case study sir delapena

8/3/2019 Case Study Sir Delapena

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINESTamag, Vigan City

__________________________________________________________________________

_

COLLEGE OF NURSING

A Case Study

(CEREBROVASCULAR ACCIDENT/STROKE)

In Partial Fulfillment in the Requirements of the Subject

(RLE)Related Learning Experience

St. James Hospital

Vigan City, Ilocos Sur

__________________________________________________________________________

_

Presented by:

Inocencio Tiri Jr.

BSN III-Delphinium

Presented to:

Mr. Raymund dela Pena RN, RM

Clinical Instructor


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July 21,2010

TABLE OF CONTENTS

I. Introduction and Objectives---------------------------------------------------------

II. Patients Profile----------------------------------------------------------------------

III. Past and present History-----------------------------------------------------------

IV. Physical Assessment---------------------------------------------------------------

V. Diagnostic Exams-------------------------------------------------------------------

VI. Anatomy and Physiology ---------------------------------------------------------

VII. Pathophysiology-------------------------------------------------------------------

VIII. Medical/Surgical Management-------------------------------------------------

IX. Nursing Care Plan------------------------------------------------------------------

X. Preventive and Promotive----------------------------------------------------------

XI. Drug Study--------------------------------------------------------------------------

XII. Consent-----------------------------------------------------------------------------


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Evaluation Sheet

Part Rating

Introduction and Objectives

Patients Profile

Past and present History

Physical Assessment ( Cephalocaudal)

Diagnostic Exams

Anatomy and Physiology

Pathophysiology

Medical/Surgical Management

Nursing Care plan

Preventive and Promotive

Drug Study

Consent

Remarks:


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I. Introduction and Objectives

A stroke (sometimes called a cerebrovascular accident (CVA)) is the rapidlydeveloping loss of brain function(s) due to disturbance in the blood supply to the brain. This

can be due toischemia (lack of blood flow) caused by blockage (thrombosis or arterial

embolism) or due to ahemorrhage (leakage of blood). As a result, the affected area of the

brain is unable to function, leading to inability to move one or more limbs on one side of the

body, inability to understand orformulate speech, or inability to see one side of the visual

field.

A stroke is a medical emergency and can cause permanent neurological damage,

complications, and death. It is the leading cause of adult disability in the United States and

Europe and it is the number two cause of death worldwide. Risk factors for stroke

includeadvanced age, hypertension (high blood pressure), previous stroke or transient

ischemic attack(TIA), diabetes, high cholesterol, cigarette smoking and atrial

fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

A stroke is occasionally treated with thrombolysis ("clot buster"), in a "stroke unit".

Secondary prevention may involve antiplatelet drugs (aspirin and often dipyridamole), blood

pressure control,statins, and in selected patients with carotid

endarterectomy and anticoagulation. Treatment to recover lost function is stroke

rehabilitation, involving health professions such as speech and language therapy, physical

therapy and occupational therapy.

The traditional definition of stroke, devised by the World Health Organization in the

1970s, is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is

interrupted by death within 24 hours". This definition was supposed to reflect the

reversibility of tissue damage and was devised for the purpose, with the time frame of 24

hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic

attack, which is a related syndrome of stroke symptoms that resolve completely within 24

hours. With the availability of treatments that, when given early, can reduce stroke severity,

many now prefer alternative concepts, such as brain attack and acute ischemic

cerebrovascular syndrome (modeled after heart attack and acute coronary

syndrome respectively), that reflect the urgency of stroke symptoms and the need to act

swiftly

A stroke occurs when the blood supply to part of your brain is interrupted or severely

reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.

A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize

brain damage and potential complications.


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The good news is that strokes can be treated and prevented, and many fewer Americans now

die of stroke than was the case even 15 years ago. Better control of major stroke risk factors

high blood pressure, smoking and high cholesterol is likely responsible for the decline.

