opd case pres

Far Eastern University Institute of Nursing

CASE PRESENTATION

Concept: INPCerebral Vascular Accident (CVA)

Submitted By:Dulay,CarlaJaneena

Pangilinan, Brylle JaeReyes, Kristine Irish

Sallan, ShermaneCriszenSernande, Marlon Nikko

Subijano, AljonlexterTaguiam,Marvin Gardner

Tria, Juris Ezra

BSN504 Group 16

Submitted To:

Clinical Instructor

Date Submitted: March 3, 2015

I. Demographic Data

Name: E.D.J.Address: 23 E. Castillo St. Barangay Commonwealth Q.C.Current Address: 23 E. Castillo St. Barangay Commonwealth Q.C.Age: 63Birth Date: August 5, 1951Birth Place: Educational Attainment: Occupation before Admission: Security GuardMarital Status: marriedReligion: CatholicChief Complaint: double visionImpression Diagnosis: C.V.A

II. Past Health History

The patient has no history of hypertension. He has a type 2 diabetes mellitus. He has a complete immunization whenhe was still a child. No know allergies in any drugs or foods.

III. Present Health History

Patient come in referral from internal medicine with a diagnosis of R/O reinfarction, S/P CVA in 2002 and 2009 with the complaint of having a double vision but no pain in the eye and no blurring of vision.

III. Family History

Patient has a family history of hypertension and diabetes mellitus but no history of cancer

III. Gordon’s Assessment

Gordon’s Assessment

Before Admission During Admission Analysis Interpretation

Health Perception and Management

When asked about his perceptions

about being healthy, he stated, “Pagmalusogangis

angtao, kumakainnggulay at nag eexercise”. He also said that

he rates his health 5/10 because he

believes that being healthy is not only seen in physical

aspects. He thinks he is mentally,

emotionally and spiritually healthy.

The client also said that whenever he

has problems about health he

always consult his doctor.

“Hindi ako masyado makalad kasi nanghihina

yung kanang paa ko. Hindi ko na magawa

yung normal na Gawain ko simula nung Friday noong dinala ako ditto

dahil nga doble na nakikita ko”, as

verbalized by the client.

He also said that he rates his health 5/10

because he believes that being healthy is not only seen in physical aspects. He thinks he is mentally,

emotionally and spiritually healthy.

Health perceptions (or perceived health status) are subjective ratings by the affected individual of his or her health status6. Some people perceive themselves as healthy despite suffering from one or more chronic diseases.

Reference: American Thoracis Society,

2007)..

Normal

Nutritional Pattern

The client prefer eating

vegetables ,fruits and fish only. He

likes food with “sabaw” like sinigang. He

seldom eat meats especially if it is

fried.

He said that he drinks plenty of

water in a day. He drinks 7-8 glasses of water in a day.

The client has changes in appetite. He was having a difficulty in

swallowing and he thinks that it is because of his cough and his mouth is

deviated to the right side.

The middle aged adult should continue to eat a healthy diet, following the recommended portions of the food groups, with special attention to protein, calcium and limiting cholesterol and caloric intake. Two or three litters of fluid\should be included in the diet. (Kozier&Erb’s, Fundamentals of Nursing 8th Edition Vol. 2 page 1243).

Although the nutritional content of

Deviation from normal

food is an important consideration when



planning a diet, an individual’s food preferences and

habits are major factor affecting actual food

intake. (Kozier&Erb’s, Fundamentals of

Nursing 8th Edition Vol. 2 page 1237).

Elimination Pattern

The client usually defecates once or

twice a day he doesn’t have any difficulty letting it out. The client

urinates 5-7 times a day because he

drinks a lot of water everyday. When he

feels the urge to urinate, he’s going

to the bathroom immediately to urinate and he stated that he

doesn’t feel any difficulty when

urinating.

The client usually defecates once or twice a day he doesn’t have any difficulty letting it out. The client urinates 5-7 times a day because he drinks a lot of water everyday. When he feels the urge to urinate, he’s going to the bathroom immediately to urinate and he stated that he doesn’t feel any difficulty when urinating.

The frequency of defecation is highly individual, varying from several times per day totwo or three times per week.

(Kozier&Erb’s, Fundamentals of Nursing 8th Edition Vol. 2 page 1325 and 1284).

