FAR EASTERN UNIVERSITY

INSTITUTE OF NURSING

CASE PRESENTATION

ON

CEREBROVASCULAR ACCIDENT
(INTRACRANIAL HEMORRHAGE)

SUBMITTED BY:

GARCIA, Niña Carla

ORTEGA, Jamine Joyce
RELUCIO, Jessica
REMOTO, Hayzel
RIVERA, Rica Pauline
ROSEUS,Cattleya

BSN 128
GROUP 112- A

SUBMITTED TO:

PROF. Myrna Sacdalan

SUBMITTED ON

AUGUST 25, 2010

 INTRODUCTION

Cerebrovascular Accident (Stroke)

Stroke is defined as the onset and persistence of neurologic

dysfunction lasting longer than 24 hours which occurs when the blood supply
to a part of your brain is interrupted or severely reduced, depriving brain
tissue of oxygen and nutrients.
It can be classified into major categories: ischemic and hemorrhagic strokes.
Ischemic stroke occurs when blood clots or other particles block arteries to
your brain and cause severely reduced blood flow (ischemia). Hemorrhagic
stroke occurs when a blood vessel in your brain leaks or ruptures.
It is the leading cause of serious, long-term adult disability in the
United States. It is also the third leading cause of death after heart disease
and cancer killing nearly 160,000 people each year. The incidence of stroke
is higher for males than for females, especially in the under 65 age group.
It is the leading cause of serious, long-term adult disability in the United
States. It is also the third leading cause of death after heart disease and
cancer killing nearly 160,000 people each year. The incidence of stroke is
higher for males than for females, especially in the under 65 age group.
Hypertensive intra-cerebral hemorrhage is a type of stroke in
which there is bleeding in the brain due to high blood pressure. When blood
pressure has remained high for a significant period of time, the walls of the
blood vessel become weak. Constant, high blood pressure wears away the
vessel walls and can lead to blockage of the vessels and leakage into the
brain.
Brain tissue swelling and a Hematoma within the brain put
increased pressure on the brain and can eventually destroy it. Bleeding may
occur in the hollow spaces (ventricles) in the center of the brain or into the
subarachnoid space (the space within the brain and the members that cover
the brain).
Intracerebral hemorrhage can affect the body and is most
common in older people.
 NURSING HEALTH HISTORY

Biographical Data

• NAME OF CLIENT: CGL

• AGE: 66yrs old
• SEX: Female
• CIVILSTATUS: Married
• ADDRESS: Brgy.Busac, Oas, Albay
• OCCUPATION: Retired Teacher
• RELIGION: Roman Catholic
• BIRTHDATE: March 18, 1943
• ADMISSION DATE: August 29, 2009
• ADMISSION TIME: 2:15PM
• CHIEF COMPLAINT: Severe headache and dizziness
• SOURCE OF INFORMATION: Husband
• PRINCILPE DIAGNOSIS: Cerebrovascular Accident (intracranial
hemorrhage)
• ATTENDING PHYSICIAN: Dra. Sabalbarino

History of Present Illness

A case of client CGL, 66 years old, female, Filipino, residing at

Proj.6, Quezon City was admitted at East Avenue Medical Canter last August
29, 2009 at 2:15pm with a chief complaint of severe headache and
dizziness.
A week prior to admission, she experienced episodes of
headache and dizziness. Her BP was monitored at home. She has been
known hypertensive for 15yrs with BP reading from 160/100mmHg and she’s
taking versant to lower her blood pressure and Glimepiride for her DM.
Prior to admission while Mrs. CGL was doing her household
chores (washing dishes), she suddenly experienced severe headache and
dizziness. She was immediately brought to Jose Reyes Memorial Medical
Center and accompanied by her husband because she cannot tolerate
anymore the pain. She was confined for 3 days before being transferred to
East Avenue Medical Center.

