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I.

INTRODUCTION
A. Background of the study

Stroke (or cerebrovascular accident (CVA)) is a condition that occurs when an


area of the brain is denied oxygen and nutrients. The cause can be an embolus, (blood
clot from another part of the body that travels to the brain), or a thrombus, (a blood clot in
the brain's circulation).

In medicine, the process of being struck down by a stroke, fit, or faint is


sometimes referred to as an ictus [cerebri], from the Latin icere ("to strike"), especially
prior to a definitive diagnosis.

Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden
paralysis. Apoplexy, from the Greek word meaning "struck down with violence,” first
appeared in Hippocratic writings to describe this phenomenon.

In 1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause
of hemorrhagic stroke when he suggested that people who had died of apoplexy had
bleeding in their brains. Wepfer also identified the main arteries supplying the brain, the
vertebral and carotid arteries, and identified the cause of ischemic stroke when he
suggested that apoplexy might be caused by a blockage to those vessels.

The word stroke was used as a synonym for apoplectic seizure as early as 1599,
and is a fairly literal translation of the Greek term.

The traditional definition of stroke, devised by the World Health Organization in


the 1970s, is of a "neurological deficit of cerebrovascular cause that persists beyond 24
hours or is interrupted by death within 24 hours". This conceptual definition was
supposed to reflect the reversibility of tissue damage and was largely devised for the
purpose of research and the time frame of 24 hours appears purely arbitrarily chosen as a
cut-off point. It divides stroke from TIA, which is the same as above but completely
resolves clinically within 24 hours. The division of stroke and TIA into separate clinical
entities is considered impractical and even unhelpful in practice by many stroke doctors.
The main reason for this is the fact that stroke and TIA are caused by the same disease
process, and both persons with a stroke or a TIA are at a higher risk of a subsequent
stroke. Moreover, enhanced imaging techniques reveal that damage to the brain tissue
actually occurs in most patients within a few hours even if overt clinical signs disappear
following this time (subtle signs on extensive neuropsychological testing may be
elicitable). In recognition of this, and improved methods for the treatment of stroke, the
term "brain attack" is being promoted in the Western World as a substitute for stroke or
TIA. The new term makes an analogy with "heart attack" (myocardial infarction),
because in both conditions, an interruption of blood supply causes death of tissue that is
highly time dependent ("time is brain") and potentially life-threatening.

A stroke happens when a blood vessel that feeds the brain becomes blocked or
bursts. When this happens, part of the brain does not get the oxygen and nutrients it needs

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and that area becomes damaged. The damaged area cannot work, and neither can the part
of the body it controls.

The actual disease case condition as such was studied by Jillianne M. Bertiz,
Siena College BSN-3A student. The study was conducted in Rizal Provincial Hospital at
Charity Ward Bed No. 03 Rm1. All the source of data was from the patient, his chart and
relatives which are entirely gathered during the patient’s hospitalization.

B. Objectives

General Objectives:
• To be able to gain knowledge about brain attack or stroke.
• To be able to prevent the occurrence of brain attack.

Specific Objectives:
• To be able to discuss what is brain attack, its causes and treatments.
• To be able to know the warning signs of and risk factors of stroke
• To explain the pathophysiology of the disease condition

C. Significance of the study

The significance of this study is to share pieces of information about


“brain attack” or stroke.
This study will also serve as reference and guide to fellow nursing
students that will conduct a study that is related to stroke.
As a Nurse, we must be knowledgeable about the disease condition and
the nursing management that should be rendered in different kinds of
circumstances to patients with brain attack.

D. Scope and limitation

The scope and limitations of this study is from the admission, assessment, and
history data gathering; discuss the Anatomy and physiology, Pathophysiology, make a
Nursing Care Plan, a Drug Study and do Discharge Planning.

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E. Theoretical framework

Within a health promotion context that views health as a resource for daily living,
self-care is seen as empowering. Through acquisition of self-care skills, people are able
to participate more actively in fostering their own health and in shaping conditions that
influence their own health.

Helping the patient improve self-care skills and move towards being as
independent as possible is the nurse's ultimate goal. The patient may need assistance after
leaving the hospital, but this can be achieved by assistance from the family members or a
home-health care giver.

