TOMAS CLAUDIO MEMORIAL COLLEGE

College of Nursing

A CASE STUDY OF A
CLIENT WITH
CEREBROVASCULAR
ACCIDENT
(CVA)
Presented by:
Natividad, Mark
Obrero, Lorelie
Ocampo, Janina Kyreen
Pangandaman, Sittie Naomie
Pelicano, Shiela Marie
Perez II, Elizabeth
Pigtain, Asia
Ramirez, Jomel
Ramirez, Rossini
Repato, Karen Marie
Presented to:
Mrs. Rommelyne Robles, RN, MAN
Clinical Instuctor

I.

INTODUCTION
A stroke, previously known medically as a cerebrovascular
accident (CVA), is the rapidly developing loss of brain function(s) due
to disturbance in the blood supply to the brain. This can be due
to ischemia (lack

of

(thrombosis, arterial

blood

flow)

embolism),

or

caused

by

blockage

a hemorrhage (leakage

of

blood). As a result, the affected area of the brain is unable to function,

leading to inability to move one or more limbs on one side of the body,
inability to understand or formulate speech, or an inability to see one
side of the visual field.
Ischemic stroke is the most common type of stroke and is caused
by a blockage of the blood vessels supplying the brain. This may be
due to hardening and narrowing of the arteries (atherosclerosis) or by
a blood clot blocking a blood vessel.
The most severe type of stroke is a hemorrhagic stroke. It occurs
when a blood vessel in the brain bursts, allowing blood to leak and
cause damage to an area of the brain. There are 2 types: subarachnoid
hemorrhage, which occurs in the space around the brain; and an
intracerebral hemorrhage, the more common type, which involves
bleeding within the brain tissue itself.
The symptoms of a stroke usually appear suddenly. Initially the
person may feel sick, and look pale and unwell. They may complain of
a sudden headache. They may have sudden numbness in their face or
limbs, particularly down one side of their body. They may appear
confused and have trouble talking or understanding what is being said
to them. They may have vision problems, and trouble walking or
keeping

their

balance.

Sometimes

seizure

(fit)

or

loss

of

consciousness occurs.
Depending on what function the damaged part of the brain had,
a person may lose one or more of the following functions:

ability to perform movements usually affecting one side

of the body;

speech;

part of vision;

co-ordination;

balance;

memory; and

perception

The warning signs are:

Sudden weakness or numbness of the face, arm and leg on

one side of the body.

Loss of speech, or difficulty talking.

Dimness or loss of vision.

Unexplained dizziness, especially when associated with any

of the above signs.

Unsteadiness or sudden falls.

Headache (usually severe and of sudden onset).

Confusion.

Confirmation of diagnosis and initial treatment of strokes usually

takes place in a hospital. A computerized CT scan of the brain is done
which produces a two or three dimensional pictures of the part of the
brain.

Another

laboratory

procedure

done

is

(MRI)or

Magnetic

Resonance Imaging scan which uses a large magnet, low-energy radio

waves and a computer to produce a two or three dimensional pictures
of the body.
If a stroke has occurred, treatment should begin as soon as the
stroke is diagnosed to ensure that no further damage to the brain
occurs. Initially, the doctor may administer oxygen and insert an
intravenous drip to provide the affected person with adequate
nutrients and fluids.

In cases of ischemic stroke, it is common to give aspirin to

reduce the risk of death or of a second stroke.
If the cause of the stroke was a clot, it is possible that the quick
administration of certain clot-dissolving drugs, such as alteplase, will
prevent some symptoms such as paralysis. However, this is not a
suitable treatment for all strokes, and can increase the risk of
hemorrhagic stroke, so there are strict guidelines determining the
circumstances in which it should be used.
Once a stroke has permanently damaged the brain, the damage
cannot

be

undone.

