I.

INTRODUCTION
A cerebrovascular accident is the medical term for a stroke. A stroke is when
blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood
vessel. There are important signs of a stroke that you should be aware of and watch out
for. A left-side stroke happens when the blood supply to the left side of the brain is
interrupted. Without oxygen and nutrients from blood, the brain tissue quickly dies. The
cerebrum is the largest part of the brain. It is made of a left and a right hemisphere. In
most people, the left hemisphere is in charge of the functions on the right-side of the
body. It is also involved in abilities such as the ability to speak, or use language. There
are two main types of stroke: ischemic and hemorrhagic.

Hemorrhagic stroke accounts for about 13 percent of stroke cases. It results from
a weakened vessel that ruptures and bleeds into the surrounding brain. The blood
accumulates and compresses the surrounding brain tissue. The two types of
hemorrhagic strokes are intracerebral (within the brain) hemorrhage or subarachnoid
hemorrhage.

Globally, measurements undertaken by the WHO revealed an up to ten-fold

difference in age-adjusted and sex-adjusted mortality rates and burden (measured in
disability-adjusted life year loss rates (DALYs)) among countries. Both were
considerably higher in low-income countries (North Asia, Eastern Europe, Central
Africa, and South Pacific) compared to high-income countries (Western Europe, North
America). 795,000 new or recurrent strokes occur per year in the US, accounting for
approximately 1 in 18 deaths. In Europe, the incidence of stroke varies from 101.1 to
1

239.3 per 100,000 in men and 63.0 to 158.7 per 100,000 in women. Within 5 years of a
stroke, over half of patients aged 45 years will die: 52% of men and 56% of women.
Stroke is the second leading cause of death above the age of 60 years, and the
fifth leading cause of death in people aged 15 to 59 years old. Every year, 15 million
people worldwide suffer a stroke. Nearly six million die and another five million are left
permanently disabled. Stroke is the second leading cause of disability, after dementia.
Disability may include loss of vision and / or speech, paralysis and confusion. Stroke is
less common in people under 40 years, although it does happen. In young people the
most common causes are high blood pressure or sickle cell disease. In many developed
countries the incidence of stroke is declining even though the actual number of strokes
is increasing because of the ageing population. In the developing world, however, the
incidence of stroke is increasing. In China, 1.3 million people have a stroke each year
and 75% live with varying degrees of disability as a result of stroke. The predictions for
the next two decades suggest a tripling in stroke mortality in Latin America, the Middle
East, and sub-Saharan Africa.
Nationally, according to the latest WHO data published in April 2011 Stroke
Deaths in Philippines reached 40,245 or 9.55% of total deaths. The age adjusted Death
Rate is 82.77 per 100,000 of population ranks Philippines #106 in the world.
Locally, there are no records of incidence of stroke published online for Davao
Del Norte. However, in Davao City, Councilor Rene Elias Lopez said stroke is now the
top cause of morbidity in the city, with 1,800 people dying from the disease in 2008.

OBJECTIVES
The objective of the study is to present all the information we have gathered
about the case of our patient who has an admitting diagnosis of T/C Cerebrovascular
accident; CAP-MR. This study intends to help develop our Leadership and Management
skills that are beneficial in dealing with patients who have this condition. It also aims to
enhance the nursing skills that weve learned to even become better in providing
excellent care to patients with the said condition and even all other health conditions.
Moreover, it will help to broaden our knowledge regarding nursing research on how to
perform extensive and massive research to acquire relevant information about the case.
Furthermore, this aims to share the knowledge based on information gathered to the
patient, the significant others and to our fellow nursing students.
Specifically, this study intends to:

Obtain sufficient and relevant information regarding our patients condition.

Present personal data of our patient.

Trace the past medical history affecting the patients present health condition.

Present factual information by conducting a thorough head-to-toe assessment

with our chosen subject serving as our baseline data.

Show and discuss the anatomy and physiology of the involved organ and system
basing from our patients diagnosis.

List down the actual laboratory results of our patient.

Present the medical interventions done to the patient including the different drugs
ordered with their action in alleviating the underlying causes of present condition.

Identify the needs of the patient and formulate effective nursing care plans
appropriate for the patients case.

Impart suitable and realistic health teachings to the patient himself and to his
significant others (watcher).

Evaluate the outcome of the condition of the patient.

II. ASSESSMENT
A. Biographical Data
Name: Patient Kowowo
Age: 65 years old
Birthdate: July 10, 1949
Birthplace: Bohol
Sex: Male
Status: Married
Address:Purok 02A, Magdum, Tagum City
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: December 7, 2014
Time admitted: 6:25 pm
Attending Physician: Dr. Kintanar
B. Chief Complaint
Right Sided Weakness
C. History of present illness
Patient Kowowo was admitted on December 7, 2014 at Bishop Joseph
Regan Memorial Hospital. Few minutesPTA,had sudden onset of Right Sided
Weakness associated with Chest pain, (+) cough.

D. Past Medical History

It is the first time for the patient to be admitted due to cerebrovascular
accident. He was not able to experience any major diseases that could lead him in
hospitalization.
E. Personal, Family and Socio-Economic History
Patient Kowowo belongs to the middle class family. He currently a
pensioner.
F. Patient Need Assessment
Date: December 9,2014
Name of patient: Patient Kowowo
Age: 65 years old

Sex: M

Status: Married

Date/ Admission Time: December 7, 2014/ 6:25 PM

Arrived on Unit by: Stretcher From: Emergency Room
Admitting weight/VS: Weight:70kg .Temp: 35.7 C BP: 260/130 mmHg
RR: 22cpm PR:88bpm
Clients Reason for Admission: Nikalitrapagnaogniyasa motor namuragnawadan naogkusogogdilinakalihokang right side saiyanglawas as verbalized by the
watcher.
How was problem been managed by client at home? Patient was immediately
brought to the hospital.
Allergies: No known allergies
Medication (at home): No medications at home

Physiologic Needs
I.

Oxygenation: BP = 140/100 mmHg; PR = 85bpm; RR = 20cpm (regular

respiration).
Lungs (per auscultation: sound, character, chest pain): With symmetrical
chest expansion upon inhalation and distress not noted upon assessment.
With crackles heard upon lung auscultation.
Cardiac Status (per auscultation: sound, character, chest pain): With
normal cardiac sound of Lubbdubb heard upon auscultation and no
complains of chest pain upon assessment.
Capillary Refill: With capillary refill of 2 seconds upon blanching.
Skin Character and Color: Brownish skin complexion, warm to touch. With
good skin turgor.
Life Supporting Apparatus: With O2inhalation @ 2LPM via nasal cannula.
With IVF #2 PNSS 1L @ KVO rate infusing well @ L metacarpal vein.
Other Observations: No other observations

II.

Temperature Maintenance
Temperature: 37.1o C
Skin Character: Brownish, warm to touch and with good skin turgor.

III.

Nutritional Fluid
Height: 57
Weight: 70 kg.
Amount of Food Consumed: Able to consume meal served.
Prescribed diet: DAT

Eating pattern: 3x a day

Eating problems: Needs assistance and aspiration precaution should be
considered.
IVF/Fluid Intake: IVF- 200cc, Water 300 cc
IV.

Elimination
Last bowel movement: Unable to defecate within the shift.
Normal pattern: once a day
Urination: Able to urinate 400 cc, yellow in color, within the shift.
Other observations: With Foley catheter attached to urobag

V.

