CEREBRO VASCULAR

ACCIDENT

CARDIOEMBOLIC STROKE

I.
A

INTRODUCTION

stroke is the death of brain tissue that occurs when the brain does not get enough blood and oxygen. A stroke from cardiogenic embolism occurs when blood clots travel from the heart to an artery supplying the brain.

WHAT IS GOING ON IN THE BODY?

a blood clot is formed in the heart Travels through the bloodstream to block one of the arteries supplying the brain

Then cause swelling in the brain

The brain cells then die from lack of oxygen

Can damage the brain tissue

WHAT ARE THE CAUSES AND RISKS OF THE CONDITION?

Atrial

Fibrillation severe congestive heart failure

Nonmodifiable Factors

Welldocumented Modifiable Factors

high blood pressure Smoking diabetes\ asymptomatic carotid stenosis, or narrowing of one of the arteries in the neck sickle cell anemia high cholesterol levels in the blood, including total cholesterol and LDL/HDL atrial fibrillation

Potentially Modifiable Factors

Obesity sedentary lifestyle alcohol abuse high blood levels of homocysteine drug abuse blood disorders hormone replacement therapy(HRT use of birth control pills, or oral contraceptives inflammatory processes

Increasing age- > 55 y/o Race- blacks and Hispanics Gender- men have more chance Family historystroke or TIA

WHAT ARE THE SIGNS AND SYMPTOMS OF THE CONDITION?

Problems with movement, such as weakness, clumsiness, or paralysis headache numbness or a lack of feeling speech impairments inability to recognize family members or common objects

Dementia visual impairment hearing impairment personality changes difficulty swallowing balance problems coma The inability to breathe on one's own

HOW IS THE CONDITION DIAGNOSED?

Cranial

MRIs Cranial CT scans - shows the type, size, and location of the stroke. Echocardiogram - uses ultrasound waves to visualize the heart as it is beating. Blood clots in the heart can often be seen using this test.

II. ASSESSMENT

Pt's Profile Name: Patient M Sex: Female Age: 87 y/o Status: Widowed Religion: Jehovas Witness

PRESENT HEALTH HISTORY

5
  

days PTC the patient was noted for:

sudden weakness loss of gait vomiting of previously ingested food for 3 episodes loss of appetite

days PTC the patient experienced:  progression of weakness  slurring of speech  oliguria  intermittent dementia
2

Last September 26, 2011 at 4:00pm she was admiited at Malipayon District Hospital with a diagnosis of Cerebrovascular

Accident Problem; Cardioembolic Stroke

PAST HEALTH HISTORY

gum

bleeding acute gastritis

FAMILY HEALTH HISTORY

The

patient has family health history of hypertension on her mothers side. Diabetes Mellitus on fathers side

LABORATORY FINDINGS
RBS- 9.16 mmol-09/27/11 10.7 mmol-10/03/11 12 L ECG  absent P wave  Irregular rhythm  Rate <159 bpm  Narrow QRS  Multiatrial contraction  Preventricular contraction

PHYSICAL ASSESSMENT
SKIN: (+) pallor Cold clammy skin Dry skin Dry oral skin HEAD-EENT: No facial asymmetry Pale palpebral conjunctiva Anicteric sclera CHEST Lungs: (-) retraction Cardiovascular: irregular rhythm

PHYSICAL ASSESSMENT
ABDOMEN: (+) distended abdomen hypogastric area MUSCULOSKELETAL: MMT Right U.E. 3/5 5/5 L.E. 4/5 5/5 NEUROLOGICAL: Responsive to noxious stimulation Localize stimuli Confused conversation GCS of 11 upon admission

Left

REVIEW OF SYSTEM

CIRCULATION OF BLOOD IN THE HEART

WELL-DOCUMENTED

NONMODIFIABLE Age: 87 y/o Family Hx of stroke

LESS WELL-DOCUMENTED

Sedentary lifestyle exercise high salt high fat

HPN DM ECG result Absent P wave Irregular rhythm Narrow QRS Multi atrial contraction PVCs

Formation of atherosclerosis

Irregular conduction of impulses

Narrowing of Blood Vessels

Irregular, disorganized, chaotic, and very rapid contraction of atria

Dislodges of the atherosclerosis Blood tends to form clots

Travel/flow to circulation

Block the blood vessels at Circle of Willis on Left part

Insufficient blood supply to left part of brain

Progressive weakness Loss of gait

Slurring of speech Responsive to stimuli

Vomiting of previously injested food

DRUG STUDY

NURSING CARE PLAN

DISCHARGE PLANNING
M Medication Advise patient to take home medication following right drug, frequency, dosage and timing as prescribed by the physician such as follows: 1. Omeprazole 20mg/tab, 1 tab after breakfast and before bedtime for 1 week 2. Al Mg (OH)2 suspension 30ml every 6 hours for 1 week

3. 4. 5. 6. 7. 8.

Verapamil 40mg/tab, 1 tab every 12 hours after breakfast and dinner Clopidogrel 75mg/tab, 1 tab once a day after lunch Gliclazide 80mg/tab, tab after breakfast and dinner Bisacodyl suppository, 1 supp before bedtime Apply petroleum jelly over buttocks Mupuricin cream, 3x a day over affected area for 5 days

Encourage patient to follow drug regimen especially maintenance medications

E Environment
Instruct

patient to stay in calm, quiet environment. Home environment must be free from slipping or accident hazards. Instruct SO to provide patient with well ventilated room so that patient can rest well. Advice the SO to stay with the patient always.

T Treatment -Inform patient to come back once

laboratory results available. - inform that the removal and replacement of Foley catheter is after 5 days

H Health Teachings
Encourage

client to engage to range of motion

exercises. Advise patient to increase adequate fluid intake for hydration purposes Encourage patient not to participate in strenuous activities Encourage SO to turn the patient side to side in a regular schedule of time for atleast every 2 hours Promote rest periods among the client Advise SO to position first the patient on MHBR position before offering meals to avoid aspiration Encourage SO to offer small frequent meals to patient

O Observable Signs and Symptoms

D Diet

client to increase intake of potassium - Instruct to increase fluid intake - Instruct to increase intake of nutritious foods rich in Vitamin C such as fruits and vegetables to boost ones immune system. - Emphasize on low salt low fat diet
Encourage

S- Spirituality
Advise

patient to keep believing on Gods holy will so that she could be spiritually motivated. SO to constantly participated patient on religious activities so that his faith could be more strengthened.

Tell