Past Medical History

Client husband state that the patient had experienced childhood

illness such as measles, chicken pox, mumps, cough, and common colds.
She had no allergies to food or any medication and had not encountered
accidents or serious injuries before however the client had under gone
appendectomy when she was at her 20’s.
 Year 1993 she was diagnosed with hypertension at BRTH
without recalling the exact date as claimed by her husband. After 5 years
she was also diagnosed with type II DM. she was taking versant for her
hypertension and Glimiperide for her DM but not taking it regularly only
when she experienced headache and dizziness.

Family Health History

Psychosocial History

Client is a non smoker, she drinks wine occasionally. Her food

consists of fish and vegetables, but she also loves to eat fatty and dried
foods. Her sleep wake pattern is from 10pm-5am. She goes to church every
morning then spends most of her time walking around their brgy, visiting
friends. When at home she does the usual household chores.
She has good relationships w/ her husband, daugther and
relatives. She is a retired teacher from Proj.6 Elementary School. According
to his husband her wife has been a very good teacher w/ good record during
her teaching career.

PHYSICAL ASSESSMENT

REVIEW OF SYSTEM
General Assessment
• Seen lying on bed conscious with an IVF of D5LR inserted at the right
metacarpal vein regulated at 30gtts/min, with NGT for feeding and
with indwelling catheter draining to urobag
• Appears weak and pale, warm to touch.
• with the following vital signs
o Temp – 38.7oC
o PR – 91 bpm
o RR - 24 cpm
o BP 150/90 mmHg

Body Parts
• technique used: inspection
• actual findings: symetrical in size no lumps and lesions noted
• normal findings: Symmetrical in size absence of lumps, lesions and
nodules
• remarks: normal

Head
• technique used: inspection
• actual findings: Evenly distributed hair whitish in color no infections or
infestation noted
• normal findings: Evenly distributed hair with shiny black in color
absence of infection and infestation

Eyes
• technique used: inspection
 • Actual findings: Blurring of vision noted on the left eye, pupil is black
and equal in size.
• normal findings: No edema or tenderness over the lacrimal gland,
pupil black equal in size, conjunctiva is shiny and smooth and pink
transparent capillaries
• remarks: normal

Ears
• technique used: inspection
• actual findings: Color is the same as facial skin, symmetrical in size
pinna recoils slowly after it is folded.
• normal findings: Symmetrical auricle alignedin outer canthus of eye
sounds is heard on both ears pinna is firm and recoils after it is folded
• remarks: normal

Nose
• technique used: inspection
• actual findings: Symmetric in shape no lesion no discharges and no
nasal flaring note
• normal findings: Symmetric and straight no tenderness, no lesion no
discharge or flaring
• remarks: normal

Mouth
• technique used: inspection
• actual findings: Oral mucosa is pink no discharges noted, inability to
purse lips and dry lips.
• normal findings: Lips are pink in color ability to purse lips pink gums
and white shiny tooth enamel
• remarks: due to hemiparesis

Skin
• technique used: inspection
• actual findings: Light brown in complexion uniform in color except for
areas expose to sun light no skin lesion noted
• normal findings: Uniform in skin color when pinch skin springs back to
previous sate
• remarks: normal

Nails
• technique used: inspection
• actual findings: Capillary refill of 5 sec and cyanosis noted no
clubbing.
 • normal findings: Capillary refill is 2-3 secs. absence of cyanosis or
clubbing
• remarks: due to altered tissue perfusion
Abdomen
• technique used: inspection
• actual findings: Skin at the abdominal area is unblemished and
uniform in color, whole abdomen is slightly rounded in shape
• normal findings:No evidence of enlargement of liver and spleen, no
lumps, masses or tenderness noted.
• remarks: Normal

Upper and lower extremities

• technique used: Inspection
• actual findings: Upper and lower extremities are of equal size of both
sides of the body no contractures noted. Weakness on left arm and leg
noted.
• normal findings: Absence of edema contractures and masses
symmetrical in size and length
• remarks: due to hemiparesis

NEUROLOGIC ASSESSMENT
Consciousness
• The client is conscious but slightly unresponsive. Drowsy and slightly
difficult to arouse with normal stimuli, however, patient is easily
aroused by loud noise, deep pressure and pain.

