A Case

Study
Cerebrovascular
Accident
Introduc
tion
Cerebrovascular
Accident
Cerebrovascular accident, also
known as ischemic stroke or brain
attack, is the sudden loss of
function resulting from
disruption of the blood supply to
a part of the brain. This event is
usually the result of long-
standing cerebrovascular disease.
Types of CVA

• Transient Ischemic Attack

• Cerebral Thrombosis
• Cerebral Embolism
• Cerebral hemorrhage
General Objective
The general objective of
this study is to analyze
and understand the disease
process of cerebrovascular
accident , the risk factors
and its possible
complication .
Learning
Objectives
v To know the biographic data of the
patient under the study
v To know more about the history of the
patient ’ s condition
v To determine the cause of CVA
v To know more about the medications
given to patient with CVA
v To know the different laboratory works
done to patient and their significance
v To be able to prepare nursing care plan
 Anatomy
and
Physiology
Nervous System
Nervous system is the
master controlling and
communicating system of
the body. Electrical
impulses are rapid and
specific and cause almost
immediate responses.
Structural Classification
of the Nervous System

A . Central Nervous System

B. Peripheral Nervous
System
The Central Nervous System
The Central Nervous System
The central nervous system
consists of the brain and the
spinal cord, which occupy the
dorsal body cavity and act as
the integrating and command
centers of the nervous system.
They interpret incoming
sensory information and issue
instructions based on past
experience and current
condition.
Functional Anatomy of the
Brain
 Cerebral Hemispheres
 Diencephalon
 Brain stem
 Cerebellum

Cerebrum
The cerebrum is divided into
"lobes" which are broad regions of
the brain: frontal, temporal,
parietal and occipital lobes. The
cerebrum is the largest area of
the brain and controls many high
level functions: reasoning,
judgment, learning, problem solving,
emotions, movement, temperature,
touch, vision and hearing.
Cerebral Hemispheres
LEFT HEMISPHERE
The left hemisphere controls language,
speech, skilled hand movements, and other
right-sided body movements. In most people,
the left hemisphere is the "dominant"
hemisphere. However, in about one third of
individuals who are left-handed, speech
function and skilled hand control may be
located on the right side of the brain,
instead of the left.

RIGHT HEMISPHERE
The right hemisphere controls left-sided
body movements, and in most people, controls
many abstract reasoning skills and spatial
processing.
Lobes of the Brain
 FRONTAL LOBE
 PARIETAL LOBE
 TEMPORAL LOBE
 OCCIPITAL
LOBE
Frontal Lobe
Frontal lobes are behind the
forehead and are the largest of
the four lobes. They are
responsible for many important
functions such as voluntary
movement, speech, intellect and
behavior.
Parietal
Lobe
Parietal lobes interpret signals
received from other areas of the
brain such as pain and touch. The
parietal lobe also helps a person
to identify objects and understand
spatial relationships such as,
where one's body is compared to
objects around the person.
Temporal Lobe
Temporal Lobes are located on
each side of the brain at about
ear level and are involved in
memory, speech, and sense of smell.
Occipital
Lobe
Occipital lobes are at the back
of the brain and control vision.
The occipital lobe on the right
interprets visual signals from the
left visual space, while the left
occipital lobe performs the same
function for the right visual
space.
Functional area of the
Brain
The Peripheral Nervous
System
The Peripheral Nervous
System
The peripheral nervous system, part
of the nervous system outside the
CNS, consist mainly of the nerves
that extends from the brain and
the spinal cord. These serves as
communication lines that links all
parts of the body by carrying
impulses from the sensory
receptors to the CNS and from the
CNS to the appropriate glands or
muscles
Arterial Supply of the
Brain
Arterial Supply of the
Brain
A continuous blood supply to the
brain is crucial, since lack of
blood supply for even a few
minutes causes the delicate brain
cells to die. The brain is supplied
by two pairs of arteries:
* internal carotid
artery
* vertebral artery
Internal Carotid Artery
and Vertebral Artery
Internal carotid arteries run through
the neck and enter the skull through the
temporal bone. Once inside the cranium ,
each divides into the anterior and middle
cerebral artery, which supply most of the
cerebrum.
Vertebral arteries pass through upward
from the subclavian artery at the bas of
the neck. Within the skull, the vertebral
arteries joins to form the basilar artery,
which serves the brain stem and the
cerebellum as it travels upward. At the base
of the cerebrum, the basilar artery divides
to form the posterior cerebral arteries,
which supply the posterior part of the
Arterial Circle and
Arteries of the Brain
Anterior Cerebral Artery
 

