I. Introduction.

Overview of the Study

Cerebrovascular Accident: The sudden death of some brain cells due to lack of
oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to
the brain. A CVA is also referred to as a stroke.
Symptoms of a stroke depend on the area of the brain affected. The most common
symptom is weakness or paralysis of one side of the body with partial or complete loss of
voluntary movement or sensation in a leg or arm. There can be speech problems and
weak face muscles, causing drooling. Numbness or tingling is very common. A stroke
involving the base of the brain can affect balance, vision, swallowing, breathing and even
unconsciousness.
A stroke is a medical emergency. Anyone suspected of having a stroke should be
taken immediately to a medical facility for diagnosis and treatment.
The causes of stroke: An artery to the brain may be blocked by a clot (thrombosis)
which typically occurs in a blood vessel that has previously been narrowed due to
atherosclerosis ("hardening of the artery"). When a blood clot or a piece of an
atherosclerotic plaque (a cholesterol and calcium deposit on the wall of the artery) breaks
loose, it can travel through the circulation and lodge in an artery of the brain, plugging it
up and stopping the flow of blood; this is referred to as an embolic stroke. A blood clot can
form in a chamber of the heart when the heart beats irregularly, as in atrial fibrillation;
such clots usually stay attached to the inner lining of the heart but they may break off,
travel through the blood stream, form a plug (embolus) in a brain artery and cause a
stroke. A cerebral hemorrhage (bleeding in the brain), as from an aneurysm (a widening
and weakening) of a blood vessel in the brain, also causes stroke.

The diagnosis of stroke involves a medical history and a physical examination. Tests
are done to search for treatable causes of a stroke and help prevent further brain damage.
A CAT scan (a special X-ray study) of the brain is often done to show bleeding into the
brain; this is treated differently than a stroke caused by lack of blood supply. A CAT scan
also can rule out some other conditions that may mimic a stroke. A soundwave of the
heart (echocardiogram) may be done to look for a source of blood clots in the heart.
Narrowing of the carotid artery (the main artery that supplies blood to each side of the
brain) in the neck can be seen with a soundwave test called a carotid ultrasound. Blood
tests are done to look for signs of inflammation which can suggest inflamed arteries.
Certain blood proteins are tested that can increase the chance of stroke by thickening the
blood.
Stroke look-alikes: Just because a person has slurred speech or weakness on one
side of the body does not necessarily mean that person has had a stroke. There are many
other nervous system disorders that can mimic a stroke including a brain tumor, a
subdural hematoma (a collection of blood between the brain and the skull) or a brain
abscess (a pool of pus in the brain caused by bacteria or a fungus). Virus infection of the
brain (viral encephalitis) can cause symptoms similar to those of a stroke, as can an
overdose of certain medications. Dehydration or an imbalance of sodium, calcium, or
glucose can cause neurologic abnormalities similar to a stroke.
Treatment of a stroke: Early use of anticoagulants to minimize blood clotting has
value in some patients. Treatment of blood pressure that is too high or too low may be
necessary. (Lowering elevated blood pressure into the normal range is no longer
recommended during the first few days following a stroke since this may further reduce
blood flow through narrowed arteries and make the stroke worse.) The blood sugar
glucose in diabetics is often quite high after a stroke; controlling the glucose level may
minimize the size of a stroke. Drugs that can dissolve blood clots may be useful in stroke

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treatment. Oxygen is given as needed. New medications that can help oxygen-starved
brain cells survive while circulation is reestablished are being developed.
Rehabilitation: When a patient is no longer acutely ill after a stroke, the aim turns to
maximizing the patient's functional abilities. This can be done in an inpatient rehabilitation
hospital or in a special area of a general hospital and in a nursing facility. The
rehabilitation process can involve speech therapy to relearn talking and swallowing,
occupational therapy for regaining dexterity of the arms and hands, physical therapy for
improving strength and walking, etc. The goal is for the patient to resume as many of their
pre-stroke activities as possible.

II. Patient Profile.

Client’s Name: Mrs. S
Age: 82 years old
Address: Kawit, Cavite
Sex: Female
Religion: Roman Catholic
Date of admission: February 07, 2011
Time of admission: 11:35 am
Chief complaint: Slurring of Speech
Admitting diagnosis: t/c CVA prob. Infarct, (L) MCA
Attending physician: Dr. G. Espiritu

II. Patient History.

History of Present Illness:

5 days PTA - Px was noted to have slurring of speech, sought consult to AP &
admitted at Salamanca Hospital then transferred @ Bautista Hospital;
Px’s relatives opted transfer to Cavite Medical Center hence admission.

