Drugs (2 marks)

Trade name Generic name Dose Indication Classification

Acetylsalicylic acid 100 mg *1 Aspirin blocks the Platelet inhibitor
Aspirin effects of
cyclooxygenase-1
(COX-1) and COX-2
enzymes which
prevents the
synthesis of
prostaglandins
lolip Atrovastatin 40 mg *1 Inhibitor of 3- antihypercholesterolemia
hydroxy-3-
methylglutaryl
coenzyme A (HMG-
CoA) reductase, the
rate-limiting enzyme
in cholesterol
synthesis
Randine  ranitidine 50 mg * 3 Competitive
inhibition of antiacid
histamine at H2-
receptors of the
gastric parietal cells,
which inhibits
gastric acid
Case oral exam 1 hamdallah
 secretion, gastric
volume, and
hydrogen ion
concentration are
reduced.
plavix clopidogrel 75 mg * 1 Inhibit platelet Platelet inhibitor
aggregation by
blocking APP receptor
on platelet

Significant diagnostic evaluation: (1.5 marks)

Test Normal values Patient result rational

WBC 4.0-10.9 10*3/ML 12.9 10*3/ml High,
RBC 3.76-5.70 10*6/ML 2.56 10*6/ml Low, B/f anemia
HGB 12-17.5 G/dl 7.7 g/dl Low, B/f low of RBC
HCT 33.5-51.% 22.6 % Low,B/f low of RBC
PT 11-15 sec 14.5 sec With normal rang
INR 1.23 High, B/f ischemic stroke
PTT 25-35 sec 35 sec Within normal rang
ESR (0-15 mm) 65 mm High
glucose (74-109) mg/dl 189 High, patient diabetic
Na+ 135-145 meq/l 133 Within normal rang
K+ 2.5-3.5 meq/l 4.5 High , renal disease
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 creatinine 0.7-1.2 11.51 High , renal disease

Pathophysiology: (1.5 marks)

Ischemic Occlusion of a blood vessel from thrombus, embolism, or conditions that produce low systemic
perfusion pressure Cerebral thrombosis is a formation or developing clot within the cerebral arteries or their
branches. Thrombi can lead to ischemia or occlusion of an artery which could result in a cerebral infarctions or
tissue death

Nursing care (5 marks)

Nursing diagnosis:
1.Impaired physical mobility related to hemiparesis, loss of balance and coordination,
spasticity, and brain injury.

2.Impaired verbal communication related to brain damage.

Nursing interventions:

 Positioning. Position to prevent contractures, relieve pressure, attain good body alignment, and prevent compressive neuropathies.
 Prevent flexion. Apply splint at night to prevent flexion of the affected extremity.
 Prevent adduction. Prevent adduction of the affected shoulder with a pillow placed in the axilla.
 Prevent edema. Elevate affected arm to prevent edema and fibrosis.

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  Full range of motion. Provide full range of motion four or five times a day to maintain joint mobility.
 Prevent venous stasis. Exercise is helpful in preventing venous stasis, which may predispose the patient to thrombosis and
pulmonary embolus.
 Personal hygiene. Encourage personal hygiene activities as soon as the patient can sit up.
 Manage sensory difficulties. Approach patient with a decreased field of vision on the side where visual perception is intact.
 Visit a speech therapist. Consult with a speech therapist to evaluate gag reflexes and assist in teaching alternate swallowing
techniques.
 Voiding pattern. Analyze voiding pattern and offer urinal or bedpan on patient’s voiding schedule.
 Assess skin. Frequently assess skin for signs of breakdown, with emphasis on bony areas and dependent body parts.

Confirmed diagnosis: ischemic stroke

Age : 68 year
Gender : female

Assessment (5marks)
1- Reason for hospitalization (chief complaint):
Left side weakness, Dizziness, fatigue, loss of consciousness

2- History:
 Signs and symptoms: (OPQRST)
: weakness, fatigue, slurred speech, severe headache from increased intracranial pressure
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  Risk factors:
Diabetes mellitus, hyperlipidemia, and hypertension
 Past medical history:
: Diabetic since 2005, Hypertension since 2008
 Past surgical history:
Free surgical history

Case oral exam 5 hamdallah