NORTH VALLEY COLLEGE FOUNDATION, INC.

Lanao, Kidapawan City, Province of Cotabato

Nursing Department

CEREBROVASCULAR DISEASE (CVD)

INFARCT

An Undergraduate Case Presentation to the Faculty

of North Valley College Foundation, Inc.

In Partial Fulfillment of the Requirement for the degree

Bachelor of Science in Nursing

DAYMIEL, MART C.

DULATRE, DAPHNE O.

ESPIRITU, MARY GRACE M.

FERMOSA, MICKAELA L.

FLORES, JUSTINE ROSE M.

ISANAN, ERIKA JOY

KALIM, ARNAISA MAE M.

KAMSA, SAKINA U.

LUBALANG, JAMAYKA K.

MASUAL, IRENE H.

Bachelor of Science in Nursing 4-C

DECEMBER 2023
 ACKNOWLEDGMENT

Words cannot express our gratitude to our clinical instructors for their
invaluable patience and feedback. We could not have undertaken this journey
without each other back, who generously provided knowledge and expertise.
Additionally, this endeavor would not have been possible without the generous
support from our very supportive parents.

We are also grateful to our friends and classmates, especially to

ourselves, for great teamwork, late-night brain storming sessions, and moral
support. Thanks should also go to the librarians, research assistants, and study
participants of our research, who impacted and inspire us.

Finally, we would want to thank the hospital or organization for giving us

the tools and chances to participate in valuable clinical practice and education.
Our preparation for this case presentation and next clinical attempts has been
greatly aided by their dedication to healthcare quality and ongoing learning.
 TABLE OF CONTENT
Pages

Title Page i

Acknowledgment ii

Table of Content iii

I. INTRODUCTION 1
Background of the Study

II. OBJECTIVES 3
General Objectives

Specific Objectives

III. PATIENT’S DATA 4

IV. FAMILY BACKGROUND 6

Family Health History

Effects and Expectations of Illness to Self/Family

Clients Health History

Past Illnesses

Present Illnesses

V. DEVELOPMENT DATA 8

VI. DEFINITION OF COMPLETE DIAGNOSIS 11

VII. PHYSICAL ASSESSMENT 12

VIII. ANATOMY AND PHYSIOLOGY 16

IX. ETIOLOGY AND SYMPTOMATOLOGY 20

X. PATHOPHYSIOLOGY 23
Manangement
Prognosis
Findings

XI. DOCTOR’S ORDER 26

XII. DIAGNOSTIC EXAM 36

XIII. DRUG STUDY 47

XIV. SURGICAL PROCEDURE 69

XV. NURSING THEORIES 69

XVI. NURSING CARE PLAN 49

XVII. DISCHARGE PLAN 51

Medications

Exercise

Treatment

Health Education/Teaching

Out-Patient Schedule

Diet

XVIII. RECOMMENDATION 83
Community

Patients

Nurses
 Future Researchers

XIX. DEFINITION OF TERMS 84

XX. REFERENCES 85
 1

CHAPTER I

INTRODUCTION

Background of the Study

Stroke is a disease of the brain in the form of impaired neural

function locally and/or globally, the appearance of sudden, progressive,
and fast. Nerve function impairment in stroke is caused by non traumatic
brain circulation disorder. These neurological disorders cause symptoms
such as paralysis of the face or limbs, speech is not fluent, speech is not
clear (pelo), maybe changes in consciousness, impaired vision, and other.
(Kemenkes RI, 2013)

Ischemic stroke is the most common type of stroke that is 85% of

the total number of the stroke patient. Ischemic stroke is a stroke caused
by atherosclerosis. Atherosclerosis is a condition when there is a pile of fat
and cholesterol or plaque that will form a blockage. The blockage can
occur along the artery to the brain so that the brain passes through the
blood vessel suffers from a lack of blood supply and results in a lack of
energy and oxygen supply. Brain cells that lack oxygen supply cannot
function properly. The cell can stop working temporarily or will die
completely, depending on the severity. (Purwani, 2017)

Globally, cerebrovascular disease (stroke) is the second leading

cause of death. It is a disease that predominantly occurs in mid-age and
older adults. WHO estimated that in 2005, stroke accounted for 5.7 million
deaths world wide, equivalent to 9.9 % of all deaths. Over 85% of these
deaths will have occurred in people living in low and middle income
countries and one third will be in people aged less than 70 years. (WHO,
2015)

International prevalence of stroke among women is also higher in

Canada when compared to men. As of 2018, approximately 405,000
people were living with stroke in Canada. Out of this total, approximately
 2

214,000 are women, whereas 191,000 are men (Heart and Stroke
Foundation of Canada, 2018)

In the Philippines, a total of 14 studies were included in this review.

Based on these studies, the national stroke incidence rate ranged from
3.95% to 5.61%, while the national stroke prevalence rate ranged from
0.486% to 6.0%. Hypertension remains the commonly reported risk factor
of stroke alongside diabetes, smoking, and high cholesterol level
(Collantes MEV et,. al, 2022)

In this case scenario, patient KD is a 62-year-old male patient,

divorced, Christian and a Businessman. Patient drinks alcoholic
beverages (4 glasses almost everyday), loves to eat salty and fatty foods
in great amount, into fast food, not into vegetables, physically and sexually
inactive, and is a chain smoker for 2 decades. Patient lives alone in Davao
City and doesn't have children. Patient is known to have hypertension and
diabetes mellitus. Both parents were known to be hypertensive and both
died from complications of cardiovascular diseases (Father-heart attack:
mother-stroke). He was brought to the medicine ward because of loss of
consciousness. Prior to admission, the patient suffered from headache,
blurred vision, speech problem, weakness and paralysis of the left side of
the body. CT scan revealed blood clot formation in the middle cerebral
artery. Vital signs were taken: BP 180/120 mmHg, PR 87 bpm. RR 30
bpm, body temperature of 36.7 °C. and SpO2 of 84%. The doctor ordered
for different laboratory tests and revealed creatine kinase MB isoenzymes
of 20 IU/L, troponin I of 0.24 mg/mL and troponin T of 0.13 mg/ml,
triglycerides and cholesterol of 282 and 274 mg/dl respectively, high
density lipoprotein of 28 mg/dL, and low density lipoprotein of 145 mg/dL.
The patient was given Rosuvastatin. Aspirin. Coumadin, and Nimotop.
 3

CHAPTER II

OBJECTIVES

General Objectives

The case involves a patient who is a 62-year-old male, separated, and not doing
great in living a healthy lifestyle. This study aims to understand the causes of the
patient’s different health issues and symptoms and to provide an effective
nursing care plan. This study will also discuss the appropriate treatment and
medications for the patient’s illnesses. Lastly, this study will give other nursing
students knowledge about ischemic stroke, hypertension, diabetes, excessive
intake of salty and fatty foods, alcoholic, smoking cigarettes, and other symptoms
that the patient experiences. At the end of three days exposure, the group will be
able to come up with comprehensive study on Cerebrovascular Disease Infarct.

Specifically, it aims to:

a. Provide an introduction consisting of the definition of the disease and a brief

overview of the patient’s condition;

b. discuss the patient’s clinical data, past health history, and developmental
data;
c. conduct a thorough physical assessment:
d. define the complete diagnosis of the Cerebrovascular disease Infarction
e. review the anatomy and physiology and illustrate the pathophysiology of the
affected organs and systems in Cerebrovascular disease Infarction
f. identify the predisposing and precipitating factors that contribute to the onset
of the disease and state the symptomatology of the case;
g. relate a nursing theory applicable to the case;
h. formulate nursing care plan base on the priority needs of the patient
 4

i. prepare a discharge planning using the method format.

CHAPTER III

PATIENT’S DATA

PATIENT CASE PRESENTATION

A. Patient’s Profile Name: KD

Age: 62 yrs Old

Sex: Male

Nationality: Filipino

Civil Status: Separated

Occupation: Businessman

Religion: Roman Catholic

Educational Attainment: High School Level

Ward and Room Number: Med Ward

Date of Admission: November 15, 2023

Date of Discharge: Still admitted

Chief of Complaint: A male patient presented to the emergency department on

November 15, 2023 with the chief complaint of loss of consciousness.