Family Health History:

(-) DM
(-) BA
(-) Allergies

Past Health History:

*No previous surgery or confinement

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III. Physical Assessment.
Vital signs
The client’s pulse rate is 88 beats per minute, her respiratory rate is 20 breaths per
minute, temperature is 37°c, blood pressure is 160/90.

General appearance
The client is in medium frame with decorticate posture, the client is bedridden since she
was admitted to the hospital last February 07, 2011. Well groomed and has no body odor.
She doesn’t have any deformity.

Mental status
The client can’t talk because she was stroke.

Skin
The client’s skin is of normal racial tone which is brown. It is dry and smooth. The skin
turgor is wrinkled and loss of elasticity. The body hair is evenly distributed. She doesn’t
have any edema.

Nail
The client’s nail shape is convex clubbing, the nail is rough and the nail bed is pink. The
capillary refill is within 3 seconds and this is an absence of beau’s line.

Head and Face

The client’s skull is proportionate to the body size, There were no tenderness in the scalp.
There were no presence of nodules, and infestation. Her hair is evenly distributed and the
strands are thin and brittle. The color of her hair is a mixture of white and black. Her head
is round and symmetrical its consistency is hard. She can’t control her head and the shape
of her face is round and asymmetrical and its consistency is soft.

Eyes
Pupils are equal in size. Pupils are equally round and reactive to light and accommodation.
The lacrimal apparatus are moist.

Ear
The color of the ear is of normal racial tone which is brown, it is symmetrical. The
alignment of the pinna is symmetrical. The pinnas are elastic and recoil when folded. The
mastoid process is tender. The auditory canal contains some cerumen, the color is brown
and there is an absent of discharges.

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Nose
The color of the client’s nose is of racial tone which is brown. Her septum is in the midline.
The mucosa is pink, nostrils are both patent, nasal flaring is absent. Landmarks are visible.
Sinuses are non-tender. There is an NGT in her right nostrils.

Mouth and Oropharynx

The lips is symmetrical and pink, the consistency is smooth, buccal mucosa is pink, the
gum is pink, the tongue is in the midline, the color is pink and it is smooth. The tongue
movements are not that smooth.

Neck
The neck has involuntary movement and with resistance, the muscle strength 3/5. The
trachea is in the midline, thyroid is in the midline and it is smooth. Maxillary lymph nodes
are palpable.

Breast
The breasts are symmetrical with flat contour. Shape is flat, the skin surface is smooth.

Chest and Lungs

The color of the chest is of normal racial tone which is brown, the shape is AP to lateral
ratio 1:2. There is absence of intercoastal retraction, costal angle is 45° chest wall are
symmetrical, and the chest expansion is symmetrical. No adrentition sound. Respiratory
rate is 20 breaths per minute.

Heart
The rhythm is regular. PMI is located in the apical pulse. Heart rate is 88 beats per minute.

Abdomen
Skin is of normal racial tone which is brown, the contour is flat. Peristalsis is non-visible.

Upper extremities
The client cannot resist force when asked to resist. Muscle strength is 3/5. She have a skin
lesion in her right elbow, The peripheral pulses are equal. Lympnodes are not palpable.
The IV site is in her left arm.

Lower extremities
The client cannot resist force when asked to resist. Muscle strength is 2/5. she doesn’t
have any deformity. The peripheral pulses are equal. Lympnodes are non-palpable.

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VI. Anatomy and Physiology.:
BRAIN
Cerebrum - The biggest part of the brain is
the cerebrum. The cerebrum makes up 85%
of the brain's weight, and it's easy to see
why. The cerebrum is the thinking part of the
brain and it controls your voluntary muscles

Cerebellum - The cerebellum is at the back

of the brain, below the cerebrum. It's a lot
smaller than the cerebrum at only 1/8 of its
size. But it's a very important part of the
brain. It controls balance, movement, and
coordination (how your muscles work
together).

Brain Stem - The brain stem sits beneath the cerebrum and in front of the cerebellum. It
connects the rest of the brain to the spinal cord, which runs down your neck and back. The
brain stem is in charge of all the functions your body needs to stay alive, like breathing air,
digesting food, and circulating blood.

Midbrain/ Mesencephalon - the rostral part of the brain stem, which includes the
tectum and tegmentum. It is involved in functions such as vision, hearing, eyemovement,
and body movement. The anterior part has the cerebral peduncle, which is a huge bundle
of axons traveling from the cerebral cortex through the brain stem and these fibers (along
with other structures) are important for voluntary motor function.

Pons - part of the metencephalon in the hindbrain. It is involved in motor control and
sensory analysis... for example, information from the ear first enters the brain in the pons.
It has parts that are important for the level of consciousness and for sleep. Some
structures within the pons are linked to the cerebellum, thus are involved in movement
and posture.

