CHN Stroke Final-Manuscript

TAGUM DOCTORS COLLEGE, INC.
Nursing Department
Mahogany St., Rabe Subd.,
Visayan Village, Tagum City
A Case Study Presented on

Stroke
In Partial Fulfilment of the Requirements in

Related Learning Experience 116
Presented by:
ALAMILLO, DEMARK
BANGI-AN, RHEA
CAJILIG, NICE
CASTROMAYOR, JEAN
DACLES, JOANNA MARIE
GONZALES, MARK JOSEPH
GUZMAN, BLESSY
HOSEÑA, KATHEA
MALABOSA, MICHELLE
PALMA, JIM CLARENCE
PALO, ROSS CHITO
PERASOL, KRYZL MARIE
VERTUDAZO, DASHIEL ROXETTE
Presented to:
CHERYL MAY V. AGUILAR, RN

Clinical Instructor
April 2023
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TABLE OF CONTENTS
CONTENTS PAGE
Cover Page i
Table of Contents ii
Acknowledgment iii
Introduction 4
Objectives 6
Barangay Profile 8
Family Data 14
Family Genogram 26
Physical Assessment 27
PhilPen Screening Result 35
Anatomy and Physiology 36
Etiology and Symptomatology 42
Pathophysiology 46
Drug Study 49
Family Nursing Care Plan 66
Recommendation 75
Reference 76
Appendix 78
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ACKNOWLEDGMENT
First and foremost, we would like to express our deepest gratitude to our
Almighty God, the author of knowledge and wisdom for his countless love and for
giving us strength in making this case study. May His glory and power enlighten us all.
To our beloved VP of Academics & Dean of Nursing, Mrs. Anabel Franada, RN,
MN, and to our clinical instructors, especially to Ma’am Cheryl May V. Aguilar, RN.
This case study would not have been possible without their endless support and
guidance. The enthusiasm, knowledge, effort, time, understanding spirit and exacting
attention to detail have been an inspiration to us and kept the work on track. Those
will serve as a guide and will forever be remembered and cherished in our hearts as
we pursue this course and to become successful Registered Nurses in the future.
To our parents, guardians, and relatives who have been more important to us,
whose love, support, and sacrifices are with us in whatever we pursue, thank you.
They are the ultimate role models.
To our group members, whom we had the pleasure to work with during the case
study in one way or another. Each of the members has contributed their time, effort,
knowledge, and talent to this. The completion of this undertaking could not have been
possible without the participation and assistance of so many people, whose names
may not all be enumerated. Their contributions are sincerely appreciated and gratefully
acknowledged.
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INTRODUCTION
Community health nursing is the synthesis of nursing and public health practice
applied to promoting and protecting the health of populations, with a focus on
individuals, families, and communities. It focuses on promoting and maintaining the
health of individuals, families, and communities. It involves working with individuals
and groups to assess health needs, develop and implement healthcare plans, and
evaluate outcomes. The first consideration in this framework is the population,
provider, and procedures interaction. (ANA, 2019). Family is an open and growing
system of interacting personalities with a structure and process enacted in
interpersonal relationships, regulated by resources and pressures, and operating
within a broader community. Nuclear families, single-parent families, blended families,
same-sex relationships, couples without children, and sibling families are all examples
of this type of family. Family members are defined as everyone who has made a
significant commitment to each other outside of marriage (RNpedia, 2019). The World
Health Organization (WHO) also recognizes the importance of family in community
health, family is the primary unit of care in many cultures and therefore can serve as
a powerful vehicle for improving health and well-being in communities (WHO, 2021).
Stroke is a medical condition that occurs when the blood supply to a part of the
brain is interrupted or reduced, leading to brain cell damage or death. There are two
main types of strokes: ischemic stroke and Hemorrhagic Stroke. Hemorrhagic stroke,
also known as cerebral hemorrhage. It is a type of stroke that occurs when a blood
vessel in the brain ruptures, causing bleeding within or around the brain. This bleeding
can damage the surrounding brain tissue and may lead to a loss of brain function.
There are two main types of Hemorrhagic Stroke: intracerebral hemorrhage and
subarachnoid hemorrhage. Risk factors for hemorrhagic stroke include high blood
pressure, smoking, heavy alcohol consumption, old age, genetics, gender, race and
use of blood thinning medications. Symptoms of Hemorrhagic Stroke may include
sudden severe headache, nausea and vomiting, seizures, weakness or numbness on
one side of the body, difficulty speaking or understanding speech, dizziness, vision
problem, neck stiffness and confusion. If Hemorrhagic Stroke is not treated, the
bleeding in the brain can lead to significant brain damage, death, disability and
recurrence of stroke (American Stroke Association, 2020).
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The prevalence rate of Hemorrhagic Stroke varies across different regions of
the world. According to a Global Burden of Disease Study (2020), the age-
standardized incidence rate of hemorrhagic stroke in high-income regions was 11.7%
per 100,000 population, while in low- and middle-income regions, it was 27.3% per
100,000 population. The study also found that the incidence of Hemorrhagic Stroke
was highest in East Asia, where it accounted for approximately 40% of all strokes.
According to the Philippine Stroke Society Registry (2018), Hemorrhagic Stroke

accounted for 31.6% of all stroke cases in the Philippines, the study reported that the
overall incidence of stroke in the Philippines was 1.11% per 1,000 person-years. The
study also found that hypertension was the most common risk factor for Hemorrhagic
Stroke in the Philippines.
In local statistics, the student nurses were not able to obtain the total number
of residents with Stroke cases in Barangay Health Center Station 2 Purok Narra
Visayan, Tagum City. However, total cases of hypertension which is the primary cause
of stroke is obtained. There has been newly identified hypertensive adults within 20
years of age and older gathered: 1,366 females and 985 males, for a total of 2,351
cases in 2022. The prevalence rate of hypertension in the year 2022 was 0.10% out
of 21, 569 total population within the vicinity. Therefore, hypertension is the most
common case in the Barangay Health Center Station 2 Purok Narra Visayan, Tagum
City and individual that has it, is more susceptible to Stroke.
The third-year student nurses from Bachelor of Science in Nursing chose this
case about Hemorrhagic Stroke in the community to be a learning opportunity and a
source of further knowledge since it focuses on the mechanism of the disease,
assessing the patient’s condition thoroughly to address its goals – to improve the
health and well-being of the patient by providing the necessary and appropriate plan.
This case study aims to benefit the patient and significant others as the primary goal
is to understand the family health deficit, health threat, foreseeable crisis, and
pathophysiology of the said condition to have a proper family nursing intervention to
help the patient and the family to recover and somehow prevent further complications.
All the data we gathered is objectively written and analyzed as observed in the
succeeding sections of the case study. The student nurses who conducted this case
study hope that this will educate and increase the level of awareness of the condition.
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OBJECTIVES
A. General Objectives:
Within three days of our rotational duty, our fundamental goal for this study is to
identify health problems or potential threats that could arise to our patients and to
properly give immediate nursing intervention prior to the Barangay Health Center. As
student nurses, it is expected from us that we should apply what we have learned from
our class lectures to the actual setting. Through comprehensive physical examination,
one-on-one interviews, and thorough research, we will be able to gain knowledge and
understanding about Hemorrhagic Stroke within the community to provide holistic and
effective family nursing care to prevent further complications.
B. Specific Objectives
Upon the completion of this study, the student nurses will be able to:
a. Knowledge
• Define the complete diagnosis of the patient’s condition;
• Comprehend the effect of poor sanitation/hygiene/lifestyle to their health
and well-being;
• Determine family’s coping index in assessing the functioning and potential
areas of the family strength and resources;
• Apply knowledge and skills on how to give health education to the
community in relation to their identified problem;
• Gather information about the barangay profile;
• Gather the biographical data of the patient;
• Gather information about the family’s past and present illnesses, medical
history, family history, and personal/social history;
• Review the anatomical and physiological landmarks involved with the
patient’s condition;
• Identify the etiology and symptomatology of the problem;
• Trace down the pathophysiology of the disease;
• Relate the medication taken by the patient to their illness; and
• Formulate a family nursing care plan;
b. Skills
• Demonstrate proper measures of cleaning the environment;
• Perform a complete physical assessment (in a cephalocaudal format), and
determine the complaints of the patient;
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• Provide the best quality of care along with the principles of nurse-to-patient
relationship;
• Conduct health teachings to the family to promote health and prevent
diseases that can be acquired on daily lifestyle;
• Render effective independent nursing interventions to minimize or reduce
possible health risks;
• Generate recommendation that focuses on the care for the family and
patient with Hemorrhagic Stroke, and how it can be attain and maintain
optimum quality of life; and
• Present summary, evaluation to the family with implications to the study
c. Attitude
• Establish good rapport with the patient to gain trust and cooperation;
• Show respect, genuine concern, and empathy to the patient by giving care
and attention;
• Follow instructions given by the clinical instructors for the making of this
paper, and be able to perform the knowledge and skills from the learned
experiences; and
• Accepts responsibilities as student nurses for the enhancement of the
knowledge and skills throughout the making of this study.
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BARANGAY PROFILE
Historical Population
The population of Barangay Visayan Village in Tagum City has experienced
significant growth over the years. Specifically, the population has increased from 14,
746 in the year 1990 to 45,342 in the current year. This represents a substantial
population change of 56.6% over the period.
Furthermore, the latest census indicates that the barangay experiences an
annual population change of 1.1%. This growth rate suggests that the population will
continue to increase in the coming years, albeit at a slower pace than in the past.
Table 1: Historical Population of Barangay Visayan Village,

Tagum City from 1990 – 2023
Date Population Growth Rate
1990 May 1 14,726 -
1995 Sep 1 23,939 9.53%
2000 May 1 28,932 4.15%
2007 Aug 1 30,756 0.85%
2010 May 1 35,323 5.17%
2015 Aug 1 40,297 2.54%
2020 May 1 42,648 1.20%
2023 March 28 45,324 1.10%
Figure 1: Historical Population of Visayan Village, Tagum City from 2000 – 2023
Barangay Visayan Village Growth from 2000-2023