The anterior cerebral artery

extends upward and forward from the
internal carotid artery. It supplies
the frontal lobes, the parts of the
brain that control logical thought,
personality, and voluntary movement,
especially the legs. Stroke in the
anterior cerebral artery results in
opposite leg weakness.  If both
anterior cerebral territories are
affected, profound mental symptoms
may result (akinetic mutism).
Middle Cerebral Artery
The middle cerebral artery is the
largest branch of the internal
carotid. The artery supplies a
portion of the frontal lobe and
the lateral surface of the
temporal and parietal lobes,
including the primary motor and
sensory areas of the face, throat,
hand and arm and in the dominant
hemisphere, the areas for speech.
The middle cerebral artery is the
artery most often occluded in
stroke.
Posterior Cerebral Artery
The posterior cerebral arteries
stem in most individuals from the
basilar artery but sometimes
originate from the ipsilateral
internal carotid . The posterior
arteries supply the temporal and
occipital lobes of the left
cerebral hemisphere and the right
hemisphere. When infarction occurs
in the territory of the posterior
cerebral artery, it is usually
secondary to embolism from lower
segments of the vertebral basilar
system or heart.
PATHOPHYSIOLO
GY
 Predisposing Factors:
Precipitating Factors:
Precipitating Factors:
•Hypertension (180/110mmHg)
•Age (55 yrs. Old)
Hypertension (180/110) •Diet (ice
•Diabetes Mellitus
Diabetes Mellitus (FBS-189 cream,softdrinks,juice,table
mg/dl) salt)
•Lack of Exercise
Lack of Exercise
•Obesity (167 lbs)
Obesity (167 lbs) •Hereditary (mother side)

sodium
Accumulation of fats and

Hardening of blood
vessel

That leads to atherosclerosis formation

of plaque

Emboli (moving clot Thrombus Decrease

that blocks the (stationary cerebral tissue
blood vessel) clot) perfusion
Decrease passageway Narrowing of Decrease oxygen
of blood blood vessel in the blood

Decrease
blood supply

Decrease oxygen
blood supply to
the brain

Cerebral
edema

Vascular
congestion

Compression
of the
tissue
Anterior cerebral Posterior
Artery Middle cerebral cerebral
Artery artery

right side
Confusion >right arm especially the
impaired paralysis side of body
thought >aphasia (disorder lysis of one
process of language) >hemiplegia(para
>perception
deficits

