cerebrovascular disease (bleed)

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CEREBROVASCULAR DISEASE(BLEED)

CASE PRESENTATION

Prepare By: Aprille Anne C.Sagmit

E Na!



INTRODUCTION



OBECTIVES3eneral O+4e$ti-e:

T %lly %n&er#tan& t"e %n&erlying &i#ea#e pr$e## $ere+r-a#$%lar &i#ea#e (+lee&) an& it# n%r#ingmanagement.

Spe$i5$ O+4e$ti-e#:

6.T learn a+%t t"e ma4r etilgie# $ere+r-a#$%lar &i#ea#e(+lee&).

7.T &etermine t"e pre-i%# an& pre#ent $lini$al "i#try t"e

patient.8.T perrm p"y#i$al a##e##ment !it" #pe$ial attentin n t"e

#y#tem# $%#.

9.t #"! t"e la+ratry eaminatin re#%lt# !it" t"e$rre#pn&ing nrmal -al%e#' a$t%al re#%lt rm t"e patient' an&it# interpretatin.



.T %n&er#tan& t"e anatmy an& p"y#ilgy t"e+l& #%pply in t"e +rain an& tra$e it#

pat"p"y#ilgy.

;.T learn t"e +a#i$ prin$iple n%r#ing

management $ere+r-a#$%lar &i#ea#e (+lee&).

/.T %#e t"e n%r#ing pr$e## t i&entiy n%r#ingpr+lem# an& %n&er#tan& t"e p"arma$lgi$almanagement #et n t"e $lient an& pr-i&e t"eapprpriate n%r#ing $are plan.

<.T i&entiy t"e &i#$"arge plan r t"e patient1#re"a+ilitatin t $n&%$t an e-al%atin t"e $lient1#$n&itin rm a&mi##in t pre#ent



PATIENT1S PRO=ILE

Patient1# Name : Patient S

Age : ;< year# l& 8 mnt"# 8> &ay#

A&&re## : 9?7/ INT. 7 Valen@%ela St. Sta. 2e#a'

2anila3en&er : 2ale

E&%$atinal Attainment : Cllege 3ra&%ate

Ci-il Stat%# : i&!er

Birt"&ay : Septem+er ;' 6?9/

Religin : Cat"li$

Natinality : =ilipin

O$$%patin : Retire& Tai Dri-er



2e&i$al Data

C"ie Cmplaint : Se-ere "ea&a$"e an& -miting

A&mitting Diagn#i#: Se-ere "emrr"agi$ #tr*e' C"rni$"yperten#in' Crnary Artery Di#ea#e

=inal Diagn#i# : Cere+r-a#$%lar Di#ea#e (Blee&)

Time an& Date A&mitte&: 6>:7? P2 De$em+er 86' 7>6

Atten&ing P"y#i$ian : Dra. Sa&a-a

S%rgen : Dr. De+%%e

Ane#t"e#ilgi#t : Dra. 3%e-arra

Preperati-e Diagn#i# : Intra$ere+ral "emrr"age' rig"t

tempr,parietalOperatin Perrme& : Cranitmy an& e-a$%atin

"ematma' Rig"t rnt, temprparietal

P#tperati-e Diagn#i# : Intra$ere+ral "emrr"age' rig"t

tempr,parietal RO Arteri-en%#2alrmatin (AV2)



Chief Complaint:

“Sobrang sumasakit na yung ulo

niya nung gabi pa lang tapos biglana siyang nagsususuka” a#-er+ali@e& +y t"e patient1# &a%g"ter.



History of Present Illness

A$$r&ing t t"e &a%g"ter t"e patient' / "%r# prir ta&mi##in' Patient S #tarte& t "a-e "ea&a$"e rig"t #i&e !it" a

pain #$ale 6>6> ra&iating t rig"t r+ital area. T"i# !a#a##$iate& !it" 6> epi#&e# -miting pre-i%#ly inge#te&& an& !ater' let +&y !ea*ne##' #l%rring #pee$" an&!it" a +l& pre##%re 6><> mm"g. T"i# prmpte& $n#%lt"en$e a&mi##in.

