ischemic stroke is a improper blood supply to brain and causes the improper functioning and the damages of the tissue of the brain..

1. Presented by :
B.Sunil Kumar Nayak

2. Patient Name : ABC
Age : 58 Yrs
Sex :Female
Unit : General Medicine Dept.

3.  Slurring of speech since 2days.
 Deviation of mouth and weakness of right upper limb
and lower limb since 1 day.

4.  MEDICAL HISTORY :- No Histories
 MEDICATION HISTORY :- Nothing significant
 FAMILY HISTORY :- Nothing significant
 SOCIAL HISTORY :-Non-veg

5. S - Subjective Evidence
O - Objective Evidence
A - Assessment
P - Planning

6.  PROVISIONAL DIAGNOSIS:-
CVA with Right Hemiparasis….?

7. Sr.Alkaline Phosphatases: 148 U/L (35-110)
MRI Brain: Acute infract in the left capsulogangilonic
region.
Carotid Doppler Study: Diffuse atherosclerotic changes
FINAL DIAGNOSIS:-
ISCHEMIC STROKE

8.  To reduce the ongoing neurologic injury
 To prevent the reoccurrence of the stroke

9. S.I NO DRUGS
(Generic names)
DOSE ROA FRE DA DS
1 Oxygen inhalation SOS 1 12
2 Inj.Ranitidine 2cc IV BID 1 12
3 Tab.Rosuvastatin 20mg PO OD 1 12
4 Tab.Aspirin+Clopidogril 75+75mg PO OD 3 12
5 Inj.Citicholine 500mg IV BID 5 12
6 IVF-NS 1 PINT IV 100m
l/hr
9 9
7 Tab.Hyosine butyl bromide - PO OD 12 11

10. DAYS PROGRESS
DAY
-1
O/E: Temp:98F, P/A: soft, PR:71bpm, RR:20/min,
LAB DATA
Blood Urea: 33mg/dl, Sr.Creatinine:0.8mg/dl, Sr.total
protein:7g/dl, albumin:3.8g/dl, globulin:3.2g/dl, gamma
GT:18IU/L, R.B.S:125mg/dl, Sr.total bilirubin:0.5mg/dl, direct
BR:0.1mg/dl, indirect BR:0.5mg/dl,Sr.ALT:14IU/L,
Sr.AST:15IU/L, Sr.ALP:148IU/L, Na+:142m.mol/l,
K+:3.5m.mol/l, Cl-:107m.mol/l
Platelets:3.29L/cumm, R.B.C:4.6mill/cumm, W.B.C:
8.0kcells/cumm, Hb:12.6g/dl
N-58%, L-27%, M-4%, E-11%, B-0%
HBsAg, HIV, HCV : Non-reactive
DAY-2 O/E: Pt is c/c, PR:63/min, BP:130/80mmhg, RR:18/min,
CVS:s1s2+, P/A:soft
LAB DATA
F.B.S:101mg/dl
MRI-BRAIN: Acute infract in the left capsuloganglionic region

11. DAYS PROGRESS
DAY-3 O/E:Pt is c/c, PR:70/min, BP:130/80mmhg, CVS:s1s2+
LAB DATA
Sr.total cholesterol:116mg/dl, Sr.triglycerides:99mg/dl,
HDL:37mg/dl, LDL:106mg/dl, VLDL:19mg/dl
DAY-4 O/E:Pt is c/c, Afebrile, BP:130/80mmhg,PR:74/min,
CVS:s1s2+
LAB DATA
2D ECHO: Grade I diastolic dysfunction, good RV/LV function

12. DAY PROGRESS
DAY-5 O/E:Pt is c/c, BP:120/80mmhg, PR:70/min, CVS:s1s2+
DAY-6 O/E:No fresh complaints, Afebrile
BP:120/80mmhg, PR:100/min, RS:BAE+
DAY-7 O/E:Pt is c/c, No fresh complaints, PR:70/min,
BP:100/60mmhg,RS:BAE+
DAY-8 O/E Pt is c/c, P/A:soft, PR:72/min, BP:110/80mmhg
LAB DATA
U.S.G Abdomen: No sonographic abnormalities detected.
C.U.E: Normal
C/O: Pain in abdomen, spasmodic in nature
DAY-9 O/E Pt is c/c, PR:82/min, BP:130/80mmhg, CVS:S1S2+
DAY-10 O/E Pt is c/c, PR:78/min, BP:120/80mmhg, CVS:S1S2+
DAY-11 O/E Pt is c/c, PR:78/min, BP:130/70mmhg, CVS:S1S2+
DAY-12 O/E Pt is c/c, PR:88/min, BP:110/80mmhg, CVS:S1S2+,
RS:BAE+

13.  The symptoms like slurring of speech, deviation of
mouth was subsided.
 Medication was given to prevent the reoccurrence of
stroke.

14.  Assess the patients Airway, Breathing and Circulation.
 Monitor the levels of the Glucose and Cholesterol.
 Monitor Blood Pressure.

15. Drug – Drug interactions :
Aspirin < > Clopidogrel
MOA
If Clopidogrel is coadministered with Aspirin on a long-
term basis that may cause GI lesions.
MANAGEMENT
Patients should also be counseled to avoid any other
over-the-counter salicylate products.

16.  Discharge medications:
1.Tab.Aspirin+Clopidogrel
75+75mg-po-od
2.Tab.Rousuvastatin
20mg-po-hs
3.Tab.Ranitidine
150mg-po-od

17. 1.About Disease
2.About Medication
3.About life style modifications