Normal

Activity and Exercise pattern

Since the client experience CVA

before, he is religiously doing

his exercise everyday for 15 to

30 minutes. His form of exercise are walking, wall

push ups and stationary biking.

When he has nothing to do he

takes nap at noon time or sometimes

watching TV.

Even though the client is experiencing weakness on his right foot he still do his stationary biking as his daily exercise .

According to researchers at Harvard’s School of Public Health (HSPH), a regular physical activity is the best form of health promotion and maintenance. (Kozier&Erb’s, Fundamentals of Nursing 8th Edition Vol. 2 page 1105).

Normal



Sleep rest pattern

The client usually sleep at around 10 in the evening and wakes up at 6 in the morning. He

describes his sleep as deep and has

interuptions only if he has to go to the

bathroom.

The daughter said that the client is having difficulty in sleeping lately because of his

cough.

Most adults need 7 to 9 hours of sleep a night. However, there is individual variation as some adults may be able to function well with 6 hours sleep and others may need 10 hours to function optimally. (Kozier&Erb’s, Fundamentals of Nursing 8th Edition Vol. 2 page 1168).

Normal

Cognitive – Perceptual

Pattern

When asked about the changes that he observed while aging, he stated, “ Lumabo mata ko pero nagsimula yun matagal tagal na, reading glass lang”.

When asked about if there were situations that he experienced having difficulty recalling things, he said, “Hindi pa naman masyado, nakakaalala pa naman ako, lalo na yung mga matatagal na mga bagay na, ‘di pa naman ako malilimutin ngayon”.

When asked about the changes that he observed while aging, he stated, “ Lumabo mata ko pero nagsimula yun matagal tagal na, reading glass lang”.

When asked about if there were situations that he experienced having difficulty recalling things, he said, “Hindi pa naman masyado, nakakaalala pa naman ako, lalo na yung mga matatagal na mga bagay na, ‘di pa naman ako malilimutin ngayon”.

Any alteration in people’s sensory functions can affect their ability to function within the environment. A number of factors affect amount and quality of sensory including a person’s developmental stage.

(Kozier&Erb’s, Fundamentals of Nursing 8th Edition Vol. 2 page981-982).


. Self-perception – Self-concept

Pattern

The client describes his self

as a happy person. He said that he feels satisfied

about his self even though he has

The client describes his self as a happy person.

He said that he feels satisfied about his self even though he has health problems. He

feels happy and

A positive self concept is essential to a person’s mental and physical health. Individuals with positive self concept are better able to

Normal

health problems. He feels happy and

satisfied with his life. He gets along easily with

develop and maintain interpersonal



satisfied with his life. He gets along

easily with other people and look on

things positively.

other people and look on things positively.

relationships and resist psychological and physical illness. An individual possessing a strong self concept should be better able to accept or adapt to changes that may occur over the life span. How one views one self affects one’s interaction with others.

(Kozier&Erb’s, Fundamentals of Nursing 8th Edition Vol. 2 page 1003).

Role – Relationship

Pattern

The client is happy and proud that he has a happy family

and that he was able to provide the needs of his family. He said that he is happy that he has

his family especially his wife and daughter that

is always their supporting him

and taking care of him during his first stroke attack and

up until now.

The client is happy and proud that he has a

happy family and that he was able to provide the needs of his family. He

said that he is happy that he has his family

especially his wife and daughter that is always

their supporting him and taking care of him during his first stroke attack and

up until now.

Generativity versus stagnation is the seventh stage of Erik Erikson’s theory ofpsychosocial development. This stage takes place during middle adulthood between the ages of approximately 40 and 65. During this time, adults strive to create or nurture things that will outlast them; often by having children or contributing to positive changes that benefits other people.

Reference: The Seventh Stage of Psychosocial Development by Kendra Cherry

Normal



Coping – Stress Tolerance

Pattern

The client said that whenever he is

facing problems, he just don’t want

to think about it. He doesn’t want to

stress to much. But when he needs

someone to vent it out, he said that he talks to his wife or

his eldest daughter.

He said that he is very thankful

because he has his family taking care

of him.

The client said that whenever he is facing problems, he just don’t

want to think about it. He doesn’t want to stress to

much. But when he needs someone to vent it out, he said that he talks to his wife or his eldest

daughter.

He said that he is very thankful because he has his family taking care of

him.