Past Health History

T"e patient S !a# +rn Septem+er ;' 6?9/. Unre$alle&imm%ni@atin# #ai& +y t"e &a%g"ter t"e patient. 0e "a# a"i#try "yperten#in an& $rnary &i#ea#e r alm#t /

year# n! !it" a maintenan$e me&i$ine T!yn#ta <>mgn$e a &ay' Va#tarel 2R 8mgta+ n$e a &ay' Lipitr 7>mgn$e a &ay' A#pirin 6>>mg n$e a &ay an& 2etrpll >mgn$e a &ay. A$$r&ing t "i# &a%g"ter' "e "a# a *n!n allergyt Pn#tan' #"rimp' an& egg.



Personal/Social History

Patient S i# t"e el&e#t in t"eir amily. Bt"parent# pa##e& a!ay. 0e "a# 6 +rt"er an& 8

#i#ter# !" are all marrie& an& #ettle&. 0e "a# a6> year gap t "i# #e$n& #i#ter. 0e i# a !i&!er.0i# !ie &ie& la#t 7>69 &%e t C"rni$ i&neyDi#ea#e. 0e "a# a #n an& a &a%g"ter' !" are all

marrie& an& #ettle&. 0e %#%ally &rin*# li%r 7,8a !ee*. 0e1# nt really a$ti-e in term# eer$i#e.

T"e nly eer$i#e "e &e# i# !al*ing ar%n& t"eneig"+r"& n$e in a !"ile i "e elt li*e

!al*ing. A$$r&ing t "i# &a%g"ter' patient S "a#n -i$e# e$ept r $$a#inal &rin*ing al$"l.Sme mrning "e #!eep# %t#i&e "i# "%#e an&prepare# +rea*a#t r "i# gran&$"il&ren.



Environmental History (Living/Neighborhood/Circmstances!

A$$r&ing t patient S1# &a%g"ter' "e i# li-ing !it" "i# #n an&&a%g"ter in$l%&ing t"eir !n amily. T"ey li-e in a "%#e !"i$" "ean& "i# !ie +%g"t many year# ag.

T"eir "%#e i# !it"in a #%+&i-i#in *in& type !"ere %#%al-e"i$le# pa## +y. T"e patient1# &a%g"ter al# #ai& t"at t"eir "%#e i#a $m+inatin $ement an& !& !"i$" i# en%g" r "i# amilyan& gran&$"il&ren t li-e in. A$$r&ing t t"e &a%g"ter' $$*ra$"e#'ie# an& m#%ite# are pre#ent at t"eir "%#e. T"ey al# !n #meapplian$e# li*e tele-i#in' ra&i' ele$tri$ an' per#nal $mp%ter an&air $n&itiner. T"ey "a-e an ele$tri$ an& !ater $nne$tin. T"ey li-ein a pla$e !"ere "%#e# are a little +it $l#e +%t nt $l#er t ea$"t"er. S"e al# #ai& t"at "er at"er1# en-irnment i# a little +it ni#yan& $r!&e&.

"amily HistoryBa#e& n "i# &a%g"ter' t"ere are "i#trie# "yperten#in in "er

at"er1# paternal #i&e. S"e al# #ai& t"at patient S gre! %p $l#e t+t" mt"er an& at"er #i&e. S"e $annt re$all any &i#ea#e in +t" "er at"er1# parent#1 #i&e.



