A case study on a Patient Diagnosed with

Cardioembolic Stroke, Cardiac Arrhythmia,

Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional
Class IV, and Aspiration Pneumonia
Presented by : Group 3 BSN-4
CHAPTER I
Introduction
Background
- Stroke is also referred to as Cerebro-Vascular Accident (CVA) or "brain
attack." A stroke is the loss of brain function brought on by an issue with
the brain's blood flow. It happens when a blood clot restricts blood flow in
an artery or vessel or when a blood vessel bursts, cutting off blood supply
to a portion of the brain. Both of these events cause the death of brain cells

- From 2009 to 2019, stroke continued to be the second most significant

cause of death and one of the top five major causes of disability in the
Philippines, according to the Institute of Health Metrics (February 2021).
Background
- According to Georgia Rural Health in 2019, the condition of stroke
is treatable and preventable. Unfortunately, stroke patients and
their families may face lifelong difficulties. An arm, hand, or leg
weakness in a stroke victim can make daily activities very
challenging. Both patients and their care providers may experience
depression following a stroke, which can have an impact on
personality. After a stroke, these alterations may be permanent
(although they may get better over time), which is why stroke
prevention is so important.
Background
- The conductors pursue this case study to enhance their understanding on
the disease process of CVA and to identify the nursing needs of the client
in order for them to formulate nursing diagnosis and provide
comprehensive nursing care to patient.
STATEMENT OF THE PROBLEM
-This study aims to determine the status of the holistic health of our
selected patient who is diagnosed with Cardioembolic Stroke,
Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and
Aspiration Pneumonia
OBJECTIVE OF THIS STUDY
General Objectives
-This case study will help student nurses to enhance our
understanding on the disease process of CVA, its nursing
management and paves a way to us student-nurses appreciate our
roles of being health care providers in the country’s quest for health
progress and development.
OBJECTIVE OF THIS STUDY
Specific Objectives
At the end of this study, the researchers aim to:

• To perform a health assessment of the client with cerebrovascular accident.

• To identify the nursing needs of the client with cerebrovascular accident.
• To formulate nursing diagnosis for the client with cerebrovascular accident.
• To provide comprehensive nursing care to patient with cerebrovascular accident
• To learn about cerebrovascular accident and its management in detail.
• To identify and prevent complication.
• To teach family members and patients in detail about follow-up care.
SIGNIFICANCE OF THE STUDY
This case study will be favorable to the following:

-Student Nurses. This could also hold more promise in contribution to nursing
education since student nurses could also be more in tune with having to treat the
process with maximum efficiency, and convenience if given an opportunity of taking
care Cerebrovascular Accident (Stroke) Patients.
SIGNIFICANCE OF THE STUDY
This case study will be favorable to the following:

- People Risk for CVA. This study will help them understand more about
Cerebrovascular Accident and help them know what are the effects and address its
underlying experiences for people who experienced CVA.

- Future Researchers. This study will help the future researchers to have a basis
regarding the conditions and experiences of Cerebrovascular Accident (Stroke)
Patients.
RELATED LITERATURE
A study conducted by Brass in 2014 stated that an abrupt loss
of function brought on by an interruption in the blood flow to a
portion of the brain is known as a cerebrovascular accident. When
the arteries leading to the brain are clogged or burst, it results in a
stroke, also known as a brain attack or an ischemic stroke. A stroke
can result in paralysis, a loss of the capability to speak or
understand, 5 and other diseases brought on by brain damage
when the brain does not get the necessary amount of oxygen.
Types of Strokes
Ischemic Strokes
- Abiodun Stated in 2018 that About 70% of strokes are ischemic strokes, which are
brought on by a lack of blood supply to the brain. There are several stroke subtypes
that fall under the umbrella of ischemia.

- One prevalent type is cerebral athero-thrombosis (also known as large artery

disease), which is brought on by a thrombus that prevents blood from flowing
through an artery.
Types of Strokes
Ischemic Strokes
- Other one is Embolic, Embolic strokes are usually caused by a blood clot that
forms elsewhere in the body (embolus) and travels through the bloodstream to the
brain. Embolic strokes often result from heart disease or heart surgery and occur
rapidly and without any warning signs. About 15% of embolic strokes occur in people
with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers
of the heart do not beat effectively (Brass, 2014).
Types of Strokes
Hemorrhagic Stroke

- This type of stroke is where blood leaks through a blood artery wall into the brain or
the area surrounding the brain (intra-cerebral hemorrhage) (subarachnoid
hemorrhage). When a person has an intra-cerebral hemorrhagic stroke, blood seeps
from tiny brain-base arteries

- Abiodun A. in 2018 stated that persistently high blood pressure weakens these tiny
arteries' walls, leading to their eventual rupture. Diabetes and atherosclerosis
exacerbate the damage; around two-thirds of individuals with an intra-cerebral
hemorrhage have a history of hypertension.
Epidemiology, Incidence and Prevalence
of Stroke
-From 2009 to 2019, stroke continued to be the second most significant
cause of death and one of the top five major causes of disability in the
Philippines, according to the Institute of Health Metrics (February 2021).