Objectives:

>enhance knowledge in a certain disease through researches

>to be able to know the signs and symptoms, risk factors and complications of CVA

>to know how to assess or diagnose CVA

>to be able to know the the treatment of CVA


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II. Patients Profile

Name: Romulo Rabang

Address: Pantay Fatima, Vigan City

Age: 59y/0

Sex: Male

Religion: Roman Catholic

Occupation: Security Supervisor

Marital Status: Married

Time/Date Admitted: June 19, 2010/2:30 am

Physician: Dra Pipo/Dr. Ong


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III. History of Past and Present Illness

History of past illnessTata Romulo experienced some of childhood diseases like measles, chickenfox,

cough and colds and others. He was raised in their house in Pantay Fatima.they have also a

history of hypertension and diabetes.

He was a policeman in Vigan City and leave the Philippines to stay for 10 years in

Rome, Italy with his wife and three children namely Romel, Jema and Sheraldine. He went

back here in the Philippines when his father died in 1998. he never went back in Italy and

entered as ROTC trainor in The University of Northern Philippines in 2006. And in 2009 he

was entered by his cousin in Lanting Security and Watchman Agency at Balanga, Bataan. He

was then promoted as the security supervisor this 2010 and an apartment for him to stay.

History of present illness

Wednesday, June 16, 2010, after eating his lunch, he works in his apartment before

going to his duty in Balanga, Bataaan. He was really tired and he took a bath. In his way

going to his work using his single motor, he feel dizziness and severe nape pain. When he

cant no longer bear pain, he stand his motor and hold into a marker along the highway. Then

he loss his conciousness and was drop down into the ground.

Someone saw and brought him immediately in ICMC( Isaac and Catalina Medical

Center) in Balanga City. After different exams, they came out with the following diagnosis:

-CVA, Hemorrhagic

-LOC and was found slumped on the ground, BP was @ 160/80 mmmHg, the patient was

brought to ER

After two days, he was transferred in St.James Hospital in Vigan, City via ambo

bagging, under NPO, IVF of PNSS 1L @ 20 gtts/min. He arrived in the hospital early in

morning in June 19 at 2:30 am and immediately received in ICU. Sunday, he was transferred

in private room in NS2, room 214. Still he was unconcious, with NGT, IFC and ET tube

connected to mechanical ventilator.


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IV. Physical Assessment (Cephalocaudal)

Skull

Generally round, with prominences in the frontal and occipital area. (Normocephalic).

No tenderness noted upon palpation.

Scalp

Lighter in color than the complexion.

No scars noted.

Free from lice, nits and dandruff.

No lesions

No tenderness nor masses on palpation.

Hair

black

Evenly distributed covers the whole scalp (No evidences of Alopecia)

thick, smooth.

dry.

Head

rounded.

Face is symmetrical.

No involuntary muscle movements.

Cant move facial muscles at will.

Eyebrows

Symmetrical and in line with each other.

black

Evenly distributed.

Eyes

Evenly placed and inline with each other.

Non protruding.

Equal palpebral fissure.


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Eyelashes

Evenly distributed.

Turned outward.

Pupil

Pupillary size 1 mm, and are equal in size.

Equally round.

Nose

With NGT

Nose in the midline

No Discharges.

No flaring alae nasi.

Both nares are patent..

No tenderness noted on palpation.

Ears

The ear lobes are bean shaped, parallel, and symmetrical.

Skin is same in color as in the complexion.

No lesions noted on inspection.

The ear canal has normally some cerumen of inspection.

No discharges or lesions noted at the ear canal.

Mouth

ET Tube connected to mechanical ventilator with the ff. set up:

TV: 500 ml

FiO2: 40%

BUR:20

with productive saliva secretion

Neck

The neck is straight.

No visible mass or lumps.

Symmetrical


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Thorax

The shape of the thorax is elliptical; the anteroposterior diameter is less than the transverse

diameter at approximately a ratio of 1:2.

Moves symmetrically on breathing with no obvious masses.

The spine is straight, with slightly curvature in the thoracic area.

There is no scoliosis, kyphosis, or lordosis.

Abdomen

-post op wound in right lower quadrant

Skin color is uniform, no lesions.

No venous engorgement.

Genitals

with IFC

with diaper

bed ulcer on gluteus

Extimities

with an IVF of PNSS 1L x 20 gtts/min inserted alternately into right and left metacarpal

veins.

