone and is approximately the size of
a closed fist. The blunt point of the cone is
the apex; and the larger, flat part at the
opposite end of the cone is the base. The
heart is located in the thoracic cavity
between the two pleural cavities. It lies obliquely in the mediastinum, with its base directed posteriorly
and slightly superiorly and the apex directed interiorly and slightly inferiorly.
B. The Circulation
The one-way circulatory system carries blood to all parts of the body. This process of blood flow
within the body is called circulation. Arteries carry oxygen-rich blood away from the heart, and veins
carry oxygen-poor blood back to the heart. In pulmonary circulation, though, the roles are switched. It is
the pulmonary artery that brings oxygen-poor blood into the lungs and the pulmonary vein that brings
oxygen-rich blood back to the heart. (Rod R. Seeley et. al, Essentials of Anatomy and Physiology 5th
edition, McGraw-Hill Int. NY 10020 2005)
Functions of the Peripheral Circulation:
1. Carry blood
2. Exchange nutrients, waste products and gases

3. Transport
4. Regulate blood pressure
5. Direct blood flow
Twenty major arteries make a path through the tissues, where they branch into smaller vessels
called arterioles. Arterioles further branch into capillaries, the true deliverers of oxygen and nutrients to
the cells. Most capillaries are thinner than a hair. Once the capillaries deliver oxygen and nutrients and
pick up carbon dioxide and other waste, they move the blood back through wider vessels called venules.
Venules eventually join to form veins, which deliver the blood back to the heart to pick up oxygen.
Vasoconstriction or the spasm of smooth muscles around the blood vessels causes and decrease in
blood flow but an increase in pressure. In vasodilation, the lumen of the blood vessel increase in
diameter thereby allowing increase in blood flow. There is no tension on the walls of the vessels
therefore, there is lower pressure. (Rod R. Seeley et. al, Essentials of Anatomy and Physiology 5 th
edition, McGraw-Hill Int. NY 10020 2005)
Major Vessel Types
C. The Arteries
Arteries are blood vessels that carry blood away from the heart.
Classifications:
1. Elastic arteries are the largest diameter arteries and have the thickest walls.
2. Muscular arteries are the medium –sized and small-diameter arteries and are
responsible for the regulation of blood flow to different regions of the body.
3. Arterioles are the ones that transport bllod from small arteries to the capillaries and are
the smallest arteries.
D. Capillaries
Capillaries have thinner walls and it is where exchange occurs between the blood and tissue
fluids. The blood flows more slowly and its thin walls facilitate diffusion between the capillaries ad the
surrounding cells.

E. The Veins
From the capillaries, blood flows into the veins. Veins are blood vessels that carry blood toward
the heart.
Classifications:
1. Venules are tubes with a diameter slightly larger than that of capillaries and are
composed of endothelium resting on a delicate connective tissue layer.
2. Small Veins are slightly larger in diameter than that of the venules.
3. Medium-sized veins collect blood from small veins and deliver it to large veins.
4. Large veins
Various external factors also cause changes in blood pressure and pulse rate. An elevation or
decline may be detrimental to health. Changes may also be caused or aggravated by other disease
conditions existing in other parts of the body.

F. The Blood
The blood is part of the circulatory system. Whole blood contains three types of blood cells,
including: red blood cells, white blood cells and platelets.
Functions of the blood:
1. Transport of gases, nutrients and waste products
2. Transport of processed molecules
3. Transport of regulatory molecules
4. Regulation of pH and osmosis
5. Maintenance of body temperature
6. Protection against foreign substances
7. Clot formation
These three types of blood cells are mostly manufactured in the bone marrow of the vertebrae,
ribs, pelvis, skull, and sternum. These cells travel through the circulatory system suspended in a
yellowish fluid called plasma. Plasma is 90% water and contains nutrients, proteins, hormones, and
waste products. Whole blood is a mixture of blood cells and plasma.
 Red blood cells (also called erythrocytes) are shaped like slightly indented, flattened disks.
Red blood cells contain an iron-rich protein called hemoglobin. Blood gets its bright red color
when hemoglobin in red blood cells picks up oxygen in the lungs. As the blood travels through
the body, the hemoglobin releases oxygen to the tissues. The body contains more red blood
cells than any other type of cell, and each red blood cell has a life span of about 4 months.
Each day, the body produces new red blood cells to replace those that die or are lost from the
body.
 White blood cells (also called leukocytes) are a key part of the body's system for defending
itself against infection. They can move in and out of the bloodstream to reach affected tissues.
The blood contains far fewer white blood cells than red cells, although the body can increase
production of white blood cells to fight infection. There are several types of white blood cells,
and their life spans vary from a few days to months. New cells are constantly being formed in
the bone marrow.
Several different parts of blood are involved in fighting infection. White blood cells called
granulocytes and lymphocytes travel along the walls of blood vessels. They fight bacteria and viruses
and may also attempt to destroy cells that have become infected or have changed into cancer cells. (Rod
R. Seeley et. al, Essentials of Anatomy and Physiology 5th edition, McGraw-Hill Int. NY 10020 2005)
Certain types of white blood cells produce antibodies, special proteins that recognize foreign
materials and help the body destroy or neutralize them. When a person has an infection, his or her
white cell count often is higher than when he or she is well because more white blood cells are being
produced or are entering the bloodstream to battle the infection. After the body has been challenged by
some infections, lymphocytes remember how to make the specific antibodies that will quickly attack the
same germ if it enters the body again.
 Platelets (also called thrombocytes) are tiny oval-shaped cells made in the bone marrow. They
help in the clotting process. When a blood vessel breaks, platelets gather in the area and help
seal off the leak. Platelets survive only about 9 days in the bloodstream and are constantly
being replaced by new cells.
Blood also contains important proteins called clotting factors, which are critical to the clotting
process. Although platelets alone can plug small blood vessel leaks and temporarily stop or slow
bleeding, the action of clotting factors is needed to produce a strong, stable clot.