Orem's search for the meaning of nursing


was structured by three questions:
*What do nurses do and what should
nurses do as practitioners of nursing?
*Why do nurses do what they do?
*What results from what nurses do as
practitioners of nursing?

This consists of three related theories:


(subtheories)
Theory of self-care
Theory of self-care deficit
Theory of nursing system

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II. NURSING ASSESSMENT
A. Personal Data

Fiscal year: 2007 Admitting physician: Dra. Magtoto


Admission number: 697 Department: Medical Ward
File Record number: 508193

Name: Edgardo Camas Age: 62


Maiden Name: Almonte Sex: Male
Birth Date: January 13, 1945 Status: Married
Occupation: Carpenter

Admission Date: November 18, 2007 Admission Time: 4:25pm

B. Chief Complain

The patient’s principal complains was numbness in his left extremities together with
severe weakness that made them come to the hospital.

C. Impression and Diagnosis


The patient has Left sided paresthesia, & weak diagnosed to have Cerebrovascular
Accident / Stroke.

D. History of Past illness

The patient had diagnosed to have tuberculosis in year 2004 and was treated for seven
months. His commonly experienced illness for the past 5 years was only cough and cold.
The patient self medicated by taking bio flu if they have money but if none, relaxation is
the choice of remedy.

A. History of Present Illness

The patient was unaware that he is hypertensive.He only knew this when he was
hospitalized. He do not know his average BP .He habitually drinks alcohol and have a
exhausting energy demanding workload.

E. Family History

Patient has no infectious or hereditary disease among his blood relations. None of
which he lives within the house has infectious disease like influenza or tuberculosis.

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F. Patient’s Concept of health illness and Hospitalization

What is Health: “kalusugan” as verbalized by the patient.


What is Illness: “nanghihina ka…na-aaburido, ” as verbalized by the patient.
What is Hospitalization: “pag may saket dito pumupunta para malunasan ang sakit
pero imbis na gumaling na lalu lumalala pag nandito e,… an init pa,” as verbalized by the
patient.

G. Psychosocial History
The patient has only one sexual partner and eight siblings. No use of prohibited
drugs. Don’t use cigarette. However do drink alcoholic beverages with neighbors and
friends sometimes at home or after work two times a week wherein they share common
utensils and food. He was sixteen years of age when he first drink alcohol, until now that
his 45. He only stopped his drinking habit when he was hospitalized.

H. Physical Examination/Assessment
I. HEAD AND Method of NORMAL Actual findings ANALYSIS AND
NECK Assessment FINDINGS INTERPRETATI

A. Head Inspection Symmetrical, Symmetrical, Normal


Rounded, head Rounded, head
positioned at positioned at
midline and erect midline and erect
with no lumps or with no lumps or
ridges ridges
B. Scalp and Inspection White scalp, hair Hair is evenly Normal with at age.
Hair evenly distributed; thin,
distributed, hair, and rigid hair. No
thick, silky and infection or
resilient hair, no infestation.
infection or
infestation.
C. Face inspection Oval round or Oval round or Normal with at age.
square, square,
symmetrical symmetrical
facial expression facial expression
depends on the depends on the
mood, smooth mood, dry with
free from wrinkles, in
wrinkles, uniform uniform
consistency, and consistency, and
absence of nodule absence of nodule
or masses. or masses.
II. EYES AND
VISION

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D. Eyebrows inspection Evenly hair Evenly hair Normal
distributed, distributed,
symmetrical symmetrical
E. Eyeball inspection No protrusion, No protrusion, Normal
scant amount of scant amount of
secretion. secretion.
F. Lip margins inspection No scaling, lips No scaling, lips Normal
close close
symmetrical, no symmetrical, no
charges. charges.
G Sclera inspection White, clear White, clear Normal
III. Ears/
Hearing

