CEREBROVASCULAR DISEASECASE PRESENTATION OF BSN III-4 IIIGROUP 16 @ ARMED FORCES OF THE PHILIPPINES MEDICAL HOSPITAL

Introduction

Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause. Cerebrovascular disease includes all disorders in which an area of the brain is temporarily or permanently affected by bleeding or lack of blood flow. Cerebrovascular diseases included stroke, carotid stenosis, stenosis, vertebral stenosis and intracranial stenosis, stenosis, aneurysms and vascular malformations. Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), (stenosis), blockage (embolism), or blood vessel rupture (hemorrhage). Lack of sufficient blood flow (ischemia) affects brain tissue and may cause a stroke.

Cerebrovascular Disease StatisticsStroke is the third leading cause of death in the United States. Of the more than 700,000 people affected every year, about 500,000 of these are first attacks, and 200,000 are recurrent. About 25 percent of people who recover from their first stroke will have another stroke within five years. Stroke is a leading cause of serious long-term longdisability. Each year, an estimated 30,000 people in the United States experience a ruptured cerebral aneurysm and as many as 6 percent may have an unruptured aneurysm.

Objectives

At the end of the presentation, nursing students will be able to.. - learn about the topic or the disease - know how this disease affect people - understand the disease - know the signs and symptoms and as well as the causes of the disease.

Nursing HistoryA. Biographical Data :Name: Normita Esplana Age: 56 years old Sex: Female Nationality: Filipino Religion: Roman Catholic Address: # 53 Bogna Legaspi City, Albay Birth Day: August 8, 1954 Birth Place: Ilocos Norte Date of Admission: July 28, 2011 Chief Complaint: Body Weakness Diagnosis: Cerebrovascular Disease Fronto Parietal Area Bilateral with hemorrhagic Conversion Parietal Area

B. Reasons for Seeking Health Care :

The patient has experiencing body weakness 2 weeks ago, when we was interviewed her.

C. History of Past IllnessUpon Interview to the patient, she said that in her childhood times she never experienced any major illness. She also said that she only experienced those common illness like fever, colds, cough and flu. The patient cannot tell about her immunization because she has forgotten if she is fully immunized or not. The patient has no allergy to any foods, medicines and environment. The patient also told that she had never been hospitalized and never had a major accidents.

D.

History of Present Illness

Patient N.E was admitted in V.Luna General Hospital (Female Medical Ward) last July 28. Prior to admission, the patient stated that the onset of her illness was occur 2 weeks ago before she was admitted. Patient N.E started complaining of left sided body weakness associated difficulty in ambulation. There was no associated of difficulty of breathing, Diabetes Mellitus, Headache and Level of consciousness.

E. Family History

There is a history of illnesses in there family. Hypertension Diabetes Asthma

Mellitus

Anatomy & Physiology

PATHOPATHO-PHYSIOLOGYmodifiable non modifiable Increase triglycerides: 242.48mg/dL Decrease HDL:29.73mg/dL Carotid stenosis Decrease cardiac output Compensatory aldosterone ADHcathecolamine compensatory release ADHcathecolamine Adequate or increase blood volume increase SVR

Increase preload, stroke volume and heart rate Systemic and pulmonary edema requirements

increase myocardial oxygen

EDEMA fraction

decrease cardiac output, decrease ejection

Increase BP

decrease tissue perfusion

Impaired cellular metabolism

Gordons Functional Pattern

Health perception- health management: perceptionThe patient understands her condition she is taking medications prescribed by her physician & follows all the advice in order to improve her health Nutrition metabolic : She is advised to eat low fat low sodium foods & she takes consideration of it. Although sometimes she cannot eat, she feels so dizzy & nauseated. Before she used to eat fatty foods but now it was changed. Elimination: She frequently urinate during daytime & defecate every other day, she dont have any problem in urinating or defecating even before hospitalization.

ActivityActivity-exercise: The patient stays on bed all day long she ambulates only when shes urinating. She experienced shortness of breath when she is walking & leg cramps. According to her son even before hospitalization the patient stays on bed oftentimes. Sleep & rest: The patient sometimes suffering from difficulty of sleeping due to her leg cramps & headache even before she was hospitalized CognitiveCognitive-perceptual : The patient sometimes was disoriented she cannot verbalized what she feels & sometimes cannot recognize some of her family member also due to her age. Most of the times she feels restless & dizzy at bed she also experiences some sort of pain in her leg, shortness of breath. Headache & nausea.

Role relationship:

According to her son her mom is a plain housewife living with them before she was still strong she can cook food for them & clean their house but when she gets old & her condition worsen she can no longer do the things she used to do before.

