Cvd Case Study REGOR

7/29/2019 Cvd Case Study REGOR

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I. INTRODUCTION

Cerebrovascular disease is a group of brain dysfunctions related to disease of the bloodvessels supplying the brain. Hypertension is the most important cause; it damages the bloodvessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiatea repairing process which is not always complete and perfect. Sustained hypertension

permanently changes the architecture of the blood vessels making them narrow, stiff, deformed,uneven and more vulnerable to fluctuations in blood pressure.

A stroke is caused by the interruption of the blood supply to the brain, usually because a bloodvessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causingdamage to the brain tissue.

The most common symptom of a stroke is sudden weakness or numbness of the face, arm or leg,most often on one side of the body. Other symptoms include: confusion, difficulty speaking orunderstanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss ofbalance or coordination; severe headache with no known cause; fainting or unconsciousness.

The effects of a stroke depend on which part of the brain is injured and how severely it is

affected. A very severe stroke can cause sudden death.

The 1990 Global Burden of Disease (GBD) study provided the first global estimate on the burdenof 135 diseases, and cerebrovascular diseases ranked as the second leading cause of deathafter ischemic heart disease.

During the past decade the quantity of especially routine mortality data has increased, and is nowcovering approximately one-third of theworlds population. The increase in data availability provides the possibility forupdating theestimated global burden of stroke.

Data on causes of death from the 1990s have shown that cerebrovascular diseases remain aleading cause of death.

In 2001 it was estimated that cerebrovascular diseases (stroke) accounted for 5.5 million deathsworld wide, equivalent to 9.6 % of all deaths Two-thirds of these deaths occurred in people livingin developingcountries and 40% of the subjects were aged less than 70 years.

Additionally, cerebrovascular disease is the leading cause of disability in adults and each yearmillions of stroke survivors has to adapt to a life with restrictions in activities of daily living as aconsequence of cerebrovascular disease. Many surviving stroke patients will often depend onotherpeoples continuous support to survive.

II. OBJECTIVES

GENERAL OBJECTIVES

1. To be able to discuss the effect, signs and symptoms of the disease, Cerebrovascular

Disease.

2. How to diagnose, prevent and the treatment should the nurse give for the patient full

recovery.

SPECIFIC OBJECTIVES


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1. To be able to discuss patients background ( lifestyle, history of the past illness, family

health history) to show how may this effect on the occurrence of this disease.

2. To be able to discuss the anatomy and the physiology of the heart, for you to be able to

understand where the infection takes place.

3. To be able to discuss the pathophysiology of cardiovascular diseases and also to know

and understand the etiology of the disease.

4. To be able to discuss the patient activities of daily living. To know if theres a factor that

triggers the disease

5. To be able to discuss, nursing care plan for our patient.

6. To be able to discuss, the medication / drugs that the patient taken and the diagnostic

test that being perform for the patient.

7. Lastly, to be able to discuss our discharge plan for fully recovery of our patient.

III. PATIENTS PROFILE

NAME: T.V

AGE: 47 YEARS OLD FEMALE

GENDER: FEMALE

ADDRESS: MONCADA TARLAC

CHIEF COMPLAINT:

Numbness to the left side of the body

Body weakness

Nape pain

IV. PHYSICAL ASSESSMENT

GENERAL SURVEY

Mrs. T.V was lying semi-fowlers on bed, conscious, coherent, afebrile with

monitoring devices.

A. VITAL SIGNS

Date Shift Time Temp BP RR PR Intake Output


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07/18/13 3pm-11pm 36.8 210/100 58 20

B. HEAD

Pink papillary conjunctiva, no nuchal rigidity and no carotid bruit.

C. NEUROLOGIC STATUS

-Oriented to time, person and place.

CRANIAL NERVES ASSESSMENT

CN I- can smell

CN II- (2-3) ERTL

CN III, IV, VI- EDM, intact

CN V- (+) corneal reflex

CN VII- no facial asymmetry

CN IX- (+) gag reflexCN XI- can shrug shoulder

CN XII- tongue at midline

D. PULMONARY SYSTEM

-Respiratory rate was 58 cpm

-SCE, no vesicular breath sounds.

-AP, Apical beat at the 6th

ICS anterior axillary line normal sounds.

E. GASTROINTESTINAL SYSTEM

Flabby, NaBS, no abdominal bruit, (-) edema,(-) cyanosis.