Rest and Sleep

Bed time: 7:00 P.M

Waking up: 8:00 A.M

Sleep (pattern, amount of sleep): Able to sleep at long intervals and only
wakes up to attend needs.
VI.

Pain Avoidance
Rate of pain (using scale 0-10): No complains of pain upon assessment.
Character: N/A
Location: N/A
Frequency:N/A
Duration: N/A
Behavior: N/A
Other Observations: None

VII.

Stimulation/ Activity
Work: He was once a laborer in a Banana Plantation before and is
currently retired, a pensioner.
Recreation or past time: Hes doing household chores.
Hobbies or vices: Stopped smoking several years from now but is still and
alcoholic drinker.

VIII.

Safety Security needs

Neuro VS: score of 15 out of 15
Mental status: Conscious; Slurred speech.
Emotional Problems: None
Other objective cues: R hand grip and R leg movement is absent

IX.

Love and belonging

He feels very secure and happy living with his wife, they were gifted with
four loving children. He feels grateful toward his familys loving and caring
support, especially in terms of his current condition.

X.

Self- esteem
The client has a low self-esteem at presentbecause of his current
condition that would really limit or make him unable to perform ADL and
total assistance of significant others is highly needed.

XI.

Self-actualization
The client was able to raise their four children successfully with the help of
his loving wife. He was successful in his previous job as hes now
receiving his pension every month. However, the client has no limit in

eating foods and is continuously drinking alcoholic beverages that

aggravated his current condition.

Ericksons Developmental Task

Erickson envisions life as a sequence of levels of achievement. Each stage
signals a task that must be achieved. The resolution of the task can be complete,
partial, or unsuccessful. Erickson believes that the greater the task achievement, the
healthier the personality of the person: failure to achieve a task influences the persons
ability to achieve the next task. These developmental tasks can be viewed as a series of
crises, and successful resolution of these crises is supportive to the persons ego.
Failure to resolve the crises is damaging the ego.

Generativity vs. Stagnation

Patient Kowowo, 65 years old, falls under the Mid Adulthood from 35-65 years
old which has the central task of Generativity versus Stagnation. This stages major task
is creativity, productivity and concern for others. Self-indulgence, self-concern, lack of
interests and commitments are the indicators of negative resolution. In the case of our
patient, Patient Kowowo, he attained the Generativity for he was able to achieve and
realize the major task successfully by showing concern to his family especially to his
wife and children despite of the condition he has. He always thinks of whats best for his
family, willing to give the excellent care and love that he can.

10

PHYSICAL ASSESSMENT
General Survey
Patient Kowowo, 65 years old, male, stands 5 feet and 7 inches tall and weighs
70kg. With the following VS as monitored and recorded upon admission Temp = 35.7o
C; BP= 260/130 mmHg; PR = 88 bpm; RR = 22cpm. With IVF bottle # 1 PNSS 1L @
KVO rate infusing well. He is conscious and his words were hard to understand due to
slurred speech.
Vital Signs Monitoring Sheet
Name: Patient Kowowo

Sex: M

Ward: St. Francis

Room/Bed: 405-2

Date/Shift

Time

Temperature

12/07/2014

6:25 PM

35.7

Age: 65 Y.O

Blood

Respiratory

Pressure

Rate

260/130

22

88

Cardiac Rate

311
6:30 PM

12/08/2014

180/100

8:00 PM

39.3

180/190

21

87

12:00 AM

36.8

200/140

22

96

200/110

25

98

180/100

28

96

150/80

25

97

117
1:00 AM
2:00 AM

36.7

2:30 AM
3:00 AM

36

150/100

25

98

4:00 AM

37

150/80

24

86

11

12/08/2014

8:00 AM

37

150/100

20

90

19

89

73
10:00 AM
12:00 NN

140/90
37.1

1:00 PM
12/08/2014

150/100
170/100

4:00 PM

37.3

140/90

21

86

6:00 PM

37.4

150/90

21

87

8:00 PM

36.5

150/90

22

83

12:00 MN

36.7

150/90

22

88

4:00 AM

37.1

160/100

22

80

180/90

22

89

311

12/09/2014
117

6:00 AM
12/09/2014

8:00 AM

36.8

150/80

20

86

10:00 AM

36.6

180/100

21

84

12:00 NN

37.1

140/100

20

85

2:00 PM

37.3

190/90

20

81

4:00 PM

37

160/90

22

76

8:00 PM

37.4

160/80

20

75

12:00 MN

37

180/100

20

76

4:00 AM

37

160/90

20

78

8:00 AM

36.9

160/100

21

90

73

12/09/2014
311

12/10/2014
117

12/10/2014
73

12

10:00 AM

36.8

170/100

20

91

12:00 NN

37.2

130/100

20

88

2:00 PM

37.1

160/90

21

89

REVIEW OF SYSTEMS
Integumentary System
Generally, patient Matabahas brownish skin that is warm to touch, with the presence of
hair, with good skin turgor and capillary refill of 2 seconds.
HEENT
HEAD

Head is normocephalic, can lift head fully and turn them from side to side. Hair is
short, thick and evenly distributed. No dandruff, head and scalp lesions not
noted.

EYES

Eyes are symmetrical and black in color; No eye discharges noted. The pupil is
brisk and constricted at 2mm when diverted to light and dilated when the patient
looks into the distance; Pale and palpebral conjunctivae not noted, with white and
anicteric sclera. Eyelashes are equally distributed.

EARS
13

Both symmetrical; with no discharges noted within both ears. There were no
lesions, wounds or discoloration noted upon inspection, and there were no
problems in hearing.

NECK

Short and mobile. Able to perform the different neck ROM exercises or
maneuvers. No tracheal deviations felt upon placing a finger along one side of
the trachea, noting the space and comparing with the opposite side. No swollen
lymph nodes upon palpation.

THROAT

Gums are in good condition. Tongue midline and mobile with visible papillae.
Tonsils are not inflamed. Pinkish hard and soft palate. Gag reflex is present.

Pulmonary System

With crackles heard upon auscultation; regular breathing pattern and symmetrical
chest expansion. Theres an equal rise and fall of the chest with normal depth of
respiration.

Cardiovascular System

Normal lubbdubb heard upon auscultation and apical pulse heard per
auscultation. No heaves and thrills heard. No murmurs, regular cardiac rate and
rhythm heard upon auscultation.

14

Gastrointestinal System

Abdomen is distended, and has the same color as the rest of the body. 5-15

clicks per minute heard upon auscultation.

Musculoskeletal System

Unable to perform ADL alone and assistance is really needed. Right Hand grip

and Right Leg movement is absent.

Genito-urinary System

Was able to urinate 400 cc, yellow in color. With Foley catheter attached to
urobag.

15

III. LABORATORY AND DIAGNOSTIC EXAMINATION

HEMATOLOGY
Date: 12/07/2014
LABORATORY

RESULT

EXAMINATIONS/

NORMAL

UNIT

IMPLICATION

g/L

Normal

VALUE

DETERMINATION
Hemoglobin

137

134.00160.00

Hematocrit

0.41

0.40-0.54

Leukocytes No. of

8.9

5-10x10^9

0.32

0.40-0.60

Normal
L

Normal

Concen.
Segmenters

Low. It may indicate Viral

infections; autoimmune
diseases.

Lymphocytes

0.52

0.25-0.40

High. It may indicate Acute

infection.