-Although stated estimates range from 0.9% (2005) (Navarro et al., 2014)
to 2.6% (2017) of the population, the actual prevalence of stroke is
unknown (Castillo et al., 2019).
Epidemiology, Incidence and Prevalence
of Stroke
- According to the varieties of strokes, ischemic strokes account for seven
out of ten instances, while hemorrhagic strokes account for the remaining
three (Navarro et al., 2014).

-The latest WHO figures show that 74,167 stroke deaths—or 11.0% of all
deaths—occurred in the Philippines in 2020.
Risk Factors for Strokes

- High blood pressure, heart disease, smoking, diabetes,

cholesterol, obesity, inactivity, oral contraceptives, estrogen
replacement therapy, history of ischemic attacks, heredity and
family history, age, an earlier stroke, carotid bruit, race, and an
elevated hematocrit (number of red cells in the blood) are just a few
of the risk factors for stroke (Abiodun A., 2018).
THEORETICAL FRAMEWORK

Care, Cure, Core Theory

-This study was anchored on the Care, Cure, Core Theory of Lydia Hall. According
to Lydia Hall's theory, nursing is defined as "participation in the care, core, and cure
components of patient care, where the CORE and CURE are shared with other
medical team members, but the CARE is the primary responsibility of nurses." The
main objective of treatment is to get to know the patient as a person in order to
assist the growth of the core (Gonzalo, 2021)
THEORETICAL FRAMEWORK

Care, Cure, Core Theory

-The following are the presumptions made by Hall in her Care, Cure, Core Theory:
First, the patient possesses the drive and energy required for healing, not the
medical staff. Second, rather than being seen as operating separately, the three
components of nursing should be seen as being interconnected. Third and last,
when the patient's overall progress is considered, the three elements interact, and
the circles that symbolize them alter in size (Gonzalo, 2021).
THEORETICAL FRAMEWORK

Care, Cure, Core Theory

-For instance, during the care phase, the nurse assists the patient with everyday
routines like showering and using the restroom. In the healing stage, the nurse treats
the patient using their medical expertise. The nurse attends to the patient's social
and emotional requirements for comfortable surroundings and successful
communication throughout the core period.
THEORETICAL FRAMEWORK

Comfort Theory

-In addition, it was also based on the Comfort Theory of Katherine Kolcaba. It was a
middle-range theory for health practice, education, and research.

-For nursing, comfort was a very important concept, and this theory was meant to
provide patients with comfort. When they were relaxed, they felt better.
THEORETICAL FRAMEWORK

Comfort Theory

-There are three types of comfort which were relief, ease, and transcendence. Relief
referred to a patient who fulfilled a particular need; ease referred to the state of
relaxation and lastly, transcendence is that state in which one rises above the
difficulties experienced.
THEORETICAL FRAMEWORK

Comfort Theory

-These types of comfort may occur in four contexts. First, the physical context
referred to a person’s bodily sensations. Second, the psychospiritual context related
to the inner consciousness of oneself, including esteem, concept, sexuality, and
meaning in one’s life and one’s relationship to a higher being. Third, the environment
referred to the external surroundings, conditions, and influences. Lastly, social
referred to interpersonal, family, and societal relationships (Alligood, 2018).
THEORETICAL FRAMEWORK

Adaptation Model

-Adaptation Model of Sister Callista Roy is also utilized in this study. In her theory,
she saw humans as a collection of interrelated systems that aim to maintain a
balance between different stimuli.

