Escolar Documentos
Profissional Documentos
Cultura Documentos
ANGELES CITY
COLLEGE OF NURSING
March 5, 2009
1
I. INTRODUCTION
1. Description of the disease
When an area of the brain loses its blood supply it stops working, the part of the
body it controls also stops working. This is what happens with a Transient Ischemic
Attack, better known as TIA.
When the brain loses blood supply, it tries to restore blood flow. If blood supply is
restored, function may return to the affected brain cells, permitting return of function to
the affected body part.
Transient ischemic attack is also known as a mini-stroke, a hemorrhagic stroke, or
an ischemic stroke. Some people call a TIA a mini-stroke, because the symptoms are like
those of a stroke but do not last long. Generally, a TIA happens when platelets in the
blood clump together in your arteries (a blood clot) making blood flow to a part of the
brain be blocked or reduced. After a short time, blood flows again and the symptoms go
away. Symptoms usually last only 10 - 15 minutes and clear up within 24 hours. With a
stroke, the blood flow stays blocked, and the brain has permanent damage. TIAs
sometimes happen before strokes, and they are considered a warning sign of stroke.
It is estimated that more than 300,000 TIAs occur each year in the United States.
The highest incidence for a second stroke is within the first seven days after a TIA. The
prevalence for cerebral infarct after TIA is 11% at the ages of 55 to 64, 22% between the
ages of 65 to 69, 28% at the ages of 70 to 74 years, 32% between 75 to 79 years and 40%
at ages 80 to 85 years. TIA’s are the precursor in 15% of all strokes and if unrecognized,
can represent the greatest morbidity and mortality for stroke patients in the first thirty-
ninety days after their first TIA.
Fifty-percent of patients who experience a TIA fail to notify their healthcare
provider. Approximately one-third of TIA’s would reveal as a true ischemic event by
diffusion-weighted magnetic resonance imaging. Within the first year of having their
first TIA, 25% of patients will die. It has been estimated that only 9% of the general
population is familiar with typical TIA symptoms, and as few as 22% of primary health
care workers even know the definition of a TIA. This education gap poses a great
challenge for health workers when eliciting a history from patients and families.
2
While TIA itself has short term effects, the significance is that this can herald a
major stroke, which is why it requires timely and aggressive treatment to prevent death
and disability.
It has been shown that stroke and TIA patients alike decrease their secondary
stroke risk considerably by learning about their own cardiovascular health maintenance,
risk assessment and lifestyle behaviors.
TIA is a common marker of cerebrovascular disease which, when correctly
diagnosed and managed, can lead to the prevention of significant morbidity and mortality.
2. Nurse-Centered Objectives
Upon the completion of this case study, the student-nurses shall have:
Described and explained what transient ischemic attack is.
Reviewed the anatomy and physiology of the organs involved.
Identified the risk factors contributing to the occurrence of the disease.
Expounded on the laboratory and diagnostic procedures done with the
patient, their purposes, and specific nursing responsibilities before, during
and after the procedure.
Enumerated the different medications administered for the disease their
indications, contraindications, side effects, and specific nursing
responsibilities.
Formulated significant nursing diagnoses, with their significantly related
nursing care plans.
3
II. NURSING HISTORY
1. Personal History
a. Demographic Data
Mrs. Attack was born in Quezon City on February 17, 1980. She is 29 years old,
a Filipino citizen, married and has one child. She lives with her family, residing at
Pandan, Angeles City. She was admitted in a private hospital on February 22, 2009 at
12:05 in the morning with a chief complaint of syncope. She was discharged four days
after the admission.
b. Socio-Economic and Cultural Factors
Mrs. Attack finished her college degree at Republic Central Colleges with the
course Education. She has her job as a cashier in a casino. She and her family were
baptized as Roman Catholics. They regularly attend Sunday masses and novenas
together. With minor illnesses such as fever, cough and colds, self medication is applied.
Although they seek the advice of their physician, they also believe in the albularyo and
the manhihilot.
2. Family Health-Illness History
Mrs. Attack’s father had a cerebrovascular accident in the year 2000 and was then
bedridden for almost nine years. Also, one of her first degree relatives, her aunt (her
mother’s sister), had her cerebrovascular accident in the year 2001 and is suffering from
hypertension. Other than these incidents, there were no other reported illnesses within
her family and relatives.
3. History of Past Illness
Mrs. Attack was confined in the same hospital two years ago (year 2007) with a
diagnosis of Gastroenteritis and was healed and discharged after few days of
confinement. Other than that, there were no known related ailments and past illnesses
with the present one.