Monocytes

0.08

0.01-0.12

Normal

Eosinophils

0.06

0.01-0.05

High. It may indicate Allergy;

asthma; parasitic infections.

Basophils

0.005

Stabs

0.01-0.05

Thrombocytes

333.5

150-

Normal

440x10^9
Blood type

16

Rh type

URINALYSIS
Date: 12/08/2014
LABORATORY

RESULT

NORMAL VALUE

UNIT

IMPLICATION

Light

Light yellow to a dark -

yellow

amber color

Sugar

negative

0 to trace amounts.

Normal

Albumin

negative

Negative

Normal

Reaction

5.0

4.5 - 7.2

Normal

Sp gravity

1.020

1.005 to 1.025

Normal

Crystlas

Few

Casts

Negative

Epithellial cells

few

Normal

Mucous threads

Pus cells

3-6

0-2

Hpf

Abnormal: Infection

Rbc

0-2

0-2

Normal

Bacteria

Negative

Pus in clumps

Negative

hpf

EXAMINATIONS/
DETERMINATION
Color

Normal

17

CT CRANIAL
Date: 12/08/2014
This report is based on radiographic findings and should be correlated with clinical and
laboratory data and other imaging modality.
Multiple plain axial tomographic sections of the head were taken and reveal the
following findings:
There is an irregular intraparenchymalhyperdensity focus in the left capsule-thalamic
area, extending up to the corona radiate with an approximate volume of 12.0 cc.
Surrounding hypodense edema noted. Hyperdense bleed extensions into the ventricular
system (lateral and 3rd ventricles). There is slight midline shift to the right with a distance
of 0.5cm from midline. No other abnormal density changes in the brainstem nor brain
parenchyma.
The ventricles, cortical sulci, tissues and cisterns are prominent.
The sella, orbits, petromastoids and the paranasal sinuses are not unusual.
Physiologic calcifications are seen in the pineal gland and basal ganglia.
No other significant findings.
IMPRESSION:
Acute bleed (12.0cc) in the left capsulo-thalamic areas with parenchymal and
intraventricular bleed extensions, edema and slight mass effect as described.
Cerebral atrophy, age related.

18

CHEST PA
Date: 12/08/2014
Hazy densities are seen in both areas.
The heart is enlarged with left ventricular prominence. Aortic knob is calcified
Hemidiaphragm and costophrenic sulci are intact.
Minimal spurrings are seen in the lateral edges of the thoracic spines.
No other significant interval chest findings
IMPRESSION:
Compatible with bibasal pneumonia.
Left ventricular cardiomegaly with atherosclerotic aorta.
Minimal hypertrophic degenerative spurs, thoracic spines.

19

ECG
Ecg no. 5285

A.R.: 75/min

Rhythm: Sinus

V.R.: 75/min

P.R.: .16sec.

Q.T.: .32sec.

Q.R.S.: .08sec.

QRS Axis: +15o

Impression:
Nonspecific ST segment. R/O myocardial ischemia

20

IV. REVIEW OF ANATOMY AND PHYSIOLOGY

NERVOUS SYSTEM

21

The brain is a spongy organ made up of nerve and supportive tissues. It is

located in the head and is protected by a bony covering called the skull. The base, or
lower part, of the brain is connected to the spinal cord. Together, the brain and spinal
cord are known as the central nervous system (CNS). The spinal cord contains nerves
that send information to and from the brain.

The CNS works with the peripheral nervous system (PNS). The PNS is made up
of nerves that branch out from the spinal cord to relay messages from the brain to
different parts of the body. Together, the CNS and PNS allow a person to walk, talk, and
throw a ball and so on.

The brain is the bodys control centre. It constantly receives and interprets nerve
signals from the body and responds based on this information. Different parts of the
brain control movement, speech, emotions, consciousness and internal body functions,
such as heart rate, breathing and body temperature.

The brain has 3 main parts: cerebrum, cerebellum and brain stem.

Cerebrum
The cerebrum is the largest part of the brain. It is divided into 2 parts (halves)
called the left and right cerebral hemispheres. The 2 hemispheres are connected by a
bridge of nerve fibres called the corpus callosum.

22

The right half of the cerebrum (right hemisphere) controls the left side of the
body. The left half of the cerebrum (left hemisphere) controls the right side of the body.

The outer surface of the cerebrum is called the cerebral cortex or grey matter. It
is the area of the brain where nerve cells make connections, called synapses, that
control brain activity. The inner area of the cerebrum contains the insulated (myelinated)
bodies of the nerve cells (axons) that relay information between the brain and spinal
cord. This inner area is called the white matter because the insulation around the axons
gives it a whitish appearance.

The cerebrum is further divided into 4 sections called lobes. These include the
frontal (front), parietal (top), temporal (side) and occipital (back) lobes.

Each lobe has different functions:

The frontal lobe controls movement, speech, behaviour, memory, emotions and
intellectual functioning, such as thought processes, reasoning, problem solving,
decision making and planning.

The parietal lobe controls sensations, such as touch, pressure, pain and temperature. It
also controls spatial orientation (understanding of size, shape and direction).

The temporal lobe controls hearing, memory and emotions. The left temporal lobe also
controls speech.

The occipital lobe controls vision.

23

Cerebellum
The cerebellum is the next largest part of the brain. It is located under the
cerebrum at the back of the brain. It is divided into 2 parts or hemispheres and has grey
and white matter, much like the cerebrum.

The cerebellum is responsible for:

movement

posture

balance

reflexes

complex actions (walking, talking)

collecting sensory information from the body

Brain stem
The brain stem is a bundle of nerve tissue at the base of the brain. It connects
the cerebrum to the spinal cord and sends messages between different parts of the
body and the brain.

The brain stem has 3 areas:

midbrain

pons

medulla oblongata
The brain stem controls:

breathing

24

body temperature

blood pressure

heart rate

hunger and thirst

Cranial nerves emerge from the brainstem. These nerves control facial
sensation, eye movement, hearing, swallowing, taste and speech.

Other important parts of the brain

Cerebrospinal fluid (CSF)

The cerebrospinal fluid (CSF) is a clear, watery liquid that surrounds, cushions
and protects the brain and spinal cord. The CSF also carries nutrients from the blood to,
and removes waste products from, the brain. It circulates through chambers called
ventricles and over the surface of the brain and spinal cord. The brain controls the level
of CSF in the body.
Meninges
The brain and spinal cord are covered and protected by 3 thin layers of tissue
(membranes) called the meninges:

dura mater thickest outer layer

arachnoid layer middle, thin membrane

pia mater inner, thin membrane

25

CSF flows in the space between the arachnoid layer and the pia mater. This
space is called the subarachnoid space.

The tentorium is a flap made of a fold in the meninges. It separates the cerebrum
from the cerebellum.

The supratentorial area of the brain is the area above the tentorium. It contains the
cerebrum, the first and second (lateral) ventricles, the third ventricle, and glands and
structures in the centre of the brain.

The infratentorial area is located at the back of the brain below the tentorium. It contains
the cerebellum and brain stem. This area is also called the posterior fossa.

Corpus callosum
The corpus callosum is a bundle of nerve fibres between the 2 cerebral
hemispheres. It connects and allows communication between both hemispheres.
Thalamus
The thalamus is a structure in the middle of the brain that has 2 lobes or
sections. It acts as a relay station for almost all information that comes and goes
between the brain and the rest of the nervous system in the body.
Hypothalamus
The hypothalamus is a small structure in the middle of the brain below the
thalamus. It plays a part in controlling body temperature, hormone secretion, blood
pressure, emotions, appetite, and sleep patterns.

