HEMORRHAGIC CEREBRO

VASCULAR DISEASE
What Is Cerebral Vascular Disease?
Cerebrovascular disease: Disease of the blood vessels and, especially, the arteries
that supply the brain

Cerebrovascular disease is usually caused by atherosclerosis and can lead to a stroke.

What Is It?

-Hemorrhagic stroke is a term used to refer to the sudden onset of bleeding within the brain. The
cause of this brain hemorrhage can vary depending on the underlying pathology that caused the
stroke.

Primary hemorrhage can be caused by pathologies that can lead to sudden bleeding. Some
examples of these causes are:

 Aneurysmal Subarachnoid Hemorrhage: The rupture of a cerebral aneurysm leads to

subarachnoid hemorrhage, bleeding around the brain in the subarachnoid space. This
typically leads to the sudden onset of headache and/or other neurological symptoms and
is one of the most common forms of spontaneous brain hemorrhage.
 Hypertensive Hemorrhage: High blood pressure (hypertension) can lead to spontaneous
hemorrhage into the brain leading to the sudden onset of neurological symptoms.

-Hemorrhagic stroke can also refer to a condition that occurs secondary to an ischemic stroke
(cerebral infarction). If the brain and blood vessels are damaged by decreased blood flow to a
region of the brain and then blood flow is restored, either due to some treatment or to natural
processes within the body, then bleeding into that area of damaged brain can occur. The
previously "bland" infarct can then undergo "hemorrhagic transformation", bleeding into the area
of infarction. This is often referred to as a hemorrhagic form of stroke.
 CONTENTS:
I. Objectives of the Study
II. Patient’s Profile
– Personal Data
– History of Present Illness

– Past Medical History

– Familial History

– Social/Lifestyle History
– Physical Examination

III. Anatomy and Physiology

IV. Pathophysiology
V. Diagnostic Test/Special Procedure
– Laboratory Test
– Special Procedures

VI. Treatment
– Drug Study
VII. Nursing Care Plan
VIII. Health Education/Patient’s Education
GENERAL OBJECTIVES:
-This study aims to convey familiarity and provide effective nursing
care to a patient diagnosed with Cerebral Hemorrhage; HPN, Cerebro
Vascular Diseases through understanding the patient history, disease
process and management.

SPECIFIC OBJECTIVES:
• Formulate a workable nursing care plan on the subjective and
objective cues gathered through nurse-patient interaction to be
able to help the patient towards wellness.
• To plan management/strategies to patient.
• To use the nursing process as a framework for care in patients
with hernia.
• To improve status of the patient
• To correct defect and prevent strangulation.
• To include adequate nutritional intake.
• Enumerate the necessary medications needed and be familiar to
its mode of action.
PATIENT’S PROFILE
 PERSONAL DATA

Name : Ms. Z
Age : 82 years old
DOB : March 16, 1928
Place of Birth : Mauban, Quezon
Sex : Female
Religion : R. Catholic
Occupation : none
Nationality : Filipino
Civil Status : Single
 History of present illness
 

Date of Admission : September 2, 2010

Time of Admission : 2:50a.m
Chief Complaint : U.T.I. , Hypertension
Admitting Diagnosis : Hemorrhagic Cerebro Vascular
  Disease

Vital Signs:
Temp: 37°C
BP: 140/70 mmHg
Pulse Rate: 72 bpm
RR : 23 cycle/min
PAST MEDICAL HISTORY
(+)Community acquired Pneumonia
(+)Gastritis
(-) Allergy
(+) Asthma- Last attack during childhood
 
FAMILY HISTORY
 
(+) Hypertension – Parent’s Side

SOCIAL/LIFESTYLE
 
-Non smoker
 
-Non-Alcoholic Beverage Drinker
 
-His diet consist of nutritional intake
according to his satisfaction
 Physical Examination
•General Survey:
Conscious and Coherent

