NORTHEASTERN COLLEGE

COLLEGE OF NURSING
Villasis, Santiago City

CEREBROVASCULAR ACCIDENT

A CASE STUDY

SUBMITTED BY:

BSN 3B – GROUP 3

Agangaya, Bishy-Shelly
Asingal, Kristine Joy
Ballesteros, Whella Mhay
Blanza, Arlene
Buyucan, Gay Marie
De Guzman, Jingkie
Gomez, Lord Allen
Gupuchon, Disiryl
Faustino, Avegail
Mapili, Jay Ryan

Eden Anievas, RN
Clinical Instructor

April, 2024
OBJECTIVES:

GENERAL OBJECTIVE
This case study was able to acquaint us with realization, understanding the constant overall
disease, improved our skills and acquiring a way of thinking as needed in dealing with diverse
clients, performing basic nursing skills with confidence and competence as well as providing
appropriate nursing management to a patient incapable of dealing with Cerebrovascular Accident
(CVA)

SPECIFIC OBJECTIVES:
•To establish rapport towards the patient, significant other/s and to provide our fellow student
nurses and future aspiring nursing students informative knowledge
•To present an informative overview of the disease;
•To acquire the physical assessment for further problems to be managed;
•To discuss the anatomy and pathophysiology of the affected body part of the disease;
•To determine how CVA affects the body;
•And to recognize the effects of CVA in an individual.

OVERVIEW
A Cerebrovascular Accident (CVA), an ischemic stroke or “brain attack,” is a sudden
loss of brain function resulting from a disruption of the blood supply to a part of the brain.
It is a functional abnormality of the central nervous system. The result is an interruption in the
blood supply to the brain, causing temporary or permanent loss of movement, thought, memory,
speech, or sensation.

Classifications:
Ischemic stroke. This is the loss of function in the brain as a result of a disrupted blood supply.
Hemorrhagic stroke. Hemorrhagic strokes are caused by bleeding into the brain tissue, the
ventricles, or the subarachnoid space.

Statistics:
Globally, one in four people over age 25 will have a stroke in their lifetime. 15-49 years
1,978,946 50.29 (43.02-58.71) - Each year, over 16% of all strokes occur in people 15-49 years
of age. <70 years 7,622,088 104.79 (92.54-119.06) - Each year, over 62% of all strokes occur in
people under 70 years of age. (World Stroke Organization, 2022).
The mortality from stroke during the last 10 years remains high with an average of 63,804 deaths
per year (Figure 1) (4). In 2021, despite the COVID pandemic, the recorded annual Philippine
stroke death was 68,180 (5), increased from 64,381 in 2020.

Signs and symptoms:

Stroke can cause a wide variety of neurologic deficits, depending on the location of the lesion,
the size of the area of inadequate perfusion, and the amount of the collateral blood flow.

•Motor Loss
Hemiplegia, hemiparesis
Flaccid paralysis and loss of or decrease in the deep tendon reflexes (initial clinical feature)
followed by (after 48 hours) reappearance of deep reflexes and abnormally increased muscle tone
(spasticity)

•Communication Loss
Dysarthria (difficulty speaking)
Dysphasia (impaired speech) or aphasia (loss of speech)
Apraxia (inability to perform a previously learned action)

•Perceptual Disturbances and Sensory Loss

Visual-perceptual dysfunctions (homonymous hemianopia [loss of half of the visual field])
Disturbances in visual-spatial relations (perceiving the relation of two or more objects in spatial
areas), frequently seen in patients with right hemispheric damage
Sensory losses: slight impairment of touch or more severe with loss of proprioception; difficulty
in interrupting visual, tactile, and auditory stimuli

•Impaired Cognitive and Psychological Effects

Frontal lobe damage: Learning capacity, memory, or other higher cortical intellectual functions
may be impaired. Such dysfunction may be reflected in a limited attention span, difficulties in
comprehension, forgetfulness, and lack of motivation.
Occipital lobe damage. Partial vision loss, visual hallucinations, or even total blindness.
Temporal lobe damage. Speech problem called Wernicke's aphasia, which is characterized by
trouble making sense of spoken language. It can also include: Pure word deafness: An inability
to hear language. Transcortical aphasia: Problems ranging from difficulty speaking to hearing
loss.
Parietal lobe damage. Disorientation and loss of coordination, weakness and paresthesia, and
problems with speech and memory.
Depression, other psychological problems: emotional lability, hostility, frustration, resentment,
and lack of cooperation.