Vital Signs During Admission:

VITAL SIGNS VALUE NORMAL INFERENCE

VALUE
 5

NORMAL

The patient’s
temperature is normal,
which is beneficial for
Temperature 36.7 Celsius 34.7 Celsius-
someone suffering
37.3 Celsius
from a stroke. There is
no significant rise in
the temperature,
therefore, the patient
has a mild stroke.

Normal: <120
Blood 180/120 mmHg INCREASE
mmHg/
Pressure
Because of the factors
<80 mmHg
it leads to
Elevated: 120-
vasoconstriction,
129
increase vascular
mmHg/ <80
resistance it can affect
mmHg
the cardiac output by
Stage 1: 130-
increasing it.
139 mmHg/
80-89 mmHg The following factors
Stage 2: 140 led to patients' high
mmHg/ 90 blood pressure:
mmHg
Hypertensive Diet: High sodium
Crisis: > consumption can raise
180 mmHg/ 120 blood pressure, and
mmHg high blood pressure is a
major risk factor for
heart disease and
stroke. Most of the
sodium that the patient
consumes is in the form
of salt. As well as,
saturated fat plaques
narrow the arteries,
leaving less space for
blood to flow. The heart
compensates by
pumping blood more
 6

forcefully, resulting in
an increase in blood
pressure.

Smoking: Smoking
causes an acute
increase in blood
pressure (BP) and
heart rate and has been
found to be associated
with malignant
hypertension. Nicotine
acts as an adrenergic
agonist, mediating local
and systemic
catecholamine release
and possibly the
release of vasopressin.
Drinking: Alcohol
increases blood levels
of the hormone renin,
which causes the blood
vessels to constrict.

NORMAL

The patient has a

normal pulse rate of
Pulse Rate 87 bpm 60-100 87 bpm for his age.
bpm
high resting heart
rates were associated
with an increased
risk of ischemic
stroke compared with
low and normal heart
rates.

INCREASED
Older patients’ who
are alone or who are
independent have
 7

normal respiration
rates ranging from 12-
18 bpm. The patients’
respiratory rate is
elevated. Different
Respiratory respiratory diseases
30 bpm 12-20 are brought on by
Rate
bpm
post-stroke brain
injury, which disrupts
the central regulation
of respiration. They
may be brought on by
chest movements and
weakened respiratory
muscles, both of
which may indirectly
worsen a poor
ventilation system and
it increases in the
absence of exercise
due in part to the
stiffening of the lungs
due to congestion
and/or edema.

Oxygen 84% Normal O2 DECREASE

Saturation saturation:
Low oxygen levels are
95%-100% common in stroke
patients. it may lead to
further damage to a
brain that is already
short of oxygen. During
and after a stroke, blood
supply to part of the
brain is reduced. Over
time it becomes less
effective at pumping
 8

oxygen-rich blood
through his body. That
causes oxygen levels to
drop.

Glasgow Coma Scale

BEHAVIOR RESPONSE SCORE

Eye opening No response 1

response

Best verbal No response 1

response

Best motor No response 1

response

Total: Totally 3
unresponsive

Admitting diagnosis:

1. CVD Infarct

Attending Physician: Dr. O.

Source of Information/Informant’s: Distant relative

 9

CHAPTER IV

FAMILY BACKGROUND/ HEALTH HISTORY

Separate
d

This diagram illustrates the patient’s family members, how they are related, and
their medical history. This genogram enables the patient to see ancestral
behavioral tendencies as well as medical and psychological issues that run in
families.

Mother: Deceased, stroke.

Father: Deceased, heart attack. No brothers or sisters.
There is a positive family history of hypertension, both died from complications of
cardiovascular diseases.

Effects/Expectation of Illness to Self/Family

 10

The patient has a great knowledge about the illness and considering his
unhealthy lifestyle, it really affect his daily routine especially on his profession it
became a hindrance to keep his work. In the other hand, due to the patient's
illness, his distant relatives' have been affected, especially with their finances.
The distant relatives rely heavily on the patient's business which had also been
affected due to the business no longer having the patient as its manager.

CLIENT HEALTH HISTORY

Past Illness/es

The patient have a history of Hypertension and Diabetes Mellitus.

He also drink alcohol four glasses almost everyday and is a chain smoker
for two decades. He also love to eat fatty foods in great amount and not
really into vegetables. He currently have been taking meds such as
rosuvastatin, aspirin, coumadin and nimotop.

Present illness/es

Prior to hospital admission, the patient experiences headache,

blurred vision, speech problems, weakness and paralysis on the left side
of the body. The patient was brought to the emergency room due to loss
of consciousness.
 11

CHAPTER V
DEVELOPMENTAL DATA

ERIK ERIKSON’S PSYCHOSOCIAL STAGES OF DEVELOPMENT

Erick Erikson was a developmental psychologist and psychoanalyst who is well

known for his theory of psycho social development. His theory proposed that
human development occurs in stages throughout the lifespan, and that each
stage is characterized by a particular psycho social crisis that must be resolved
in order for an individual to progress to the next stage.

The Integrity vs. despair involves a retrospective look back and life and either
feeling satisfied that life was well-lived (integrity) or regretting choices and
missed opportunities (despair).

TASK ACHIEVED JUSTIFICATION

Integrity vs Despair ✓ Achieved due to the fact
that the patient is qualified
in the age bracket in this
theory. Furthermore, In
the stage of integrity vs
despair,Erik Erikson
suggests that individuals
reflect on their life,
assessing
accomplishments and
failures. A businessman,
separated with his wife
living alone, a provider to
his niece and nephews in
terms of financial issues
and living in a contented
life. The exploration of
integrity involves
accepting life choices and
finding meaning, while
despair arises if one feels
 12

regret or unfulfilled.

HAVIGHURST'S THEORY OF DEVELOPMENTAL

Theory Havighurst's theory of development stated that change and growth are
continuous throughout the entire life, from birth through death.

The developmental tasks of later maturity differ in only one fundamental respect
from those of other ages. They involve more of a defensive strategy that is of
holding on the life rather than of seizing more of it. In the physical, mental and
economic spheres the limitations become especially evident.

TASK ACHIEVED JUSTIFICATION

Later Maturity ✓ Achieved due to the fact
that the patient is qualified
base on Havighurt’s
theory. Individuals'
developmental duties
under Havighurst's idea of
later maturity include
adapting to bodily
changes, sustaining social
roles, and adjusting to
retirement. A 62-year-old
businessman with a
(CVD) infarct facing
physical health and
possibly legal practice
issues. Getting through
this period successfully
requires adapting to
health changes,
reevaluating career
duties, and discovering
new sources of fulfillment.
he may need to re-
evaluate his goals,
 13

possibly focusing more on

personal well-being and
relationships, in line with
Havighurst's concept of
handling duties pertinent
to later phases of life.

JEAN PIAGET THEORY OF DEVELOPMENTAL

Jean Piaget was a psychologist Who developed a theory of cognitive
development focused on intellectual development of children. He suggest that
children’s intelligence undergoes changes as they grow. Cognitive development
in children is not only related to acquiring knowledge, children needs to build or
develop a mental model of their surrounding world.

The formal operation stage is the final stage of Jean Piaget’s theory of cognitive
development, theoretical, hypothetical, and counter factual thinking.
Abstract logic and reasoning. strategy and planning.

TASK ACHIEVED JUSTIFICATION

Formal operation ✓ Achieved for a reason that
the formal operational
stage, according to Jean
Piaget, is characterized
by abstract thinking,
hypothetical reasoning,
and problem-solving
abilities. Piaget's formal
operational stage typically
occurs during
adolescence and
continues into adulthood.
While age alone is not a
definitive indicator, a 62-
year-old high school
graduate with life
experience and problem-
solving skills may indeed
14

exhibit formal operational

thinking. It's important to
note that Piaget's stages
are generalized, and
individuals may develop
cognitive abilities at
different rates. Factors
such as education, life
experiences, and
personal growth
contribute to cognitive
development..
 15

CHAPTER VI

DEFINITION OF COMPLETE DIAGNOSIS

 Ischemic stroke is the most common type of stroke. It occurs when the blood
arteries in the brain become restricted or clogged, resulting in substantially
reduced blood flow (ischemia). Blood clots or other debris that move through
the bloodstream, most typically from the heart, and lodge in blood vessels in
the brain cause blocked or narrowed blood vessels.
Cause
 There are two main causes of stroke: a blocked artery (ischemic stroke) or
leaking or
 bursting of a blood vessel (hemorrhagic stroke). Some people may have only
a temporary disruption of blood flow to the brain, known as a transient
ischemic attack (TIA), that does not cause lasting symptoms.