•Vital Signs:
Temp=36.8º c
PR: 98 bpm
RR: 20 cycles/min
BP: 100/70 mmHg
•Integumentary:

-Skin:
Warm, Moist skin
-Hair:
Hair evenly distributed
Oily with traces of white hairs evenly distributed
Absence of dandruff
Absence of infestation
Thick hair
-Nails:
Oval in shape with slight thickness
At end part of nail, smooth texture
Normal Capillary refill (1-2 secs.)
•Head and Neck:
-Head:
Normocephalic Symmetric
-Eyes:
Visual acuity and convergence was not assessed
Both eyes coordinated movement with parallel alignment
Symmetric evenly distributed Eyebrow/Eyelashes
Eyelids color matches the skin with coordinated movement
Pink partial conjunctiva
-Ears:
Symmetric , Smooth auricle with light brown color, Small in shape
No discharge, No wounds, Presence of cerumen
-Nose:
Located at the midline of the face and there is no swelling or lesions
noted
-Mouth:
Pale lips, smooth and not scaly.
Absence of tooth decay
Pinkish and reddish gums.
Pink pharynx
Normal flow of saliva
Tongue is pinkish in color, both
palate is still and normal position
-Neck:
Client was able to turn his neck from left to right motion
Head position is equal on both sides
-Thorax and lungs:
Spine vertically aligned
No tenderness or masses
Client is tachypneic with 23 cycles per minute with occasional
dyspnea.
-Abdomen:
Unblemished skin and uniform in color
Dullness at the lower right quadrant
-Musculoskeletal:
Irregular movements
Weak in appearance
-Lower Extremities:
Symmetrical on both sides of the body with no contractures
Muscles are weak with limited movements
No deformities, no tenderness, or swelling with joints moving
smoothly
-Neurologic:
Full consciousness, response to verbal stimuli
-Genitourinary System:
Client refuse
 DIAGNOSIS
-Cerebrovascular disease (CVD) includes all disorders in which an area of the brain is
transiently or permanently affected by ischemia or bleeding and one or more of the
cerebral blood vessels are involved in the pathological process.

-A doctor commonly diagnoses a stroke through a physical examination of the person

affected as well as a description of the symptoms they are experiencing. A doctor
attempts to find the location in the person's brain that has experienced damage through
testing involving a CT or MRI scans, which may also help to rule out brain hemorrhage
or tumors. A doctor considers the person's age, as well as any vascular, cardiac, or
brain conditions the person may have. The doctor will attempt to determine whether the
stroke was either hemorrhagic or ischemic. Ischemic strokes are often followed by
additional strokes unless the problem is treated. A doctor may order an EEG if the
person has experienced seizure activity, or an echocardiogram if they have a pre-
existing heart condition. A doctor will attempt to rule out things such as encephalitis,
meningitis, bleeding inside the person's skull, neurodegenerative disorders, brain
abscess, or migraines as causes of the stroke symptoms the person is experiencing.

There are a number of tests that a doctor can use to assist in reaching a diagnosis of
cerebrovascular disease. The majority of the tests involved are designed to detect
carotid artery disease (CAD) before the person experiences a stroke. CAD, unlike
hemorrhagic cerebrovascular disease, often progresses for many years while
presenting no symptoms at all, accounting for approximately ninety-five percent of all
cases of cerebrovascular disease.

Causes, Incidence, And Risk Factors:

-A stroke happens when blood flow to a part of the brain is interrupted because a blood
vessel in the brain is blocked or bursts open.

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and
oxygen. Brain cells can die, causing permanent damage.

2 major type of stroke:

-Ischemic stroke

-Hemorrhagic stroke
 ANATOMY AND PHYSIOLOGY

A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes
called a "brain attack”. A stroke happens when blood flow to a part of the brain is interrupted
because a blood vessel in the brain is blocked or bursts open.