However,

many

symptoms

can

improve

considerably in the days following a stroke, because the areas of brain

on the periphery of the stroke can recover. In addition, your doctor will
suggest ways to prevent a future stroke, including modifying your
lifestyle to minimize your risks of stroke, and taking medications.
Depending on the type and cause of the stroke, anticoagulant
drugs (blood thinners) may be prescribed to help prevent new blood
clots from forming, in order to prevent a future stroke. Examples
include aspirin, aspirin plus dipyridamole (Asasantin), clopidogrel (e.g.
Plavix) and warfarin (Coumadin or Marevan).
Where there is a blockage in a neck artery, surgery may be
performed to remove the build-up of plaque in order to prevent a
future stroke. This operation is called a carotid endarterectomy.
Men are 25% more likely to suffer strokes than women, yet 60%
of deaths from stroke occur in women. Since women live longer, they
are older on average when they have their strokes and thus more often
killed (NIMH 2002). Some risk factors for stroke apply only to women.
Primary among these are pregnancy, childbirth, menopause and the
treatment thereof (HRT).
The incidence of stroke increases exponentially from 30 years of
age, and etiology varies by age. Advanced age is one of the most
significant stroke risk factors. 95% of strokes occur in people age 45

and older, and two-thirds of strokes occur in those over the age of
65. A person's risk of dying if he or she does have a stroke also
increases with age. However, stroke can occur at any age, including in
childhood.

II.

OBJECTIVES
GENERAL OBJECTIVES

This

study

aims

to

present

information

that

discussed

the

Cerebrovascular Accident (CVA) and possible complications that may

arise and interface with regards to the condition of the client. And to
develop, implement and evaluate plans for health promotion, using
professional effective nursing care with direct nursing activities. To
arrive at this point at which decision can be made. And to help client in
terms of physical adaptation.

SPECIFIC OBJECTIVES

Establish rapport and gain the trust and cooperation of the

patient and immediate family members.

 Perform

and

obtain

thorough

and

complete

physical

assessment using the assessment techniques following the

cephalocaudal approach; obtain complete medical, sociocultural, and family history related to the patients current
health condition.
Analyze and prioritize problems based from the gathered
pertinent data to come up with the correct nursing diagnoses.
Plan the appropriate nursing interventions to address the
patients health needs. The interventions should address not
only the physical well being of the patient but also her
emotional, social, and mental welfare.
Implement the planned nursing interventions to meet the
desired outcomes and help improve patients condition.
Impart useful health teachings to the patient and immediate
family members to prevent further development of the
patients condition and other related complications, and for
the patient to be able to adjust well and continue with her
normal life after being discharged from the hospital

III.

DATA BASE
A.

Patients Profile
Name
Age
Address

:
:
:

Mr. M
59 years old
P. Sta. Maria St. Brgy. Balibago, Cardona,

Rizal
Gender
Civil Status
Date of Birth
Nationality
Religion

:
:
:
:
:

Male
Married
February 7, 1951
Filipino
Roman Catholic

:
February 1, 2011
:
8:41a.m.
11020002

B. Admission Data
Date of Admission
Time of Admission
File Record Number

IV.

Hospital

Queen Mary Help of Christian Hospital

Inc.
Chief Complaint
Admitting Diagnosis

:
:

Right sided body weakness

HCVD(Hemorrhagic
Cerebrovascular

Disease)
Attending Physician

Alexander Abe

HISTORY OF PAST AND PRESENT ILLNESS

PAST HEALTH HISTORY
His right eye was hit by a bamboo streaks that leads into
blindness

during

his

adolescence.

The

patient

underwent

herniorrhaphy and her wife stated that the patient is not hypertensive
or diabetic.
PRESENT HISTORY
Last February 1,2011 two hours PTA the patient was found at the
living room experiening dizziness

and complaining for right sided

body weakness. He was brought to QMCHI the same day at 8:41a.m.

to seek for medical assistance. He was drowsy but easily arouse. The
strength of his right upper and lower extremities were 1 out of 5, and 5
out of 5 on the left extremities. His neurovital signs were E4V4M6 with a
total score of 14 in Glasgow Coma Scale. His left pupil were 3mm
reacted to light. He has a negative Babinski Reflex. He was seen by
Dr.Alexander Abe and has an admitting diagnosis of CVA and has a
final diagnosis of HCVD last February 2, 2011.
His admitting vital signs reveal the following:
Blood pressure
170/120 mmHg
Cardiac Rate
62bpm
Respiration Rate
24cpm
Temperature
36.6 C
FAMILY HISTORY OF DISEASES

During assessment, the patients wife stated that his husbands

two brothers have history of hypertension and diabetes mellitus.
However, he was not diagnosed having even the two diseases.