#$ %&'&N)S

"*NC+I&N,L HE,L+HP,++E'NS



BE=ORE

0OSPITALIFATION

DURIN3

0OSPITALIFATION

ANALGSIS AND

INTERPRETATIONA$$r&ing t patient

S1# &a%g"ter' "e

per$ei-e& "ealt" a#

+eing a+le t !r*'

%l5ll "i#

re#pn#i+ilitie# a# a

g& at"er an& g&pr-i&er. S"e

+elie-e# t"at "er

at"er t"in*# t"at

"ealt" i# a -ery

imprtant !eapn tli-e a lng an&

pea$e%l lie. Ba#e&

n t"e &a%g"ter

t"e patient' !"en

patient S eel# li*e"e1# ging t "a-e a

Patient S1#

&a%g"ter reali@e&

t"at it1# &iH$%lt t

+e #i$* +e$a%#e

t"e p"y#i$al an&

5nan$ial

$n#traint#.Patient S &%ring

"#pitali@atin i#

$n#$i%#' $alm

an& let"argi$. 0e

"a# plenty me&i$atin# #%$"

a#

anti"yperten#i-e'

anti+iti$' an&

#mti$ &i%reti$&r%g#. T"%g"

2any peple &e5ne an&

&e#$ri+e "ealt" a#:

Being ree rm

#ymptm# &i#ea#e

an& pain a# m%$" a#

p##i+le' +eing a+le t

+e a$ti-e an& t &!"at t"ey !ant r m%#t'

an& +eing g& in #pirit#

m#t t"e time.

(@ier. =%n&amental#

N%r#ing' <t"

e&.)

it" "im +eing in a

!ea*ene& #tate' "e

$annt %l5ll "i# rle a#

a at"er a# lng a# "i#

illne## $ntin%e#. 0i#"ealt" i# im aire& an&

Health Perception/Management Pattern



BE=ORE

0OSPITALIFATION

DURIN3

0OSPITALIFATION

ANALGSIS AND

INTERPRETATIONPatient "a# *n!n

&&r%g allergie# t

#"rimp' egg an& Pn#tan.

A$$r&ing t t"e patient1#

&a%g"ter' "e %#%ally eat#

& #%$" a# green leay

-egeta+le#' an& r%it#. 0i#

%#%al &iet in t"e "%#e i#mre n 5#". 0e &e#n1t

li*e m%$" atty &#. 0e

eat# 8 %ll meal# a &ay:

+rea*a#t' l%n$"'

#metime# a #na$* in t"e

aternn an& &inner. 0e&e# &rin* al$"l 7 t 8

time# a !ee* an& &rin*# 6>

t 67 gla##e# !ater

e-ery &ay. 0e al# &e#n1t

li*e t m%$" #!eet#alty

&# an& $ra$*er#. 0eper$ei-e& t"at eating

Patient S "a# a

na#ga#tri$ t%+e

!"i$" a$t# a# t"e

prtal entry "i#

& an&

me&i$atin#. T"e

patient1# &iet i# li%i&

#te%ri@e& ee&ing6'>> $al &i-i&e&

int ; e%al ee&ing#

!it" an IV %i&

PNSS 6L in%#ing !ell

at 7>,76 &rp#min.

Patient S al# "a# anen&tra$"eal t%+e

$nne$te& t "im

t"at ma*e# eating

rally imp##i+le.

0ealt" #tat%# greatly aJe$t#

ne1# eating "a+it# an&

n%tritinal #tat%#. Di#ea#e

pr$e## $an &i#r%pt

meta+li#m an& $alri$ nee&#

an l&,age&. Alteratin# in

t"e $lient1# &iet are ten

nee&e& t treat a &i#ea#epr$e##' t in$rea#e r

&e$rea#e !eig"t' r t all!

an rgan t re#t an& prmte

"ealing. (@ier.

=%n&amental# N%r#ing' <t"

e&.)

0i# $%rrent &iet i#

"yperten#i-e &iet !"i$" i# l!

at #alt an& l! in at an& i#

#till t"e #ame a# "i# nrmal

&iet !"i$" in-l-e# a lt

green leay -egeta+le#' 5#"

• Nutritional/Metabolic Pattern



ELI-IN,+I&N P,++E'NBE=ORE

0OSPITALIFATION

DURIN3

0OSPITALIFATION

ANALGSIS AND

INTERPRETATIONPatient S1# &a%g"ter

reprte& t"at "e -i&# an&&ee$ate# reg%larly. 0e

pa##e# %t #tl n$e a &ay.