Platelets and clotting factors work together to form solid lumps to seal leaks, wounds, cuts, and
scratches and to prevent bleeding inside and on the surfaces of our bodies. The process of clotting is like
a puzzle with interlocking parts. When the last part is in place, the clot is formed.
When large blood vessels are cut the body may not be able to repair itself through clotting
alone. In these cases, dressings or stitches are used to help control bleeding.
In addition to the cells and clotting factors, blood contains other important substances, such as
nutrients from the food that has been processed by the digestive system. Blood also carries hormones
released by the endocrine glands and carries them to the body parts that need them. (Rod R. Seeley et.
al, Essentials of Anatomy and Physiology 5th edition, McGraw-Hill Int. NY 10020 2005)
Blood is essential for good health because the body depends on a steady supply of fuel and
oxygen to reach its billions of cells. Even the heart couldn't survive without blood flowing through the
vessels that bring nourishment to its muscular walls. Blood also carries carbon dioxide and other waste
materials to the lungs, kidneys, and digestive system, from where they are removed from the body. (Rod
R. Seeley et. al, Essentials of Anatomy and Physiology 5th edition, McGraw-Hill Int. NY 10020 2005)
THE NERVOUS SYSTEM
The nervous system is a network of specialized cells that communicate information about an
animals surroundings and its self, it processes this information and causes reactions in other parts of the
body. It is composed of neurons and other specialized cells called glia, that aid in the function of the
neurons.
Functions of the Nervous system:
1. Sensory input
2. Integration
3. Homeostasis
4. Mental activity
5. Control of muscle and glands

A. The Neurons
Neurons or nerve cells receive stimuli and transmit action potential to other neurons or to
effector organs. Each neuron consists of a cell body and two types of processes: Dendrites – receive
information from sensory receptor and transmit it toward the cell body; and axons – receive
information from the motor receptor and conduct impulses away from the CNS.
 Neuralgia
Neuralgia or the glial cells are the nonneuronal cells of the CNS and PNS.
Types:
1. Astrocytes serve as the major supporting tissue in the CNS and form the blood brain barrier.
2. Ependymal cells line the fluid filled cavities within the CNS and some produce CSF and help it
move through the CNS.
3. Microglia help remove bacteria and cell debris from the CNS
4. Oligodendrocytes produce myelin sheath around the CNS
5. Schwann cells form myelin sheath around the PNS
The nervous system is divided broadly into two categories; the peripheral nervous system and
the central nervous system. Neurons generate and conduct impulses between and within the two
systems. The peripheral nervous system is composed of sensory neurons and the neurons that connect
them to the nerve cord, spinal cord and brain, which make up the central nervous system. In response
to stimuli, sensory neurons generate and propagate signals to the central nervous system which then
process and conduct back signals to the muscles and glands. (Rod R. Seeley et. al, Essentials of Anatomy
and Physiology 5th edition, McGraw-Hill Int. NY 10020 2005)
The neurons of the nervous systems of animals are interconnected in complex arrangements
and use electrochemical signals and neurotransmitters to transmit impulses from one neuron to the
next. The interaction of the different neurons form neural circuits that regulate an organism’s
perception of the world and what is going on with its body, thus regulating its behavior. Nervous
systems are found in many multicellular animals but differ greatly in complexity between species
The central nervous system (CNS) is the largest part of the nervous system, and includes the
brain and spinal cord. The spinal cavity holds and protects the spinal cord, while the head contains and
protects the brain. The CNS is covered by the meninges, a three layered protective coat. The brain is also
protected by the skull, and the spinal cord is also protected by the vertebrae. (Rod R. Seeley et. al,
Essentials of Anatomy and Physiology 5th edition, McGraw-Hill Int. NY 10020 2005)
B. The Brain
Brain is a part of the Central Nervous
System, it plays a central role in the control
of most bodily functions, including
awareness, movements, sensations,
thoughts, speech, and memory. Some reflex
movements can occur via spinal cord
pathways without the participation of brain
structures. (Rod R. Seeley et. al, Essentials of
Anatomy and Physiology 5th edition, McGraw-
Hill Int. NY 10020 2005)
The cerebrum is the largest part of
the brain and controls voluntary actions,
speech, senses, thought, and memory.
The surface of the cerebral cortex has