V.

13 AREAS OF ASSESSMENT
I.

Social Status
Mr. M is a 59 years old, married and was born on February 7,
1951. He is currently residing at P. Sta. Maria St. Brgy. Balibago,
Cardona, Rizal. He is a high school graduate, a fisherman and they
owned a fish pen. He is affiliated in the Roman Catholic Religion
and has one child. He is a smoker; he can consume one pack of
cigarette every day and he drinks occasionally.
According to Erik Eriksons stages of Psychosocial
Development, the patient was in the stage of Generativity vs.
Stagnation, wherein the patient was in positive development, his
wife said that his husband has mentioned in one of their
conversation that he is happy and contented with what he and his
family have.

II.

Mental Status
During assessment, we have observed that the patient is
alert, and oriented to the persons around him. He was also aware
that he is in the hospital. The patient was cooperative and
evidenced by answering questions through sign language
(examples of questions are: How many? Does it hurt? And those
questions answerable by yes or no.); he was also able to maintain
an eye-to-eye contact and could follow simple directions such as
placing his hands above his head and holding the nurse hand.
His eyes opens spontaneously, oriented and obeys command.
His neurovital sign was E4V5M6 with a total score of 15 in Glasgow
Coma Scale.
He was not also able to speak. Hindi n siya mkapag salita
mula nung inatake sya as stated by his wife.

III.

Emotional Status
Whenever Mr. M had problems, he consulted to his wife and
other relatives to seek for some advices. He is optimistic and does

not show any signs of hopelessness and helplessness. He is willing

to fight for his recovery.
IV.

Sensory Perception
Vision
Eyes are black and are almond in shape. He was able to
follow the six cardinal gazes. Left eye was reactive to light and
accommodating well and his pupil was round. PERRLA assessment
was not applicable on right eye because it is blind, reported by his
wife. No discharges found during inspection.
Smell
Mr. Ms nose is symmetrical in shape. He can identify smell.
No further assessment was done due to oxygen therapy via nasal
cannula.
Hearing
Ears are symmetrical in terms of size and shape. There is no
presence of earwax and no discharges found during inspection. We
assessed his hearing ability by asking him to close his eyes and
identify the sound made by tapping of a ball pen and a coin in the
side rails of his bed and by making a sound of a crumpled paper.
He was able to hear the sounds made at a specific distance. He
was able to identify the sound that he hears by asking him to point
out which of the two (ball pen or paper) he hears first and last.
Taste
He had pale, dry and cracked lips. When we inspect his teeth,
he had no cavities and had dentures on the upper part of his teeth.
No further assessment was done due to having an NGT.
Touch
He reacted through facial mask of pain when his skin was
tested intradermally on his left arm. When we asked him if he feels
any pain, he pointed his head and rates it as one from a pain scale
of 1-10. He reported feeling of numbness on the right upper and
lower extremities

V.

Motor Ability

He cannot move his right upper and lower extremities, but

his left upper and lower extremities can move fully. Have proper
symmetry between left and right upper and lower extremities.
There is no presence of deformities. He cannot turn to his left side
because he cannot move his right upper and lower extremities. He
also feels numbness on the affected part.
On assessment last February 07, 2011 the patients
muscoskeletal strength on the right extremities improved. He can
now move his right arm but only limited range of motions were
performed. He

VI.

Temperature
Mr. Ms temperature as of February 01, 2011 at 7:00 p.m. is
36.8C taken at the left axilla, using a digital thermometer and
marked as normal. His skin was warm to touch.