Continue
inadequate blood
perfusion
flow
Return of normal

Decrease edema Further

tissue
compression
function
Cerebral
Improved
death
Nursing Health
History
Biographic data
Name: Patient XYZ
Address: 1243 Bagong Kalsada, Calamba, Laguna
Age: 55 y.o.
Sex: Female
Marital Status: Married
Educational Attainment: College; Undergraduate
Occupation: None
Religion: Catholic
Date of admission: February 26, 2010
Attending Physician: Dr. Moran
Dr. Montes
Dr. Gurango
Dr. Romeo
Chief complaint: “ naliliyo siya, tapos ang taas ng
BP at blood sugar nya” as verbalized by the pt.’s
son.
History of present illness
As reported by the patient’s son, a day PTA ( about 2pm
of Feb. 25, 2010), while the patient was resting, she
suddenly complained for dizziness. The patient’s
complain prompted the pt’s son to take her blood
pressure and blood glucose where he found out that
both were increased. The blood pressure of the pt was
230/200 and her blood glucose was 200. Trying to
control the pt’s condition, her son gave her the
medication which she usually takes to control the blood
glucose level, ( her son does not remember the
medication). He also gave the pt Neobloc,
antihypertesive, which is the patient’s maintenance
drug for hypertension. Few hours later, the pt was
brought to the hospital for consult.
In the hospital, 12 hrs PTA, , patient was noted to have
slurring of speech. Pt also complained of weakness in
the lower extremeties, headache, dizziness, chest pain,
DOB. The pt’s was assessed by the ROD, VS was
monitored, other laboratories was requested by the
ROD. Upon assessment, the ROD had the initial
diagnosis of HPN stage II, t/c TIA R/O CVD infarct.
Laboratories done revealed that the pt had CVA, infarct
L capsulothalamic area/ MCA distribution, aspiration
pneumonia, CKD, HCVD Stage II and DM type II
Past Health History
B1
As seen from the patient record and as reported by
the pt’s son, the pt was admitted at the same hospital,
LBDH, on year 2004, the pt was 49 y.o and was
diagnosed of diabetes mellitus type II and Hypertension.
Upon discharged, the doctor prescribed Neobloc as her
maintenance medication for her blood pressure.
Medication for her blood sugar was also prescribed by
the doctor but the relative was not able remember the
name of the medication.
At that time the pt had left hemiplegia. To overcome
paralysis, the patient undergone physical therapy. After
a week or two, her body regained it’s functioning and
she was able to move the left side of her body. From this
time, she started to do her usual ADL before she become
ill.
 b.2 Prophylactic medical dental care:
none

b.3 Childhood illness:

chicken pox, measles, and mumps

b.4 Immunization:

b.5 Major illness Hospitalization:

the patient was hospitalized last year 2004 with
diagnosis of DM type II and hypertension

b.6 Current Medication

ORAL MEDICATION: IV/IM MEDICATION:
b.7 Allergies
Ingestant: shrimp
Injectant: none
Inhalants: none
Contactants: none

b.8 Habits:
Alcohol: none
Caffeine: none
Drugs: none
Tobacco: none
Family history

The patient had history of hypertension and

diabetes. Her grandfather and her mother were
know diabetic and hypertensive. Her mother
died due to the complication of diabetes. Two
of her sisters has diabetes too.
Gordon’s Functional
Health
Health perception – Health
management pattern
After recovering from her past illness which is
mild stroke, and having her present illness, the
patient believes that she will still recover from
her condition.
The patient’s health management before was
not good because even she knows that she is
hypertensive and diabetic, she keeps on eating
foods that are not good for her condition. Now
that the patient developed her current illness, the
son of the patient verbalized that he will try to
help his mother to recover from her illness. He
will also try to give her mother the right diet for
her so recovery could be sooner.
Nutritional – Metabolic
Pattern
Food consumption:
before hospitalization
breakfast: Milo and bread
lunch: rice (about 2- 2 ½ cups), meat/poultry/fish/
vegetables, ice cream, juice/water/soda
dinner: rice (about 2- 2 ½ cups), meat/poultry/fish/
vegetables
during hospitalization
- osteorized feeding every 4 hours (1600cal - total)

Metabolic (Wt. gain/loss)