Medulla Oblongata - is the lower portion of the Brainstem. It deals with autonomic
functions, such as breathing and blood pressure. The cardiac center is the part of the
medulla oblongata responsible for controlling the heart rate.

Hypothalamus - The hypothalamus is like your brain's inner thermostat (that little box on
the wall that controls the heat in your house). The hypothalamus knows what temperature
your body should be (about 98.6° Fahrenheit or 37° Celsius).

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VII. Pathophysiology.

VIII. Nursing Care Plan.

Assessment Diagnosis Planning Intervention Evaluatio
n
Subjective: Impaired At the end of • Encourage to increase At the end
“Suka siya ng verbal 4 hours fluid intake of 8 hours
suka” as communication nursing Rationale: To regain fluid nursing
verbalized by related to intervention, loss. interventio
the patient’s neuromuscular the patient n, the
mother. impairment as will be able to • Monitor intake and output patient
evidence by restore fluid balance. was able to
Objective: absence of and Rationale: To ensure restore
Cool extremities responding electrolyte accurate picture of fluid fluid and
Sunken eyes imbalances status electrolyte
Dry skin imbalances
Watery stool • Observed for excessively
Persistent dry skin and mucous Goal
vomiting membranes, decreased skin Partially
turgor, slowed capillary Met
refill.
Rationale: Indicates
excessive fluid
loss/resultant dehydration

Dependent:
Provide supplement fluids
as indicated D5LR 1Lx8o
Rationale: Fluids may be
given in this manner if
patient is unable to take
oral fluid

IX. Laboratory Test.

CBC:
Result Normal Value Interpretation

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 Female: Dehydrationproduces a falsely high
Hemoglobin 183 g/L 110 – 170 g/L hemoglobin which disappears when
proper fluid balance is restored.
Female: Normal
Hematocrit 0.38 %
0.37% - 0.54%
Occurs an infection, allergy,
White Cell
14,351 g/L 4,500 - 10,000 g/L systemic illness, inflammation,
Count
tissue injury, and leukemia.

UA:
Color – Light Transparency - Hazy Reaction (pH) – Specific Gravity –
Yellow 7.5 1.010
CHON – Negative Glucose – Negative RBC – 0 – 2/hpf PUS Cells – 1 –
2/hpf
Epithelial Cells – Mucus Threads – Urate/Phospates Bacteria - Moderate
Few Moderate - Moderate

X. Drug Study:
Drug Action Indication Contra- Adverse Nsg. Resp
Name indication Effects
Cifroflaxa Ciprofloxacin Recommended Any Dizziness to This medication
cin inhibits an for use against previous tremors, may make you
Cipro enzyme against a wide adverse hallucinations, more sensitive to
“antibiotic” called DNA variety of reaction to psychosis and the sun. Avoid
gyrase that infections when Ciprofloxaci convulsions prolonged sun
is an susceptibility is n. Avoid have been seen exposure,
essential demonstrated. giving to in small tanning booths,
component Specific dosage adolescent numbers of and sunlamps.
of the regimes are at s, pregnant patients. As with Use a sunscreen
mechanism the discretion of or lactating many other and wear
that passes the attending women, antibiotics it can protective
genetic physician acting those with kill the healthy clothing when
information on information known bacteria of the outdoors.
onto daighter from the neurologica gut and give
cells when a manufacturer and l problems. rise to a This medication
cell divides. the national disorder called may be taken
authority for drug pseudomembra with or without
safety and use. nous colitis. It food, usually
Suggested can also make twice a day in
dosages for users sunburn the morning and
specific agents easily and can evening or as
may be on the cause muscle or directed by your
individual agent tendon doctor.
pages, inflammation or
damage. .

Drug Action Indication Contra- Adverse Nsg. Resp

Name indication Effects
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Omepraz Gastric acid- Short-term Contraindic CNS: Headache, Administer
ole pump treatment of active ated with dizziness, before meals.
Omepron inhibitor: duodenal ulcer; hypersensit asthenia, Caution patient
“GI Agent” Suppresses First-line therapy in ivity to vertigo, to swallow
treatment of
gastric acid omeprazole insomnia, capsules whole—
heartburn or
secretion by symptoms of or its apathy, anxiety, not to open,
specific gastroesophageal component paresthesias, chew, or crush
inhibition of reflux disease s; dream them.
the (GERD); Short-term Use abnormalities Arrange for
hydrogen- treatment of active cautiously Dermatologic: further
potassium benign gastric with Rash, evaluation of
ATPase ulcer; GERD, severe pregnancy, inflammation, patient after 8
enzyme erosive esophagitis, lactation. urticaria, wk of therapy for
system at poorly responsive pruritus, gastroreflux
symptomatic GERD;
the secretory alopecia, dry disorders; not
Long-term therapy:
surface of Treatment of
skin intended for
the gastric pathologic GI: Diarrhea, maintenance
parietal cells; hypersecretory abdominal pain, therapy.
blocks the conditions nausea, Symptomatic
final step of (Zollinger-Ellison vomiting, improvement
acid syndrome, multiple constipation, dry does not rule out
production. adenomas, mouth, tongue gastric cancer,
systemic atrophy which did occur
mastocytosis); Respiratory: URI in preclinical
Eradication of H.
symptoms, studies.
pylori with
amoxicillin or
cough, epistaxis
metronidazole and Other: Cancer in
clarithromycin; preclinical
Prilosec studies, back
pain, fever