Mentation
• Patient is oriented to time, place and person and is aware of her
current illness. Patient can recall recent and past memory with mild
difficulty. Emotional lability noted.

Language and Speech

• Patient has slurred speech and dysarthria.

Motor Function
• Patient is able to project facial expressions such as smile and a pout.
Unable to eat on her own due to lack of muscle strength and inability
to swallow, has NGT for feeding.
• Eye movements are visible. Patient is able to open eyelids.
• Hemiparesis noted at the left side of the body.

Sensory Function
• The patient is able to see and follow movements. Vision on the left eye
is unclear. The nose to fingertip assessment reveals that the patient
 can’t see where the examiner’s fingertips are particularly when it is
positioned on the L side.

• Patient is able to smell unable to hear, but can hear voices when
spoken louder.
• Patient cannot easily detect soft objects like blanket on the affected
side but feels the touch of the hand(when pressed) when she is
awake.

Bowel and Bladder Function

• Client has FCTUB draining at an average of 160 cc/day.
• The client’s stool is brownish and hard and defecate an interval of 2-3
days
Cardiovascular system Analysis
no complain of chest pain and Normal
has a cardiac rate of 91bpm,
chest is symmetric in size.
Respiratory System Due to body weakness and
The client respiratory rate ishemiplegia.
slightly increased with an RR
of 24 cpm and no crackles
noted.
Gastrointestinal System
Client defecate 2-3 days of Due to body weakness and
interval with brownish in colorhemiplegia.
and slightly hard stool.
Genitourinary System Due to decreased fluid
Client has difficulty inintake.
urination with foley catheter
attached to urobag . With
urine output of 20ml/hr,
yellow in color.
Cranial Name Type Function Findings
nerve

1 Olfactory Sensory Smell Normal

2 Optic Sensory Visual and vision Blurred vision of

the left eye

3 Oculomotor Motor Pupil constriction Pupil in the left eye

is nonreactive

4 Trocheal Motor Eye movement, Eyeballs on the left

Controls superioreye is unable to
oblique muscle move constantly
because of
hemiparesis and
hemiplegia
5 Trigeminal Sensory Controls muscle ofImpaired
optalmic branch mastication; swallowing or
sensation of thedysphagia,
face and cornea trigeminal neuralgia
6 Abducens Motor Eye movement Partial gaze palsy

7 Facial Motor Controls musclesThere was paralysis

and for facial expression on the left side of
sensory the face due to
hemiparesis and
hemiplegia, other
 side of the face can
able to project
facial expression.
8 Auditory Sensory Hearing Unable to hear soft
voices on the left
ear because of
hemiparesis and
hemiplegia
9 Glossopharygeal Motor Controls muscle ofInability to
and the throat swallow(dysphagia)
sensory
10 Vagus nerve Motor Controls muscle ofInability to
and the throat,swallow(dysphagia)
sensory parasympathetic Loss of gag reflex
nervous systemDysarthria
stimulation of
thoracic and
abdominal organs
11 Spinal Motor Controls Inability move the
Accessory strenocleidomastoid head and the
and trapeziusshoulders on the
muscles left side of the body
12 Hypoglossal Motor Movement of theDeviation of the
tongue tongue to one side
of the mouth

GLASGOW COMA SCALE

Faculty Measured Score Response

Eye Opening 4 Spontaneous
3 To verbal command
2 To pain
1 No response
Motor Response 6 To verbal command
5 To localize pain
4 Flexes and withdraws
3 Flexes abnormally
2 Extends abnormally
1 No response
 Verbal Response 5 Oriented, converses
4 Disoriented, converses
3 Uses inappropriate words
2 Makes incomprehensible sounds
1 No response
Moderate stroke: 13

MUSCLE STRENGTH

RIGHT LEFT

3/5 2/5

3/5 2/5

N. I. H. STROKE SCALE

Level of Consciousness
• Not alert, requires loud noise or painful stimuli to arouse
• Answers 1 of 2 questions correctly
• Performs 1 of 2 tasks correctly – there is noted lack of
cooperation

Best Gaze
• Partial gaze palsy, gaze is abnormal on one (L) eye but gaze
paresis is not present.
Visual
• (L) homonymous Hemianopia. (R) gaze preference.