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K. Pupil inspection Constrict when Constrict when Normal
the light is the light is
pointed to eye pointed to eye
and dilates when and dilates when
the light is the light is
removed, removed,
constrict when constrict when
object is move object is move
closer to the eyes closer to the eyes
and dilates when and dilates when
moved away. moved away.
Hearing acuity inspection Able to hear Able to hear Normal
whisper spoken 2 whisper spoken 2
feet away feet away
L. Nose inspection Nasal system Nasal system Normal
intact and in intact and in
midline, midline,
symmetrical, no symmetrical, no
discharges, discharges,
patent, no flaring. patent, no flaring.
IV. Mouth
M. Lips inspection Pinkish, smooth, Pinkish, chapped, Not normal, dry lips
moist well dry, well defined, maybe due to lack
defined, symmetrical of fluid intake and
symmetrical the lips is crack.
N. Gum inspection Pinkish, smooth, Pinkish, smooth, Normal
moist, no moist, no
swelling, no swelling, no
discharges, no discharges, no
retractions. retractions.
O. Teeth inspection Well aligned, free Staining; have Not normal,
from caries or missing tooth staining tooth may
filing, no halitosis due to lack of oral
care and have two
missing tooth
(molar tooth)
P. Tongue inspection Central position, Central position, Normal
large or rough on large or rough on
top, smooth, top, smooth,
along the lateral along the lateral
margin, moist, margin, moist,
shiny and freely shiny and freely
movable, no movable, no
lesions. lesions.
Q. Palate inspection Hard palate- Hard palate- Normal
lighter pink, more lighter pink, more
irregular texture irregular texture
soft palate-light soft palate-light
pink, smooth pink, smooth
uvulva in midline uvulva in midline

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R. Orophrynx/ inspection Pink, smooth, no Pink, smooth, no Normal
tonsils discharges, discharges,
behind tonsillar behind tonsillar
pillars, gag reflex pillars, gag reflex
present. present.
S. Neck inspection Pink, smooth, no Pink, smooth, no Normal
discharges, discharges,
behind tonsillar behind tonsillar
pillars, gag reflex pillars, gag reflex
present. present.
T. Posterior inspection Chest is Chest is Normal
thorax symmetric, symmetric,
vertically aligned vertically aligned
spine, spinal spine, spinal
column is column is
straight, right and straight, right and
left shoulders and left shoulders and
hips are at same hips are at same
height, skin height, skin
intact; uniform intact; uniform
temperature Chest temperature Chest
wall intact; no wall intact; no
tenderness; no tenderness; no
masses, full masses, full
symmetric and symmetric and
chest expansion chest expansion
bilateral bilateral
symmetry of symmetry of
vocal fremitus, vocal fremitus,
fremiyus is heard fremiyus is heard
most clearly at most clearly at
the apex of the the apex of the
lungs percussion lungs percussion
notes reasonate, notes reasonate,
except over except over
scapula, lowest scapula, lowest
point of point of
reasonance at the reasonance at the
diaphragm (8th diaphragm (8th
and 10th rib and 10th rib
posteriorly) posteriorly)
vesicular and vesicular and
bronchovesicular bronchovesicular
breath sounds. breath sounds.
U. Anterior inspection Thorax in greater Thorax in greater Normal
thorax diameter laterally diameter laterally
than than
anteroposteriorly. anteroposteriorly.
Skin color Skin color
matches the rest matches the rest

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complexion. complexion.
Quite, rhythmic, Quite, rhythmic,
and effortless and effortless
respiration full respiration full
symmetric symmetric
excursion; excursion;
thumbs normally thumbs normally
separate 3-5cm. separate 3-5cm.
Bilateral Bilateral
symmetry of symmetry of
vocal fremitus, vocal fremitus,
fremitus is heard fremitus is heard
most clearly at most clearly at
the apex of the the apex of the
lungs percussion lungs percussion
notes resonate notes resonate
down to the 6th down to the 6th
rib. rib.
V. Heart inspection No heave or No heave or Normal
abnormal abnormal
pulsation apical pulsation apical
pulse 60-80 beats pulse 60-80 beats
per-veins not per-veins not
visible visible
W. Breast inspection Symmetrical, Symmetrical, Normal
Nipple, Areola slightly slightly
pinkish/brown pinkish/brown
nipples (no nipples (no
dimpling and dimpling and
discharge) discharge)
uniform skin uniform skin
color, smooth and color, smooth and
intact, no lumps, intact, no lumps,
no masses, no masses,
tenderness tenderness
X. Abdomen inspection Unblemished Unblemished Normal
skin, uniform skin, uniform
color, symmetric color, symmetric
movement cause movement cause
by respiration by respiration
liver may not be liver may not be
palpable bladder palpable bladder
is not palpable is not palpable
Y. Upper inspection Symmetrical, Symmetrical, Normal
extremities equal in length, equal in length,
no lesions, no no lesions, no
deformities, able deformities, able
to do flexion, to do flexion,
extension and extension and
ROM 5 fingers ROM 5 fingers

