Cerebrovascular Accident: “A Case

Study Presentation”

Submitted to:

Mr. Roque Cordero II, RN

In Partial Fulfillment

On the Course

NCM 103

Submitted by:

Cyrus Tubeza Jr.

Marie Alejandro

Kate Modesto

Kristine Young

October 9, 2018
 INTRODUCTION

Cerebrovascular accidents are the problems that result from inadequate blood

supply to the brain. CVA or in Layman’s term, “stroke” is probably the first disorder that

comes to the mind in considering cerebrovascular disorders.

A cerebrovascular accident or stroke is infarction of a specific portion of the brain

due to insufficient blood supply. It can occur from an occlusion of one of the major

vessels feeding the brain, a partial or complete obstruction of a major intracranial

vessel, or it can also be a hemorrhage within the brain. The blood vessels affected

determines the area and extent of infarction.

The third most common cause of death in most countries is CVD disorders,

approximately 0.5 to 1.0 per 1000 people. The narrowing or complete closure of one of

the vessels supplying the brain is the most common cause of this accident.

Furthermore, thrombosis, embolism and hemorrhage are included. Thrombosis is the

most common cause of stroke and is usually due to atherosclerosis or the fat or lipid

deposition in the major vessel of the cranium. It may occur anywhere along carotid

artery and its branches; a common site is at bifurcation of the common carotid into the

internal and external carotid arteries. Cerebral embolism is the occlusion of the cerebral

vessel by emboli and some fragments of clotted blood, tumor, fats, bacteria and even

air. Intracerebral hemorrhage results from rupture of a cerebral vessel that causes the

bleeding into brain tissue.

There are risk factors prior to the recurrence of CVA such as hypertension,

polycythemia, hypercholesterolemia, smoking, oral contraceptives use, emotional

stress, obesity, family history of stroke and age. This condition may alter the original

circulation of blood, then leads to stroke. In line with this, as we all know almost all of

the illicit drugs, alcohol and nicotine found in cigarettes are one of the potent

vasoconstrictor.
 Stroke depends primarily on the location of the lesion or infracted tissue. If the

brain stem is affected, blood pressure fluctuations altered respiratory patterns and

cardiac dysrythmias are all possible.

Coma can follow stroke from various causes; strokes due to occlusal disease

(thrombus, embolus) rarely caused sudden death. When sudden death thus occurs it is

usually due to heart failure. Respiratory infection and brain stem failure are two primary

causes of death with stroke.

In lieu of the forgoing study, the Researchers presented this case study to

enhance the level of competency not only for the health care providers and the health

institution itself, but also for the knowledge enhancement of ordinary people.
 PATIENT PROFILE

Name : FBB

Age : 51 years old

Address : Maybato Sur, San Jose, Antique

Religion : Iglesia Ni Cristo

Civil Status : Married

Date and Time Admitted: 09/29/2018

11:40 AM

Date of Interview: October 4, 2018

Informant : M. B.

Relationship to the Patient: Husband

Chief Complain: Right sided weakness

Admitting Diagnosis: Cerebrovascular accident, Bleed vs infarct at the left FFP

Admitting Physician: E. M. D, MD

History of Present Illness

The patient is having Cerebrovascular Accident (CVA) or commonly known as

stroke. According to her, the symptoms started on September 29, 2018 (Saturday). The
patient had many chores to do that day, after feeding her pig, she went to the field to dry
the rice grains, then immediately washed the laundry at her house. She started to feel
coldness in her right extremities, light headed and nauseaous while hanging the clothes.
Then she felt numbness in the right side of her body.

Past Medical History

The patient had a cyst on her ovary 5years ago, she experienced bleeding for
three days. She had an ultrasound and her doctor prescribed medicine for her. She said
she completed taking the medicine for two months but was unable to return to her
doctor for a follow up check up. She went to the RHU instead and had an ultrasound.
The patient stated that the finding was negative.

Past Surgical History

The patient had not undergone any surgeries.

 PHYSICAL ASSESSMENT

General Survey:

Body build, height and weight in relation to the patient’s age is proportional;

patient is conscious and coherent; partially assisted during hospitalization.

Vital Signs:

Blood Pressure: 130/80 mmHg

Temperature: 37.1oC

Respiratory Rate: 22 resp/min

Pulse Rate: 70 bpm

02sat: 99%

Body Part Tools Normal Findings Interpretation

Skin and Nails Inspection, Varies from light to Normal

Palpation deep brown;
uniform skin
temperature and
within normal
range; skin turgor;
normal nail texture;
highly vascular and
pink color of nails

Hair Inspection Evenly distributed Normal

hair; thick and silky;
no infections or
infestations;
 variable amount of
hair

Head Inspection, Rounded; smooth Normal

palpation skull contour;
uniform
consistency;
symmetric facial
features and
movement