grooves or infoldings (called sulci), the largest of which are termed fissures. Some fissures separate
lobes.
The convolutions of the cortex give it a wormy appearance. Each convolution is delimited by two
sulci and is also called a gyrus (gyri in plural). The cerebrum is divided into two halves, known as the
right and left hemispheres. A mass of fibers called the corpus callosum links the hemispheres. The right
hemisphere controls voluntary limb movements on the left side of the body, and the left hemisphere
controls voluntary limb movements on the right side of the body. Almost every person has one
dominant hemisphere. Each hemisphere is divided into four lobes, or areas, which are interconnected.
 The frontal lobes are located in the front of the brain and are responsible for voluntary
movement and, via their connections with other lobes, participate in the execution of sequential
tasks; speech output; organizational skills; and certain aspects of behavior, mood, and memory.
 The parietal lobes are located behind the frontal lobes and in front of the occipital lobes. They
process sensory information such as temperature, pain, taste, and touch. In addition, the
processing includes information about numbers, attentiveness to the position of one’s body
parts, the space around one’s body, and one's relationship to this space.
 The temporal lobes are located on each side of the brain. They process memory and auditory
(hearing) information and speech and language functions.
 The occipital lobes are located at the back of the brain. They receive and process visual
information (Rod R. Seeley et. al, Essentials of Anatomy and Physiology 5th edition, McGraw-Hill
Int. NY 10020 2005)
THE PATIENT AND HIS ILLNESS

Modifiable and Non Modifiable Factors (Book Based)
1. Modifiable
a. Smoking –nicotine content of cigarettes causes vasoconstriction there by resulting
hypertension which may lead to CVA.
b. Hypertension –this is due to plaque deposits on the wall of the arteries which causes
narrowing of the blood vessel thereby causing hypertension which may lead to hemorrhagic
stroke.
c. Hyperlipidemia –too much lipid in the blood may cause increase plaque formation which may
cause thrombus formation.
d. Drug addiction –This may cause vasopasm, hypertension, hypercoagulability and cerebral
eschemia which may cause CVA.
e. Excessive alcohol consumption –heavy alcohol consumption increases one’s risk of a stroke,
light or moderate alcohol may protect against ischemic stroke.
(Joyce M. Black et al Medical Surgical Nursing 7th edition Elsevier Suanders 2005)
f. Diabetes Mellitus –The mechanism is related to macrovascular changes in people with
diabetes mellitus. There is an increase viscousity of blood which may cause formation of
thrombus formation.
g. Atrial fibrillation –pulling of blood from poorly emptying atrial which leads to formation of tiny
clots in Left atrium which can move on the cerebral circulation.
h. Type A personality –stress causes hypertension thereby increasing chance of having
hemorrhagic stroke.
i. Sedentary lifestyle –increase of having DM and Obesity which one of the factors of having CVA

2. Non-Modifiable
a. Age –Intracranial hemorrhage is most often secondary to hypertension and is most common after
age 50 years.
b. Family history of CVA – Family history of stroke increase one’s risk
c. Family history of DM –Family which has history of DM especially type 2 is high risk of having
stroke due to accelerated atherosclerosis.
d. Sex (Male) –Incidence of stroke in men is slightly higher than that of women.
e. Race – (more prevalent among African Americans than whites or Hispanics)
PATHOPHYSIOLOGY
Modifiable Factors:
1. Smoking
Non modifiable Factors:
2. Hypertension
3. Excessive alcohol consumption 1. Age
4. Sedentary lifestyle 2. Gender
Hypertension
Basal Ganglia Thalamus Brainstem Cerebellum
Rupture of an arteriosclerotic small artery in the brainstem
Hemorrhage accumulates as a mass
Neuronal dysfunction
Large hematoma leading to increase ICP
Pressure from Edema

supratentorial hematoma
1. Increase blood pressure
2. Weakness
3. Decreased/limited body movements
4. Visual deficits

V. LABORATORY EXAMINATION/DIAGNOSTIC PROCEDURES

Date/ Laboratory Test Normal Value Client Result Reason for the test Nursing Intervention for
Abnormal Result
August 18’2009
BLOOD CHEMISTRY:
a. FBS 3.8-5.8 mmol/L 4.98  To determine
undiagnosed diabetes
mellitus.  Refer to physician.
b. Cholesterol 3.6-6.2 mmol/L 2.95  Used to estimate risk  Assess patient for
of developing a signs and symptoms of
disease. presence of disease.
 Teach patient on
proper nutritional
intake to increase
abnormal cholesterol
levels by eating:
a. Meat or animal
products at
moderate
amounts.
b. Drinking
pineapple juice
c. Eating eggs.
c. Triglycerides 0.46-1.7 mmol/L 0.76  Used as part of the
lipid profile to
determine risk of
heart disease (for
elevated levels) and
brain infarction (for
low levels).
d. HDL 0.78-1.95mmol/L 1.29  Check the level of
cholesterol in the