-Roy explained that adaptation happens when people react positively to changes in
the environment and that it was the process and outcome of individuals and groups
who used conscious awareness, self-reflection, and choice to create human and
environmental integration (Gonzalo, 2019).
THEORETICAL FRAMEWORK

The abovementioned theories support this case study on a patient

diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial
Fibrillation, Hypertensive Cardiovascular Disease, Coronary Artery
Disease, Functional Class IV, and Aspiration Pneumonia. In comparison,
one of the objectives of this study is to identify the client's nursing needs
and provide comprehensive nursing care to this patient. Thus, by following
the abovementioned theories, we can ensure that the nursing interventions
we perform for the client are all appropriate and provide quality care.
CONCEPTUAL FRAMEWORK
The figure presented below shows the direct relationship between the variables in this
case study to better analyze and understand the study.
CHAPTER II
Methodology
Design
- In this study, the illustrative case study approach was used. Descriptive studies that
show one or more aspects of an event's conditions to clarify the situation are known
as illustrative case studies. This kind of case study describes a scenario or
phenomenon, what is occurring with it, and why it is happening, according to Hayes,
Kyer, and Weber (2015).

- Thus, this method is suitable in our case study since this study will give
enlightenment to the curiosity of many people most especially those people who are
at risk for Cardiovascular Accident (Stroke).
Design
- This study will also help student nurses to enhance our understanding on
the disease process of CVA, its nursing management and paves a way to
us student-nurses appreciate our roles of being health care providers in the
country’s quest for health progress and development.
Setting
- This case study was conducted at the St. Camillus Hospital of Mati City
located at Barangay Central, Madang, Mati City, Davao Oriental. St.
Camillus is a level 1 hospital owned & managed by the Camillians, whose
mission is to provide humanized care. This hospital is where the participant
of this case study was confined due to her illness, thus, making this
hospital our research locale.
Participant
- The participant of this study is a 79-year-old female patient who is
confined in St. Camillus Hospital Mati City. She has a final diagnosis of
Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive
Cardiovascular Disease, Coronary Artery Disease, Functional Class IV, and
Aspiration Pneumonia. Thus, making her more suitable for our case study
about Cerebrovascular Accidents (Stroke).
Measures
- For this case study, it is imperative to use data-collecting procedures,
gather necessary background knowledge on the case, and maintain access
to or engagement with the case. The Components of Health History, Vital
Signs, Laboratory Results, and Client Records are the measures in this
Case Study of Cerebrovascular Accidents (Stroke) that we've conducted.
Procedure
-First thing the researchers do is ask permission to the attendant of the patient since
the patient's chief complaint in admission is Altered Sensorium, and she is
unconscious, we, the conductors of this study, are unable to interview her.

-Finding the patient's main complaint—an altered sensorium— comes next. Going
deeper into a detailed investigation of the patient's complaint and problem. A
thorough interview with her attendant includes questions about the patient's previous
health history and current health history.
Procedure
- Thirdly, the researchers rewrote the information in the patient's record to
collect data on her vital signs, radiologic tests, including an X-ray report
and an electrocardiogram, and laboratory findings. For instance, the
Complete Blood Count (CBC), Chemistry, Urinalysis, and Serum Typing
findings were included.

- Fourth, after obtaining all the data, the researchers then organized and
analyzed all the data that has been collected.
Procedure
- Fifth, we then finalized all the data and made a discussion of the results
out of it.

- Then, the researchers then formulated drug study about the medications
administered to the Client.

- Afterwards, the researchers initiated to create Nursing Care Plan for the
client.

- Lastly, the researchers then formulated the summary, conclusion, and

recommendation for this case study.
Data Analysis
- The gathered data was evaluated and analyzed to understand further this
case study's dilemma in relation to its medical diagnosis. The causative
factors based on the patient's and family's health history were emphasized
to evaluate the contributing factors to its occurrence.

- The laboratory results were also analyzed, indicating how they affected
the patient's medical condition.
Data Analysis
- In terms of developing the nursing care plan, the researcher
considered the chief complaints of the patient as evidenced by vital
signs and laboratory results irregularities.
- The growth and development were included in addition to
determining how the patient responded and managed the dilemma
during the terminal stage considering its sociodemographic status.
Data Analysis
- In terms of developing the nursing care plan, the researcher
considered the chief complaints of the patient as evidenced by vital
signs and laboratory results irregularities.
- The growth and development were included in addition to
determining how the patient responded and managed the dilemma
during the terminal stage considering its sociodemographic status.
CHAPTER IV
Discussion
Discussion
- The main purpose of this study was to determine the pathophysiologic factors as
the patient was diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial
Fibrillation, Hypertensive Cardiovascular Disease, Coronary Artery Disease,
Functional Class IV, and Aspiration Pneumonia.