VII.

Circulatory
Mr. Ms blood pressure was taken and recorded as 160/90
mmHg. His pulse rate was 65 bpm, and is within normal range of
60-100 for an adult as of February 1, 2011 at 7:00 p.m. There was
no presence of edema with a capillary refill ranging from 1-2
seconds taken at the left index finger.

VIII.

Respiratory
Respiratory rate was taken and recorded as 20cpm on
Feb.01, 2011 at 7:00p.m. His chest is symmetrical in shape. There
is no presence of phlegm and abnormal breath sounds. The patient
uses oxygen therapy via a nasal cannula regulated at 2-3lpm.
On assessment last February 07, 2011 wheezes are heard
upon auscultation. The patient also had a cough as stated by his
wife. He is still on oxygen therapy.
Umuubo siya saka may plema
nailalabas as stated by his wife.

IX.

kaya

lang

hindi

niya

Nutritional Status
Before hospitalization:
He eats 2 cups of rice and drinks 2 glasses of water every meal.
He eats vegetable, fish, and chicken.

During hospitalization:
Hirap syang makakain, hindi nya kayang lumunok as stated by
his wife.
He has an NGT and has a diet of have a low salt low fat diet. As
of February 7,2011 he has an IV fluid of D5NaCl 1 L at the level of
800cc regulated at 20-21gtts/min.

X.

Elimination
Prior to hospitalization:
Mr. M defecates once daily and voids more than 5 times a day.
During hospitalization:
As of February 01, 2011 Mr. M does not defecate yet. He has an
indwelling folley catheter and his urine output within 3 hours is
1100cc. His urine appears yellow in color.
On assessment last February 07, 2011 his wife reports that Mr.M
had defecate once daily and releases a semi-solid stool. He was
also on a bladder training every 2hours.

XI.

Reproductive
He underwent a surgical procedure in the 1980s due to
hernia. He only had one child.

XII.

State of Physical Rest and Comfort

Before admission:
According to his wife, the client spend his time at night by
watching television and used to sleep at midnight, and wakes up at
3:00am because he needs to woke up early to go to their fish pen.
He also takes nap in the afternoon for one hour.
During Hospitalization:
According to his wife the patient completed an eight hour sleep
at night. The client takes nap in the afternoon and sometimes
become irritable when the hospital gets hot.

XIII.

VI.

State of Skin and Appendages

Mr. M has dry, dark and warm skin. The skin turgor is poor.
There is no reported history of skin disease or allergy. She had
thick, black, curly hair and was fully distributed; he has a healthy
scalp as evidenced by absence of dandruff and lice. His nails are
found to be properly trimmed and no traces of dirt are noted.

LABORATORIES

CLINICAL CHEMISTRY
DATE: February/01/2011
Examination

Result

Normal Values

SGPT (ALT)
BUN
Creatinine
Sodium

10U
3.8mmol/L
87mmol/L
131mmol/L

4-36 U
3.2-7.1mmol/L
71-133mmol/L
136-145mmol/L

Potassium

3.6mmol/L

3.5-5.1mmol/L

Significant
Findings
Normal
Normal
Normal
Indicates kidney
failure
Normal

URINALYSIS
DATE:February/02/2011
Result
Color
Transparency
pH
Sp. Gravity
Sugar
Protein
Microscopic:

Yellow
Slightly turbid
5.0
1.010
(-)
Trace

Normal
Values
Clear
Straw/amber
4.6-8.0
1.005-1.030
Negative
Negative

Significant
Findings
Dehydration
Infection
Normal
Normal
Normal
Due to HPN

Puss Cell
RBC
Bacteria
Epithelial Cell

2-3hpf
10-12hpf
Few
Moderate

None
0-2
none
Small amount

infection
due to BPH
infection
infection

HEMATOLOGY
Examination

Result

Normal Values

Significant
Findings
Due to O2
decrease
due to
infection

Hemoglobin
Hematocrit
WBC

133g/L
0.39%
11.110/L

149-170g/L
0.24-0.51%
5.0-10.010/L

Segmenter:
Neutrophil
Lymphocytes
Monocytes

0.90mmol/L
0.07mmol/L
0.03mmol/L

0.42-0.75mmol/L
0.20-0.51mmol/L
0.02-0.09mmol/L

infection
infection
Normal

Analysis
Normal
Associated
with
atherosclerosi
s
Associated
with
atherosclerosi
s
Associated
with
atherosclerosi
s
Associated