blood and to
determine the risk of
disease.
e. LDL 2.08-5.26mmol/L 1.81  Used to check the  Refer to the physician.
level of cholesterol in  Teach the patient on
the blood and the proper nutritional
probable risk of intake focusing on:
acquiring a disease. a. Severe
restriction on
fatty acids to 15
g per day.
b. Vitamin E
Supplementatio
n.
August 17’ 2009
CHEMISTRY:
a. Random Blood Sugar <11.1 mmol/L 12 Measures blood glucose  Refer to the physician
(HGT) regardless of when you  Take patient’s Blood
last ate. pressure
 Assess for presence of
hypertension, DM
August 17 ‘2009
BLOOD CHEMISTRY:
a. BUN 1.7-8.3 mmol/ L 3.80  To determine
presence of kidney or
renal failure
(decreased levels)
b. Creatinine 53-115 mmol/L 148  Evaluate renal  Refer to physician

function.  Assess for signs and
symptoms of renal
impairment.
 Monitor patient’s BP
 Health teaching–
smoking cessation,
weight loss, aerobic
exercise, limit alcohol
intake, limit sodium
intake (low salt diet)
 Provide medication-
aspirin and lipid
lowering therapy as
prescribed by
physician.
c. Sodium 136-148 mmol/L 133.0  To evaluate fluid and  Refer to physician.
electrolyte status.  Assess for signs and
symptoms of
hyponatremia.
 Maintain Na balance/
water restriction as
ordered by the
physician.
d. Potassium 3.5-5.5 mmol/L 3.64  To evaluate fluid and
electrolyte status.
August 17’ 2009
HEMATOLOGY REPORT:
a. WBC count 5-10 10^3/ uL 9.1 10^3/ uL  Used as a screening
and/or diagnostic tool
because it can help
detect substances or
cellular material in the
urine associated with
different metabolic
and kidney disorders.
b. RBC count 4.6 -6.2 10^6/uL 5.18 10^6/uL
c. Hemoglobin 13.5 -18.0 g/dl 17.8 g/dL

d. Hematocrit 40.0-54.0% 54.4%  Refer to physician

 Assess the patient for
signs of chronic
obstructive pulmonary
disease.
e. MCV 80-100 fL 105 fL
 Assess for presence of
liver disease,
pernicious anemia and
alcoholism.
 Health teaching –
slowly decrease
alcohol consumption.
f. MCH 27-32 pg 34.4 pg  Assess for presence of

anemia.
g. MCHC 32.0-36 g/dl 32.7 g/dL  Refer the result to the

physician.
 Assess for signs and
symptoms of physical
and emotional stress;
cushing’s syndrome;
h. Platelet Count 150-450 10^3/uL 228 10^3/uL acute infection etc.
DIFFERENTIAL COUNT:
a. Segmenters 40-60% 84.1%  Refer the result to the
physician.
symptoms of
immunodeficiency
disease.
b. Lymphocyte 20-40% 10.9%  Refer the result to the

physician.
symptoms of acute or
chronic inflammation.
c. Monocyte 2.0-8.0% 4.7%  Refer result to the

physician.
d. Eosinophil 1.0-6.0% 0.3%  Assess for signs and
symptoms of allergic
reactions,
Hyperthyroidism and
Stress reactions.
e. Basophil 2.5-7.5% 0.0  Refer result to the

physician.
symptoms of anemia
or bone marrow
failure to infection.
f. Retic Count 0.5-1.5% -
August 17’2009
URINALYSIS:
I. Macroscopic
a. Color Straw like Hazy Yellow  Refer result to the
b. Transparency Clear Clear physician
II. Microscopic symptoms of renal
a. Pus Cells: 0-3 1-3/hpf dysfunction or urinary
b. RBC Negative or rare 0-1 tract infection.
A. Urates/ phosphates
a.Epithelial cells Few Few
b.Mucus threads Few Few
III. Chemical Strip

a. Reaction pH 4.6-8 Acidic
b. Specific Gravity 1.003-1.030 1.010
c. Sugar Negative Negative
d. Protein Negative Negative
Date/ Diagnostic Procedure Client Result Reason for Test

August 17’ 2009
CT SCAN EXAMINATION:  There is a connection of acute intraparenchymal  Used to determine small nodules or
Plain Cranial hemorrhage seen in the right brainstem and right tumors in a person’s body not usually
thalamo ganglionic areas with intraventricular seen with the use of an x-ray.
dissection.  CT or CAT scans are special x-ray tests that
 Focal perilesional edema noted. produce cross-sectional images of the
 There is mild leftward boning of midline body using x-rays and a computer.
structures.
 No hydrocephalus seen.
 Basal cisterns, sella, visualized paranasal sinuses,
petromastoids and bony calvarium are intact.
IMPRESSION:
Acute intraparenchymal hemorrhage, right brainstem
and right thalamo – ganglionic areas with
intraventricular dissection.
August 17’ 2009
RADIOLOGY REPORT Chest Sup:  Used to study the images of the human
 Fibrohazed densities in the right upper lobe. body using radiant energy.
 Heart is normal in size.
 Diaphragm and bony thorax are unremarkable.
IMPRESSION:
Mild PTB, right upper lobe of undetermined activity.

