a case study on cerebrovascular disease

A Case Study on

Cardiovascular Disease

Introduction:A cardiovascular disease is one

of the greatest concerns on health today. This disease is known as a silent killer. It just comes with no apparent signs and symptoms and people are not warned with any manifestation to signal they contain this disease.

One way to detect its presence is to trace your family history. You are at

risk of it if one or more family members died because of it, more

so with an advanced age. Other medical condition like Diabetes

Mellitus can predispose such individual to having cardiovascular

diseases.

Aside from genetic predisposition, diet has also been a great

contributory factor, if not indeed the cause, to having such disease.

An excessive intake of salty and sodium-rich foods and over

consumption of fats and cholesterol, alcohol and substance abuse and smoking are more often than not,

the predisposing factors of cardiovascular diseases.

An excessive intake of salty and sodium-rich foods and over

consumption of fats and cholesterol, alcohol and substance abuse and smoking are more often than not,

the predisposing factors of cardiovascular diseases.

CVDs, as it is commonly known, are diseases that involve merely the

heart and the blood vessels, which should be detected at an earlier

time to possibly reduce its morbidity more so, its mortality.

Many deaths were reported of this disease. In fact, most countries face

greater risks of this over cancer.

For us, to better understand its causes for we know once you are

affected with this disease you can't find any way out and it could cause

you multiple organ failure.

More so, We'd like to impart health teaching to our parents, relatives

and friends, now that we can foresee its manifestations. As much

as possible, we want them to be conscious of their health too.

We want them to be aware of this disease and how morbid it is. We

want them to live longer as much as we want me to stay longer too. This case study is not just for us to learn

but also for them to know and understand.

II.CLIENT'S PROFILE

Patient X is a 76-year old female, widowed at age 75 and has 8 grown-up children. She used to stay at one of her child’s house at Adela, Camaman-an, Cagayan de Oro where she helps in their ''ALACART” business as the 'puso'-maker.

She wakes up at around 6 in the morning and drinks her cup of

coffee. Taking care of her grandchildren before they get to school is what she usually does

during weekdays.

She then eats her breakfast, watch TV afterwards and do some

household chores. In the afternoon, after lunch, is her ample time to do

the 'puso' and prepare in making barbecues. This is what she keeps

doing almost everyday.

History of Present Illness

Just few hours before admission, Patient X was watching TV with her child and grandchildren when her child noticed she was no longer answering her questions and her lower jaw is slightly misplaced.

Her child tried to put on some cold packs to somehow soften the

hardened jaw part but it didn't work so they brought the patient for

check-up but the doctor ordered for admission subsequently.

Patient X then was diagnosed with, Cardiovascular Disease, probably

cardioembolic, CAD, atrial fibrilation and in controlled

ventricular response. Few days on admission, patient X was apparently well but each day gets worse, until she can hardly speak and open her

eyes.

She was also unable to swallow foods even fluids so the doctor ordered for Nasogastric Tube

insertion. Her doctor also orders for oxygen administration regulated at

4 liters per minute.

Review of Systems

Upon assessment, the patient's vital signs were: BP 130/90, PR 92 beats per minute of irregular and bounding rhythm, RR 20 cycles per minute and temperature of 37.8 degree Celsius

General Appearance

She looks generally weak and stuporous, she does not respond to questions and even to painful stimuli.

Respiration/ Respiratory StatusShe elicits rales and crackling

sounds during respiration noted upon auscultation. She breathes 20 cycles per minute but of irregular rhythm with frequent apneic periods. Lung expansion is slightly assymetrical due to prolonged bed boundedness and immobility. Non-productive cough was also noted.

SKINGeneral Color Pallor

Texture smooth

Turgor firm

Temperature Cool

Moisture dry

Facial Movements Symmetrical

Fontanels Closed

Hair dry

Scalp With dandruff and lice

Lids Symmetrical

Preorbital region Intact/Full

Conjunctiva Pallor

Sclera Anicteric

Reaction to light R-briskL-brisk

Reaction to accomodation

Uniform constriction/Convergence

Vicual Acuity Grossly Normal

Peripheral Vision Intact/Full

Septum Midline

Mucosa Pallor

Patency Both patent

Gross Smell Normal/Symmetrical

Sinuses Non-tender

External Pinnae Normoset; Symmetrical

Tympnic Membrane

Intact

Gross Hearing Normal

Lips Pallor

Mucosa Pallor

Tongue Midline

Teeth Dentures

Gums Pallor

Trachea Midline

Thyroids Non-palpable

Others Normal ROM

Uvula Midline

Tonsils Not inflamed

Posterior Pharynx

Not inflame

Mucosa Pallor

General Normal

Configuration Symmetrical

Bowel Sounds Normoactive

Percussion Tympanic

Range of Motion Normal

Musle tone and strength

Fair

Spine Midline

Gait Coordinated

Elimination Pattern The patient use to defecate

once every morning in soft consistency and in yellow to brownish color. She has no problems or any discomfort in defecation. Her bowel sounds are hypoactive upon auscultation. She was given Senna Concentrate to manage constipation.

