CASE STUDY

CEREBROVASCULAR STROKE

- NURSING INTERNSHIP
PREPARED BY: EMAN ALOWA
 TABLE OF
CONTENTS
Reason of
Demographic Definition admission and
data chief
complaint

History
Physical Pathophysiology
Assessment
 TABLE OF
CONTENTS
Clinical Lab and
Etiology manifestations radiological
(signs and investigation
symptoms )

Medication
Nursing diagnosis
and treatment Nursing intervention
1. DEMOGRAPHIC DATA
CEREBROVASCULAR STROKE PT

• - Patient Initials: M.H.A.

• - Age: 72 years
• - Gender: Male
• - Weight: 64 kg | Height: 169 cm
• - Date of Admission: 17/05/2025
• - Unit: ICU (Medical Intensive Care Unit)
• - Primary Diagnosis: Subacute Ischemic Stroke (Lacunar
infarct)
 [Link]
CEREBROVASCULAR STROKE

A cerebrovascular stroke is a sudden loss of brain function

resulting from a disruption in the blood supply to part of
the brain. It can be ischemic (due to blockage) or
hemorrhagic (due to bleeding).

My PT has Subacute Ischemic

Stroke
 [Link]
CEREBROVASCULAR STROKE

My PT has Subacute Ischemic Stroke / subtype of cva

Subacute Ischemic Stroke, which

refers to an ischemic stroke that
occurred within the subacute
phase approximately 1 to 3 weeks
after onset. It follows the acute
phase and is marked by
neurological recovery, a continued
risk of complications, and the start
of rehabilitation
 [Link] OF ADMISSION AND CHIEF COMPLAIN
Reason for Admission:
Patient was admitted due to symptoms
consistent with subacute ischemic stroke
confirmed by MRI, along with associated
complications including chest pain and
uncontrolled nasal epistaxis.

Chief Complaint:
“Dizziness, imbalance, and
unsteady gait for 5 days.”
[Link]
HPI:
Presented with 5-day history of dizziness, imbalance, and
unsteady gait. MRI confirmed subacute ischemic stroke.
Also had chest pain and nasal bleeding.
PMH:
Diabetes with polyneuropathy
Hypertension
Hyperlipidemia
Ischemic heart disease
PSH:
Gastric sleeve
Spinal fixation
Family History:
none
 [Link] ASSESSMENT
Neurological:
Respiratory: GI/GU &
Patient is alert with right-sided
Breath sounds clear, stable Metabolic:
hemiparesis, facial droop,
respiratory rate. No distress. No GI complaints.
expressive aphasia, and mild
Aspiration risk due to neurologic
confusion. Fall risk identified.
deficits. Adequate urine
Musculoskeletal: output; no
Cardiovascular:
Unsteady, hemiplegic gait; abnormalities
Elevated BP, irregular pulse
requires assistance. High fall noted.
(AFib), possible murmur on
risk.
auscultation.
History: Spinal fixation.
ECG/ECHO: No acute ischemia.
Integumentary:
History: Hypertension,
Skin intact, warm, and dry. No
ischemic heart disease,
pressure injuries noted.
hyperlipidemia.
 [Link]

Stroke is caused by interrupted brain blood flow,

leading to cell damage. Ischemic stroke occurs from a
clot blocking blood flow. In the subacute phase (1–3
weeks), some healing begins but risks like swelling
and complications remain.
 [Link]

Etiology of Ischemic Stroke

Ischemic stroke is caused by obstruction of
cerebral blood flow due to:
Thrombosis (from atherosclerosis)
Embolism (often from atrial fibrillation)
Small vessel disease (linked to
hypertension and diabetes)
Risk factors include hypertension, diabetes,
hyperlipidemia, atrial fibrillation, and
cardiovascular disease.
8. CLINICAL MANIFESTATIONS (SIGNS AND SYMPTOMS)
SUDDEN
NUMBNESS/WEAKNESS
(ESPECIALLY UNILATERAL)
CONFUSION, TROUBLE
SPEAKING OR
UNDERSTANDING
VISUAL DISTURBANCES
DIZZINESS, LOSS OF
BALANCE
SUDDEN SEVERE
HEADACHE
LOSS OF CONSCIOUSNESS
(IN SEVERE CASES)
 Lab [Link] TEST AND INVESTIGATION
Cardiac Markers:
Troponin I: 0.018 µg/L – Within
normal range (suggests no acute investigation
myocardial injury)
CK-MB: 0.6 µg/L – Normal • - MRI: Acute
CK Total (CPK): 35 U/L – Normal
BNP: 1,127.9 pg/mL – Elevated,
lacunar infarct
suggests possible heart failure or • - CT brain: Rule out
volume overload
Electrolytes & Renal Function: hemorrhage
Sodium: 140 mmol/L – Normal
Potassium: 4.1 mmol/L – Normal
Chloride: 106 mmol/L – Normal
Magnesium: 0.85 mmol/L – Normal
Phosphorus: 1.09 mmol/L – Normal
BUN (Urea): 4.5 mmol/L – Normal
Creatinine: 80.6 µmol/L – Normal
Inflammatory Markers:
C-Reactive Protein (CRP): 4.8
mg/L – Slightly elevated, may
indicate low-grade
inflammation
[Link] AND TREATMENT
Thrombolytics
Antiplatelets (, Aspirin, )
Anticoagulants (clexane )
Surgery (e.g., aneurysm clipping, hematoma evacuation)
Supportive Care: Oxygen, IV fluids, DVT prophylaxis, rehabilitation
Medication chart 1