CLINICAL CHEMISTRY
DATE:February/02/2011
Examination
Blood Sugar (FBS)

Result
4.5mmol/L

Normal Values
4.4-5.9mmol/L

Cholesterol

5.61mmol/L

<5.20mmol/L

Triglyceride

1.08mmol/L

<1.69mmol/L

HDL cholesterol

1.11mmol/L

0.91mmol/L

LDL cholesterol

4.01mmol/L

<3.36mmol/L

with
atherosclerosi
s

February 02, 2011

CT SCAN REPORT:

Plain axid cranial CT scans show subtle wedge shaped, hypodense

lesion in the left posterior parietal lobe.
Cortical sulci, cisterns and ventricles are prominent.
Midline structure are undisplaced.
Posterior fossa structures are unremarkable.
Intimal calcifications are seen in the basilar and internal carotid
arteries.
Calcifications are seen in the right orbit.
Bony calvarium, petromostoids and paranasal sinuses are intact.
Impression:
Subtle, wedge-shaped, hypodense lesion in the left posterior parietal
lobe.
Suggest follow up contrast enhanced CT scan to rule out acute
infarction.
Cerebral atrophy.
Atherosclerotic basilar and internal carotid arteries.
Calcifications in the right orbit.

RADIOLOGICAL REPORT
DATE:
February 02, 2011
PROCEDURE:
PA ADULT
There is suspicious soft tissue density in the midthoracis region cavity
slight (right) deviation of the trachlear air column to the right.
Heart is enlarged.
Aorta is tortuous and calcified
Hemidiaphragm and Costrophrenic sinuses are intact.
Impression:
Suspiscious mass suggest right lateral view.
Cardiomegally
Atheromatous Aorta

DATE: February 07, 2011

There is fullness of the anterior and posterior mediastinal area seen in
lateral view.
Impression:
The right hemidiaphragm is elevated.
The aorta is tortuous
Other findings remain unchanged
Suggest clinical correlation and CT- scan
Correlation for further evaluation

VII.

CONCEPTUAL AND THEORETICAL FRAMEWORK

Conservation Theory
Myra Levine's
It is focused in promoting adaptation and maintaining wholeness using
the principles of conservation. The model guides the nurse to focus on the
influences and responses at the organismic level. The nurse accomplishes
the goals of the model through the conservation of energy, structure, and
personal and social integrity
METAPARADIGM IN NURSING
Person
a holistic being who constantly strives to preserve wholeness and
integrity and one who is sentient, thinking, future-oriented, and
past-aware.
Environment
Completes the wholeness of the individual. The individual has
both an internal and external environment.
Internal Environment
combines the physiological and pathophysiological aspects of
the individual and is constantly challenged by the external
environment.
External Environment
Perceptual environment - is that portion of the external
environment which individuals respond to with their sense
organs and includes light, sound, touch, temperature,
chemical change that is smelled or tasted, and position sense
and balance.
Operational environment - is that portion of the external
environment which interacts with living tissue even though
the individual does not possess sensory organs that can