A Cerebrovascular disease can be caused due to any disease that affects the arteries
supplying blood and oxygen to the brain. The most common disease being is
Atherosclerosis, which is caused due to fatty deposits (plaques) in the arterial wall
which in turn causes narrowing of the arteries.
Another factor that could cause a blockage in the artery or arteries is a blood clot, also
known as Thrombosis. In this situation, the blood clots usually occur in the heart and
parts of that blood clot then break off and travel (embolize) to the arteries in the brain
and cause a stroke. This condition is known as Embolism which can cause Transient
ischaemic attacks (TIAs) in the brain leading to a loss of brain function in one area.

The rupture of an artery causes hemorrhage (bleeding) in the brain and is known as
Cerebral hemorrhage.

The most common condition that can cause bleeding within the brain is an uncontrolled
High Blood Pressure.

A second condition that could affect the arteries is a defect or weakness in a blood
vessel causing it to expand or balloon out is known as an aneurysm or arteriovenous
malformations (AVM) in which there is an abnormal collection of blood vessels that are
fragile and can cause bleeding.
PATHOPHYSIOLOGY
 DIAGNOSTIC TEST
&
SPECIAL PROCEDURE
 HEMATOLOGY
Date run: 9/01/10 – 7:31:06 A.M.

Examination Result Normal Value

White Blood Cells 17.5 M:5-10x10 9/L F:5-10x10 9/L
Red Blood cells 3.83 M:4.5-6x10 12/L F:4.5-5.5x10 12/L
Hemoglobin 116 M:130-160 g/L F:120-140g/L
Hematocrit 0.34 M:0.40-0.50 F:0.37-0.47
Platelet Count Adequate 150-350 g/L

DIFFERENTIAL COUNT

Segmenters 0.30 .40-.60%

Lymphocytes 0.10 .20-.40%
Eosionophil 0.00 .01-.04%
Monocytes 0.00 .02-.04%

Remarks: Platelet Adequate

2nd Hematology
Date run: 9/02/10 – 3:41:13 P.M.
 Examination Result Normal Value
White Blood Cells 11.0 M:5-10x10 9/L F:5-10x10 9/L
Red Blood cells 4.28 M:4.5-6x10 12/L F:4.5-5.5x10 12/L
Hemoglobin 130 M:130-160 g/L F:120-140g/L
Hematocrit 0.38 M:0.40-0.50 F:0.37-0.47
Platelet Count Adequate 150-350 g/L

DIFFERENTIAL COUNT

Segmenters 0.87 .40-.60%

Lymphocytes 0.13 .20-.40%
Eosionophil 0.00 .01-.04%
Monocytes 0.00 .02-.04%
TOTAL: 100%

Remarks: Platelet Adequate

Blood Chemistry
Date run:9/03/10 – 2:31:19 P.M.
 Examination Result Normal Value
FBS(Fasting Blood Sugar) ↑8.45 3.89 - 5.84mmol/l

Creatinine 93.9 υmol/l 44.16-150.16 υmol/l

Urinalysis
Date run: 9/1/2010 – 9:53:30 P.M.
 Physical Microscopic

Color Dark-Yellow RBC:2-4 /HP

Turbidity Turbid WBC: Too numerous to

count
Reaction Acidic Squamous: Moderate

Specific Gravity 1.020 Mucus: Moderate

Bacteria: Moderate

A.Urates: Moderate

Chemical Examination:

• Sugar: Negative

• Albumin: Negative

2nd Urinalysis
Date run: 9/2/2010 – 9:55:40 P.M.

Physical Microscopic
 Color Yellow RBC:0-1 /HP

Turbidity Turbid WBC: >100 /HP

Reaction Acidic Squamous: Moderate

Specific Gravity 1.015 Mucus: Few

Bacteria: Rare

A.Urates: Few

Chemical Examination:

• Sugar: Negative

• Albumin: Trace

3rd Urinalysis
Date run: 9/4/2010 – 7:53:16 A.M.