26

Pituitary gland
The pituitary gland is a small, pea-sized organ in the centre of the brain. It is
attached to the hypothalamus and makes a number of different hormones that affect
other glands of the bodys endocrine system. It receives messages from the
hypothalamus and releases hormones that control the thyroid and adrenal gland, as
well as growth and physical and sexual development.
Ventricles
The ventricles are fluid-filled spaces (cavities) within the brain. There are 4
ventricles:

The first and second ventricles are in the cerebral hemispheres. They are called lateral
ventricles.

The third ventricle is in the centre of the brain, surrounded by the thalamus and
hypothalamus.

The fourth ventricle is at the back of the brain between the brain stem and the
cerebellum.
The ventricles are connected to each other by a series of tubes. The fluid in the
ventricles is cerebrospinal fluid (CSF). The CSF flows through the ventricles, around the
brain in the space between the layers of the meninges (subarachnoid space) and down
the spinal cord.
Pineal gland
The pineal gland is a very small gland in the third ventricle of the brain. It
produces the hormone melatonin, which influences sleeping and waking patterns and
sexual development.
Choroid plexus
27

The choroid plexus is a small organ in the ventricles that makes CSF.
Cranial nerves
There are 12 pairs of cranial nerves that perform specific functions in the head
and neck area. The first pair starts in the cerebrum, while the other 11 pairs start in the
brain stem. Cranial nerves are indicated by number (Roman numeral) or name.
Types of cells in the brain
The brain is made up of neurons and glial cells:

neurons

These cells carry the signals that make the nervous system work.

They cannot be replaced or repaired if they are damaged.

glial cells (neuroglial cells)

These cells support, feed and protect the neurons.

The different types of glial cells are:

astrocytes

oligodendrocytes

ependymal cells

microglial cells

Structure and function of the spine

The spine is made up of:

vertebrae, sacrum and coccyx bony sections that house and protect the spinal
cord (commonly called the spine)

The vertebral body is the biggest part of a vertebra. It is the front part of the vertebra,
which means it faces into the body.

28

spinal cord a column of nerves inside the protective vertebrae that runs from the
brain to the bottom of the spine

disc a layer of cartilage between each vertebra that cushions and protects the
vertebrae and spinal cord

The spine is divided into 5 sections:

cervical the vertebrae from the base of the skull to the lowest part of the neck

thoracic the vertebrae from the shoulders to mid-back

lumbar the vertebrae from mid-back to the hips

sacrum the vertebrae at the base of the spine

The vertebrae in this section are fused and do not flex.

coccyx the tail bone at the end of the spine

The vertebrae in this section are fused and do not flex.

Spinal nerves
The spine relays messages between the body and the brain. These nerve
messages control body functions like movement, bladder and bowel control and
breathing. Each vertebra has a pair of spinal nerves that receive messages from the
body (sensory impulses) and send messages to the body (motor impulses). The spinal
nerves are numbered from the cervical spine to the sacral spine.

29

Stroke occurs when the

supply of blood to the brain is
either interrupted or reduced.
When this happens, the brain
does not get enough oxygen or
nutrients which cause brain
cells to die.
If the stroke occurs in the
left side of the brain, the right
side

of

the

body

will

be

affected, producing some or all

of the following:Paralysis on
the right side of the body;
Speech/language

problems;

Slow, cautious behavioral style

and Memory loss.

Hemorrhagic stroke accounts for about 13 percent of stroke cases. It results from
a weakened vessel that ruptures and bleeds into the surrounding brain. The blood
accumulates and compresses the surrounding brain tissue.

30

V. ETIOLOGY OF THE DISEASE

Etiology

High blood pressure

Actual

Rationale
Uncontrolled increase of blood pressure can
cause a vessel to explode or burst. Thus,
causes

hemorrhagic

strokehttp://www.strokeassociation.org/STROK
EORG/AboutStroke/UnderstandingRisk/Under
standing-StrokeRisk_UCM_308539_SubHomePage.jsp#
Uncontrolled diabetes can cause increase

Uncontrolled
diabetes

viscosity

of

blood

in

the

blood

stream

http://www.strokeassociation.org/STROKEOR

G/AboutStroke/UnderstandingRisk/Understand
ing-StrokeRisk_UCM_308539_SubHomePage.jsp#

High cholesterol

Having high Cholesterol contributes to blood

vessel

disease,

which

often

leads

to strokehttps://www.google.com.ph/?gfe_rd=c
r&ei=qKiOVMEBYSK8Qfw6oD4Bw&gws_rd=ssl#q=high+ch
olesterol+in+CVA

Smoking

Smoking also nearly doubles the risk of

31

ischemic stroke.3 Smoking acts synergistically

with other risk factors, substantially increasing
the

risk

of

CHD.4Smokers

are

also

at

increased risk for peripheral vascular disease,

cancer, chronic lung disease, and many other
chronic
diseaseshttp://circ.ahajournals.org/content/96/
9/3243.full

Excessive alcohol
intake

The role of alcohol consumption as an

independent risk factor for ischemic brain
infarction has remained unclear. Both mortality
and morbidity from ischemic brain infarction
seem to be increased among heavy alcohol
drinkershttp://stroke.ahajournals.org/content/30
/11/2307.full

Race

African-Americans

(opens

in

new

window) have a much higher risk of death from

a stroke than Caucasians do. This is partly
because blacks have higher risks of high blood
pressure, diabetes and
obesity.http://www.strokeassociation.org/STRO
KEORG/AboutStroke/UnderstandingRisk/Unde

32

rstanding-StrokeRisk_UCM_308539_SubHomePage.jsp#

Age (>65)

People aging 65 years old above are at great

risk for CVA. . atrial fibrillation is the direct

cause

of

one

in

four

strokes.

https://www.google.com.ph/?gfe_rd=cr&ei=9JOVLPoO8uL8QeCyoC4DA&gws_rd=ssl#q=rati
onale+for+65+years+old+person+with+stroke

Family history of
stroke

Your stroke risk may be greater if a parent,

grandparent, sister or brother has had a
stroke. Some strokes may be symptoms of
genetic disorders like CADASIL (Cerebral
Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy),
which is caused by a gene mutation that
leads to damage of blood vessel walls in the
brain, blocking blood flow. Most individuals
with CADASIL have a family history of the
disorder each child of a CADASIL parent
has

50%

chance

of

inheriting

the

disease.http://www.strokeassociation.org/ST
ROKEORG/AboutStroke/UnderstandingRisk/

33

VI. SYMPTOMATOLOGY
Symptoms

Weakness or

Actual

Rationale

Numbness

can

occur

from

dysfunction

numbness of the

anywhere along the pathway from the sensory

face, arm, or leg on

receptors up to and including the cerebral

one side of the body

cortexhttp://www.merckmanuals.com/professi

onal/neurologic_disorders/approach_to_the_n
eurologic_patient/numbness.html

Loss of speech,
difficulty talking, or

communication deficits are characterized by

difficulty in understanding or producing

understanding what

speech correctly (aphasia), slurred speech

others are saying

consequent to weak muscles (dysarthria),

and/or difficulty in programming oral muscles
for speech production (apraxia). These
deficits vary in nature and severity depending
on the extent and location of the damage.
Some individuals may also have difficulty in
social communication, such as difficulty taking
turns in conversation and problems
maintaining a topic of
conversation.http://www.asha.org/public/spee
ch/disorders/Stroke/
34