Sexuality reproductive:Of course because of her age & condition she can no longer engage in any sexual activities.

Coping stress: When the patient have problems she verbalized it in her children & husband mostly problems regarding her condition. The patient cannot effectively cope up with stress by her own, basically she needs her family support

Physical AssessmentArea Assessed Skin Color Technique Inspection Normal Findings Light brown, tanned skin (vary according to race) Lighter colored palms, soles, lips and nail beds Skin normally dry Actual Findings brown Evaluation Normal

Lips, nail beds, soles and palms Moisture

Inspection

Pallor nail beds

Normal

Inspection/ Palpation Palpation Palpation

Dry

Normal

Temperature Texture

Normally warm Smooth, soft and flexible palms and soles (thicker) Skin snaps back immediately

Warm to touch Smooth

Normal Normal

Turgor

Palpation

Goes back immediately

Normal

Skin appendages a. Nails Nail beds Nail base Capillary refill

Inspection Inspection Inspection Inspection/ Palpation

Transparent, smooth and convex Pinkish Firm White color of nail bed under pressure should return to pink within 2-3 seconds Evenly distributed Black Smooth Parallel to each other PERRLA- Pupils equally round react to light and accommodation Symmetrical in size, extension, hair texture and movement Distributed evenly and curved outward Transparent with light pink color Color is white Transparent, shiny Black, constrict briskly Clearly visible

Pinkish, Convex Pinkish Firm White color of nail beds under pressure returned to pink within 2-3 seconds 2Evenly distributed Grayish Uneven Parallel to each other PERRLAPERRLA- Pupils equally round react to light and accommodation Symmetrical in size, extension, hair texture and movement Distributed evenly and curved outward Transparent with light pink color Color is white Transparent, shiny Black, constrict briskly Clearly visible

Normal Normal Normal Normal

b. Hair Distribution Color Texture c. Eyes Eyes Visual Acuity

Inspection Inspection Inspection/ Palpation Inspection Inspection (penlight)

Normal Normal because of old age Normal Normal Normal

Eyebrows

Inspection

Normal

Eyelashes Conjunctiva Sclera Cornea Pupils Iris

Inspection Inspection Inspection Inspection Inspection Inspection

Normal Normal Normal Normal Normal Normal

Ears Ear canal opening Hearing Acuity

Inspection

Free of lesions, discharge of inflammation Canal walls pink Client normally hears words when whispered

Free of lesions, discharge of inflammation Canal walls pink Client sometimes doesnt hear words when whispered, sometimes you have to speak louder Smooth, symmetric with same color as the face Close to midline, thicker anteriorly than posteriorly Oval, symmetric and without discharge Dry and pale Dry Slightly pink color, Dry and not tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red pt. has bite plane Hard palate- dome-shaped Soft Palate- light pink

Normal Normal Abnormal , d/t old age

Inspection

Nose Shape, size and skin color Nasal septum Nares Mouth and Pharynx Lips Buccal mucosa Gums

Inspection

Smooth, symmetric with same color as the face Close to midline, thicker anteriorly than posteriorly Oval, symmetric and without discharge Pink, moist symmetric Glistening pink soft moist Slightly pink color, moist and tightly fit against each tooth Moist, slightly rough on dorsal surface medium or dull red Firmly set, shiny Hard palate- dome-shaped Soft Palate- light pink

Normal

Inspection Inspection Inspection Inspection Inspection

Normal Normal Normal d/t the mouth is always open Normal

Tongue

Inspection

Normal

Teeth Hard and soft palate

Inspection Inspection

To prevent dislocation of teeth Normal

Neck Symmetry of neck muscles, alignment of trachea Neck Rom Thorax and Lungs Abdomen

Inspection

Neck is slightly hyper extended, without masses or asymmetry Neck moves freely, without discomfort Clear breath sounds Skin same color with the rest of the body

Neck is slightly hyper extended, without masses or asymmetry Neck moves freely, without discomfort Clear breath sounds Skin same color with the rest of the body

Normal

Inspection Auscultation Inspection

Normal Normal Normal

Normal Bowel sounds Neurology system Level of consciousness Behavior and appearance Auscultation Inspection Clicks or gurgling sounds occur irregularly Fully conscious, respond to questions quickly Makes eye contact with examiner, hyperactive expresses feelings with response to the situation Clicks or gurgling sounds occur irregularly Lethargic , do not respond to questions quickly Sometimes doesn't makes eye contact with examiner, not hyperactive in expressing feelings with response to the situation Abnormal

Inspection

Abnormal

Diagnostic/ Laboratory Examinations

Lipid profileType Normal Findings Actual findings121

Elevated

Decreased

Triglycerides