Physical Microscopic

Color Yellow RBC:0-3 /HP

 Turbidity Turbid WBC: >100 /HP

Squamous: Few

Specific Gravity 1.010 Mucus: Few

A.Urates: Few

Chemical Examination:

• Sugar: Negative

• Albumin: Negative

DRUG STUDY
Buscopan® [amp]- 10mg I.V q⁰8
Classification : Antispasmodics

Mechanism of action:

To relieve pain in gastrointestinal and urogenital tract. Its targets are muscles in the walls of
stomach and intestines. Buscopan helps those muscles to relax.

Indications:
GIT spasm & hypermotility. Spastic pain in the biliary & urinary tract. Dyskinesia, peptic ulcer,
spastic constipation & dysmenorrhea. Post-op vomiting.
Contraindications:
Tachycardia, megacolon (parenteral only); glaucoma, urinary or GI obstruction, intestinal atony,
paralytic ileus, asthma, myasthenia gravis, ulcerative colitis, hiatal hernia, serious hepatic or
renal disease.

Adverse Drug Reactions:

Increased intraocular pressure, cycloplegia, mydriasis, dry mouth, blurred vision, flushing,
urinary hesitancy & retention, tachycardia, palpitations, constipation, elevated body temp, CNS
excitation, rash, vomiting, photophobia.

Drug Interactions:
Anticholinergic activity may be increased by other parasympatholytics. Guanethidine, histamine
& reserpine can antagonise the inhibitory effect of anticholinergics on gastric acid secretion.
Antacids may impair absorption.

Nursing Responsibility:

-Drug compatibility should be monitored closely in patients requiring adjunctive therapy

-Avoid strict heat

Lanoxin® [amp]- .25 mg. I.V

Contents:
Digoxin

Mechanism of Action:

Inhibits sodium potassium-activated adenosine triphosphatase, promoting movement of

calcium from extracellular to intracellular cytoplasm and strengthening myocardial
contraction. Also acts on CNS to enhance vagal tone, slowing conduction through the SA
and AV nodes and providing an anti-arrhythmic effect.

Indications
Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where
systolic dysfunction or ventricular dilatation is dominant; management of certain
supraventricular arrhythmias, particularly chronic atrial flutter & fibrillation.
Contraindications
Intermittent complete heart block or 2nd degree AV block esp if there is a history of Stokes-
Adams attacks; arrhythmia caused by cardiac glycoside intoxication, supraventricular arrhythmia
caused by Wolff-Parkinson-White syndrome; ventricular tachycardia or fibrillation; hypertrophic
obstructive cardiomyopathy. Hypersensitivity to other digitalis glycosides.

Adverse Drug Reactions

CNS disturbances, dizziness; visual disturbances (blurred or yellowish vision); arrhythmia,
conduction disturbances, bigeminy, trigeminy, PR prolongation, sinus bradycardia; nausea,
vomiting, diarrhea; urticarial or scarlatiniform w/ eosinophilia.

Drug Interactions
Sensitivity is increased w/ agents causing hypokalemia

Classification:

Cardiac Drugs

Nursing Responsibility:

-Monitor apical pulse for 1 full min. before administering.

-Assess for peripheral edema,& auscultate lungs for rales/crackles through out therapy.

Nubain® [amp]- 10mg. I.V.

Contents:
Nalbuphine HCl

Indications:
-For the relief of moderate to severe pain. Nalbuphine HCl can also be used for preoperative
analgesia, as a supplement to balanced anesthesia, surgical anesthesia, for obstetrical analgesia
during labor and for the relief of pain following acute myocardial infarction. Postoperative
somatic and visceral pain.

Contraindications
Patients who are hypersensitive to nalbuphine HCl.

Mechanism of Action:

-Clinical experience suggests that in some patients, analgesia may be longer lasting than from
comparable doses of morphine, effects having been observed in acute and chronic pain for 3-8
hrs.
Nalbuphine HCl has the effect of lowering the cardiac work load and can be used immediately in
myocardial infarction (use with caution where emesis is involved).