Risk factors:
Nonmodifiable
•Advanced age (older than 55 years)
•Gender (Male)
Modifiable
•Hypertension
•Atrial fibrillation
•Hyperlipidemia
•Obesity
•Smoking
•Diabetes
•Asymptomatic carotid stenosis and valvular heart disease (eg, endocarditis, prosthetic heart
valves)
•Periodontal disease

Causes:
Large artery thrombosis. Large artery thromboses are caused by atherosclerotic plaques in the
large blood vessels of the brain.
Small penetrating artery thrombosis. Small penetrating artery thrombosis affects one or more
vessels and is the most common type of ischemic stroke.
Cardiogenic emboli. Cardiogenic emboli are associated with cardiac dysrhythmias, usually
atrial fibrillation.

Complications:
Tissue ischemia. If cerebral blood flow is inadequate, the amount of oxygen supplied to the
brain is decreased, and tissue ischemia will result.
Cardiac dysrhythmias. The heart compensates for the decreased cerebral blood flow, and with
too much pumping, dysrhythmias may occur.

Diagnostics:
CT scan. Demonstrates structural abnormalities, edema, hematomas, ischemia, and infarctions.
Demonstrates structural abnormalities, edema, hematomas, ischemia, and infarctions. Note: May
not immediately reveal all changes, e.g., ischemic infarcts are not evident on CT for 8–12 hr;
however, intracerebral hemorrhage is immediately apparent; therefore, emergency CT is always
done before administering tissue plasminogen activator (t-PA). In addition, patients with TIA
commonly have a normal CT scan
PET scan. Provides data on cerebral metabolism and blood flow changes.
MRI. Shows areas of infarction, hemorrhage, AV malformations, and areas of ischemia.
Cerebral angiography. Helps determine specific cause of stroke, e.g., hemorrhage or obstructed
artery, pinpoints site of occlusion or rupture. Digital subtraction angiography evaluates patency
of cerebral vessels, identifies their position in head and neck, and detects/evaluates lesions and
vascular abnormalities.
Lumbar puncture. Pressure is usually normal and CSF is clear in cerebral thrombosis,
embolism, and TIA. Pressure elevation and grossly bloody fluid suggest subarachnoid and
intracerebral hemorrhage. CSF total protein level may be elevated in cases of thrombosis because
of inflammatory process. LP should be performed if septic embolism from bacterial endocarditis
is suspected.
Transcranial Doppler ultrasonography. Evaluates the velocity of blood flow through major
intracranial vessels; identifies AV disease, e.g., problems with carotid system (blood
flow/presence of atherosclerotic plaques).
EEG. Identifies problems based on reduced electrical activity in specific areas of infarction; and
can differentiate seizure activity from CVA damage.
Skull x-ray. May show a shift of pineal gland to the opposite side from an expanding mass;
calcifications of the internal carotid may be visible in cerebral thrombosis; partial calcification of
walls of an aneurysm may be noted in subarachnoid hemorrhage.
ECG and echocardiography. To rule out cardiac origin as source of embolus (20% of strokes
are the result of blood or vegetative emboli associated with valvular disease, dysrhythmias, or
endocarditis).
Laboratory studies to rule out systemic causes: CBC, platelet and clotting studies,
VDRL/RPR, erythrocyte sedimentation rate (ESR), chemistries (glucose, sodium).