F. MUSCULOSKELETAL SYSTEM

The patient manifested good posture and moved voluntarily; he had

symmetrical musculature on both sides of the body. Weakness was noted.

G. GENITO- URINARY SYSTEM

Patient voided 60 350 cc per shift as weighed and yellow in color.


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V. LABORATORY AND DIAGNOSTIC EXAMINATION

Complete Blood Count

COMPONENT RESULTS NORMAL

VALUES

SIGNIFICANCE

Hemoglobin 136 120 140g/L

Normal

Platelet 302 150

3.50x10g/l

may indicate

altered clotting

factor

Hematocrit 0.437 0.38 0.48

g/l

abnormal

WBC 3.6 4.5

10x10g/l

abnormal

RBC 5.5 4.5

5.5x10g/l

normal

Neutrophil 12.8 0.40 0.60

g/l

abnormal

Lymphocyte 1.52 0.20 0.40

g/l

abnormal

Monocyte 1.43 0.02 0.08 abnormal

MPV 5.93 7.5-11.5 fL. abnormal

Urinalysis

RESULTS

Color Light Yellow

Transparency Slightly Turbid

Specific Gravity 1.010

Sugar ( - )


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Albumin ( - )

Pus cell 0 1

RBC 0 2

Mucus threads Few

Epith cell Moderate

Bacteria Rare

Acid 6.5

Laboratory Tests for Heart Failure

Routine lab blood tests are important in the evaluation of people with heart failure. These testscan help identify causes ofheart failure; whether other organs, such as the kidneys and liver,have been affected by the heart failure; or whether medicines, such as diuretics, have affectedthe normal electrolyte levels, such as sodium or potassium levels. The following lab tests may bedone in people with signs or symptoms of heart failure.

Complete Blood Count (CBC)

A reduced red blood cell count (anemia) may mean that heart failure is caused or aggravated bya decrease in the oxygen-carrying capacity of the blood. A very low blood count may be a signthat anemia is a contributing factor that is making your heart failure worse. Even if this is not thecase, a low blood count can make your heart work harder and can be dangerous if you havesevere heart failure. Knowing the white blood cell count can be helpful, because an elevatedwhite count often indicates that you have an infection, which places additional stress on yourheart.

Serum Creatinine

This test measures the level of a substance in the blood called creatinine. Thecreatine level canhelp determine how well the kidneys are working. Creatinine is excreted in the urine. High levelsof creatinine may indicate that a kidney problem is responsible for fluid buildup in the body, notheart failure.

Bloo d Urea Nitrogen (BUN)

A blood urea nitrogen (BUN) test measures the amount of nitrogen in the blood that comes fromurea. A BUN test helps estimate how well the kidneys are functioning. Severe heart failure candecrease kidney function. Several common heart failure medicines-particularly diuretics andangiotensin-converting enzyme (ACE) inhibitors-can also decrease kidney function.
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Brain Natr iuretic Peptide (BNP)

A brain natriuretic peptide (BNP) test measures the amount of the BNP hormone in your blood.BNP is made by your heart and tells how well your heart is working. Normally, only a low amountof BNP is found in your blood. However, if your heart has to work harder over a long period oftime, such as from heart failure, the heart releases more BNP and the blood level of BNP will get

higher. The BNP level may drop when treatment for heart failure is working.

Serum Album in

Albumin is a protein in the body. Decreased levels of this protein may indicate that fluid buildup inthe body is caused by an intestinal disorder (hypoalbuminemia), a liver problem, or kidneydisease.

Thyro id Hormon e Testsan dThyro id-St imulat ing Horm one Test

Thyroid hormone measurements may be needed if you have a rapid, irregular heartbeat (atrialfibrillation), have evidence of thyroid disease, or are older than 65. Abnormal findings may be asign that heart failure is caused or made worse by an underactive thyroid (hypothyroidism) or anoveractive thyroid (hyperthyroidism).

Urinalysis

Protein or red blood cells in the urine may indicate a kidney disorder.

Blood Glucose

A fasting blood glucose test measures the amount of glucose in your blood after you have noteaten for at least 8 hours. Glucose is a natural sugar in the body that is used for energy. Highlevels of glucose in the blood may indicate diabetes.

Lipid Panel

A lipid panel is a blood test that measures lipids-fats and fatty substances used as a source ofenergy in your body. Lipids include cholesterol, triglycerides, high-density lipoprotein (HDL),and low-density lipoprotein (LDL).