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for both side the for both side the
hands, pinkish hands, pinkish
nail beds, clean, nail beds, clean,
can do ROM. can do ROM.
Z. Lower inspection Symmetrical, Symmetrical, Normal
extremities equal in length, equal in length,
no lesions, no no lesions, no
deformities, able deformities, able
to do flexion, to do flexion,
extension and extension and
ROM 5 fingers ROM 5 fingers
for both side the for both side the
hands, pinkish hands, pinkish
nail beds, clean, nail beds, clean,
can do ROM. can do ROM.

I. Usual Pattern of daily living

Before Hospitalization During Hospitalization


Able to walk and sit Able to walk and sit
Able to socialize with neighbors Unable to socialize in the hospital
Able to do his work Limited work to do in the hospital premises
Able to sleep comfortably at home Limited sleep duration due to the poor ventilation
in the hospital as verbalized by the patient
Experiencing left sided numbness and Alleviated numbness but partial Left sided
weakness weakness
J. Laboratory Examination

Hematology Findings Normal Date Analysis/


values Interpretation
Hemoglobin 89 g/L 140-170 g/L 11-18-07 ↓ suggests anemia or
hemodilution
Hematocrit 0.45 0.40 - 0.50 11-18-07 Normal
WBC 9.0 g/L 5-10 x 109 11-18-07 ↑ suggest presence of infection
Differential count 0.71 0.2 - 0.35 11-18-07 ↑ suggests leukemia, aplastic
anemia
Segme 0.2 0 11- Normal
nters 9 . 18-
4
5
07

0
.
6
5

Blood Chemistry Findings Normal values Date Analysis/


Interpretation
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Glucose 3.54 mmoL/L 4.2 – 6.4 mmoL/L 11-21-07 ↓ Related to
hypoglycemia

L. Course on the ward

Date Shift Doctors Odrer Nurses Notes


Nov.18.2007 6am-2pm  Admitted 62 years old male
 IV PNSS 1L + 2 accompanied by relative with chief
amp Trivimin; Tycol 2 complain of Left sided body
amp then 1 amp q6 weakness
TIV; catapres 75mg  BP-160/90 CR-84 RR-16
SL PRN; FElops 5mg T-39.9
OD  S/E by Dra. Magtoto orders
made & carried out
 Lab: Hgt, FBS, CT  On IVF of PNSS 1L + 2amp
scan Trivimin x 8 @ 31gtts/min
 Meds still
2pm-10pm  received from ER per
wheelchair with PNSS 1L + 2amp
Trivimin Full
 on ↑ back rest
 V/S taken & recorded
 Meds given
 For labs compliance
 Low salt & low fat diet
 For more care & management
10pm-6am  received on bed with an IVF
of PNSS 1L @ 450cc level
 2 amps Trivimin prescribed
 Still for lab compliance
 V/S taken & recorded:
BP-140/80 T-36.6
 Slept with interval
Nov.19.2007 6am-2pm  continue meds  received pt. on bed awake
12:45pm  CT scan  conscious & coherent
 BP-140/100  with ongoing IVF PNSS 1L +
2 amps Trivimin x 8hrs regulated @
30gtts/min
 V/S taken & recorded
 Carried out Doctor’s order
addendum
 S/E by Dra. San Jose with
new orders
 Needs attended
2pm-10pm  received patient awake lying

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4:00pm on bed
4:45pm  coherent & coherent
 with IVF of PNSS 1L + 2
amps Trivimin @ 100cc regulated @
31gtts/min
 on ↓ Salt & ↓ Fat diet
 V/S taken & recorded:
T-36.5 PR-81 RR-20 BP
-150/90
 Above IVF consume &
followed with PNSS 1L + 2 amps
Trivimin @ same rate
 Due meds given
 Still for urinalysis FSB, FBS,
Lipid profile, Crea, Na+, K+
 Advised to ↑ fiber intake
 Encouraged to verbalize
concern
 Watched out for internal
 Kept comfortable
 Needs attended
10pm-6am  on bed with same IVF on @
800 level
 afebrile
 meds prescribed
 LS & LF
 Oral
Nov.20.2007 6am-2pm  >Piracetam 400  Received lying on bed asleep
2caps BID, follow up  On going IVF of PNSS 1L +
10:20am official request of CT 2 amps of Trivimin reg @ 31gtts/min
scan; B-Complex @ 200cc level infusing well
 V/S taken & recorded:
 Above IVF & consumed
followed with PNSS 1L + 2 amps of
Trivimin reg @ 31gtts/min
 Needs attended
2pm-10pm  Received pt. lying on bed
with 1L + 2 amps Trivimin @
31gtts/min on & infusing well
V/S taken & recorded