Eyes Inspection, Eyebrows Normal

palpation symmetrically
Penlight aligned; skin intact;
no discharge; no
discoloration;
transparent; shiny
and smooth cornea;
pupils are black in
color; round and
smooth;
coordinated ocular
movements and
move in unison.
Inspection, Symmetrical; Normal
Ears palpation auricle aligned with
outer canthus of the
eye, firm, and not
tender.
Inspection, External nose is Normal
Nose palpation symmetric and
straight; no
discharge; uniform
in color
Inspection, Lips are pink in Normal
Mouth palpation color; soft and
moist; gums is pink,
moist and pink in
texture.
 Inspection Muscles equal in Normal
Neck size and head
centered;
coordinated and
smooth head
movements with no
discomfort; equal
muscle strength;
not palpable lymph
nodes.
Stethoscope, Chest symmetric; Normal
Thorax and lungs inspection and supine vertically
palpations aligned, skin and
chest wall is intact;
full and symmetric
chest expansion;
costal angle is less
than 90 degrees.

Abdomen Inspection, Uniform in color; no Normal

auscultation, evidence of
palpation, enlargement of liver
percussion or spleen;
symmetric
movements caused
by palpations;
audible bowel
sounds; no
tenderness in
abdomen; relaxed
with smooth and
consistent tension.

Glasgow Coma Scale

Behavior Response Score

Eye opening response Spontaneously 4

Bets verbal response Oriented to time, place, and person 5

Best motor response Obeys command 5

Total score Best response 14

MRC (Medical Research Council) Scale

>Grade limb movement Right arm → 4 (Active movement with against

gravity and resistance)

Right leg → 4 (Active movement with against

gravity and resistance)

Left arm → 1 (No contraction)

Left leg 1 (No contraction)

Gordon’s 11 Functional Pattern

 Before Hospitalization
 Patient FBB viewed health
as a state in which she can
perform her work daily and
with the absence of illness
and disease, she
considered herself as a
Health healthy human being. She
Perception never had a check up with
the doctor and if she
experienced fever, cough
and colds,she just takes
OTC drugs such as
Paracetamol, Neozep, and
Bioflu. Patient FBB cannot
recall if she is fully
immunized.
 The patient had no
allergies to foods and
drugs, she eats her meals
3x a day with no snacks in
Nutritional between. She drinks 2-3
Metabolic liters of water a day, she
Pattern also drinks 1 cup of coffee
in the morning. She never
drinks alcohol, she does
not take any vitamins.
 The patient usually voids
6x a day, she defecates
once daily. She doesn’t
Elimination experience any problems
Pattern in voiding and defecating.
She never used any
chemical laxatives and
stool softeners.
 Patient does most of the
household chores such as
Activity and cleaning the house and
Exercise doing laundry, also does
Pattern pig-raising and drying rice
grains in the sun.
During Hospitalization
 The patient stated that she feels
she is not healthy anymore due to
her condition. She struggles to
adjust with the changing
environment as she is used to
being always busy with her daily
routine and now she is just lying
down and doing nothing in her
bed. She is willing to listen and
accept health teaching and she
wants to recover as soon as
possible. She complies with all
her medication and orders from
the health care team.
 The patient is under DAT(Diet as
tolerated). She rarely eats food
served in the hospital, her family
brings food for her everyday. She
drinks 1liter of water a day and
also I cup of milk every morning.
 The patient usually voids about 4-
6x a day, she defecates once
daily. The patient doesn’t have a
problem regarding voiding and
defecating.
 She can only perform limited
activities due to her condition. The
doctor says she should avoid
getting tired. Her exercise is
walking around the hospital
vicinity.
  The patient usually sleeps  The patient sleeps at 9:00pm and
7-8 hours , her earliest wakes up at 3:00am. She is
time going to sleep is 11pm sometimes distracted and her
and she wakes up at sleep is interrupted due to the
Sleep-Rest 6:00am. She doesn’t take visitors and other health care
Pattern naps in the afternoons. team.
She doesn’t have any
difficulties in going to sleep
and doesn’t use any
medication to promote
sleep.
 The patient is oriented to  The patient is oriented to time and
people, time and place, place and she is aware of her
responses to stimuli condition.
verbally and physically.
She can speak and
Cognitive and understand Cebuano and
Perceptual Hiligaynon and can
Pattern understand tagalog. Her
highest educational
attainment is grade six and
she is able to read and
write.
 The patient is able to  The patient states that she believe
express her feelings about the admission will help her get
Self her condition. Money better
Perception/Sel problems and sometimes
f Concept conflict between family
members are the things
that made her feel
stressed.
 The patient plays the role  The patient is well-supported by
Role of mother to her children her family. They provided her
Relationship and a wife to her husband, comfort and reassurance and she
Pattern she spends most of her receives positive reinforcement
time taking care of the from them.
family’s needs.
 The patient copes up with  The patient rests when she feels
stress by watching soap tired and takes a nap. She is very
Coping Stress
operas on the tv, cleaning vocal about her desire to recover
Pattern the house and talking to and she fully accepts her
her friends. Whenever situation, stating that she will
family problems occur, the cooperate with the doctor.
patient talks with her family
and they try to resolve it.