50,000
40,000
30,000
20,000
10,000
0
1990 1995 2000 2007 2010 2015 2020 2023
Population
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Location
Visayan Village is situated at approximately 7.4350, 125.8001, in the island of
Mindanao. Elevation at these coordinates is estimated at 16.2 meters or 53.1 feet
above mean sea level.
Figure 2: Geologic Location of Visayan Village, Tagum City
Figure 3: Spot Map
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The Barangay Visayan Village is the largest barangay out of 23 barangays that
Tagum City has. It has a total land area of 153,943.75 sq. m. and a population of
45,342. They are estimated to have 9,435 households with an average household size
of 4.24. The population can be divided into three age groups. The first group is
comprised of infants/babies, children, and young adolescents/teenagers, all of whom
are aged 14 and below. This group, which is known as the young dependent
population, constitutes a total of 28.31% or 11,410 individuals. The second group
consists of those aged 15 up to 64, which is considered the economically active
population, and those who can potentially become members of the workforce. This
group makes up the majority of the population, with a total of 67.40% or 27,160
individuals. The last group is composed of senior citizens aged 65 and over, which is
known as the old dependent population, making up only 4.29% or 1,727 individuals.
The age group with the highest population in Visayan Village is 20 to 24, with 4,235
individuals. Conversely, the age group with the lowest population is 80 and over, with
251 individuals.
Barangay Visayan Village, which was once a simple community, has now
transformed into an urbanized hub with numerous establishments such as shopping
malls, hospitals, restaurants, schools, and gas stations. The barangay is densely
populated and is considered a center of economic activity with various industries and
businesses operating within its vicinity. Due to the mix of people from diverse
ethnicities, nationalities, religions, and socioeconomic backgrounds, Visayan Village
has a rich and diverse cultural and social landscape. The barangay has a well-
developed transportation system that includes tricycles, which are affordable and
make commuting easier. However, like most urban communities, Visayan Village has
a higher cost of living compared to rural areas due to the high demand for housing,
goods, and services.
Table 2: Age Group Population

Age group Population (2015) Age group percentage
Under 1 779 1.93%
1 to 4 3,137 7.78%
5 to 9 3,823 9.49%
10 to 14 3,671 9.11%
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15 to 19 4,168 10.34%
20 to 24 4,235 10.51%
25 to 29 3,701 9.18%
30 to 34 3,111 7.72%
35 to 39 2,900 7.20%
40 to 44 2,396 5.95%
45 to 49 2,123 5.27%
50 to 54 1,800 4.47%
55 to 59 1,493 3.70%
60 to 64 1,233 3.06%
65 to 69 757 1.88%
70 to 74 448 1.11%
75 to 79 271 0.67%
80 and over 251 0.62%
Total 45, 324 100.00%
In Barangay Visayan Village, there are two barangay health centers located in
Purok Narra and Purok Capagngan. These centers are vital hubs that provide
essential services and programs to the community. Managed by the barangay
community health nurse and health workers, the centers are responsible for delivering
basic health care services such as immunization, check-ups, and prenatal care. The
main purpose of these centers is to promote the community's health and well-being
while also fostering community development and social welfare. By providing these
services and programs, the barangay health centers play a crucial role in ensuring that
the residents of Barangay Visayan Village have access to quality healthcare services.
The barangay currently faces various health issues, with the most common
diseases being animal bites, coughs and colds, hypertension, and type 2 diabetes
mellitus. On average, the barangay health center receives 10 to 15 patients daily
seeking medical attention, with animal bites having the highest incidence rate of 5 to
8 patients per day, and coughs and colds having an estimated rate of 1 to 2 patients
per day. Moreover, in 2022, a total of 2,351 newly identified hypertensive cases were
reported among adults aged 20 years and above, with 1,366 cases in females and
985 cases in males. Additionally, a total of 221 newly identified cases of type 2 diabetes
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mellitus were reported, with 104 cases in males and 117 cases in females. Despite
these health challenges, the barangay health center continues to provide crucial
services to its residents, offering medical attention and treatment for various illnesses
and diseases, while also conducting programs and initiatives to promote community
health and wellness.
Table 3: The top four disease confronting Barangay Visayan Village.

Case Total Number of Cases
Annually
Animal Bites 9,467
Coughs and Colds 2,400
Hypertension 2,351
Diabetes Mellitus 221
Table 4: Programs and Services Offered in the Barangay Health Center

NUTRITION PROGRAM
Operation Timbang
Vitamin A Supplementation
Deworming
Feeding
CONTROL OF ACUTE RESPIRATORY INFECTION PROGRAM
CONTROL OF DIARRHEA DISEASE PROGRAM
CARDIOVASCULAR DISEASE CONTROL PROGRAM
BP Taking and Monitoring
RABIES CONTROL PROGRAM
CANCER CONTROL PROGRAM
Breast Examination
Pap Smear
TUBERCULOSIS PROGRAM
Sputum Examination
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The Barangay Visayan Village is comprised of 30 Puroks namely, Purok,
Kahayag, Jalandoni I, Palmera, Buli, Bunga, Saint Therese, Cacao, Narra, Margarette,
Durian, Anahaw, Talisay 1, Talisay 2, Libra, Aquarius, Cebole, Villa Paraiso, Timog,
Cattleya, Dara, Lanzones, Pioneer, Café, Cogon, Renzo, North Eagle 1, White Dove,
Rambutan, Calachuchi, and Saging. each with its own Purok Leader. To maintain
harmony within the community, there is also a Barangay Chairman who serves as the
overall leader. The current Barangay Chairman of Visayan Village is Mr. Alfredo B. De
Veyra, who is joined by seven council members, one treasurer, one secretary, and one
SK Chairman.
Barangay Organizational Chart
Alfredo B. De Veyra Jr.

Barangay Chairman
Barangay Council
Kelly G. Coquilla Kheen V. Batingal Catherine S. Elioy- Richard O. Orongan Jesus V. Parcon Melvin D. Lemos Carmelita S. Malacaste
Paguio
Rogelio A. Sanchez, Jr.

Barangay Secretary
Lenyln M. Pagay
Barangay Treasurer
Liezel Mae Cajes

SK- Chairman
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FAMILY PROFILE
I. FAMILY STRUCTURE, CHARACTERISTICS, AND DYNAMICS
A. Members of the Household and Relationship to the Head of the Family

The Hernandez family is headed by Mr. Joel and his wife, Mrs. Abeth.
They have five children: Jong, Jean, Jovelyn, Jay R, and Macky. However, only
Jay R and Macky are the ones living with them.
B. Demographic Data
Table 5: Demographic Profile of the Hernandez Family
FAMILY MEMBER AGE BIRTHDAY SEX POSITION IN CIVIL STATUS
THE FAMILY
Mr. Joel 64 11-03—1959 M Father Married
Mrs. Abeth 69 07-16-1953 F Mother Married
Jong 35 05-03-1987 M Child 1 Married
Jean 33 05-27-1989 F Child 2 Single
Jovelyn 31 08-06-1991 F Child 3 Married
Jay R 29 07-03-1995 M Child 4 Single
Macky 25 10-25-1999 M Child 5 Single
C. Place of Residence of Each Family Member

The Hernandez family resides in the urban community of Purok Café,
located in Visayan Village, Tagum City. Only two of their five children, Jay R
and Macky, currently live with their parents under the same roof. The eldest,
Jong, has established his own home in front of his parent's lawn, while Jean
has relocated to Cotabato City. Jovelyn, on the other hand, still resides in the
same barangay, but now shares a living space with her husband's family.
D. Significant Others
In addition to the immediate family, Jong's wife, Joy, and Jovelyn's husband,
Bonifacio, are also part of the Hernandez clan. However, they do not share the
same roof as the rest of the family, as they have their own separate households.
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E. Type of Family Structure
The Hernandez Family is a nuclear household that includes one mother,
one father, and at least one child.
F. Dominant Family Members in Terms of Decision Making

The Hernandez family adheres to a patriarchal structure, where Mr. Joel
assumes the role of the head of the household and has the final say in making
decisions about family matters. Even when Mr. Joel was unwell, he still retained
the power to decide whether to seek medical attention or not. However, Mrs. Abeth
takes the lead in managing their household affairs and financial matters.
G. General Family Relationship/Dynamics

The Hernandez family faces daily struggles to make ends meet, but their
relationships within the household remain harmonious despite financial
constraints. They have become accustomed to living without extravagance, and
as such, disputes over money are a non-issue. However, there are underlying
tensions between Jong's wife and her parents-in-law, stemming from unresolved
issues in the past.
II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS
A. Income and Expenses

Table 6: Occupation and Income of the Hernandez Family
FAMILY OCCUPATION INCOME PLACE OF WORK
MEMBERS
Mr. Joel Rice Field Owner PHP 5,500 per month Rice Field Farm
PHP 30,000 during the
harvest
Mrs. Abeth Unemployed - -
Jay R Laborer PHP 8,000 Rice Mill
PHP 13,500
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Table 7: Monthly Expenses of the Hernandez Family
MONTHLY EXPENDITURE AMOUNT
Food PHP 6,500.00
Drinking Water PHP 400.00
Gas PHP 1,000.00
Medicines PHP 1,000.00
Loan PHP 3,400.00
Other Expenses PHP 2,500.00
TOTAL PHP 14,800.00
HERNANDEZ FAMILY MONTHLY EXPENSES

Other Expenses
17%
Food
Drinking Water Food
44%
Gas
Medicines
Loan
Loan
23%
Other Expenses
Medicines
Gas Drinking Water
7%
7% 2%
Figure 4: Monthly Expenses of the Hernandez Family
As depicted in the graph, the Hernandez family's most substantial expense in a

given month is their food, accounting for 44% of their total expenses. Their loan
repayment follows closely behind at 23%, with other expenses constituting 17% of the
total. Gas and medicine both account for 7%, while drinking water rounds out the
remaining 2%. Unfortunately, the total sum of their monthly expenditures surpasses their
income, which could lead to a variety of drawbacks such as financial distress, mounting
debts, and insufficient funds to save for emergencies, leaving them vulnerable to
unanticipated expenditures or financial hardship.
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B. Educational Attainment of Each Member
Table 8: Educational Attainment of Each Member
FAMILY EDUCATIONAL SCHOOL
MEMBER ATTAINMENT
Mr. Joel Elementary Level Sorsogon Pilot Elementary
School
Mrs. Abeth High School Graduate Negros Occidental High
School
Jong Highschool Undergrad Tagum City National High
School
Jean College Level STI- Tagum Campus
Jovelyn College Graduate Northlink Technological
College
Jay R Highschool Undergrad Tagum City National High
School
Macky No Formal Education -
C. Ethnic Background and Religious Affiliation

The Hernandez family has a rich ethnic heritage, with roots in both the Bicolano
and Ilocano cultures. Mr. Joel was born and raised in the Bicol region, while Mrs. Abeth
hails from Ilocos Norte. Despite their different backgrounds, the family is united by their
shared Roman Catholic faith.
While Mrs. Abeth and their son Macky attend church every Sabbath, the other
members of the family choose to worship at home. Regardless of their differing
preferences, they all hold their religious beliefs in high regard and strive to live their lives
in accordance with Catholic teachings.
D. Relationship of the Family to Larger Community