Patient S1# &a%g"ter #ai& "e

&i& nt "a-e any &iH$%lty

%rinating r &ee$ating.

Ba#e& n t"e n%r#ing

a##i#tant !" &i& t"emrning $are

a$ti-itie#' patient S

&i& nt pa## any #tl

r "! many &ay#

alrea&y. 0e "a# an

in&!elling ley

$at"eter. T"ere are

+-i%# #ign# !ater

retentin in "i# arm#'

"an&# an& eet.

T"e "ealt"y +&y maintain# a

+alan$e +et!een t"e am%nt %i& inge#te& an& t"e

am%nt %i& eliminate&. T"e

e$retry %n$tin t"e

*i&ney &imini#"e# !it" age'

+%t %#%ally nt #igni5$antly

+el! nrmal le-el# %nle## a

&i#ea#e pr$e## inter-ene#.

T"e re%en$y &ee$atin i#

"ig"ly in&i-i&%alK t"e am%nt

al# -arie# rm per#n t

per#n. 2any l&er peple

+elie-e t"at reg%larityM mean#

a +!el m-ement e-ery &ay.

(@ier. =%n&amental#

N%r#ing' <t" e&.)

0i# $%rrent %rine %tp%t

in&i$ate# n "! "i# +&y i#

#%Jering rm t"e &i#ea#e. An

altere& eliminatin pattern i#

-ery &etrimental t any

er#n.



,ctivity/E.ercise Pattern

E"&'E

H&SPI+,LI0,+I&N

*'IN%

H&SPI+,LI0,+I&N

,N,L1SIS ,N

IN+E'P'E+,+I&N

,ccording to patient S)s

daghter2 he)s not really

active in terms of e.ercise$

+he only e.ercise he does is

3al4ing arond the

neighborhood once in a3hile if he felt li4e 3al4ing

and every morning he

s3eeps otside his hose

and for her daghter it)s his

only e.ercise$

Patient !a# a&mitte& in

t"e inten#i-e $are %nit.

T%rning t"e patient

e-ery 7 "%r# an&

"a-ing +e& +at" !a# "i#

nly a$ti-ity an&m-ement.

Peple ten &e5ne t"eir "ealt"

an& p"y#i$al 5tne## +y t"eir

a$ti-ity +e$a%#e mental !ell,

+eing an& t"e eJe$ti-ene##

+&y %n$tining &epen& largely

n t"eir m+ility #tat%#. Peple!it" m+ility impairment# may

eel "elple## an& +%r&en#me t

t"er#. (@ier. =%n&amental#

N%r#ing' <t" e&.)

0i# $n&itin "a# #e-erely

impaire& "i# &aily a$ti-itie# an&

e-en t"e m#t #imple t"#e

ta#*# are imprtant. It i# &iH$%lt

t a&4%#t int ant"er

a$ti-ityeer$i#e pattern 4%#t t

a$$mm&ate "i# limite&

a+ilitie# in perrming a$ti-itie#.



Sleep/ 'est Pattern

E"&'E H&SPI+,LI0,+I&N *'IN%

H&SPI+,LI0,+I&N

,N,L1SIS ,N

IN+E'P'E+,+I&N

Patient S)s daghter

verbali6ed that patient

S sleeps at arond 7 to

89pm after 3atching

+$#$ +he late time hesleeps is 88pm$ He also

ta4es a nap in the

afternoon after lnch$

She said that his father

never e.perienced

sleeping late at night$88pm is the ma.imm

time he can handle$ He

3a4es p in the

morning to coo4

brea4fast to his

grandchildren and ta4ethem to school$ ,fter

D%ring

"#pitali@atin'

patient S1# nly

a$ti-ity !a# t #leep

an& re#t. T"ere !eretime# !"en "e !a#

nt a+le t

#leepre#t a#i&e

rm "i# $n&itinK

ant"er a$tr i# t"e

-i#itatin t"en%r#e# !" ta*e# "i#

"%rly -ital #ign#'

me&i$ine#' an&

$$a#inal

#%$tining.