Liver Funct ionTests

Liver function tests include a variety of tests that measure certain enzymes and other substancesproduced by the liver. If the levels of these substances are high, it may mean damage or diseasein the liver. Heart failure may also cause fluid buildup in the liver, which also may cause elevatedliver function test results. For more information, see the topics Alanine Aminotransferase(ALT) and Aspartate Aminotransferase (AST).

Electrolytes

People with heart failure need to maintain the concentration of electrolytes in the blood(particularly sodium, potassium, and magnesium). This is especially true for people who takediuretics, which can lower sodium, magnesium, or potassium levels in the blood if the dose is toohigh. Other medicines such as ACE inhibitors, by contrast, can cause high potassium levels.Your electrolytes should be checked regularly, particularly if your symptoms are changing or ifyour medicines are being adjusted.

Prothrombin Time(PT) andPart ia l Thromboplast in Time(PTT)

A PT or PTT test are blood tests that measure how long it takes blood to clot. These tests can beused to check for bleeding problems. PT is also used to check how medicine to prevent bloodclots is working. A PT test may also be called an INR test.
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VI. ANATOMY AND PHYSIOLOGY

The Brain

Three cavities, called the primary brain vesicles, form during the early embryonic

development of the brain. These are the forebrain (prosencephalon), the midbrain

(mesencephalon), and the hindbrain (rhombencephalon).

The telencephalon generates the cerebrum (which contains the cerebral cortex,

white matter, and basal ganglia).

The diencephalon generates the thalamus, hypothalamus, and pineal gland.

The mesencephalon generates the midbrain portion of the brain stem.

The metencephalon generates the pons portion of the brain stem and thecerebellum.

The myelencephalon generates the medulla oblongata portion of the brain stem


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Figure 1 The four divisions of the adult brain.

The cerebrum consists of two cerebral hemispheres connected by a bundle of nerve

fibers, the corpus callosum. The largest and most visible part of the brain, the

cerebrum, appears as folded ridges and grooves, called convolutions. The following

terms are used to describe the convolutions:

A gyrus (plural, gyri) is an elevated ridge among the convolutions.

A sulcus (plural, sulci) is a shallow groove among the convolutions.

A fissure is a deep groove among the convolutions.


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The deeper fissures divide the cerebrum into five lobes (most named after bordering

skull bones)the frontal lobe, the parietal love, the temporal lobe, the occipital lobe,

and the insula. All but the insula are visible from the outside surface of the brain.

A cross section of the cerebrum shows three distinct layers of nervous tissue:

The cerebral cortex is a thin outer layer of gray matter. Such activities as

speech, evaluation of stimuli, conscious thinking, and control of skeletal

muscles occur here. These activities are grouped into motor areas, sensory

areas, and association areas.

The cerebral white matter underlies the cerebral cortex. It contains mostly

myelinated axons that connect cerebral hemispheres (association fibers),

connect gyri within hemispheres (commissural fibers), or connect the

cerebrum to the spinal cord (projection fibers). The corpus callosum is a

major assemblage of association fibers that forms a nerve tract that

connects the two cerebral hemispheres.

Basal ganglia (basal nuclei) are several pockets of gray matter located deep

inside the cerebral white matter. The major regions in the basal gangliathe

caudate nuclei, the putamen, and the globus pallidusare involved in

relaying and modifying nerve impulses passing from the cerebral cortex to

the spinal cord. Arm swinging while walking, for example, is controlled here.

The diencephalon connects the cerebrum to the brain stem. It consists of

the following major regions:

The thalamus is a relay station for sensory nerve impulses traveling from the

spinal cord to the cerebrum. Some nerve impulses are sorted and grouped

here before being transmitted to the cerebrum. Certain sensations, such as

pain, pressure, and temperature, are evaluated here also.

The epithalamus contains the pineal gland. The pineal gland secretes

melatonin, a hormone that helps regulate the biological clock (sleep-wake

cycles).

The hypothalamus regulates numerous important body activities. It controls

the autonomic nervous system and regulates emotion, behavior, hunger,


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thirst, body temperature, and the biological clock. It also produces two

hormones (ADH and oxytocin) and various releasing hormones that control

hormone production in the anterior pituitary gland.

The following structures are either included or associated with the hypothalamus.

The mammillary bodies relay sensations of smell.