Loss of vision or

Vision loss can be both a symptom and result

dimming (like a

of a stroke. Temporary vision loss can be a

curtain falling) in one

sign of impending stroke and requires

or both eyes

immediate medical attention. Learn about how

stroke may affect vision and what to do about
ithttp://www.stroke.org/strokeresources/library/stroke-and-vision-loss

Sudden, severe
Pain

can

also

accompany

stroke.

headache with no
Numbness and pain can also alternate in the
known cause
same area as the brain is having difficulty
communicating with nerves in a certain

area.http://www.healthline.com/health/stroke/c
omplications

Loss of balance or

Problems with balance are common after

unstable

walking,
stroke. If your balance has been affected, you

usually

combined
may feel dizzy or unsteady which could lead

with

another
to a fall or loss of confidence when walking

symptom
and moving around. Loss of balance can be a
result especially if certain part of the brain is
affected.
http://www.stroke.org.uk/factsheet/balanceproblems-after-stroke

35

VII. PATHOPHYSIOLOGY
A. Written Pathophysiology
Strokes are divided into two main categories: Ischaemic and Haemorrhagic.
Haemorrhagic strokes are due to the rupture of a blood vessels leading to compression
of brain tissue from an expanding haematoma. In addition, the pressure may lead to a
loss of blood supply to affected tissue with resulting infarction.Intracerebral
haemorrhage is the accumulation of blood anywhere within the brain, i.e.
intraparenchymal haemorrhage, intraventricular haemorrhage. This will form a gradually
enlarging haematoma (blood pool). Intracerebral Haemorrhages can be caused by local
vessel abnormalities (hypertension, vasculitis, vascular malformation) or systemic
factors (drugs, trauma, tumours and sickle cell anaemia/leukaemia). Haemorrhaging
directly damages brain tissue and raises intracranial pressure giving headaches,
vomiting nausea and eventually coma and death.Subarachnoid haemorrhage is the
gradual collection of blood in the subarachnoid space of the Dura. These can be
traumatic or spontaneous. Spontaneous haemorrhages occur through saccular (berry)
aneurysms and through extensions of intracranial haemorrhaging or due to similar
causes. Approximately one third of those who suffer a subarachnoid haemorrhage die.it
is the subarachnoid space which can pathologically fill with blood.

36

B. Diagram of Pathophysiology
Predisposing Factors:

Precipitating Factors:

- Age
Age of 65 years old
- Family History of Stroke

Excessive alcohol
intake
Sedentary Lifestyle

Hemorrhagic- Impaired tissue

perfusion

Infarction of cerebral vessels

known as stroke
Space-occupying blood clots
put more pressure on the brain
tissues

The regulatory mechanisms of

the brain attempt to maintain
equilibrium by increasing BP
and ICP

The ruptured cerebral vessels

may constrict to limit blood loss
however, the vasospasm will
result to further ischemia and
necrosis of brain tissues.

SIGNS AND SYMPTOMS:

-Loss of Balance
-Loss of Speech

- Sudden or severe headache - Loss of vision

-Weakness or Numbness of face and extremities
37

Pharmacological Management

Complications

Furosemide
Loss of Muscle
Ceftriaxone

Control/Paralysis

Citicoline
Omeprazole
Amlodipine

Speech Problems
Swallowing Difficulties

Losartan
Mannitol

Cognitive Impairments
Personality and Mood
Changes

Nursing Management:
Depression
1. Reposition client q2
2. Support dependent body
parts with pillows
3. Provide safety measures
including environmental

BAD PROGNOSIS

management
4. Encourage SOs
involvement in activities &
decision making
5. Peroform passive range of
motion exercises daily
6. Increase functional
activities as strength
improves
GOOD PROGNOSIS

38

VIII. PLANNING
A. NURSING CARE PLAN
Date /
Time
Decem
ber 10,
2014
7-3 shift

Assessment

Need

Subjective cues:
Wala baya jud
kusog iyang tuo
nga parte sa
lawas sir as
verbalized by the
watcher.

S
E
L
F

Objective cues:
-VS: BP160/100
PR- 90
RR- 21
Temp- 36.9
-crumpled linens
noted
-pillows are
placed just
above the head
-bags and other
unnecessary
things are placed

C
A
R
E

Nursing
Diagnosis
Self-care deficit
r/t right sided
body weakness
secondary to
Cerebrovascular
accident
Rationale:
Motor deficit are
the most obvious
effect of stroke.
Symptoms are
caused by
destruction of
motor neurons in
the pyramidal
pathways (nerve
fibers in the brain
and passing
through the
spinal cord to the
motor tract.)
When this

Objective of
Care
Within the shift,
there will be
demonstration of
self-care, as
evidenced by:

Nursing Interventions

-Established rapport.
R: To gain trust and
cooperation.
-Monitored VS.
R: To have a baseline
data.
a. Placing
-Placed unnecessary
the
things in bedside table.
unnecess R: To have orderliness
ary things and to give comfort.
at bedside -Assisted during bed
on his
bath.
own.
R: To give comfort.
b. Changing -Assisted in changing
of clothes the clothes.
with at
R: To give comfort and
least
to assess for the parts
minimal
which cannot be move
assistance frequently.
.
-Stretched and tucked
c. Daily
properly the linens.
bathing
R: To prevent the
with
feeling of being

Evaluation
Within the shift,
GOAL
PARTIALLY
MET, as
evidenced by:
a. Being
unable
to place
the
unneces
sary
things at
bedside
on his
own.
b. Being
able to
change
clothes
with
minimal
assistan
39

at the bed
-needs total
assistance
during ADL like
bathing and
clothing

happens,
activities of daily
living can be
impaired and
even self-care.
Reference:
http://nurseslabs.
com/cerebrovasc
ular-accidentnursing-careplans/.
Date Retrieved:
December 11,
2014

Date /
Time
Decemb
er 10,
2014
7-3 shift

Assessment

Need

Subjective cues:
Gi-ubo sya sir, dili
sya kaginhawa
kaau as verbalized
by the watcher.

P
H
Y
S
I

Nursing
Diagnosis
Ineffective airway
clearance r/t
tracheobronchial
inflammation and
increased sputum

minimal
uncomfortable when
assistance lying in bed.
.
Dependent:
-Administer meds as
prescribed.
R: To continuously treat
underlying causes and
symptoms.

ce.
c. Being
unable
to take a
bath
without
total
assistan
ce.

Collaborative:
-Encouraged watchers
to assist patient in ADL
like daily bed bathing
and oral hygiene.
R: To help patient
maintain a proper
hygiene and prevent
accidents.