Both extremities are equal in size.

Have the same contour with prominences of joints.

Color is even.

Has equal contraction and even.

Can perform complete range of motion.

No crepitus must be noted on joints.

General

patient is unconscious

with generalized edema

Has no response to pain, other stimulations.

with fever at all times

Initial V/S

T- 39.3 c

BP- 140/ 90 mmHg

RR- 20 cpm

PR-78 bpm


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V. Diagnostic Exams

IDEAL:

Physical Examination

Physicians will listen to the heart, look into the eyes and do a general exam to evaluate the

patient for other signs of vascular disease. A stethoscope may be used to listen for a bruit (an

abnormal sound produced by turbulence in one of the two main arteries that supply blood to

the head). A bruit often indicates atherosclerosis (fatty deposits that block the flow of blood

through the arteries).

Basic Laboratory Tests

In addition to checking blood pressure and cholesterol levels, doctors may test patients for

diabetes and check the blood for an elevated level of the amino acid homocysteine. A high

level of homocysteine may be associated with an increased risk of cardiovascular disease and

is a risk factor for stroke. Homocysteine levels may be modified with certain treatments.

Computed Tomography (CT)

CT scans are generally the first diagnostic test completed when a patient with suspected

stroke arrives in the emergency room. CT scans are used to distinguish between ischemic and

hemorrhagic stroke. The test involves low-dose X-rays and allows physicians to visualize the

brain.

Computed Tomography Angiography (CTA)

In CTA, dye is injected into the blood vessels. X-ray beams then create a three-dimensional

image of blood vessels in the neck and brain. CTA is used to

identify aneurysms,arteriovenous malformation and arterial narrowing.

Magnetic Resonance Imaging (MRI)

MRI uses a strong magnetic field to generate a three-dimensional view of the brain. MRI is

used to detect an area of brain tissue damaged by ischemic stroke. It provides a high level of

anatomic detail to help physicians locate the stroke site precisely and determine the extent of

damage.

MRI procedures are performed in a special room free of metallic equipment for safety. New

technologies developed for the early detection of stroke, including diffusion and perfusion-

weighted MRI.


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Magnetic Resonance Angiography (MRA)

MRA is a noninvasive technology that images the cerebral (head) arteries and veins. It also

yields valuable information regarding other arteries supplying the brain. This procedure uses

a strong magnetic field similar to MRI. Mayo Clinic researchers are at the forefront of

research that has optimized the clarity of MRA images.

Carotid Ultrasonography

In this ultrasound of the neck, sound waves pass through tissue and then return, creating on-

screen images that show any narrowing or clotting in the carotid (neck) arteries and how fast

blood is flowing through them to the brain.

Transcranial Doppler (TCD)

TCD is an ultrasound procedure that shows blood flow through the cerebral vessels via a

small probe placed against the skull. TCD is a portable test that can be performed at a

patient's bedside to follow the progress of medical treatment for stroke.

Positron Emission Tomography (PET)

PET scans measure brain cell metabolism to show whether the brain tissue is functioning,

even though blood flow to that area appears diminished.

Arteriography

Arteriography produces a detailed view of arteries in the brain not normally seen in X-rays.

A catheter is inserted in an artery in the arm or leg and dye is injected into the blood vessels

leading to the brain. X-ray images show any abnormalities of the blood vessels, including

narrowing, blockage or malformations such as aneurysms or arteriovenous malformations.

Echocardiogram (ECG)

ECG is an ultrasound of the heart. It is conducted to determine whether an underlying heart

problem is contributing to the risk of stroke. In ECG, a transducer (wand-like device) collects

echoes (reflected sound waves) from the heart and transmits them to a machine. The

ultrasound probe may be placed on the chest or a small tube may be inserted down the throat.