 The patient had her first  The husband of the patient

Sexual menstruation at age 11, got claimed that they are not sexually
Reproductive married at 22 and had 5 active due to her health condition.
Pattern children with her husband

 The patient’s religious  The patient’s relationship with

Values Belief affiliation is Iglesia ni God remains unchanged. She
Pattern Cristo, she went to church believes God will not give her a
with her husband and kids. burden she cannot carry.
She believes in quack
doctors.

ANATOMY AND PHYSIOLOGY

(Nervous System)
 The nervous system integrates and monitors the countless actions

occurring simultaneously throughout the entire human body. Therefore, every task, no

matter how menial, accomplished by a person is a direct result of the components of the

nervous system. These actions can be under voluntary control, like touching a computer

key, or can occur without your direct knowledge, like digesting food, releasing enzymes

from the pancreas, or other unconscious acts.

It is difficult to understand all the complexities of the nervous system

because the field of neuroscience has rapidly evolved over the past 20 years. Moreover,

answers to new questions are being found almost daily. However, a thorough

knowledge of the individual components of the nervous system and their functions will

lead to a better understanding of how the human body works and facilitate the

acquisition of knowledge in the future.

The nervous system consists of two parts; the central nervous system

(CNS) consists of the brain and spinal cord and the peripheral nervous system (PNS)

consists of nerve outside the CNS.

Nerves of the PNS are classified in three ways. First, PNS nerves are

classified by how they are connected to the CNS. Cranial nerves originate from or

terminate in the brain, while spinal nerves originate from or terminate at the spinal cord.

Second, nerves of the PNS are classified by the direction of nerve propagation. Sensory

(afferent) neurons transmit impulses from skin and other sensory organs or from various

places within the body to the CNS. Motor (efferent) neurons transmit impulses from the

CNS to effectors (muscles or glands). Third, motor neurons are further classified

according to the effectors they target. The somatic nervous system (SNS) directs the

contraction of skeletal muscles. The autonomic nervous system (ANS) controls the

activities of organs, glands, and various involuntary muscles, such as cardiac and

smooth muscles.

The autonomic nervous system has two divisions; the sympathetic

nervous system is involved in the stimulation of activities that prepare the body for

action, such as increasing the heart rate, increasing the release of sugar from the liver
into the blood, and other activities generally considered as fight-or-flight responses

(responses that serve to fight off or retreat from danger) and the parasympathetic

nervous system activates tranquil functions, such as stimulating the secretion of saliva

or digestive enzymes into the stomach and small intestine.

Generally, both sympathetic and parasympathetic systems target the

same organs, but often work antagonistically. For example, the sympathetic system

accelerates the heartbeat, while the parasympathetic

slows the heartbeat. Each system is stimulated as is

appropriate to maintain homeostasis.

The brain is an organ located in the skull.

It weighs about 3 pounds. The senses

(taste, smell, sight, hearing, and touch),

emotions, thoughts, and movement are

controlled by the brain. The right side of the brain controls the left side of

the body and the left side of the brain controls the right side of the body.

There are three main part of the brain: the cerebrum, the cerebellum, and the

brain stem. Cerebrum controls higher brain functions and has four lobes, each

with different functions:

 Frontal lobe: executive function, decisions, personality, language, planning,

movement

 Parietal lobe: intelligence, reasoning, sensation, reading

 Occipital lobe: vision

 Temporal lobe: language, behavior, hearing, vision, emotions, memory

Cerebellum controls balance, coordination, and fine muscle control.

The Spinal cord starts at the brain stem and goes to the tail bone. It is

about as wide as your little finger and extends the length of your back. Messages are

carried from the spinal cord to and from the brain to the rest of the body. Nerves extend
from the spinal cord on each side and go to the parts of the body. The brain and spinal

cord are protected by bony structures: the skull and the spinal column.

Meninges are membranes that cover and protect the brain and spinal

cord.

There are three layers of meninges: Dura mater (closest to the bone), Arachnoid loosely

around the brain, Pia mater is closely attached to the brain and spinal cord surface.

Cerebrospinal Fluid (CSF) cushions the brain and spinal cord. It is a clear,

water-like fluid, also called spinal fluid, found between the arachnoid and pia mater. It is

made within the four ventricles of the brain. The area in the lateral ventricles that makes

spinal fluid is called the choroid plexus. About 20cc of spinal fluid is made but not

absorbed each hour. There is about 140 cc (about ½ can of soda) of spinal fluid that

surrounds the brain and spine. The brain and spinal cord are bathed and cushioned by

this spinal fluid, which flows and circulates around the brain and spine.
 PATHOPHYSIOLOGY

Risk Factors:
 Sedentary Lifestyle

 Substance Abuse
 Increased lipid and

Hypertension Hyperlipidemi
Arterioschlero a

Thrombi

Atheroschlero

Dislodged
Thrombus
from Sire of

Emboli
Obstruction in

Increased
Pressure in

Transient

Cerebral Cerebral
Blood Vessel Blood Vessel

Brain Spasm of
Tissue Adjacent

Cerebrovascular
Accident with Bleeding
 Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Reactions
Frequency, Timing)

