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CEREBROVASCULAR DISEASE(BLEED)
CASE PRESENTATION
Prepare By: Aprille Anne C.Sagmit
E Na!
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INTRODUCTION
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OBECTIVES3eneral O+4e$ti-e:
T %lly %n&er#tan& t"e %n&erlying &i#ea#e pr$e## $ere+r-a#$%lar &i#ea#e (+lee&) an& it# n%r#ingmanagement.
Spe$i5$ O+4e$ti-e#:
6.T learn a+%t t"e ma4r etilgie# $ere+r-a#$%lar &i#ea#e(+lee&).
7.T &etermine t"e pre-i%# an& pre#ent $lini$al "i#try t"e
patient.8.T perrm p"y#i$al a##e##ment !it" #pe$ial attentin n t"e
#y#tem# $%#.
9.t #"! t"e la+ratry eaminatin re#%lt# !it" t"e$rre#pn&ing nrmal -al%e#' a$t%al re#%lt rm t"e patient' an&it# interpretatin.
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.T %n&er#tan& t"e anatmy an& p"y#ilgy t"e+l& #%pply in t"e +rain an& tra$e it#
pat"p"y#ilgy.
;.T learn t"e +a#i$ prin$iple n%r#ing
management $ere+r-a#$%lar &i#ea#e (+lee&).
/.T %#e t"e n%r#ing pr$e## t i&entiy n%r#ingpr+lem# an& %n&er#tan& t"e p"arma$lgi$almanagement #et n t"e $lient an& pr-i&e t"eapprpriate n%r#ing $are plan.
<.T i&entiy t"e &i#$"arge plan r t"e patient1#re"a+ilitatin t $n&%$t an e-al%atin t"e $lient1#$n&itin rm a&mi##in t pre#ent
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PATIENT1S PRO=ILE
Patient1# Name : Patient S
Age : ;< year# l& 8 mnt"# 8> &ay#
A&&re## : 9?7/ INT. 7 Valen@%ela St. Sta. 2e#a'
2anila3en&er : 2ale
E&%$atinal Attainment : Cllege 3ra&%ate
Ci-il Stat%# : i&!er
Birt"&ay : Septem+er ;' 6?9/
Religin : Cat"li$
Natinality : =ilipin
O$$%patin : Retire& Tai Dri-er
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2e&i$al Data
C"ie Cmplaint : Se-ere "ea&a$"e an& -miting
A&mitting Diagn#i#: Se-ere "emrr"agi$ #tr*e' C"rni$"yperten#in' Crnary Artery Di#ea#e
=inal Diagn#i# : Cere+r-a#$%lar Di#ea#e (Blee&)
Time an& Date A&mitte&: 6>:7? P2 De$em+er 86' 7>6
Atten&ing P"y#i$ian : Dra. Sa&a-a
S%rgen : Dr. De+%%e
Ane#t"e#ilgi#t : Dra. 3%e-arra
Preperati-e Diagn#i# : Intra$ere+ral "emrr"age' rig"t
tempr,parietalOperatin Perrme& : Cranitmy an& e-a$%atin
"ematma' Rig"t rnt, temprparietal
P#tperati-e Diagn#i# : Intra$ere+ral "emrr"age' rig"t
tempr,parietal RO Arteri-en%#2alrmatin (AV2)
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Chief Complaint:
“Sobrang sumasakit na yung ulo
niya nung gabi pa lang tapos biglana siyang nagsususuka” a#-er+ali@e& +y t"e patient1# &a%g"ter.
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History of Present Illness
A$$r&ing t t"e &a%g"ter t"e patient' / "%r# prir ta&mi##in' Patient S #tarte& t "a-e "ea&a$"e rig"t #i&e !it" a
pain #$ale 6>6> ra&iating t rig"t r+ital area. T"i# !a#a##$iate& !it" 6> epi#&e# -miting pre-i%#ly inge#te&& an& !ater' let +&y !ea*ne##' #l%rring #pee$" an&!it" a +l& pre##%re 6><> mm"g. T"i# prmpte& $n#%lt"en$e a&mi##in.