Facial Palsy
• Normal symmetrical movement

Motor Arm and Leg

• Arm and legs drift down to bed with effort against gravity
(when elevated at 45 and 30 degrees correspondingly)

Limb Ataxia
• Present on left upper and lower extremities.

Sensory
• Mild sensory loss

Best Language
• Mild to moderate aphasia.

Dysarthria
• Mild to moderate, patient slurs some words and can be
understood with some difficulty.

Distal motor function

• No voluntary extension after 5 secs.

Pattern Before illness During Analysis

hospitalization
Diet o Client eat o 250-300 ml o Clients
3x a day, of eating
she loves to osteorized pattern
eat fried feeding or declined
and fatty approximat bec of
foods . ely 900 ml/ her
o She usually day illness.
eat two
cups of rice
with dried
fish, meat,
chicken w/
vegetables
as her
viand. She
also eat
sweet and
salty food.

Habit o Goes to o Clients o Clients

church daily habit daily
every has totally habit has
morning at stopped stopped
around 5:00 due to
am. spend her
most of her present
time illness
walking
around their
BRGY
visiting
friends and
reading
books and
bible.
Exercise o Client o Clients o Clients
consider her daily daily
house Exercise Exercise
routine as has totally has
her daily stop stopped
exercise due to
and walking her
around present
illness

Sleeping o She usually o she usually o client

pattern sleeps 6-7 sleep 4-5 sleeping
hours a day hours daily, pattern
Sleeps o sleeping has
around 10 position is decline
pm and semi from 6-7
wake up at fowlers, hours to
around 4 -5 o use only 4-5 hours
am on one pillow of sleep a
typical day. that day.
she takes support her o this may
day time head indicate
naps for 2-3 disturban
hours ce during
o Her favorite sleep or
sleeping deprivati
position is on of
side lying sleep
position
o She uses
two pillow
one pillow
to support
her head
and one for
 the legs

Elimination Defecate once aDefecate with anClient’s

pattern day early in theinterval of 2-3elimination
morning. days. Stool waswas declined
Urination wasbrownish anddue to her
normal. slightly hard. illness.
Was oliguric,
with fully
catheter attach
to the urobag.
Urine color is
turbid and 160ml
w/n a shift.
Drinking She drinks 7-83 glass of waterClients
glasses of waterper day ordrinking
daily orapproximately pattern has
approximately 90ml/day decline due to
1,920ml of waterTotally stoppedher illness
per day drinking wine experience
She occasionally
Drinks wine

Personal She takes a bathUnable to take aCapability in

hygiene every day atbath sincedoing her
around 4:30 amadmitted, herpersonal
with warm water way of bathing ishygiene has
Brush her teethby means ofdecline due to
after eating hersponge bath. her illness.
breakfast, lunch
and dinner.

LABORATORY AND DIAGNOSTICS

COMPUTED TOMOGRAPHY SCAN
A medical imaging method employing tomography. Digital geometry
processing is used to generate a three-dimensional image of the
inside of an object from a large series of two-dimensional X-ray
images taken around a single axis of rotation.

• Indications for CT Scanning:

– Bleeding, brain injury and skin fractures
– Brain tumors
– A blood clot or bleeding
– Enlarged brain cavities, etc.

• Technique
– Plain CT scan of the brain using fused 5.0 and 10.0 mm
axial slices were done.