4. History of Present Illness
a. Chief Complaint: Syncope
b. Sequence of the appearance of signs and symptoms up to the time patient
was admitted.
4
Before going to bed at almost before midnight, Mrs. Attack experienced sudden
chest pain and left-sided weakness followed by loss of consciousness. She was brought
to the hospital already awake and was admitted minutes after midnight.
5
III. PHYSICAL ASSESSMENT
1. Assessment done upon admission: February 22, 2009 (copied from chart)
EENT: anicteric sclerae, pink palpebral conjunctiva
Lungs: Clear BS, no rales
Heart: NRRR, no murmur, soft full equal pulses
Abdomen: flabby, NABS,
2. Cephalocaudal assessment: February 26, 2009
Head
With long hair, black and equally distributed
Without palpable lumps
With ucombed hair
Skin
Dry and warm to touch
With fair skin complexion
With good skin turgor
Eyes
With dark brown iris
With white sclera
Pupils equally round and reactive to light accommodation (PERRLA)
With pink palpebral conjunctiva
Ears
Pinna recoils after folding
Absence of discharge
Without any obstructions
With ear piercing
6
Nose and Sinuses
With thick nasal hair
Absence of scar
Absence of discharge
Positioned at the center/midline
Neck
Absence of palpable masses
Absence of swelling
Without stiffness present
Without swollen lymph nodes
Breast
Symmetrical in shape
Abdomen
With presence of horizontal scar on the hypogastric region (from past caesarian
section incision)
With presence of striae
Flabby
7
CRANIAL NERVES:
OLFACTORY: able to smell alcohol in cotton.
OPTIC: able to read the newspaper at a readable distance.
OCULOMOTOR: pupil equally round and reactive to light and
accommodation.
TROCHLEAR: able to follow the up and down movement of the pen.
TRIGEMINAL: able to open mouth against resistance.
ABDUCENS: able to follow the left and right movement of the pen.
FACIAL: able to taste; no difficulty in swallowing.
AUDITORY: able to repeat whispered words
GLOSSOPHARYNGEAL: able to move the tongue in all directions.
VAGUS: able to say “aaahh”; with gag reflex.
ACCESSORY: able to elevate the shoulders against resistance.
HYPOGLOSSAL: able to protrude tongue.
8
IV. DIAGNOSTIC AND LABORATORY PROCEDURES
9
sodium level
means you have
hypernatremia,
almost always
due to
excessive loss
of water
(dehydration)
without enough
water intake.
Glucose: FBS Glucose, February 83.8 76-111 Normal
formed by 22, 2009 mg/ dl
digestion of
carbohydrates
and the
conversion of
glycogen by
the liver, is the
primary source
of energy for
most cells.
BUN The BUN test February 7.0 7-21 mg/dl Normal
is primarily 22, 2009 -Increased
used, along BUN levels
with the suggest
creatinine test, impaired
to evaluate kidney
kidney function. This
function under may be due to
a wide range acute or chronic
of kidney disease,
circumstances damage, or
and to monitor failure.
patients with -Low BUN
acute or levels are not
chronic kidney common and
dysfunction or are not usually
failure a cause for
concern. They
may be seen in
severe liver
disease,
malnutrition,
and sometimes
when a patient
is overhydrated
10
(too much fluid
volume), but
the BUN test is
not usually used
to diagnose or
monitor these
conditions.
Uric Acid The uric acid February 5.07 2.5-7 Normal
test is used to 22, 2009 mg/dl - Higher than
learn whether normal uric
the body might acid levels
be breaking mean that the
down cells too body is not
quickly or not handling the
getting rid of breakdown of
uric acid purines well.
quickly The doctor will
enough. The have to learn
test also is whether the
used to cause is the
monitor levels over-production
of uric acid of uric acid, or
when a patient if the body is
has had unable to clear
chemotherapy away the uric
or radiation acid.
treatments. - Low levels of
uric acid in the
blood are seen
much less
commonly than
high levels and
are seldom
considered
cause for
concern.
Although low
values can be
associated with
some kinds of
liver or kidney
diseases,
exposure to
toxic
compounds,
and rarely as
11
the result of an
inherited
metabolic
defect, these
conditions are
typically
identified by
other tests and
symptoms and
not by an
isolated low
uric acid result.
12
triglyceride differ
levels. depending on
whether
triglycerides are
high or normal.