Drug Action Indication Contra- Adverse Nsg. Resp

Name indication Effects

8
Erceflora Contributes to Acute diarrhea with Not for use CNS: Headache, • Shake drug well
“Antidiarrhe the recovery duration of ≤14 in dizziness, before
als” of the days due to immunocom asthenia, vertigo, administration.
intestinal infection, drugs or promised insomnia, apathy, • Monitor patient
microbial flora poisons. Chronic or patients anxiety, for any unusual
altered during persistent diarrhea (cancer paresthesias, effects from drug.
the course of with duration of patients on dream •
microbial >14 days. chemothera abnormalities Administer drug wi
disorders of py, patients Dermatologic: thin 30 minutes
diverse origin. taking Rash, after opening
It produces immunosupp inflammation, container.
various ressant urticaria, pruritus, • Dilute drug with
vitamins, meds) alopecia, dry skin sweetened milk,
particularly GI: Diarrhea, orange juice or
group B abdominal pain, tea.
vitamins thus nausea, vomiting, • Administer drug
contributing to constipation, dry orally.
correction of mouth, tongue
vitamin atrophy
disorders Respiratory: URI
caused by symptoms, cough,
antibiotics & epistaxis
chemotherape Other: Cancer in
utic agents. preclinical
Promotes studies, back
normalization pain, fever
of intestinal
flora.
Drug Action Indication Contra- Adverse Nsg. Resp
Name indication Effects
Buscopan Contributes to Relief of smooth • • tachycardia Drug
HYOSCINE the recovery muscle spasm of contraindicate compatibility
BUTYLBROMI of the d in Glaucoma
the should be
DE intestinal monitored closely
“Antispasmo gastrointestinal • other
microbial flora in patients
dic” and adverse
altered during requiring
the course of genitourinary effects
systems include: dry adjunctive
microbial therapy. The
disorders of mouth,
decreased safety of
diverse origin.
perspiration, Buscopan has not
It produces
various mydriasis, been established
vitamins, increased for intramuscular
particularly intraocular (IM)
group B pressure administration.
vitamins thus Administration of
contributing to • use with Buscopan results
correction of caution in in heart rate
vitamin prostatic elevation. Heart
disorders hypertrophy rate can not be
caused by used as a valid
antibiotics & indicator of
chemotherape severity of pain
utic agents. for 30 minutes
Promotes following IV
normalization injection.
of intestinal
flora.
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X. Discharge Planning.
Medication:
• Patient has to continue his medication. Amlodipine 5mg/ tab once a day, Zantac
150 mg twice a day, 8am and 6pm.

Exercise:
• The patient was advised to have complete bed rest until strength is regained.
Have turn side to side every 2 hours to prevent bed soars. Have ROM exercise on to
enhance client's body function.

Treatment:
• Should undergo speech therapy to learn talking and swallowing. Oxygen
inhalation if necessary and if possible 3-4 liters per minute.

Health Teaching:
• Teach the client how to have a healthy lifestyle. Teach patient the foods to eat
and the foods to avoid. Teach the family members how to prepare low sodium and
low fat diet. Encourage environmental modification to enhance safety and prevent
injury.

Out Patient Follow-Up:

• The client was advised to have a follow-up check-up, as indicated by the
physician.

Diet:
• Patient was instructed to maintain the low salt and low fat diet. The low salt diet is
designed to induce a loss of sodium and water from the body or avoid sodium
retention. A 2000 mg low sodium diet is sufficient to control blood pressure. A low
fat diet help lose weight to decrease risk of having CVA again

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 Emilio Aguinaldo College
College of Nursing
Dasmariñas, Cavite

Case Study of

Acute
Gastroenteritis
In Partial Fulfillment of the Requirement in NCM 104 – RLE

11
 Submitted To:
Fritz Ian Estrella Floresca, RN

Submitted By:
Group 3 (2nd Group)
Pineda, Paul Stephen E.
Regala, Laarni Nasser
Robles, Robin
Sabilala, Neil Anderson
Solis, Michelle
Tana, Kim Aron
Zamora, Ma. Cristina

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