- According to the patient's medical chart, a cerebrovascular accident described by

Patient S's abrupt loss of function due to a disruption in the blood supply to a part of
the brain.
Discussion
- A stroke can result in various illnesses like paralysis, loss of speech or
understanding, and paralysis that are brought on by brain damage when
the brain does not receive enough oxygen. Cardioembolic Stroke, Cardiac
Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular Disease,
Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia
are all part of Patient S's final diagnosis.
Discussion
- Several conditions that increase the risk of stroke include high
blood pressure, heart disease, smoking, diabetes, cholesterol,
obesity, inactivity, oral contraceptives, estrogen replacement
therapy, a history of ischemic attacks, heredity and family history,
age, an earlier stroke, carotid bruit, race, and an elevated
hematocrit (the percentage of red blood cells in the blood).
Discussion (Cardioembolic Stroke )
- Cardioembolic stroke is defined as the presence of a potential
intracardiac source of embolism in the absence of cerebrovascular
disease in a patient with non-lacunar stroke.
- It is responsible for approximately 20% of all ischemic strokes (L.
Marcoff, S. Homma, 2017). Cardiac embolism accounts for an
increasing proportion of ischemic strokes and might multiply
several folds during the next decades.
Discussion (Cardiac Arrhythmia)
- This a type of condition in which the heart's normal rhythm is
disrupted. Cardiac arrhythmias are associated with abnormal
initiation of a wave of cardiac excitation, abnormal propagation of a
wave of cardiac excitation, or some combination of the two.
- Cardiac arrhythmias can manifest themselves in many different
ways, and it is still not always possible to determine the mechanism
of an arrhythmia.
Discussion (Atrial Fibrillation)
- One of the risk factors for Cardioembolic stroke is atrial fibrillation.
AF is a disorder of heart rhythm that affects 33 million people
worldwide. AF is associated with a 3- to 5-fold increased risk of
stroke.
- Patients who remain in atrial fibrillation and develop hemodynamic
unstability due to rapid ventricular rates should undergo emergency
cardioversion (Lip, G. Y., & Tse, H. F. 2007)
Discussion (Hypertensive Cardiovascular Disease )
- Hypertensive crisis can be further classified as a hypertensive
urgency or hypertensive emergency depending on end-organ
involvement including cardiac, renal, and neurologic injury.
- The prompt recognition of a hypertensive emergency with the
appropriate diagnostic tests and triage will lead to the adequate
reduction of blood pressure, ameliorating the incidence of fatal
outcomes (Rodriguez, M. A., Kumar, S. K., & De Caro, M. 2010).
Discussion (Coronary Artery Disease)
- It is projected that CAD will be the leading cause of death in developing
countries by the year 2020. Identification of risk factors for CAD, namely
diabetes, genetics, hypercholesterolemia, hypertension, and smoking, has
led to successful preventive efforts in industrialized nations (Okrainec, K.,
et. al., 2004).

- Coronary artery disease is a common heart condition that involves

atherosclerotic plaque formation in the vessel lumen. This leads to
impairment in blood flow and thus oxygen delivery to the myocardium.
Discussion (Functional Class IV)
- A rare, life-threatening lung illness that affects the pulmonary arteries,
which are responsible for carrying the blood from the right heart ventricle to
the lungs. The condition is characterized by high blood pressure in the
lungs, leading to the pulmonary arteries becoming restricted and thickened.

- The pulmonary hypertension functional classification divides the stages of

the disease into classes, helping physicians identify and diagnose the
disease earlier and more effectively.
Discussion (Aspiration Pneumonia )
- Aspiration pneumonia is the most common type of community-
acquired and healthcare-associated pneumonia, and it is a primary
cause of death in the elderly population. The infectious pulmonary
process that occurs after abnormal entry of fluids into the lower
respiratory tract is termed aspiration pneumonia.
- The aspirated fluid can be oropharyngeal secretions, particulate
matter, or can also be gastric content.
 CHAPTER V
Summary, Conclusion, and
Recommendations
Summary
- Patient S arrived in the hospital with altered sensorium as chief complaint
along with the decreased in level of consciousness.

- The patient's history record of illness presented of known hypertension

and diabetes with no history of cerebrovascular accident and myocardial
infarction and reveals drowsiness in general physical examination.

- Hence, the admitting diagnosis of patient S was Community Acquired

Pneumonia-Moderate Risk; to consider Cerebrovascular Disease.
Summary
- The vital signs of patient S presented all normal except for the slightly
elevated blood pressure and respiratory rate.