• Findings:
– There is hyper-density noted on the right side of the pons
and midbrain
– Grey white matter differentiation is observed
– The midline structures are in place
– The cisterns, sulci and ventricles are normal in size and
configuration
– The mastoids are well aerated
– No fracture on the cranial vault noted.

• Impression:
ACUTE CEREBRAL HEMATOMA, PONS AND MIDBRAIN

• Chest AP view
• The basal lung markings are still accentuated with no
significant interval change in present radiograph as compared
with previous study dated 8-26-09
• The rest of the findings are unchage

12-LEAD ELECTROCARDIOGRAM
The standard ECG is a representation of the heart’s electrical activity
recorded from electrodes on the body surface.
• Rate : 75 beats per minute
• Rhythm : Sinus
• Remarks : Regular Sinus Rhythm

CAPILLARY BLOOD GLUCOSE MONITORING

 DATE TIME RESULT REMARKS CLINICAL
SIGNIFICANT

09-06- 6:10 AM 177 mg/dl Increased DM

09 12:00 NN 255 mg/dl Increased
6:00 PM 161 mg/dl Increased

09-07- 7:00 AM 200 mg/dl Increased DM

09

09-08- 6:00 AM 189 mg/dl Increased DM

09 6:00 PM 195 mg/dl Increased

09-09- 6:00 AM 172 mg/dl Increased DM

09

09-10- 7:00 AM 200 mg/dl Increased DM

09

CLINICAL CHEMISTRY
SIGNIFICANCE RESULT NORMAL REMARKS CLINICAL
VALUES SIGNIFI
CANT
 K+ Potassium is09/01/09 3.6-5.5 Normal
checked in3.9 mmol/L
order to assessmmol/L
a known or
suspected 09/12
disorder 3.7mmol/L
associated
with renal
disease,
glucose
Na+ metabolism,
trauma or 134-148 Incresed Hyperna
burns 09/01/09 mmol/L tremia
162.9 Increased
Sodium plays ammol/L
major role in
homeostasis in09/12
a variety of151mmol/L
ways including
retention and
excretion of
water.

HEMATOLOGY
SIGNIFICAN RESULT NORMA REMARK CLINICAL
CE L S SIGNIFICAN
VALUE CE
S
Hgb To monitor09/01/09 M: 140-Normal
Hgb value in135 g/L 180
the RBC; To09/12/09 g/L
suggest the116g/L F: 120-
presence of 160
body fluid09/01/0911.0 g/L decrease
deficit dueg/L09/12/0912.80 d
WBC to elevatedg/L 5-10 X Could
Hgb levels. 10g/L Slightly indicate
09/01/09 Increase presence of
0.40g/L d. infection.
09/12009
To detect0.33
infection or09/01/01
inflammatio 0.23g/L Aspiration
n. This09/12/09 increase pneumonia
Hct evaluates 0.10g/L d
the number
of condition M:
and 0.40- Normal
differentiate 0.52
s the causes F:
Lymph of alteration 0.37-
o-cytes in the total 0.47
WBC count decrease
including d
inflammatio
n, infection Normal
and tissue 0.18-
necrosis. 0.48