Adverse Drug Reactions

-The most commonly occurring reactions are sedation, drowsiness, sweating, nausea, dry mouth
and dizziness. Pain at injection site, headache, vomiting and lightheadedness occur less
frequently. Restlessness, blurred vision, chills, euphoria and impaired respiration have been
infrequent.
-Nubain produces few if any psychotomimetic side effects eg, visual hallucinations and
dysphoria.

Drug Interactions:
-With Other Central Nervous System Depressants: Although nalbuphine HCl possesses narcotic
antagonistic activity, there is evidence that in non-dependent patients, it will not antagonize a
narcotic analgesic administered just before, concurrently, or just after an injection of nalbuphine
HCl. Therefore, patients receiving narcotic analgesics, general anesthetics, phenothiazines or
other tranquilizers, sedatives, hypnotics or other CNS depressants (including alcohol)
concomitantly with nalbuphine HCl may exhibit an additive effect. When such combined therapy
is contemplated, the dose of one or both agents should be reduced.

Classification:

Anaesthetics - Local & General / Analgesics (Opioid)

Nursing Resposibility:

-Caution patient to change positions slowly to minimize orthostatic hypotension

-Encourage patient to turn, cough, & breathe every 2 hrs. to prevent atelectasis

Micardis Plus® [40/12.5 mg tab] 1tab daily

Indications:
-Treatment of essential hypertension for patients in whom combination therapy is appropriate.

Mechanism of action:
- A combination of an angiotensin II receptor antagonist, telmisartan and a thiazide
diuretic, hydrochlorthiazide. The combination of these ingredients has an additive
antihypertensive effect, reducing blood pressure to a greater degree than either
 component alone. Micardis Plus once daily produces effective and smooth reductions in
blood pressure across therapeutic dose range.

Administration:
-May be taken with or without food

Contraindications:
-Cholestasis & biliary obstructive disorders. Severe hepatic & renal impairment.

Adverse Drug Reactions:

-Telmisartan: Headache, upper resp tract infection, dizziness. Hydrochlorothiazide: Anorexia,
gastric irritation, muscle spasm, sleep disturbances.

Classification:

-Angiotensin II Antagonists / Diuretics

Nursing Responsibility:

-Special precaution in patients with impaired hepatic and renal impairment

-Special precaution with volume and/or Na-depleted patients

Dilzem®- 30mg./tab
Contents:
Diltiazem HCl

Mechanism of Action:

-Block calcium entrance into cardiac and vascular smooth muscle cells by blocking the L-type
voltage sensitive calcium channel which is abundant in cardiac and smooth muscle. In smooth
muscle, calcium binds to calmodulin resulting in activating myosin light chain kinase, an
enzyme that phosphorylates the myosin light chain. This phosphorylation is essential for muscle
contraction, thus by decreasing calcium levels in the vascular smooth muscle these agents lessen
contraction. In the heart, calcium binding to troponin removes the inhibitory effect of troponin
on the actin-myosin interaction thus allowing contraction. Thus, blockade of the slow calcium
channel by these agents can result in negative inotropic effect.
Indications:

-Treatment of angina pectoris due to coronary artery spasm. Treatment of spontaneous coronary
artery spasm presenting as Prinzmetal's variant angina (resting angina with ST-segment elevation
occurring during attacks).
-Treatment of hypertension: It may be used alone or in combination with other antihypertensive
medication eg, diuretics.

Administration:

Should be taken on an empty stomach (Preferably taken before meals. SA & SR tab: Swallow
whole, do not chew/crush.).

Contraindications:

Patients who are hypersensitive to diltiazem; with sick sinus syndrome except in the presence of
a functioning ventricular pacemaker; with 2nd- or 3rd-degree AV block except in the presence of
a functioning ventricular pacemaker; with hypotension (<90 mm Hg systolic); with acute
myocardial infarction; with pulmonary congestion documented by x-ray on admission.

