SAINT MICHAEL’S COLLEGE OF LAGUNA

School of Nursing and Midwifery

Old National Highway, Platero, Biñan Laguna.

Influenza
A Case Study

Submitted by:
Almazan, Nathaniel Paulo B.
Student

Submitted to:
Ms. Edith Vizcarra R.N
Instructor
What is a stroke?

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 blood flow) caused by blockage (thrombosis,
arterial embolism), or 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.[2]

A stroke is a medical emergency and can cause permanent neurological damage,

complications, and even death. It is the leading cause of adult disability in the United
States and Europe and it is the number two cause of death worldwide. Risk factors for
stroke include advanced age, hypertension (high blood pressure), previous stroke or
transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial
fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

A stroke is occasionally treated in a hospital with thrombolysis (also known as a "clot

buster"). Post-stroke prevention may involve the administration of antiplatelet drugs
such as aspirin and dipyridamole, control and reduction of hypertension, the use of
statins, and in selected patients with carotid endarterectomy, the use of anticoagulants.
Treatment to recover any lost function is stroke rehabilitation, involving health
professions such as speech and language therapy, physical therapy and occupational
therapy.

Classification
Strokes can be classified into two major categories: ischemic and hemorrhagic.
Ischemic strokes are those that are caused by interruption of the blood supply, while
hemorrhagic strokes are the ones which result from rupture of a blood vessel or an
abnormal vascular structure. About 87% of strokes are caused by ischemia, and the
remainder by hemorrhage. Some hemorrhages develop inside areas of ischemia
("hemorrhagic transformation"). It is unknown how many hemorrhages actually start as
ischemic stroke.

Signs and symptoms

Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases
do not progress further. The symptoms depend on the area of the brain affected. The
more extensive the area of brain affected, the more functions that are likely to be lost.
Some forms of stroke can cause additional symptoms. For example, in intracranial
hemorrhage, the affected area may compress other structures. Most forms of stroke are
not associated with headache, apart from subarachnoid hemorrhage and cerebral
venous thrombosis and occasionally intracerebral hemorrhage.
Anatomy And Physiology Of The Circulatory System

The circulatory system is an organ system that passes nutrients (such as amino acids,
electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body
to help fight diseases and help stabilize body temperature and pH to maintain
homeostasis.

This system may be seen strictly as a blood distribution network, but some consider the
circulatory system as composed of the cardiovascular system, which distributes
blood, and the lymphatic system, which distributes lymph. While humans, as well as
other vertebrates, have a closed cardiovascular system (meaning that the blood never
leaves the network of arteries, veins and capillaries), some invertebrate groups have an
open cardiovascular system. The most primitive animal phyla lack circulatory systems.
The lymphatic system, on the other hand, is an open system.

Two types of fluids move through the circulatory system: blood and lymph. The blood,
heart, and blood vessels form the cardiovascular system. The lymph, lymph nodes, and
lymph vessels form the lymphatic system. The cardiovascular system and the lymphatic
system collectively make up the circulatory system.

The Heart

The heart is a myogenic muscular organ found in all animals with a circulatory system
(including all vertebrates), that is responsible for pumping blood throughout the blood
vessels by repeated, rhythmic contractions. The term cardiac (as in cardiology) means
"related to the heart" and comes from the Greek καρδιά, kardia, for "heart".

The vertebrate heart is composed of cardiac muscle, which is an involuntary striated

muscle tissue found only in this organ, and connective tissue. The average human
heart, beating at 72 beats per minute, will beat approximately 2.5 billion times during an
average 66 year lifespan, and weighs approximately 250 to 300 grams (9 to 11 oz) in
females and 300 to 350 grams (11 to 12 oz) in males.

The Arteries

Arteries are blood vessels that carry blood away from the heart. This blood is normally
oxygenated, exceptions made for the pulmonary and umbilical arteries.

The circulatory system is extremely important for sustaining life. Its proper functioning is
responsible for the delivery of oxygen and nutrients to all cells, as well as the removal of
carbon dioxide and waste products, maintenance of optimum pH, and the mobility of the
elements, proteins and cells of the immune system. In developed countries, the two
leading causes of death, myocardial infarction and stroke, each may directly result from
an arterial system that has been slowly and progressively compromised by years of
deterioration.