Past Health History
T"e patient S !a# +rn Septem+er ;' 6?9/. Unre$alle&imm%ni@atin# #ai& +y t"e &a%g"ter t"e patient. 0e "a# a"i#try "yperten#in an& $rnary &i#ea#e r alm#t /
year# n! !it" a maintenan$e me&i$ine T!yn#ta <>mgn$e a &ay' Va#tarel 2R 8mgta+ n$e a &ay' Lipitr 7>mgn$e a &ay' A#pirin 6>>mg n$e a &ay an& 2etrpll >mgn$e a &ay. A$$r&ing t "i# &a%g"ter' "e "a# a *n!n allergyt Pn#tan' #"rimp' an& egg.
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Personal/Social History
Patient S i# t"e el&e#t in t"eir amily. Bt"parent# pa##e& a!ay. 0e "a# 6 +rt"er an& 8
#i#ter# !" are all marrie& an& #ettle&. 0e "a# a6> year gap t "i# #e$n& #i#ter. 0e i# a !i&!er.0i# !ie &ie& la#t 7>69 &%e t C"rni$ i&neyDi#ea#e. 0e "a# a #n an& a &a%g"ter' !" are all
marrie& an& #ettle&. 0e %#%ally &rin*# li%r 7,8a !ee*. 0e1# nt really a$ti-e in term# eer$i#e.
T"e nly eer$i#e "e &e# i# !al*ing ar%n& t"eneig"+r"& n$e in a !"ile i "e elt li*e
!al*ing. A$$r&ing t "i# &a%g"ter' patient S "a#n -i$e# e$ept r $$a#inal &rin*ing al$"l.Sme mrning "e #!eep# %t#i&e "i# "%#e an&prepare# +rea*a#t r "i# gran&$"il&ren.
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Environmental History (Living/Neighborhood/Circmstances!
A$$r&ing t patient S1# &a%g"ter' "e i# li-ing !it" "i# #n an&&a%g"ter in$l%&ing t"eir !n amily. T"ey li-e in a "%#e !"i$" "ean& "i# !ie +%g"t many year# ag.
T"eir "%#e i# !it"in a #%+&i-i#in *in& type !"ere %#%al-e"i$le# pa## +y. T"e patient1# &a%g"ter al# #ai& t"at t"eir "%#e i#a $m+inatin $ement an& !& !"i$" i# en%g" r "i# amilyan& gran&$"il&ren t li-e in. A$$r&ing t t"e &a%g"ter' $$*ra$"e#'ie# an& m#%ite# are pre#ent at t"eir "%#e. T"ey al# !n #meapplian$e# li*e tele-i#in' ra&i' ele$tri$ an' per#nal $mp%ter an&air $n&itiner. T"ey "a-e an ele$tri$ an& !ater $nne$tin. T"ey li-ein a pla$e !"ere "%#e# are a little +it $l#e +%t nt $l#er t ea$"t"er. S"e al# #ai& t"at "er at"er1# en-irnment i# a little +it ni#yan& $r!&e&.
"amily HistoryBa#e& n "i# &a%g"ter' t"ere are "i#trie# "yperten#in in "er
at"er1# paternal #i&e. S"e al# #ai& t"at patient S gre! %p $l#e t+t" mt"er an& at"er #i&e. S"e $annt re$all any &i#ea#e in +t" "er at"er1# parent#1 #i&e.