ROM/ Exercise Pattern

Patient's inability to do range of motion exercises by herself is impaired. Her joints are flexed through passive ROM except for the head. Muscle tone and strength were decreased and are possible for atrophy.

The presence of rales and crackles, apneic periods and cough upon auscultation are signs and symptoms of pulmonary edema. Edema and ascites formation also signal fluid movement from the intravascular compartment to the interstitial compartment indicative of fluid overload.

III. ANATOMY and PHYSIOLOGY

The heart is the main organ responsible for pumping blood all through out the systems. It is responsible for the delivery of oxygen to the tissues for nourishment and uses the circulating blood as the medium for the removal and excretion of the cell's metabolic wastes through exhalation.

The heart is situated in the anterior chest cavity. It has four chambers, the upper ones are called the atria and are divided into two, the right and left. And the ones situated below are the right and left ventricles.

These chambers are divided by valves the tricuspid and the bicuspid valve, and still divided laterally by a septum called atrioventricular septum.

Blood from the systemic circulation is already deoxygenated, passes trough the superior and inferior vena cavae. It then, enters the right atrium, passing through the tricuspid valve and moves to the right ventricle, goes to the lungs via the pulmonic artery.

Oxygenation and gas exchange happens in the alveoli of the lungs through the process of diffusion. The oxygenated blood then gets back to left atria passing through the pulmonic vein. It moves to the left ventricles through the bicuspid valve then it passes the aorta for systemic nourishment.

The pumping action starts with the simultaneous contraction of the two atria. This contraction serves to give an added push to get the blood into the ventricles at the end of the slow-filling portion of the pumping cycle called "diastole.

" Shortly after that, the ventricles contract, marking the beginning of "systole." The aortic and pulmonary valves open and blood is forcibly ejected from the ventricles, while the mitral and tricuspid valves close to prevent backflow. At the same time, the atria start to fill with blood again.

After a while, the ventricles relax, the aortic and pulmonary valves close, and the mitral and tricuspid valves open and the ventricles start to fill with blood again, marking the end of systole and the beginning of diastole.

It should be noted that even though equal volumes are ejected from the right and the left heart, the left ventricle generates a much higher pressure than does the right ventricle.

IV. PATHOPHYSIOLOGY

V. DIAGNOSTIC PROCEDURES and LABORATORY RESULTS

The diagnostic procedures patient X has undergone were Electrocardiogram (ECG), complete blood count CBC and urinalysis. The ECG reads a lightly depressed P wave, widened QRS waves and peak T wave. This means that the atria (P wave) are contracting less and atrial filling is decreased. QRS or the time for the ventricles to contract and depolarize takes greater time. And the time for the ventricles to relax for ventricular filling T wave, is prolonged.

BLOOD CHEMISTRY

Result Unit ReferenceWBC 9.8 10^3/uL 5.0-10.0RBC 3.9 10^6/uL 4.2-5.4Hgb 7.9 g/dL 12.0-16Hct 23.6 % 37-47Differential CountLymphocytes 8.1 % 17.4-48.2Neutrophils 73.2 % 43.4-76.2Monocytes 7.2 % 4.5-10.5Eosinophils 3.6 % 1.0-3.0 Basophils 0.4 % 1.0-3.0Platelet 170 10^3/uL 150-400

Diagnostic/Laboratory Procedures Indication/purposes Result Analysis and Interpretation

1. Urinalysis

Ordered: last July 1, 2010

To diagnose and monitor renal or urinary tract

disease

Color: yellow

Clarity: hazy

pH: 6.0

Specific Gravity: 1.015

Puss cells: 4-6

RBC: 18-20

Bacteria: plenty

Epithelial cells: occasional

Albumin: 3+

Laboratory results revealed that there is

presence of albumin in the blood; this

indicates that glomerular cannot filter

large molecules such as that of albumin.