Generic Name: Classification: Indication: Headache, flatulence, 14 Rights of Medication

Atorvastatin Dyslipidaemic agent Reduction of risk of diarrhoea, nausea, 1. Right Drug/Medication
stroke and heart attack 2. Right Client/Patient
vomiting, anorexia, 3. Right Route
Brand Name: in type 2 diabetes xerostomia, 4. Right Dose
Lipitor patients without angioedema, myalgia, 5. Right Time & Frequency
evidence of heart
Mechanism of rash/pruritus, alopecia, 6. Right Assessment
disease but with other 7. Right Approach
Action: CV risk factors, and
allergy, infection, chest
8. Right Education
Atorvastatin revascularization pain. 9. Right Evaluation
Dosage: competitively inhibits procedures in patients 10. Right Documentation
80mg 1tab HMG-CoA reductase, without evidence of Potentially Fatal: 11. Right to Refuse
the enzyme that coronary heart disease Thrombocytopenia. 12. Right Principle of Care
catalyses the (CHD) but with Rhabdomyolysis with 13. Right Prescription
multiple risk factors 14. Right Nurse Clinician
Route: conversion of HMG- acute renal failure
 Stress that atorvastatin is an
Oral CoA to mevalonic other than diabetes
adjunct to– not a substitute
acid. This results in (eg, smoking, HTN, low for low-cholesterol diet
Frequency: the induction of the HDL-C, family history  Tell patient to take drug at the
of early CHD) Patients same time each day to
OD LDL receptors,
with CHD, to reduce maintain its effects
leading to lowered risks of MI,  Instruct patient to take a
LDL-cholesterol revascularization missed dose as soon as
Timing: concentration. procedures, possible. If it’s almost time
HS hospitalization for CHF, for his next dose, he should
and angina skip the missed dose.
 Advise patient to notify
Contraindication: prescriber immediately if he
Hypersensitivity, active develops unexplained muscle
pain, tenderness, or
liver disease or
weakness, especially if
unexplained persistent accompanied by fatigue or
elevations of serum fever
transaminase,
porphyria, pregnancy,
lactation
 Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Reactions
Frequency,
Timing)

Generic Name: Classification: Indication: Mild to moderate  Observe 14 rights in

Azithromycin Antibiotics Treatment of lower nausea, vomiting, medication
respiratory infections: abdominal pain,  Monitor patient for
Acute bacterial dyspepsia, flatulence, superinfection. Drug may
Brand Name: exacerbations of COPD diarrhoea, cramping; cause overgrowth of
Zithromax,Zmax due to Haemophilus angioedema, cholestatic nonsusceptible bacteria or
influenzae, jaundice; dizziness, fungi.
Moraxellacatarrhalis, headache, vertigo,  If patient vomits within
Dosage: Streptococcuspneumoni somnolence; transient 60minutes of taking Zmax,
500mg 1 tab ae;community-acquired elevations of liver notify prescriber;
pneumonia due to enzyme values. additional or different
Mechanism of S.pneumoniae, therapy may be needed.
Action: H.influenzae  Monitor patient for allergic
Route: Azithromycin blocks and skin reactions.
Oral transpeptidation by Contraindication: Discontinue drug if
binding to50s Contraindicated in reaction occurs.
ribosomal subunit of patients hypersensitive  Monitor patient for
susceptible to azithromycin, jaundice,
Frequency: organisms and erythromycin, or other hepatotoxicity, and
OD disrupting RNA- macrolide or ketolide hepatitis.
dependent protein antibiotics and in those Discontinue drug
synthesis at the chain with history of immediately if signs
elongation step cholestatic jaundice or and symptoms
Timing: hepatic dysfunction from (yellowing of skin or
prior use of sclera, abdominal
azithromycin. pain, nausea,
vomiting, dark
urine) occur.
 Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Reactions
Frequency,
Timing)