To aid the decrease

diagnosis of d
abnormal
states of
hydration,
polycythemi
a anemia

To detect
presence of
infection
within the
body.
 DRUG STUDY

Piracetam Nootropic • increase blood • used in cases of • First trimester of

flow and oxygen severe brain pregnancy; severe
to the brain, aid disease parenchymal liver
stroke recovery • cerebro-cranial or kidney disease;
trauma in acute agitated
stage depression,
• Piracetam tablets particularly in the
are used in elderly
cerebro-vascular
disease
Citicoline Nootropics & • Citicoline seems • Cerebrovascular • Must not be
Neurotonics to increase a accident in acute administered to
brain chemical and recovery patients with
called phase and signs of hypertonia of the
phosphatidylcholi cerebral parasympatetic.
ne. This brain insufficiency such
chemical is as dizziness,
important for memory loss, poor
brain function. concentration,
Citicoline might disorientation, etc.
also decrease and recent cranial
brain tissue traumatism and
damage when the their sequelae.
brain is injured.
Simvastatin • Antilipemics • Inhibits HMG-CoA • Reduce risk of • Contraindicated to
reductase, an death from CV pregnant and
early step in disease and CV lactating women
cholesterol event in pt at high • Pt with hyper
biosynthesis risk for coronary sensitivity to
event drugs and with
lactive liver
disease.
Fluimucil mucolytics • It reduces the • URTIs • Hypersensitivity to
viscosity of • LRTIs LRTIs any of the
• bronchial • COPD COPD ingredients.
secretions. • Pregnancy &
bronchial Lactation
secretions Pregnancy &
• Fluimucil Lactation
prevents the
formation of
disulphide bonds
& thereby
• regulates the
viscosity of the
muc regulates the
viscosity of
mucus
Ceftazidime • 3rd generation • Inhibit cell wall • CNS infection. • Pt with
cephalosporin synthesis, hypersensitibity to
promoting drugs or other
osmotic cephalosporins
instobility
Levofloxacin Antibiotic • It functions by • . indicated for the • patients with a
inhibiting DNA treatment of known
gyrase, a type II adults (>/=18 hypersensitivity to
topoisomerase, years of age) with Levofloxacin or
and mild, moderate, other quinolone
topoisomerase iv and severe drugs.
[44], which is an infections caused • Caution should be
enzyme by susceptible exercised in
necessary to strains of the prescribing to
separate designated patients with liver
replicated DNA, microorganisms disease
thereby inhibiting • To pregnant
cell division. mother
• Levofloxacin is
also considered to
be contraindicated
in patients with
epilepsy or other
seizure disorders
Sucralfate Antiulcer drugs • Protect the ulcer • Maintenace • Allegy to
against pepsin therapy for sucralfate, chronic
and bile salt, duodenal ulcer at renal failure or
promote ulcer reduced dosage dialysis.
healing
• Inhibits pepsin
activity in gastric
juices
 ANATOMY AND PHYSIOLOGY

Central Nervous System

• Composed of brain and spinal cord
• Composed of three major functional divisions:
• higher level brain ( cerebral cortex )
• ower level brain ( basal ganglia, thalamus, hypothalamus )
• spinal cord

The Brain
• largest and most complex part of the nervous system
• receives 20% of the total resting cardiac output or 750 ml of
blood per minute.
• 4 main regions : brainstem, diencephalons, cerebellum,
cerebrum.

a. BRAIN STEM
• composed of medulla oblongata, pons, midbrain.
Medulla Oblongata:
• the most inferior portion of the brainstem

functions:
• regulator of heart rate and blood vessel diameter
• breathing, swallowing, vomiting center
 • coughing, sneezing center
• balance and coordination
• sensory relay and autonomic function

Pons

• relays information between cerebrum and cerebellum

functions:
• respiratory center: apneustic and pneumotaxic center
• regulator of breathing and swallowing

Midbrain
• short section of brainstem between the diencephalons and
pons.
• main function is coordination of eye movements

Diencephalon
• located bet the cerebrum and the brainstem.
• composed of the thalamus, hypothalamus, and epithalamus

Hypothalamus

 Small portion of diencephalons located below the thalamus

Functions are as follows:

1. cardiovascular regulation
2. body temp regulatio
3. water and electrolyte imbalance
4. regulation of hunger
5. control of gastrointestinal activity
6. sexual response
7. limbic and emotion
8. control of endocrine function
9. sleeping and wakefullness

Thalamus
• largest part of the diencephalons
functions:
• performs some sensory interpretation responding to general
sensory stimuli and provides crude awareness
• plays a role in the initial autonomic response of the body to
intense pain.
• partly responsible for the physiologic shock that follows
serious trauma
 Epithalamus:
• consist of vascular choroids plexus where cerebrospinal fluid is
produced
• involved in emotional response to odor
• consist of pineal body and endocrine gland that influences the
onset of puberty.