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ACTUAL:

Radiology Department

-Left basal haziness is noted

-The heart is enlarged

-The diaphragm

Impresion:

-Pneumonia, Left

-Cardiomegaly

-atheromatous aorta

Hematology Report

CBC RESULT NORMAL VALUE

Hemoglobin

Hematocrit

RBC

Mean Cell Volume

Mean Cell Hgb

Mean Cell Concentration

WBC

Differential Count

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils

TOTAL

135

0.399

10.8

64.1

11.7

16.7

5.5

2.0

100

115-180g/L

0.37-0.54 x 10 l/L

0.37-0.54 x 1012/L

3.5-6.5 fL

80-100g

310-360g/L

4.6-10.2 x 10/L

50-70 %

20-40 %

2-8 %

1-4 %

0-2 %

Implications: Elecated monocytes may indicate Chronic inflammatory / immune

disease: ulcerative colitis, regional enteritis, systemic lupus erythematosus, sarcoidosis


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Blood Chemistry

RESULT NORMAL

BUN-8.25

Crea-120.8

Na-142.9

K-5.99

2.5-7.5 mmol/L

65-120 mmol/L

135-148 mmol/L

3.5-5.3 mmol/L

Implication: may indicate the ff:

Impaired renal function

Congestive heart failure as a result of poor renal perfusion

Dehydration

Shock

Hemorrhage into the gastrointestinal tract

Acute myocardial infarction

Stress

Excessive protein intake or protein catabolism

Test Result Normal Value

Glucose

Cholesterol

Triglycerides

HDL

LDL

22.14

5.85

2.71

1.46

3.16

4.10-6.10 mmol/L

0-5.70 mmol/L

0.68-1.88 mmol/L

0.78-1.81 mmol/L

1.71-4.60 mmol/L

Implications: hyperglycemia, hypercholesterolemia

ABG Analysis

Analyte Result Normal Value

Ph

PCO2

PO2

HCO3

7.441

39.4

96.3

25.8

7.35-7.45

35-45 mmHg

80-100 mmHg

22-26 mmHg

Implication:Normal

Urinalysis

Physical Exam Chemical Exam

Color Yellow with CHON 1+ Nitrate ( - )


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RBC

Clarity turbid Glucose 3+ Bilirubin 2+

S. Gravity 1.010 Hgb 3+ Urobilirubin Normal

pH 6 Keton 1+ leukocyte ( - )

VI. ANATOMY AND PHYSIOLOGY OF THERELATED ORGAN

The nervous system is an organ system containing a network of specialized cells

calledneurons that coordinate the actions of an animal and transmit signals between different

parts of its body. In most animals the nervous system consists of two parts, central and

peripheral. The central nervous system of vertebrates (such as humans) contains

the brain, spinal cord, and retina. The peripheral nervous system consists of sensory neurons,

clusters of neurons called ganglia, and nerves connecting them to each other and to the

central nervous system. These regions are all interconnected by means of complex neural

pathways. The enteric nervous system, a subsystem of the peripheral nervous system, has the

capacity, even when severed from the rest of the nervous system through its primary

connection by the vagus nerve, to function independently in controlling the gastrointestinal

system.

Neurons send signals to other cells as electrochemical waves travelling along thin

fibres called axons, which cause chemicals called neurotransmitters to be released at

junctions called synapses. A cell that receives a synaptic signal may be excited, inhibited, or


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otherwise modulated. Sensory neurons are activated by physical stimuli impinging on them,

and send signals that inform the central nervous system of the state of the body and the

external environment. Motor neurons, situated either in the central nervous system or in

peripheral ganglia, connect the nervous system to muscles or other effector organs. Central

neurons, which in vertebrates greatly outnumber the other types, make all of their input and

output connections with other neurons. The interactions of all these types of neurons form

neural circuits that generate an organism's perception of the world and determine its

behavior. Along with neurons, the nervous system contains other specialized cells called glial

cells (or simply glia), which provide structural and metabolic support.

Nervous systems are found in most multicellular animals, but vary greatly in

complexity.Sponges have no nervous system, although they have homologs of many genes

that play crucial roles in nervous system function, and are capable of several whole-body

responses, including a primitive form of locomotion. Placozoans and mesozoansother

simple animals that are not classified as part of the subkingdomEumetazoaalso have no

nervous system. In Radiata (radially symmetric animals such as jellyfish) the nervous system

consists of a simple nerve net. Bilateria, which include the great majority of vertebrates and

invertebrates, all have a nervous system containing a brain, one central cord (or two running

in parallel), and peripheral nerves. The size of the bilaterian nervous system ranges from a

few hundred cells in the simplest worms, to on the order of 100 billion cells in

humans. Neuroscience is the study of the nervous system.