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#$ %&'&N)S
"*NC+I&N,L HE,L+HP,++E'NS
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BE=ORE
0OSPITALIFATION
DURIN3
0OSPITALIFATION
ANALGSIS AND
INTERPRETATIONA$$r&ing t patient
S1# &a%g"ter' "e
per$ei-e& "ealt" a#
+eing a+le t !r*'
%l5ll "i#
re#pn#i+ilitie# a# a
g& at"er an& g&pr-i&er. S"e
+elie-e# t"at "er
at"er t"in*# t"at
"ealt" i# a -ery
imprtant !eapn tli-e a lng an&
pea$e%l lie. Ba#e&
n t"e &a%g"ter
t"e patient' !"en
patient S eel# li*e"e1# ging t "a-e a
Patient S1#
&a%g"ter reali@e&
t"at it1# &iH$%lt t
+e #i$* +e$a%#e
t"e p"y#i$al an&
5nan$ial
$n#traint#.Patient S &%ring
"#pitali@atin i#
$n#$i%#' $alm
an& let"argi$. 0e
"a# plenty me&i$atin# #%$"
a#
anti"yperten#i-e'
anti+iti$' an&
#mti$ &i%reti$&r%g#. T"%g"
2any peple &e5ne an&
&e#$ri+e "ealt" a#:
Being ree rm
#ymptm# &i#ea#e
an& pain a# m%$" a#
p##i+le' +eing a+le t
+e a$ti-e an& t &!"at t"ey !ant r m%#t'
an& +eing g& in #pirit#
m#t t"e time.
(@ier. =%n&amental#
N%r#ing' <t"
e&.)
it" "im +eing in a
!ea*ene& #tate' "e
$annt %l5ll "i# rle a#
a at"er a# lng a# "i#
illne## $ntin%e#. 0i#"ealt" i# im aire& an&
Health Perception/Management Pattern
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BE=ORE
0OSPITALIFATION
DURIN3
0OSPITALIFATION
ANALGSIS AND
INTERPRETATIONPatient "a# *n!n
&&r%g allergie# t
#"rimp' egg an& Pn#tan.
A$$r&ing t t"e patient1#
&a%g"ter' "e %#%ally eat#
& #%$" a# green leay
-egeta+le#' an& r%it#. 0i#
%#%al &iet in t"e "%#e i#mre n 5#". 0e &e#n1t
li*e m%$" atty &#. 0e
eat# 8 %ll meal# a &ay:
+rea*a#t' l%n$"'
#metime# a #na$* in t"e
aternn an& &inner. 0e&e# &rin* al$"l 7 t 8
time# a !ee* an& &rin*# 6>
t 67 gla##e# !ater
e-ery &ay. 0e al# &e#n1t
li*e t m%$" #!eet#alty
&# an& $ra$*er#. 0eper$ei-e& t"at eating
Patient S "a# a
na#ga#tri$ t%+e
!"i$" a$t# a# t"e
prtal entry "i#
& an&
me&i$atin#. T"e
patient1# &iet i# li%i&
#te%ri@e& ee&ing6'>> $al &i-i&e&
int ; e%al ee&ing#
!it" an IV %i&
PNSS 6L in%#ing !ell
at 7>,76 &rp#min.
Patient S al# "a# anen&tra$"eal t%+e
$nne$te& t "im
t"at ma*e# eating
rally imp##i+le.
0ealt" #tat%# greatly aJe$t#
ne1# eating "a+it# an&
n%tritinal #tat%#. Di#ea#e
pr$e## $an &i#r%pt
meta+li#m an& $alri$ nee&#
an l&,age&. Alteratin# in
t"e $lient1# &iet are ten
nee&e& t treat a &i#ea#epr$e##' t in$rea#e r
&e$rea#e !eig"t' r t all!
an rgan t re#t an& prmte
"ealing. (@ier.
=%n&amental# N%r#ing' <t"
e&.)
0i# $%rrent &iet i#
"yperten#i-e &iet !"i$" i# l!
at #alt an& l! in at an& i#
#till t"e #ame a# "i# nrmal
&iet !"i$" in-l-e# a lt
green leay -egeta+le#' 5#"
• Nutritional/Metabolic Pattern
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ELI-IN,+I&N P,++E'NBE=ORE
0OSPITALIFATION
DURIN3
0OSPITALIFATION
ANALGSIS AND
INTERPRETATIONPatient S1# &a%g"ter
reprte& t"at "e -i&# an&&ee$ate# reg%larly. 0e
pa##e# %t #tl n$e a &ay.
