A case study on cerebrovascular disease

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Group case study. Our CI corrected us that CVD is cerebrovascular disease and not cardiovascular, enjoy browsing.

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A case study on cerebrovascular disease

  1. 1. A Case Study onCardiovascular Disease
  2. 2. Introduction: A cardiovascular disease is oneof the greatest concerns on healthtoday. This disease is known as asilent killer. It just comes with noapparent signs and symptoms andpeople are not warned with anymanifestation to signal they containthis disease.
  3. 3. One way to detect its presence is totrace your family history. You are at risk of it if one or more family members died because of it, more so with an advanced age. Other medical condition like Diabetes Mellitus can predispose such individual to having cardiovascular diseases.
  4. 4. Aside from genetic predisposition, diet has also been a greatcontributory factor, if not indeedthe cause, to having such disease.
  5. 5. An excessive intake of salty and sodium-rich foods and overconsumption of fats and cholesterol, alcohol and substance abuse and smoking are more often than not, the predisposing factors of cardiovascular diseases.
  6. 6. An excessive intake of salty and sodium-rich foods and overconsumption of fats and cholesterol, alcohol and substance abuse and smoking are more often than not, the predisposing factors of cardiovascular diseases.
  7. 7. CVDs, as it is commonly known, are diseases that involve merely the heart and the blood vessels, which should be detected at an earliertime to possibly reduce its morbidity more so, its mortality.
  8. 8. Many deaths were reported of thisdisease. In fact, most countries face greater risks of this over cancer.
  9. 9. For us, to better understand its causes for we know once you areaffected with this disease you cantfind any way out and it could cause you multiple organ failure.
  10. 10. More so, Wed like to impart health teaching to our parents, relatives and friends, now that we canforesee its manifestations. As much as possible, we want them to be conscious of their health too.
  11. 11. We want them to be aware of this disease and how morbid it is. Wewant them to live longer as much aswe want me to stay longer too. Thiscase study is not just for us to learn but also for them to know and understand.
  12. 12. II.CLIENTS PROFILE Patient X is a 76-year oldfemale, widowed at age 75 and has8 grown-up children. She used tostay at one of her child’s house atAdela, Camaman-an, Cagayan deOro where she helps in theirALACART” business as the puso-maker.
  13. 13. She wakes up at around 6 in the morning and drinks her cup of coffee. Taking care of hergrandchildren before they get to school is what she usually does during weekdays.
  14. 14. She then eats her breakfast, watch TV afterwards and do somehousehold chores. In the afternoon,after lunch, is her ample time to do the puso and prepare in making barbecues. This is what she keeps doing almost everyday.
  15. 15. History of Present Illness Just few hours beforeadmission, Patient X was watchingTV with her child and grandchildrenwhen her child noticed she was nolonger answering her questions andher lower jaw is slightly misplaced.
  16. 16. Her child tried to put on some cold packs to somehow soften thehardened jaw part but it didnt work so they brought the patient forcheck-up but the doctor ordered for admission subsequently.
  17. 17. Patient X then was diagnosed with, Cardiovascular Disease, probably cardioembolic, CAD, atrial fibrilation and in controlled ventricular response. Few days onadmission, patient X was apparently well but each day gets worse, until she can hardly speak and open her eyes.
  18. 18. She was also unable to swallow foods even fluids so the doctor ordered for Nasogastric Tubeinsertion. Her doctor also orders for oxygen administration regulated at 4 liters per minute.
  19. 19. Review of Systems Upon assessment, the patientsvital signs were: BP 130/90, PR 92beats per minute of irregular andbounding rhythm, RR 20 cycles perminute and temperature of 37.8degree Celsius
  20. 20. General Appearance She looks generally weak andstuporous, she does not respond toquestions and even to painfulstimuli.
  21. 21. Respiration/ Respiratory Status She elicits rales and cracklingsounds during respiration notedupon auscultation. She breathes 20cycles per minute but of irregularrhythm with frequent apneicperiods. Lung expansion is slightlyassymetrical due to prolonged bedboundedness and immobility. Non-productive cough was also noted.
  22. 22. SKINGeneral Color PallorTexture smoothTurgor firmTemperature CoolMoisture dry
  23. 23. Facial Movements SymmetricalFontanels ClosedHair dryScalp With dandruff and lice
  24. 24. Lids SymmetricalPreorbital region Intact/FullConjunctiva PallorSclera AnictericReaction to light R-brisk L-briskReaction to Uniformaccomodation constriction/ConvergenceVicual Acuity Grossly NormalPeripheral Vision Intact/Full
  25. 25. Septum MidlineMucosa PallorPatency Both patentGross Smell Normal/SymmetricalSinuses Non-tender
  26. 26. External Pinnae Normoset; SymmetricalTympnic IntactMembraneGross Hearing Normal
  27. 27. Lips PallorMucosa PallorTongue MidlineTeeth DenturesGums Pallor
  28. 28. Trachea MidlineThyroids Non-palpableOthers Normal ROM
  29. 29. Uvula MidlineTonsils Not inflamedPosterior Not inflamePharynxMucosa Pallor
  30. 30. General NormalConfiguration SymmetricalBowel Sounds NormoactivePercussion Tympanic
  31. 31. Range of Motion NormalMusle tone and FairstrengthSpine MidlineGait Coordinated
  32. 32. Elimination Pattern The patient use to defecateonce every morning in softconsistency and in yellow tobrownish color. She has noproblems or any discomfort indefecation. Her bowel sounds arehypoactive upon auscultation. Shewas given Senna Concentrate tomanage constipation.