The nervous system consists of two types of cells. Nerve cells are called neurons.

Various support cells are associated with the neurons, most typically, Schwann cells. The

parts of a neuron include the dendrite which receives the impulse (from another nerve cell or

from a sensory organ), the cell body (numbers of which side-by-side form gray matter) where

the nucleus is found, and the axon which carries the impulse away from the cell. Wrapped

around the axon are the Schwann cells, and the spaces/junctions between Schwann cells are

callednodes of Ranvier. Collectively, the Schwann cells make up the myelin sheath (numbers

of which side-by-side form white matter).

Schwann cells wrap around the axon (like the camp food, pigs in a blanket). Having

an intact myelin sheath and nodes of Ranvier are critical to proper travel of the nerve

impulse. Diseases which destroy the myelin sheath (demyelinating disorders) can cause

paralysis or other problems. Schwann cells are analogous to the insulation on electrical wires,

and just as electrical wires short out if theres a problem with the insulation, so also, neurons

cannot function properly without intact myelin sheaths.

The nervous system has three basic functions:

sensory neurons receive information from the sensory receptors,

interneurons transfer and interpret impulses, and

motor neurons send appropriate impulses/instructions to the muscles and glands.


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A nerve impulse is an electrical charge that travels down the cell membrane of a

neurons dendrite and/or axon through the action of the Na-K pump. Ordinarily, the inside of

a neurons cell membrane is negatively-charged while the outside is positively-charged.

When sodium and potassium ions change places, this reverses the inner and outer charges

causing the nerve impulse to travel down the membrane. A nerve impulse is all-or-none: it

either goes or not, and theres no halfway. However, a neuron needs a threshold stimulus, the

minimum level of stimulus needed, to trigger the Na-K pump to go and the impulse to travel.

A neuron cannot immediately fire again; it needs time for the sodium and potassium to return

to their places and everything to return to normal. This time is called the refractory period.

A junction between two nerve cells or a nerve and a muscle cell is called a synapse. In a

synapse, various chemicals are used to transfer the impulse across the gap to the next cell.

These are collectively known as neurotransmitters, and include such chemicals as dopamine

(brain levels of which are low in Parkinsons disease), serotonin, and acetylcholine (levels of

which are low in myasthenia gravis).

The nervous system can be subdivided several ways depending on if one is looking at

function or location: Most body organs/systems are enervated by both sympathetic and

parasympathetic nerves, and these have opposite effects on the various organs. For example,

the sympathetic NS prepares for action by increasing heart and respiration rates. by telling

the liver to release stored glycogen as sugar, and by decreasing digestive processes.

Conversely, the parasympathetic NS stores energy by slowing heart and respiration rates, by

telling the liver to store up sugar as glycogen, and by increasing digestive processes.

The brain consists of the cerebrum which is the large, anterior portion;

the cerebellum which is the wrinkled-looking, posterior part; thepons which is the closest,

larger bulge at the top of the spinal cord; the medulla which is the farther, smaller bulge

between the pons and the top of the spinal cord; then the spinal cord starts after the medulla.

Also note under the cerebrum, the optic chiasma, the place where the optic nerves cross to

the other side of the brain. The cerebellum, medulla, and pons are collectively referred to as

the hindbrain. Many of their functions are involved in homeostasis, coordination of

movement, and maintenance/control of breathing and heart rate. While a stroke in the

cerebrum might result in partial paralysis, a stroke in the hind brain is actually, potentially

more dangerous becuase it could knock out coordination of the cerebrums activities, or

worse yet, automatic control of breathing and/or heart beat. The midbrain is responsible for

receiving and integrating of information and sending/routing that information to other

appropriate parts of the brain. The forebrain is composed of the cerebrum and related parts,

and functions in pattern and image formation, memory, learning, emotion, and motor control.