 Conscious & coherent
 Health teachings instructed as
follows:
*Increase fluid intake
*Continuously assume active
Rom exercises
 Due meds given

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 Maintained low fat & low salt
diet
10pm-6am  On bed with same IVF going
on @150cc level
 Afebrile
 BP 150/90
 Conscious
 Coherent
 On LSLF
 PNSS + amp B-complex
Nov.21.2007 6am-2pm  Follow up  received pt. on bed with on
official CT scan IVF of PNSS 1L + 2 amps Trivimin
request @ 800cc level
11:05am  BP-120/90  on moderate high back rest
 Follow up  V/S taken & recorded:
blood chem. Referrals  Due meds given
 Continue meds  S/E by Dra.Alcantar with new
 Refer orders made & carried out
accordingly  On LSLF
 May give high  Referred FBS result to
sugar diet Dra.Ocampo with new orders made
& carried out
 Advised pt. to eat sweet foods
 Still for lab compliance
 Needs attended
2pm-10pm  Received pt. sitting on bed
with PNSS + 1L + 2 amp Trivimin x
8hrs regulated @ 31gtts/min @ 300cc
level
 Initial V/s taken & recorded:
 Health teachings as follows:
Due meds given *Advised to eat high
glucose foods
*Continuously assume active
ROM exercises
 On low Salt & low Fat diet
 Able t ambulate on the ward
 Encourage to turn side to side
q2
 Needs attended
 Still on lab compliance
 Endorsed

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I. ANATOMY AND PHYSIOLOGY
The back of the brain controls
vision.

The brain stem takes care of basic


body functions such as breathing,
blood flow, swallowing, and
consciousness.

The left side of the brain controls


the right side of the body. It also
handles language, reading, and
writing.

The right side of the brain controls


the left side of the body. The right
side also handles the ability to judge
distance, size, and one's own
abilities.

The front of the brain deals with reasoning and the ability to control emotions. Strokes
here may cause changes in personality.

Right-Brain Stroke
Be on the lookout for the following symptoms of a Right-brain stroke. If you have any
signs, call 911 right away!

• Left side paralysis or weakness and loss of sensation.


• Tendency to neglect or ignore the left side of the body or objects that are to the
left of the center of one's visual field.
• Visual loss or blurring on the left side of both eyes.
• Memory loss and confusion related to performing activities. (Experiences action
or gestures as "static.")
• Loss of spatial-perceptual skills such as judging distance, size, position, rate of
movement, form, and how parts relate to wholes.
• Tendency to be impulsive and a poor judge of one's own abilities and safety.
• Poor social skills, frequent mood changes, depression, and/or change in
personality.
• Problems with bowel and bladder control.
• Change in level of awareness.
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Left-Brain Stroke
Be on the lookout for the following symptoms of a Left-brain stroke. If you have any
signs, call 911 right away!

• Right side paralysis or weakness and loss of sensation.


• Tendency to neglect or ignore the left side of the body or objects that are to the
left of the center of one's visual field.
• Visual loss or blurring on the right side of both eyes.
• Memory loss and confusion related to performing activities. (Experiences action
or gestures as "static.")
• Problems with speech (loss or slurred), language, and swallowing (dysphagia).
Asphasia - difficulty with speaking and/or understanding. Dysarthria - difficulty
pronouncing words.
• Tendency to be impulsive and a poor judge of one's own abilities and safety.
• Poor social skills, frequent mood changes, depression, and/or change in
personality.
• Problems with bowel and bladder control.
• Change in level of awareness.