- In response to optimizing patient's health, nurses provide care

management which involve monitoring vital signs including neuro vital
signs, providing NGT feeding, administering prescribed drugs, maintaining
hygiene, and promoting health education to the significant others to
alleviate the patient's condition.
Conclusion
- The findings from diagnostic tests presented that patient S have atrial
fibrillation and hypertension that manifested in cardiac arrhythmias which
trigger 76 cardiovascular accident.
- The researchers conclude that patient S had a cardioembolic stroke
based on the sign and symptoms and gathered data. In this case study, it is
important for a student nurse to provide high-quality patient care as it will
affect the patient's health status.
Conclusion
- We provided nursing care plan that can help the patient recover
more quickly and can enhance the physical and mental well-being.
By learning about the physiological and psychological impacts of
stroke, as well as by receiving education and training in these
areas, we may all contribute to improving outcomes.
Conclusion
- We provided nursing care plan that can help the patient recover
more quickly and can enhance the physical and mental well-being.
By learning about the physiological and psychological impacts of
stroke, as well as by receiving education and training in these
areas, we may all contribute to improving outcomes.
Nursing Care Plan #1
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Nursing Care Plan #1
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Nursing Care Plan #2
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Nursing Care Plan #2
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Nursing Care Plan #3
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Nursing Care Plan #3
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Nursing Care Plan #3
Patient Diagnosed with Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive Cardiovascular
Disease, Coronary Artery Disease, Functional Class IV, and Aspiration Pneumonia.
Growth and Development
- The pattern of patient S’ life transformed according to the physiological
changes in her body. She began her aging process while still being healthy,
independent, and active in life. However, eventually, her daughter noticed
that patient S is being unresponsive one day during their meal which
signifies as alarm for her daughter that she was having stroke attack; and
immediately transported at St. Camillus Hospital in Mati City. In the health
history, there were two conditions that patient S had experienced in life,
which is hypertension and diabetes, with no history of CVA and myocardial
infarction. Once, her lifestyle had to change after learning the diagnoses
from her physician, and that includes her abstinence from foods that will
compromise her condition.
Health Beliefs and Practices
- Patient S was attended by her daughter. Patient S’s daughter always
performs body massage to her, as they believe it can aid the pain Patient
S’s felt. Upon the admission of Patient S, she always ask for a body
massage, but since the day she couldn’t talk, the daughter alone assumes
and initiated to massage Patient S. And also, their family believes in
“mananambal” that’s why they always let Patient S intake every herbal
medicine that the “mananambal” told them to.
Health Beliefs and Practices
- Since Florence Nightingale invented contemporary nursing, nurses have
received training in massage therapy (Westman & Blaisdell, 2016). And
nurses can usually administer massage to a patient that has an
intervention that is associated to it. But it is also the nurses’ responsibility to
tell the patient’s significant other when and where should the massage can
happen because there are also patients that are not allowed to be
massaged.
Communicating and Teaching
- Every second counts for a person experiencing a stroke. And in
those crucial times, your actions may be able to save someone's
life. When a client is experiencing a stroke, she will feel sudden
numbness or weakness, typically on 92 one side of the body, in the
face, arm, or leg.
Communicating and Teaching
- Also, sudden bewilderment, difficulty speaking or interpreting
words, a loss of coordination, and unexpected difficulty seeing in
one or both eyes. By being aware of the stroke symptoms, you can
act quickly to perhaps save a life or even your own. If someone is
having a stroke, time matters a lot. The longer a stroke is left
untreated, the more damage to the brain may be done, possibly
permanently.
Integral Components of Client Care
- Patients with cerebrovascular accident receive primary care in the
hospital, including specialist interference which meet the evidence-practice
gap and guarantee that every patient receives the kind of treatment
recommended by guidelines (Kernan et. al., 2021).

- The final diagnoses of patient S stipulated on the chart are as follows,

Cardioembolic Stroke, Cardiac Arrhythmia, Atrial Fibrillation, Hypertensive
Cardiovascular Disease, Coronary Artery Disease, Functional Class IV, and
Aspiration Pneumonia upon the admission to the facility.
Integral Components of Client Care
- Pillai et. al. (2022) stated in their study that cardioembolic stroke is a
serious condition that could result in recurrence and high-risk complications
if left untreated. The healthcare workers provided essential care for the
client to modify further complications which involves safety and skin
integrity measures, providing hygiene, multiple diagnostic tests, and
medications to optimize patient’s health.
Integral Components of Client Care
- Pillai et. al. (2022) stated in their study that cardioembolic stroke is a
serious condition that could result in recurrence and high-risk complications
if left untreated. The healthcare workers provided essential care for the
client to modify further complications which involves safety and skin
integrity measures, providing hygiene, multiple diagnostic tests, and
medications to optimize patient’s health.