The patient’s weight upon admission was not indicated in the patient’s
record but as reported by the relative of the patient slightly lost weight since
admission
Elimination Pattern
a. Bowel
before hospitalization
- once or twice a day
- characteristic of bowel:
color: brown
odor: fruity
consistency: formed
during hospitalization
- changes diapers 7-8times a day; 1 or 2 with feces,
sometimes none
- characteristic of bowel:
color: brown
consistency: formed
b. Bladder
before hospitalization
- four to five times a day
during hospitalization
- have her diaper changed for 7-8 times a day
A.
Activity/Exercise Pattern
Self care Activity
Feeding-III Toileting-III
Dressing-II Home Maintenance-IV Shopping-IV
Bathing-II
Bed Mobility-II Grooming-II
Cooking-IV Gen. Mobility-IV
Legend:Functional Level Code
O- Full Self-care
I-Requires use of equipment or device
II-Requires assistance or supervision from another person
III- Requires assistance or supervision from another
person and equipment or device
IV-Is dependent and does not participate
Oxygen Perfusion
(-) DOB
- capillary refill takes 3-4 seconds
before the color of the nails becomes
pink in appearance after applying
pressure
Sleep and Rest Pattern

time of sleep: 7 or 8 o’clock in the

evening
time of rise: 4 or 5 o’clock in the
morning
rest: watching television
Cognitive Perception
Pattern
A . Hearing
- the patient responds to questions
and commands accordingly
B. Vision
- the patient has good visual acuity
C. Sensory perception
- the patient blinks her eyes when
there is stimulus. She is able to feel
with her paralyzed body part.
Role Relationship Pattern

The patient has good

relationship with her family. She
has five siblings who are all
willing to take care of her when
she got home. Her husband is not
always with her because he
works in Las Piňas. She go home
every Friday and go back to work
by Sunday.
Sexuality – Reproductive
Pattern
The patient is experiencing
from global aphasia which
makes it difficult to gain
information about the subject.
Coping Stress
Tolerance Pattern
The relative of the patient
reported that though the
patient is ill, she still smiles
when they are talking to each
other. He said that he has not
seen any sign that the patient
is experiencing any
depression due to her
paralysis.
Values – Belief Pattern

The relative verbalized that

the patient does not believe
to those folk healers.
 Physical Assesssment

General Survey
The patient was seen awaked and lying on his bed. She appears weak
in appearance, pale looking and restless. During conversation the patient
interacts pleasantly and response to questions by means of hand gestures.
Vital Signs
Day1 Day2 Day3
Temperature 36.5℃ 36.3℃ 36.8℃
Pulse rate 83cpm 88cpm 100cpm
Respiration 22bpm 26bpm 24bpm
Blood pressure 180/100mmHg 150/110mmHg 180/100mmHg
AREA NORMAL FINDINGS ACTUAL FINDINGS

HEAD:
SKULL Normocephalic Normocephalic

HAIR Thickness, shiny, even Blackish to white in

distribution, color it is thick , curly
straight, curly, kinky and short.

SCALP Clean and no dandruff With the presence of

dandruff
FACE Color should be fair There is slight redness
with the color of the around the nose and near
neck; symmetrical in the cheeks.
shape

EYES enopthalmos Slightly bigger than her

face proportion

EYEBROWS Present bilaterally The eyebrows are present

and move symmetrical bilaterally, only the left
as the facial eyebrows moves as the
expression changes. facial expression changes,
and have no lesions

EYELIDS Fair color, cover the Color same as the face, 22

eye when the eyes blinks/min, cover fully the
closed, blinks 20- eyes when asked to close
25/min, the eyes
PUPILS size: 2-3mm, PERRLA size: 3mm, PERRLA

IRIS Flat normally appears , Normally appears flat, with

with around regular around regular shape and even
shape and even coloration
coloration
SCLERA White in color and clear Slightly yellowish in color
and clear

VISUAL ACUITY Should be, 20/20 Object (penlight) was used in

20ft away from the patient
since snelen'schart is not
available and the patient is
unable to stand.
COLOR VISION can determine the basic Able to determine the basic
color (R,B,G,Y) colors (R,B,G,Y)
No d/c The ears is equal in size
EARS auricle align to the bilaterally with no swelling
outer canthus of the eye and discharge, auricle align
symmetrical to the outer canthusof the
size: small, medium, large eye the skin color is fair
paited- hearing ability with the facial skin color,
with lesions noted in both
concha and normal hearing
ability.
NOSE location: midline, no The nose is symmetric, in
discharge, able to the midline with no
smell aromas discharge and unable to
smell diff. aromas due to
attached ngt tube.