In addition, the right side functions more in artistic and spatial concepts, while the left side

controls speech, language, and calculations. Keep in mind that motor skills are controlled by

the opposite half of the brain, thus a left-brain stroke would cause paralysis on the right side


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of the body. Also, a left-brain stroke might cause problems with speech while a right-brain

stroke is more likely to cause abnormal/inappropriate emotional responses.

VII.PATHOPHYSIOLOGY

Predisposing Factors:

Life style (sedentary)Vices (Alcohol, smoke)

AgeDiet

Sex

Heredity

Self-medication

Precipitating Factors:

Hypertension

Hyperlipidemia

Diabetes Mellitus

Heart Diseases

Atherosclerosis

Arteriosclerosis

Thrombosis

Severe dehydration

Ischemic

Stroke

Subarachnoid

Hemorrhage

Transient

Ischemic

Attack

Venous Stroke

Large Artery

Strokes

Small Artery

Stroke

Embolic

strokes

VASOCONSTRICTION

Blockage of the bloodvessel

Lack of oxygen &nutrients supply

Embolism

Hypoxia

Altered cerebral

metabolism

AneurysmRupture

Cerebral Ischemia

- Cell death

- Decreased

Oxygen level

Decreased cerebral

perfusion

Intracerebral

hemorrhage

CytotoxicEdema

Local

Acidosis

Brain tissue

Necrosis

P

A

R

A

L

Y

S

I

S

D E A T H Severe Cases

High blood pressure, smoking, heart

diseases, diabetes, narrowing of arteries

supplying the brain, high cholesterol and

an unhealthy lifestyle.

High blood pressure, smoking, and a

family history of burst aneurysms.

Severe dehydration, severe infection in

the sinuses of the head and medical or

genetic conditions that increase a persons

tendency to form blood clots.

Hypertension, diabetes, smoking and high

cholesterol levels.

Same with Ischemic stroke

Hypertension, diabetes andsmoking.

Irregular heart beat (atrial fibrillation), aheart attack (myocardial infarction), heart

failure or a small hole in the heart called a

PFO (Patent Foramen Ovale).


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A stroke is caused by a blocked or bleeding artery in the brain. Most strokes are due to

blocked arteries that supply blood to the brain and are called ischemic strokes. Strokes due to

bursting of brain blood vessels are called hemorrhagic strokes. Intracerebral hemorrhage is

caused by bleeding into the brain itself, while subarachnoid hemorrhage is due to bleeding

around the base of the brain. A TIA (transient ischemic attack) is caused by a temporary

blockage of blood flow to a blood vessel to the brain lasting less than 24 hours. Another,

rarer, form of stroke can occur when a vein (that drains blood out of the brain) is

blocked. This is called a venous stroke.


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Intracerebral Hemorrhage

This type of stroke is caused by the bleeding of a blood vessel within the brain. As a result of

the bleeding a blood clot forms in the brain, which puts pressure on the brain and damages it.

Although intracerebral hemorrhage is less common than ischemic stroke and it is more

serious. The most common cause of intracerebral hemorrhage is high blood pressure.

Another cause, especially in younger people with intracerebral hemorrhages, is abnormally

formed blood vessels in the brain (vascular malformations or aneurysms).

VIII.Medical and Surgical Management

Medical

-Admitted to ICU under the service of Dr. Ong

-V/S every hour-I&O qshift

-IVF of PNSS 1L @ 20 gtts/min

-Diagnostic exams

CBC

U/A

BUN Crea

Hgt

FBS

CXR

ECG

-intubation due

-mechanical ventilator with the following set-up:

TV: 500 cc

BUR: 20

FiO2: 100 %

-Paracetamol 300 mg IV prn for fever

-Diet: Ensure 1600 kcal/day, 6 equal feedings


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Medications:

Ceftazidime 1 gm IV q6

Citicoline 1 gm IV q12

Omeprazole 40 mg OD

Combivent neb q4

Para 300 mg IV PRN

Tazocin 4.5 gm IV

Fluimucil 600 mg IV

Mannitol 20 % 100cc/ IV

Rebamipide 100 mg/tab

Clindamycin 300 mg QID

Amlodipine 5 mg OD

Olmesartan 20 mg OD

Ciprofloxacin 500 mg 1 tab OD

In a hemorrhagic stroke, treatment is based on the underlying cause of the hemorrhage and

the extent of damage to the brain.