The Capillaries

Capillaries (pronounced /ˈkæpɨlɛri/) are the smallest of a body's blood vessels and are
parts of the microcirculation. They are only 1 cell thick. These microvessels, measuring
5-10 μm in diameter, connect arterioles and venules, and enable the exchange of water,
oxygen, carbon dioxide, and many other nutrient and waste chemical substances
between blood and surrounding tissues.
The Aorta
The aorta (pronounced /eɪˈɔrtə/; from Greek ἀορτή - aortē, from ἀείρω - aeirō "I lift,
raise") is the largest artery in the body, originating from the left ventricle of the heart and
extending down to the abdomen, where it branches off into two smaller arteries (the
common iliacs). The aorta distributes oxygenated blood to all parts of the body through
the systemic circulation.
Patient’s Profile:

Name: Pt. X

Age: 62

Gender: Male

Civil Status: Married

Religion: Catholic

Address: Soro – Soro Biñan, Laguna

AP: Dr. Arnold Mina

CC: Dysphagia

Neurological Examination:
- Awake

- Slurred speech

- Responsive

- Able to follow commands and simple instructions

Past Medical History

1 day ptc noted difficulty of swallowing, no consultation

Day of admission, condition persists with slurring of speech, consult

(+) smoker

(+) alcoholic drinker

(-) diabetic
 NCP

Assessment Nursing Planning Implementation Rationale Evaluation

Diagnosis

Subjective: Activity within the shift, -established rapport -To gain pt’s trust After the shift,
intolerance r/t promote safety & safety and
Objective: generalized comfort measures to -monitored v.s. -to see the pt’s condition comfort
Received lying body weakness prevent aspiration measures were
on bed c # 12 D5 during feeding the pt. -regulated ivf -to maintain fluid & electrolyte maintained and
0.3 NaCl 500 cc thru NGT balance aspiration
@ L hand precaution was
infusing well c -o.f. feeding done -to give the pt. his dietary estabished
SD of D5 LR iL + need
8 amps -instructed s.o. to turn pt
Diazepam x 24 side to side q2 -to avoid pressure ulcers and
- c slurred promote good blood
speech -demonstrated to the s.o. circulation
- s abdominal how to do the PROM
spasms -to help the s.o. learn how to
- s DOB -instructed s.o. to do PROM perform the PROM
- c muscle for the pt.
weakness -for good blood circulation
- c NGT, patent
- on OF 1,600
Kcal/day for four
equal feedings
 Assessment Nursing Planning Implementation Rationale Evaluation
Diagnosis

Subjective: Sleep pattern Within the shift, the pt. will -established rapport -To gain pt’s trust After the shift, the
disturbance r/t be able to sleep pt. was able to sleep
slight presence of
Objective: abdominal spasms
-monitored v.s. -to see the pt’s condition
Received lying
on bed c # 12 D5 -regulated ivf -to maintain fluid & electrolyte
0.3 NaCl 500 cc balance
@ L hand
infusing well c -o.f. feeding done -to give the pt. his dietary
SD of D5 LR iL + need
8 amps
Diazepam x 24 -instructed s.o. to turn pt -to avoid pressure ulcers and
- c slurred side to side q2 promote good blood
speech circulation
- s abdominal
spasms -maintained quiet environment - promotes relaxation
- s DOB
-instructed pt to maintain
- c muscle adequate rest periods and sleep -to promote relaxation
weakness
- c NGT, patent
- on OF 1,600
Kcal/day for four
equal feedings

Drug Study
 Drug Name Indications Dosage and Side Effects Contraindications
Administration