The infundibulum connects the pituitary gland to the hypothalamus.

The optic chiasma passes between the hypothalamus and the pituitary

gland. Here, portions of the optic nerve from each eye cross over to the

cerebral hemisphere on the opposite side of the brain.The brain stem connects the diencephalon to the spinal cord. The brain stem

resembles the spinal cord in that both consist of white matter fiber tractssurrounding a core of gray matter. The brain stem consists of the following four

regions, all of which provide connections between various parts of the brain and

between the brain and the spinal cord

Figure 2 Prominent structures of the brain stem.

The midbrain is the uppermost part of the brain stem.

The pons is the bulging region in the middle of the brain stem.

The medulla oblongata (medulla) is the lower portion of the brain stem that

merges with the spinal cord at the foramen magnum.

The reticular formation consists of small clusters of gray matter interspersed

within the white matter of the brain stem and certain regions of the spinal

cord, diencephalon, and cerebellum. The reticular activation system (RAS),

one component of the reticular formation, is responsible for maintaining

wakefulness and alertness and for filtering out unimportant sensory

information. Other components of the reticular formation are responsible for

maintaining muscle tone and regulating visceral motor muscles.

The cerebellum consists of a central region, the vermis, and two winglike

lobes, the cerebellar hemispheres. Like that of the cerebrum, the surface of the

cerebellum is convoluted, but the gyri, called folia, are parallel and give a pleated

appearance. The cerebellum evaluates and coordinates motor movements by

comparing actual skeletal movements to the movement that was intended.


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Modifiable factors:

Smoking

vasospasm

Embolus that

dislod e

Increase oxygen

demand

Decrease oxygen

supply in the blood

The limbic system is a network of neurons that extends over a wide range of areas of the

brain. The limbic system imposes an emotional aspect to behaviors, experiences, and

memories. Emotions such as pleasure, fear, anger, sorrow, and affection are imparted to

events and experiences. The limbic system accomplishes this by a system of fiber tracts

(white matter) and gray matter that pervades the diencephalon and encircles the inside

border of the cerebrum. The following components are included:

The hippocampus (located in the cerebral hemisphere)

The denate gyrus (located in cerebral hemisphere)

The amygdala (amygdaloid body) (an almond-shaped body associated with the

caudate nucleus of the basal ganglia)

The mammillary bodies (in the hypothalamus)

The anterior thalamic nuclei (in the thalamus)

The fornix (a bundle of fiber tracts that links components of the limbic system)

VII. PATHOPHYSIOLOGY


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Inadequate blood perfusion

Cell injury and death

Motor, sensory, cranial nerves

disrupted

Cerebrovascular

disease

Dizziness, stiffening of

extremeties, and non projectile

vomiting

Cerebrovascular disease or brain attack happened due to modifiable factors possessedby the patient such as smoking, ingesting fatty foods, and hypertension that leads to vasospasm

and an embolus that dislodged from an area of origin to the brain that results to increase oxygen

demand and decrease oxygen supply in the blood. Because of inadequate blood perfusion it

leads to brain cells injury and death, at this point neurons are no longer able to maintain aerobic

respiration that caused to produce neurological dysfunction.


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NURSING CONSIDERATIONS

1. Maintain a patent airway to promote adequate oxygenation

2. Administer oxygen therapy with possible intubation and mechanical ventilation to ensureadequate tissue perfusion

3. Maintain bed rest to minimize metabolic requirements

4. Provide I.V. fluids to support blood pressure and maintain volume

5. Administer dexamethasone to reduce cerebral edema

6. Administer anticoagulants and antiplatelet drugs for thrombotic conditions after hemorrhage has

been ruled out

7. Administer sedatives, such as Phenobarbital, to decrease metabolic requirements

8. Assess the patients neurologic status; observe for CVA progression and level of consciousness

(LOC) change as evidenced by decreasing numerical score on the GLASGOW COMA SCALE.

9. Correct cardiovascular abnormalities, such as atrial fibrillation, that may be contributing factors

10. Consider surgical procedures to correct circulatory impairment, prevent repeated hemorrhage, or

relieve cerebral pressure

11. Begin bedside range-of-motion exercise to preserve mobility and prevent deformities

12. Teach the patient to identify risk factors and necessary life-style modifications, such as diet,

stress reduction, and smoking cessation

13. Direct the family to community groups that provide support or rehabilitation

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Cvd Case Study REGOR