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II. PATHOPHYSIOLOGY
(Schematic Diagram)

ors
Predisposing Fact Precip
itating
Factor
s
Excessive
Alcohol
Age

Intake

Hypertension
Male

Atherosclerosis

Partial occlusion of cerebral blood


vessel

Partial occlusion of cerebral blood


vessel

↓ blood & O2 supply to brain cells

BRAIN ATTACK

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Left sided Numbness & Paresthesia

V. DRUG STUDY
Medication & Indication Drug Classification Nursing
Dosage & Consideration
Action

Felodipine To treat chronic Ca Channel Highly Protein


(Plendil) angina pectoris and Blockers bound (>95%).
5mg OD manage
hypertension. Reduces O2 demand Special Precautions:
by the heart. A Asthma, heart
potent peripheral failure, avoid abrupt
vasodilator thus interruption of
increasing heart rate chronic ß-Blockade.
and myocardial
contractility. Contra Indication:
Pregnancy, 2nd or 3rd
degree AV
block,sick sinus
syndrome,
noncompensated
heart failure,
cardiogenic shock.

Adverse Reactions:
Headache,
hypotension,
dizziness & flushing
of the skin.

Drug to drug
Interaction:
Concominant
administration of
substances which
interefere with the
cytochrome P-40
enzyme system may
affect plasma
concentration of
felodopine and
metoprolol

17
Drug Classification Nursing
Medication & Indication & Consideration
Dosage Action

Citicholine CVA in acute & Neurotonic Contra Indication:


(Tycol) recovery phase; Parasympathetic
2amps then + 1amps Signs & Symptoms hypertonia
q6 TIV of cerebral
insufficiency e.g. Dosage: Acute &
dizziness, memory recovery phase
loss, poor stroke & cerebral
concentration, trauma
disorientation, Inj:1-2amp/day
recent cranial
trauma & their
sequelae.

Medication & Indication Drug Classification Nursing


Dosage & Consideration
Action

Clonidine HCl For hypertension. Anti-hypertensive Special Precaution:


(Catapres) Treatment of any Diseases affecting
75mg etiology, except the rhythmic & AV
S.L. PRN pheochromocytoma conduction system
form. of the heart; Renal
failure.Impairement
of ability to drive or
operate
machinery.Sudden
discontinuance.

Contra Indication:
Sick sinus syndrome

Drug to drug
Interaction:
Enhanced anti-
hypertensive effects
by use of diuretics,
vasodilators & ß-
Blockers & cardiac
glycosides.
Reduction in BP-
18
lowering effect with
tricyclic
antidepressants.

Medication & Indication Drug Classification Nursing


Dosage & Consideration
Action

Piracetam 400mg Treatment of CVA Nootropic Special Precautions:


2 caps BID e.g sequelae of Renal insufficiency
stroke in particular, ( CLc1 <80ml/min),
aphasia. Post- underlying
traumatic haemostatic
syndromes disorders, severre
haemorrhage. Long
term treatment in
elderly abrupt
discontinuation in
myodinic pts.

Adverse Reactions:
Hyperkenisea, wt
gain, anemia,
nervousness,
agitation, irritability,
anxiety & sleep
disturbances.

Medication & Indication Drug Classification Nursing


Dosage & Consideration
Action

Vitamin B-complex Pheripheral neuritis, Water soluble Adverse Reactions:


(VitB1 thiamine, Dermatitis, cracked Vitamin Large doses causes
VitB2 riboflavin, corner of the mouth, GI irritation&
Vit3 niacin, VitB6 inflammation of vasodilation,
pyrodoxine) skin and tongue, resulting in flushing
BID Pellagra & sensation
hyperlipidemia

19
VI. NUSING CARE PLAN

20
21
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VII. Evaluation
A. Prognosis

The patient condition will gain left sided stability. He must also follow what the
physician ordered and prescribed so that, there will be continuity of care. The patient will
able to do his activities of daily living independently. He will be able to do his work and
have a sound sleep at home.

B. Discharge Planning/ Health Teachings

(M.E.T.H.O.D.S)
M-EDICATIONS

Instruct the patient about the medical treatments that are implemented and take home
medication that are prescribed by the physician. Tell him the medication schedule and if
possible, explain the action of each drug.

E-XERCISE

Instruct the patient to make a regular exercise with emphasis on his left sided to promote
stability ant prevent atrophy. Having a walk around for 30 minutes to promote blood
circulation, stretching then walking or jogging as tolerated are encouraged and are
acceptable.