Objective of
Care
Within the
shift, will be
able to:
a. Identify or

Nursing Interventions

Evaluation

-Monitored VS.
R: To monitor patients
condition and compared
with baseline data.
-Placed on MHBR

Within the
shift,
GOAL
PARTIALL
Y MET, as
40

Objective cues:
-VS: BP- 160/100
PR- 90
RR- 27
Temp- 36.9
-productive
-crackles lung
sound heard upon
auscultation.
-(+) use of
accessory muscle
when breathing.
-lying flat on bed

O
L
O
G
I
C
A
L

production
secondary to
CAP-MR

Rationale:
Pneumonia is infl
ammation of the
terminal airways
and alveoli
Need caused by acute
infection by
various agents.
Oxyge Community
nation Acquired
pattern Pneumonia
(CAP) is a
disease in which
individuals who
have not recently
been hospitalized
develop an
infection of the
lungs. It is an
acute
inflammatory
condition thats
result from
aspiration of
oropharyngealsec

demonstrate
behaviors to
achieve
airway
clearance.
b. Display
patent airway
with breath
sounds
clearing.

position.
R: It promotes relaxation
and helps in promoting
effective airway
clearance.
-Assisted in turning to
sides every 30 minutes.
R: To promote circulation
as well as to prevent
further complications in
the pulmonary system.
-Encouraged to increase
OFI.
R: It helps to soften and
expectoration of
secretions.
-Encouraged to do deep
breathing and coughing
exercises.
R: Deep breathing
exercises facilitate
maximum expansion of
the lungs and smaller
airways. Coughing is a
reflex and a natural selfcleaning mechanism that
assists the cilia to
maintain patent airways.
-Demonstrated proper

evidenced
by:
a. being
able to
identify/de
monstrate
behaviors
to achieve
airway
clearance
such as
deep
breathing
and
coughing
exercises.
b. crackles
lung sound
still heard
upon
auscultatio
n.

41

retions or
stomach contents
in the lungs.
Therefore, airway
clearance is not
effective.

back and chest tapping

to watchers.
R: It can aid to
mobilization and
expectoration of
secretions.

Reference:
http://nursingcrib.
com/
Date Retrieved:
December 11,
2014

Dependent:
-Administer meds as
prescribed.
R: To continuously treat
underlying causes and
symptoms.
Collaborative:
-Encouraged watchers to
assist patient in turning
to sides as well as in
performing ADL.
R: To prevent further
complications and to
prevent accidents that
may lead to injury.

42

Date/Time

Assessment

Need

December
11, 2014
7-3 shift

Subjective
cues:
Dilikalihokako
ngtuonakamot
ogtiil, as
verbalized.

S
A
F
E
T
Y

Objective
cues:
-weak in
appearance
-decreased
strength in left
side of the
body
-needs
assistance
when turning
into sides
-needs total
assistance in
ambulation
-unable to
perform ADL
alone
-absence of
side rails

A
N
D
S
E
C
U
R
I
T
Y

Nursing
Diagnosis
Risk for injury:
fall r/t right sided
body weakness
secondary to
Cerebrovascular
accident
Rationale:
The sudden
death of some
brain cells due to
lack of oxygen
when the blood
flow to the brain
is impaired by
blockage or
rupture of an
artery to the
brain, this can
cause body
weakness or
paralysis of the
one side of the
body, depending
on the area of
the brain that is
affected. This

Objective of Care
Within the shift, will
be able to:
a. Verbalize
understandin
g of individual
factors that
contribute to
possibility of
injury.
b. Be free from
injury.

Nursing
Interventions
-Monitored VS.
R: To monitor
patients condition
and compared with
baseline data.
-Assisted in
performing ADL.
R: To decrease risk
of accident.
-Provided security by
providing assistance
on the bed and keep
the barrier remained
in place.
R: To keep clients
safety and to avoid
further injury.
-Placed in the middle
of the bed.
R: To prevent from
falling from the bed.
-Encouraged to stay
in bed as much as
possible.
R: To conserve
energy and prevent
accidents.

Evaluation
Within the
shift, GOAL
MET, as
evidenced
by:
a.
Magtarongk
ooghigdanad
irikosatunga
sakama as
verbalized.
b. Being free
from injury.

43

will increase the

risk of accident
leading to
serious injuries.
Reference:
http://www.medi
cinenet.com/scri
pt/main/art.asp?
articlekey=2676.
Date Retrieved:
December 11,
2014

Dependent:
-Administered meds
as prescribed.
R: For continuous
treatment of
underlying cause and
symptoms.
Collaborative:
-Encouraged
watchers to support
the patient by
assisting in
performing ADL.
R: To provide safety
and avoid accidents
that may cause
injury.

44

B. DISCHARGE PLAN
Areas

Objective

Activities
1. Encourage the patient to comply
with the prescribed medication.

Medication

100 % compliance to home medicines

This prevents further

development of the disease
process and other possible
complication.
2. Encourage the client to take the
medicine into the right time,
right dose, right amount, and
right frequency and take note
the side effects of the medicine.
This would enable them to
know what are the drugs and its
desired dosage. The exact

45

dosage and time are important

to ensure the drugs
effectiveness.
3. Instruct patient to notify
physician if there is any
abnormalities after taking the
medicine.
4. Instruct patient to do not buy
any drugs that does not
prescribed by the physician.
To avoid the ineffectiveness
of the drug prescribed, and to
ensure the safety of the client.
1. Avoid strenuous activities.
2. Encourage patient to have
Exercise

To stabilize the condition of the patient.

activities of daily living.

46

Encourage to do light exercise and

3. Encourage client to have

understands its important.

adequate rest periods

between activities.
1. Explain the purpose of
the medication that is

Treatment

Understanding the recommended

treatment or lessen underlying illness.

prescribed by the
physician.
2. Inform the significant of
the treatment others that
they should be involved
in the treatment of the
client.
3. Encourage to take
medications religiously.
1. Instruct to take extra care in
doing daily ADL especially in

47

ambulation.
2. Instruct the client to have a
Health teachings

To prevent the risk of any

complications that may lead to death.

proper diet and hygiene.

3. Encourage client to wash hands
before and after doing things.
4. Patient is advised to avoid
strenuous activities until full
recovery is achieved
5. Encourage significant others to
give total supportive care.
1. Continue prescribed medicines
and its right dosage.

Out - patient

To maintain quality health and

independence towards self - care.

To attain the therapeutic

effect of each medicines
towards the client.
2. Follow up with appointments

48

with physician.
To evaluate the progress of
the treatment and condition.
3. Encourage the patient to have
adequate rest and sleep
periods.
These aid faster recovery
from the illness and to have
enough strength in performing
activities of daily living and
range of motion exercises.
4. Encourage him to comply with
all the modifications and
instructions given to her
In order to have a fast
recovery.

49

1. Emphasize intake of
nutritious foods.
Diet

Decrease intake of fatty and salty

foods as well as those foods that can
irritate the GI tract including spicy and
acidic foods. Include a variety of
vegetables and fruits in the diet.

2. Encourage foods that are

less fatty and salty.
3. Observe proper handling of
foods.
4. Instruct to include variety of
fruits and vegetables in the
diet.

50

IX. PHARMACOLOGICAL MANAGEMENT

Generic
Name

Brand
Name

Classification

Mechanism of
action

Indication

Furosem
ide

Lasix

Loop diuretic

Furosemide inhibits
reabsorption of Na
and chloride mainly
in the medullary
portion of the
ascending Loop of
Henle. Excretion of
potassium and
ammonia is also
increased while uric
acid excretion is
reduced. It
increases plasmarenin levels and
secondary
hyperaldosteronism
may result.
Furosemide
reduces BP in
hypertensives as
well as in
normotensives. It
also reduces
pulmonary oedema
before diuresis has
set in.