VI. DRUG STUDY

1. MANNITOL (OSMOFUNDIN)
Drug: Mannitol Appropriate dosage Drug classification: Nursing implications: Nursing intervention/ Why client is
(Osmofundin) for 24 hrs drug Osmotic diuretic 1. What do you need Consideration related receiving the drug
computation: to check or do prior to effects of drug: based on history of
Dosage: 150 cc 900 cc/day Action: to drug  Monitor IV site present illness:
(average dose)  Increases osmotic administration: carefully to avoid The pt is diagnosed
pressure of plasma  Assess ocular extravasation and with Intracerebral
Route: IV in glomerular condition and tissue necrosis. Hemorrhage. This
filtrate, inhibiting record  Monitor for the condition can be
Frequency: q4hrs tubular pretreatment possible drug- predisposed by
(every 4 hours) reabsorption of intraocular induced adverse uncontrolled
water & electrolytes pressures. reactions. hypertension and can
(including K & Na)  Document baseline  In comatose cause increased
- these actions VS & ECG patient, insert intracranial pressure.
enhance water flow  Assess pt’s & indwelling catheter Giving osmotic
from various tissues family’s knowledge as ordered to dieresis can decrease
and ultimately on drug therapy. monitor urine BP & at the same
decrease  Use cautiously in: output. time, lower ICP.
intracranial and - severe renal  Monitor renal
intraocular disease, heart function tests,
pressures; serum Na failure, mild to urinary output,
level rises while K moderate fluid balance,
and blood urea dehydration central venous
levels fall - pregnant or pressure, and
 Protects kidneys by breastfeeding pts electrolyte levels
preventing toxins (especially Na & K).
from forming and 2. major side effects  Watch for
blocking tubules. of drug: excessive fluid loss
 CNS: dizziness, and s/sy of
headache, seizures hypovolemia and
 CV: chest pain, dehydration.
hypotension,  Assess for evidence

hypertension, of circulatory
tachycardia, overload, including
thromboplebitis, pulmonary edema,
heart failure, water intoxication,
vascular overload and heart failure.
 EENT: blurred  Teach pt about
vision, rhinitis importance of
 GI: nausea, monitoring exact
vomiting, diarrhea, urine output.
dry mouth  Advice pt to report
 GU: polyuria, pain at infusion site
urinary retention, as well as adverse
osmotic nephrosis reactions, such as
 Metabolic: increased
dehydration, water shortness of breath
intoxication, or pain in back, legs
hypernatremia, or chest.
hyponatremia,  Tell pt drug may
hyperkalemia, cause thirst or dry
metabolic acidosis mouth. Emphasize
 Respiratory: that fluid
pulmonary restrictions are
congestion necessary, but that
 Skin: rash, urticaria frequent mouth
 Other: chills, fever, care should ease
thirst, edema, these symptoms.
extravasation with  As appropriate,
edema and tissue review all other
necrosis significant & life-
threatening
adverse reactions
and interactions

2. AMLOPIDINE MALEATE (STAMLO-M)

Drug: Amlopidine Appropriate dosage Drug classification: Nursing implications: Nursing intervention/ Why client is
Maleate (Stamlo-M) for 24 hrs drug Calcium Antagonist 1. What do you need Consideration related receiving the drug
Dosage: 5mg x 1 tab 5 mg/day Action: to drug  Monitor if platelet present illness:
 Inhibits influx of administration: count is Since pt has constant
Route: Oral calcium ion across  Use cautiously in <150,000/mm3; hypertension, the
cell membranes to pts with: CHF, drug is usually drug is given to
Frequency: OD (once produce relaxation hepatic impairment discontinued & decrease the BP.
a day) of coronary  Assess another drug
vascular smooth cardiorespiratory started
muscle (dilatation status: angina pain,  Teach pt to use as
of coronary BP, pulse, directed even if
arteries) respiration, ECG feeling better; may
 Decrease  Assess hydration be taken with
peripheral vascular and fluid volume other
resistance of status: I&O ratio, cardiovascular
smooth muscle presence of edema, drugs (nitrate,
(decrease blood distended neck beta-blockers),
pressure) veins, lung crackles, food helps
 Increases adequate pulses & decrease stomach
myocardial oxygen skin turgor upset.
delivery in patients  Monitor liver  Advise pt to avoid
with vasospastic function: ALT, AST, hazardous
angina bilirubin activities until
stabilized on drug
2. major side effects and dizziness is no
of drug: longer a problem.
 Palpitations Report symptoms
 Peripheral edema of chest pain,
 Syncope swelling of
 Tachycardia extremities,
 Bradycardia irregular pulse,
altered vision,
 Arrhythmias shortness of breath