MOUTH:
LIPS Pink/red, moist, and pale and dry chopped lips
smooth

Color: pink Color: pink

TONGUE moist, smooth, moist, smooth, symmetrical,
symmetrical, move unable to move freely and
freely and no no tenderness
tenderness Slightly placed to the
right side of the mouth
GUMS pink color, smooth, pink in color, smooth, firm
firm and moist and moist
TEETH No dental carries,
white in color or
slightly yellowish

With dental caries,

absence of the upper first
and second premolars and
lower first and second
premolars

TONSILS Left and right Left and right located,

located, pink and pink and moist
UVULA moist
Pendant hanging in Pendant hanging in the
the midline and rise midline and rise with the
with the soft palate soft palate
 Hard palate: Lighter pink and Hard palate: Lighter pink and
(PALATE soft and hard) more irregular texture more irregular texture
Soft palate: Light pink, smooth Soft palate: Light pink, smooth

FACIAL SINUSES:
FRONTAL SINUS no tenderness no tenderness
ETHMOID SINUS no tenderness no tenderness
SPHENOID SINUS no tenderness no tenderness
MAXILLARY SINUS no tenderness no tenderness

NECK Color ; same as the face Color ; same as the face

no neck stiffness no neck stiffness

LYMPHNODES:
Preauricular No tenderness No tenderness
Postauricular
Occipital,
Supraclavicular
Anterior cervical
Tonsilar
Submental
Submandibular

THYROID Centrally located, painless, and Centrally located, the patient is

rise freely when swallowing unable to swallow
THORAX
ANTERIOR THORAX Symmetrical, elliptical shape; The shape is symmetrical; the client has
Inspection quiet, rhythmic, and effortless quiet, rhythmic and effortless respiration
Palpation respiration During deep inspiration thumbs separate 4 cm
Percussion Full symmetric excursion; With present of vibration in the larynx
Auscultation thumbs normally separate 3 to transmitted through the bronchopulmonary
5 cm and present of tactile system to the chest wall
fremitus resonant sounds down to sixth intercostal
Percussion notes resonates space
down to the sixth rib at the Bronchovesicular breath sounds
POSTERIOR THORAX level of the diaphragm
Inspection Bronchialvesicular
Anteroposterior to breath
transverse The anteroposterior to transverse diameter
Palpation sounds
diameter in ratio of 1:2 and in ratio is 1:2 and chest symmetrical, spine
Percussion chest vertically aligned
Auscultation symmetrical, spine vertically During deep inspiration
aligned thumbs separate 3-5 cm , vibration felt
Full and symmetric chest bilaterally down over the lung field
Expansion and present of Resonate sounds down to sixth intercostal
tactile fremitus space
Percussion notes resonate Bronchial sounds
sound
CARDIOVASCULAR Vesicular and, regular
No pulsation bronchovesicular
cardiac Carotid pulse equal bilaterally, elastic. No
breath sounds
rhythm, CR=60-100 bpm bruits over carotid . apical impulse palpated
in the 5thICS. Apical heart rate ,
83beats/min, regular rhythm in S1 heard best
at apex.
BREAST Rounded shape; slightly The shape is round and it is
 

AREOLA unequal in size; generally generally symmetric.