Cerebellum
• known as “little brain”
• 2nd largest structure of the brain.
functions:
1. maintain balance and muscle tone
2. coordination of fine motor movements

Cerebrum
• largest and most obvious part of the brain.
• divided by the longitudinal fissure into right and left
hemisphere
• each of the hemisphere is connected by the corpus callosum
that contain central cavity called lateral ventricle that is filled
with cerebrospinal fluid
Functions:
• responsible for higher mental functions: memory and reason
• accounts 80% of the total mass of the brain.

Frontal Lobe
• anterior portion of the cerebral hemisphere
functions:
• control of voluntary motor movement
• motivation, mood
• aggression, olfactory reception

Temporal lobe

• below the parietal lobe and posterior of the frontal lobe

function:
• olfactory and auditory sensation, and memory

Parietal Lobe

• posterior portion of frontal lobe.

• Function:
 • principal center for reception and conscious perception of
general sensory information: touch, temperature, taste,
balance, pain.

Occipital Lobe

• posterior portion of the cerebrum

Functions:
• for vision
• integrates eye movement by focusing and directing the eye
• visual association- correlating visual images with previous
visual experiences.

Functional Areas of the Cerebral Cortex:

A. Primary Sensory Area

 sensory pathway that project to specific regions of the cerebral

cortex where sensations are perceived

B. Secondary Sensory Area/ Primary Somesthetic Cortex

 located in the parietal lobe

C. Primary Motor Cortex

 posterior portion of the frontal lobe
 control voluntary movement of skeletal muscles.
D. Premotor Area
 anterior portion of frontal lobe/ pre frontal area
 staging area where motor function are organized before they
are actually initiated at the primary motor cortex
 foresight to plan and initiate movement
Speech Area
 left cortex
consist of 2 cortical areas:
1.Wernicke’s Area
 sensory speech area
 parietal lobe
2. Broca’s Area
 motor speech area
 frontal lobe
 damage to these areas may result to aphasia, absent or
defective speech or problem in language comprehension
PATHOPHYSIOLOGY

Predisposing Factor: I ntracranial Hemorrhage Precipitating

factors:
Hypertension
Modifiable
DM
HPN (+)
Head injury
DM (+)
HPN high cholesterol
DM level
High salt
Weakens blood
vessels Lypolysis Low fiber diet
Non-Modifiable
Age (66 years old)
Accelerates
atherosclerosis Familial history (+)
ANGIOPATHY occurs

Inflammation of the blood vessel

Blood vessels rupture

Hematoma formation
Neuronal damage occurs

Cognitive and psychological

Communication loss Perceptual and sensory loss
Motor loss effect

Dysarthia Impairment of touch

Hemiplegia Emotional lability
Dysphasia Left visual field cut
Hemiparesis Lack of cooperation
Apraxia Right gaze preference
 PROBLEM IDENTIFICATION