 Ventricular or hypotension
asystoles  Advise pt to
 Headache comply in all areas
 Dizziness of medical
 Fatigue regimen: diet,
 Lethargy exercise, stress
 Somnolence reduction, smoking
 Dermatitis cessation, & drug
 Rash therapy
 Pruritis
 Urticaria
 Nausea
 Abdominal
discomfort
 Cramps
 Dyspepsia
 Shortness of breath
 Dyspnea
 Wheezing
 Flushing
 Sexual difficulties
 Muscle cramps
 Pain
 Inflammation

3. CITICOLINE (ZYNAPSE)
Drug: Citicoline Appropriate dosage Drug classification: Nursing implications: Nursing intervention/ Why client is
(Zynapse) for 24 hrs drug Cerebroprotective/ 1. What do you need Consideration related receiving the drug
computation: Neurotropic/CNS to check or do prior to effects of drug: based on history of
Dosage: 1 gm 2 gm/day Stimulant to drug Contraindicated in present illness:
administration: patients with  Citicoline
Route: IV Action:  Use cautiously in hypertonia of the accelerates the
 Citicoline activates persistent ICH, parasympathetic. recovery of
Frequency: q12hrs the biosynthesis of administer very consciousness and
(every 12 hours) structural slowly. overcoming motor
phospholipids in  Use with caution in deficit in stroke
the neuronal pregnant and patients.
membrane, lactating women.
increases cerebral
metabolism and 2. major side effects
increases the level of drug:
of various  Increased
neurotransmitters, parasympathetic
including effects
acetylcholine and  fleeting & discrete
dopamine. hypotensor effect
 Citicoline has
shown
neuroprotective
effects in situations
of hypoxia and
ischemia, as well as
improved learning
and memory
performance in
animal models of
brain aging.
 Furthermore, it has
been demonstrated
that citicoline
restores the activity
of mitochondrial
ATPase and of
membrane Na+/K+
ATPase, inhibits the
activation of
phospholipase A2
and accelerates the
reabsorption of
cerebral edema in
various
experimental
models.
4. LACTULOSE (RILAX)
Drug: Lactulose Appropriate dosage Drug classification: Nursing implications: Nursing intervention/ Why client is
(Rilax) for 24 hrs drug Laxative 1. What do you need Consideration related receiving the drug
Dosage: 30 cc 30 cc/day Action: to drug  Do not use if in the present illness:
 Causes an influx of administration: presence of Forceful bowel
Route: Oral fluid in the  Use cautiously in abdominal pain, expulsion or
intestinal tract by pts with lactose nausea, fever or constipation can
Frequency: OD HS increasing the intolerance & vomiting. cause increased
(once a day, hour of osmotic pressure diabetes, elderly,  Should not be taken intracranial pressure
sleep) within the debilitated, and for more than 1 wk and increase in blood
intestinal lumen pregnant & w/o the advice of pressure. Laxative
 Bacterial lactating women. physician. administration aids in
metabolism of the  Assess pt’s  Advice pt to dilute decreasing risk for
drug to lactate and condition before drug with juice or increased ICP and BP.
other acids which therapy and water or take with
are only partially reassess regularly food to improve
absorbed in the thereafter to taste.
distal ileum and monitor drug’s
colon augments the effectiveness.  Teach pt that

osmotic effect of Identify cause of normal bowel
lactulose. constipation: Assess mov’ts do not
 The distention of lifestyle in relation always occur daily
the colon due to to fluids, bulk and and that adequate
increased fluid exercise. fluid consumption
enhances intestinal  Monitor fluid & is necessary
motility and electrolyte status:  Inform pt of
secretion. These urine output, I&O possible adverse
result to the ratio to identify effects and the
passage of soft fluid loss, need to notify
stools. hypokalemia and physician
 Decrease in the hypernatremia. immediately if
lumenal pH (due to  Assess pt’s and these occurs.
bacterial family’s knowledge Remind pt not to
metabolism) of drug therapy. use in presence of
further increase abdominal pain,
motility and 2. major side effects nausea, and
secretion. of drug: vomiting
 Abdominal  Instruct pt that
discomfort bowel tone may be
associated w/ lost if used as
flatulence and laxative for long
intestinal cramps tern therapy. Do
 Nausea not give at bedtime
 Vomiting because it may
 Diarrhea on interfere with
prolonged use sleep.
 Inform pt that
diarrhea may
indicate
overdosage.

