36351789 cerebral bleeding cva hemorrhage

8/6/2019 36351789 Cerebral Bleeding CVA Hemorrhage

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Cerebral bleeding

(CVA

hemorrhage)Presented by group 3 104


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Learning objectives


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A. General Objectives

This study aims to convey

familiarity and provide effective

nursing care to a patient diagnosedwith Cerebral Hemorrhage; HPN

and Seizure through understanding

the patient history, disease process

and management.


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B. Specific Objectives

At the end of the session, the students will be able

to:

Present a thorough assessment regarding Cerebral

Hemorrhage; HPN and Seizure, through NursingHealth History, Gordons Functional Health Pattern,

Physical Assessment, and the interpretation of the

laboratory examinations done on the patient.

Discuss the anatomy and physiology of the heart,

pathophysiology of the patients condition, usual

clinical manifestations and possible complications

of the condition.


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Enumerate the necessary

medications needed and be familiar

to its mode of action.

Formulate a workable nursing care

plan on the subjective and objectivecues gathered through nurse-

patient interaction to be able to help

the patient towards wellness.


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Introduction


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Cerebro-vascular accident

A stroke (sometimes called

a cerebrovascular accident (CVA)) is the

rapidly developing loss of brains function(s)

due to disturbance in the blood supply to the

brain.

is a "neurological deficit of cerebrovascular

cause that persists beyond 24 hours or isinterrupted by death within 24 hours"


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Classification of CVA

2 Types:

1. Ischemic

a. thrombosis cause by severeatherosclerosis.

b. embolic thrombus that travels

to the Circle of Willis.


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2. Hemorrhagic rupture of bloodvessels

Causes:- HPN

- aneurysm

- arterio-venous malformations


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Hemorrhagic strokes account for

15% of cerebrovascular disorders

and are primarily caused by anintracranial or subarachnoid

hemorrhage. Hemorrhagic strokes

are caused by bleeding into the

brain tissue, the ventricles, or the

subarachnoid space.


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Primary intracerebral hemorrhage from a

spontaneous rupture of small vessels accounts

for approximately 80% of hemorrhagic strokes

and is primarily caused by uncontrolledhypertension (Qureshi et al.,2001). Secondary

intracerebral hemorrhage is associated with

arteriovenous malformations (AVMs),intracranial aneurysms, or certain medications

(eg, anticoagulants and amphetamines)

(Qureshi et al., 2001).


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The patient with a hemorrhagic stroke can

present with a wide variety of neurologic

deficits, similar to the patient with ischemic

stroke. A comprehensive assessment will

reveal the extent of the neurologic deficits.

Many of the same motor, sensory, cranial

nerve, cognitive, and other functions that aredisrupted following ischemic stroke are

altered following a hemorrhagic stroke.


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In addition to the neurologic deficits that

are similar to ischemic stroke, the

patient with an intracranial aneurysm orAVM can have some unique clinical

manifestations. Rupture of an aneurysm

or AVM usually produces a sudden,unusually severe headache and often

loss of consciousness for a variable

period.


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At times, an aneurysm or AVM leaks

blood, leading to the formation of a clot

that seals the site of rupture. In thisinstance, the patient may show little

neurologic deficit. In other cases, severe

bleeding occurs, resulting in cerebraldamage followed rapidly by coma and

death.


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Prognosis depends on the neurologic

condition of the patient, age, associated

diseases, and the extent and location ofan intracranial aneurysm. Subarachnoid

hemorrhage from an aneurysm is a

catastrophic event with significantmorbidity and mortality. (Pfohman &

Criddle, 2001).


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Demographic data


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Name: R.O.D. Age: 52 yo Gender: Male

Civil Status: Married

Address: 109 Anabu 1-A Imus, Cavite

Birth date: 10/10/1957 Birth Place: Bicol

Religion: Roman Catholic

Language Spoken: Filipino

Admitting Diagnosis / Impression: CVA , hemorrhagic Admitting Physician: Dr. J. Sembrano

Source ofInformation: Wife


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NURSING HISTORY

ChiefComplaint: LOC

History of present illness: The patient is a

known cause of HPN was to maintained onClonodine and Lanoxine with poor

compliance few monitor PTC, patient was

noted to home loss of consciousness

GCS 3

Pupil 2-3 cm

CH Brudzinki


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Past Medical History

Hospitalization (Cause / organ

damage / Removed / Treatment):

Gallblader stone


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Family History

Parents: Mother died of stroke

Sibling: Hypertension

Spouse: None Children: None

Illness in the family similar to the patients:

Hypertension in the family


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Physical assesment


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Vital signs

The patient is afebrile with a

temperature of 36.5 C . Pulse

rate was 118 beats per minute.Patient is tachycardic.

Respiratory rate of 22 cycles perminute and his blood pressure

was 280/120 mmHg.


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General survey

The patient is in distress , bedridden

and has cardiopulmonary distress.

Patient is comatose GCS:3,incoherent and disoriented.


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Skin

The patient has pale complexion,

the texture smooth, skin turgor was

good, warm and dry.