**Antiplatelets** **Aspirin, Clopidog **Prevent clot form **Oral** **Standard for ischemic stroke**

**Anticoagulants** **Clexane (Enoxapar **Prevent blood clots, especia **Subcutaneous injection***Monitor bleeding risk**

**Statins** **Crestor (Rosuvastatin)** **Lower cholesterol, reduce stro **Oral** **Used for secondary prevention**
 .MEDICATION CHART 2

Medication Dose Frequency Route Start Date Stop Date Remarks

Tresiba FlexTouch 100IU Per order Once daily at 1Subcutaneous 17/05/2025 20/05/2025 PM dose

Proskin Zinc Oxide Cream QS Twice daily (06:00, 18:00) Topical 17/05/2025 20/05/2025

Glucare XR 1000 m 1000 mg Twice daily after meals Oral 17/05/2025 20/05/2025 Take after meals

Crestor 20 mg T 20 mg Once daily at 18:00 Oral 17/05/2025 20/05/2025 As per doctor instruc
 NURSING DIAGNOSIS
Ineffective cerebral tissue perfusion
Related to reduced blood flow to the brain caused by a stroke

1 (lacunar infarct).
As evidenced by dizziness, altered level of consciousness, and
MRI results.

Risk for aspiration

2 Related to decreased consciousness and weak swallowing

reflex after stroke.
As evidenced by patient’s history of difficulty swallowing and
lowered alertness.

3 Impaired physical mobility

Related to muscle weakness and paralysis caused by stroke.
As evidenced by limited ability to move and need for help.
Assessments
NURSING Diagnosis
DIAGNOSIS Goal Intervention Rationale Evaluation

Ineffective
cerebral tissue
perfusion
Related to
Dizziness, reduced blood tive Cerebral Tissue Pe
altered flow to the brain ogical status hourly (GC [Link] detection of dete Goal is met Patient
Patient will [Link] reduce intracran
consciousne caused by a ain head elevation at 30 maintains stable
[Link] adequate cere
ss, MRI stroke (lacunar maintain stable tain blood pressure wit neurological status
[Link] oxygen deliv
shows infarct). neurological status er supplemental oxygen [Link] sudden drops without worsening
lacunar As evidenced by oid sudden position cha symptoms
infarct dizziness, altered
level of
consciousness,
and MRI results.
 NURSING
Assessments DIAGNOSIS
Diagnosis Goal Intervention Rationale Evaluation

Decreased
consciousne Risk for aspiration 1. Assess swallowing ab [Link] swallowing d
Patient will remain 2. Position patient uprig [Link] gravity to reduce Goal is met Clears
ss, weak related to impaired
free from 3. Provide thickened liq [Link] fluids reduc secretions that could
swallow swallowing and
aspiration during 4. Suction oral secretion [Link] secretions that obstruct airway and
reflex, decreased [Link] safe feeding p cause aspiration.
5. Educate patient and c
history of consciousness feeding and care 6.
dysphagia
 NURSING
Assessments DIAGNOSIS
Diagnosis Goal Intervention Rationale Evaluation

Impaired Physical
1. Assist with passive a Goal is met Patient
Muscle Mobility — relevant Patient will Prevents joint stiffness
2. Encourage gradual m shows slight
weakness, due to hemiparesis Helps rebuild strength
improve mobility 3. Provide assistive dev improvement in
limited and weakness from Enhances safety and p
movement,
and perform 4. Reposition patient ev
Reduces risk of pressu
muscle strength but
the stroke affecting 5. Collaborate with phys
activities with less Ensures specialized re still requires
needs movement and If
assistance significant assistance
assistance requiring with movement..
assistance.
 REFERENCES
Ignatavicius, D. D., & Workman, M. L. (2018).
Medical-Surgical Nursing: Patient-Centered
Collaborative Care (9th ed.). Elsevier.
Comprehensive nursing resource covering cerebral
perfusion, stroke care, aspiration risk, and mobility
impairment.
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2019).
Nursing Diagnosis Handbook: An Evidence-Based
Guide to Planning Care (12th ed.). Elsevier.
Detailed nursing diagnoses including Ineffective
Cerebral Tissue Perfusion, Risk for Aspiration, and
Impaired Physical Mobility.
American Stroke Association. (2023). Stroke Facts
and Prevention. [Link]
Up-to-date clinical guidelines on stroke types,
complications, and management.
Carpenito-Moyet, L. J. (2019). Nursing Diagnosis:
Application to Clinical Practice (15th ed.).
Lippincott Williams & Wilkins.
 CONCLOUSION

Subacute ischemic stroke is a type of

stroke marked by reduced blood flow to
the brain, occurring days to weeks after
onset, often requiring close monitoring
and early rehabilitation to prevent
complications and support recovery.