VII. NURSING CARE PLAN

Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
Subjective cues: Ineffective cerebral Short term goal: Independent:
" Ang sakit ng ulo tissue perfusion After 3 hours of 1. Monitor Fever may reflect Goal met.
ko," as stammered related to nursing temperature and damage to After 3 hours of
by the patient. interruption of interventions, the regulate hypothalamus. nursing
blood flow by a patient with the environmental Increased metabolic interventions, the
Objective cues: space-occupying help of the support temperature. needs and oxygen patient with the
Altered mental hemorrhage as person will be able Administer tepid consumption occur, help of the support
status evidenced by to demonstrate sponge bath in which can further person wias able to
Speech altered level of techniques and presence of fever. increase ICP. demonstrate
abnormalities consciousness and behaviors to techniques and
Restlessness changes in motor prevent further 2. Monitor intake Useful indicator of behaviors to
Changes in motor responses. aggravation of and output. total body water, prevent further
response intracranial which is an integral aggravation of
pressure. part of tissue intracranial
perfusion. pressure.
3. Maintain head Turning head to one

Long term goal: and neck in midline side compresses the Goal met.
After 2 days of or neutral position. jugular veins and After 2 days of
nursing Avoid placing head inhibits cerebral nursing
interventions, the on large pillows. venous drainage, interventions, the
patient with the thereby increasing patient with the
help of the support ICP. help of the support
person will be able person was able to
to maintain absence 4. Decrease Provides calming maintain absence of
of signs of increased extraneous tissue effect, reduces signs of increased
intracranial stimuli and provide adverse physiologic intracranial
pressure. comfort measures response, and pressure.
like back massage, promotes rest to
quiet environment maintain/ lower ICP.
and gentle touch.

5. Investigate These nonverbal

increasing cues may indicate
restlessness, increasing ICP or
moaning and reflect presence of
guarding behaviors. pain when client is
unable to verbalize
complaints.
6. Position the Promotes venous

patient in moderate drainage from head,
high back rest. therby reducing
cerebral congestion
and risk of increased
ICP.
Dependent:
1. Administer Reduces hypoxemia,
supplemental which is known to
oxygen at 2-3 LPM increase cerebral
thru nasal cannula vasodilation and
as ordered by the blood volume,
physician. elevating ICP
2. Administer Diuretics are used to

medications as draw water from
ordered by the brain cells, reducing
physician: ICP.
Diuretics
Mannitol(IV), 150
ml, IV.
Antipyretics 150 mg, Reduces/ controls

IV. fever and its
deleterious effect
on cerebral
metabolism/ oxygen
needs and
insensible fluid
losses.

Subjective cue: Elevated body Short term goal: Independent:
“Ang sakit ng ulo temperature related After 4 hours of 1. Advise mother to Heat loss by Goal met.
ko,” as stammered to a disease and nursing promote surface radiation and After 4 hours of
by the patient. exposure to hot interventions, the cooling by means of conduction. nursing
environment as patient will be able undressing and interventions, the
Objective cues: evidenced by to achieve normal reducing the use of patient was able to
T= 38.6°C increase in body body temperature bed linens. achieve normal
RR = 22 breaths per temperature higher within normal range body temperature
minute than normal range 2. Advise patient to Reduce metabolic level within normal
Warm to touch and increased maintain bedrest. demands and range.
repiratory rate. oxygen
consumption.
Long term goal: Goal met.
After 1 day of 3. Maintain cool Heat loss by After 1 day of
nursing environment by convection. nursing
interventions, the using room fan. interventions, the
client will be able to client was able to
maintain body 4. Provide surface Heat loss by maintain body
temperature within cooling by means of evaporation and temperature within
normal range. continuous tepid conduction. normal range.
sponge bath (TSB).
5. Monitor body Monitor therapeutic

temperature. effectiveness of
interventions.

Dependent:
1. Administer Pharmacologic
paracetamol, 150 intervention.
mg, thru IV as antipyretics are
ordered by the used to reduce fever
physician. by its central action
on the
hypothalamus.
2. Administer Support circulating

replacement IV volume and tissue
fluids and perfusion.
electrolytes as
ordered by the
physician.

Subjective cues: Risk for impaired Short term goal: Independent:
" Mainit kasi dito, skin integrity related After 3 hours of 1. Inspect skin, Provides Goal met.
lagi siyang to reduced mobility, nursing tissues, and mucous opportunity for After 3 hours of
pinagpapawisan. motor deficits, interventions, the membranes early intervention of nursing
Hirap din akong altered circulation, patient with help of routinely. the patient who interventions, the
ibahin ang posisyon bladder excretions, the support person have thin, less patient with help of
nya," as the wife of and problems with will be able to elastic, and more the support person
the patient self-care. demonstrate fragile skin and was able to
verbalized. behaviors and 2. Anticipate and tissues. demonstrate
techniques to use preventive behaviors and
Objective cues: prevent skin measures to prevent Decubitus ulcers are techniques to
Immobility breakdown. skin breakdown by difficult to heal, and prevent skin
Presence of foley repositioning the prevention is the breakdown.
cathether patient every 2 best treatment.
Long term goal: hours. Positioning Goal met.

After 2 days of improves After 2 days of

nursing circulation, muscle nursing
interventions, the tone, and joint interventions, the
patient with the motion and patient with the
help of the support 3. Maintain skin promotes client help of the psupport
person will be able hygiene, using mild participation. person was able to
to maintain intact soap, drying gently maintain intact skin.
skin. and thoroughly. Cleansing is needed
to keep skin soft and
protect susceptible
4. Keep bed sheets skin from
and bedclothes breakdown.
clean, dry and free
from wrinkles. Avoids friction of
skin.