Depending on the severity, treatment includes lifesaving measures, relief of symptoms and

repair of the cause of the bleeding.Immediate treatment for hemorrhagic strokes is best administered in an intensive care unit,

where medical personnel can immediately detect any complications. Sometimes persons

experiencing a hemorrhagic stroke develop irregular breathing patterns or stop breathing.

Medical intervention may be needed to protect the airway and avoid choking or inhaling

secretions into the lungs if a patient is unconscious or semiconscious.

Surgical No surgical procedure done

Surgery or another procedure may be needed to save a patient's life or to improve the

chances of meaningful recovery. The type of surgery depends upon the cause of the

bleeding, which may include aneurysm, arteriovenous malformation or hemorrhage.

X. Preventive and Promotive

PREVENTION


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Control high blood pressure (hypertension). One of the most important things you can

do to reduce your stroke risk is to keep your blood pressure under control. If you've

had a stroke, lowering your blood pressure can help prevent a subsequent transient

ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight,

and limiting the amount of sodium and alcohol you eat and drink are all ways to keep

high blood pressure in check. Adding more potassium to your diet may also help. In

addition to recommendations for lifestyle changes, your doctor may prescribe

medications to treat high blood pressure, such as diuretics, calcium channel blockers,

angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.

Lower the amount of cholesterol and saturated fat in your diet. Eating less cholesterol

and fat, especially saturated fat and trans fats, may reduce the plaques in your arteries.

If you can't control your cholesterol through dietary changes alone, your doctor may

prescribe a statin such as simvastatin (Zocor) or atorvastatin (Lipitor) or another type

of cholesterol-lowering medication.

Don't smoke. Smoking raises the risk of stroke for both the smoker and nonsmokers

exposed to secondhand smoke. Quitting smoking reduces your risk several years

after quitting, a former smoker's risk of stroke is the same as that of a nonsmoker.

Drink alcohol in moderation, if at all. Alcohol can be both a risk factor and a

preventive measure for stroke. Binge drinking and heavy alcohol consumption

increase your risk of high blood pressure and of ischemic and hemorrhagic strokes.

However, drinking small to moderate amounts of alcohol can increase your HDL

cholesterol and decrease your blood's clotting tendency. Both factors can contribute

to a reduced risk of ischemic stroke.

Don't use illicit drugs. Certain street drugs, such as cocaine and methamphetamines,

are established risk factors for a TIA or a stroke.

PROMOTION

Control diabetes. You can manage diabetes with diet, exercise, weight control and

medication.

Exercise regularly. Aerobic exercise reduces your risk of stroke in many ways.

Exercise can lower your blood pressure, increase your level of high-density

lipoprotein (HDL, or "good") cholesterol, and improve the overall health of yourblood vessels and heart. It also helps you lose weight, control diabetes and reduce

stress. Gradually work up to 30 minutes of activity such as walking, jogging,

swimming or bicycling on most, if not all, days of the week.


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Maintain a healthy weight. Being overweight contributes to other risk factors for

stroke, such as high blood pressure, cardiovascular disease and diabetes. Weight loss

of as little as 10 pounds may lower your blood pressure and improve your cholesterol

levels.

Knowing your stroke risk factors, following your doctor's recommendations and

adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If

you've had a stroke or a TIA, these measures may also help you avoid having another

one. Many stroke prevention strategies are the same as for preventing heart disease.

In general, a healthy lifestyle means that you:

Eat a diet rich in fruits and vegetables. A diet containing five or more daily servings

of fruits or vegetables may reduce your risk of stroke.

XII. Consent


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June 28, 2010

Im allowing my student nurse, Inocencio Tiri Jr. to take my case a requirement in the

Subject RLE, and without invading private matters.

___________________

Lucia Rabang

case study sir delapena

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