Problem Identified Cues

Subjective: Ineffective Cerebral Tissue
• “no verbal cues” perfusion related to interruption
Objective: of blood flow secondary to
• altered LOC Intracranial Hemorrhage as
dysphagia evidenced by altered LOC,
• lack of cooperation hemiparesis, and hemiplegia.
with FCUB
• hemiparesis
with NGT for feeding
• Hemiplegia
Vital signs:
• Apraxia T-
38.7o C
• Dysarthria
P-91 bpm
• Dry skin R-24
cpm
• Febrile BP-
150/90 mmHg
• impairment of touch
left visual field cut
Subjective: Impaired swallowing related to
No verbal cues neuromuscular impairment
Objective: secondary to disease process as
• Dysphagia Dry evidenced by dysphagia, w/ NGT
skin for feeding, hemiparesis,
• w/ NGT for feeding hemiplegia & body weakness.
Febrile
• Hemiplegia with
NGT for feeding
• Hemeparesis
with FCUB
• Dysarthia Vital signs:
• Apraxia T-
38.7o C P-91 bpm
• altered LOC R-24
cpm BP-150/90 mmHg
lack of cooperation
Subjective: “Hindi ako makagalaw Impaired physical mobility related
magmula ng mastroke ako,” as to neuromuscular impairment
verbalized by the client. secondary to cerebrovascular
Objectives: accident as evidenced by
• limited ROM hemiparesis, hemiplegia body
apraxia weakness.
• body weakness dysarthria
• hemiplegia left eye
visual cut
• hemiparesis with
foley catheter to urobag
• altered LOC with
NGT feeding
• with slurred speech V/S
• dysphagia T-
38.7o C P-91 bpm
• lack of cooperation
R-24 cpm BP-150/90 mmHg
•
Subjective: Impaired verbal communication
• “no verbal cues” related to decrees circulation to
Objective: the brain secondary to intracranial
• Slurred speech hemorrhage as evidence by
febrile dysarthia, aphasia, slurred
• Dysarthria speech.
apraxia
• Aphasia left
visual field cut
• altered LOC
Dry skin
• lack of cooperation
Vital sign
• hemiparesis
T-38.7o
• Hemiplegia
P-91 bpm
impairment of touch
R-24 cpm
• w/ NGT feeding
BP-150/90
• inability to swallow
 •
Subjective: Impaired skin integrity related to
• “no verbal cues” physical immobilization as
Objective: hemiparesis evidence by hemiparesis,
• altered LOC hemiplegia hemiplegia,, limited ROM, dry
• dry skin with FCUB skin.
draining
• paralysis of the left side
febrile
of the body
apraxia
• Slurred speech
Vital sign
• Dysarthria T-
38.7o P-91 bpm
• Aphasia
• lack of cooperation
 HEALTH TEACHING
• 1 Therapies such as positioning and range of motion exercise can help
prevent complication related to stroke, such us infection and bedsore
• 2 Recommending that all patient with high blood reassure monitor
their blood pressure at home on regular basis
• 3 Caregivers may need to show the person pictures, repeatedly
demonstrate how to perform task or use another communication
strategies, depending on the type and extend of the language
problem.
• 4. Encourage high fiber, low salt, low fat diet.
• 5. Encourage to stop smoking and control alcohol use.
• 6. Teach the patient and family to adapt home environment for safety.
• 7. Instruct the patient in need for rest periods throughout the day.
• 8. Encourage to participate in cognitive retraining program, reality
orientation, visual imagery, and cueing procedure
• 9. Teach patient to use nonaffected side for activities of daily living but
not to neglect affected side
• 10. Reassure th family that it is common for poststroke patient to
experience emotional labilityand depresion.

PROGNOSIS RECOMMENDATION AND SUMMARY

PROGNOSIS

• The case of our patient Mrs. CGL, 66 years of age, residing at Brgy.
Lalawigan Borongan E. Samar is presented with the diagnosis of
Cerebrovascular Accident (Intracranial hemorrhage). Prognosis is
good since the treatment regimen was implemented and the patients
family complied with the treatment regimen further more, the patient
was already discharge and went home improved medical condition.

SUMMARY

• A case of CGL, female, 66 years of age and is married is presented

with the diagnosis of Intracranial (or intra-cerebral) Hemorrhage, is
presented. A known hypertensive and diabetic for years, such
conditions, including her age and familial tendencies, increased the
risk of having the disease.
• After a thorough assessment of physical and neurological health, and a
review and analysis of her laboratory examinations and diagnostic
procedures, the pathophysiology was traced and appropriate nursing
care plans were produced.
• The prognosis of the client is good since the treatment regimen was
implemented and the patient and patient’s family complied with the
treatment regimen. Further more, the patient was already discharged
and went home with improved medical condition. Recommendations
were also suggested to help the patient maximize her recovery.