NURSING THEORY
Orem’s General Theory of Nursing
For Dorothea E. Orem, self care refers to those activities an individual performs independently
throughout life to promote and maintain personal well-being. In the case of Mr. NC, he cannot provide
care for himself. Mr. NC needs a dependent care agent, a person other than himself who provides care.
The self care demands are greater than the self care activities. Health deviation self care are the needs
that are required for the patient due to his condition.
Self care deficit resulted because the self care agency is not adequate to meet the known self
care demand. There are contributing factors affecting the self care agent and demand of the patient.
People can be assisted through the 5 methods of helping: acting, guiding, teaching, supporting and
providing an environment that promotes the patient’s abilities to meet current and future demands. A
wholly compensatory system is required because the patient is unable to control and monitor the
environment and process information.
VIII. DISCHARGE PLANNING

Medication
 Emphasize necessity of compliance to taking medications as directed by the physician.
Environment
 Encourage family to promote an environment conducive to recovery. Provide for him a place
where he could rest and get away from the hassles.
Health teaching
 Instruct the family to initiate providing proper hygienic care to the patient.
Out Patient
 Follow up check up regarding the patient’s condition.
Diet
 Advise family that it is good to provide healthy food to the patient.
 A balanced diet of fruits, vegetables, and carbohydrates are necessary for the patient’s faster
recovery.
Spiritual
 Encourage the family the need for prayers and great faith to God.

IX. IMPLICATIONS OF THE CASE STUDY TO THE FOLLOWING

Nursing Research
The study can help in further improving researches related to the disease and could help
provide more information regarding its manifestations and prevalence among the geriatric
patients in the Philippines. This research could provide more knowledge for future researchers
in the said disease and could provide more in depth solutions to the problem so that such
diseases could be prevented in the society.
Nursing Education
The research would be of much help in the nursing profession because it will be able to
provide more information on the importance of managing the disease of the patients by
providing proper care and treatment to the patients. Also, it gives a more descriptive
characteristic of the clinical manifestations of the geriatric patients with the said disease and a
deeper understanding of its etiology, pathophysiology and the prevalence of the disease among
geriatric patients.
Nursing Practice
The research could help as a guide for the health care team most especially for nurses to
further improve on their nursing interventions when it comes to dealing with the patient and
his/ her needs. This study will help student nurses in understanding the disease better and help
improve their skills and knowledge when it comes to dealing with the patient and other
members of the health care team that will allow them to become better nurses in the future.

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TRINITY UNIVERSITY OF ASIA

[CASE PRESENTATION: INTRACEREBRAL HEMORRHAGE]

B. Definition of the case:

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 1

C. General signs and symptoms:

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 2

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 3

III. PATIENT PROFILE

 Health- Perception-Health –Management Pattern

 Nutritional and Metabolic Pattern

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 4

 Activity- Exercise Pattern

 Self- Perception - Self- Concept Pattern

 Role –Relationship Pattern

 Sexuality- Reproductive Pattern

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 5

 Coping-Stress –Tolerance Pattern

 Value- Belief Pattern

E. Present History of Illness:

G. Course in the ward:

Date/ Time Remarks

August 21,2009 (Friday)

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 6

August 22, 2009

IV. ANATOMY AND PHYSIOLOGY

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 7

Major Vessel Types

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 8

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 9

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 10

THE NERVOUS SYSTEM

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 11

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 12

THE PATIENT AND HIS ILLNESS

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 13

Basal Ganglia Thalamus Brainstem Cerebellum

Rupture of an arteriosclerotic small artery in the brainstem

Hemorrhage accumulates as a mass

Large hematoma leading to increase ICP

Pressure from Edema

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 14

V. LABORATORY EXAMINATION/DIAGNOSTIC PROCEDURES

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 15

b. Creatinine 53-115 mmol/L 148  Evaluate renal  Refer to physician

c. Hemoglobin 13.5 -18.0 g/dl 17.8 g/dL

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 17

d. Hematocrit 40.0-54.0% 54.4%  Refer to physician

f. MCH 27-32 pg 34.4 pg  Assess for presence of

g. MCHC 32.0-36 g/dl 32.7 g/dL  Refer the result to the

b. Lymphocyte 20-40% 10.9%  Refer the result to the

c. Monocyte 2.0-8.0% 4.7%  Refer result to the

e. Basophil 2.5-7.5% 0.0  Refer result to the

III. Chemical Strip

Date/ Diagnostic Procedure Client Result Reason for Test

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 20

VI. DRUG STUDY

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 21

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 22

2. AMLOPIDINE MALEATE (STAMLO-M)

 Arrhythmias shortness of breath

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 24

colon augments the effectiveness.  Teach pt that

AMANG RODRIGUEZ MEMORIAL MEDICAL CENTER | Group 1 of 3NU05 27