NIPPLES symmetric The skin is uniform in color and
Skin uniform in color; skin smooth it is also smooth and intact.
ABDOMEN and intact. The shape is round, bilaterally  

Inspection Round /oval; bilaterally

Unblemished skin; uniform thecolor
same; the
The same
color; widely
is lightlight pink tobrown
to medium
Abdominal girth color varies widely from light dark brown . No
Flat, rounded; symmetric contour, and it is uniform. Unblemishedmasses and
Auscultation pink to dark
symmetric brown. No
movements lumpsby
caused , tenderness
skin.
Percussion (4 masses or
respiration. areas of Round evertedisand
The abdomen flatequal in size.
and rounded
quadrants) tenderness
gurgling sound freq. 3-15/min every Similar and has in color with
a symmetric areola. and
contour
Palpation Round ;
5-15sec. everted / inverted ; equal in texture
60 inches is smooth
Light and Deep size ; similar
Tympanic over in
thecolor .
stomach and gas- And soft/min
10 gurg , No begin
discharges
in theand right
palpation Soft and smooth ; no discharge , lesions nor masses
filled bowels; dullness, especially lower quadrant at the ileocecal .
masses
over the orliver
lesionsand. No lumps
spleen , oranda valve.
masses
full bladder Tympanic is heard over the stomach
No tenderness and gas-filled bowels; dullness,
sound is
heard over the liver and spleen,
or a full bladder
No tenderness
GENITOURINARY
 

ELIMINATION
A. Bladder Non palpable Non palpable, no tenderness
Frequency 3-5 times during day and 1-2 times 4 times a day and 3 times at night
Color at night Yellowish to orange color
Musculoskeletal
 

Odor Clear to yellowish color Aromatic ; fruity odor

system
B. Bowel normal response
Aromatic odor Skin fair in color
Upper extremities
Frequency With dryaskin
3 times week
Lower extremities
Consistency 1-2 times a day With poor skin turgor
soft and formed
Muscle function and
Color Soft and tubular shape With
Brownpoor
colorcapillary refill, takes 4
strength Yellowish to brown color seconds before color return
REFLEXES unable to do range of motion in the
deep tendon right side of the body and weak
biceps unable to shrug and turn head
triceps against resistance.
brachioradialis Poor reflexes
patellar -hypoactive reflex
ankle
INTEGUMENTARY
Skin Light to deep brown; uniform
color except to unexposed are
Uniform; with normal range
When pinched, skin springs
back to previous state
Nails
Convex curvature; angle of
nail
plate is 160 degrees
Smooth in texture
Color is highly vascular and
pink in light skinned clients;
dark skinned clients may have
brown or black pigmentation in
longitudinal steaks
Blanch test, prompt return of
usual color about 2 seconds.
NEUROLOGIC
Behavior - the persons maintain eye
Manner of speech contact .with comfortable and
cooperative with interacts
pleasantly.
Clear and understandable
Color: light brown skin
Pale color in palms and soles,
and pale lips
Temperature: normally warm 37℃
Texture : dry
Turgor : poor skin turgor , skin
turns back within 4seconds
The shape is convex curvature
and angle is 160 degrees.
Smooth in texture
pale in color
poor capillary refill
-looks tired and weary , slightly
irritable
-comfortable and cooperative ;
interacts pleasantly
-unable to speak
 Cranial Nerve II (Optic) Vision (acuity and field of vision); Able to see the
 

pupil reactivity to light and object clearly about

accommodation (afferent impulse) 20ft away from her
Cranial Nerve III (Oculomotor) >Pupil will react to penlight -Pupil equally round
 

equally and constrict about 2-3mm. reactive to light

>Eye will follow the object in six accommodation(PERRLA).
ocular movements size of pupils is
2mm.
- Eye followed object
 

Cranial Nerve IV (Trochlear) EOM (turns eye downward and in

Thesix
eyeocular
movement of
laterally) movements
the patientbutwas
hasable
difficulty when
Cranial Nerve V (Trigeminal) Blinking reflex ; feel both deep and to downwardblinking
>Positive
turning to the right
 

soft sensation, clench teeth reflex

side. when touched
with cotton wool.
>unable to clenched
his teeth
>Able to feel the
deep sensation when
stroked with pen.
>Unable to feel the
light sensation on
his lower extremities
when stroked with
cotton
Cranial Nerve VI EOM (turns eye laterally) unable to move eyes to the right sides
(Abducens )