record the presence of these factors and includes all forms of

radiation, microorganisms, and pollutants.
Conceptual environment - is that portion of the external
environment that consists of language, ideas, symbols, and
concepts and inventions and encompasses the exchange of
language, the ability to think and experience emotion, value
systems, religious beliefs, ethnic and cultural traditions, and
individual psychological patterns that come from life
experiences.
Health
implied to mean unity and integrity and is a wholeness and
successful adaptation
Nursing
The nurse enters into a partnership of human experience where
sharing moments in timesome trivial, some dramaticleaves
its mark forever on each patient
MAIN CONCEPTS:
ADAPTATION
Is the process of change, and conservation is the outcome of
adaptation. Adaptation is the process whereby the patient
maintains integrity within the realities of the environment
CONSERVATION
Product of adaptation.
Conservation describes the way complex systems are able to
continue to function even when severely challenged.
WHOLENESS/INTEGRITY
the unceasing interaction of the individual organism with its
environment does represent an open and fluid system, and a
condition of health, wholeness, exists when the interaction or
constant adaptations to the environment, permit easethe
assurance of integrityin all the dimensions of life.
KEY CONCEPTS (Conservational principle)
Conservation of energy
Refers to balancing energy input and output to avoid excessive
fatigue. It includes adequate rest, nutrition and exercise.
Conservation of structural integrity
Refers to maintaining or restoring the structure of body
preventing physical breakdown and promoting healing.
Conservation of personal integrity
Recognizes the individual as one who strives for recognition,
respect, self awareness, selfhood and self determination.

 Conservation of social integrity

An individual is recognized as some one who resides with in a
family, a community, a religious group, an ethnic group, a political
system and a nation.

Self-Care Deficit Theory

Dorothea Orem
Dorothea E. Orem identified three theories of self-care, self-care
deficit, and nursing systems. The ability of the person to meet daily
requirements is known as self-care, and carrying out those activities is selfcare agency. Parents serve as dependent care agents for their children. The
ability to provide self-care is influenced by basic conditioning factors
including but not limited to age, gender, and developmental state. Self-care
needs are partially determined by the self-care requisites, which are
categorized as universal (air, water, food, elimination, activity and rest,
solitude and social interaction, hazard prevention, function with social
groups), developmental, and health deviation (needs arising from injury or
illness and from efforts to treat the injury or illness).
The total demands created by the self care requisites are identified as
therapeutic self-care demand. When the therapeutic self-care demand
exceeds self-care agency, a self-care deficit exists and nursing is needed.
Based on the needs, the nurse designs nursing systems that are wholly
compensatory (the nurse provides all needed care), partly compensatory
(the nurse and the patient provide care together), or supportive-educative
(the nurse provides needed support and education for the patient to exercise
self-care).
CONCEPTS
Nursing client
A human being who has "health related /health derived limitations that
render him incapable of continuous self care or dependent care or
limitations that result in ineffective / incomplete care.
A human being is the focus of nursing only when a self care requisites
exceeds self care capabilities

Nursing problem
deficits in universal, developmental, and health derived or health
related conditions
Nursing process
a system to determine (1)why a person is under care (2)a plan for
care ,(3)the implementation of care
Nursing therapeutics
deliberate, systematic and purposeful action

OREMS GENERAL THEORY OF NURSING

A. Theory of Self Care
Self care
practice of activities that individual initiates and perform on their
own behalf in maintaining life ,health and well being
Self care agency
is a human ability which is "the ability for engaging in self care"
-conditioned by age developmental state, life experience
sociocultural orientation health and available resources
Therapeutic self care demand
"totality of self care actions to be performed for some duration in
order to meet self care requisites by using valid methods and
related sets of operations and actions"
Self-care requisites
Action directed towards provision of self-care. 3 categories of self
care requisites are
Universal
Universal self-care requisites
Developmental self-care requisites
B. Theory of self-care deficit
Specifies when nursing is needed
Nursing is required when an adult (or in the case of a dependent,
the parent) is incapable or limited in the provision of continuous
effective self-care.
Orem identifies 5 methods of helping:
1. Acting for and doing for others
2. Guiding others
3. Supporting another

4. Providing an environment promoting personal development

in relation to meet future demands
5. Teaching another
C. Theory of Nursing Systems
Describes how the patients self care needs will be met by the
nurse , the patient, or both
Identifies 3 classifications of nursing system to meet the self care
requisites of the patient:o Wholly compensatory system
o Partly compensatory system
o Supportive educative system
VIII.