Signs and symptoms of stroke include:

 Trouble speaking and understanding what others are saying. You may
experience confusion, slur words, or have difficulty understanding speech.
 Paralysis or numbness of the face, arm, or leg. You may develop sudden
numbness, weakness or paralysis in the face, arm, or leg. This often affects
just one side of the body. Try to raise both your arms over your head at the
same time. If one arm begins to fall, you may be having a stroke. Also, one
side of your mouth may droop when you try to smile.
 Problems seeing in one or both eyes. You may suddenly have blurred or
blackened vision in one or both eyes, or you may see double.
 Headache. A sudden, severe headache, which may be accompanied by
vomiting, dizziness or altered consciousness, may indicate that you are
having a stroke.
 Trouble walking. You may stumble or lose your balance. You may also have
sudden dizziness or a loss of coordination.
 16

Diagnostic Test
●Computerized tomography (CT) scan: The CT scan will be able to
detect bleeding in the brain, and ischemic stroke, a tumor, and other
conditions. A dye will be injected into the bloodstream to detect in greater
detail.
●Magnetic resonance imaging (MRI): This will be able to detect damaged
brain tissue by an ischemic stroke and brain hemorrhages. A dye will be
injected in order to detect in greater detail.
●Carotid ultrasound: In this test, sound waves create detailed images of
the inside of the carotid arteries in the neck. This test shows buildup of
fatty deposits (plaques) and blood flow in the carotid arteries.
●Cerebral angiogram: In this uncommonly used test, your doctor inserts
a thin, flexible tube (catheter) through a small incision, usually in the
groin, and guides it through the major arteries and into the carotid or
vertebral artery. Then your doctor injects a dye into the blood vessels to
make them visible under X-ray imaging. This procedure gives a detailed
view of arteries in the brain and neck.
●Echocardiogram: An echocardiogram uses sound waves to create
detailed images of the heart. An echocardiogram can find a source of
clots in the heart that may have traveled from the heart to the brain and
caused a stroke.
●Trans-cranial Doppler (TCD) ultrasound: Doppler ultrasound is a test
that uses sound waves to measure blood flow. Also used with a CT or
MR angiogram, the TCD helps your doctor find out which artery in your
brain is blocked.
●Electroencephalogram (EEG): An EEG is done less often. This test
records electrical activity in the brain to be sure your stroke symptoms
are not caused by a seizure. Seizures can cause symptoms like
movement problems and confusion. These can be mistaken for the
symptoms of stroke or transient ischemic attack (TIA). During this test,
you'll have sticky electrodes placed on your head, with wires attached to
 17

a machine. The machine records the electrical signals picked up by the

electrodes.
●Electrocardiogram (ECG or EKG): This test detects and records your
heart's electrical activity. It can help your doctor find out if atrial fibrillation
caused the stroke. An ECG can be done during physical activity to
monitor your heart when it is working hard.

CHAPTER VI
PHYSICAL ASSESSMENT
Personal Data
Patient KD who was admitted to the hospital with chief complaint of Loss of
Consciousness.

General Survey
 18

 Upon the assessment, the patient appears weak, lying in bed with a
GCS score of 3/15 (totally unresponsive). There’s an evidence of
asymmetrical structures on his faceand jaw, and an evidence of left
facial drop. His jugular vein appears distended, and he has been
administered with mechanical ventilator. Upon inspection the client's
skin appears older, paler and more transparent (thin) due to the fact
that he was already old. The patient has been administered
catheterization to strictly monitor fluid intake and output.

VITAL SIGNS

VITAL SIGNS VALU NORMAL INFERENCE

E VALUE
NORMAL

The patient’s
temperature is normal,
Temperature 36.7 Celsius 34.7 Celsius- which is beneficial for
37.3 Celsius someone suffering
from a stroke. There is
no significant rise in
the temperature,
therefore, the patient
has a mild stroke.

Blood 180/120 mmHg Normal: <120 INCREASE

Pressure mmHg/
<80 mmHg
The following factors led
Elevated: 120- to patients' high blood
129 pressure:
mmHg/ <80
mmHg Diet: High sodium
Stage 1: 130- consumption can raise
139 mmHg/ blood pressure, and
80-89 mmHg high blood pressure is a
major risk factor for
Stage 2: 140 heart disease and
 19

mmHg/ 90 stroke. Most of the

mmHg sodium that the patient
consumes is in the form
Hypertensive of salt. As well as,
Crisis: saturated fat laques
> narrow the arteries,
180 mmHg/ 120 leaving less space for
mmHg blood to flow. The heart
compensates by
pumping blood more
forcefully, resulting in
an increase in blood
pressure.
Smoking: Smoking
causes an acute
increase in blood
pressure (BP) and
heart rate and has been
found to be associated
with malignant
hypertension. Nicotine
acts as an adrenergic
agonist, mediating local
and systemic
catecholamine release
and possibly the
release of vasopressin.

Drinking: Alcohol
increases blood levels
of the hormone renin,
which causes the blood
vessels to constrict.
NORMAL

The patient has a

normal pulse rate of
Pulse Rate 87 bpm 60-100 87 bpm for his age.
bpm high resting heart
 20

rates were associated

with an increased
risk of ischemic
stroke compared with
low and normal heart
rates.

INCREASED
Older patients’ who
are alone or who are
independent have
normal respiration
rates ranging from 12-
18 bpm. The patients’
respiratory rate is
elevated. Different
Respiratory 30 bpm 12-20 respiratory diseases
Rate bpm are brought on by
post-stroke brain
injury, which disrupts
the central regulation
of respiration. They
may be brought on by
chest movements and
weakened respiratory
muscles, both of
which may indirectly
worsen a poor
ventilation system and
it increases in the
absence of exercise
due in part to the
stiffening of the lungs
due to congestion
and/or edema.

Oxygen 84% Normal O2 DECREASE

Saturation saturation:
Low oxygen levels are
95%-100% common in stroke
patients. it may lead to
 21

further damage to a
brain that is already
short of oxygen. During
and after a stroke, blood
supply to part of the
brain is reduced. Over
time it becomes less
effective at pumping
oxygen-rich blood
through his body. That
causes oxygen levels to
drop.

SKULL AND HEAD MOVEMENT:

Significant Findings:
 Asymmetrical structures in the face and the jaw
 Left facial droop
 One side of the face may become numb or weak.
 Uncontrolled Hypertension can lead to headache

Inference
ABNORMAL
Hardening and thickening of the arteries due to high blood pressure or
other factors can lead to a heart attack, stroke or other complications. A
neural connection between the neck and the brain has been shown to
control a wide range of automatic body functions, including blood
pressure, pulse rate, and respiration.
 22

EARS & HEARING:

Significant Findings:
 Loss of high frequency sound hearing that is progressive and
symmetrical.
 No condition
 Zero discharge
 Equal-sized ears
Inference
NORMAL
The Ears and hearing are unaffected by the condition. The Presbycusis means
gradual loss. It’s a common issue associated with aging.

NOSE & MOUTH:

Significant Findings:

 left facial droop ( left sutructure side of the mouth & nose)

 Dysphagia with NGT attached to the patient

 Xerostomia
Inference

ABNORMAL
Xerostomia, refers to a condition in which the salivary glands in your mouth don't
make enough saliva to keep your mouth wet. Dry mouth can be due to certain
health conditions, such as diabetes, and stroke. Damage to the nerves in your
head or neck can affect the ability of your salivary glands to produce saliva. This
can result in dry mouth. A stroke might affect control of the muscles in the mouth
and throat, making it difficult for you to talk clearly, swallow or eat.