The Hernandez family has the potential to make a positive impact in the
community, despite their current lack of involvement in community activities. Although
they recently had a quarrel with a neighbor, the family remains open to resolving any
issues and maintaining positive relationships with those around them. It is also noted
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that they are registered voters, which demonstrates their commitment to participating
in the democratic process.
III. HOME AND ENVIRONMENT
Table 9: House Profile of the Hernandez Family

Ownership of the House Owned
Construction and Transportation Light Materials
Lighting Facility Solar Powered
Lighting Adequate Inadequate Lighting
Ventilation Poor Ventilation
Water Supply Well
Drinking Water Purified Water
Communication and Transportation Cellular Phone and Motorcycle
Figure 5: Hernandez’s Household Floor Plan
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A. Housing
• Adequacy of Living Space
The Hernandez family resides in a spacious urban community, which offers a
peaceful and uncrowded environment for them to call home. Their house is made
up of light materials, which are affordable and easy to maintain, and their
foundation may be in need of improvement. The use of nipa as a roof is a traditional
material that provides insulation from heat and rain, but the distance between the
roof and the floor can cause poor ventilation.
Despite the limitations of their home, the Hernandez family has made the best
of their living situation. Although they do not have a living room to welcome visitors,
they warmly invite guests into their homes and offer them a comfortable place to
stay. The size of their house is adequate for their family size, providing them with
enough space to live and grow. Overall, the Hernandez family's home is a
testament to their resilience and adaptability in making the best of their situation.
• Sleeping Arrangement
Each family member of the Hernandez family has their own bed, which is a
testament to the value they place on providing individual space and comfort for
each person in their household. While the beds may not be made of wood and lack
foam, they are still maintained with care and cleanliness. Each bed has clean cover
sheets and pillows with fresh pillowcases, ensuring a comfortable and inviting place
to rest. Despite the challenges of their housing situation, the Hernandez family has
prioritized the well-being and comfort of their family, creating a warm and inviting
home for themselves and their visitors.
• Presence of Breeding or Resting Sites of Vector Diseases

Unfortunately, the Hernandez family's home lacks proper drainage, causing
waste from their kitchen sink to flow into the canal below. The stagnant water in
the canal, coupled with unsanitary conditions, can create a breeding ground for
disease-carrying vectors such as flies and mosquitos. This situation poses a
potential health risk not only to the Hernandez family but also to their neighbors.
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• Presence of Accidents Hazards
The Hernandez family's home has several potential accident hazards,
including scrap wood and a nearby coconut tree that could potentially fall and
cause harm. In addition, the lack of proper storage for sharp objects poses a risk
of accidental injury, while the use of light materials in their home increases the risk
of fire.
• Food Storage and Cooking Facilities
The Hernandez family's home has a few challenges when it comes to food
storage and cooking facilities. They don't have a refrigerator and instead rely on
covering leftover food with plates. Their utensils are covered with fabric, which
could potentially harbor bacteria and germs. They use both firewood and a gas
range to prepare their meals, and their kitchen is unorganized. In addition, they do
not have enough storage boxes or drawers, and they lack a garbage bin, which
could lead to unsanitary conditions. Despite these challenges, the Hernandez
family makes the best of their situation and takes care to prepare meals safely and
efficiently.
• Water Supply
The Hernandez family's access to water is limited, with no proper water supply
in their home due to financial constraints. As a result, they use water from a nearby
well for cleaning their utensils and bathing, which is covered for safety but is located
near a canal. However, the family is resourceful in providing purified water for
drinking to ensure their health and safety.
• Toilet Facilities
Due to their limited financial resources, the Hernandez family is unable to
construct their own comfort room in their home. Instead, they are forced to share
a common bathroom with their neighbors, which can be inconvenient and
uncomfortable. The shared bathroom is located 10 meters away from their house
and lacks proper ventilation, making it susceptible to unsanitary conditions.
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• Garbage Refusal/Disposal
The Hernandez family's home lacks a proper garbage disposal system, which
can lead to unsanitary conditions and health hazards. Without a designated
garbage bin, waste is often left lying around the house or thrown in the canal,
contributing to environmental pollution.
• Drainage System
The Hernandez family's home has a poor drainage system, which can lead to
stagnant water and unsanitary conditions. Their kitchen sink drains into a canal,
creating a breeding ground for disease-carrying vectors like flies and mosquitoes.
B. Kind of Neighborhood
The Hernandez family resides in a spacious urban community, which

provides a peaceful and uncrowded environment for them to call home. Their
house is situated far away from other houses, providing them with ample space
and privacy.
C. Social and Health Facilities Available

The Hernandez family is fortunate to have easy access to the Barangay
Health Center, which is located just a short 10-minute ride away from their home.
By taking advantage of the health center's consultation services on weekdays, the
family can effectively address their health concerns. Additionally, the center
provides free medications and immunizations, which can help improve the overall
health and well-being of the family. In addition to the accessible Barangay Health
Center, the Hernandez family is also fortunate to have the Department of Social
Welfare and Development (DSWD) office conveniently located near their
community. The family can easily seek assistance and support from DSWD for
their various social and economic needs, including education, employment, and
housing. This accessibility to resources provides the family with an added sense
of security and comfort in their community.
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D. Communication and Transportation Facilities Available
The Hernandez Family utilizes cellular phones to communicate with each other.
In addition, they stay up-to-date with current events through their television and
radio. They also use their motorcycle as their main mode of transportation for
commuting to get around the city.
IV. HEALTH STATUS OF EACH FAMILY MEMBER

Table 10: Health Profile of the Hernandez Family
FAMILY HEALTH STATUS
MEMBER
Mr. Joel's health status is currently compromised due to his history
of stroke attack in January 2022, which has resulted in him being
Mr. Joel half paralyzed on his left side. In addition, he has been diagnosed
with high blood pressure, with a range of 130/90 - 170/90 mmHg.
Mrs. Abeth is proactive about her health and regularly visits the
health center to monitor her blood pressure and blood sugar
levels. Although she does not have hypertension or diabetes, she
Mrs. Abeth has been diagnosed with eye cataracts, which has affected her
eyesight. The cataract has progressed to the point that the left
side of her eyes can no longer see and her vision in the other eye
is starting to deteriorate as well.
Jay R does not currently have any reported health conditions, but
Jay R he experienced a severe toothache last month.
Macky has autism and he does not experience any complications
Macky associated with it such as seizures, sleep disorders, or
gastrointestinal issues.
V. VALUES, HABITS, AND PRACTICE ON HEALTH PROMOTION,

MAINTENANCE, AND DISEASE PREVENTION
A. Immunization Status of Family Members

Mr. and Mrs. Hernandez were not vaccinated during their childhood, yet they
did not encounter any vaccine-preventable diseases. Their children, however,
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completed their immunization schedule, ensuring their protection against vaccine-
preventable illnesses. The family is currently unvaccinated against COVID-19.
Only Mrs. Abeth received a vaccination before, which was the PCV injection
administered at the barangay health center.
B. Healthy Lifestyle Practices

The Hernandez family practices healthy habits such as consuming vegetables,
staying hydrated by drinking lots of water and milk, maintaining personal hygiene
by taking a bath and ensuring a good night's sleep.
C. Activities of Daily Living
• Sleeping Patterns
The Hernandez family follows a strict sleep schedule, as they sleep at 7 pm
and wake up at 3 am, ensuring that they have a full 8 hours of rest every night.
• Eating Patterns
The Hernandez family follows a healthy and balanced diet by eating three
meals a day, consisting of boiled eggs and dried fish for breakfast, fish or vegetable
stew for lunch, and fried or grilled fish for dinner. They also prioritize reducing their
sodium intake and opt for drinking water and milk whenever possible. The
Hernandez family also practices eating their meals at the correct time, ensuring
that they have breakfast in the morning, lunch at midday, and dinner in the evening.
D. Adequacy of:
• Rest and Sleep

The Hernandez family places a high value on rest and maintaining a healthy
sleep pattern, which is why they adhere to their strict sleep schedule. They believe
that getting enough sleep is essential for their physical and mental health.
Additionally, they also have a resting pattern where they take a nap in the afternoon
by sleeping on their hammock outside their house. This is their way of rejuvenating
23
themselves in the middle of the day, especially since their daily activities require
physical labor.
• Exercise
The Hernandez family may not engage in strenuous exercise, but they keep
themselves active by treating their daily activities as a form of exercise.
• Use of Protective Measure

The Hernandez family takes precautionary measures to protect their feet from
sharp objects and insects by wearing slippers when walking, but they do not use
boots when planting their rice during planting season. They also use mosquito nets
at night to prevent mosquito bites and protect themselves from diseases like
dengue.
• Relaxation and Other Stress Management Activities

The Hernandez family employs various methods to manage stress and relax,
including keeping problems to themselves, which may result in stress or
depression for Mr. and Mrs. Hernandez, while Jay R copes by drinking alcohol and
smoking cigarettes. However, as a family, they tend not to confront the problem
and instead choose to keep it to themselves.
• Use of Promotive-Preventive Health Services