ANATOMY AND PHYSIOLOGY

The supply of freshly oxygenated blood from the heart to the

brain is delivered via the carotid and basilar arteries.
Carotid Arteries
The carotid arteries run up both sides of the neck, and supply
oxygen to the "carotid territory" of the brain. The carotid territory
includes the frontal and temporal lobes. Strokes in the carotid territory,
the "front" of the brain, are referred to as anterior strokes. Anterior
strokes produce the most common stroke symptoms. Anterior strokes
can be caused by blood clots or narrowing in the carotid arteries as

well as in smaller arteries within the brain. Speech difficulties, vision

problems, tingling, and paralysis may result from an anterior stroke.
Basilar Arteries
The basilar arteries are part of the vertebrobasilar circulation
system, located at the base of the skull. The two vertebral arteries
connect to form a single basilar artery that provides the
"vertebrobasilar territory" of the brain with oxygen. This territory
includes the brain stem, cerebellum, and occipital lobes. A stoke in this
region of the brain is referred to as a posterior stroke (meaning the
stroke affects the back of the brain). Posterior strokes cause some of
the less common stroke. Strokes in the basilar territory can sometimes
affect both sides of the body. Posterior strokes may also cause
headaches, visual disturbances, speech problems, nausea, difficulty
swallowing, and weakness in the legs or arms.
Circle of Willis
The Circle of Willis (also called Willis' Circle, cerebral arterial
circle, arterial Circle of Willis, and Willis Polygon) is a circle of arteries
that supply blood to the brain.
The Circle of Willis comprises the following arteries:

Anterior cerebral artery (left and right)

Anterior communicating artery
Internal carotid artery (left and right)
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right)

The basilar artery and middle cerebral arteries, though they

supply the brain, are not considered part of the circle
1. The anterior cerebral arteries (ACA) are a pair of arteries on
the brain that supply oxygen to most medial portions of frontal
lobes and superior medial parietal lobes. The 2 anterior cerebral
arteries arise from the internal carotid artery and are part of the
Circle of Willis.The left and right anterior cerebral arteries are
connected by the anterior communicating artery.

2. The anterior communicating artery is a blood vessel of the

brain that connects the left and right anterior cerebral arteries.
3. The internal carotid arteries are major arteries of the head and
neck that supply blood to the brain
4. The posterior cerebral artery (PCA) is one of a pair of blood
vessels that supplies oxygenated blood to the posterior aspect of
the brain (occipital lobe) in human anatomy
5. The posterior communicating artery is one of a pair of rightsided and left-sided blood vessels in the circle of Willis

IX.

PATHOPHYSIOLOGY CEREBROVASCULAR DISEASE

(HEMORRHAGIC STROKE)
Precipitating Factors:

Predisposing Factors:

Hypertension
Cigarette Smoking
Undesirable levels of

Age
Heredity
Sex

cholesterol
Poor diet

Atherosclerosis

Formation of Plaque deposits

Thrombosis
Hypertension

Occlusion by major vessel

Lysed or moved thrombus

from the vessel

Vascular wall becomes

weakened and fragile

Leaking of blood from the

fragile vessel wall
Mass of blood forms and
grows
Cerebral Hemorrhage

Sx:, headache,
unconsciousness,
nausea/vomiting, visual
disturbances

Blood seeps into the

ventricles

Formation of small
and large clots

Vasospasm of
tissue and arteries

Obstruction of CSF
passageway

CEREBRAL
HYPOPERFUSION

Accumulation of CSF in
the ventricles

Sx: dizziness,
confusion,
headache

Impaired distribution of
oxygen and glucose

Ventricles dilate behind

the point of obstruction

Increased ICP

Tissue hypoxia and

cellular starvation
Lodges unto
other cerebral
arteries

Cerebral Ischemia
Initiation of ischemic
cascade

Anaerobic metabolism by
mitochondria

Generates large amounts

of lactic acid

Failure production of
adenosine triphosphatase

Metabolic Acidosis

Failure of energy dependent

process
(ion pumping)
Release of excitatory
neurotransmitter glutamate

Production of oxygen free

radicals and other reactive
oxygen species

Damage to the blood

vessel endothelium

Influx of calcium

Activates enzymes that

digest cell proteins, lipids
and nuclear material

Failure of
mitochondria

Further energy
depletion
Transient Ischemic Attack

Brain sustains an irreversible

cerebral damage
Release of metalloprotrease
(zinc and calcium-dependent enzymes)