Generic Name: Classification: Indication:  CNS: Observe the14 Rights of

Clopidogrel Antiplatelet agents; Reduction of Depression, Dizziness, Medication
Platelet aggregation atherosclerotic Fatigue, Headache.
Brand Name: inhibitors events(MI, stroke,  EENT: Implementation
Plavix vascular death) in Epistaxis.
patients at riskfor such Discontinue clopidogrel 5-7
 Resp:
eventsincluding recent days before planned surgical
Cough, Dyspnea.
Mechanism of MI,acute  CV: procedures.
Dosage: Action: coronarysyndrome Chest Pain, Edema, PO:
75mg 1 tab Inhibits the binding of (unstable angina/non-Q- Hypertension. Administer once daily without
adenosine waveMI), stroke, or  GI: regards to food.
diphosphate (ADP) to peripheral vascular GI Bleeding, Abdominal
Route: its platelet receptor, disease. Pain, Diarrhea,
Oral impeding ADP- Contraindication: Patient/Family Teaching
Dyspepsia, Gastritis. Instruct patient to take
mediated activation Contraindicated in:
 Derm:
and subsequent Hypersensitivity medication exactly as
Pruritus, Purpura, Rash.
Frequency: platelet aggregation, Pathologic bleeding directed. Take missed doses
 Hemat:
OD and irreversibly (peptic ulcer, intracranial as soon as possible unless
Bleeding, Neutropenia,
modifies the platelet hemorrhage). almost time for next dose; do
Thrombotic
ADP receptor. Use Cautiously in:
Thrombocytopenic not double doses. Advise
Timing: Patients at risk for
7am Purpura. patient to notify health care
bleeding
(trauma,surgery, or  Metab: professional promptly if fever,
other pathologic Hypercholesterolemia. chills, sorethroat, or unusual
conditions)History of GI  MS:
bleeding or bruising occurs.
bleeding/ulcer disease Arthralgia, Back Pain.
Advise patient to notify health
Severe hepatic  Misc:
Fever, Hypersensitivity care professional of
impairment
Reactions medication regimen prior to
 treatment or surgery

Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Reactions
Frequency,
Timing)
Generic Name: Classification: Indication: Observe the14 Rights of
 Minimal GI upset.
Paracetamol Non-narcotic analgesic, Mild to moderate pain Medication
Antipyretic and fever.  Methemoglobinemia
 Hemolytic Anemia -Advise patient that drug is
Mechanism of Action:  Neutropenia only for short term use and
Brand Name:
Biogesic Decreases fever by inhibiting  Thrombocytopenia to consult the physician if
the effects of pyrogens on  Pancytopenia giving to adults for longer
the hypothalamic heat  Leukopenia than 10 days.
regulating center and by a Contraindication:
Dosage: hypothalamic action leading  Urticaria
-Advise patient or
500 mg 1 tab to sweating and vasodilation. Hypersensitivity:  CNS stimulation
caregiver that many over
Relieves pain by inhibiting  Hypoglycemic coma the counter products
prostaglandin synthesis at Intolerance
 Jaundice contain acetaminophen; be
the CNS but does not have
Route: anti-inflammatory action  Glissitis awareof this when
Oral because of its minimal effect  Drowsiness calculating total daily dose.
of peripheral prostaglandin  Liver Damage
synthesis -Warn patient that high
Frequency: doses or unsupervised
Q4H
long term use can cause
Timing: liver damage.
6, 10, 2, 6

Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Reactions
Frequency, Timing)
Generic Name: Classification: Indication: CNS: headache,  14 Rights of Medication
Nicardipine HCl Therapeutic class: For treatment of dizziness,  Closely monitor BP and
Antihypertensives chronic stable lightheadedness, HR.
angina, hypertension asthenia, drowsiness,  Tell patient to report
Brand Name: Pharmacologic class: paresthesia injection site pain
Cardene IV Calcium channel  Advise patient to report
blockers CV: angina, peripheral chest pain immediately.
edema, palpitations,
 Tell patient to get up
Dosage: flushing, hypotension,
from a sitting or lying
2mg tachycardia,
position slowly to avoid
Mechanism of Contraindication:
dizziness caused by a
Action: Contraindicated in GI: nausea, vomiting,
decrease in BP.
Route: Inhibits calcium ion patients abdominal discomfort,
 Tell patient drug may be
IV influx across cardiac hypersensitive to dry mouth
taken with or without
and smooth muscle drug and in those
food but shouldn’t be
cells but is more with advanced aortic Musculoskeletal: myalgia
taken with high-fat foods
selective to vascular stenosis and weakness
or grapefruit products.
Frequency: smooth muscle than
cardiac muscle. Drug Skin: rash, diaphoresis,
also dilates coronary injection-site reaction
artery and arterioles.
Timing:

Name of Drug Classification and Indication and Side Effects or Adverse Nursing
(Dosage, Route, Mechanism of Action Contraindication Reactions Responsibilities
Frequency,
 Timing)

Generic Name: Classification: Indication: Shock: rarely, shock  Observe the 14

Citicoline Central stimulant, Treatment of stupor may occur. rights of
Nootropic agent caused by head trauma, medication
cerebral surgery, acute Hypersensitivity:
Brand Name: stage of cerebral eruption may occur, in  Instruct patient to
Citilin infarction and hemiplegia this case administration take medication as
Mechanism of Action:
after cerebral apoplexy. should be discontinued. prescribed.
Citicoline consumption
promotes brain
Dosage: Psychoneurologic:  Teach the patient
metabolism by restoring
1gm headache, vertigo, that citicoline may
phospholipid content in
Contraindication: excitation can develop. be taken with or
the brain and regulation
Patients with without food.
of neuronal membrane
parasympathetic Gastrointestinal:
excitability. It also
Route: hypertonia occasionally, nausea  Monitor for adverse
influences the
IV and rarely anorexia may effects; instruct
mitochondria or energy
factories of the brain occur patient to report
cells and found to immediately if
Frequency: Hepatic: abnormalities he/she develops
improve memory
Q12H in hepatic test may chest tightness, the
function. After several
clinical trials, Citicoline occur. tingling in mouth
has been shown to raise and throat,
the amount of Others: sometimes, headache, diarrhea
acetylcholine in the burning sensation, and blurring of
Timing: temporary change in vision.
brain.
7, 7 blood pressure and
malaise may appear