Due to financial challenges, the family is unable to avail of regular check-ups,
screening tests, and other preventive health services that can help detect and
manage health conditions early on. As a result, they are at a higher risk of
developing health problems that could have been prevented through these
services. Moreover, the lack of awareness about the importance of preventive
health measures could also be a factor. The family may not fully understand the
value of regular check-ups, screenings, and vaccinations in maintaining good
health and preventing illnesses.
This lack of understanding and knowledge could prevent them from seeking out
these services, even if they were financially accessible. In addition, there may be
other barriers to accessing preventive health services, such as the availability of
24
health facilities and the distance to these facilities. The family may also have
difficulty finding time to go to the health center or hospital due to work and other
responsibilities.
Overall, the lack of access to and utilization of promotive-preventive health
services can negatively impact the family's health and well-being in the long run. It
is important to address these challenges and promote the importance of preventive
health measures to ensure that individuals and families can take steps toward a
healthier future.
VI. Perception of the Role of Health Professionals and Their Services and
Past Experiences with Health Professionals
Despite appreciating the hard work of the medical team, the Hernandez family
sometimes doubts the need for medical consultations and believes that the
medicine may cause more harm than good. They also have a negative perception
of COVID-19 disease and the efficacy of the vaccine. Although they have not had
any bad experiences with health professionals, they find seeking medical help,
especially in public hospitals, to be a hassle.
25
26
TAGUM DOCTORS COLLEGE, INC.
Mahogany Street Rabe Subdivision Tagum City
Tel/ No. (084) 655-6971,09994759793
Email: [email protected]
COMPREHENSIVE PHYSICAL ASSESSMENT
Name of Patient: Joel Hernandez Age: 64 years old Sex: Male Civil Status: Married
Impression/ Diagnosis: Cerebrovascular Accident – Infarction
Date of Assessment: April 03, 2023
I. Health History
Chief Complaint:
Stroke; Left-Sided Weakness
Present Health Status:
The patient has made significant progress in their recovery and is now able to perform
activities of daily living but with some limitations. He is able to move around and is no
longer bedridden, but still experiences some pain, numbness, and weakness, particularly
in his fingers, left arm, and left lower extremities. His overall physical and mental well-
being is stable, but he continues to experience some anxiety related to his health condition.
Past Health History:
The patient was diagnosed with CVA infarction in January 2022, which was his first
stroke attack. Prior to hospitalization, the patient reported severe headaches for two days
that were unresponsive to Paracetamol. The day before admission, he experienced a
seizure while feeding his chickens, along with symptoms of stroke such as slurred speech,
facial drooping, overall body weakness, blurry vision, dizziness and muscle stiffness. The
patient was taken to a provincial hospital before being transferred to Tagum Doctors
Hospital for specialized treatment.
During his hospitalization, the patient received clot-busting medication and was closely
monitored by medical professionals. The patient also underwent laboratory tests and a CT
scan to help diagnose and monitor his condition. After his hospital stay, the patient
received ongoing care and follow-up visits, such as physical therapy and medication
management. Although the patient had no known history of hypertension or other
significant medical conditions before his stroke, it is being put into consider his lifestyle
that may have contributed to his overall risk of developing a stroke.
Current Lifestyle:
Mr. Joel is currently residing at home and has been unable to tend to his rice field due
to his health condition. He now spends his time raising chickens in their yard, which
provides some physical activity and engagement. The patient has made significant
changes to his diet, such as adopting a low-sodium, low-fat diet that includes local
vegetables like 'law-uy.' Additionally, he has stopped smoking and consuming alcohol,
which are important factors in reducing his risk of future stroke events.
In addition, the patient is also prioritizing rest and sleep, which has helped him put on
some weight and improve his overall health. Although he is no longer receiving physical
therapy, his mobility has shown improvement compared to his previous condition. It would
27
be relevant to note any ongoing medical treatments or follow-up appointments the patient
is receiving, as well as any social or emotional support he may require to maintain his
current lifestyle.
Psychological Status:
The patient, Mr. Joel, has expressed some concerns about his mental well-being. He
has reported that his family tends to keep their challenges and problems to themselves,
which suggests a potential lack of communication and support within his household.
Additionally, the patient has shared that he often thinks about these issues in the evenings,
which could suggest a tendency to ruminate and dwell on negative thoughts. Furthermore,
Mr. Joel has expressed fears of experiencing another stroke and has reported
experiencing anxiety as a result, he even verbalized "Adunay panagsa nga mahadlok ko
kay basin atakehon ko ug usab, wala jud raba mi ika pang hospital." This anxiety could be
impacting his overall quality of life and could potentially lead to negative health outcomes
if left unaddressed.
Family History:
The patient's family history reveals that his mother had hypertension and suffered a
stroke, which ultimately led to her passing at the young age of 40. While it is unclear if any
other family members have experienced similar health issues, research has shown that
certain genetic factors can increase the risk of stroke
II. Physical Examination
A. Integumentary
Skin Color: [X] Cyanosis [X] Edema [X] Erythema [X] Jaundice [X] Pallor
[X] Petechiae [X] Rashes
Texture: [/] smooth and intact [X] dry [X] not intact; specify
Turgor: [/] normal [X] poor
Temperature: [/] warm [X] cool
Hair Distribution: The patient’s body hair appears sparse and fine, with less overall
coverage in areas such as the arms, legs, chest, and back.
Lesion: [X] Pustule [X] Cyst [X] Nodule [X] Wheal [X] Fissure [X] Bulla [X] Macule
[X] Ulcer [X] Vesicle [X] Papule Location:
Remarks: There was no presence of lesions seen.
Stoma [/] Not Applicable

[ ] Clean [ ] Redness [ ] Chronic Redness [ ] Drainage
[ ] Chronic Drainage [ ] Prolapsed
Remarks:
Fingernails and Toenails

Color: Translucent
Shape: Convex
Thickness: 0.5mm
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Contour: Beau’s Line
Remarks: The patient has well-groomed fingernails with no signs of clubbing,

spooning, or discoloration. However, their toenails appear poorly groomed, and
horizontal ridges known as Beau's lines are visible. These ridges may indicate a
previous illness or injury.
B. Head and Neck

Head Motion:
[x] Asymmetric Head Motion [x] Periorbital Edema [x] Thyroid Enlargement
[x] Tracheal Displacement [/] Shrugs Shoulder [x] Unable to support head
Remarks: The neck appears symmetrical with the head centered and no visible
masses protruding. The thyroid and cricoid cartilage move upwards in a symmetrical
manner as the patient swallows. The trachea appears to be in the midline, and there
is no evidence of swelling, enlargement, or tenderness of the lymph nodes. The jugular
vein does not appear distended, bulging, or protruding, and no abnormal sounds such
as bruits were auscultated at the thyroid or carotid arteries. The patient is able to shrug
his right shoulder but shows limited mobility on the left side.
C. Nose and Sinuses

[x] Nasal drainage [x] Inflamed [x] Tender [x] Polyps/Lesions [x] Edema
Remarks: The nose is in the midline of the face and there are no noticeable swellings,
bleeding, lesions, or masses present. Both nostrils appear to be patent and
unobstructed, and the patient reports being able to detect smells without difficulty.
D. Mouth and Pharynx

Mucous membrane
a. Color: Pink
b. Condition: Moist
c. Lesions: Nothing Assessed
Teeth
a. Number: 27
b. Color: Yellowish
c. Condition of teeth: Full of Tooth Decays
[x] Bruxism [x] Loose Teeth [/] Tooth Decay [x] Halitosis [x] Dry, cracked Lips
[x] Gums inflamed [x] Gums Bleeding [x] Gums retraction
[x] Tongue dry and cracked [x] Tongue fissures [x] Tongue bleeds
d. Gag Reflex: [x] not present [/] hyperactive
Remarks: The patient's lips appear to be smooth and well-hydrated, without any
noticeable swelling or lesions. However, the teeth show signs of decay and yellowing,
and some are missing. The tongue appears to be centrally located within the mouth
and is pink in color with a slightly rough texture from the presence of papillae. The
gums appear to be pink, firm and well-hydrated with a tight margin around the teeth.
E. Eyes and Ears

a. Eyes
Visual Acuity: 20/70
Visual Field/Peripheral: Extends up to 90 degrees
Eyes Tracking: [/] Up [/] Down [/] Right [/] Left
[/] Corneal Reflex; Specify: Both eyes blink rapidly
29
[/] Blink Reflex; Specify: Both eyes blink rapidly
[/] Pupillary Reaction; Specify: Pupils are Equally Round and Reactive to Light and
Accommodation
Pupil Color: Dark Brown
Pupil Size: 4mm
Pupil Shape: Round
Remarks: The patient's eyebrows appear symmetrical and move appropriately. The
eyelashes appear to be evenly distributed and extend outward. The upper and lower
eyelids close easily and meet completely when shut. There are no noticeable signs of
redness, swelling, or lesions on the skin around either eyelid. No discharge was
observed from the puncta upon palpating the nasolacrimal duct. The conjunctiva
appears to be pink, smooth, and moist, while the sclera appears white. The iris appears
round and evenly colored.
b. Ears
External ear structures: The cartilages are firm and movable.
Color: Same as the color of the skin.
Size: 2.4 inches
Shape: Free Earlobe
Drainage: Small cerumen is observed
Otoscopic Exam: NOT ASSESSED

[x] Cone of light visualized [x] Cone of light not visualized
[x] Tympanic membrane inspected [x] Excessive Cerumen [x] Impacted Cerumen
Remarks: Ears are equal in size bilaterally. A small amount of odorless cerumen
(earwax) is the only discharge normally present.
D. Cardio Pulmonary
Heart and Vascular
[/] Heart Sounds Rhythm: S1 and S2
[/] Apical Pulse Rate: 95 bpm Rhythm: Regular Rhythm
[x] Jugular Veins Distention
[/] Peripheral Pulses Rate: 70 bpm Rhythm: -
[x] Murmurs:
Capillary Refill: <3 seconds
Blood Pressure: 153/91 mmHg
Remarks: Apical pulse is palpated in the mitral area. No pulsations or vibrations in the
apex, sternal border, and base. Heart Rate is within the normal range (60-100) bpm
with a regular rhythm. S1 and S2 are normally present. No heart murmurs.
E. Thorax and Lungs

a. Breast
Deviations assessed in: [/] Size [/] Symmetry [/] Contour
[/] Shape [/] Skin Color [/] Texture
Nipple Deviations: [x] Retraction [x] Discharge [x] Bleeding [x] Nodules
[x] Edema [x] Ulcerations
Remarks: There are no abnormalities assessed.
b. Lungs
Inspected: [/] Anterior Chest [/] Posterior Chest [/] Lateral Thorax
Respiratory rate: 20 CPM
30
Rhythm: Constant and Regular
Depth: Normal
Symmetry of chest movements:
Chest Wall: [x] Barrel Chest [x] Funnel Chest
[x] Pigeon Chest [x] Thoracic Kyphoscoliosis
Vocal fremitus: Positive

Bronchophony: Negative
Egophony: Negative
Whispered Pectoriloquy: Negative
Pattern:
[x] Tachypnea [x] Bradypnea [x] Apnea
[x] Hyperpnea [x] Kussmaul’s Respiration
[x] Cheyne-Stokes Respiration [x] Biot’s Respiration
Breath Sounds:
[x] Fine Crackles [x] Coarse Crackles [x] Wheezes [x] Ronchi
Respiratory Distress: [x] Nasal Flaring [x] Use of accessory muscles

[x] SOB [x] Intercostal Retraction
Remarks: The patient does not exhibit any signs of leaning forward to improve their
breathing capacity, and there are no indications of diminished breath sounds. Upon
palpation, there is no tenderness or pain detected over the lung area during respiration.
F. Gastrointestinal
Abdomen: [/] Flat [x] Distended [/] Soft [x] Firm [x] Rounded [x] Rebound Tenderness
[x] Gastrostomy [x] Jejunostomy [x] Large Intestine Transverse Ostomy
[x] Large Intestine Sigmoidostomy
Bowel Sounds: [/] Present [x] Absent: Location: __________________________