NECK & THROAT:

Significant Findings:
 23

 Jugular vein distention

 Dysphagia

Inference

ABNORMAL

When blood vessel pressure rises to dangerous levels, the walls of the blood
vessels thicken and stiffen, allowing less blood to pass through. This condition is
known as jugular vein distention. A stroke may impair your ability to control your
mouth and throat muscles, making it challenging for you to speak clearly,
swallow food, or chew it. Food and drink issues can result from dysphagia. Food
or drink might go down the wrong way and get into your lungs.

THORAX & LUNGS:

Significant Findings:

 Pulmonary edema

 Mechanical Ventilation has been administered to the patient

 GCS:3/15(totally unresponsive)

 Symmetric and complete thorax expansion

Inference
ABNORMAL

Patients’ speech had been slurred or occasionally they could not make
sounds that were understandable as speech. This was typically brought
on by weakening in the facial muscles necessary for producing speech on
one side. While ischemic stroke can result in pulmonary edema when the
brainstem's major blood vessels are infarcted. Elevated blood troponin
levels, EKG abnormalities, and altered wall motion on echocardiography
show that this happens independently of concurrent cardiac
involvement. Mechanical ventilation is necessary during treatment
because of the patient's low oxygen level (84 %).
 24

CARDIOVASCULAR SYSTEM:

Significant Findings:

 Vital signs: Hypertension stage III (hypertensive crisis) 180/120

 Respiration rate 30 bpm

Inference

ABNORMAL

One of the most prevalent and significant risk factors for the onset of
an ischemic stroke is hypertension. Because of a number of variables,
including psychological stress, discomfort, and elevated intracranial
pressure, blood pressure(BP) frequently increases when a stroke occurs.
A stroke may also impair breathing by interfering with the central rhythm
generation process.

GASTROINTESTINAL SYSTEM & BOWEL ELIMINATION:

Significant Findings:

 Patient has been administered catheterization to strictly monitor of

fluid status due to bladder function

Inference

ABNORMAL

Incontinence
 25

It's possible to develop incontinence after a stroke. Weakened muscles that

regulate urination and feces cause this. The most typical symptom is
unconscious leaking, however you could also be experiencing other bladder
issues.

The patient is weak and has nerve damage that affects his ability to pee on its
own. Catheterization allows urine to drain if the patient has an obstruction in the
tube that carries urine out.

NEUROLOGIC SYSTEM:

Significant Findings:

 Loss of consciousness

 Headache

 Weakness or numbness and;

 Paralysis of the left side of the body

Inference

ABNORMAL

Stroke occurs due to reduced perfusion to a brain region, resulting in death

or permanent neurological deficits including hemiplegia, numbness, loss of
sensory and vibratory sensation, balance problems, ptosis, decreased reflexes,
visual field defects, apraxia, and aphasia due to neuronal damage of pathways of
the central nervous system (CNS), including the brainstem or cerebellum.
(Pandaya, R. 2011)

EXTREMITIES:

Significant Findings:

 Muscle weakness

 Paralysis
 26

 Stiffness

Inference

ABNORMAL
Hemiparesis
A common consequence of stroke is hemiparesis, which results in
weakness on one side of the body. Your mobility may be restricted by this
one-sided weakness, which may also have an impact on your ability to dress,
eat, and walk. Hemiplegia and hemiparesis are frequently misunderstood. Both
ailments are brought on by strokes.
INTEGUMENTARY (SKIN/NAILS):
Significant Findings:
 The client's skin appears older, paler, and more transparent (thin).
 Due to the gradual loss of melanocytes with aging,uneven
tanning may be typical.
 The client's nails have longitudinal ridges, there is no crescent-
shaped lunula, and they are becoming dull and brittle, which are all
signs of normal aging.

Inference

NORMAL

Generally speaking, a reduction in blood flow causes pale skin. The

skin's and mucous membranes' bluish hue is brought on by inadequate
circulation or reduced oxygenation. Hair loss occurs as a result of
insufficient blood flow depriving the body of the oxygen and blood it needs
to function.
 27

CHAPTER VIII

ANATOMY AND PHYSIOLOGY

 28

CEREBROVASCULAR DISEASE INFARCT

 29

ISCHEMIC
STROKE

The brain is the most metabolically active organ in the body.

While representing only 2% of the body's mass, it requires 15–
20% of the total resting cardiac output to provide the necessary
glucose and oxygen for its metabolism.
Knowledge of cerebrovascular arterial anatomy and the
territories supplied by the cerebral arteries helps determine which
vessels are involved in acute stroke. Atypical patterns of brain
ischemia that do not conform to specific vascular distributions may
indicate a diagnosis other than ischemic strokes, such as venous
infarction.

BRAIN

The brain regulates thought, memory, emotion, touch, motor

skills, vision, breathing,temperature, and hunger. The brain and spinal
cord make up the CNS. The average adult brain is 3 pounds and 60% fat.
40% is water, protein, carbs, and salts. Brains aren't muscles. It contains
blood vessels and nerves, including neurons and glial cells. The brain
sends and receives chemical and electrical signals throughout the body.
Your brain interprets signals controlling different processes. Others cause
pain or fatigue.

There are two

parts of the central
nervous system:
 30

gray matter and white matter. In the brain, gray matter refers to the darker outer
portion, while white matter describes the lighter inner section underneath. In the
spinal cord, the order is reversed: White matter is on the outside, and the gray
matter sits within.

Gray matter is primarily composed of neuron somas (the round

central cell bodies), and white matter is made chiefly of axons (the long
stems that connect neurons) wrapped in myelin (a protective coating). The
different composition of neuron parts makes the two appear as various
shades on specific scans.

MAIN PARTS OF THE BRAIN AND THEIR FUNCTIONS

At a high level, the brain can be divided into the cerebrum, brainstem and
cerebellum.

CEREBRUM

The cerebrum (front of the brain) contains gray and white matter.
The cerebrum controls movement and
temperature. Other cerebrum areas control
speech, judgment, thinking, reasoning,
problem-solving, emotions, and learning.
Other functions involve sight, hearing,
touch, and other senses.

Cerebral Cortex
 31

The cerebral cortex is divided into two hemispheres. It is covered

with ridges (gyri) and folds (sulci). A prominent, deep sulcus connects the
two parts of the head, from the

front to the back. The right hemisphere controls the body's left side of the body,
whereas the left half controls the right side of the body. The corpus callosum
connects the two halves of the brain.

The Corpus callosum is in the cerebrum.

BRAINSTEM

The brainstem (middle of brain)

connects the cerebrum with the spinal
cord. The brainstem includes the midbrain,
the pons and the medulla.

> Midbrain. Midbrain (mesencephalon) is a complex structure including neuron

clusters (nuclei and colliculi), neuronal connections, and other structures. These
characteristics facilitate hearing, mobility, reaction calculation, and environmental
change. The midbrain includes the substantia nigra, a region rich in dopamine
neurons and part of the basal ganglia that allows movement and coordination.

> Pons. The pons is the origin of four of the 12 cranial nerves, which
control tear formation, chewing, blinking, vision, balance, hearing, and
facial expressions. Named after the Latin word for "bridge," the pons
connect the midbrain and medulla.
> Medulla. At the bottom of the brainstem, the medulla joins the spinal
cord. The medulla is vital. The medulla regulates heartbeat, respiration,
blood flow, oxygen, and carbon dioxide levels. The medulla generates
sneezing, vomiting, coughing, and swallowing.
The spinal cord passes through a massive aperture in the skull
from the medulla. The spinal cord sends information to and from
the brain and the body.
 32

CEREBELLUM

The cerebellum ("small brain") is placed in the back of the skull,

below the temporal and occipital lobes, and above the brainstem. Like the
cerebral cortex, it has two hemispheres. The
inner part connects with the cerebral cortex. It
maintains posture, balance, and equilibrium by
coordinating voluntary muscle movements. New
studies examine the cerebellum's function in
thinking, emotions, and social interaction and its
likely relevance in addiction, autism, and schizophrenia.

LOBES OF THE BRAIN AND WHAT THEY CONTROL

Each brain hemisphere (parts of the cerebrum) has four sections, called lobes:
frontal, parietal, temporal and occipital. Each lobe controls specific functions
 33

> Frontal lobe. The largest lobe of the brain, located in the front of the head, the
frontal lobe is involved in personality characteristics, decision-making and
movement. Recognition of smell usually involves parts of the frontal lobe. The
frontal lobe contains Broca’s area, which is associated with speech ability.