Pletaal 100mg Pletaal is indicated for The recommended Body as a whole: Cilostazol and several of
the reduction of dosage of Pletal is 100 Chills, face edema, its metabolites are
symptoms of mg b.i.d. taken at least fever, generalized inhibitors of
half an hour before or edema, malaise, neck phosphodiesterase III.
intermittent claudication,
two hours after rigidity, pelvic pain, Several drugs with this
as indicated by an breakfast and dinner. A retroperitoneal pharmacologic effect
increased walking dose of 50 mg b.i.d. haemorrhage. have caused decreased
distance. should be considered Cardiovascular: Atrial survival compared to
during coadministration fibrillation, atrial flutter, placebo in patients with
of such inhibitors of cerebral infarct, cerebral class III-IV congestive
CYP3A4 as ischemia, congestive heart failure. Pletal is
ketoconazole, heart failure, heart contraindicated in
itraconazole, arrest, haemorrhage, patients with congestive
erythromycin and hypotension, myocardial heart failure of any
diltiazem, and during infarction, myocardial severity.
coadministration of such ischemia, nodal
inhibitors of CYP2C19 arrhythmia, postural
as omeprazole. hypotension,
supraventricular
Patients may respond tachycardia, syncope,
as early as 2 to 4 weeks varicose vein,
after the initiation of vasodilation, ventricular
therapy, but treatment extrasystoles,
for up to 12 weeks may ventricular tachycardia.
be needed before a Digestive: Anorexia,
beneficial effect is cholelithiasis, colitis,
experienced. duodenal ulcer,
duodenitis,
 Drug Name Indications
Celecoxib 200mg CELEBREX is indicated
for relief of the signs and
symptoms of pain
Dosage and Side Effects Contraindications
Administration
Use lowest effective Gastrointestinal: NSAIDs, including
dose for the shortest Constipation, CELEBREX, cause an
duration consistent with diverticulitis, dysphagia,
increased risk of serious
treatment goals for the eructation, esophagitis, gastrointestinal adverse
individual patient. gastritis, gastroenteritis,
events including
gastroesophageal bleeding, ulceration, and
These doses can be reflux, hemorrhoids, perforation of the
given without regard to hiatal hernia, melena, stomach or intestines,
timing of meals. dry mouth, stomatitis, which can be fatal.
tenesmus, vomiting These events can occur
Osteoarthritis at any time during use
Cardiovascular: and without warning
For relief of the signs Aggravated symptoms. Elderly
and symptoms of OA hypertension, angina patients are at greater
the recommended oral pectoris, coronary artery risk for serious
dose is 200 mg per day disorder, myocardial gastrointestinal events.
administered as a single infarctionGeneral:
dose or as 100 mg twice Allergy aggravated,
daily. allergic reaction, chest
pain, cyst NOS, edema
Rheumatoid Arthritis generalized, face
edema, fatigue, fever,
hot flushes, influenza-
For relief of the signs
like symptoms, pain,
and symptoms of RA
peripheral pain
the recommended oral
dose is 100 to 200 mg
twice daily.
 Drug Name Indications Dosage and Side Effects Contraindications
Administration

metropolol indicated for the Central Nervous Cardiac Failure:

treatment of Hypertension System: Tiredness and Sympathetic stimulation
hypertension. They may dizziness have occurred is a vital component
The dosage of in about 10 of 100 supporting circulatory
be used alone or in
Lopressor tablets patients. Depression function in congestive
combination with other has been reported in heart failure, and beta
should be
antihypertensive agents. individualized. about 5 of 100 patients. blockade carries the
Lopressor tablets Mental confusion and potential hazard of
should be taken with or short-term memory loss further depressing
immediately following have been reported. myocardial contractility
meals. Headache, nightmares, and precipitating more
and insomnia have also severe failure. In
The usual initial dosage been reported. hypertensive and angina
of Lopressor tablets is patients who have
100 mg daily in single or Cardiovascular: congestive heart failure
divided doses, whether Shortness of breath and controlled by digitalis
used alone or added to bradycardia have and diuretics, Lopressor
a diuretic. The dosage occurred in should be administered
may be increased at approximately 3 of 100 cautiously.
weekly (or longer) patients. Cold
intervals until optimum extremities; arterial
blood pressure insufficiency, usually of
reduction is achieved. In the Raynaud type;
general, the maximum palpitations; congestive
effect of any given heart failure; peripheral
dosage level will be edema
apparent after 1 week of
therapy.