SGOT/AST used to detect February 13 5-35 u/L Normal
liver damage. 22, 2009 Very high levels
of AST (more
than 10 times
the highest
normal level)
are usually due
to acute
hepatitis, often
due to a virus
infection.
SGPT/ ALT To detects February 9 7-56 u/L Normal
liver injury. 22, 2009 Very high levels
of ALT (more
than 10 times
the highest
normal level)
are usually due
to acute
hepatitis, often
due to a virus
infection. In
acute hepatitis,
ALT levels
usually stay
high for about
1–2 months, but
can take as long
as 3–6 months
to come back to
normal.
Potassium To determine February 3.7 3.6-5.0 Normal
the amount of 23, 2009 mmo/L -Increased
Potassium potassium
present in the levels indicate
blood. hyperkalemia.
Potassium is Decreased
an important levels of
electrolyte that potassium
helps regulate indicate
the flow of hypokalemia
13
fluids in and -Decreased
out of the cells levels of
potassium
indicate
hypokalemia.
14
getting rid of
enough carbon
dioxide, or
that there is a
problem with
kidney
function. If
left untreated,
these
conditions
create an
imbalance that
could
eventually be
life
threatening.
WBC Determines February 7.6 4.3-10.0 Normal
the number of 22, 2009
circulating -An elevated
WBCs per number of
cubic ml of white blood
whole blood. cells is called
It is an leukocytosis.
indicator of This can result
immune from bacterial
function and infections,
helps to inflammation,
determine leukemia,
infection or trauma,
inflammation intense
exercise, or
15
stress.
A decreased
WBC count is
called
leukopenia. It
can result
from many
different
situations,
such as
chemotherapy,
radiation
therapy, or
diseases of the
immune
system.
16
leukocytes range
originating
from fetal
stem cells. It
is especially
helpful in the
evaluation of
the patient
with
infection.
HGB Measures the February 11.2 12-16 Below-normal
amount of 22, 2009 hemoglobin
hemoglobin levels may
in blood and lead to anemia
is a good that can be the
measure of result of iron
the bloods deficiency
ability to
carry oxygen
throughout
the body.
17
5. For blood sample, instruct that the medical technician will perform
venipuncture to extract blood.
6. Acknowledge questions regarding the safety of the procedure.
B. During the procedure:
1. If the test is to be done at bedside, remain with the patient.
2. Assist with the collection of specimen if allowed.
C. After the procedure:
1. Check the site for bleeding, cyanosis, or swelling.
2. Apply pressure and warm compress.
3. Check vital signs for any changes.
4. Document the data (attach result in the chart).
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3. Advise the significant other to wash perineal area prior to collection of specimen.
B. During the Procedure
1. Collect a fresh urine specimen in a urine container.
2. Obtain clean catch midstream urine if possible.
C. After the Procedure
1. Transfer the urine specimen to the laboratory promptly.
2. Document the procedure.
3. Attach the result in the patient’s chart.
19
B. During the procedure:
1. Stay with the patient.
C. After the procedure:
1. Document the procedure.
2. Attach the result in the patient’s chart
20
V. THE PATIENT AND HER ILLNESS
21
of these vessels. Arteries carry blood from the heart. Veins return blood to the heart.
Capillaries are extremely tiny vessels that connect the arteries and the veins.
The blood consists chiefly of liquid called plasma, and three kinds of solid
particles known as formed elements. Plasma is made up mostly of water, but it also
contains proteins, minerals, and other substances. The three types of formed elements are
called red blood cells, white blood cells, and platelets. Red blood cells carry oxygen and
carbon dioxide throughout the body. White
blood cells help protect the body from
disease. Platelets release substances that
enable blood to clot. Platelets thus aid in
preventing the loss of blood from injured
vessels.
The nervous system is a very
complex system in the body. It has many,
many parts. The nervous system is divided
into two main systems, the central nervous
system (CNS) and the peripheral nervous
system. The spinal cord and the brain
make up the CNS. Its main job is to get
the information from the body and send
out instructions. The peripheral nervous
system is made up of all of the nerves and
the wiring. This system sends the
messages from the brain to the rest of the
body.
One of the parts of the CNS is the brain. It keeps the body in order. It helps to
control all of the body systems and organs, keeping them working like they should. The
brain also allows us to think, feel, remember and imagine. In general, the brain is what
makes us behave as human beings.
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The brain communicates with the rest of the body through the spinal cord and the
nerves. They tell the brain what is going on in the body at all times. This system also
gives instructions to all parts of the body about what to do and when to do it.