Cranial Nerve VII (Facial) Facial expression; taste; able to Taste sweets, salty, sour
corneal reflex (motor); eyelid bitter, and raise eyebrows, unable puff
and lip closure out cheeks and close eyes

Cranial Nerve VIII Romberg’s test, can hear spoken can hear spoken words, felt bone
(Acoustic or words, felt bone conduction conduction
Vestibulocochlear)

Cranial Nerve IX Gag reflex should be present The gag reflex is not present and the
(Glossopharyngeal ) And the tongue moves side to tongue doesn't move side to side
side

Cranial Nerve X (Vagus) Gag reflex is present Impaired gag reflex

Cranial Nerve XI Shrug shoulders and turns head unable to shrug shoulders and turned
(Acessory ) side to side against resistance head against resistance

Cranial Nerve XII Protrude tongue unable to control tongue movement

(hypoglossal )
Laboratories
 FBS (Fasting Blood Sugar)
February 26, 2010

Parameter Result Normal Analysis

FBS 189 60-110
Values Indicates
mg/dl increase
level of
blood
glucose
 Blood Chemistry
February 26, 2010

Parameter Result Normal Values Analysis

Triglycerides
293 mg/dl 40-200 mg/dl High triglycerides levels
often accompanied high total
cholesterol and high HDL
Cholesterol 331 mg/dl 140-220 mg/dl Elevated cholesterol in the
blood is due to abnormalities
in the level of lipoprotein the
particles that carry
cholesterol in the
LDL 228 mg/dl 0-130 mg/dl bloodstream
May indicate that bad
cholesterol is higher than
good cholesterol and
compromise the person to
develop atherosclerosis
hemoglobin 13.7% 12-16% Within normal range
11000 cu mm 5000-10000 cu mm
Hematocrit
WBC 4.8 million/cu mm 4.5-5.5million Within
Within normal
normal range
range

RBS 67 55-65% Within normal range

Segmenters Within normal range
Lymphocytes 28 25-35% Within normal range
Monocytes 5% 3-7% Within normal range
Ct scan
Feb.26,2010
Pertinent history: Hypertension, to
consider transient ischemic attack.
Impression:
Subacute left external capsule infarct
with intercurrent acute to sub-acute
external sinus disease.
CHEST X-RAY
Feb.27, 2010
Impression:
Cardiomegaly with dilated left ventricular
component
Atherosclerotic aortacapsule and left
thalamic infarcts right mastoid and sphenoid
Minimal left sided pleural effusion.
Sub-segmental atelectasis, left lower lobe
Degenerative osseous changes
ECG
(Electrocardiography)
Feb.27,2010
Impression:
Sinus rhythmic left ventricular heart by
voltage with problem secondary to strain
pattern to consider ischemia.
Medication
Generic name Classificat Indication Adverse Contra Nursing
Brand name ion effect indication responsibil
ities

NORIZEC Anti Type 2 DM Dizziness , Diabetic Monitor for

Glimepiride diabetic or in asthenia , keto hypoglycemi
agents combination head ache , acidosis a
with nausea , with or Monitoring
metformin vomiting , with out for fasting
or insulin abdominal coma and post
pain , prandial
blood
glucose .
Instruct
the patient
to avoid
drinking
alcohol
Generic name Classificati Indication Adverse Contra Nursing
Brand name on effect indication responsibili
ties

LOSARTAN Anti Management Abdominal Hyper Monitor BP

Combizar hypertensive of pain , edema , sensitivity Notify
hypertension head ache , to physician of
palpitation , sulfonamides symptoms of
diarrhea , patients hypotension
nausea , back with anuria Lab test ,
pain , and depleted monitor CBC
dizziness , In adequate
dry cough response may
be improved
by splitting
the daily
dose into
twice daily
dose .
Generic name Class ificati Indication Adverse Contra Nursing
Brand name on effect indication responsibili
ties