Peple re%ire #leep in

r&er t $pe !it" &aily

#tre##e#' t pre-ent atig%e'

t $n#er-e energy' t

re#tre t"e min& an& +&y'an& t en4y lie mre %lly.

Illne## t"at $a%#e# pain'

p"y#i$al &i#tre## per#nal

pr+lem# an& #tre## $an

re#%lt in #leep pr+lem#.

(@ier. =%n&amental# N%r#ing' <t" e&.)

Sleep &epri-atin +eing

pre#ent mean# t"at "i#

pattern !a# &i#r%pte&. 0i#

$%rrent $n&itin $a%#e#

pain an& t"%# &%e t it "e



Self>Perception Pattern

E"&'EH&SPI+,LI0,+I&N

*'IN%H&SPI+,LI0,+I&N

,N,L1SIS ,N IN+E'P'E+,+I&N

Patient S)s daghter

perceived that her

father felt good abot

himself before the

hospitali6ation becasehe 3as able to 3or4 and

fl<ll his

responsibilities$ She

also reported that her

father is patient abot

things and ma4es it apoint to resolve all

matters that annoys

him$ She also thin4s

that her father does not

have any negative

feelings abot himself

D%ring

"#pitali@atin an&

&%ring treatment'

patient !a#

$n#$i%#'re#pn#i-e an&

let"argi$. Patient S

!a# $nne$te& t an

en&tra$"eal t%+e

t"at ma*e# tal*ing r

#pea*ing' -ery&iH$%lt an& pain%l.

A p#iti-e #el, $n$ept i#

e##ential t a per#n1#

mental an& p"y#i$al "ealt".

Sel, $n$ept al# eten&# t

t"e $"i$e# peple ma*e an&per$eptin# t"ey "a-e a+%t

t"eir "ealt". Peple re#pn&

t #tre##r# #%$" a# illne##

an& alteratin# in %n$tin

relate& t aging in -ariety

!ay#. In&i-i&%al# !it" pr#el,$n$ept may epre##

eeling# !rt"le##ne##'

#el,&i#li*e r e-en #el,

"atre&. T"ey may eel #a&'

r "pele##' an& may #tate

t"ey la$* energy t perrm



'ole/'elationship Pattern

E"&'E

H&SPI+,LI0,+I&N

*'IN%

H&SPI+,LI0,+I&

N

,N,L1SIS ,N

IN+E'P'E+,+I&N,ccording to the

daghter of the

patient2 patient S

lives 3ith his son and

daghter inclding

their families$

Patient S)s daghter

also said that herfather has good

relationship 3ith his

friends2 neighbors

and family$ She also

thin4s that her fatheris a very caring and

D%ring

"#pitali@atin'

t"e #i+ling# an&

t"e &a%g"ter

t"e patient #tay#

!it" "im in t"e

"#pital +%t #tay#

nly at t"e +a$* t"e rm +e$a%#e

patient S !a#

a&mitte& in an

inten#i-e $are

%nit. T"ey nlygt t -i#it "im

T"r%g"%t lie' peple

%n&erg n%mer%# rle

$"ange#. Ea$" per#n

%#%ally "a# #e-eral rle#.

=ail%re t ma#ter a rle

$reate# r%#tratin# an&

eeling# ina&e%a$y'

ten !it" $n#e%entl!ere& #el,e#teem.

(@ier. =%n&amental#

N%r#ing' <t" e&.)