Classification: Calcium Antagonists

Nursing Responsibility:

-Monitor BP & Pulse before therapy, during titration, & periodically during therapy.

-Monitor intake & output ratios and daily weight.

Vastarel MR® [tab]- 35mg/tab

Contents:
Trimetazidine

Mechanism of Action:

-Metabolic anti-ischemic agent.

-By preserving the energy metabolism in cells exposed to hypoxia or ischaemia, trimetazidine
prevents a decrease in intracellular ATP levels, thereby ensuring the proper functioning of ionic
pumps and transmembranous sodium-potassium flow while maintaining cellular homeostasis.

Indications

-Long-term treatment of episodes of coronary insufficiency; angina pectoris.

Administration

-Should be taken with food (Swallow whole, do not chew/crush.) 1 tab at mealtimes in the
morning and evening.

Contraindications
-Hypersensitivity to any of the constituents of Vastarel MR

Side Effects:

Rare cases of gastrointestinal disorders (nausea and vomiting)

Classification:

-Anti-Anginal Drugs

Nursing Responsibility:

-use cautiously in patients with heart failure or hypertension and in elderly patients

Kremil-S (Reformulated)® [tab]- 1 tab

Indications:

Symptomatic relief of hyperacidity associated w/ peptic ulcer, gastritis, esophagitis & dyspepsia.
Supplement to H2-blockers or proton pump inhibitors for rapid relief of ulcer symptoms.
Antiflatulent to alleviate the symptoms of gassiness, including post-op gas pain, associated w/
hyperacidity.

Mechanism of action:
-May increase the intestinal absorption of aluminium by forming aluminium citrate, which is
more soluble and absorbable, resulting in increased aluminium serum concentrations. This may
lead to aluminium accumulation, encephalopathy and toxicity, especially in patients with renal
failure. Fatalities have been reported in patients with renal failure, hence this combination should
be strictly avoided in renal patients.

Dosage:
Adult 1-2 tab 1 hr after each meal and at bedtime.

Administration:
Should be taken on an empty stomach (Take 1 hr after each meal & at bedtime. Break/ chew
before swallowing.)
Contraindications:
Patients with renal failure. Partial intestinal obstruction, appendicitis, fecal impaction, gastric
outlet obstruction & constipation. Phosphate depletion, low serum phosphate & osteomalacia.

Classification:

Antacids, Antireflux Agents & Antiulcerants

Nursing Responsibility:

-Advise patient that changing positions often and walking will help pass flatus.

-Tell patient to chew tablet before swallowing.

Rowagel® [gel]- CAP, P.O/ T.I.D.

Contents:
Carbenoxolone Na

Mechanism of action:

-Exerts a mineralocorticoid effect causing fluid retention and hypokalaemia. When co-administered with
digoxin, carbenoxolone may theoretically increase the risk of digoxin toxicity (including arrhythmias) due
to its hypokalaemic effect. If coadministration cannot be avoided, use with extreme caution and take
steps to avoid hypokalaemia. Serum potassium should be monitored at regular

Indications:

Mouth ulcers, lip sores, cold sores, orofacial lesions, sores or blisters caused by herpes simplex,
herpes labialis, herpes febrilis or herpes stomatitis.

Contraindications:

Severe cardiac, renal or hepatic failure. Patients on digitalis glycosides.

Classification:

ENT Drugs/ Mouth/Throat Preparations/Genito-Urinary System

Nursing Responsibility:

-Advise patient to avoid the use of herbal meds or to consult his prescriber.

-Encourage patient to eat potassium-rich foods.

Levofloxacin-200mg T.I.V. q⁰12

Mechanism of action:

Microbiology: Antimicrobial Spectrum of Activity: Levofloxacin has antimicrobial activity

against the following gram-positive and gram-negative aerobic and anaerobic bacteria, as well as
Chlamydia pneumoniae and Mycoplasma pneumoniae:

Indications:

Treatment of adults ≥18 yr w/ mild, moderate & severe infections caused by susceptible strains
of microorganisms in the following conditions: Community-acquired pneumonia, acute bacterial
exacerbation of chronic bronchitis, acute maxillary sinusitis, complicated & uncomplicated skin
& skin structure infections, acute pyelonephritis, complicated & uncomplicated UTI, nosocomial
pneumonia, chronic bacterial prostatitis.