-Edema
associated
with CHF,
cirrhosis,
renal disease
-Acute
pulmonary
edema

Side Effects/
Adverse
Reaction
Fluid and
electrolyte
imbalance.
Rashes,
photosensitivi
ty, nausea,
diarrhoea,
blurred vision,
dizziness,
headache,
hypotension.
Bone marrow
depression
(rare), hepatic
dysfunction.
Hyperglycae
mia,
glycosuria,
ototoxicity.
Potentially
Fatal: Rarely,
sudden death
and cardiac
arrest.
Hypokalaemi
a and
magnesium

Time
and
Dosage
40mg
OD
IVTT

Nursing
Responsibilities
-Reduce dosage
if given with other
antihypertensives
; readjust dosage
gradually as BP
responds.
-Administer with
food or milk to
prevent GI upset.
-Give early in the
day so that
increased
urination will not
disturb sleep.
-Avoid IV use if
oral use is at all
possible.
-WARNING: Do
not mix
parenteral
solution with
highly acidic
solutions with pH
below 3.5.

51

depletion can
cause cardiac
arrhythmias.

-Do not expose to

light, may
discolor tablets or
solution; do not
use discolored
drug or solutions.
-Discard diluted
solution after 24
hr.
-Refrigerate oral
solution.
-Measure and
record weight to
monitor fluid
changes.
-Arrange to
monitor serum
electrolytes,
hydration, liver
and renal
function.
-Arrange for
potassium-rich
diet or
supplemental
potassium as
needed.

52

Generi
c Name

Brand
Name

Classification

Indication

Action

Ceftriax
one

Forgram

Cephalosporins

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

Works by
inhibiting the
mucopeptide
synthesis in
the bacterial
cell wall. The
beta-lactam
moiety of
Ceftriaxone
binds to
carboxypeptid
ases,endopep
tidases, and
transpeptidas
es in the
bacterialcytopl
asmicmembra
ne. These
enzymes are
involved in
cell-wall
synthesis and
cell division.
By binding to
these
enzymes,
Ceftriaxone

Side Effects/
Adverse
Reaction
Pain
Induration
Phlebitis
Rash
Diarrhea
Thrombocytosi
s
Leucopenia
Glossitis
Respiratory
super
infections

Time &
Dosage

Nursing
Responsibilities

1 gram
every 12
hours
ANST (-)
IVTT

-Assess patients
Previous
sensitivity
reaction to
penicillin or other
cephalosphorins.
-Assess patient
for signs and
symptoms
of infection before
and during the
treatment
-Obtain C&S
before beginning
drug therapy to
identify if correct
treatment has
been initiated.
-Report signs
such as
petechiae,
ecchymotic areas,
epistaxis or other
forms
of unexplained

53

results in the
formation of
of defective
cell walls and
cell death.

Generic
Name

Brand
Name

Classification

Indication

Action

Citicoline

Cholin
erv

CNS stimulant,
Peripheral
Vasolidlator

Cerebrovascula
r Diseases,
accelerates the
recovery
of consciousne
ss and
overcoming
motor deficit

Citicoline activates
the biosynthesis of s
tructural phospholipi
ds in the neuronal
membrane,
increases cerebral
metabolism and
increases the level
of various
neurotransmitters,
including
acetylcholine and
dopamine. Citicoline
has shown

bleeding.

Side Effects/
Adverse
Reaction
citicoline may
exert a
stimulating
action of
the parasymp
athetic, as
well as a
fleeting and
iscretehypote
nsor effect.

Time &
Dosage

Nursing
Responsibilities

500mg 1
cap TID

-Watch out
for hypotensive
effects.
-Must not be
administered along
with medicaments
containing

54

neuroprotective
affects in situations
of hypoxia and
ischemia.

Generic
Name

Brand
Name

Classific
ation

Indication

Action

Omeprazol
e

Omepro
n

Proton
pump
inhibitor

Short term
treatment
of active
duodenalulcer,
gastroesophageal
reflux disease
(GERD),
including erosive
esophagitis and
symptomatic
GERD. Long term
treatment
of pathologic
hypersecretory
condition: to
maintain healing
of erosive
esophagitis. Short

Suppresses
gastric
secretion by
inhibiting
hydrogen/pota
ssium ATP as
enzyme
system in the
gastric parietal
cell:
characterize as
a gastric acid
pump inhibitor,
since it block the
final step
of acid
production.

Side Effects/
Adverse
Reaction
Diarrhea,
nausea,
fatigue,
constipation,
vomiting,
flatulence,
utycaria, dry
mouth,
dizziness,
headache

Time
and
Dosage
40 mg
IVTT OD

Nursing Responsibilities

-Assess other medications

patient maybe taking for
effectiveness and
interaction.
-Monitor therapeutic
effectiveness and adverse
reaction at the beginning
of therapy and periodically
throughout the therapy.
-Assess GI system: bowel
sounds 8 hrly, abdomen
for pain and swelling,
appetite loss.
-Monitor hepatic enzymes.
Assess knowledge/teach
appropriate use of this
medication, interventions
to reduce side effects, and

55

term treatment
of active benign
gastric ulcer

Generic
Name

Brand
Name

Amlodipin
e

Norvasc

Classification

Calcium
channel
blocker

Mechanism of
action

Inhibits the
transport
of calcium into
myocardial and
vascular smooth
muscle cells,
resulting in the
inhibition
of excitation
contraction
coupling and
subsequent
contraction

other symptoms to report

Indication

Side
Effects/
Adverse
Reaction
Alone or with
CNS:
other agents in headache,
the
dizziness,
management
fatigue CV:
of hypertensio peripheral
n, angina
edema,
pectoris and
angina,
vasospastic
bradycardia,
angina
hypotension,
palpitations
GI: gingival
hyperplasia,
nausea
DERM:
flushing

Time
and
Dosage

Nursing
Responsibilities

10mg 1
tab OD

-Monitor blood
pressure and pulse
before therapy, during
dose titration, and
periodically during
therapy. Monitor ECG
during prolonged
therapy.
-Monitor intake and
output ratios and daily
weight. Assess for
signs of CHF
(peripheral edema,
rales/crackles,
dyspnea, weight gain
and jugular venous
distention

56

Generic
Name

Brand
Name

Classificatio
n

Mechanism of
action

Indication

Losartan

Cozaar

Antihypertensive

Inhibits
vasoconstrictive
and aldosteronesecreting action of
angiotensin II by
blocking
angiotensin II
receptor on the
surface of
vascular
smooth muscle
and other tissue
cells

Hypertension,
Nephepaticall
y in type 2
diabetic
patients, to
reduce risk of
CVA in
patients with
hypertension
and left
ventricular
hypertrophy

Side Effects/
Adverse
Reaction
CNS-dizziness,
asthenia,
fatigue,
headache,
insomia. CVedema,
chest pain.
EENT-nasal
congestion,
sinusitis,
pharyngitis,
sinus disorder.
GI-Abdominal
pain, nausea,
diarrhea,
dyspepsia.Musc
uloskeletalmuscle cramps,
myalgia, back or
leg
pain.
Respiratorycough, upper
respiratory
infection

Time and
Dosage

Nursing
Responsibilities

10mg 1
tab OD

-Monitor patients
BP.
-Monitor patients
who are also
taking diuretics for
symptomatic
hypotension.
-Assess patients
renal function
-Tell patient to
avoid salt
substitutes

57

Generic
Name

Brand
Name

Classification

Mannitol

Osmitrol Osmotic
Diuretic

Mechanism of
action

Indication

Increases
osmotic
pressure of
plasma in
glomerular
filtrate, inhibiting
tubular
reabsorption of
water and
electrolytes
(including
sodium and
potassium).
These actions
enhance water
flow from various
tissues and
ultimately
decrease
intracranial and
intraocular
pressures