Se.ality/'eprodctivePattern

E"&'E

H&SPI+,LI0,+I&N

*'IN%

H&SPI+,LI0,+I&N

,N,L1SIS ,N

IN+E'P'E+,+I&Nased on the patient)s

daghter2 patient S)s

3ife died last ?98 de

to Chronic @idney

isease$ Ever since his

3ife died2 he never

loo4ed for another

3oman becase for

him2 her mother 3as

his life2 strength and

happiness$ ,ccording

to the daghter2

sometimes she can feel

and notice that her

father is sad and lonely

that)s 3hy she let her

children sleeps at her

)

D%ring

"#pitali@atin'

patient S i# %n&er

#%per-i#in

n%r#e# an& &$tr#

&%e t "i# $n&itin.

0i# #e%al pattern

remaine& t"e #ame.

Regar&le## gen&er' age'

ra$e' #$ie$nmi$ #tat%#'

religi%# +elie#' p"y#i$al

an& mental "ealt"' r t"er

&emgrap"i$ a$tr#'

peple epre## t"eir

#e%ality in a -ariety

!ay# t"r%g"%t t"eir li-e#.

Se%al "ealt" i# t"e

integratin t"e #mati$'

emtinal' intelle$t%al an&

#$ial a#pe$t# #e%al

+eing' in !ay# t"at are

p#iti-ely enri$"ing an&

t"at en"an$e per#nality'

$mm%ni$atin an& l-e.

(@ier. =%n&amental#



E"&'E H&SPI+,LI0,+I&N *'IN%

H&SPI+,LI0,+I&N

,N,L1SIS ,N

IN+E'P'E+,+I&N

+he daghter said

that her father felt a

little bit satis<ed

3ith his life btthere are parts of

him that she thin4s

her father regrets$

He is a 'oman

Catholic and goes tochrch every Snday

and visits Aiapo

chrch on a "riday$

Be$a%#e t"e

patient1#

$n&itin' t"e

$"aplain t"e"#pital &e# "i#

r%n&# an& t"at1#

t"e nly time' t"e

patient re$ei-e#

"ly #a$rament.Pl%# t"e "ly

ma## t"at !a#

+eing playe& all

-er t"e "#pital

rm#.

Spirit%al "ealt" a#

&e5ne& +y t"e N%r#ing

O%t$me# Cla##i5$atin

prte$t (2r"ea&' "n#n' 2aa#' 7>>9

p.6?)' i# t"e

Cnne$te&ne## !it"

#el' t"er#' "ig"er

p!er' all lie' nat%rean& t"e %ni-er#e t"at

tran#$en&# an&

emp!er# t"e #elM.

(@ier. =%n&amental#

N%r#ing' <t" e&.)

•Value/Belief Pattern



#I$ Physical ,ssessment %eneral ,ppearance:

Patient !a# re$ei-e& a!a*e' re#pn#i-e +%t let"argi$' !it"nging IV= in%#ing !ell at 67 PNSS6L 67Q !it" 7>,76gtt#min at t"e rig"t meta$arpal -ein. Patient "a# an en&mrp"i$type +&y +%ilt an& !eig"# <> *ilgram#. 0eig"t !a# nt ta*en.0ygiene an& $leanline## are maintaine&. 0e i# %lly a##i#te&

&%ring "#pitali@atin. T"ere i# t"e pre#en$e en&tra$"eal t%+ein "i# m%t" $nne$ting t t"e me$"ani$al -entilatr' pre#en$e p%l#e imeter n t"e re 5nger $nne$te& t a $ar&ia$mnitring &e-i$e' !it" a a$*#n,Pratt &rainage n t"e rig"ttempr,parietal #i&e t"e "ea& !it" a 6>$$ am%nt +l&.Al#' t"ere i# a pre#en$e e&ema n t"e +t" %pper an& l!eretremitie#' pre#en$e "ernia n t"e mi& rig"t %pper %a&rant t"e a+&men an& +-i%# &rling #ali-a &%e t t"e in#erte&na#ga#tri$ t%+e in "i# m%t".

#ital Signs:+ B 8/.6QC

P B ?9 +pm

cerebrovascular disease (bleed)

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