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Group 1 CaseHypertension with left-sidedbody weakness

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Pathophysiology

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Medical Management

Medical Management for HYPERTENSION:

Pharmacologic Interventions

Non pharmacologic Interventions

Laboratory/ Diagnostics

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PharmacologicInterventions

A-

B-

C-

D-

S-

Ace Inhibitor

Beta blocker

Calcium channel blocker

Diuretic, Direct-acting vasodilator

Sedatives (optional)

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PharmacologicInterventions

Ace Inhibitor

Captopril(Capoten)

AnaprilEnapril(vasotec)

Benazepril(lotensin)

Beta blocker

Propanolol(Enderal)

Timolol

Diuretic

Spironolactone(Aldactone)

Direct-acting vasodilator

Hydralazine(Apresoline)

SedativeDiazepam (Valium)

Calcium channel blocker

Verapamil

NifedipineDiltiazem

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Nonpharmacologic

Interventions

JNC 7 recommendations:

Weight loss

DASH

Limit alcohol intake

Reduce sodium intake Stop smoking and reduce intake of dietary saturated fat and

cholesterol

Aerobic exercise

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Laboratory/ Diagnostics

Blood pressure test done several times

Diagnose by physician (Type or stage)

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Medical Management

Medical management for ISCHEMIC STROKE:

1. Thrombolytic Therapy

Thrombolytic agents--- to dissolve the clot

t-PA

U-Urokinase

S-Stretokinase

A-Alteplase

Dose: 0.9 mg/kg (max 90 mg IV) 10% bolus, 90% infusion pumpIn 60 minutes

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2. IVF Therapy:

IV within 3 hours

Management after giving Thrombolytics:

No other Anti-thrombolytics given in 24 hours of TPAs

Notice decrease LOC, Neurodeficit----STOP drug

Give cryoprecipitate/ Fresh frozen plasma

No Catheterization for 2 hours from Administration

Medical Management

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Drugs for secondary prevention during stroke:

Anticoagulantpatients with atrial fibrillationHeparin

Warfarin

Antiplatelet (TCA)--Dec incidence of cerebral infarction

TiclopidineClopidrogel

Aspirin

Medical Management

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3. Treat increase ICP

Hyperosmotic Diuretic: IV mannitol

Stool softener: Prevent valsalva Manuever

Corticosteroid (Prednisolone): for acute inflammation

Mechanical ventilation: Adjunctive therapy

Oxygen causes constriction, thus decreasing ICP

Medical Management

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4. Treat Decrease CPP

Volume Expanders: Dextran, Albumin, Hetastarch & 3L

PNSS

Oxygen therapy

Medical Management

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Laboratory/ Diagnostics

CT scan--- detects fresh bleeding, MRI cant but candetect extent of damage

Shows: hypointensity (black)

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Nursing Management

A. Improve Mobility and Prevent Joint Deformities

1. Position the patient correctly

2. Assist in maintaining good body alignment

3. Prevent shoulder adduction

4. Position hand and fingers5. Change clients position every 2 hours

6. Establish an Exercise program

7. Prepare for ambulation

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Nursing Management

B. Prevent shoulder pain

C. Enhance self care

D. Manage sensory-perceptual difficulties

E. Assist with Nutrition

F. Attain Bowel and bladder control

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Nursing Management

G. Improve thought Processes

H. Improve communication

I. Maintain skin integrity

J. Improve family coping

K. Helping the patient cope with sexual dysfunction

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