[/] Hyperactive [x] Hypoactive [x] Tympanic
Remarks: The patient's skin appears unblemished and uniform in color with a
symmetric contour. It does not appear distended. Symmetrical movements during
respiration. Upon auscultation, audible sounds were heard in all four quadrants. No
masses or pain were detected upon palpation.
G. Genitourinary
Genitourinary and Gynecologic
External Genitalia Inspected: [x] Excoriations [x] Rash [x] Lesions [x] Vesicles
[x] Inflammation [x] Bright red color [x] Swelling [x] Bulging [x] Discharge; specify
[x] Inguinal Hernia [x] Tight Scrotal skin [x] Large scrotum [x] Phimosis [x] Displace
Meatus
Testicular Exam: [x] Independent [/] Needs instructions to compete [x] Unable to
complete
Remarks: The patient reported that his penis appeared symmetrical and relaxed when
flaccid. He also reported that the skin of his scrotum appeared smooth without any
noticeable lesions or masses. When asked about his testes, he stated that they were
symmetrical with a smooth surface and without any lumps. I also asked the male
patient about his urine output. He reported that he urinates regularly and does not
31
experience any pain or discomfort while urinating. He said to have a urine output of 1
and a half of his urinals, therefore 1,000-1,500 mL is calculated. I also asked the patient
if he has noticed any changes in his urine, and he reported that his urine appeared
clear and yellowish, without any blood or visible abnormalities.
H. Musculoskeletal System
[/] Gait Abnormalities: The patient has a hemiplegic gait. His left leg is swung out to
the side, his right leg is elevated excessively, and the affected arm swings.
[/] Posture Abnormalities: The affected area leans laterally, there is also shoulder
elevation resulting to unbalance weight distribution causing poor posture.
[/] Impaired weight-bearing stance: The patient is displaying an uneven distribution of

body weight on both legs, indicating an impaired weight-bearing stance.
[x] Bilateral symmetry:
[/] Asymmetry: The patient's body exhibits asymmetry, particularly in the shoulders,
with one shoulder appearing higher or lower than the other. This discrepancy is due to
a swung-out side of the body of the patient.
[x] Bilateral Alignment:
[/] Misalignment: Misalignment is noted in the patient's hips and shoulders, with one
hip appearing higher than the other and one shoulder more elevated than the other.
[/] Decreased ROM: The patient exhibited limited joint mobility in all planes of motion,
and stiffness was occasionally observed. Furthermore, the patient had muscle left
body weakness, numbness, and resistance in the left leg and arm.
[x] Joint swelling [/] Stiffness [x] Tenderness

[x] Increased muscle tone
[/] Hypotonicity: The patient shows signs of hypotonicity in the affected limbs,
characterized by reduced muscle tone and difficulty in initiating movement. The limb
feels heavy and exhibits diminished strength, resulting in uncoordinated muscle
activity.
Remarks: The patient has experienced a stroke and displays several physical
assessment findings related to the condition. The patient's gait is hemiplegic, with the
left leg swinging out to the side and the right leg excessively elevated. The patient's
left side leans laterally, resulting in unbalanced weight distribution and poor posture.
Additionally, there is an impaired weight-bearing stance, asymmetry in the shoulders,
and misalignment in the hips and shoulders. The patient also exhibits limited joint
mobility, occasional stiffness, left-body muscle weakness, numbness, and resistance
in the left leg and arm. Finally, the patient displays signs of hypotonicity in the affected
limbs, characterized by reduced muscle tone and difficulty initiating movement.
I. Neurologic System
Mental and Emotional Status
[/] Alert [/] Aware of environment [x] Impaired Consciousness
[/] Glasgow Coma Scale score: 15
[/] Able to communicate [/] Vocalizes sounds
[x] Limited Verbalizations [x] Non-Verbal Communication Device:
32
Remarks: The patient displays intact consciousness and orientation to time, place, and
date, with appropriate responsiveness. However, the patient experiences difficulty with
proper pronunciation of words, despite no evident aphasia noted.
J. Cranial Nerve Function

CN I – Olfactory [/] Intact [ ] Impaired
CN II, III, IV, V – Optic, Oculomotor, Trochlear, Abducens [/] Intact [ ] Impaired
CN VI – Trigeminal (facial sensory and jaw motor) [ ] Intact [/] Impaired
CN VII – Facial (symmetry in facial expression and taste) [ ] Intact [/] Impaired
CN VIII – Acoustic [/] Intact [ ] Impaired
CN IX – Glossopharyngeal (Taste at back of tongue) [/] Intact [ ] Impaired
CN X – Vagus (palate movement and vocal motor) [ ] Intact [/] Impaired
CN XI – Spinal Accessory (Head motion and shrug) [ ] Intact [/] Impaired
CN XII – Hypoglossal (tongue position and motor) [/] Intact [ ] Impaired
Remarks: The patient's cranial nerve I (olfactory), II (optic), III (oculomotor), IV

(trochlear), V (trigeminal), VIII (acoustic), IX (glossopharyngeal), and XII (hypoglossal)
are all intact. This indicate that the patient has normal sensory and motor functions
related to smell, vision, eye movement, facial sensation and jaw movement, hearing,
taste, tongue movement, and motor functions related to the eyes and tongue.
However, cranial nerve VI (abducens) and XI (spinal accessory) are impaired, and
cranial nerve VII (facial) and X (vagus) are also impaired. The patient exhibits impaired
facial expression symmetry, impaired jaw motion and sensory function of the face,
impaired palate movement and vocal motor, and impaired head motion and shrugging.
K. Sensory Function (sharp end of syringe then with the dull end)
Touch: [/] Fingers [/] Shoulders [/] Toes [/] Thighs [/] Trunk
Remarks: The patient has intact sensory function despite being a stroke patient. This
means that the patient is able to receive and interpret sensory information from various
parts of the body, including touch, pain, temperature, and proprioception. The absence
of sensory deficits is a positive indication that the stroke did not significantly affect the
patient's somatosensory pathways.
L. Motor Function
[/] Impaired Coordination [/] Fine Motor Skills Impaired
[/] Balance Maintained While Standing with Eyes Closed [/] Loss of Balance
Remarks: These findings indicate that the patient has impaired motor function,
specifically in terms of coordination, motor skills, and balance. The patient has difficulty
performing fine and gross motor movements with precision, resulting in uncoordinated
and jerky movements. There is a notable delay in initiating movements, as well as
difficulty with movements that require rapid alternating or sequential actions.
Additionally, there is a loss of balance and the patient requires assistance to maintain
a standing or sitting position using a wooden stick. The patient also exhibits muscle
weakness which can further impact their motor function.
M. Reflexes
Biceps Reflex [ ] 0= Absent impulses [/] +1= Diminished [ ] +2= Normal
[ ] +3= Increased [ ] +4= Hyperactive
Triceps Reflex [ ] 0= Absent impulses [/] +1= Diminished [ ] +2= Normal
Brachioradialis Reflex [/] 0= Absent impulses [ ] +1= Diminished [ ] +2= Normal
33
Patellar Reflex [ ] 0= Absent impulses [/] +1= Diminished [ ] +2= Normal
Achilles Reflex [ ] 0= Absent impulses [/] +1= Diminished [ ] +2= Normal
Plantar Reflex [ ] 0= Absent impulses [/] +1= Diminished [ ] +2= Normal
Remarks: The patient's deep tendon reflexes are generally diminished, with the biceps
and triceps reflexes rated +1 indicating mild reduction in reflex response, the
brachioradialis reflex showing absent impulses, and the patellar and Achilles reflexes
also rated +1 indicating a mild decrease in reflex response. The patient's plantar reflex
is also rated +1, which signifies a mild decrease in response. Furthermore, the
absence of impulses in the brachioradialis reflex indicates a potential neurological
issue, possibly involving the spinal cord or nerve roots.
N. Nursing Diagnosis
1. Activity Intolerance related to generalized body weakness as manifested by inability

to perform activity.
2. Impaired Physical Mobility related to limited range of motion secondary to paralysis.
3. Risk for Diffuse Syndrome related to physical inactivity related to reduced ROM,
overall body weakness, impaired balance and coordination and decreased physical
endurance.
34
35
ANATOMY AND PHYSIOLOGY
Central Nervous System

The central nervous system (CNS) is made up of the brain and spinal cord. It
is one of the nervous system's two components. The peripheral nervous system, which
consists of nerves linking the brain and spinal cord to the rest of the body, is the other
component. The body's processing center is the central nervous system.The majority
of bodily processes, including awareness, movement, thought, speech, and the five
senses of sight, hearing, feeling, tasting, and smelling, are controlled by the brain. A
brain extension is the spinal cord. It communicates with the brain by way of a network
of peripheral nerves that are attached to it.
The Brain
The brain is a complicated organ that regulates the body's thoughts, memory,
emotion, touch, motor skills, vision, breathing, temperature, and hunger. The central
nervous system, or CNS, is made up of the brain and the spinal cord that extends from
it. Throughout the body, the brain sends and receives chemical and electrical
messages. Different signals control various processes, which the brain interprets.
Areas of the Brain