> Parietal lobe. The middle part of the brain, the parietal lobe, helps a person
identify objects and understand spatial relationships (where one’s body is
compared with objects around the person). The parietal lobe is also involved in
interpreting pain and touch in the body. The parietal lobe houses Wernicke’s
area, which helps the brain understand spoken language.

> Occipital lobe. The occipital lobe is the back part of the brain that is involved
with vision.

> Temporal lobe. The sides of the brain, temporal lobes are involved in short-
term memory, speech, musical rhythm and some degree of smell recognition
 34

BRAIN CIRCULATION

Cerebral circulation is the

blood flow in your brain. It’s essential
for healthy brain function. Circulating
blood gives oxygen and nourishment
to your brain. Blood delivers oxygen
and glucose to your brain. Although
your brain is a small part of your
body’s total weight, it requires a lot
of energy to function. According to the UA Davis Lab, your brain needs
15% of your heart’s cardiac output for oxygen and glucose. It requires a lot
of blood to be healthy.

When this circulation is impaired, your brain can become damaged. Many
conditions and disabilities related to neurological function can occur as a result.

WHERE DID THE CIRCULATION START?

The arterial supply to the brain comes from two paired arteries:internal carotid
and vertebral. Each of these arteries has quite a long course as they extend
rostrally to the cranial vault. Let's start with the aorta, the main route that carries
blood away from your heart to the rest of your body.

AORTA

The aorta is the largest artery in the body.

The aorta begins at the top of the left ventricle,
the heart's muscular pumping chamber. The heart
pumps blood from the left ventricle into the aorta
through the aortic valve. Three leaflets on the
 35

aortic valve open and close with each heartbeat to allow a one-way flow of
blood.

So from the arc of the aorta, there are left and right common carotid
arteries and left and right subclavian arteries. Since we are focusing on
brain circulation, let’s proceed to the carotid arteries.

CAROTID ARTERY

The carotid arteries are major blood vessels in

the neck that supply blood to the brain, neck, and
face. There are two carotid arteries, one on the
right and one on the left. In the neck, each
carotid artery branches into two divisions:

 The internal carotid artery supplies blood to

the brain.

 The external carotid artery supplies blood

to the face and neck.

Like all arteries, the carotid arteries are made of

three layers of tissue:

 Intima, the smooth innermost layer

 Media, the muscular middle layer

 Adventitia, the outer layer

The carotid sinus, or carotid bulb, is a widening of a carotid artery at its main
branch point. The carotid sinus contains sensors that help regulate blood
pressure. The carotid artery pulse can usually be felt in the neck by pressing the
fingertips against the side of the windpipe or trachea.
 36

MIDDLE CEREBRAL ARTERY

The middle cerebral artery (MCA) is a

terminal branch of the internal carotid artery and
is part of the anterior cerebral circulation. The
MCA supplies many deep brain structures, the
majority of the lateral surface of the cerebral
hemispheres, and the temporal pole of the brain.
It travels from the base of the brain through the
lateral sulcus (of Sylvius) before terminating on
the lateral surface of the brain.

CIRCLE WIILS
The circle of Willis (cerebral arterial circle
or circulus arteriosus) is an anastomotic ring of
arteries located at the base of the brain. This
arterial anastomotic circle connects the two
major arterial systems to the brain, the internal
carotid arteries, and the vertebrobasilar
(vertebral and basilar arteries) systems. It is
formed by four paired vessels and a single
unpaired vessel with numerous branches that
supply the brain.

The primary function of the circle of Willis

is to provide a collateral blood flow between the
anterior and posterior arterial systems of the brain. Additionally, it offers
alternate blood flow pathways between the right and left cerebral
hemispheres. This way, the circle protects the brain from ischemia and
stroke in cases of vascular obstruction or damage.
 37

From the circle of willis the circulation will pass through the occipital area of the
brain to the basilar artery.

BASILAR ARTERY

The basilar artery is a blood vessel at the back of your brain. It supplies
oxygen-rich blood to portions of your brain and central nervous system.

The basilar is the main artery that carries blood to the back portion of your
brain. It forms when the blood vessels that extend through your spinal cord
(vertebral arteries) come together. The basilar artery and all its branches are
called the vertebrobasilar system.

The basilar artery carries oxygen-rich blood to the following:

 Brainstem, which regulates functions such

as heart rate, sleeping, and breathing.

 Cerebellum, which controls voluntary

functions such as movements, speech, and
balance.

 Occipital lobes, which help your brain

process what you see.

Your basilar artery has several branches:

 Cerebellar arteries connect the basilar artery

to the cerebellum.

 Pontine arteries connect the basilar artery to the pons, a group of nerves in
the brainstem that carries messages to different parts of your brain.

 Posterior cerebral arteries connect the basilar artery to your occipital lobes
and temporal lobes, which help you process sights and sounds.
 38

Any disruption to blood flow in your brain is an emergency. Brain cells can die
quickly without oxygen and other nutrients, leading to long-term brain damage.

If there's a disrupted blood flow in your brain, You could experience these
symptoms:

 Balance problems or sudden loss of coordination.

 Confusion or disorientation.

 Difficulty understanding others.

 New or sudden vision loss.

 Numbness or weakness in one arm, leg, or one side of your face.

 Severe headaches.

CEREBELLAR ARTERY

The cerebellum is mainly supplied by the following three long cerebellar arteries
arising from either the vertebral or basilar artery:

Posterior inferior cerebellar artery (PICA)

mainly supplies the inferior vermis, the inferior
and posterior part of the cerebellum, and the
lateral posterior medulla.

Superior cerebellar artery (SCA) supplies the

superior half of the cerebellar hemispheres, the
vermis, and the dentate nucleus.

Anterior inferior cerebellar artery (AICA) vascularizes the anterior part of the
cerebellum, the flocculus, and the middle cerebellar peduncles.
 39

These three cerebellar arteries also build a pial anastomotic network on the
surface of the cerebellum. In addition, the AICA often delivers blood supply to the
lower and the SCA to the upper part of the pontine tegmentum.

WHY BRAIN CIRCULATION IS IMPORTANT?

Cerebral circulation is the blood flow in your brain. It’s essential for healthy
brain function. Circulating blood supplies your brain with the oxygen and nutrients
it needs to function properly. Each individual needs good cerebral circulation to
provide our brain with oxygen- and nutrient-rich blood. Cerebral circulation helps
remove your brain’s carbon dioxide and other waste products. If your cerebral
circulation becomes impaired, it can lead to serious health issues, and one of
these severe health issues is stroke.

ISCHEMIC STROKE

This is the most common type of

stroke. It happens when the brain's blood
vessels become narrowed or blocked,
causing severely reduced blood flow
(ischemia). Blocked or narrowed blood
vessels are caused by fatty deposits that
build up in blood vessels or by blood clots or
other debris that travel through the
bloodstream, most often from the heart, and lodge in the blood vessels in the
brain.
 40

CHAPTER X

PATHOPHYSIOLOGY
 41

Prognosis

IF TREATED UNTREATED

Medical/Pharmacological

 Emergency IV
medications HEADACHE
 Emergency
endovascular
procedures
HYPERTENSION
 Beta-blocker drug
Nursing Management

 Monitor blood
pressure CARDIAC ARREST
 Administer
hypertensive
medications
 Instruct the patient DEATH
to avoid a high in
fat and maintain
healthy diet.
 Educate the
patient to reduce
the bad habit, for
not trigger the
disease.
 Encouraged to
exercise and
lessen the stress
to promote good
health.

GOOD PROGNOSIS
 42

Medical Management
To treat a CVD Infarct, doctors must quickly restore blood flow to the brain. This
may be done
with:
Emergency IV medication. Therapy with drugs that can break up a clot
has to be given within 4.5 hours from when symptoms first started if given
intravenously. The sooner these drugs are given, the better. Quick treatment not
only improves your chances of survival but also may reduce complications.

An IV injection of recombinant tissue plasminogen activator (TPA) — also

called alteplase (Activase) or tenecteplase (TNKase) — is the gold standard
treatment for ischemic stroke. An injection of TPA is usually given through a vein
in the arm within the first three hours. Sometimes, TPA can be given up to 4.5
hours after stroke symptoms started.