T-REATMENT

o Explain that TB is a communicable disease and that taking medications is the


most effective way of preventing transmission.

o Instruct about hygiene measures, including mouth care, covering mouth and
nose when coughing and sneezing, proper disposal of tissue.
o Instruct about medications, schedule, and side effects
o Assess patient’s ability to continue therapy at home.

H-EALTH TEACHINGS

23
o Instruct the client to follow the drug regimen exactly as prescribed and always to
have a supply on hand.
o Discuss about the risk factors and of stroke prevention

Risk factors and prevention

Prevention of stroke can work at various levels including:

1. primary prevention - the reduction of risk factors across the board, by public
health measures such as reducing smoking and the other behaviors that increase
risk;
2. secondary prevention - actions taken to reduce the risk in those who already have
disease or risk factors that may have been identified through screening; and
3. tertiary prevention - actions taken to reduce the risk of complications (including
further strokes) in people who have already had a stroke.

The most important modifiable risk factors for stroke are hypertension, heart disease,
diabetes, and cigarette smoking. Other risks include heavy alcohol consumption, high
blood cholesterol levels, illicit drug use, and genetic or congenital conditions. Family
members may have a genetic tendency for stroke or share a lifestyle that contributes to
stroke. Higher levels of Von Willebrand factor are more common amongst people who
have had ischemic stroke for the first time. The results of this study found that the only
significant genetic factor was the person's blood type. Having had a stroke in the past
greatly increases one's risk of future strokes.

One of the most significant stroke risk factors is advanced age. 95% of strokes occur in
people age 45 and older, and two-thirds of strokes occur in those over the age of 65. A
person's risk of dying if he or she does have a stroke also increases with age. However,
stroke can occur at any age, including in fetuses.

Sickle cell anemia, which can cause blood cells to clump up and block blood vessels, also
increases stroke risk. Stroke is the second leading killer of people under 20 who suffer
from sickle-cell anemia.

Men are 1.25 times more likely to suffer strokes than women, yet 60% of deaths from
stroke occur in women.[21] Since women live longer, they are older on average when they
have their strokes and thus more often killed (NIMH 2002). Some risk factors for stroke
apply only to women. Primary among these are pregnancy, childbirth, menopause and the
treatment thereof (HRT). Stroke seems to run in some families.

Prevention is an important public health concern. Identification of patients with treatable


risk factors for stroke is paramount. Treatment of risk factors in patients who have
already had strokes (secondary prevention) is also very important as they are at high risk
of subsequent events compared with those who have never had a stroke. Medication or
drug therapy is the most common method of stroke prevention. Aspirin (usually at a low
dose of 75 mg) is recommended for the primary and secondary prevention of stroke. Also
see Antiplatelet drug treatment. Treating hypertension, diabetes mellitus, smoking
cessation, control of hypercholesterolemia, physical exercise, and avoidance of illicit

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drugs and excessive alcohol consumption are all recommended ways of reducing the risk
of stroke.

In patients who have strokes due to abnormalities of the heart, such as atrial fibrillation,
anticoagulation with medications such as warfarin is often necessary for stroke
prevention.

Procedures such as carotid endarterectomy or carotid angioplasty can be used to remove


significant atherosclerotic narrowing (stenosis) of the carotid artery, which supplies blood
to the brain. These procedures have been shown to prevent stroke in certain patients,
especially where carotid stenosis leads to ischemic events such as transient ischemic
attack. (The value and role of carotid artery ultrasound scanning in screening has yet to
be established.)

O-UT-PATIENT FOLLOW UP/ CHECK UP

After discharge in the hospital refer patient to the nearest health center for BP check-ups
and consultation if any signs and symptoms of stroke occur. Patient was also advised to
slowly lessen alcohol intake and better stop it. It is important that patient should comply
with annual general check up to determine to have a baseline of his health state and if the
patient is recovering well.

D-IET

Advise the patient to eat low salty and low fatty foods.

S-PIRITUAL PRACTICES

o This stage is very crucial for the patient’s feeling and faith regarding our Lord.
So, this is the time where his faith is tested. So, it is the time to encourage the
patient to go to mass on Sunday, so he will be guided from the words of Gospel.
o Personal prayer is also advice because in his condition, for he was not able to go
to church.

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