Patient S1# &a%g"ter #ai& "e
&i& nt "a-e any &iH$%lty
%rinating r &ee$ating.
Ba#e& n t"e n%r#ing
a##i#tant !" &i& t"emrning $are
a$ti-itie#' patient S
&i& nt pa## any #tl
r "! many &ay#
alrea&y. 0e "a# an
in&!elling ley
$at"eter. T"ere are
+-i%# #ign# !ater
retentin in "i# arm#'
"an&# an& eet.
T"e "ealt"y +&y maintain# a
+alan$e +et!een t"e am%nt %i& inge#te& an& t"e
am%nt %i& eliminate&. T"e
e$retry %n$tin t"e
*i&ney &imini#"e# !it" age'
+%t %#%ally nt #igni5$antly
+el! nrmal le-el# %nle## a
&i#ea#e pr$e## inter-ene#.
T"e re%en$y &ee$atin i#
"ig"ly in&i-i&%alK t"e am%nt
al# -arie# rm per#n t
per#n. 2any l&er peple
+elie-e t"at reg%larityM mean#
a +!el m-ement e-ery &ay.
(@ier. =%n&amental#
N%r#ing' <t" e&.)
0i# $%rrent %rine %tp%t
in&i$ate# n "! "i# +&y i#
#%Jering rm t"e &i#ea#e. An
altere& eliminatin pattern i#
-ery &etrimental t any
er#n.
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,ctivity/E.ercise Pattern
E"&'E
H&SPI+,LI0,+I&N
*'IN%
H&SPI+,LI0,+I&N
,N,L1SIS ,N
IN+E'P'E+,+I&N
,ccording to patient S)s
daghter2 he)s not really
active in terms of e.ercise$
+he only e.ercise he does is
3al4ing arond the
neighborhood once in a3hile if he felt li4e 3al4ing
and every morning he
s3eeps otside his hose
and for her daghter it)s his
only e.ercise$
Patient !a# a&mitte& in
t"e inten#i-e $are %nit.
T%rning t"e patient
e-ery 7 "%r# an&
"a-ing +e& +at" !a# "i#
nly a$ti-ity an&m-ement.
Peple ten &e5ne t"eir "ealt"
an& p"y#i$al 5tne## +y t"eir
a$ti-ity +e$a%#e mental !ell,
+eing an& t"e eJe$ti-ene##
+&y %n$tining &epen& largely
n t"eir m+ility #tat%#. Peple!it" m+ility impairment# may
eel "elple## an& +%r&en#me t
t"er#. (@ier. =%n&amental#
N%r#ing' <t" e&.)
0i# $n&itin "a# #e-erely
impaire& "i# &aily a$ti-itie# an&
e-en t"e m#t #imple t"#e
ta#*# are imprtant. It i# &iH$%lt
t a&4%#t int ant"er
a$ti-ityeer$i#e pattern 4%#t t
a$$mm&ate "i# limite&
a+ilitie# in perrming a$ti-itie#.
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Sleep/ 'est Pattern
E"&'E H&SPI+,LI0,+I&N *'IN%
H&SPI+,LI0,+I&N
,N,L1SIS ,N
IN+E'P'E+,+I&N
Patient S)s daghter
verbali6ed that patient
S sleeps at arond 7 to
89pm after 3atching
+$#$ +he late time hesleeps is 88pm$ He also
ta4es a nap in the
afternoon after lnch$
She said that his father
never e.perienced
sleeping late at night$88pm is the ma.imm
time he can handle$ He
3a4es p in the
morning to coo4
brea4fast to his
grandchildren and ta4ethem to school$ ,fter
D%ring
"#pitali@atin'
patient S1# nly
a$ti-ity !a# t #leep
an& re#t. T"ere !eretime# !"en "e !a#
nt a+le t
#leepre#t a#i&e
rm "i# $n&itinK
ant"er a$tr i# t"e
-i#itatin t"en%r#e# !" ta*e# "i#
"%rly -ital #ign#'
me&i$ine#' an&
$$a#inal
#%$tining.