Coping may be described as dealing with change-successfully or unsuccessfully. A coping strategy or coping mechanism is a natural or learned way of responding to a changing environment or specific problem or situation. Coping strategies vary among individuals and are often related to the individual’s perception of the stressful event.

(Fundamentals of Nursing Kozier and

Erb’s Fundamentals of Nursing Volume 2,

pp.1068).

Normal

Value – Belief Pattern

The client said that he and his family

always go to church. He said

that his daughters were very active in their church before.

They were once member of the

choir. As a family, they always pray the Holy Rosary

daily.

The daughter said that her parents

taught them to be God fearing and

respectful to other people.

The client’s daughter said that their faith

became more stronger when they learned that their father had CVA.

A person’s value-belief system is the core of his or her existence and interconnectedness with his or her spiritual side as well as with his or her environment.

Reference: Muhammad Iqbal, Value- Belief Pattern: Advanced Concept in Nursing)

Normal

III. Physical Assessment

VITAL SIGNS: BP: Temp: PR: RR: O2 saturation:

Assessment of Head to ToeAreas assessed

( or Test Performed)

Technique Used Analysis Actual

Findings Interpretation

I. Skull InspectionRounded (normocephalic and symmetric, with frontal, parietal, and occipital prominence) ; smooth skull contour

[Krozier&Erb’s Fundamentals of Nursing, 8th Edition].

Rounded and symmetric

Normal

Palpation Smooth, uniform consistency; absence of nodules or masses


No nodules and masses

- Normal

II. Hair and Scalp

Inspection Scalp is clean and dry. Sparse dandruff may be visible

[Weber & Kelly, Health Assessment in Nursing, 3rd Edition]

Scalp has dandruff and dirty

Deviations from Normal

- Self-care deficit

Hair Inspection Evenly distributed, thick, silky and resilient hair, no infection or infestation


Hair is dirty and oily. Minimal loss of hair.

Deviation from normal- Self-care

deficit- Age 63 years

old

III. Face Inspection Symmetric or slightly asymmetric facial features; palpebral fissures equal in size; symmetric nasolabial folds; symmetric facial movements


The clients right facial muscle is paralyzed

- Deviation from normal

- The client is status post CVA

IV. Eye Structures and Visual Acuity a. Eyebrows

Inspection

Hair evenly distributed; skin intact; eyebrows symmetrically aligned; equal movement


The clients eyebrows are evenly distributed

- Normal

b. Eyelashes Inspection Equally distributed; curled slightly outward


The client’s eyelashes are short, thin and sparse but are evenly distributed over the eyelids and

Normal

are curved outward along the lid margins.

c. Eyelids Inspection Skin intact; no discharge ; no discoloration; lids close symmetrically

Approximately 15 to 20 involuntary blinks per minuteWhen lids open, no visible sclera above corneas, and upper and lower borders of cornea are slightly covered


The clients eyelids skin is intact and able to blink 15-20 per min

- Normal

d. Bulbar conjunctiva

Inspection Transparent; capillaries sometimes evident; sclera appears white (darker or yellowish and with small brown macules in dark-skinned clients)


No opportunity to assess


e. Palpebral conjunctiva

Inspection Shiny, smooth, and pink or red [Krozier&Erb’s Fundamentals of Nursing, 8th Edition].



f. Lacrimal gland

Inspection No edema


The clients lacrimal gland has no edema

- Normal

Palpation No tenderness over lacrimal gland


No tenderness over lacrimal gland

- Normal

g. Lacrimal sac and nasolacrimal duct

Inspection No edema


No Edema - Normal

Palpation No tearing

[Krozier&Erb’s Fundamentals of Nursing, 8thEdition].

No tearing in the eye when palpated

Normal

h. Cornea Inspection Transparent, shiny, and smooth; details of the iris are visibleIn older people, a thin, grayish white ring around the margin, called arcussenilis, may be evident Client blinks when the cornea is touched, indicating that the trigeminal nerve is intact


The clients cornea has grayish white ring around the margin and thin.