Name of Drug Classification and Indication and Side Effects or Adverse Nursing
(Dosage, Route, Mechanism of Action Contraindication Reactions Responsibilities
Frequency, Timing)

Generic Name: Classification: Indication:  Cold or flu  Observe the 14

Losartan Angiotensin receptor Treatment of symptoms such as rights of
blockers (ARB), hypertension, alone or stuffy nose, medication
Antihypertensive in combination with sneezing, sore
Brand Name: other hypersensitive throat, fever;  Administer
Cozaar agents  Dry cough without regard to
 Muscle cramps meals
 Pain in your legs or
Dosage: Mechanism of Action: back  Monitor patient
50 mg 1tab Selectively blocks the  Stomach pain, closely in any
binding of angiotensin II diarrhea situation that may
to specific tissue  Headache, dizziness lead to a
receptors found in the Contraindication: decrease in blood
 Tired feeling or
Route: vascular smooth muscle Contraindicated with pressure
 Sleep problems
Oral and adrenal gland; this hypersensitivity to secondary to
(insomnia)
action blocks the losartan reduction in fluid
Frequency: vasoconstriction effect volume—
OD of the renin-angiotensin excessive
system as well as the perspiration,
release of aldosterone dehydration,
Timing: leading to decreased vomiting, diarrhea
blood pressure. —excessive
hypotension can
occur

Name of Drug Classification and Indication and Side Effects or Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Adverse Reactions
Frequency, Timing)

Generic Name: Classification: Indication: Hypercalcemia may  Observe the 14 rights

Ketoanalogue+ Other drugs acting on Prevention and develop of medication
Essential Amino the Genito-Urinary therapy of damages
Acids System due to faulty or 
deficient protein
metabolism in chronic
Mechanism of Action: renal insufficiency in
Brand Name: Ketolog tablet works by connection with limited
Ketolog diminishing the rate of protein food of <40
urea in the body and in g/day (for adults).
the body fluids;
Dosage: activating the muscle
600mg 1tab protein anabolism in the Contraindication:
elderly Hypercalcemia,
Route: disturbed amino acid
Oral metabolism. In case of
hereditary
Frequency: phenylketonuria, it has
TID to be taken into
account that Ketolog
contains
Timing: phenylalanine.

Name of Drug Classification and Indication and Side Effects or Adverse Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Reactions
Frequency, Timing)

Generic Name: Classification: Indication: CNS: headache,  Observe the 14 rights

Bisoprolol Therapeutic class: Hypertension dizziness, hypoesthesia, of medication
Antihypertensives insomnia, asthenia,
Brand Name: fatigue  Monitor BP closely.
Zebeta Pharmacologic class: Contraindication:
selective beta blockers Contraindicated in CV: chest pain,  Avoid use in patients
patients peripheral edema, with acute HF because
Dosage: hypersensitive to bradycardia of worsening of
15mg Mechanism of Action: drug and in those disease.
Selectively blocks with cardiogenic EENT: dry mouth,
Route: cardiac adrenoceptors, shock, overt cardiac pharyngitis, rhinitis,  Use cautiously in
Oral reducing resting and failure, second- or sinusitis patients with known
exercise HR, decreasing third –degree AV compensated HF.
Frequency: cardiac output, block, or marked GI: diarrhea, nausea
OD depressing rennin sinus bradycardia and vomiting  Tell patient to report
secretion, and slowed heartbeat,
decreasing tonic MUSCULOSKELETAL: difficulty breathing, or
Timing: sympathetic outflow Arthralgia other signs of HF.
from the vasomotor
centers in the brain. Respiratory:  Warn diabetic patient
Cough, dyspnea, URI that bisoprolol may
mask signs and
SKIN: sweating symptoms of
hypoglycaemia.

Name of Drug Classification and Indication and Side Effects or Nursing Responsibilities
(Dosage, Route, Mechanism of Action Contraindication Adverse Reactions
Frequency, Timing)

Generic Name: Classification: Indication:  Mild gastric  Observe the 14 rights of

Betahistine diHCl Anti vertigo drug Contraindication: complaints medication
Hypersensitivity to
betahistine diHCl or to  Skin rashes  Instruct patient that drug
Brand Name: any of the exepients of should be taken with food
Serc Mechanism of Serc.
Action:
Serc exerts a relaxant
Dosage: action on the
16mg 1 tab precapillary
sphincters of the
Route: microcirculation of the
oral inner ear, and thereby
increases the blood
supply to the stria
Frequency: vascularis of the
OD labyrinth.
Investigations into the
Timing: acute, sub acute and
chronic effects of
betahistine in animals
have demonstrated
the low toxicity and
safety of the drug
 LABORATORY AND DIAGNOSTIC STUDIES

Name of examination: Electrolytes Test

Definition: Electrolytes are minerals that are found in the body tissues and
blood in the form of dissolved salts. As electrically charged
particles, electrolytes help move nutrients into and wastes out of
the body’s cell, maintain a healthy water balance, and help stabilize
the body’s acid/ base (pH) level.

