I. INTRODUCTION Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain.

Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect. Sustained hypertension permanently changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and more vulnerable to fluctuations in blood pressure. A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue. The most common symptom of a stroke is sudden weakness or numbness of the face, arm or leg, most often on one side of the body. Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. The effects of a stroke depend on which part of the brain is injured and how severely it is affected. A very severe stroke can cause sudden death. The 1990 Global Burden of Disease (GBD) study provided the first global estimate on the burden of 135 diseases, and cerebrovascular diseases ranked as the second leading cause of death after ischemic heart disease. During the past decade the quantity of especially routine mortality data has increased, and is now covering approximately one-third of the worlds population. The increase in data availability provides the possibility for updating the estimated global burden of stroke. Data on causes of death from the 1990s have shown that cerebrovascular diseases remain a leading cause of death. In 2001 it was estimated that cerebrovascular diseases (stroke) accounted for 5.5 million deaths world wide, equivalent to 9.6 % of all deaths Two-thirds of these deaths occurred in people living in developing countries and 40% of the subjects were aged less than 70 years. Additionally, cerebrovascular disease is the leading cause of disability in adults and each year millions of stroke survivors has to adapt to a life with restrictions in activities of daily living as a consequence of cerebrovascular disease. Many surviving stroke patients will often depend on other peoples continuous support to survive.

II. OBJECTIVES GENERAL OBJECTIVES 1. To be able to discuss the effect, signs and symptoms of the disease, Cerebrovascular Disease. 2. How to diagnose, prevent and the treatment should the nurse give for the patient full recovery. SPECIFIC OBJECTIVES 1. To be able to discuss patients background ( lifestyle, history of the past illness, family health history) to show how may this effect on the occurrence of this disease. 2. To be able to discuss the anatomy and the physiology of the heart, for you to be able to understand where the infection takes place. 3. To be able to discuss the pathophysiology of cardiovascular diseases and also to know and understand the etiology of the disease. 4. To be able to discuss the patient activities of daily living. To know if theres a factor that triggers the disease 5. To be able to discuss, nursing care plan for our patient. 6. To be able to discuss, the medication / drugs that the patient taken and the diagnostic test that being perform for the patient. 7. Lastly, to be able to discuss our discharge plan for fully recovery of our patient.

III. PATIENTS PROFILE

IV. PHYSICAL ASSESSMENT GENERAL SURVEY

Mr. X was lying semi-fowlers on bed, conscious, coherent, afebrile with monitoring devices. A. VITAL SIGNS Date 07/18/09 Shift 3am11pm Time Temp 36.8 BP 180/130 RR 88 PR 20 Intake 550cc Output 100cc

B. HEAD Pink papillary conjunctiva C. NEUROLOGIC STATUS -Oriented to time, person and place. CRANIAL NERVES ASSESSMENT CN I- can smell CN II- (2-3) ERTL CN III, IV, VI- , intact CN V- (+) corneal reflex CN VII- no facial asymmetry CN IX- (+) gag reflex CN XI- can shrug shoulder CN XII- tongue at midline D. PULMONARY SYSTEM -Respiratory rate was 20 cpm -SCE, no vesicular breath sounds. -AP, Apical beat at the 6th ICS anterior axillary line normal sounds. E. GASTROINTESTINAL SYSTEM Flabby, NaBS, no abdominal bruit, (-) edema,(-) cyanosis. F. MUSCULOSKELETAL SYSTEM The patient manifested good posture voluntarily; she has muscle atrophy at right side and moved

G. GENITO- URINARY SYSTEM Patient voided 60 100cc per shift and yellow in color.

V. ANATOMY AND PHYSIOLOGY The Brain Three cavities, called the primary brain vesicles, form during the early embryonic development of the brain. These are the forebrain (prosencephalon), the midbrain (mesencephalon), and the hindbrain (rhombencephalon).

The telencephalon generates the cerebrum (which contains the cerebral cortex, white matter, and basal ganglia).

The diencephalon generates the thalamus, hypothalamus, and pineal gland.

The mesencephalon generates the midbrain portion of the brain stem. The metencephalon generates the pons portion of the brain stem and the cerebellum.

The myelencephalon generates the medulla oblongata portion of the brain stem

Figure 1 The four divisions of the adult brain.

The cerebrum consists of two cerebral hemispheres connected by a bundle of nerve fibers, the corpus callosum. The largest and most visible part of the brain, the cerebrum, appears as folded ridges and grooves, called convolutions. The following terms are used to describe the convolutions:

A gyrus (plural, gyri) is an elevated ridge among the convolutions.

A sulcus (plural, sulci) is a shallow groove among the convolutions.

A fissure is a deep groove among the convolutions.

The deeper fissures divide the cerebrum into five lobes (most named after bordering skull bones)the frontal lobe, the parietal love, the temporal lobe, the occipital lobe, and the insula. All but the insula are visible from the outside surface of the brain. A cross section of the cerebrum shows three distinct layers of nervous tissue:

The cerebral cortex is a thin outer layer of gray matter. Such activities as speech, evaluation of stimuli, conscious thinking, and control of skeletal muscles occur here. These activities are grouped into motor areas, sensory areas, and association areas.

The cerebral white matter underlies the cerebral cortex. It contains mostly myelinated axons that connect cerebral hemispheres (association fibers), connect gyri within hemispheres (commissural fibers), or connect the cerebrum to the spinal cord (projection fibers). The corpus callosum is a major assemblage of association fibers that forms a nerve tract that connects the two cerebral hemispheres.