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Head

head is normocephalic. The hair is fine,

equally distributed and has dandruff seen on

the scalp. The pupil size: 2 3mm and it

reacts to light sluggishly with unequal

constriction.


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Ears

The ears are symmetrical.There

were no discharges.


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Nose

There were no discharges and

mucosa is pink.


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Mouth

He has pale lips, the speech is not

assessed because the pt. is comatose


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NECK

The trachea is in the midline.

There are palpable cervical

lymph nodes. Patient neck is

rigid.


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Chest and lungs

The patient is tachypneic with 35 cycles

per minute with occasional dyspnea.


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abdomen

The bowel sounds are normoactive.

with positive dullness over the right

upper quadrant. There are notenderness.


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BACK ANDEXTREMITIES

The peripheral pulses are symmetrical, equal and faint in the

upper extremities. The nail beds are pallor. The muscle tone and

strength is cachexic. The bilateral lower extremities are weak and

have muscle dystrophy.


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Neurologic assessment

Motor response- 1

Eye response- 1

Verbal response- 1

------GCS 3


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Pathophysiology


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Laboratory studies


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Examination:CT scan: Cranial CT Scan plain

There is a massive hematoma seen in the cerebellum with intraventricular

hemorrhagic extravasations into the third ventricle the lateral ventricles are

dilated. There are also small malacic changes in both frontal periventricular

regions.

Remarks:

Massive cerebellar hematoma with intraventricular extravasations,

brainstem edema, obstructive hydrocephalus, chronic frontal

periventricular ischemic infarcts.


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Drug study


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Nursing care plan


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medicine

Comply with the treatment regimen.

Do not use any medicines, over-the-counter drugs, vitamins,

herbs, or food supplements without first talking to caregivers or

physician.

Do not quit taking your medicines until you discuss it with yourcaregiver. If you are taking medicine that makes you drowsy, do

not drive or use heavy equipment.


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Exercise

Regular exercises are good for the heart and lungs and could

stimulate proper circulation and oxygenation in the body.

Regular exercise should be minimal and basic in order not to

increase the workload of the heart

Follow your doctors recommendations for physical activity.


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Treatment

. Instructed client for strict compliance of treatment regimen.


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Hygiene

- Good oral hygiene and proper dental care apply to all age

groups but the needs of the elderly population can be slightly

different than the needs of the younger people. Client should also

observe regular hand and body hygiene to decrease the risk of

acquiring infection. Daily bath is recommended as well asfrequent hand hygiene, not only for the client but also for the

clients significant others.


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Out patient

Seek medical advice only from doctors


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Diet

Limiting the amount of fat to no more than 25 to 35% of daily

calories is recommended to promote good health.

. A low-fat diet also helps lower high total and LDL (the bad)

cholesterol levels, another risk factor for coronary artery disease.

Eating at least five servings of fruits and vegetables daily candecrease the risk of coronary artery disease.

The diet should contain the recommended daily requirements of

vitamins and minerals. Vitamin supplements are not considered

an acceptable substitute for a healthy diet


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Spirituality

Always pray for guidance and strength


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Final evaluation


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After the continuous treatment which consists of the medical and

the nursing management of the patient, a development of her

present health status is projected. Continuous administration of

therapy had partially alleviated the clients suffering from the

disease. Although disease process is incurable and has thetendency to attack again ones life, if the client will undergo

treatment, by some means this will help reduce the sufferings of

the client brought by the disease. But if the client will not subject

herself to any medical management, this could lead to further

complications; signs and symptoms of the disease will progressand will evidently manifested by the client. Furthermore, this

would worsen the condition and eventually leads to death.


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Evaluation of learning outcomes


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EVALUATION

After our thorough assessment, comprehensive

observation, interpretation of the patients laboratory results, the

nursing responsibilities of the prescribed medication, knowing the

factors that affect the disease process and the nursing

interventions rendered to our patient, we came up with thefollowing evaluations:

General:

The group was able to present all the accumulated information

about our patients case, duly diagnosed with Cerebrovascular

Accident Bleed, has improved our skills and knowledge pertainingon caring patients with the above mentioned disease.


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Specific:

1.) The incidence of CVA Bleed in global, national, and local

setting was determined.

2.) The inclusive assessment of the patient involving

biographical data, chief complaint upon admission, past andpresent medical history, personal, family and socio-economic

status as an apparent substantiation to the condition were

present.

3.) Review of systems through detailed but comprehensive

physical assessment was conducted.

4.) The significant diagnostic test and laboratory examinations,

comparing abnormal results from normal values with its

corresponding interpretation in relation to the current status of the

client was determined.


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5.) The predisposing and precipitating factors that contributed to

the disease process and present comprehensively in a written

and diagrammatic illustration were identified.

6.) The pathophysiology of CVA Bleed and its symptomatology

and complications of the client was discussed. 7.) The clients condition in the ICU from the day of admission

until the student nurses assessment was determined.

8.) The pharmacological management of CVA Bleed, and its

nursing considerations were enumerated.

9.) Three (3) prioritized health needs/ problems of the client and

formulate nursing plan as a framework of care identified and

applied.

36351789 cerebral bleeding cva hemorrhage

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