Preparation: Requires no specific preparation.

Purpose: To detect problem with the body’s electrolyte balance

Date: September 30, 2018

Electrolytes Result Form

Constituent Result Normal Values Interpretation

Sodium 149.1 mmol/L 135-145 Indicates water excess.

Indicates decreased kidney

Potassium 4.68 mmol/L 3.4-4.0 functioning.

Chloride - 92-102

Calcium - 2.02-2.6

Name of examination: Creatinine Test

Definition: Creatinine blood test measures the level of creatinine in blood.
Creatinine is a waste product that forms when creatinine, which is
found in your muscle, breaks down. Creatinine levels on the blood can
provide your doctor with information about how well your kidneys are
working

Preparation: Creatinine blood test doesn’t require much preparation. Fasting isn’t
necessary. You can and should eat and drink the same as you
normally to get an accurate result.

Purpose: To access your creatinine levels if you show signs of kidney disease.

Date: September 30, 2018

Results Normal Values Significance

164.0 umol/L Male:59 – 104 Elevated level indicates

Female:45 - 84 impaired kidney function

Name of examination: Hematological Test

Definition: Hematology is the study of blood and its disorders. Hematology
tests can help diagnose anemia, hemophilia, blood-clotting
disorders, and leukemia. It is actually a panel of tests that examines
different parts of the blood. It also helps to determine the general
health status of the patient.

Preparation: If your blood sample is being tested only for a complete blood
count, you can eat and drink normally before the test.

Purpose:

 To review your overall health. Your doctor may recommend a complete blood
count as part of a routine medical examination to monitor your general health and
to screen for a variety of disorders, such as anemia or leukemia.

 To diagnose a medical condition. Your doctor may suggest a complete blood

count if you're experiencing weakness, fatigue, fever, inflammation, bruising or
bleeding. A complete blood count may help diagnose the cause of these signs
and symptoms. If your doctor suspects you have an infection, the test can also
help confirm that diagnosis.

 To monitor a medical condition. If you've been diagnosed with a blood disorder

that affects blood cell counts, your doctor may use complete blood counts to
monitor your condition.

 To monitor medical treatment. A complete blood count may be used to monitor

your health if you're taking medications that may affect blood cell counts.

Date: September 29, 2018

 Result Normal Range Interpretation

Has normal oxygen

Hemoglobin 128 gm/l 120-180 carrying capacity of
the blood.

Has normal pack of

Hct .379 0.370-0.540
RBC/ blood viscosity.

Electrolyte count x109/L 4.0-6.0

Leucocyte count x109/L 4.6-10.0

Differential Count

Increased level
indicates acute
Neutrophils Bands .78 0-0.05
infection, stress or
trauma

Segmenter .78 0.60-0.70

Indicates increased
Lymphocytes .19 0.20-0.40
WBC capacity.

Monocytes 0-0.07

Eosinophils 0-0.08

Basophils 0-0.1

Low level may

Platelet count 242 340-360 indicate
thrombocytopenia

Name of Examination: ALANINE AMINOTRANSFERASE (ALT/SGPT)

Definition: ALT is an enzyme found in the liver that helps your body metabolize
protein. When the liver is damaged, ALT is released into the
bloodstream and levels increase.

Preparation: Certain foods and medications can affect the results of your liver
function tests. Your doctor will probably ask you to avoid eating
food and taking some medications before your blood is drawn.

Purpose: Liver function tests can be used to:

 Screen for liver infections, such as hepatitis

 Monitor the progression of a disease, such as viral or alcoholic hepatitis,

and determine how well a treatment is working

 Measure the severity of a disease, particularly scarring of the liver (cirrhosis)

 Monitor possible side effects of medications

Date: September 30, 2018

Results Normal Values Significance

34 u/L Male:up to 41 Elevated level indicate liver

Female:up 31 damage.
Name of Examination: Computed Tomography Of The Brain

Definition : Computed tomography (CT) of the head uses special x-ray equipment to
help assess head injuries, severe headaches, dizziness, and other
symptoms of aneurysm, bleeding, stroke, and brain tumors. It also helps
your doctor to evaluate your face, sinuses, and skull or to plan radiation
therapy for brain cancer. In emergency cases, it can reveal internal injuries
and bleeding quickly enough to help save lives.

Preparation: You should wear comfortable, loose-fitting clothing to your exam. You may
be given a gown to wear during the procedure.

Metal objects, including jewelry, eyeglasses, dentures and hairpins, may

affect the CT images and should be left at home or removed prior to your
exam. You may also be asked to remove hearing aids and removable
dental work. Women will be asked to remove bras containing metal
underwire. You may be asked to remove any piercings, if possible.