CLONIDINE Cardi o Central Hypotension , Pregnancy , Monitor BP

HCL vascu lar acting anti peripheral lactation closely
Catapres , agent adrenergic edema , ECG use of whenever a
Anti hyper derivative changes , clonidine drug is
tensi ve alpha 2 increase in patch in in added to
adrenergic BP , dry poly Monitor I & O
receptors in mouth , arteries during
CNS to constipation period of
inhibits , abdominal dosage
sympathetic pain , head adjustment .
vasomotor ache , Report
centers drowsiness , changes in
fatigue I&O
Determine
weight
daily .
Supervise
closely the
patients
with history
of mental
depression
Generic name Classificatio Indication Adverse Contra Nursing
Brand name n effect indication responsibilit
ies

FUROSEMIDE Anti diuretic Treatment of Postural History of Observe

Fumide, edema hypotension, hyper patient
Lasix associated dizziness, sensitivity receiving
with CHF, acute to furosemide parenteral
May be used hypotensive or drug
for episodes, sulfonamides carefully
management of diarrhea, Closely
hypertension constipation, monitor BP
abdominal Monitor for
cramping signs and
jaundice symptoms of
hypokalemia.
Monitor BP
during
periods of
dieresis and
through out
period of
dosage
adjustment
Monitor I&O
ratio pattern.
Note
excessive
dehydration.
Generic name Classificatio Indication Adverse Contra Nursing
Brand name n effect indication responsibilit
ies

TELMISARTAN Anti Treatment of Back pain, flu Hyper Monitor BP

Micardis hypertensive hyper tension like syndrome, sensitivity carefully
dizziness, to after initial
chest pain, telmisartan dose
peripheral or other Monitor vital
edema, angiotensin sign
receptorantag Monitor
onist, dialysis
patients
closely for
orthostatic
hypotension.
Monitor
patient for
sign and
symptoms of
hypotension
Monitor
concomitant
digoxin
levels
through out
therapy.
Generic name Classification Indication Adverse effect Contra Nursing
Brand name indication responsibilities

LEVOX Anti Patients with Disorders of Hyper With hold therapy

Levofloxacin infectiveness known or the GI, liver, sensitivity and report to
suspected CNS heart rate patients with physician
disorder, anemia, history of immediately any
predisposed to metabolic & tendon dis of the ff. skin
seizures or low nutritional order rash or other
seizure thresh disorder, sign of
hold hypersensitivity
reaction such as
seizures,
confusion,
hallucination
Instruct patient
to avoid exposure
to excess
sunlight or
artificial
sunlight
Advised patient
to increase fluid
intake.
Do C&S test prior
to beginning
therapy and
periodically.
Generic name Classification Indication Adverse effect Contra Nursing
Brand name indication responsibilitie
SENOKOT Gastro Functional Abdominal Hypersensitivit Monitor
s V &S
Senokot forte intestinal constipation of cramps,flatulenc y appendicitis Reduce dose in
hospitalized e, nausea, fecal patient who
patient, watery diarrhea,impactation experience
functional excessive loss irritable colon,considerable
constipation of water and nausea, vomitingabdominal
due to intake electrolytes. undiagnosed, cramping
of certain Weight loss abdominal pain, Consult
drugs. intestinal physician if
obstruction constipation
persist
Be aware that
drug may alter
urine and feces
color.
Generic Classificat Indication Adverse Contra Nursing
name ion effect indication responsibil
Brand name ities

PRIALTA Antidiabeti Adjunct to Head ache , Diabetic Monitor for

Pioglitazon c agents diet and upper keto sign and
e hcl exercise to respiratory acidosis , symptoms of
improve tract hypoglycemi hypo
glycemic infection , a glycemia
control in fluid Monitor
patient retention closely for
with type 2 sign and
DM symptoms of
CHF or
exacerbatio
n of
symptoms
Monitor
weight and
notify
physician
of
development
of edema
Nursing Care Plans