Treatments:
Recombinant tissue plasminogen activator would be prescribed unless contraindicated, and
there should be monitoring for bleeding.
Increased ICP. Management of increased ICP includes osmotic diuretics, maintenance of
PaCO2 at 30-35 mmHg, and positioning to avoid hypoxia through elevation of the head of the
bed.
Endotracheal Tube. There is a possibility of intubation to establish patent airway if necessary.
Hemodynamic monitoring. Continuous hemodynamic monitoring should be implemented to
avoid an increase in blood pressure.
Neurologic assessment to determine if the stroke is evolving and if other acute complications
are developing
Carotid endarterectomy. This is the removal of atherosclerotic plaque or thrombus from the
carotid artery to prevent stroke in patients with occlusive disease of the extracranial cerebral
arteries.
Hemicraniectomy. Hemicraniectomy may be performed for increased ICP from brain edema in
severe cases of stroke.

Prevention
Healthy lifestyle. Leading a healthy lifestyle which includes not smoking, maintaining a healthy
weight, following a healthy diet, and daily exercise can reduce the risk of having a stroke by
about one half.
DASH diet. The DASH (Dietary Approaches to Stop Hypertension) diet is high in fruits and
vegetables, moderate in low-fat dairy products, and low in animal protein and can lower the risk
of stroke.
Stroke risk screenings. Stroke risk screenings are an ideal opportunity to lower stroke risk by
identifying people or groups of people who are at high risk for stroke.
Education. Patients and the community must be educated about recognition and prevention of
stroke.
Low-dose aspirin.

Nursing Management
During the acute phase, a neurologic flow sheet is maintained to provide data about the
following important measures of the patient’s clinical status:
Change in level of consciousness or responsiveness.
Presence or absence of voluntary or involuntary movements of extremities.
Stiffness or flaccidity of the neck.
Eye opening, comparative size of pupils, and pupillary reaction to light.
Color of the face and extremities; temperature and moisture of the skin.
Ability to speak.
Presence of bleeding.
Maintenance of blood pressure.
During the postacute phase, assess the following functions:
Mental status (memory, attention span, perception, orientation, affect, speech/language).
Sensation and perception (usually the patient have decreased awareness of pain and
temperature).
Motor control (upper and lower extremity movement); swallowing ability, nutritional and
hydration status, skin integrity, activity tolerance, and bowel and bladder function.
Continue focusing nursing assessment on impairment of function in patient’s daily activities.

DEMOGRAPHIC DATA
Name: Patient AC
Sex: Female
Age: 84
Birthdate: July 5, 1939
Address: Calao east, Santiago City
Civil status: Widowed
Nationality: Filipino
Religion: Born Again
Occupation: Retired teacher
Educational Attainment: College Graduate
Admitting time: 9:14pm
Admitting date: April 8, 2024
Chief of complaints: Body Weakness and cough
Admitting diagnosis: TO CONSIDER CEREBROVASCULAR ACCIDENT

MEDICAL HISTORY
Past Medical History:
According to SO, patient AC hospitalized in year 2008 due to stroke. Since then, the
patient experienced right side paralysis. The SO also stated that patient AC has hypertension
with a maintenance of Losartan and she's also using over the counter drugs like biogesic for fever
or mild pain, Vitex Negundo L. for cough and neozep for flu. She didn't receive any COVID 19
vaccine. Had no known allergy to food and drugs.

History of Present Illness:

SO, stated that in January 2024, patient AC went to Costales Medical Clinic due to
cough. The SO didn't know the drugs prescribed to the patient. March 23 the patient experienced
stroke again and had a slurred speech. The SO stated that the son of the patient decided not to
admit her to the hospital because the patient insist to and she's not experiencing difficulty
swallowing.
March 24, patient accompanied by her son and went to Costales Medical Center for check-up
and due to her persistent non-productive cough and difficulty breathing when coughing. She
undergoes ECG and chest x-ray and she was diagnosed with mild stroke and pneumonia. She
received pneumonococcal polysaccharide vaccine (PPSV23) and she was advised to use
nebulizer. The clinic prescribed Atorvastatin, Trimetazidine, Clopidogrel and Diltiazem.
After a week the SO noticed that the patient can't eat properly. She asked her if she's
experiencing difficulty swallowing and the patient nodded.
April 5, they went to SIMC but they decided to not admit the patient because the qeue of
stroke patients was too long. After 3 days SOs admitted to FMMC due to body weakness and
cough. Vital signs upon admission; blood pressure of 180/80mmgh, heart rate of 76bpm, a
respiratory rate of 24cpm, 36°c temperature and has a 77%O2Sat. The patient admitting
diagnosis is To Consider Cerebrovascular Accident.