The brain is composed of three parts: the cerebrum, the cerebellum, and the
medulla oblongata
36
.
The cerebrum is the largest component of the brain, initiating and coordinating
movement as well as regulating temperature. Other parts of the cerebrum are
responsible for communication, judgment, thought and reasoning, problem-solving,
emotions, and learning. Additional senses are represented by vision, hearing, touch,
and other activities.
The cerebellum, also known as the "little brain," is a fist-sized part of the brain
found in the back of the head, below the temporal and occipital lobes and above the
brainstem. It, like the cerebral cortex, is divided into two halves. The outside portion is
made up of neurons, whereas the inner portion connects with the cerebral cortex. Its
purpose is to coordinate voluntary muscle movements and to keep posture, balance,
and equilibrium.
The Medulla oblongata the medulla connects the brain to the spinal cord. The
medulla is critical for survival. Several biological operations, including heart rhythm,
respiration, blood flow, and oxygen and carbon dioxide levels, are regulated by
medulla functions. The medulla is responsible for reflexive actions such as sneezing,
vomiting, coughing, and swallowing.
The brain stem is the smallest, oldest, and most primordial component of the
brain from an evolutionary perspective. The hindbrain and midbrain segments that
make up the brain stem run concurrently with the spinal cord. The brainstem includes
the midbrain, the pons and the medulla.
37
The Midbrain is a component of the central nervous system and is located at
the top of the brainstem and underneath the cerebral cortex. This small but vital
structure is crucial in the processing of auditory and visual inputs.
The Hindbrain orchestrates vital survival processes like breathing rhythm, motor
activity, sleep, and awakening. It is a section of the growing vertebrate brain made up
of the cerebellum, pons, and medulla oblongata.
The Cerebellum is regarded as not being a component of the brain stem but rather
the third portion of the hindbrain. The cerebellum's roles in posture, balance, and fine
motor coordination are clued.
The Pons is the starting point for four of the 12 cranial nerves, which are
responsible for a variety of functions including the ability to produce tears, chew, blink,
focus eyesight, balance, hear, and convey facial expression. The pons, which means
"bridge" in Latin, serves as the midbrain's and the medulla's connection.
The Medulla oblongata is located at the base of the brain. Since the brain and
spinal cord meet there, it serves as a vital route for nerve messages traveling to and
from the body. Moreover, it aids in the regulation of critical functions like blood
pressure, respiration, and heartbeat.
38
The Forebrain is in charge of a number of activities, such as processing sensory
information, thinking, perceiving, creating, and understanding language, as well as
controlling motor activity. This consists of the diencephalon and cerebrum.
The Diencephalon acts as a primary relay and processing center for sensory
information and autonomic control. The plethora of communicating pathways between
these structures and other parts of the body makes the diencephalon a functionally
diverse area. The thalamus and hypothalamus are parts of the diencephalon.
Thalamus is the body's information transfer center. Before being delivered to

the cerebral cortex of the brain for interpretation, all information from the body's senses
(apart from smell) must first be processed through the thalamus. Moreover, the
thalamus affects consciousness, learning, memory, alertness, and sleep.
Hypothalamus is located above the pituitary gland and sends it chemical

messages that control its function. It regulates body temperature, synchronizes sleep
patterns, controls hunger and thirst, and also plays a role in some aspects of memory
and emotion.
The Cerebrum is the largest part of the human brain, and it is split into a left
and a right hemisphere that are joined together by a structure called the corpus
callosum.
The cortex is divided into four lobes: occipital, temporal, parietal, and frontal.
No region of the brain functions alone, although major functions of various parts of the
lobes have been determined.
39
The occipital lobe (back of the head) receives and processes visual
information.
The temporal lobe receives auditory signals, processing language and the
meaning of words.
The parietal lobe is associated with the sensory cortex and processes
information about touch, taste, pressure, pain, heat, and cold.
The frontal lobe conducts three functions: Motor activity and integration of
muscle activity, Speech, and Thought processes.
Two paired arteries, the internal carotid arteries, and the vertebral arteries, push
blood out of the heart and deliver it to the brain. The anterior (front) regions of the brain
are supplied by the internal carotid arteries, whereas the posterior (back) regions are
supplied by the vertebral arteries. The right and left vertebral arteries combine to
produce the basilar artery after passing through the skull. At the base of the brain, in
a ring known as the Circle of Willis, the basilar artery and the internal carotid arteries
connect with one another. The cerebral artery that is frequently obstructed during a
stroke is the middle cerebral artery.
40
When blood flows to a portion of the brain is interrupted, a stroke occurs. Within
a few minutes, brain cells begin to die because they can't acquire the oxygen and
nutrients they require from blood. It may result in death, severe disabilities, or
permanent brain damage. Along with difficulty speaking, seeing, or walking, this may
also cause a rapid loss of strength, numbness, or other symptoms. The injured area
is often one that is right next to the stroke since different brain regions regulate diverse
body functions.
41
ETIOLOGY AND SYMPTOMATOLOGY
ETIOLOGY
Precipitating Factors
Etiology Actual Findings Rationale
1. Hypertension The patient is diagnosed High blood pressure can damage
with hypertension with the walls of blood vessels, making
an average blood them more susceptible to the
pressure of 144/96- build-up of plaque, which can lead
154/82 mmHg. to stroke.
2. Smoking The patient verbalizes Smoking cigarettes or using other
that he used to engage tobacco products can double or
in smoking but stopped even quadruple your risk of stroke,
in less than a year. depending on how much you
smoke and for how long. Smoking
can damage your blood vessels,
increase your blood pressure, and
make your blood more likely to
clot, all of which can contribute to
stroke.
3. Heavy Alcohol The patient verbalizes Too much alcohol intake can
Consumption that he used to consume damage the liver. A damaged liver
alcohol but eventually also damages clotting factor,
stopped after he was which is the cause of blood clot
diagnosed with a stroke. formation and blocks the artery in
the brain.
4. Overweight or The patient’s weight is Too many fatty and oily foods
obese normal, weighing 56 kg, increase the chance or risk of
and a desirable BMI of having atherosclerosis or plaque
20.57. formation in the arteries of the
body, including the brain. Plaque
formation thins the passage of
blood, which results in a decrease
of oxygenated blood in the brain
and then eventually results in
ischemia.
5. Physical The patient does not Limited physical inactivity has a
Inactivity perform strenuous chance of not melting the fats or
exercise, but he keeps cholesterol, which means plaque
himself physically active formation, which results in blood
by treating his daily obstruction.
activities as a form of
exercise such as
feeding his chicken in
their yard.
6. Use of The patient does not Women who take birth control pills
Contraceptives report to be taking or hormone replacement therapy
contraceptive pills. may have an increased risk of
42
stroke due to changes in estrogen
levels. Studies have found that
women who use these types of
contraceptives have a slightly
increased risk of stroke compared
to women who do not use
hormonal contraceptives.
7. Diet The patient’s diet Eating a diet high in saturated fats,
includes a low-sodium, trans fat, and cholesterol has been
low-fat diet that includes linked to stroke and related
local vegetables like conditions, such as heart disease.
'law-uy.' Also, getting too much salt
(sodium) in the diet can raise
blood pressure levels.
8. Diabetic The patient is not High levels of glucose (sugar) in
diabetic. the blood can damage blood
vessels over time, increasing the
risk of atherosclerosis, a condition
in which the arteries become
narrowed and hardened. This can
lead to the formation of blood
clots, which can block blood flow
to the brain and cause a stroke.
9. Atrial Fibrillation The patient’s heart When the heart beats irregularly,
(irregular heart rhythm is regular with a blood can pool in the heart and
rhythm) pulse rate of 95bpm. form clots. If a clot forms and
travels to the brain, it can block
blood flow and cause a stroke.
Predisposing Factors
1. Age The patient is 64 years Strokes are most common in
old. people over 60 whose arteries in
the brain are fragile because of
the aging process. Fragile or not
elastic arteries become narrowed,
which is not enough for the flow of
oxygenated blood, which is why
the risk of having a stroke is high.
2. Gender The patient is male. Strokes are more common in men
between the ages of 20 and 50
because testosterone levels are
higher. High levels of testosterone
cause low levels of good
cholesterol, while bad cholesterol
is not affected, which is why there
is a high chance of plaque
formation or atherosclerosis.
3. Family History The patient verbalizes The chance of stroke is greater in
of stroke or that his mother had people with a family history of
heart disease hypertension and stroke.
43
suffered a stroke, which
ultimately led to her
passing at the young
age of 40.
4. Previous stroke The patient did not Higher risk for having a second
or transient report any hx of stroke. stroke after you has already had a
ischemic attack His first stroke attack stroke.
was on January 2022.
SYMPTOMATOLOGY
The following symptoms stated in this study are manifested by the patient during our
visitation.
List of Symptoms Actual Findings Effect on the

Patient/Implication
1. Sudden Sudden numbness or weakness
Numbness or Present can cause one side of the face to
weakness in the droop, making the patient's facial
face expressions lopsided.
Dizziness can cause the patient to
2. Sudden Absent feel nauseous and vomit and
Dizziness cause them to lose their balance
and coordination, making it
difficult to walk or stand.
A severe headache can cause the
3. Severe Present patient to have vision problems,
headache including double vision, blurred
vision, or loss of vision in one or
both eyes.
This affects their daily activities
4. Decreased Present and can reduce the patient's
ROM independence, making them
dependent on others for
assistance with daily activities.
Hemiplegic gait can reduce the
5. Hemiplegic Gait Present patient's mobility and make it
difficult to walk or stand and can
increase the risk of falls due to
reduced balance and stability.
This affects their daily activities
6. Impaired Present and can also affect fine motor
Coordination skills, such as writing or using
utensils, making it difficult for the
patient to perform these tasks.
Trouble speaking to a stroke
patient causes frustration and
7. Trouble Present isolation as they struggle to
Speaking express themselves and connect
44
with others. It could also affect
their performance on everyday
tasks, such as communicating
their needs, following instructions,
and engaging in social activities.
Confusion and disorientation can
make it challenging for stroke
8. Confusion Absent patients to communicate their
needs effectively, leading to
frustration and
misunderstandings.
This affects their ability to
9. Blurry Vision Absent navigate their environment safely,
leading to an increased risk of falls
and injuries.
45
PATHOPHYSIOLOGY
Predisposing Factors Precipitating Factors
• Age • Hypertension
• Gender (Male) • Smoking
• Family History of Stroke • Heavy Alcohol
or heart disease Consumption
• Physical Inactivity
Lipohyalinosis
⚫ Severe
Rupture of Blood Headache
Vessels ⚫ Sudden
Numbness or
Weakness on
the face
Accumulation of Blood
⚫ Trouble
Speaking
Hematoma
↓ Cerebral tissue perfusion
↑ Anaerobic Metabolism
Decreased ↑ Cerebral
ATP Lactic Acid
Decrease in Cellular Functions
46
Inflammatory Response
Excessive Release of
Glutamate
Breakdown of Blood
Brain Barrier
Cerebral Edema
Increased Intracranial
Pressure
Impaired Tissue Perfusion
Hemiplegia ⚫ Decreased
ROM
⚫ Hemiplegic Gait
⚫ Impaired
Coordination
⚫ Trouble
Speaking
Diagnostic & Laboratory Test:
CT-Scan, MRI, Physical