- Normal

i. Anterior chamber

Inspection TransparentNo shadows of light on iris; Depth of about 3 mm


-

j. Pupils Inspection Black in color; equal in size; normally 3 to 7 mm in diameter; round, smooth border, iris flat and round

Pupils constrict when looking at near object; pupils dilate when looking at far object; pupils converge when near object is moved toward nose


-

k. Peripheral visual fields (retina and neuronal visual pathways)

Inspection(Neurologic Assessment)

When looking straight ahead, client can see objects in the periphery


The client can see object in periphery

- Normal

l. Six ocular movements

Inspection(Neurologic Assessment)

Both eyes coordinated, move in unison, with parallel alignment

[Krozier&Erb’sFundamentals of Nursing, 8th Edition].



m. Near vision Inspection Able to read newsprint [Krozier&Erb’s Fundamentals of Nursing, 8th Edition].



n. Distance vision

Inspection 20/20 vision on Snellen output




V. Ears and hearing a. Auricles

InspectionColor same as facial skin; symmetrical; auricle aligned with outer canthus of eye, about 10˚ from vertical


The color of the clients auricles is same as the clients facial skin.

- Normal

Palpation Mobile, firm, and not tender; pinna recoils after it is folded


The clients pinna recoils after it is folded

- Normal

b. Normal voice tone

Inspection Normal voice tones audible


The clients voice tone is audible.

- Normal

c. Watch tick test

Inspection Able to hear in both ears


The client can hear from both ears and able to respond in questions.

- Normal

d. Weber’s test Inspection Sound is heard in both ears or is localized at the center of the head (Weber negative)




e. Rinne’s test Inspection Air-conducted(AC) is greater than bone-conducted (BC) hearing, i.e., AC>BC (Rinne positive)


-

VI. Nose and Sinuses a. External nose

InspectionSymmetric and straightNo discharge or flaringUniform color


Presence of discharge from nares

Deviations from Normal

- Impaired tissue perfusion

b. Patency of nasal cavities

Inspection & palpation

Air moves freely as the client breathes through the nares


The client breathes through the nares freely

- Normal

c. Nasal cavities Inspection The nasal mucosa is dark pink, moist and free of exudates

[Weber & Kelly, Health Assessment in Nursing, 3rd Edition].

-

d. Nasal septum Inspection The nasal septum is intact and free of ulcers or perforations

[Weber & Kelly, Health Assessment in Nursing, 3rd Edition]; nasal septum is in midline [Krozier&Erb’s Fundamentals of Nursing, 8th Edition].



e. Maxillary and frontal sinuses

Palpation Not tender




VII. Mouth and Oropharynx a. Outer lips Inspection Uniform pink color (darker e.g.

bluish hue in Mediterranean people and dark-skinned people) Soft, moist, smooth textureSymmetry of contour

The lips are pale and chopped.

Deviation from normal- Impaired

tissue perfusion

Ability to purse lips


b. Inner lips and buccal mucosa

Inspection & Palpation

Uniform pink color (freckled brown pigmentation in dark clients)Moist, smooth, soft, glistening, elastic texture (drier oral mucosa in elderly due to decreased salivation




c. Teeth and gums

Inspection 32 adult teethSmooth, white, shiny tooth enamelPink gums (bluish or brown patches in dark-skinned clients)Moist, firm texture to gums No retraction of gums (pulling away from the teeth)




d. Tongue Inspection Central positionPink color (in dark clients, with brown pigmentation on tongue borders); moist, slightly rough; thin whitish coatingSmooth, lateral margins; no lesionsRaised papillae(taste buds)

Moves freely; no tenderness

Smooth with no palpable nodules




Palpation Smooth with no palpable nodules




e. Hard and soft palate

Inspection Light pink, smooth soft palateLighter pink hard palate, more irregular in texture




f. Uvula Inspection Positioned in midline of soft palate




g. Oropharynx Inspection Pink and smooth posterior wall No opportunity to assess


h. Tonsils Inspection Pink and smoothNo dischargeOf normal size or not visible




i. Gag reflex Inspection Present




VIII. Neck and Lymph Nodes a. Neck muscles

Inspection Muscles equal in size; head centered


The client can move his neck but most of the time it is on right side

- Deviation from normal

IX. Lymph Nodes Neck

Palpation Not palpable




X. Trachea Palpation Central placement in midline of neck; spaces are equal on both sides




XI. Thyroid Gland Thyroid gland

Inspection Not visible on inspectionGlands ascend during swallowing but is not visible