Social History:
She lives with his son and granddaughter in-law at the rental house at Calao east. Her son
smoked every time he is at home. SO stated that she has a good relationship with them. The
patient has no vices.

Family History: N/A

Physical Assessment

Date/Time of Assessment: April 11, 2024 at 10:50 am

General Survey: The patient AC is on semi fowler’s position wearing stripe shirt and silky
pajama. Patient is hemiplegia but she is awake and conscious with GCS of 11/15. NGT is
inserted at the left nostril, with nasal cannula and an IV line inserted on the dorsal metacarpal
gauge 22.

Vital Signs:
BP: 160/100 mmHg
Temp: 36.6°c
HR: 83 bpm
RR: 27cpm
O2: 99% via oxygen cannula

AREAS TECHNIQUE FINDINGS INTERPRETATION

HEAD Inspection • Symmetrical and NORMAL
rounded in shape

HAIR AND Inspection • The color is a NORMAL

SCALP mixture of white and
black, hair is evenly
distributed

• No signs of hair loss

(alopecia)

• No presence of
dandruff

• Slightly oily and no

presence of tenderness
and no masses upon
palpation

No presence of
deformities and lumps
Palpation
FACE Inspection • Face is asymmetrical Patient is half
paralysis
• Right side of the face
is slightly drooping
when ask to smile

• No presence of mass NORMAL

Palpation
EYES Inspection • The patient has ABNORMAL
blurry vision but not -Due to aging
using any glasses

• No discoloration in
sclera
NORMAL
• Bulbar conjunctiva -
no swelling

• Conjunctiva is
palpebral

Pupils are equally

round reactive to light
and accommodation

• Both eyes are able to

move (TROCHLEAR
NERVE IS INTACT)

• The patient’s eye can

move and follow the
objects
(ABDUSCENS
NERVE IS INTACT)

EARS Inspection • Ears are equal in size NORMAL

and same color as face

• No presence swelling
and lesions

• Has minimal
discharge

NOSE Inspection • Symmetric in NORMAL

midline

• No discharge

• No presence of nasal
flaring

MOUTH Inspection • The lips is pink NORMAL

 • Patient can able to
move her tongue NORMAL
sideways
(HYPOGLOSSAL IS
INTACT)

• She has 7 teeth and

yellow in color and NORMAL
has a false tooth in the
upper
-may indicate poor
• Presence of tooth hygiene, due to her
decay condition

• Patient has slurred -Result of damage to

speech the language centers
of the brain, typically
in the left hemisphere

NECK Inspection • Positioned at the NORMAL

midline

Palpation • There in no presence NORMAL

of tenderness and
masses

CHEST AND Inspection • Side to side NORMAL

THORAX symmetric chest shape

• Fine crackles are -It indicates presence

Auscultation present upon of fluid or secretions
Auscultation in the airway since our
patient diagnosed with
pneumonia

S4, S1, S2 heart sound Patient is hypertensive

ABDOMEN Inspection • No presence of scar NORMAL

• 5 bowel sound per

Auscultation minute (Normoactive) NORMAL

Palpation • No tenderness or NORMAL

masses

UPPER Inspection • Patient can be able to -Due to symptoms of

EXTREMETIES move her left arm stoke
while the right arm is
not (right paralysis)
 • Patient can't be able -Due to impact of
to shrug her right stroke on the motor
shoulders pathways and muscles
involved in shoulder
movement

Patient can able to NORMAL

turn her head from
side to side (cervical
rotation)

• There is no presence NORMAL

Palpation of deformities, edema
and lesions
NAILS Inspection • No clubbing NORMAL