Examination, Blood Chemistry and
Ultrasound
47
48
DRUG STUDY
Date Name of Picture Classifications Dosage/ Indication Mechanism of Possible Side Nursing
Drug Time/ Action Effects Responsibilities
Route
April Clinical Class: Dosage: An adjunctive Activation of ATP- Gastrointestina
12, Brand Name: Supplements 2 tablets drug to support sensitive potassium l problems (Dry 1. Establish
2023 NeuroAid and Adjuvant (4oomg) the recovery of channels to produce mouth, throat, rapport to the
Therapy stroke. large nausea, patient.
Generic Time: hyperpolarization vomiting, and R: To gain
Name: BID and prevent the diarrhea) trust and
MLC 901 massive release of cooperation
Route: PO excitotoxic to the client.
glutamate in
ischemic cells. 2. Explain the
purpose of
home visit to
the client.
R: To have the
client’s
knowledge of
the home
visit.
3. Assess for the

vital sign of the
client before
and after
administering
medication.
R: To have
baseline data.
4. Explain to the
patient about
49
the given
medication.
R: To give
awareness to
the patient
and also for
her to
cooperate in
taking
medication.
5. Advice the
patient to not
abruptly
discontinue the
medication.
R: This may
affect the
recovery
process.
6. Educate to the
patient that its
better to take
her capsule as
her regular
routine.
R: To make
the medicine
more effective
and for fast
recovery.
7. Advice the
patient to have
a proper sleep
or rest
50
R: To Help the
patient to
boost her
immune
system as she
is taking
vitamins for
her stroke.
8. Educate to the
patient about
the given
medication and
its benefits to
her body
R: To give her
some ideas
that this
medication
will help her in
stroke
recovery.
9. Educate the
client that it’s
ideal to get her
nutrients from
her diet
whenever
possible.
R: To give
some ideas to
the client that
there are best
foods for
stroke
51
recovery and
are rich in
brain-
boosting
vitamins and
minerals.
10. Advice the

patient to go
the near health
care center if
there is any
unusuality.
R: To help the
patient have
her regular
checkup and
also for her to
have her
medication
for free if they
do not have
enough
money to pay
for the
medicine in
the
Pharmacy.
Date Name of Picture Classifications Dosage/Time Indication Mechanism of Side Effects Nursing
Drug / Route Action Responsibilities
52
April Brand Name: Therapeutic Dosage Reduction of Clopidogrel is an Headaches 1. Establish
12, Antithromboti class: 75 mg atherosclerotic inhibitor of platelet Dizziness rapport to the
2023 c antiplatelet events like MI, activation and Nausea patient.
Time: stroke, and aggregation through Diarrhea R: To gain
Generic Pharmacologic 1 Tab Vascular death the irreversible Constipation trust and
Name: class: in patients at binding of its active cooperation.
Clopidogrel Proton pump Route: risk for such metabolite to the
inhibitors Per Orem events including P2Y12 class of ADP 2. Explain the
recent MI acute receptors on purpose of
coronary platelets. home visitation
syndrome to the client.
unstable angina R: To have the
non-Q-wave, patient’s
MI, stroke, or knowledge
peripheral about home
vascular visitation.
disease.
3. Assess the
patient’s Vital
signs.
R: To monitor
the client’s
condition and
provide
baseline data.
4. Educate the
patient on why
is it important to
understand and
follow
instruction and
medical
prescription.
R: To achieve
patient’s
53
goals of
treatment and
ensure that
medication
work
correctly.
5. Educate patient
the purpose of
medication
management.
R: To ensure
patients get
the desired
outcomes and
monitor their
safety and
efficacy.
6. Instruct patient
to eat meals
before taking
the drug to
decrease GI
upset.
R: This helps
the medicine
absorbed into
the
bloodstream
properly.
7. Educate patient
about the side
effect that may
occur and signs
54
of adverse
reaction.
R: To make
the patient
more aware of
the side
effects of the
drug.
8. Advice the
patient to visit
near health
center if there
is any
unusuality.
R: To improve
compliance of
patient
through self-
monitoring
and promote
good health in
connection
with medical
treatment.
April Brand Name: Therapeutic Dosage Citicoline drug It acts by increasing Common side 1. Take the
13 Citicoline class: 1 gram has been the synthesis of effects: patient’s vital
2023 Psychostimulant 1/2 tab investigated for phosphatidylcholine signs before
s nootropics. the treatment , the primary Stomach pain and after taking
Generic Time: of depression, neuronal Headache the drug.
Name: Pharmacologic BID schizophrenia, phospholipid, and Tachycardia R: To monitor
Nervcare class: stroke, enhancing the Restlessness for any
Route: Parkinson’s production of abnormalities.
55
Pyrimidine PO disease, brain acetylcholine and
ribonucleoside injury, and has beneficial 2. Educate the
diphosphates cognitive effects on family about
deficits (i.e., neurological the drug
mild to functions and prescribed by
moderate inhibits glutamate the physician
dementia and release during R: This will
Alzheimer’s ischemia. help the family
disease, to know and
cerebrovascular understand
disorders), as the
well as for its importance
ophthalmologic and drug
effects. route, time
and dosage to
be given.
3. Explain to the
. patient the
effect of the
drug.
R: Relay to the
patient that
this drug was
originally
used to help
improve
memory and
brain function
after a stroke.
4. Instruct patient
on the side
effects of
headaches
56
after taking the
drug
R: The patient
will be aware
that taking the
drug will have
side effects.
5. Advice patient
to relax or stay
in bed for 20-
30mins
R: This will
help the
patient to
prevent risk
falls.
6. Teach the
patient that
citicoline may
be taken with
or without food.
R: To make
patients and
families aware
of the drug
administratio
n
7. Instruct patient
to report
immediately if
develops chest
tightness,
tingling in
57
mouth and
throat,
headache,
diarrhea, and
blurring of
vision.
R: Help to
improve
patient safety
and protect
the health,
and also
improve
medicine
information
and
education.
8. Inform the
family that the
supplement
should not be
taken in the
late afternoon
or at night.
R:
Patient/family
will be aware
that the drug
can’t be taken
late afternoon,
it will cause
difficulty in
sleeping and a
change in
58
sleeping
pattern.
9. Educate the
patient that
citicoline is a
drug that helps
to improve
memory and
thinking
problems.
R: This is due
to interrupted
blood supply
of the brain.
10. Apprise the

patient not to
use this drug in
conditions
causing
increased
muscle tone or
stiffness
(rigidity,
spasticity, or
dystonia)
R: Citicoline is
only
prescribed for
the patient’s
slow function
of the brain
after stroke.
59
11. Brief the client
about
citicoline’s
benefits in
managing
patients with
mood disorders
and those
addicted to
narcotics.
R: The patient
will be aware
of cognitive
rehabilitation
which has
been used
successfully
to reduce
mood
management.
12. Establish
making sure
the patient has
understood the
health
teachings and
interventions
throughout the
assessment.
R: Enable
student
nurses to
identify and
conclude the
successful
60
nursing
intervention
Drug / Action Responsibilities
Route
April Brand Name: Therapeutic Dosage Clonidine is an Clonidine has an Feeling sleepy, 1. Establish
13 Clonidine class: 75mg antihypertensiv alpha-antagonist tired and weak rapport with the
2023 Alpha 2- e drug that effect in the Feeling dizzy patient.
Adrenergic Time: lowers blood posterior or faint when R: To gain
Generic Agonist PRN pressure and hypothalamus and standing up trust and
Name: heart rate by medulla. The final Dry mouth cooperation.
Catamed Route: relaxing the response is reduced Headaches
Pharmacologic PO arteries and sympathetic outflow 2. Explain the
class: increasing the from the central purpose of the
Anti-hypertensive blood supply to nervous system home visit to
the heart (CNS), which the client.
clinically causes a R: To have the
decrease in arterial patient’s
blood pressure. knowledge
about a home
visit.
3. Assess the
patient’s history
and current
situation.
R: To have
baseline data.
4. Tell the patient

about the
purpose of
clonidine.
R: It helps the
patient to
61
understand
that the
purpose of
clonidine is to
manage their
stroke.
5. Explain to the
patient the
possible side
effect of the
drug.
R: To make the
patients aware
of the side
effect of the
drug.
6. If the side
effects occur,
advise the
patient to take
rest.
R: To avoid
the patient’s
injury, like
falling on the
ground.
7. Educate the
patient’s family
about the
importance of
the drug so that
they always
remind the
62
patient about
their
maintenance.
R: It helps the
patient by not
accidentally
escaping their
maintenance.
8. Advise the
patient to visit a
nearby
healthcare
facility. if there
is any unusual.
R: To assist
the patient in
getting her
regular
checkups and
medication for
free if they do
not have
enough
money to pay
for the
medications
at the
pharmacy.
April Brand Name: Therapeutic Dosage: 1-tab Used alone or in Amlodipine, a Dizziness; 1. Establish
12, Norvasc class: 5mg combination dihydropyridine Drowsiness; rapport with the
2023 Antihypertensive with other Calcium-channel Feeling Tired; patient.
Time: OD medications to blocker, reduces Stomach Pain;
63
Generic Pharmacologic treat high blood peripheral vascular Nausea; R: To gain the
Name: class: Calcium Route: PO pressure in resistance and BP Flushing trust and
Amlodipine channel-blocking adults. by relaxing the (Warmth, cooperation of
agents coronary vascular Redness, Or the client.
smooth muscle and Tingly Feeling).
coronary 2. Explain the
vasodilation through purpose of the
inhibition of Calcium home visit to
ion transmembrane the client.
influx into cardiac R: To have the
and vascular client’s
smooth muscles. knowledge of
the home visit.
3. Assess the vital

sign of the
client before
and after
administering
medication.
R: To have
baseline data.
4. Explain to the
patient about
the medication.
R: To give
awareness to
the patient
and also for
her to
cooperate in
taking her
medication.
64
5. Advice the
patient to not
abruptly
discontinue the
medication.
R: This may
affect the
recovery
process.
6. Asses skin for