Palpation Lobes may not be palpatedIf palpated, lobes are small, smooth, centrally located, painless and rise freely with swallowing




XII. Posterior Thorax a. Posterior Thorax

Inspection Anteroposterior to transverse diameter in ratio of 1:2Chest symmetric




b. Spinal alignment

Inspection Spine vertically aligned;Spinal column is straight, right and left shoulders and hips are at same height

[Krozier&Erb’s Fundamentals of



Nursing, 8th Edition].c. Posterior Thorax

Palpation Skin intact, uniform temperatureChest wall intact; no tenderness no masses

[Krozier&Erb’s Fundamentals of Nursing, 8thEdition].



d. Posterior chest

Palpation Symmetrical chest expansion


Bilateral symmetry of vocal fremitusFremitus is heard most clearly at the apex of the lungs




f. Posterior Thorax

Percussion Percussion notes resonate, except over scapulaLowest point of resonance is at the diaphragmPercussion on a rib normally elicits dullness

Excursion is 3-5 cm (1 ½ to 2 in.) bilaterally in women and 5-6 inch (2 to 3 in.) in menDiaphragm is usually slightly higher on the right side




h. Chest Auscultation Vesicular and bronchovesicularbreathsounds


Positive crackles. The client has cough


XIII. Anterior Thorax a. Anterior Thorax

Inspection Breathing patterns are quiet, rhythmic, and effortless respirations

Costal angle is less than 90˚, and the ribs insert into the spine at approximately a 45˚ angle


Breathing patterns are effortless respirations

- Normal

Palpation Symmetrical chest expansion

Full symmetric excursion; thumbs normally separate 3-5 cm (1 ½ to 2



in.)


b. Anterior chest

Palpation Bilateral symmetry of vocal fremitusFremitus is normally decreased over heart and breast tissue




Percussion Percussion notes resonate down to the sixth rib at the level of the diaphragm but are flat over areas of heavy muscle and bone, dull on areas over the heart and liver, and tympanic over the underlying stomach




c. Trachea Auscultation Bronchial/tubular breath sounds




d. Anterior chest

Auscultation Bronchovesicular and vesicular breath sounds




Musculoskeletal Inspection

Equal strength on each body side

+5 - full ROM, full strength+4 - full ROM, less than normal strength+3 - can raise extremity but not against resistance+2 - can move extremity but not lift it+1 - slight movement0 - no movement

3 Grade of muscle strength 50 % of

normal strength; normal movement against gravity, can stand with support

Deviations from normal

- Activity intolerance

IV. Laboratory and Diagnostic Examinations Results

August 9, 2014

HEMATOLOGY

TEST NAME RESULT UNITREFERENCE

RANGEINTERPRETATION

CBC + DIFFComplete Blood CountWBC Count 7.51 x10˄9/L 5.00 – 10.00 Normal

Neutrophils 0.613 0.550 – 0.650 NormalLymphocytes 0.290 0.250 - 0.350 NormalMonocytes 0.060 0.020 – 0.060 NormalEosinophils 0.029 0.030 – 0.050 NormalBasophils 0.008 0.000 – 0.010 Normal

RBC Count 4.33 x10˄12/L 5.50 – 6.50 NormalHemoglobin (Hgb) 131 g/L 140 – 160 NormalHematocrit (Hct) 0.396 L/L 0.420 – 0.520 LowMCV 91.5 fL 80.0 – 100.0 NormalMCH 30.3 pg 27.0 – 34.0 NormalMCHC 331 g/L 320 – 380 Normal

RDW CV 12.4 % 11.0 – 16.0 NormalRDW SD 41.9 fL 35.0 – 56.0 NormalPlatelet Count 267 x10˄9/L 160 – 380 NormalMPV 8.8 fL 6.5 – 12.0 NormalPDW 8.7 fL 9.0 – 17.0 Normal

August 5, 2014

BLOOD CHEMISTRY

TEST REFERENCE RANGE RESULT INTERPRETATIONBUN 2.5 – 7.2 mmol/L

Creatinine 50.40 – 98.0 umol/L 80.00 NormalTotal Bilirubin 3.4 – 20.5 umol/LDirect Bilirubin 0.00 – 8.6 umol/L