There are five main senses - touch, smell, taste, hearing and sight. These are the
external sensory system, because they tell you about the world outside your body. Your
senses tell you what is happening in the outside world. Your body's sense organs
constantly send signals about what is happening outside and inside it to your control
center - the brain.
The cerebrum is part of the forebrain. The cerebral cortex is the outer layer of the
cerebrum. Certain areas of the cerebral cortex are involved with certain functions.
Sensory areas such as touch, smell, taste, hearing and sight receive messages from
the skin, nose, mouth, ears and eyes. We feel, taste, hear and see when these messages are
received by the sensory parts of the brain.
The second main part of the nervous system is the peripheral nervous system.
The nervous system is made up of nerve cells or neurons that are "wired" together
throughout the body, somewhat like communication system. Neurons carry messages in
the form of electrical impulses. The messages move from one neuron to another to keep
the body functioning.
Neurons have a limited ability to repair themselves. Unlike other body tissues,
nerve cells cannot also be repaired if damaged due to injury or disease.
23
2. Pathophysiology
A. Book-Based
a. Schematic Diagram
the extend of infarction depends on the location and size of the occluded artery
24
and the adequacy of collateral circulation to the area it supplies.
Lead to damaging both hemispheres of the brain thus leading to paralysis of the body,
speech, and ECG changes of the heart
Leads to cytotoxic edema and cell death area The area of edema after ischemia may lead to
results; temporary neurologic deficits
25
b. Synthesis of the Disease
b.1. Definition of the Disease
The definition of TIA continues to evolve. Traditionally, TIA has been defined as
the presence of neurologic symptoms of vascular etiology in one area of the brain
lasting less than 24 hours. Implicit in this definition is neuronal injury that is not
permanent in nature. However, there are several problems with this definition. It is
now clear through newer diagnostic modalities such as diffusion-weighted magnetic
resonance imaging (MRI) that this time- and symptom-based definition can be
clinically misleading. It assumes a complete correlation between the resolution of
symptoms and normalization of tissue reperfusion, which often underestimates the
potential tissue damage detected by diffusion-weighted MRI. Nearly 50% of patients
who meet the classic definition of TIA have in fact suffered subclinical strokes with
detectable cerebrovascular infarction.
A more accurate definition of TIA has been proposed by the Transient Ischemic
Attack Working Group formed by Albers and Caplan: “a brief episode of neurologic
dysfunction caused by focal brain or retinal ischemia, with clinical symptoms
typically lasting less than one hour, and without evidence of acute infarction”.
b.2. Predisposing/Precipitating Factors
Predisposing Factors
Age: Advancing age is one of the most significant risk factors of stroke.
Sex: Stroke has higher incidence in men due to physical needs and built.
History of TIA/Stroke & HTN in the family: Genetic predisposition of
stroke.
Sedentary lifestyle: Persons with a sedentary life style are at higher risk
for stroke than those with active life styles.
History of HTN: High blood pressure increases the pressure inside
arteries, causing damage. Excessive pressure on the walls of
vessels speeds up hardening and narrowing of the arteries
(atherosclerosis).
Precipitating Factors
26
Cigarette smoking: Smoking injures blood vessel walls and speeds up
hardening of the arteries (atherosclerosis). As a result, the heart
works harder, and blood pressure may increase. Heavy smokers are at
greater risk for TIA and stroke. Daily cigarette smoking can
increase the risk of stroke by 2½ times.
Diabetes Mellitus: People who have diabetes are at increased risk for
many serious health problems, including hardening of the arteries
(atherosclerosis) and heart problems, eye problems that can
lead to blindness, circulation and nerve problems, and kidney
disease and kidney failure.
Thromboembolism: A blood clot or other tissue in the blood (such as fat)
from a part of the body other than the brain can travel through blood
vessels and become wedged in a smaller brain artery. This free-roaming
clot or tissue is called an embolus (emboli is plural). Emboli often form in
the heart. They also commonly form in the neck arteries or within the
aorta.
Stress:
b.3. Signs and Symptoms with Rationale
Blurred vision in both eyes, brief blindness, or double vision
Parietal and temporal lobe strokes may interrupt visual fibers of the optic
tract and route to the occipital cortex and impair visual acuity.
Difficulty speaking
It is caused by cranial nerve dysfunction from a stroke in vertebrobasilar
artery or its branches. It may result from the weakness or paralysis of the muscles of
the lips, tongue, and larynx or form loss of sensation.