This drug restores blood flow by dissolving the blood clot causing the
stroke. By quickly removing the cause of the stroke, it may help people recover
more fully from a stroke. Your doctor will consider certain risks, such as potential
bleeding in the brain, to determine whether TPA is appropriate for you.

Emergency endovascular procedures. Doctors sometimes treat

ischemic strokes directly inside the blocked blood vessel. Endovascular therapy
has been shown to significantly improve outcomes and reduce long-term
disability after ischemic stroke.

These procedures must be performed as soon as possible:

 Medications delivered directly to the brain. Doctors insert a long, thin

tube (catheter) through an artery in the groin and thread it to the brain to
 43

deliver TPA directly where the stroke is happening. The time window for this
treatment is somewhat longer than for injected TPA but is still limited.

 Removing the clot with a stent retriever. Doctors can use a device
attached to a catheter to directly remove the clot from the blocked blood
vessel in the brain. This procedure is particularly beneficial for people with
large clots that can't be completely dissolved with TPA. This procedure is
often performed in combination with injected TPA.

The time window when these procedures can be considered has been expanding
due to newer imaging technology. Doctors may order perfusion imaging tests
(done with CT or MRI) to help determine how likely it is that someone can benefit
from endovascular therapy.

Other procedures

To decrease your risk of having another stroke or transient ischemic

attack, your doctor may recommend a procedure to open up an artery that's
narrowed by plaque. Options vary depending on the situation, but include:

 Carotid endarterectomy. Carotid arteries are the blood vessels that run
along each side of the neck, supplying the brain (carotid arteries) with blood.
This surgery removes the plaque blocking a carotid artery and may reduce
the risk of ischemic stroke. A carotid endarterectomy also involves risks,
especially for people with heart disease or other medical conditions.

 Angioplasty and stents. In an angioplasty, a surgeon threads a catheter to

the carotid arteries through an artery in the groin. A balloon is then inflated to
expand the narrowed artery. Then a stent can be inserted to support the
opened artery.

Based on the given case, the patient is not doing a healthy lifestyle.
Drinking alcohol at almost four glasses every day, has a great amount of salty
and fatty food intake, does not like vegetables, is physically and sexually inactive,
and has been a chain smoker for two decades. The client has hypertension and
 44

diabetes mellitus. The client’s parents were known to be hypertensive, and both
died from complications of cardiovascular diseases. The client’s father died from
a heart attack, and the mother died from a stroke. The client was experiencing
headaches, blurred vision, speech problems, weakness, and paralysis of the left
side of the body before being taken to the intensive care unit due to loss of
consciousness.
 45

CHAPTER XI

ETIOLOGY AND SYMPTOMATOLOGY

ETIOLOGY

BASIC
ETIOLOGY PRESENT
/ABSENT RATIONALE ACTUAL
PREDISPOSING

AGE Present The older you are, the ● 62 years

old
more likely you are to
have a stroke. The
chance of having a stroke
about doubles every 10
years after age of 55.
As we get older, our
arteries naturally become
narrower and harder.
They are also more likely
to become clogged with
fatty material, known as
atherosclerosis.

Reference:
George MG, Tong X,
Kuklina EV, Labarthe DR.
Trends in stroke
hospitalizations and
associated risk factors
among children and
 46

young adults, 1995–2008.

Annals of Neurology.
2011;70(5):713–21.

Gender Present Globally, the burden of ● Male

stroke has been
increasing in both males
and females, but it has
been greater in males.
This difference may be
because of the
improvements of more
women from stroke than
men in some countries
due to the sensitivity of
women to health
information, health-
seeking behaviours, and
early access to primary
prevention of stroke. The
other reason why stroke
is increased in men than
women is that
neurovascular risk factors
of stroke, such as
cigarette smoking, are
more common and
severe in males and
rapidly declined in
females.
 47

Reference:
Forster A, Gass A, Kern
R, et al. Gender
differences in acute
ischemic stroke: etiology,
stroke patterns and
response to
thrombolysis. Stroke.
2009;40(7):2428–2432.
doi:
10.1161/STROKEAHA.10
9.548750 [PubMed]
[CrossRef] [Google
Scholar]
Race or Present ● Asian
Ethnicity
Stroke epidemiology
studies in Asia have shown
varying levels of mortality,
incidence, prevalence, and
burden of disease. Mortality
rate and stroke burden
range from the lowest in
Japan 43.3 per 100 000
person‐years (burden
706.6/100 000 people) and
Singapore 47.9 per 100 000
person‐years (burden
804.2/100 000 people) to
the highest in Indonesia
193.3 per 100 000 person‐
years (burden
 48

3382.2/100 000 people)

and Mongolia 222.6 per
100 000 person‐years
(burden 4409.8/100 000
people), with hypertension,
diabetes mellitus, and
smoking as the main risk
factors.

The overall incidence of

stroke in Asia varied
between 116 and
483/100 000 per year. Apart
from vast differences
between countries, stroke
incidence also showed high
variation within countries,
for instance, the northern
area of China showed
higher incidence than the
southern area, being two
times higher in stroke belt
area, which is suspected to
occur due to high rates of
hypertension and obesity in
the area.

Reference:
George MG, Tong X,
Kuklina EV, Labarthe DR. ,
 49

et al
PRECIPITATING

Hypertension Present High blood pressure, also ● Increase cardiac

known as hypertension, is output (180/120)
the most important known
risk factor for stroke.
Blood pressure is a
measure of the force with
which blood presses on
the walls of your arteries
as it is pumped around
your body. This pumping
action is driven by your
heart.
Normal blood pressure is
around 120/80. If your
blood pressure is regularly
over 140/90, you have
high blood pressure.
High blood pressure puts a
strain on blood vessels all
over the body, including
the arteries that lead to the
brain. This means the
heart has to work much
harder to keep the blood
circulation going.
High blood pressure can
lead to a stroke in several
ways:
 50

It damages blood vessel

walls and makes them
weaker.
It can speed up common
forms of heart disease.
It can cause blood clots or
plaques to break off artery
walls and block a brain
artery.
The higher the blood
pressure, the greater the
stroke risk.

Reference:
Ching S, Chia YC, Chew
BN, et al.
Obesity Present Compared to normal ● loves to eat salty
and fatty foods in
weight individuals, obese
great amount,
individuals had 16% into fast food,
not into
increased risk of ischemic
vegetables,
stroke (HR 1.16, 95%CI
1.09–1.23), which was
significant after adjustment
for other metabolic
syndrome criteria, i.e.
elevated blood pressure,
glucose, or cholesterol
levels

Reference:
Wang C, Liu Y, Yang Q,
 51

Dai X, Wu S, Wang W, et
al.
Diabetes Present Diabetes is an important ● High fat diet
modifiable risk factor for ● Alcohol
stroke, especially ischemic consumption
strokes. Hyperglycemia (four glasses
during the acute stroke almost everyday)
phase is associated with
poor outcomes in both
ischemic and hemorrhagic
strokes.

Reference:
Heidenreich PA, Trogdon
JG, Khavjou OA, et al.
Forecasting the future of
cardiovascular disease in
the United States: a policy
statement from the
American Heart
Association. Circulation.
2011;123:933–944.
Smoking Cigarette smoking is a ● Chainsmoker
known risk factor for (for two
cardiovascular disease, decades)
including ischemic stroke.
The literature regarding
the rate of persistent
smoking after acute
ischemic stroke and its
effect on subsequent
 52

cardiovascular events is
scarce.