Peple re%ire #leep in
r&er t $pe !it" &aily
#tre##e#' t pre-ent atig%e'
t $n#er-e energy' t
re#tre t"e min& an& +&y'an& t en4y lie mre %lly.
Illne## t"at $a%#e# pain'
p"y#i$al &i#tre## per#nal
pr+lem# an& #tre## $an
re#%lt in #leep pr+lem#.
(@ier. =%n&amental# N%r#ing' <t" e&.)
Sleep &epri-atin +eing
pre#ent mean# t"at "i#
pattern !a# &i#r%pte&. 0i#
$%rrent $n&itin $a%#e#
pain an& t"%# &%e t it "e
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Self>Perception Pattern
E"&'EH&SPI+,LI0,+I&N
*'IN%H&SPI+,LI0,+I&N
,N,L1SIS ,N IN+E'P'E+,+I&N
Patient S)s daghter
perceived that her
father felt good abot
himself before the
hospitali6ation becasehe 3as able to 3or4 and
fl<ll his
responsibilities$ She
also reported that her
father is patient abot
things and ma4es it apoint to resolve all
matters that annoys
him$ She also thin4s
that her father does not
have any negative
feelings abot himself
D%ring
"#pitali@atin an&
&%ring treatment'
patient !a#
$n#$i%#'re#pn#i-e an&
let"argi$. Patient S
!a# $nne$te& t an
en&tra$"eal t%+e
t"at ma*e# tal*ing r
#pea*ing' -ery&iH$%lt an& pain%l.
A p#iti-e #el, $n$ept i#
e##ential t a per#n1#
mental an& p"y#i$al "ealt".
Sel, $n$ept al# eten&# t
t"e $"i$e# peple ma*e an&per$eptin# t"ey "a-e a+%t
t"eir "ealt". Peple re#pn&
t #tre##r# #%$" a# illne##
an& alteratin# in %n$tin
relate& t aging in -ariety
!ay#. In&i-i&%al# !it" pr#el,$n$ept may epre##
eeling# !rt"le##ne##'
#el,&i#li*e r e-en #el,
"atre&. T"ey may eel #a&'
r "pele##' an& may #tate
t"ey la$* energy t perrm
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'ole/'elationship Pattern
E"&'E
H&SPI+,LI0,+I&N
*'IN%
H&SPI+,LI0,+I&
N
,N,L1SIS ,N
IN+E'P'E+,+I&N,ccording to the
daghter of the
patient2 patient S
lives 3ith his son and
daghter inclding
their families$
Patient S)s daghter
also said that herfather has good
relationship 3ith his
friends2 neighbors
and family$ She also
thin4s that her fatheris a very caring and
D%ring
"#pitali@atin'
t"e #i+ling# an&
t"e &a%g"ter
t"e patient #tay#
!it" "im in t"e
"#pital +%t #tay#
nly at t"e +a$* t"e rm +e$a%#e
patient S !a#
a&mitte& in an
inten#i-e $are
%nit. T"ey nlygt t -i#it "im
T"r%g"%t lie' peple
%n&erg n%mer%# rle
$"ange#. Ea$" per#n
%#%ally "a# #e-eral rle#.
=ail%re t ma#ter a rle
$reate# r%#tratin# an&
eeling# ina&e%a$y'
ten !it" $n#e%entl!ere& #el,e#teem.
(@ier. =%n&amental#
N%r#ing' <t" e&.)
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Se.ality/'eprodctivePattern
E"&'E
H&SPI+,LI0,+I&N
*'IN%
H&SPI+,LI0,+I&N
,N,L1SIS ,N
IN+E'P'E+,+I&Nased on the patient)s
daghter2 patient S)s
3ife died last ?98 de
to Chronic @idney
isease$ Ever since his
3ife died2 he never
loo4ed for another
3oman becase for
him2 her mother 3as
his life2 strength and
happiness$ ,ccording
to the daghter2
sometimes she can feel
and notice that her
father is sad and lonely
that)s 3hy she let her
children sleeps at her
)
D%ring
"#pitali@atin'
patient S i# %n&er
#%per-i#in
n%r#e# an& &$tr#
&%e t "i# $n&itin.