It also revealed that there is bacterial

infection as evidenced by presence of

bacteria, puss cells and red cells in the

urine

1. Creatinine

Ordered: Last June 30, 2010

This test was ordered in order to evaluate renal

function

14.84 (reference Value = 0.6-1.2)

mg/dL

Result was above normal level indicating

renal malfunction. The kidney cannot

excrete nitrogenous waste product of

protein leading to its accumulation in the

blood.

1. Sodium (Na+)

Ordered: Last June 30, 2010

To evaluate fluid and electrolyte imbalance and

identify renal dysfunction

133.6 ( reference value :135-148)

mmol/L

Result was below normal level. It results

from loss of sodium-containing fluids or

from water excess, such prolonged

diuretic therapy and renal disease.

1. Potassium(K+)

Ordered: Last June 30,2010

To evaluate fluid and electrolyte imbalance and

identify renal dysfunction.

5.36 (reference value:3.5-5.3) mmol/L There is high level of potassium in the

blood which usually or normally excreted

by the kidney, but due to decreased

GFR, kidney cannot filter potassium in

the urine causing retention of potassium

in the blood.

1. BUN (Blood urea nitrogen)

ordered; last June 30,2010

To evaluate kidney function in a wide range of

circumstances, to help diagnose kidney disease

, and to monitor patients with acute or

chronic kidney dysfunction or failure.

145.6 (reference value: 4.6-23.4)

mg/dL

A greatly elevated BUN generally

indicates a moderate-to-severe degree of

renal failure. Impaired renal excretion of

urea may be due to temporary conditions

such as dehydration or 

shock, or may be due to either acute or

chronic disease of the kidneys

themselves.

Urinalysis Report

Color: YellowClarity: hazy

pH: 6.0Specific gravity: 1.020

Proteins:+3Blood: +3

VII. HEALTH TEACHINGS/DISCHARGE PLAN Medications

> Take the entire course of any prescribed medications.

> Emphasis on educating about the action of the drug, right dosage, timing and frequency on the intake of the drug and its expected side effects.

ExercisePerform assistive range

of motion exercises regularly.Inform patient and significant others about the importance of exercise on the patient's condition.

Treatment> Emphasize the importance of

early ambulation.> Encourage the use of proper

personal hygiene and handwashing.> Provision of peaceful

environment to promote rest and enhance well-being.

Home care:> Take adequate rest

periods.> Avoid activities that

can cause fatigue.

Out-patient

> Explain and emphasize the importance of compliance to follow check- up and therapeutic regimen.

Diet> Diet restrictions should

be properly observed> Intake of sodium-rich

foods should be minimized.> Encourage the intake of

proper diet at proper timing to display timely healing.

VIII. LEARNING EXPERIENCEThis is just actually our third time to be

exposed in the ward, where lots of patients are admitted. We find the experience exhausting though it's just our first rotation and we need to accomplish three more to proceed to the next round. we feel like we’re drained and we can't proceed to pursuing this course. Only until one thing came our mind, there's no way for us to quit so we have to develop the passion for us to succeed. If not, then we’re just certainly wasting our parent's fruit of labor.

We don't want it to happen so merely as early as now we should develop and learn to love the field that we are into. On the very first day of our duty, we've learned a lot not just from our instructor neither neither each of us but on our patient herself.

We learned from them not necessarily about sterile technique

nor diseases, nor what is being typically taught in the classroom but

in life at large.

They taught us of things we never knew about life. Well, so much for that, in making this case study, learnings that we have gained are outpouring and overwhelming. More so with the things that puts us and our family at risk with this silent killer disease.

We then would like to teach them proper ways of taking care of their health, what foods they ought to eat and what are those they should avoid. I also have learned from making this case study the importance of time and how to properly manage it.

If projects are given at an earlier time, make it as early as possible to avoid cramming and refrain from eleventh hour rush. Nevertheless, though we started making this case study a week before deadline, thank God that we were able to accomplish this with a heart.

The greatest learning I might have gained is that I did this despite my limited knowledge, with no assistance and dependence from others. To sum this all up, this paper might not have been made possible without God providing me the ample time to devote in making this. Thanks be to God for the success of this project.

IX. REFERENCES: Black, J.,et al. (2009). Medical Surgical Nursing. Eighth ed. Saunders Elsevier Printing office. Pp 1456-1492. http://en.wikipedia.org/wiki/Cardiovascular_disease

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