ppp case study

8/3/2019 Ppp Case Study

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CEREBRO VASCULAR

ACCIDENT

CARDIOEMBOLIC

STROKE



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.



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



WH AT ARE THE CAUSES AND

RISKS OF THE CONDITION?

Atrial Fibrillation

severe congestive

heart failure



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



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



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.



II. A SSESSMENT

Pt's ProfileName: Patient M

Sex: Female

Age: 87 y/o

Status: WidowedReligion: Jehova·s Witness



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



Last September 26, 2011 at4:00pm she was admiited

at Malipayon DistrictHospital with a diagnosis

of Cerebrovascular

Accident Problem;

Cardioembolic Stroke



P AST HE ALTH HISTORY

gum bleedingacute gastritis



F AMILY HE ALTH HISTORY

The patient has family

health history of

hypertension on her

mother·s side.

Diabetes Mellitus onfather·s side



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



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



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



REVIE W OF SYSTEM



CIRCULA TION OF

BLOOD IN THE

HE A RT



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



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



DRUGSTUDY



NURSING

CARE

PLAN



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



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



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.



T ² Treatment

-Inform patient to come back once

laboratory results available.

- inform that the removal andreplacement of Foley catheter is after

5 days



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



O ² Observable Signs and Symptoms



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



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.

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