Contraindications:

Hypersensitivity to quinolones. IV Epilepsy, history of tendon disorders related to

fluoroquinolone therapy. Childn, pregnancy & lactation.

Adverse Drug Reactions:

Diarrhea, abdominal discomfort, nausea, anorexia, abdominal pain, vomiting, stomatitis &
heartburn; insomnia, headache & dizziness; rash, pruritus & eczema; muscle & joint pain; bone
marrow depression. Increased liver enzymes. Pain, reddening at the inj site, phlebitis.

General Disorders: Ascites, allergic reaction, asthenia, edema, fever, headache, hot flashes,
influenza-like symptoms, leg pain, malaise, rigors, substernal chest pain, syncope, multiple organ
failure, changed temperature sensation, withdrawal symptoms.

Gastrointestinal Disorders: Dry mouth, dysphagia, esophagitis, gastritis, gastroesophageal reflux,

GI hemorrhage, glossitis, intestinal obstruction, pancreatitis, tongue edema, melena, stomatitis.

Liver and Biliary System Disorders: Abnormal hepatic function, cholecystitis, cholelithiasis,
increased hepatic enzymes, hepatic failure, jaundice.

Classification: Quinolones, Anti- infectives

Nursing Responsibiilty:

-Ensure that patient is well hydrated during course of therapy. -Report rash, visual changes, severe
GI problems, weakness, tremors.

Nursing Care Plan

Long Term goal: The patient will identify healthy ways to deal to enhance his/her condition.
Short Term goal: The patient will participate willingly in desired activities.

Assessment Nursing Scientific Intervention Rationale Expected

Diagnosis Rationale Outcome

S>>Patient was - Ineffective -Decrease in 1. Monitor vital 1. To know The patient will be
being observed only. oxygen resulting in signs present status able to
Tissue Perfusion of patient.
O>> V/S: related to the failure to 2. Note Baseline demonstrate
2. Provides
inadequate nourish the tissues data. comparison changes to
Temp: 37ºc at the capillary with current improve
oxygen delivery
level, problems findings. circulation.
BP:140/70mmHg to brain as 3. To optimize
can exist without 3. Encourage
manifested by patient to circulation of
PR : 72 bpm decreased cardiac
hemorrhagic change tissues & to
output relieve
RR : 23cycle/min. position every
cerebrovascular pressure.
2hrs.
-Body Malaise disease.
4. Encourage 4. To prevent
-Facial Grimacing rest periods fatigue.

-(+) Tachypnea 5. Review 5. To know

medication adverse side
-Occasionally regimen. effect/reaction
Dyspnea or drug
overdose
6. Provide for 6. Restriction of
diet protein helps
restrictions limit BUN.
Health Education/Patient’s
Education
• After the continuous treatment which consists of the medical
and the nursing management of the patient, a development of
her present health status is projected.

• Continuous administration of therapy had partially alleviated

the clients suffering from the disease. Although disease
process is incurable and has the tendency to attack again
one’s life, if the client will undergo treatment, by some means
this will help reduce the sufferings of the client brought by the
disease. But if the client will not subject herself to any medical
management, this could lead to further complications; signs
and symptoms of the disease will progress and will evidently
manifested by the client. Furthermore, this would worsen the
condition and eventually leads to death.

• Regular exercises are good for the heart and lungs and could
stimulate proper circulation and oxygenation in the body.

• Regular exercise should be minimal and basic in order not to

increase the workload of the heart

• Follow your doctor’s recommendations for physical activity.

• Enhance self-care.

• Encourage personal hygiene.