flushing and
ask if she
experiences
headaches.
R: This can be
evidence as a
side effect of
the given
medication
and also to
avoid further
complications.
7. Advice the
patient to rest
after taking the
medication.
R: To make
sure that the
patient is in
normal
condition
since the
patient should
not overwork
65
herself, as it
may trigger
her
hypertension.
8. Advice the
patient to go to
the near health
care center if
there is any
unusuality.
R: To help the
patient have
her regular
checkup and
also for her to
have her
medication for
free if they do
not have
enough
money to pay
for the
medicine in
the Pharmacy.
66
FAMILY NURSING CARE PLAN
Intervention Plan
Health Family Goal of Care Objective of Nursing Methods of Resources Evaluation
Problems Nursing Care Interventions Nurse- Required
and Cues Problems Family
Contact
a.) Presence of a.) Inability to After 1 day of Within 1 day of a.) Introduced self H Material Goal Not Met
health deficits: provide adequate Nursing Nursing and established O Resources: Within 1 day of
Health Illness nursing care to a Interventions, the Interventions, the rapport to gain the M a.) Paraphernalia Nursing
(Hemorrhagic disabled member family will: family will be able trust and E Interventions, the
Stroke) of the family due to: cooperation of the Human family was not
to inadequate a.) Be able to family. V Resources: able to:
Subjective family resources demonstrate an a.) Increase Rationale: To I a.) Family
Findings: of care understanding of awareness of the facilitate S b.) Nursing a.) Demonstrated
“Katong pagka specifically the care needs of stressor related to cooperation. I Students understanding of
stroke niya, financial their loved one caring for a T c.) Barangay the care needs of
tawun muna- constraints. with a disability member with a b.) Evaluated the Health Workers their loved one
muna gyud mi and have the disability. issues related to with a disability
ato. Pait kayo necessary skills the family's living Financial and have the
ultimo pampalit to provide care b.) Learn coping conditions, Resources: necessary skills
ug tubig wala na safely and skills that can help particularly the a.) Money for to provide care
mi. Karun gani effectively. them manage presence of Transportation. safely and
iyahang pang stress related to illness/s of the effectively.
maintenance mag b.) The family caring for their family members,
lisod pa mi ug member with a loved ones. and inquired b.) The family
budget kay mahal disability will about their member with a
kayo wala pa jud receive high- c.) Identify and perspective on disability did not
siyay senior quality care and access community the matter. receive high-
citizen nga support from their resources such as Rationale: quality care and
benepisyo” as family members, support groups or Evaluating support from their
verbalized by the which can healthcare support issues related to family members,
Mrs. Abeth. improve their from the barangay the family's which can
physical, health center and living conditions improve their
and inquiring
67
Objective emotional, and the local about their physical,
Findings: social well-being. government. perspective can emotional, and
a.) The patient’s provide insight social well-being.
left side of the c.) Have a better d.) Promote into their health
body is understanding of collaboration and status and c.) Have a better
paralyzed. the programs and communication identify potential understanding of
services offered among the family environmental the programs and
b.) The family’s by the members and with factors that services offered
house is made up government to healthcare contribute to by the
of light materials support providers to illnesses, government to
without electricity individuals with ensure that the allowing for support
for proper disabilities and nursing care appropriate individuals with
ventilation and their families. needs of the interventions disabilities and
clean running disabled family and prevention their families.
water. d.) To empower member are met. strategies.
the family d.) Empowered
c.) The patient’s members to c.) Done a the family
pill box is almost provide effective physical members to
empty. nursing care by assessment to provide effective
providing check their overall nursing care by
d.) The family’s education and physiologic providing
income does not training on the condition. education and
compensate for specific needs of Rationale: To training on the
their monthly the disabled identify potential specific needs of
expenses as family member. health problems, the disabled
presented in determine family member.
Figure 4. appropriate
interventions,
and monitor the
patient's
response to
treatment.
d.) Educated the

family about the
condition, its
68
symptoms, and its
treatment. This
can help them
better understand
their family
member's needs
and how they can
support them.
Rationale:
Educating the
family about the
condition, its
symptoms, and
treatment
empowers them
with knowledge
and
understanding
to provide
appropriate
support and care
for their family
member.
e.) Encouraged
the family
member with a
disability to do as
much for
themselves as
possible. This can
help them
maintain a sense
of control and
independence.
69
Rationale:
Encouraging
individuals with
disabilities to be
independent as
much as
possible
promotes self-
esteem, and self-
reliance, and
enhances their
quality of life.
f.) Assisted the

family in
accessing
community
resources such as
social services,
advocacy groups,
and financial
assistance
programs,
especially health
care services that
the barangay
provided like the
“Doctor in Your
House Program.”
Rationale:
Assisting
families in
accessing
community
resources such
as social
70
services,
advocacy
groups, and
financial
assistance
programs,
including health
care services,
can provide
much-needed
support and help
address their
needs, ultimately
improving their
overall well-
being.
g.) Provided
health teachings
to the family with
regards to the
importance of
follow-up
checkups for their
current health and
preventing further
complications if
there are any.
Rationale:
Providing health
teachings on
adaptive
techniques and
equipment such
as assistive
devices can
71
improve the
family's quality
of life, promote
independence,
and enable
individuals with
disabilities to
participate fully
in their daily
activities.
h.) Helped the

family member
cope with the
emotional stress
of caring for a
loved one with a
disability, such as
providing
resources for
counseling or
support groups
and simply being
a listening ear.
Rationale:
Helping families
cope with the
emotional stress
of caring for a
loved one with a
disability can
improve their
mental health,
promote
resilience, and
enhance their
72
ability to provide
care and support
for their family
members.
i.) Educated the

family about the
different programs
and services that
the government
provides to those
indigent
individuals such
as “Malasakit
Center”.
Rationale:
Educating the
family about the
different
programs and
services that the
government
provides to
indigent
individuals, such
as the
"Malasakit
Center," can
improve their
access to
healthcare
services,
promote
financial
assistance, and
ultimately
73
improve the
overall health
outcomes of the
community.
j.) Encouraged
family to seek
assistance from
the government
agencies such as
the DSWD for the
need for proper
shelter and a
conducive
environment for
the patient.
Rationale:
Encouraging
families to seek
assistance from
government
agencies such
as the DSWD for
proper shelter
and a conducive
environment for
the patient can
improve the
quality of life
and provide a
supportive living
environment for
the patient,
ultimately
improving their
74
overall well-
being.
k.) Encouraged
the family to seek
help with regard
to check-ups and
medical
assistance from
the barangay and
from the local
government.
Rationale:
Encouraging
families to seek
medical
assistance and
check-ups from
the barangay
and local
government can
promote early
detection and
management of
health issues,
improve access
to healthcare
services, and
ultimately
improve the
overall health
outcomes of the
community.
75
RECOMMENDATION
The presented case study provides valuable insights into the nursing care of
patients with stroke. To prevent stroke, individuals should be aware of the warning
signs and risk factors, such as sudden numbness or weakness, difficulty speaking,
vision problems, and dehydration.
For stroke patients, it is crucial to follow the doctor's prescription for medication,
treatment, and advice, which may include drugs, surgery, rehabilitation, or a
combination of these therapies. Rehabilitation therapy, including physical therapy,
occupational therapy, and speech therapy, can help patients regain lost function and
enhance their strength and mobility. Adopting a healthy lifestyle, such as eating a
healthy diet, quitting smoking, reducing alcohol consumption, and getting emotional
support, can also improve overall health.
Healthcare providers play a vital role in stroke treatment by acting promptly and
effectively, particularly in the initial hours following a stroke. A multidisciplinary team,
including doctors, nurses, physical therapists, occupational therapists, speech-
language pathologists, and social workers, should collaborate to offer complete care
for stroke patients. Healthcare professionals should advise patients about the risk
factors for stroke, the warning symptoms, and lifestyle changes to help avoid future
strokes. They should also provide details on the recovery process, such as
rehabilitation and community services, and monitor patients' progress through routine
appointments and check-ups.
This case study also contributes to the nursing profession's goal of protecting,
promoting, and improving health for people of all ages. Nursing students can use this
case study as a reference for future case presentations and research projects. The
nursing interventions found in our family nursing care plan can serve as a reference
for addressing identified concerns in the community and family. This study advocates
for more equitable and accessible healthcare for the community's residents, whose
majority have limited capability and resources to avail themselves of professional care.
The study also highlights the role of student nurses in bringing light to the community
and the importance of learning necessary skills by actually doing them. Finally, more
research is needed to bring about the most up-to-date evidence-based techniques for
changing a person's harmful habits in a shorter amount of time.
76
REFERENCES
American Nurses Association. (2019). Community health nursing: Scope and

standards of practice (2nd ed.). Silver Spring, MD: Author.
https://www.nursingworld.org/practice-policy/workforce/public-health-nursing/
American Stroke Association. Hemorrhagic Stroke. (2020)

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79
Appendix
Front Yard of Hernandez’s Residence Back Yard of Hernandez’s Residence
Sink of Hernandez’s Residence Kitchen of Hernandez’s Residence
80
Kitchen Utensils of Hernandez’s Residence Bed Room of Hernandez’s Residence
Bed Room of Hernandez’s Residence Covered Well as their Source of Water
81
Well as their Source of Water Kitchen Utensils of Hernandez’s Residence
Canal Under their Kitchen Sink Solar Powered Light for their Source of Light
82

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TAGUM DOCTORS COLLEGE, INC.

A Case Study Presented on

In Partial Fulfilment of the Requirements in

CHERYL MAY V. AGUILAR, RN

PhilPen Screening Result 35

Anatomy and Physiology 36

Etiology and Symptomatology 42

Family Nursing Care Plan 66

According to the Philippine Stroke Society Registry (2018), Hemorrhagic Stroke

Table 1: Historical Population of Barangay Visayan Village,

Barangay Visayan Village Growth from 2000-2023

Figure 3: Spot Map

Table 2: Age Group Population

Table 3: The top four disease confronting Barangay Visayan Village.

Coughs and Colds 2,400

Diabetes Mellitus 221

Table 4: Programs and Services Offered in the Barangay Health Center

Barangay Organizational Chart

Alfredo B. De Veyra Jr.

Rogelio A. Sanchez, Jr.

Liezel Mae Cajes

I. FAMILY STRUCTURE, CHARACTERISTICS, AND DYNAMICS

A. Members of the Household and Relationship to the Head of the Family

C. Place of Residence of Each Family Member

F. Dominant Family Members in Terms of Decision Making

G. General Family Relationship/Dynamics

II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

A. Income and Expenses

HERNANDEZ FAMILY MONTHLY EXPENSES

Figure 4: Monthly Expenses of the Hernandez Family

As depicted in the graph, the Hernandez family's most substantial expense in a

C. Ethnic Background and Religious Affiliation

D. Relationship of the Family to Larger Community

III. HOME AND ENVIRONMENT

Table 9: House Profile of the Hernandez Family

Figure 5: Hernandez’s Household Floor Plan

• Presence of Breeding or Resting Sites of Vector Diseases

The Hernandez family resides in a spacious urban community, which

C. Social and Health Facilities Available

IV. HEALTH STATUS OF EACH FAMILY MEMBER

V. VALUES, HABITS, AND PRACTICE ON HEALTH PROMOTION,

A. Immunization Status of Family Members

B. Healthy Lifestyle Practices

C. Activities of Daily Living

• Rest and Sleep

• Use of Protective Measure

• Relaxation and Other Stress Management Activities

• Use of Promotive-Preventive Health Services

COMPREHENSIVE PHYSICAL ASSESSMENT

II. Physical Examination

Turgor: [/] normal [X] poor

Temperature: [/] warm [X] cool

Remarks: There was no presence of lesions seen.

Stoma [/] Not Applicable

Fingernails and Toenails

Remarks: The patient has well-groomed fingernails with no signs of clubbing,

B. Head and Neck

C. Nose and Sinuses

D. Mouth and Pharynx