Cerebral edema

Break down of collagen, hyaluronic acid and

other elements of connective tissue
Vascular Congestion
Structural integrity loss of brain
tissue and blood vessels
Compression of tissue

Breakdown of the protective

Blood Brain Barrier

Sx:
hemiplegia,
unilateral
neglect,
altered
consciousness
dysgraphia
(inablity to write),
aphasia
(inability to
speech),

Middle Cerebral
Artery
Lateral
hemisphere,
frontal, parietal
and temporal
lobes, basal
ganglia

Increased intracranial
pressure

Impaired perfusion and

function

XII.

DISCHARGE PLAN
MEDICATION
Instruct pt to take prescribed medication and dosage religiously
to maintain health improvement.
a.
b.
c.
d.
e.
f.
g.
h.

Zynapse 1g 1 tab 2 x a day

Neurobion 1 tab once a day
Pantoloc 49mg 1 tab once a day
Lactulose 30cc at bedtime
Plarexan 75mg/tab 1tab once a day
Combizar 50/12.5 1 tab A.M
Amlodipine 40mg/tab 1 tab P.M.
Levox 750mg/tab 1 tab once a day in one week until
February 15, 2011

EXERCISE
Instruct and encourage client to balance activities with adequate
rest periods and educate client on proper body mechanics to prevent
muscle strain and enable client to relax. Instruct the significant others
on how to perform active range-of-motion. Also advice to consult to
Physical Therapist three times a week.
DIET
A low salt low fat diet is recommended for patient. And NGT was
retained and osteorized feeding was adviced.

HEALTH TEACHING
Educated client about the different methods on how to improve
health and wellness. Stress the importance of taking medications
regularly and report signs to Doctor such as increase in BP.
SCHEDULE OF NEXT VISIT
Instruct patient to return on February 12, 2011 (Saturday) for
follow up check-up. Emphasize importance of follow up check ups.

XIII. EVALUATION

Stroke is a term used to describe the neurologic changes caused by an

interruption in the blood supply to a part of the brain. The incidence of
stroke and stroke mortalities has gradually declined in many industrialized
countries in recent years as a result of increased recognition and
treatment of risk factors, which may include modifiable risk factors such
as hypertension
Public education is focused on prevention, recognition of
manifestations and early treatment of brain attack. As they say
prevention is better than cure. Therefore it is important for each and
every one of us to avoid these modifiable risk factors and change
sedentary lifestyles to healthy lifestyles. Cholesterol levels should be
brought to a normal level, diabetes should be controlled and reducing
heavy alcohol consumption. The best intervention is to stop smoking
cigarettes.
As nursing students, this study showed us the importance of early
detection of diseases such as stroke since it may lead to more serious
conditions if it is not properly managed or treated. Knowledge of the risk
factors and preventive measures can help in reducing the incidence of
stroke. Prompt recognition, which allows for early treatment of stroke is
recommended to lessen residual deficits and decreased disability. Through
this study, may we be able to help others to understand and know more
about stroke and ways to prevent and treat its signs and symptoms.
The group was able to assess one patient having a case of Cerebral
vascular accident and through the study of case the group was able to
identify of the causative factors that predisposes the patient in acquiring
such disease condition. Furthermore the group was able to identify how
was it occurred and how it would be worse if left untreated, with several
condition such as this case a lot of problems has occurred that would
might permanently affect the lifestyle of the patient.
In this study the group was able to be familiarized to medical
managements and its benefits and s side effect to patient during therapy