  33. 33. ROM/ Exercise Pattern Patients inability to do range ofmotion exercises by herself isimpaired. Her joints are flexedthrough passive ROM except for thehead. Muscle tone and strengthwere decreased and are possible foratrophy.
  34. 34. The presence of rales andcrackles, apneic periods and coughupon auscultation are signs andsymptoms of pulmonary edema.Edema and ascites formation alsosignal fluid movement from theintravascular compartment to theinterstitial compartment indicativeof fluid overload.
  35. 35. III. ANATOMY and PHYSIOLOGY
  36. 36. The heart is the main organresponsible for pumping blood allthrough out the systems. It isresponsible for the delivery of oxygento the tissues for nourishment anduses the circulating blood as themedium for the removal andexcretion of the cells metabolicwastes through exhalation.
  37. 37. The heart is situated in theanterior chest cavity. It has fourchambers, the upper ones are calledthe atria and are divided into two,the right and left. And the onessituated below are the right and leftventricles.
  38. 38. These chambers are divided byvalves the tricuspid and the bicuspidvalve, and still divided laterally by aseptum called atrioventricularseptum.
  39. 39. Blood from the systemiccirculation is already deoxygenated,passes trough the superior andinferior vena cavae. It then, entersthe right atrium, passing throughthe tricuspid valve and moves to theright ventricle, goes to the lungs viathe pulmonic artery.
  40. 40. Oxygenation and gas exchangehappens in the alveoli of the lungsthrough the process of diffusion.The oxygenated blood then getsback to left atria passing throughthe pulmonic vein. It moves to theleft ventricles through the bicuspidvalve then it passes the aorta forsystemic nourishment.
  41. 41. The pumping action starts withthe simultaneous contraction of thetwo atria. This contraction serves togive an added push to get the bloodinto the ventricles at the end of theslow-filling portion of the pumpingcycle called "diastole.
  42. 42. " Shortly after that, theventricles contract, marking thebeginning of "systole." The aorticand pulmonary valves open andblood is forcibly ejected from theventricles, while the mitral andtricuspid valves close to preventbackflow. At the same time, theatria start to fill with blood again.
  43. 43. After a while, the ventriclesrelax, the aortic and pulmonaryvalves close, and the mitral andtricuspid valves open and theventricles start to fill with bloodagain, marking the end of systoleand the beginning of diastole.
  44. 44. It should be noted that eventhough equal volumes are ejectedfrom the right and the left heart, theleft ventricle generates a muchhigher pressure than does the rightventricle.
  45. 45. IV. PATHOPHYSIOLOGY
  46. 46. V. DIAGNOSTIC PROCEDURES and LABORATORYRESULTS The diagnostic procedures patient X hasundergone were Electrocardiogram (ECG),complete blood count CBC and urinalysis. The ECGreads a lightly depressed P wave, widened QRSwaves and peak T wave. This means that the atria(P wave) are contracting less and atrial filling isdecreased. QRS or the time for the ventricles tocontract and depolarize takes greater time. Andthe time for the ventricles to relax for ventricularfilling T wave, is prolonged.