Basal ganglia (basal nuclei) are several pockets of gray matter located deep inside the cerebral white matter. The major regions in the basal gangliathe caudate nuclei, the putamen, and the globus pallidusare involved in relaying and modifying nerve impulses passing from the cerebral cortex to the spinal cord. Arm swinging while walking, for example, is controlled here. The diencephalon connects the cerebrum to the brain stem. It

consists of the following major regions:

The thalamus is a relay station for sensory nerve impulses traveling from the spinal cord to the cerebrum. Some nerve

impulses are sorted and grouped here before being transmitted to the cerebrum. Certain sensations, such as pain, pressure, and temperature, are evaluated here also.

The epithalamus contains the pineal gland. The pineal gland secretes melatonin, a hormone that helps regulate the biological clock (sleep-wake cycles).

The hypothalamus regulates numerous important body activities. It controls the autonomic nervous system and regulates emotion, behavior, hunger, thirst, body temperature, and the biological clock. It also produces two hormones (ADH and oxytocin) and various releasing hormones that control hormone production in the anterior pituitary gland.

The following structures are either included or associated with the hypothalamus.

The mammillary bodies relay sensations of smell. The infundibulum connects the pituitary gland to the hypothalamus.

The optic chiasma passes between the hypothalamus and the pituitary gland. Here, portions of the optic nerve from each eye cross over to the cerebral hemisphere on the opposite side of

the brain. The brain stem connects the diencephalon to the spinal cord. The brain stem resembles the spinal cord in that both consist of white matter fiber tracts surrounding a core of gray matter. The brain stem consists of the following four regions, all of which provide connections between various parts of the brain and between the brain and the spinal cord Figure 2 Prominent structures of the brain stem.

The midbrain is the uppermost part of the brain stem. The pons is the bulging region in the middle of the brain stem.

The medulla oblongata (medulla) is the lower portion of the brain stem that merges with the spinal cord at the foramen magnum.

The reticular formation consists of small clusters of gray matter interspersed within the white matter of the brain stem and certain regions of the spinal cord, diencephalon, and cerebellum. The reticular activation system (RAS), one component of the reticular formation, is responsible for maintaining wakefulness and alertness and for filtering out unimportant sensory information. Other components of the reticular formation are responsible for maintaining muscle tone and regulating visceral motor muscles. The cerebellum consists of a central region, the vermis, and two

winglike lobes, the cerebellar hemispheres. Like that of the cerebrum, the surface of the cerebellum is convoluted, but the gyri, called folia, are parallel and give a pleated appearance. The cerebellum evaluates and coordinates motor movements by comparing actual skeletal movements to the movement that was intended. The limbic system is a network of neurons that extends over a wide range of areas of the brain. The limbic system imposes an emotional aspect to behaviors, experiences, and memories. Emotions such as pleasure, fear, anger, sorrow, and affection are imparted to events and experiences. The limbic system accomplishes this by a system of fiber tracts (white matter) and gray matter that pervades the diencephalon and encircles the inside border of the cerebrum. The following components are included:

The hippocampus (located in the cerebral hemisphere) The denate gyrus (located in cerebral hemisphere) The amygdala (amygdaloid body) (an almond-shaped body associated with the caudate nucleus of the basal ganglia)

The mammillary bodies (in the hypothalamus)

The anterior thalamic nuclei (in the thalamus) The fornix (a bundle of fiber tracts that links components of the limbic system)

VII. PATHOPHYSIOLOGY

Modifiable factors: Smoking Ingesting fatty foods hypertension Embolus that dislodge

vasospasm

Increase oxygen demand

Decrease oxygen supply in the blood

Inadequate blood perfusion

Cell injury and death

Motor, sensory, cranial nerves disrupted Cerebrovascular disease

Dizziness, stiffening of extremeties, and non projectile vomiting

Cerebrovascular disease or brain attack happened due to modifiable factors possessed by the patient such as smoking, ingesting fatty foods, and hypertension that leads to vasospasm and an embolus that dislodged from an area of origin to the brain that results to increase oxygen demand and decrease oxygen supply in the blood. Because of inadequate blood perfusion it leads to brain cells injury and death, at this point neurons are no longer able to maintain aerobic respiration that caused to produce neurological dysfunction.

IX. NURSING CARE PLAN

XI. DISCHARGE PLANNING

M- Instructed immediate relatives to facilitate the

patient to continue taking

the drugs given to her on the right time and with the right dose to facilitate continuity of care.

E- Encouraged immediate relatives to facilitate regular exercise such as brisk

walking but not making herself too much tired. -Encouraged her not to carry heavy loads and do not force herself too much in doing household chores. Encouraged patient to limit number of hours in playing domino.

T- encouraged patient to have enough rest and comply to the physicians

when ever health problems occur

H-Encouraged and explained to her the benefits and advantages of proper

hygiene to promote wellness.

O- instructed patient to come back for follow up check up on the date

ordered.

D- advised patient to eat nutritional foods like fruits and vegetables. Eat a well
balanced diet. Instructed patient to limit eating foods high in fats and with cholesterols. And also avoid salty foods.

S- Encouraged pt to continue her habits in going to church every day and

always seek God helps when ever problems occur. XII. DEVELOPMENTAL TASK