Indirect Bilirubin 3.4 – 11.90 umol/LAlbumin 35 – 50 g/L

SGOT/AST 0 – 55 U/LSGPT/ALT 0 – 55 U/L 15.00 Normal

Sodium 136 – 145 mmol/L 135.80 LowPotassium 3.5 – 5.10 mmol/L 4.40 Normal

ALP 32-92 U/LESR

August 5, 2014

URINALYSIS

PARAMETER FINDINGSColor YellowCharacter HazyBlood NegativeBilirubin NegativeUrobilinogen NormalKetone (-)Protein (-)Nitrite (-)Glucose +1pH 6.0Specific gravity 1.015Leukocytes (-)

MICROSOCPICCast NoneCrystals None

Pus Cells 0-1 /hpfRed Blood Cells 0-1 /hpfEpithelial Cells Few

A. Urates/Phosphates OccasionalBacteria Occasional

CBG

Reference Range 8/5/2014 8/6/2014 8/7/2014

70 – 180 mg/dl6pm - 150 5am – 117 5am - 103

11am – 1705pm - 94

Gram stain of sputumSmear shows plenty gram positive cocci seen in singly, pairs, chains, and clusters. Few epithelial cells with 50-60 pus cells/hpf

August 8, 2014

Sputum Culture and Sensitivity Report

Light growth of Pseudomonas putida after growth in 24 hours of incubation.

August 5, 2014

ELECTROCARDIOGRAPHIC REPORT

RHYTHM: SINUS P-R Interval: 0.14 SEC. QRS AXIS: NRATES: AURICULAR: 83/MIN QRS Interval: 0.08 SEC.

ELECTRICALPOSITION:

VENTRICULAR: 83/MIN Q-T Interval: 0.36 SEC.

ECG INTERPRETATION

Within Normal Limits

August 5, 2014

ROENTGENOGRAPHIC REPORT

CHEST:

No active lung infiltrate seen. Pulmonary vascular markings are within normal limits. Heart is not enlarged. Diaphragm and bony thorax are unremarkable.

IMPRESSION:

Unremarkable chest

August 9, 2014

ROENTGENOGRAPHIC REPORT

CHEST#2:

Follow up film since Aug. 5, 2014 shows interval development of ill-defined densities in both lung bases suggestive of interstitial pneumonia. Heart remains unenlarged. The rest of the chest findings are unchanged including atheromatous aorta and osteodegenerative changes.

V. Overview of Disease/Anatomy and Physiology

Strokes are a heterogeneous group of disorders involving sudden, focal interruption of cerebral blood flow that causes neurologic deficit. Strokes can be ischemic (80%), typically resulting from thrombosis or embolism, or hemorrhagic (20%), resulting from vascular rupture (eg, subarachnoid or intracerebralhemorrhage). Transient stroke symptoms (typically lasting< 1 h) without evidence of acute cerebral infarction (based on diffusion-weighted MRI) are termed a transient ischemic attack (TIA). In the US, stroke is the 4th most common cause of death and the most common cause of neurologic disability in adults.

Strokes involve the arteries of the brain either the anterior circulation (branches of the internal carotid artery) or the posterior circulation (branches of the vertebral and basilar arteries).

According to the latest WHO data published in April 2011 Stroke Deaths in Philippines reached 40,245 or 9.55% of total deaths. The age adjusted Death Rate is 82.77 per 100,000 of population ranks Philippines #106 in the world. Review other causes of death by clicking the links below or choose the full health profile.

A stroke can be caused by an artery to the brain may be blocked by a clot (thrombosis) which typically occurs in a blood vessel that has previously been narrowed due to atherosclerosis ("hardening of the artery"). When a blood clot or a piece of an atherosclerotic plaque (a cholesterol and calcium deposit on the wall of the artery) breaks loose, it can travel through the circulation and lodge in an artery of the brain, plugging it up and stopping the flow of blood; this is referred to as an embolic stroke. A blood clot can form in a chamber of the heart when the heart beats irregularly, as in atrial fibrillation; such clots usually stay attached to the inner lining of the heart but they may break off, travel through the blood stream, form a plug (embolus) in a

brain artery and cause a stroke. A cerebral hemorrhage (bleeding in the brain), as from an aneurysm (a widening and weakening) of a blood vessel in the brain, also causes stroke.