Reference:
O’Donnell MJ, Chin SL,
Rangarajan S, Xavier D,
Liu L, Zhang H, Rao-
Melacini P, Zhang X, Pais
P, Agapay S, et al;
 53

CHAPTER XI
DOCTOR’S ORDER

Date & Time Procedures Medications Remarks

10/15/23 -Brought to ER due - Administered -BP monitoring

2:00PM to headache, vision done done every

clonidine
blurrspeech 30mins latest
75mcg BP= 170/100
problem,
weakness, and (sublingual) for 3 Monitored for
paralysis of the left SpO2
doses as
side of the body.
prescribed SpO2 down to
- BP: 180/120
by the doctor 82%
mmHg

- SPO2: 84%
2:50PM - Patient was
- PR: 87 bpm
hooked
- RR: 30 bpm
- T: 36.7 to oxygen via face

mask
3:20PM
- Doctor 4-6 LPM
ordered for
then later on was
Laboratory
tests intubated;
3:30PM
Endotracheal tube
- Doctor
was connected to
ordered for
ct scan: ct ambubag–
3:50PM
scan done
ambubagging
done
 54

- Doctor - Doctor
prescribed insulin
ordered for
respiratory
test
- Patient loss
consciousness

4:20PM - Checked for

vital signs

- BP: 160/90

- PR: 85
bpm

- RR: 30
bpm

- T: 36.6

- Checked
blood sugar
level 458
mg/dL

- Patient
transferred to
ICU for close
monitoring
 55

- inserted ngt
and urinary
catheter
 56

CHAPTER XII

DIAGNOSTIC EXAM

LABORATO ACTU NORMAL ANALYSIS/ REFERENCE

RY/ AL VALUE INFERENCE
DIAGNOSTI RESU
C TEST LT

Blockage or

CT scan No presence ruptures in the Neuroanato

Blood clot
of tumors, MCA lead to loss my, Middle
formation in
blood clots, of blood, oxygen, Cerebral
the middle
fractures,and and nutrients can Artery
cerebral
other atypical cause brain
artery https://
characteristic damage and impair
www.nc
s function in the
bi.nlm.nih.gov/
regions that get
books/NBK52
blood from the
6002/
MCA.

Medicine
Plus.2020.
Creatine
Ck-MB Test 20 IU/L 5 to 25 IU/ NORMAL Kinase.
L
Available
from:
https://medlin
e
plus.gov/lab-
te
sts/creatine-
kin ase/

Troponin: HIGH Cleveland

 57

Clinic.
If high levels of
troponin are found 2022.
Troponin Troponin I:
in one or more Troponin
Test 0.24mg/ml
Troponin tests over time, the Test.
I: 0 to 0.04 patient most likely Available
ng/mL had a heart attack. from:
Troponin T:
https://my.cle
0.13 mg/ml
v
Other causes of elandclinic.or
elevated troponin g/
levels include: health/diagno
st ics/22770-
● Heart
trop onin-test
failure
congestive

● Kidney
failure
● A blood clot
has formed
in your
lungs.

Triglycerides:
HIGH
JohnHopkin
Triglyceri Triglyceride
des: Less s Medicine.
than 150 levels that are 2022. Liquid
Lipid Triglycerid mg/dL higher than Panel.Availa
Profile es: 282 normal may ble
Test: mg/mL
indicate that the from:https://
Cholester
ol: Less patient is at a www.ho
Cholestero than 200 higher risk of pkinsmedici
l: 274 mg/dL
heart disease, ne.
mg/mL
 58

stroke, and other org/health/tr

LDL: LDL: artery-related eat ment-

conditions. tests-and-
145mg/mL Less than therapies/lip

HDL: 100mg/d id- panel

Cholesterol:
28mg/mL L HDL: HIGH
Medicine
60mg/dL Cholesterol levels
Plus. 2022.
that are higher
and Triglyceride
than normal may
mean that the s Test.
higher
patient has heart Available

disease. from
https://medli
ne
LDL: plus.gov/lab
BORDERLINE -te
HIGH sts/triglyceri
de s-test/:

Increase the LDL

cholesterol by
following a
healthy diet.
Choose meals
that are abundant
The
in fiber,
Cholesterol
antioxidants, and
Charity.
omega-3 fatty
acids and low Available

in saturated and from:

 59

trans fats for the https://ww

most impact. w.he

artuk.org.u
k/ge netic-
HDL: VERY LOW condition
s/low-hdl-
Lower HDL
chol esterol
cholesterol levels
may be due to an
underlying cause,
such as a health
problem or
certain
medications.
 60

CHAPTER XIV

SURGICAL PROCEDURE

a medical procedure involving an incision with instruments; performed to

repair damage or arrest disease in a living body.

NO SURGICAL PROCEDURE
 61

CHAPTER XV

NURSING THEORY
Transitions Theory

Patients, families and health systems encounter and face many changes
that prompt processes and strategies for coping with these changes and their
aftermath.

The transition experience starts before an event and has an ending point
that varies based on numerous variables. Understanding the nature of and
responses to change, facilitating the experience and responding to its different
phases, and promoting health and well being prior to, during and at the end of
the change event, is what prompts the utilization of Transitions Theory. It
provides a framework that generates research questions and guides effective
care prior to, during and after the transition. Transition Theory evolved from
clinical practice, supported by research evidence and provides a framework for
application in practice, research and theory building.

In this case, the first thing that a nurse could do is the first intervention
made to facilitate transition and promote well-being and mastery of change
consequences. This includes conceptually supporting systems through significant
others as well as a care team of advanced practice nurses. The goals are to
clarify what the patient is experiencing at the moment as well as what the patient
may experience subsequently by providing knowledge, skills, strategies and
tangible and psycho social competencies to deal with the transition experience
and responses.

The second and most important part is an understanding of the transition

experience itself, for patients and significant others, which is defined as the
experience during a passage from one state to another state. But those
experiences and responses are defined by whether the transition triggers are
developmental (becoming an adolescent, becoming a new parent), health and
illness (from healthy to acute, from healthy to chronic), situational (natural
 62

disasters, divorce) or organizational (changes in leadership or staffing patterns,

new policies or technology). It is also mediated by whether the person is going
through single or multiple transitions, the meaning they impute on the transition
and what else may be going on in the life of the person. There are many
conditions (personal, community, society, global) that exacerbate or ameliorate
responses to transitions.

In this case, the patient have a hard time coping with the fast transition of
his life with the limit of stressors with the nature of his job and most specially with
his condition. The goal of this theory is to help the patient through this rough
times and his journey fighting this disease that he could able to win this
challenges he is facing.

The Self-Care Deficit Theory

The model interrelates concepts in such a way as to create a different way

of looking at a particular phenomenon. The theory is relatively simple, but
generalize to apply to a wide variety of patients. It can be used by nurses to
guide and improve practice, but it must be consistent with other validated
theories, laws and principles.

The theory of self-care includes self-care, which is the practice of activities

that an individual initiates and performs on his or her own behalf to maintain life,
health, and well-being; self-care agency, which is a human ability that is “the
ability for engaging in self-care,” conditioned by age, developmental state, life
experience, sociocultural orientation, health, and available resources; therapeutic
self-care demand, which is the total self-care actions to be performed over a
specific duration to meet self-care requisites by using valid methods and related
sets of operations and actions; and self-care requisites, which include the
categories of universal, developmental, and health deviation self-care requisites.
 63

In this case, the theory can be used by guiding and helping the patient
improve his self-care. Since then the patient has a very busy life because of his
chosen profession that he cannot take care of his life properly or ever pamper
himself from time to time. Hectic schedule and stressful environment prevent him
from taking care of his own life well. As a nurse it is our responsibility to guide
and teach them by health teaching and various activities that could help them
improve their daily self-care.

Also in this theory Orem’s discuss about the Universal self-care requisites
are associated with life processes, as well as the maintenance of the integrity of
human structure and functioning. Orem identifies these requisites, also called
activities of daily living, or ADLs, as: the maintenance of sufficient intake of air,
food, and water ; the patient did not able to do this ADL specially the sufficient
intake of air with the nature of his work that he spend a lot of time in his office
analyzing and understanding different cases. The second one is a balance
between activities and rest, as well as between solitude and social interaction in
this requisites Patient KD didn’t have much time for rest because the fact that
being an attorney requires a lot of time just for one case and as well as his social
life with his friends, family and love ones.

In conclusion, the patient didn’t took good care of himself and also
experiencing self-care deficit. The Self-care Deficit Theory will help as nurses
guide the patient throughout his recovery.