0i# #e%al pattern
remaine& t"e #ame.
Regar&le## gen&er' age'
ra$e' #$ie$nmi$ #tat%#'
religi%# +elie#' p"y#i$al
an& mental "ealt"' r t"er
&emgrap"i$ a$tr#'
peple epre## t"eir
#e%ality in a -ariety
!ay# t"r%g"%t t"eir li-e#.
Se%al "ealt" i# t"e
integratin t"e #mati$'
emtinal' intelle$t%al an&
#$ial a#pe$t# #e%al
+eing' in !ay# t"at are
p#iti-ely enri$"ing an&
t"at en"an$e per#nality'
$mm%ni$atin an& l-e.
(@ier. =%n&amental#
7/24/2019 Cerebrovascular Disease (Bleed)
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7/24/2019 Cerebrovascular Disease (Bleed)
http://slidepdf.com/reader/full/cerebrovascular-disease-bleed 23/25
E"&'E H&SPI+,LI0,+I&N *'IN%
H&SPI+,LI0,+I&N
,N,L1SIS ,N
IN+E'P'E+,+I&N
+he daghter said
that her father felt a
little bit satis<ed
3ith his life btthere are parts of
him that she thin4s
her father regrets$
He is a 'oman
Catholic and goes tochrch every Snday
and visits Aiapo
chrch on a "riday$
Be$a%#e t"e
patient1#
$n&itin' t"e
$"aplain t"e"#pital &e# "i#
r%n&# an& t"at1#
t"e nly time' t"e
patient re$ei-e#
"ly #a$rament.Pl%# t"e "ly
ma## t"at !a#
+eing playe& all
-er t"e "#pital
rm#.
Spirit%al "ealt" a#
&e5ne& +y t"e N%r#ing
O%t$me# Cla##i5$atin
prte$t (2r"ea&' "n#n' 2aa#' 7>>9
p.6?)' i# t"e
Cnne$te&ne## !it"
#el' t"er#' "ig"er
p!er' all lie' nat%rean& t"e %ni-er#e t"at
tran#$en&# an&
emp!er# t"e #elM.
(@ier. =%n&amental#
N%r#ing' <t" e&.)
•Value/Belief Pattern
7/24/2019 Cerebrovascular Disease (Bleed)
http://slidepdf.com/reader/full/cerebrovascular-disease-bleed 24/25
#I$ Physical ,ssessment %eneral ,ppearance:
Patient !a# re$ei-e& a!a*e' re#pn#i-e +%t let"argi$' !it"nging IV= in%#ing !ell at 67 PNSS6L 67Q !it" 7>,76gtt#min at t"e rig"t meta$arpal -ein. Patient "a# an en&mrp"i$type +&y +%ilt an& !eig"# <> *ilgram#. 0eig"t !a# nt ta*en.0ygiene an& $leanline## are maintaine&. 0e i# %lly a##i#te&
&%ring "#pitali@atin. T"ere i# t"e pre#en$e en&tra$"eal t%+ein "i# m%t" $nne$ting t t"e me$"ani$al -entilatr' pre#en$e p%l#e imeter n t"e re 5nger $nne$te& t a $ar&ia$mnitring &e-i$e' !it" a a$*#n,Pratt &rainage n t"e rig"ttempr,parietal #i&e t"e "ea& !it" a 6>$$ am%nt +l&.Al#' t"ere i# a pre#en$e e&ema n t"e +t" %pper an& l!eretremitie#' pre#en$e "ernia n t"e mi& rig"t %pper %a&rant t"e a+&men an& +-i%# &rling #ali-a &%e t t"e in#erte&na#ga#tri$ t%+e in "i# m%t".
#ital Signs:+ B 8/.6QC
P B ?9 +pm
7/24/2019 Cerebrovascular Disease (Bleed)
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