• Pink nail beds

Palpation • 2 seconds capillary NORMAL

refill

LOWER Inspection • She can't move her Due to damage to the

EXTREMETIES right legs motor areas of the
brain controlling for
movement

• No presence of scar NORMAL

• No tenderness or
deformity upon
palpation

• No presence of NORMAL
Palpation edema

11 FUNCTIONAL BEFORE HOSPITALIZATION DURING

HEALTH HOSPITALIZATION
PATTERN
HEALTH According to the SO the patient The patient is taking
PERCEPTION/ considered her health prior to nebulizer to ease the
HEALTH hospitalization to be fairly good, breathing of the patient
MANAGEMENT the SO also stated that when the and it helps to loosen if
patient is sick, she takes over- there is blockage from the
the-counter drugs such as airway.
Biogesic 500mg and Neozep
500mg to treat fever, mild pain
and flu. She also takes (Vitex
Negundo L. 300mg) for coughs
and has a maintenance of
Losartan 50mg for hypertension
and using nebulizer. With
regards to her lifestyle, she is a
non-smoker and doesn’t drink
alcohol. Additionally, the patient
didn’t receive any COVID
vaccines because it might be the
death of her, but received
Pneumococcal polysaccharide
vaccine (PPSV23) this year
(march 2024) at Costales
Medical Clinic and also, she
does not have any known
allergies.
NUTRITIONAL- The patient is unable to stands so The patient is in
METABOLIC we didn’t get her BMI. The SO Nasogastric tube with the
mentioned that before OF of 250ml 4× a day.
hospitalization, the pt. consumed
coffee 3-4x a week even if it’s
forbidden to her but she is hiding
it from her family. She loves to
eat vegetable like sitaw, saluyot
and talong. She eats 3x a day and
also drinks milk every night. The
pt. Doesn’t eat meat and doesn’t
like to eat sweet and salty foods.
She consumes approximately 1-
1.5 L of water daily.
ELIMINATION BLADDER BLADDER
The SO reported that the patient The patient is using
typically urinates three to four pampers and they usually
times a day, with urine that is changed it 3X a day.
typically yellow in color. When During our assessment
she urinates or defecates, her her Input is 3050ml and
children or grandchildren assist with an output of 1700ml.
her but if she is alone and
nobody is with her, she can go to BOWEL
CR alone by holding the chair to During hospitalization she
support her but sometime she hasn’t pooped yet
using her areola.

BOWEL
Patient defecate once a day, with
a soft like stool and usually
green and brown in color. The
 SO stated the patient has no
difficulty while defecating.

ACTIVITY The patient can’t walk very well During hospitalization, the
EXERCISE because of her first stroke but patient’s usual activity is
according to the SO the patient is laying down on the bed
sitting or lying down while and resting.
listening or watching TV.

SLEEP REST The SO stated that the patient Since the patient's
usually slept at 8-9 pm and hospitalization, the patient
wakes up at 4-5 am to pray and always sleeps but
takes a nap at least 1hr in the sometimes wake up due to
afternoon. hospital disturbance.

COGNITIVE: COGNITIVE
SENSORY AND The patient is a secondary retired During hospitalization the
COGNITIVE teacher. She is able to speak patient can’t speak, but
PERCEPTUAL fluently in Filipino, and she is understand our question by
able to understand English. nodding as a respond.

SENSORY: SENSORY
The patient does not have any The patient right side of
issues with her hearing, feeling the body has a loss of
(touch), and smelling, tasting feeling or sensation.
and but her vision is Blurry due
to aging.

SELF NA NA
PERCEPTION/
SELF CONCEPT
ROLE According to the SO the patient NA
RELATIONSHIP has a good relationship with her
family and her neighbors. The
patient currently lives with her
children and grandchildren at
Calao east. She is kind and
talkative and prefer to be with
many people, and always order
her grandchildren to do laundry
and other household choirs.