Nursing Needs Theory by Virginia Henderson

The Nursing Need Theory was created by Virginia Henderson to describe

the special focus of nursing practice. The approach emphasizes how critical it is
for patients to become more independent in order to speed up their recovery.
Henderson's philosophy focuses on the fundamental needs of people and how
nurses might address them.
 64

In this case, the theory can be used by applying one of the major
assumptions where nurses care for patients until the patient can care for
themselves once again. Since Patient KD is not conscious, it is the nurse’s
responsibility to care for him when he cannot take care of himself. When
someone is unconscious, they are unable to move with purpose and are ignorant
of their surroundings. The fundamental rule to keep in mind is that the fact that
an unconscious patient is entirely dependent on others to meet all of his
requirements denotes a fundamental brain disorder. Patients desire to return to
health, but this assumption is not explicitly stated. Virginia Henderson’s emphasis
on basic human needs as the central focus of nursing practice has led to further
theory development regarding the needs of the person and how nursing can
assist in meeting those needs.

Virginia Henderson proposed that caring for the patient’s basic human
needs is essential and that nurses can help to meet those needs. The theory
covered the following four key ideas: environment, health, the individual, and
nursing. Although she does not describe the environment specifically, she claims
that it should be encouraging. Health, according to Henderson, is a state of
equilibrium in all facets of life and is closely related to independence. According
to her idea, the individual has fundamental needs that contribute to health and
must be satisfied in order to provide the desired nursing outcomes. It's interesting
to note that she doesn't merely think of patients as those who are ill.

Additionally, according to this theory, the nurse's primary role is to assist

people who are unable to satisfy one or more of Henderson's 14 demands. The
fourteen elements of the need theory are made up of these needs. However,
since the patient is in a comatose state, we can only apply the Nursing Needs
Theory’s first category which concerns the physiological state of the patient. This
includes the need to breathe normally, eat and drink adequately, eliminate body
wastes, move and stand with the desired posture, rest and sleep, dress and
undress in the desired clothes, maintain the required body temperature through
clothes adjustment or environment adjustment, cleanliness, grooming, and skin
 65

protection, and lastly, the need to avoid dangers from the environment, and
possible injury to people around the patient. These components show a holistic
approach to nursing that covers the physiological aspect of the patient’s needs.
Although the nurse is responsible for carrying out a doctor's therapy plan,
individualized care is the product of the nurse's innovative care planning. As long
as the nurse does not diagnose, prescribe therapy, or make a prognosis, which
are tasks that belong to the doctor, the nurse should be an autonomous
practitioner with the ability to reach independent decisions.

In conclusion, the Nursing Needs Theory is relatively simple, logical, and

applied to individuals of all ages. The patient KD who is unconscious requires
extensive support and a great deal of close monitoring. The goal of daily care is
to keep patients who is unconscious in a comfortable position with healthy skin,
clear lungs, and enough fluid administration.
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CHAPTER XVII
DISCHARGE PLAN (M.E.T.H.O.D)
MEDICINE

MEDICATION INSTRUCTION INFERENCE

Rosuvastatin Once a day; 20mg PO To prevent

cardiovascular disease

Nimodipine Four times a day; 60mg To treat Subarachnoid

tablets PO hemorrhage

EXERCISE

 Consult a PT for stroke rehabilitation

 Passive Exercises

 Mental Practice

 Stretching

TREATMENT
 Ask patient to monitor their oxygen saturation levels with a pulse
oximeter

 Oxygen Therapy

 Educate patient on warning signs that indicates they need to go back to

the hospital

 Advise patient to take medications as prescribed

 Refer patient to a PT for stroke rehabilitation

 Convince patient to stick with diet plan

HEALTH TEACHING

 Cardiac Rehabilitation Program

 Versatile and broaden the palate with vegetables and fruits

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 Don’t smoke and drink

 Importance the need of cutting down fast food, salty foods, and high fat
foods

 Never forget to checkup and maintenance

 Follow the doctor's order for home care service

 Always take medications on time

 Recognize the signs and symptoms that would indicate the patient need
to go to the hospital

 Carry out an exercise plan

 Talk to loved ones and those who can help throughout the patients illness

OUTPATIENT/FOLLOW UP

1. First follow up 01/22/2024

2. Second follow up 02/22/2024

3. Third follow up 03/22/2024

DIET

 Low fat, Low sodium diet

 Diet rich in vegetables, fruits, and whole grains

 Limit foods high in saturated fats

 Eat foods like fish, poultry, and beans

 Low-fat or fat-free dairy foods

 Limit intake on saturated and trans-fats and cholesterol

 Choose high fiber foods

 Reduce sugar intake

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CHAPTER XVIII

RECOMMENDATION
Based on the outcome of this study, the following will be benefited to the
following:

Community. This study will be advantageous in the community since it

focuses on community-based interventions for CVD Infarct prevention,
management, and outcomes, and contributes to evidence-based nursing practice
in the community setting.

Patient. This study can help patients with CVD Infarct to effectively
manage the condition, promote healing, prevent recurrence, raising awareness
and achieve the best possible outcomes. It is important for them to always
consult with a qualified healthcare provider for personalized medical advice and
treatment.

Nurses. This study is very important for the nurses so that they can
provide safe, effective, and patient-centered care for patients with CVD Infarct ,
promoting healing, preventing complications, and optimizing patient outcomes. It
is important for nurses to always work within the scope of nursing practice and
collaborate closely with the healthcare team for comprehensive patient care.

Future researcher. These can serve as a guide for the future researchers
in conducting research that advances the understanding of CVD Infarct.
 69

CHAPTER XIX

DEFINITION OF TERMS

Distended - swollen and large in a way that is not normal, especially because of
pressure from inside

Brain - regulates thought, memory, emotion, touch, motor skills, vision,

breathing,temperature, and hunger.

Cerebrum - cerebrum (front of the brain) contains gray and white matter. The
cerebrum controls movement and temperature.

Cerebral infarction – A stroke caused by interruption or blockage of blood flow

to the brain; also called ischemic stroke.

Glasgow Coma Scale is a tool experts use to “score” losses of consciousness.

Hemorrhagic stroke- due to bleeding into the brain by the rupture of a blood
vessel.

Intensive Care Unit (ICU)- is a separate, self-contained area within a medical

facility, equipped with high-tech specialised facilities designed for close
monitoring, rapid intervention and often extended treatment of patients with acute
organ dysfunction.

Ischemia- a condition in which blood flow (and thus oxygen) is restricted or

reduced in a part of the body.

Ischemic stroke- occurs when a blood clot, known as a thrombus, blocks or

plugs an artery leading to the brain.

Loss of consciousness- is a partial or complete loss of the perception of

yourself and all that around you.
 70

Race - is a social construct used to group people. Race was constructed as a

hierarchal human-grouping system, generating racial classifications to identify,
distinguish and marginalize some groups across nations, regions and the world.

Smoking - the act of inhaling and exhaling the fumes of burning plant material.

Transient ischemic attack- a stroke that lasts only a few minutes. It occurs
when the blood supply to part of the brain is briefly interrupted.

Obesity - defined as abnormal or excessive fat accumulation that presents a

risk to health. A body mass index (BMI) over 25 is considered overweight, and
over 30 is obese.

Weak- lacking the power to perform physically demanding tasks

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REFERENCE

Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie,
KL, et al. Guidelines for the prevention of stroke in women: a statement for
healthcare professionals from the American Heart Association/American Stroke
Association. Stroke. 2014;45(5):1545–88.
Collantes MEV, Zuñiga YMH, Uezono DR. Incidence and Prevalence of
Stroke and its Risk Factors in the Philippines: A Systematic Review. Acta Med
Philipp [Internet]. 2022Aug.15 [cited 2023Dec.1];56(14).

George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke

hospitalizations and associated risk factors among children and young adults,
1995–2008. Annals of Neurology. 2011;70(5):713–21.

Heart and Stroke Foundation of Canada. Ottawa. Ottawa: Heart and

Stroke Foundation of Canada; 2018. 2018 stroke report - lives disrupted: the
impact of stroke on women. [Google Scholar]

Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of
cardiovascular disease in the United States: a policy statement from the
American Heart Association. Circulation. 2011;123:933–944.

Henderson's Nursing Need Theory - Nursing Theory (nursing-theory.org)

O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-

Melacini P, Zhang X, Pais P, Agapay S, et al;

Orem's Self-Care Deficit Nursing Theory - Nursing Theory (nursing-

theory.org)