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CEREBRO VASCULAR
ACCIDENT
CARDIOEMBOLIC
STROKE
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I. INTRODUCTION
A stroke is the death of brain
tissue that occurs when the
brain does not get enough bloodand oxygen.
A stroke from cardiogenic
embolism occurs when bloodclots travel from the heart to an
artery supplying the brain.
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WH AT IS GOING ON IN THE BODY ?
a blood clot is
formed in the heart
Travels through thebloodstream to block one of
the arteries supplying the
brain
The brain cells then die
from lack of oxygen
Then cause swelling
in the brain
Can damage the
brain tissue
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WH AT ARE THE CAUSES AND
RISKS OF THE CONDITION?
Atrial Fibrillation
severe congestive
heart failure
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Nonmodifiable
Factors
Well-
documented
Modifiable
Factors
Potentially
Modifiable
Factors
Increasing age- >
55 y/o
Race- blacks and
HispanicsGender- men have
more chance
Family history-
stroke or TIA
high blood pressure
Smoking
diabetes\
asymptomaticcarotid stenosis, or
narrowing of one of
the arteries in the
neck
sickle cell anemiahigh cholesterol
levels in the blood,
including
total cholesterol and
LDL/HDLatrial fibrillation
Obesity
sedentary lifestyle
alcohol abuse
high blood levels of homocysteine
drug abuse
blood disorders
hormone
replacementtherapy(HRT
use of birth control
pills, or oral
contraceptives
inflammatoryprocesses
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WH AT ARE THE SIGNS AND SYMPTOMS OF
THE CONDITION?
Problems with
movement, such
as weakness,
clumsiness, or
paralysis
headache
numbness or a lack of
feeling
speech impairments
inability to recognize
family members or
common objects
Dementia
visual impairment
hearing impairment
personality changes difficulty swallowing
balance problems
coma
The inability tobreathe on one's own
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HOW IS THE CONDITION DIAGNOSED?
Cranial MRIs
Cranial CT scans - shows the
type, size, and location of thestroke.
Echocardiogram - usesultrasound waves to visualizethe heart as it is beating. Bloodclots in the heart can often beseen using this test.
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II. A SSESSMENT
Pt's ProfileName: Patient M
Sex: Female
Age: 87 y/o
Status: WidowedReligion: Jehova·s Witness
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PRESENT HE ALTH HISTORY
5 days PTC the patient was notedfor:
sudden weakness
loss of gait
vomiting of previously ingested food for 3
episodes
loss of appetite
2days PTC the patient experienced:
progression of weakness
slurring of speech
oliguria
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Last September 26, 2011 at4:00pm she was admiited
at Malipayon DistrictHospital with a diagnosis
of Cerebrovascular
Accident Problem;
Cardioembolic Stroke
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P AST HE ALTH HISTORY
gum bleedingacute gastritis
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F AMILY HE ALTH HISTORY
The patient has family
health history of
hypertension on her
mother·s side.
Diabetes Mellitus onfather·s side
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LA BORATORY FINDINGS
RBS- 9.16 mmol-09/27/11
10.7 mmol-10/03/11
12 L ECG absent P wave
Irregular rhythm
Rate <159 bpm
Narrow QRS
Multiatrial contraction
Preventricular contraction
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PH YSICAL A SSESSMENT SKIN: (+) pallor
Cold clammy skin
Dry skin
Dry oral skin
HE AD-
EENT: No facial asymmetry
Pale palpebral conjunctiva
Anicteric sclera
CHEST
Lungs: (-) retractionCardiovascular: irregular rhythm
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PH YSICAL A SSESSMENT
A BDOMEN: (+) distended abdomen
hypogastric area
MUSCULOSK ELETAL:
MMT Right LeftU.E. 3/5 5/5
L.E. 4/5 5/5
NEUROLOGICAL:
Responsive to noxious stimulation
Localize stimuli
Confused conversation
GCS of 11 upon admission
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REVIE W OF SYSTEM
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CIRCULA TION OF
BLOOD IN THE
HE A RT
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NONMODIFIA BLE
Age: 87 y/o
Family Hx of stroke
LESS WELL-DOCUMENTED
Sedentary lifestyle
exercise
high salt high fat
WELL-DOCUMENTED
HPN
DM
ECG result
Absent P wave
Irregular rhythmNarrow QRS
Multi atrial contraction
PVC·s
Formation of atherosclerosis
Narrowing of Blood Vessels
Dislodges of the atherosclerosis
Irregular conduction of
impulses
Irregular, disorganized, chaotic,
and very rapid contraction of atria
Blood tends to form clots
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Travel/flow to circulation
Block the blood vessels at Circle of Willis on Left part
Insufficient blood supply to left part of brain
Progressive weakness
Loss of gait
Slurring of speech
Responsive to
stimuli
Vomiting of
previously injested
food
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DRUGSTUDY
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NURSING
CARE
PLAN
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DISCH A RGE PLA NNINGM ² Medication
Advise patient to take
home medication following right drug,
frequency, dosage and timing asprescribed by the physician such as
follows:
1.
Omeprazole 20mg/tab, 1 tab afterbreakfast and before bedtime for 1 week
2. Al Mg (OH)2 suspension 30ml every 6
hours for 1 week
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3. Verapamil 40mg/tab, 1 tab every 12 hoursafter breakfast and dinner
4. Clopidogrel 75mg/tab, 1 tab once a day afterlunch
5. Gliclazide 80mg/tab, ½ tab after breakfastand dinner
6.B
isacodyl suppository, 1 supp before bedtime7. Apply petroleum jelly over buttocks
8. Mupuricin cream, 3x a day over affected areafor 5 days
Encourage patient to follow drug regimen especially maintenance
medications
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E ² Environment
Instruct patient to stay in calm,
quiet environment.
Home environment must be free
from slipping or accident hazards.
Instruct SO to provide patient with
well ventilated room so that patient
can rest well. Advice the SO to stay with the
patient always.
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T ² Treatment
-Inform patient to come back once
laboratory results available.
- inform that the removal andreplacement of Foley catheter is after
5 days
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H ² Health TeachingsEncourage client to engage to range of motion
exercises. Advise patient to increase adequate fluid
intake for hydration purposesEncourage patient not to participate in
strenuous activities
Encourage SO to turn the patient side to sidein a regular schedule of time for atleast every2 hours
Promote rest periods among the client
Advise SO to position first the patient onMHBR position before offering meals to avoidaspiration
Encourage SO to offer small frequent mealsto patient
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O ² Observable Signs and Symptoms
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D² Diet
Encourage client to increase intake
of potassium
- Instruct to increase fluid intake
- Instruct to increase intake of nutritious foods rich in Vitamin C
such as fruits and vegetables to boost
one·s immune system.- Emphasize on low salt low fat diet
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S- Spirituality
Advise patient to keep believing on God·sholy will so that she could be spiritually
motivated.
Tell SO to constantly participated
patient on religious activities so that his
faith could be more strengthened.