SEXUALITY - NA NA
REPRODUCTIVE
COPING/ STRESS According to SO she noticed that During hospitalization,
TOLERANCE whenever the patient has not in The SO always place her
good mood of stress due to her cellphone on the bedside
condition the patient watch TV table while it’s playing a
and listen to radio and Christian Christian song
songs to relieve her stress.
VALUES/ BELIEF The patient is Born Again. The patient loves to listen
According to SO, the patient Christian Songs.
prays every morning and doesn’t
believe in “albularyo”

DATE PROGRESS DOCTORS INTERPRETATION

TIME NOTES ORDER
4/8/24 Admit to ROC under the To assess patient and
84 F service of Dr. S. S manage properly
Secure Consent for Admission Free will to subject self of
the possible management
BP: 180/80 upon admission
mmHg Low Salt, Low Fat Diet to manage or reduce to
RR: 24 Bpm lower the cholesterol and
PR: 76 cpm reduce the risk of high
Temp: 36.0 °c blood pressure
02sat: 96% CBC, Urinalysis, Na ,K, Those are Work up labs of
Crea , Hgt ,BUA, SGPT, DR. S. S. to rule out the
SGOT, other certain medical
C-Xray PA/L conditions of the patient.
Rapid Antigen Test As per hospital protocols to
identify covid cases.
ECG To check record the
electrical activity of the
heart including abnormal
heart rhythms or heart
attack and angina.
Cranial CT Scan Plain To identify if there is a
damage in a brain and if it’s
a clot or bleeding.
IVF D5Nss 1L x 16h For nutrition Supplement
Mannitol 100ml IV q8 To decrease pressure to the
brain and it helps to reduce
this increased pressure by
drawing excess fluid out of
the brain cells and into the
blood stream. Where it can
be excreted by the kidneys.
Citicoline 1g IV q12 For regeneration of brain or
to lesser the damage of the
brain
Nebulization with Duavent q6 To ease the breathing of the
patient. It helps to loosen if
there is blockage from the
airway.
(+) Fluimucil 600mg tab in ½ To loosen the phlegm
Unproductive glass of water BID
Cough
96% O2sat O2 inhalation 2-3 LPM via To supply and support
upon Nasal Cannula oxygenation to the body
admission
Inform Attending physician
Monitor Vital signs q2 For baseline data
Refer For further management
4/9/24 New onset of (R) Extremities weakness Affected body site of the
(R) sided patient base on the
6:30AM weakness assessment
with
incomprehen
sible Speech,
Awake,
Follows
Command

0/5 (+) Body

Weakness
Facilitate Cranial CT scan To see which part of the
brain was damage if it’s
Infarct or Hemorrhagic.
For Fasting Blood Sugar To Identify if there is a
history of DM or HPN to
know the IVF to be given.
Lipid Profile To see the good cholesterol
or bad cholesterol.
Continue Maintenance To control medical
medications condition and to prevent
complications or relapses.
Refer Accordingly For further management
4/9/24 Leg Pain Give Celecoxib 1 cap once. To manage pain
12:13PM
2x a day for pain
4/10/24 Re-stroke TF: PNSS 1L x 12hrs For fluid replacement
12nn
Cranial CT Scan Result noted (Pls. See on the Diagnostic
parts)
Start Vessel Due F 300(LSU) To prevent clotting (It helps
IV q12 to melt the blood clot)
Cilostazol 100mg tab BID To reduce leg pain caused
by poor circulation
Aspirin 80mg 2 tabs now then Nsaids anti-coagulant. This
2 tabs OD after lunch can decrease the likelihood
of a blood clot blocking a
blood vessel in the heart or
brain.
(Take with meals To
prevent GI Irritation)
Atorvastatin 80mg tab OD in To lower the cholesterol
PM levels in the blood
For Trop I To determine if there is a
marker/ indication of heart
attack
Increase Mannitol 100cc IV To improve cerebral
q6 perfusion and oxygen
delivery to the affected
areas, thereby reducing the
risk of further neurological
complications. To lessen
the pressure to the brain
Refer Accordingly For further management
4/10/24 Insert NGT Patient is unable to swallow
 Diet OF 1500 Kcal For Energy & nutritional
Feeding + 2 scoop of Ensure Content
Gold
Refer Accordingly For further management
4/11/24 TF: PNSS 1L x 12hrs For Fluid replacement
1PM
Continue Meds. To effectively manage the
patient’s health
Refer Accordingly For further management