Initial symptoms occur suddenly. Generally, they include numbness, weakness, or paralysis of the contralateral limbs and the face; aphasia; confusion; visual disturbances in one or both eyes (eg, transient monocular blindness); dizziness or loss of balance and coordination; and headache.

Neurologic deficits reflect the area of brain. Anterior circulation stroke typically causes unilateral symptoms. Posterior circulation stroke can cause unilateral or bilateral deficits and is more likely to affect consciousness, especially when the basilar artery is involved.

Risk factors include: Hypertension, Cigarette smoking, Dyslipidemia, DiabetesAbdominal obesity, Alcoholism, Lack of physical activity, High-risk diet (eg, high in saturated fats, trans fats, and calories), Psychosocial stress (eg, depression), Heart disorders (particularly disorders that predispose to emboli, such as acute MI, infective endocarditis, and atrial fibrillation), Hypercoagulability (thrombotic stroke only), Intracranial aneurysms (subarachnoid hemorrhage only), Use of certain drugs (eg, cocaine, amphetamines), Vasculitis.Unmodifiable risk factors include the following:Prior stroke, older age, Family history of stroke, Male sex.

When a stroke is severe, the brain swells, increasing pressure within the skull. Increased pressure can damage the brain directly or indirectly by forcing the brain downward in the skull. The brain may be forced through the rigid structures that separate the brain into compartments, resulting in a serious problem called herniation

Computed tomography or magnetic resonance imaging of the brain is done. These tests can detect most hemorrhagic strokes, except for some subarachnoid hemorrhages. If needed to confirm the diagnosis, a specialized type of MRI, called diffusion-weighted MRI, can show areas of brain tissue that are deprived of blood. The blood sugar level is measured immediately because a low blood sugar level (hypoglycemia) can cause symptoms similar to those of stroke. Doctors evaluate people who have had a stroke for problems that can contribute to or cause a stroke, such as infection, a low blood oxygen level, and dehydration. The ability to swallow is evaluated, sometimes with x-rays taken after a radiopaque dye such as barium is swallowed. Depending on the type of stroke, more tests are done to identify the cause.

Treatments used during the first hours depend on the type of stroke. These treatments include drugs (such as antiplatelet drugs, anticoagulants, drugs to break up clots, and drugs to control high blood pressure) and surgery to remove blood that has accumulated. Later and ongoing treatments focus on preventing subsequent strokes, treating and preventing problems that strokes can cause, and helping people regain as much function as possible (rehabilitation).

VI. Ecologic Model

Predisposing factors:

I. Hosta. Gender: Maleb. Age: 63 years oldc. Family History: Hypertension

II. Agenta. Dietb. Lifestyle

III. EnvironmentLiving condition

Analysis:The model used was a wheel. The model shows that there are different contributing

factors that affect the client and leads to his CVA Infarctions. These risks factors aggravate the already present disease of the client like hisfamily history of Hypertension which contributes to bloodflow to different parts of the body. CVA Infarctions occurs when there is an occlusion to a blood vessel that leads to the brain, this diminishes the blood supplied to the brain and causes infarction resulting to damage to nerves and other cells. Age, diet and gender are also some of

the contributing factors wherein in the patient’s case this is the enabling factors for his condition, his diet consists mostly of fastfoods and salty food, with his age and gender rendering his more susceptible to the disease.

VIII. Problem Prioritization

PROBLEMS IDENTIFIED RANK JUSTIFICATIONImpairedphysicalmobility related to neuromuscular impairment secondary to CVA

SUBJECTIVE:“medyo Nahihirapan Siyang

1 This problem is highly prioritized because it is an actual problem and gives the patient discomfort.

Igalaw ung kanang parte ng katawanniya” as verbalizedby clients daughter.

OBJECTIVES:-limited rangeof motion-uncoordinatedmovements-slowed movementActivity intolerance related to body weakness secondary to CVA

Subjective“nahihirapan ako maglakad”

Objective Verbal report of fatigue or weaknessInability to begin or perform ActivityAbnormal heart rate or blood pressure (BP) response to activity

2 This is moderately prioritized because it can only prevented if other underlying aspect can be reduced or treated.

Risk for Impaired Swallowing r/t Neuromuscular Impairment

Subjective:

As verbalizes by the client “pag kumakain ako nahihirapan akong lumunok.”

3 This is moderately prioritized because it can only prevented if other underlying aspect can be reduced or treated.

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