Test dose for

marked
oliguria or
suspected
inadequate
renal function,
prevent acute
renal failure
during
cardiovascula
r and other
surgeries,
acute renal
failure, to
reduce
intracranial
pressure and
brain mass,
reduce
intraocular
pressure, to
promote
dieresis in
drug toxicity,
irrigation
during
transurethral
resection of

Side Effects/
Adverse
Reaction
CNS: dizziness,
headache,
seizures
CV: chest pain,
hypotension,
hypertension,
tachycardia,
thrombophlebiti
s, heart failure,
vascular
overload EENT:
blurred vision,
rhinitis GI:
nausea,
vomiting,
diarrhea, dry
mouth
GU: polyuria,
urinary
retention,
osmotic
nephrosis
Metabolic:
dehydration,
water
intoxication,
hypernatremia,
hyponatremia,

Time
and
Dosage
50ml
IVTT
every 6
hrs

Nursing
Responsibilities
-Monitor vital signs.
-Monitor intake and
output.
-Monitor central
venous pressure.
-Monitor pulmonary
artery pressure.
-Monitor signs and
symptoms of
dehydration.
-Monitor signs of
electrolyte imbalance

58

prostate.

hypovolemia,
hypokalemia,hy
perkalemia,
metabolic
acidosis

59

X. SYNTHESES OF CLIENTS CONDITION/STATUS FROM ADMISSION TO

PRESENT
A. Conclusion
Therefore, after we had studied the case, our client has suffered from
Cerebrovascular Accident because of some possible factors that might have contributed
on the development of the condition. Cerebrovascular Accident refers to is the medical
term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by
a blockage or a rupture of a blood vessel. There are important signs of a stroke that you
should be aware of and watch out for. If you think that you or someone around you
might be having a stroke, it is important to seek medical attention immediately. The
more quickly you get treatment, the better the prognosis. When a stroke goes untreated
for too long, there can be permanent brain damage.
The certain condition that the patient is suffering is really considered dangerous.
It is a life-threatening condition especially if the patient will not follow the prescribed
meds and a healthy lifestyle as it would lead to many other complications that may
greatly affect his life as well as his family and eventually may lead to death. Despite of
all that facts, there are treatments and preventive measures that people should do in
order to stop or prevent this condition from getting worst. We conclude that the need for
medical consultations and abiding the medical orders regarding health condition and at
least preventing the worst to happen should be really observed and taken into
consideration by the patient himself and by the significant others as well. Doing right

60

things and sufficient knowledge about the patients conditions can be of great help and
they should know the preventive measures for prevention is always better than cure.

B. Patients Prognosis
Poor

Fair

Good

Duration

Justification
Patient has been
admitted because of
right sided

weakness and still

present during our 4
day exposure.

Onset

The patient still

experienced his

chief complaint
during our shift.

Willingness

The patient has the

willingness to take
all medications after

the explanation of
the purpose of the
medicine.

Environment

The patient stayed

in a ward room and

61

was conducive for

healing and
recovery.
The patients diet

Diet

was more on salty

and fatty foods.

Computation:
Poor-

1x0=0

Fair-

2x3=6

Good-

3x2=6
12/5 = 2.4 (Fair Prognosis)

C. RECOMMENDATIONS
Giving importance to the health of ourselves and maintaining a healthy lifestyle
as individuals, is highly required to maintain a good and healthy life. It is because
ignoring the health condition could greatly affect life especially when certain conditions
or diseases would develop.
It is very important that every person should give importance to his/her health. A
person should promote healthy lifestyle changes that include adequate nutrition, clean

62

environment, and free from stress. For our patient, it is important to eliminate those
factors that can trigger to his condition.
With this we recommend the following:
1. Maintain proper hygiene all the time;
2. Deep breathing exercises to promote relaxation;
3. Adequate rest and sleep;
4. Strict compliance to the medical treatment and medical check-up;
5. Instructed watcher to assist patient in performing ADL;
6. Instructed watcher not to leave the patient alone;
7. Follow-up with appointment with the physician.

63

XI. EVALUATION OF THE OBJECTIVES OF THE STUDY

After days of collecting relevant information and sequence of analysis on related
topics of this case study, we are now presenting our evaluation related to our objectives
that have been presented. We have certified that we were able to complete the chosen
case with factual data gathered including the necessary information related to this case.
Within the span of at least of rendering care to Patient Kowowo, we have drawn
together the important and relevant information that serve as the baseline of our study
and were able to identify potential problems. By gaining the patients trust and
cooperation and with the help of the significant others, we were able to assess properly
every single data regarding the patients condition and thoroughly assessed every
system involved. We were able to obtain his past health history that contributed to the
occurrence of the condition. Additionally, we were able to get the complete diagnosis,
able to perform the cephalocaudal physical assessment of the patient, and discussed
firmly the anatomy and physiology of the systems involved. Besides, we were able to
present the pathogenesis of certain conditions included in the admitting diagnosis.
Moreover, we were able to present the factors that affect the patients condition,
comprehensively interpreted the laboratory results, discussed and enumerated the
medications prescribed including the nursing responsibilities and given the interventions
we have planned and implemented for our patient.

64

We were able to appreciate more the essence of utilizing the nursing process in
the care, service and management of our patient. This case study improves not only our
knowledge but also with our skills concerning on providing care for our patient with such
diseases and we can be able to share our learning regarding this study to the significant
people. In addition, it enhances our analysis, research, knowledge and skills on the field
of nursing. It was indeed a hard job on conducting this study yet, it gave a great impact
in our career regarding how useful it is in our chosen profession.

65

XII.

BIBLIOGRAPHY

Books

Brunner and Suddarth's Textbook of Med.-Surg. Nursing 12th ed Copyright

2010 by Lippincott Williams & Wilkins, a Wolter Kluwer business.

Medical - Surgical Nursing 7th ed. by Black Joyce M. and Jane Hokanson Hawks

PorthsEssentials of Pathophysiology 3rd EditionCopyright 2011 by Lippincott

Williams & Wilkins, a Wolter Kluwer business.

Fundamentals of Nursing, 7th ed. by Kozier, Barbara

Medical Surgical Nursing 7th ed. Copyright 2008 by Lewis, et.al. Nurses
pocket guide, 12th ed. by Doenges, Marilynn, et.al.

Nurses Handbook of Health Assessment 6th ed. by Weber, Janet

Daviss Drug Guide for Nurses. TENTH EDITION.

Daviss Nurses Pocket Guide. 12th edition

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66

http://www.world-heart-federation.org/cardiovascular-health/stroke/Date of
Retrieval: December 13, 2014

http://www.strokeforum.com/stroke-background/epidemiology.htmlDate of
Retrieval: December 13, 2014

http://www.worldlifeexpectancy.com/philippines-strokeDate of Retrieval:
December 13, 2014

http://emedicine.medscape.com Date of Retrieval: December 13, 2014

http://www.webmd.com/Date of Retrieval: December 13, 2014

http://www.healthline.com/health/Date of Retrieval: December 13, 2014

http://www.mayoclinic.org/Date of Retrieval: December 13, 2014

http://www.livestrong.com/Date of Retrieval: December 13, 2014

http://www.healthcommunities.com/ Date of Retrieval: December 13, 2014

http://emedicine.medscape.com/ Date of Retrieval: December 13, 2014

http://www.ncbi.nlm.nih.gov/Date of Retrieval: December 13, 2014

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