  47. 47. BLOOD CHEMISTRY Result Unit ReferenceWBC 9.8 10^3/uL 5.0-10.0RBC 3.9 10^6/uL 4.2-5.4Hgb 7.9 g/dL 12.0-16Hct 23.6 % 37-47Differential CountLymphocytes 8.1 % 17.4-48.2Neutrophils 73.2 % 43.4-76.2Monocytes 7.2 % 4.5-10.5Eosinophils 3.6 % 1.0-3.0Basophils 0.4 % 1.0-3.0Platelet 170 10^3/uL 150-400
  48. 48. Diagnostic/Laboratory Procedures Indication/purposes Result Analysis and Interpretation• Urinalysis To diagnose and monitor renal or urinary tract Color: yellow Laboratory results revealed that there isOrdered: last July 1, 2010 disease Clarity: hazy presence of albumin in the blood; this pH: 6.0 indicates that glomerular cannot filter Specific Gravity: 1.015 large molecules such as that of albumin. Puss cells: 4-6 It also revealed that there is bacterial RBC: 18-20 infection as evidenced by presence of Bacteria: plenty bacteria, puss cells and red cells in the Epithelial cells: occasional urine Albumin: 3+• Creatinine This test was ordered in order to evaluate renal 14.84 (reference Value = 0.6-1.2) Result was above normal level indicatingOrdered: Last June 30, 2010 function mg/dL renal malfunction. The kidney cannot excrete nitrogenous waste product of protein leading to its accumulation in the blood.• Sodium (Na+) To evaluate fluid and electrolyte imbalance and 133.6 ( reference value :135-148) Result was below normal level. It resultsOrdered: Last June 30, 2010 identify renal dysfunction mmol/L from loss of sodium-containing fluids or from water excess, such prolonged diuretic therapy and renal disease.• Potassium(K+) To evaluate fluid and electrolyte imbalance and 5.36 (reference value:3.5-5.3) mmol/L There is high level of potassium in theOrdered: Last June 30,2010 identify renal dysfunction. blood which usually or normally excreted by the kidney, but due to decreased GFR, kidney cannot filter potassium in the urine causing retention of potassium in the blood.• BUN (Blood urea nitrogen) To evaluate kidney function in a wide range of 145.6 (reference value: 4.6-23.4) A greatly elevated BUN generallyordered; last June 30,2010 circumstances, to help diagnose kidney disease mg/dL indicates a moderate-to-severe degree of , and to monitor patients with acute or renal failure. Impaired renal excretion of chronic kidney dysfunction or failure. urea may be due to temporary conditions such as dehydration or shock, or may be due to either acute or chronic disease of the kidneys themselves.
  49. 49. Urinalysis Report Color: Yellow Clarity: hazy pH: 6.0Specific gravity: 1.020 Proteins:+3 Blood: +3
  50. 50. VII. HEALTHTEACHINGS/DISCHARGE PLAN Medications > Take the entire course of anyprescribed medications. > Emphasis on educating aboutthe action of the drug, right dosage,timing and frequency on the intakeof the drug and its expected sideeffects.
  51. 51. Exercise Perform assistive rangeof motion exercisesregularly.Inform patient andsignificant others aboutthe importance of exerciseon the patients condition.
  52. 52. Treatment > Emphasize the importance ofearly ambulation. > Encourage the use of properpersonal hygiene and handwashing. > Provision of peacefulenvironment to promote rest andenhance well-being.
  53. 53. Home care: > Take adequate restperiods. > Avoid activitiesthat can cause fatigue.
  54. 54. Out-patient > Explain andemphasize the importanceof compliance to followcheck- up and therapeuticregimen.
  55. 55. Diet > Diet restrictions shouldbe properly observed > Intake of sodium-richfoods should be minimized. > Encourage the intake ofproper diet at proper timingto display timely healing.
  56. 56. VIII. LEARNING EXPERIENCE This is just actually our third time to beexposed in the ward, where lots of patientsare admitted. We find the experienceexhausting though its just our first rotationand we need to accomplish three more toproceed to the next round. we feel like we’redrained and we cant proceed to pursuing thiscourse. Only until one thing came our mind,theres no way for us to quit so we have todevelop the passion for us to succeed. If not,then we’re just certainly wasting our parentsfruit of labor.
  57. 57. We dont want it to happen somerely as early as now we shoulddevelop and learn to love the fieldthat we are into. On the very firstday of our duty, weve learned a lotnot just from our instructor neitherneither each of us but on ourpatient herself.
  58. 58. We learned from them not necessarily about sterile technique nor diseases, nor what is beingtypically taught in the classroom but in life at large.
  59. 59. They taught us of things wenever knew about life. Well, somuch for that, in making this casestudy, learnings that we have gainedare outpouring and overwhelming.More so with the things that puts usand our family at risk with this silentkiller disease.
  60. 60. We then would like to teachthem proper ways of taking care oftheir health, what foods they oughtto eat and what are those theyshould avoid. I also have learnedfrom making this case study theimportance of time and how toproperly manage it.
  61. 61. If projects are given at anearlier time, make it as early aspossible to avoid cramming andrefrain from eleventh hour rush.Nevertheless, though we startedmaking this case study a weekbefore deadline, thank God that wewere able to accomplish this with aheart.
  62. 62. The greatest learning I mighthave gained is that I did this despitemy limited knowledge, with noassistance and dependence fromothers. To sum this all up, this papermight not have been made possiblewithout God providing me theample time to devote in making this.Thanks be to God for the success ofthis project.
  63. 63. IX. REFERENCES:Black, J.,et al. (2009). MedicalSurgical Nursing. Eighth ed.Saunders Elsevier Printing office. Pp1456-1492.http://en.wikipedia.org/wiki/Cardiovascular_
  64. 64. http://www.google.com/imgres?imgurl=
  65. 65. Thank you!

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