Weakness, sometimes on only one side of the body
The deficit is usually caused by a stroke in the anterior or middle cerebral
artery, leading to infarction of motor strip of the frontal cortex.
Vertigo (a whirling or spinning feeling), headache, confusion
They occur due to decreasing oxygen level or total oxygen deprivation.
Loss of consciousness
27
It occurs due to impaired Oxygen absorption, altering or disturbing brain
cell metabolism and functioning.
Chest pain
Anything that compresses a nerve root (like a disc or multiple discs) due
to cardiac ischemia will hurt.
28
B. Client-Centered
a. Schematic Diagram
29
decrease cerebral perfusion
leading to syncope and chest pain, and left sided weakness of the body
30
B. Synthesis of the Disease
b.1. Predisposing/Precipitating Factors
Predisposing factors
History of HPN and stroke on Aunt (mother’s side) & history of
stroke on father: Genetic predisposition of stroke.
Precipitating Factors
Use of birth control pills: Taking birth control pills increases the risk for
TIA because they are said to interfere with peripheral blood flow most
especially when they are taken by cigarette smokers.
Increased fatty food on diet: Too much cholesterol in the blood is not
healthy because it can build up in the walls of arteries, narrowing and
hardening blood vessels (atherosclerosis).
Stress: A person with a stress reaction experiences symptoms of anxiety
when exposed to very stressful events. It is a factor in your environment
that causes your mind or body to be tense. You may react to the stress by
feeling tension, anxiety, fear, anger, frustration or depression and even loss
of body function.
b.2. Signs and Symptoms with Rationale
Weakness, left side of the body
The deficit is usually caused by a stroke in the anterior or middle cerebral
artery, leading to infarction of motor strip of the frontal cortex.
Loss of consciousness
Occur due to impaired Oxygen absorption, altering or disturbing brain cell
metabolism and functioning.
Chest pain
Anything that compresses a nerve root (like a disc or multiple discs) due
to cardiac ischemia will hurt.
31
VI. THE PATIENT AND HER CARE
1. Medical Management
A. IVF
a. 1. Nursing responsibilities:
PRIOR TO INSERTION:
When inserting an IV line to a patient, always prepare all the materials to
be used prior to the insertion.
Wash hands thoroughly before performing the procedure.
Identify the correct patient by checking the name on the chart or by asking
32
directly the patient.
Explain the procedure to the patient.
DURING ADMINISTRATION:
Insert the IV catheter accordingly.
Regulate and monitor infusion rate.
AFTER ADMINISTRATION:
Monitor patient’s therapeutic response to treatment.
Check the IV insertion site for signs of infiltration, bulging, heat, pain and
redness.
B. Drugs
Drugs Action Indication Date ordered, Client’s
date Response
performed,
date changed
or D/C
Generic Name: -Replaces -To prevent Date Ordered: The patient’s
Potassium potassium and hypokalemia 02-22-09 potassium
Chloride maintains level
Brand Name: potassium level returned to
Kalium Durule normal
range.
33
Osmitrol inhibiting tubular failure returned to
reabsorption of normal.
water and
electrolytes; drug
elevates plasma
osmolality;
increasing water
flow into
extracellular fluid.
34
and production (paralyzed)
speed of dopamine areas.
in the striatum,
acting then as
dopominergic
agonist through the
inhibition of
tyrosine
hydroxilase.
b. 1. Nursing responsibilities:
BEFORE ADMINISTRATION:
Check and clarify Doctors order
Prepare equipments
10 R’s of drugs
Performed skin testing
Check for the patient’s medication card and chart.
Performed hand washing
DURING ADMINISTRATION:
Read the name, amount, and expiration date three times
Check for patient’s identification
Explain the procedure to the client
AFTER ADMINISTRATION:
Document
Watch out for any side effects
D. Diet
35
Low salt and To prevent the 02/22/09 - The patient
low fat problems that complied with
result from the the doctor’s
need to withhold order.
food.
c. 1. Nursing responsibilities:
PRIOR TO INITIATION OF DIET:
Explain why diet is desired to client.
DURING INITIATION OF DIET:
Instruct patient and SO to eat healthy foods to promote wellness except those
allergic to the patient.
AFTER INITIATION OF DIET:
Explain to the patient foods that are good for fast recovery.
Instruct SO to observe strictly the diet to improve the nutrition of the patient.