You will be asked not to eat or drink anything for a few hours beforehand,
if contrast material will be used in your exam. You should inform your
physician of all medications you are taking and if you have any allergies. If
you have a known allergy to contrast material, or "dye," your doctor may
prescribe medications (usually a steroid) to reduce the risk of an allergic
reaction. These medications generally need to be taken 12 hours prior to
administration of contrast material. To avoid unnecessary delays, contact
your doctor before the exact time of your exam.

Also inform your doctor of any recent illnesses or other medical conditions
and whether you have a history of heart disease, asthma, diabetes, kidney
disease or thyroid problems. Any of these conditions may increase the risk
of an unusual adverse effect.

The radiologist also should know if you have asthma, multiple myeloma or
any disorder of the heart, kidneys or thyroid gland, or if you have diabetes
—particularly if you are taking Glucophage.

Purpose: They can locate a tumor, blood clot, excess fluid, or infection.

Date: September 29, 2018

Results:
CT OF THE BRAIN:

Chronic infarct – left external capsule.

Suspicious for acute infarct – left insula

No midline shift

No hemorrhage is seen

Sinusitis – right ethmoid, right maxillary and right sphenoid sinuses

Please correlate clinically

Significance:

 Lacunar stroke or lacunar infarct (LACI) is the most common type of

ischaemic stroke, and results from the occlusion of small penetrating arteries that
provide blood to the brain’s deep structures.

 Sinusitis occurs when mucus backs up in your sinuses and your sinuses become
infected. This is usually due to swelling of the nasal passages and your sinus
openings. Upper respiratory infections or allergies can ultimately lead to ethmoid
sinusitis.
 DISCHARGE PLANNING

Medications:

•Instructed to take the following take home medications at the right dose, time,
frequency and route

1. Atorvastatin (Lipitor) 80mg 1 tab OD HS

2. .Clopidogrel (Plavix) 75 mg 1 tab OD PC lunch

3. Losartan (Cozaar) 50 mg I tab OD PO PC breakfast

•Encouraged to comply with medications to prevent further complications.

Environment:

•Encouraged to keep environment clean as much as possible: wiping of home furniture

or decors, sweeping or moping the floor.

•Instructed to provide adequate lighting on bathrooms to avoid injury

•To keep the surroundings safe by keeping sharp and pointed objects at their right
places to avoid any accidents or wounds

•Instructed to keep poisonous chemicals at their right containers and label them
correctly to avoid confusion.

Treatment:

•Emphasized the importance of regular follow-up check-ups and as instructed by

physician.

•Advised patient and family members to seek medical advise if any unusuality arises

Health Teachings:

•Encouraged client to do at least 30 minutes of walking a day as a form of exercise.

•Encouraged to eat healthy food

•Instructed patient to take medication as prescribed.

Observable Signs and Symptoms:

 Advised immediately to seek medical assistance when one experiences fever,

chills, difficulty in breathing (dyspnea), body malaise, shortness of breath, blood on
sputum and stools, excessive weakness (fatigue); palpitation, tachycardia,
nervousness and other unusualities.

Diet:

 Client was encouraged to have a diet of food high in carbohydrate and protein. The
client was instructed to do the following:
 Eat a variety of foods to get a balanced intake of the nutrients your body
needs - carbohydrates, proteins, fats, vitamins, and minerals.
 Make changes gradually because it takes time to accomplish lasting goals.
 Reduce the amount of fat you eat by choosing fewer high-fat foods and
cooking with less fat.
  Eat more fiber by eating at least 5 servings of fruits and vegetables every
day.
 Use less salt in cooking and at the table. Eat fewer foods that are high in
salt, like canned and packaged soups, pickles, and processed meats.
 Eat smaller portions and never skip meals.
 Learn about the right serving sizes for you.
 Learn how to read food labels.
 Limit use of alcohol.

 Grains, Beans, and Starchy Vegetables: (good source of B vitamins and

fiber) 6 or more servings/day
 Fruits: (contain vitamins C, A,
potassium, folate, and fiber) 3-4
servings/day
 Vegetables: (provide vitamins A, C,
folate, and fiber) 3-5 servings/day
Milk: (source of calcium, protein,
vitamins A and D) 2-3 servings/day
 Meats and Others: (good source of
iron, zinc, B vitamins, and protein)
2-3 servings/day
 Fats, Sweets, and Alcohol: The
foods at the tip of the pyramid should be eaten in small amounts. Fats and
oils should be limited because they are high in calories. Sweets are high in
sugar and should only be eaten once in a while

Spirituality:

 Encouraged patient and family members to go to church every Sunday

 Encouraged to continue to seek God’s guidance and enlightenment.

 Emphasized the importance of prayers in healing

 Encouraged to ask for divine assistance in everything

 Encouraged to continue to pray to God.

 Encouraged to continue to have a positive outlook in life.

 Encouraged to keep faith in God and not to give up easily when hard
times come