LABORATORY AND DIAGNOSTICS

DATE: 04/08/2024
TIME:
CHEST XRAY
Impression:
MILD CARDIOMEGALY WITH ATHERMATOUS AORTA
PNEUMONIA (RLL)

DATE: 04/08/2024
TIME: 9:57 PM
HEMATOLOGY

TEST RESULTS REFERENCE INTERPRETATION

VALUES
Hemoglobin 12.1 11.0-16.0 NORMAL
hematocrit 36.3 37.0-47.0 ABNORMAL
LOW
It may indicate
anemia, which
deficiency of RBC
or hemoglobin in the
blood
RBC Count 3.94 [Link] ABNORMAL
LOW
Due to decrease
oxygen delivery to
the brain potentially
worsening the
effects of the stroke.
 WBC Count 10.1 5.0-10.0 ABNORMAL
HIGH
It may indicate an
inflammatory
response or
infection.
Platelet 385 150-400 NORMAL
MCV 92.1 82.50-98.0 NORMAL
MCH 30.7 26.20- NORMAL
32.80
MCHC 33.3 30.70-35.90 NORMAL
Segmenters 73 50-65 ABNORMAL
HIGH
It indicate an
inflammatory
response or infection
in the body
Lymphocyte 17 25-35 ABNORMAL
LOW
Could indicate a
compromised
immune system.
Monocyte 07 3-7 NORMAL
Eosinophils 03 1-3 NORMAL

DATE: 04/08/224
TIME: 10:00 PM
CLINICAL CHEMISTRY
TEST RESULT REFERENCE INTERPRETATION
VALUES
Creatinine 105. 65 53.0-97.0 ABNORMAL
HIGH
May indicate underlying
kidney dysfunction or
poor kidney function
Blood Uric 10.12 2.60- 6.00 ABNORMAL
Acid HIGH
May indicate an
increased risk for
cardiovascular events
and adverse outcomes.
and may be a marker of
underlying
cardiovascular risk
factors
Sodium 141.12 135.0-150.0 NORMAL
Potassium 4.72 3.50-5.50 NORMAL
SGOT (AST) 20.19 0.00- 31.0 NORMAL
SGPT (ALT) 16.40 0.00-34.0 NORMAL

DATE: 04/10/224
TIME: 6:45 AM
CLINICAL CHEMISTRY
TEST RESULT REFERENCE INTERPRETATION
VALUES
 FBS 275.54 74.00 – 100.00 mg/dl ABNORMAL
HIGH
May indicate
uncontrolled diabetes
Total 105.73 0.00 – 200.00 mg/dl NORMAL
Cholesterol
Triglycerides 81.46 0.00 – 150.0 mg/dl NORMAL
HDL- 29.30 42.00 – 88.00 mg/dl ABNORMAL
Cholesterol LOW
There is a higher
likelihood of plaque
formation, leading to
narrowed and hardened
arteries
LDL-Cholesterol 60.14 0.00 – 150.00 mg/dl NORMAL
VLDL 16.29 NORMAL

DATE: 04/10/224
TIME: 12:36 AM
URINALYSIS
ROUTINE:
Color Yellow
Transparency Clear
Specific Gravity 1.015
pH 5.0
Protein Trace
Glucose Negative
WBC 2-4/HPF
RBC 1-3/HPF
Epithelial Cells Rare
Amorphous Urates Occasional
Mucus Threads Rare
Bacteria Rare
Anatomy and Physiology

The brain is an amazing three-pound organ that controls

all functions of the body, interprets information from the outside
world, and embodies the essence of the mind and soul.
Intelligence, creativity, emotion, and memory are a few of the
many things governed by the brain. Protected within the skull,
the brain is composed of the cerebrum, cerebellum, and
brainstem.

Parts of the brain

Cerebrum: is the largest part of the brain and is composed of

right and left hemispheres. It performs higher functions like
interpreting touch, vision and hearing, as well as speech,
reasoning, emotions, learning, and fine control of movement.