D. Activity
Type of General Indications Date Client’s
Exercise description /purpose ordered, date response
started, date and/or
changed or reaction to
D/C the activity
36
Flexion- Flexion and To increase 02/24/09 Compliance
extension extension the muscle strength.
exercise unaffected
extremities.
d.1 Nursing Responsibilities prior to during and after start of the activity
37
VII. NURSING CARE PLAN
Problem No. 1
Cues Nursing Scientific Nursing Nursing Rationale Expected
Diagnosis Explanation Objectives interventions Outcome
S> Ø Encourage Enhance The pt’s
Ineffective Because there’s After 1 hour of early venous condition in
O> Body peripheral an decrease in NPI, pt’s ambulatio return circulation of
weakness tissue oxygen supply condition in n when the lower
Paralysis perfusion r/t in our body it circulation of possible extremity shall
of left impaired fails to nourish the left lower have
lower transport of the the tissues at extremity will Elevate To increase progressed.
extremitie O2 across the capillary have progress. HOB at gravitation
s alveolar and level resulting night al blood
BP of capillary to tissue flow
100/60 membrane perfusion
AEB paralysis Heat
of left lower Exercise increases
extremity caution in the
use hot metabolic
water demands
bottles or of already
heating pads compromis
ed tissue
Encourage Smoking
to minimize causes
places that vasoconstri
are high in ction and
smoke further
compromis
ed
perfusion
Problem No. 2
38
CUES NURSING SCIENTIFIC NURSING NURSING RATIONALE EXPECTED
DIAGNOSIS EXPLANATION OBJECTIVE INTERVENTIONS OUTCOME
S > “Di ko Impaired Due to the After 1° of Assist in self-care To promote The pt. shall
magalaw physical impairment of nursing activities. independence have
‘tong left mobility r/t blood flow in the intervention, and participated in
foot ko… neuromuscular brain’s the pt. will be enhancement of ADL’s and
Wala ring impairment neurologic able to self-concept. with the
pakiramda AEB paralysis branches, participate in desired
m of the lower dysfunction ADL’s and Encourage energy- To prevent activities.
hanggang left extremity. occurs resulting with the conserving fatigue and
waist…” to ineffective desired techniques. overexertion.
impulses sent to activities.
O > The pt. different body Provide pt. with To provide time
manifeste parts specifically ample time to to rechannel
d the ff: the extremities. perform mobility- energy and to
Numbness and related tasks. prevent exertion
with inability to move and
limited the affected area overexhaustion.
ability to occurs and
perform decreases the pt’s Place pillows on To promote
gross ability to perform the right side of the safety and to
motor desired and bed. prevent injury.
skills necessary
with activities. Change lying To prevent
difficulty position every 2 stasis of blood
in turning hours. and to reduce
with the risk of
slowed pressure ulcers.
movement
needs Offer fluids and To aid in
assistance reinforce nutritious supplementing
upon foods. normal body
39
ambulatio functions.
n
with Reinforce low salt, To assure
paralysis low fat diet. compliance
of the left with daily diet
lower regimen and to
extremity provide a
PR: continuous
54bpm recovery state.
Problem No. 3
NURSING SCIENTIFIC
CUES OBJECTIVE INTERVENTION RATIONALE EVALUATION
DIAGNOSIS EXPLANATION
40
patient unable to ability to
move the left side participate
of her body most in activities
especially the left
side of the body.
Leading the
patient to suffer
Activity
Intolerance.
41
VIII. DISCHARGE PLAN
After NPI, the pt. will Exercise 1 hour Lecture-discussion and The pt. shall have
be able to comply and Advise to: demonstration complied and have
verbalize Do deep breathing verbalized
understanding on exercises. understanding on
provided health Have ambulation with provided health
teachings and home assistance and support teachings and home
maintenance as tolerated. maintenance
management. Perform ADLs management.
involving hygiene and
self-care.
Treatment
Instruct to:
Comply strictly with
drug treatment
regimen.
Health Teachings
Demonstrate to:
Place pillows on bed
when asleep to prevent
injury and other
accident precautions.
Support the affected
part to prevent
development of
pressure ulcers.
Provide adequate rest
42
periods.
Provide energy
conservation
techniques.
Make up activities that
increase the well
being.
Out-Patient
Instruct to:
Return a week after
discharge as ordered
by the physician.
Diet
Reinforce to:
Maintain a low salt,
low fat diet.
Increase fluid, fruit
and vegetable intake.
43
IX. LEARNING DERIVED FROM THE STUDY
44