Cerebellum: is located under the cerebrum. Its function is to

coordinate muscle movements, maintain posture, and balance.

Brainstem: acts as a relay center connecting the cerebrum and cerebellum to the spinal cord. It
performs many automatic functions such as breathing, heart rate, body temperature, wake and
sleep cycles, digestion, sneezing, coughing, vomiting, and swallowing.

Right brain – left brain

The cerebrum is divided into two halves: the right and left hemispheres. They are joined by a
bundle of fibers called the corpus callosum that transmits messages from one side to the other.
Each hemisphere controls the opposite side of the body. If a stroke occurs on the right side of the
brain, your left arm or leg may be weak or paralyzed.
Not all functions of the hemispheres are shared. In general, the left hemisphere controls speech,
comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial ability,
artistic, and musical skills. The left hemisphere is dominant in hand use and language in about
92% of people.

Lobes of the brain

The cerebral hemispheres have distinct fissures,

which divide the brain into lobes. Each hemisphere
has 4 lobes: frontal, temporal, parietal, and
occipital. Each lobe may be divided, once again,
into areas that serve very specific functions. It’s
important to understand that each lobe of the brain
does not function alone. There are very complex
relationships between the lobes of the brain and
between the right and left hemispheres.

Frontal lobe

 Personality, behavior, emotions

 Judgment, planning, problem
solving
 Speech: speaking and writing
(Broca’s area)
 Body movement (motor strip)
 Intelligence, concentration, self-awareness

Parietal lobe

 Interprets language, words

 Sense of touch, pain, temperature (sensory
strip)
 Interprets signals from vision, hearing,
motor, sensory and memory
 Spatial and visual perception

Occipital lobe

 Interprets vision (color, light, movement)

Temporal lobe

 Understanding language (Wernicke’s area)

 Memory
 Hearing
 Sequencing and organization

Broca’s area: lies in the left

frontal lobe. If this area is
damaged, one may have
difficulty moving the tongue or
facial muscles to produce the
sounds of speech. The person
can still read and understand
spoken language but has
difficulty in speaking and writing (i.e. forming letters and words, doesn't write within lines) –
called Broca's aphasia.

Wernicke's area: lies in the left temporal lobe. Damage to this area causes Wernicke's aphasia.
The individual may speak in long sentences that have no meaning, add unnecessary words, and
even create new words. They can make speech sounds, however they have difficulty
understanding speech and are therefore unaware of their mistakes.

Cortex

The surface of the cerebrum is called the cortex. It has a folded appearance with hills and
valleys. The cortex contains 16 billion neurons (the cerebellum has 70 billion = 86 billion total)
that are arranged in specific layers. The nerve cell bodies color the cortex grey-brown giving it
its name – gray matter. Beneath the cortex are long nerve fibers (axons) that connect brain areas
to each other — called white matter.

DISCHARGE PLAN

NURSING ORDERS DISCHARGE RATIONALE

INSTRUCTIONS
Medication The patient is prescribed by To remain patients’ condition
the physician to continue oral as stable as long as possible.
medications.

The patient must take

medication as ordered by the
physician with an accurate
dosage and time.
Environment Advise the patient to have To promote fast healing and
complete bed rest until recovery. Ensuring that
strength is regained. Have the patients have access to
patient turn side to side every appropriate bedding, seating,
2 hours to prevent bed sore. and temperature control to
enhance their physical
comfort and overall well-
being.
Exercise Advise patients to have ROM Regular physical activity is
exercise to enhance body beneficial enhancing various
function aspects of physical health. It
can lead to improvements in
strength, flexibility, mobility,
balance, and overall
functional ability.
Outpatient Advise patient’s family to For health status monitoring
follow up the check up as
physician’s ordered.

Diet Instruct patient to have a To help promote wellness.

proper diet that she can
tolerate and advise the
patient’s family to let the
 patient eat nutritious foods
such as fruits and vegetables.

Spiritual Encourage to keep the faith in

God and not give up easily
when hard times come. To have a closer relationship
with God
Emphasize the importance of
prayers in healing.