This document outlines the learning objectives and case of a 75-year-old female stroke patient named Mrs. M. The objectives are to understand stroke including its definition, causes, signs and symptoms, complications, and treatment. Mrs. M's profile notes her medical history, vital signs, symptoms of right-sided weakness and difficulty swallowing. Her diagnosis is ischemic stroke and high cholesterol. The document further details her lab results, CT brain results, medications, nursing diagnoses and interventions.

2. At the end of this session, you will be
able to :
 State the definition of stroke.
 List the etiology of stroke.
 Identify the pathophysiology of
stroke.
 State the sign & symptom of
stroke.

3. LEARNING OBJECTIVES cont.
 Identify the complication of stroke.
 Understand regarding treatment of
stroke.
 Identify the nursing intervention &
appreciate the nursing care for
stroke patient.

5. PATIENT’S PROFILE
 MRS. M
 FEMALE
 75 YEARS OLD
 HOUSEWIFE

6. PATIENT’S PROFILE
 TROLLEY
 ANXIOUS
 ALLERGICS - NIL
 D.O.A 9/4/12 @ 1015 Hrs

7. Mrs M was admitted to 5XX-1
with complaint of right sided
weakness, slurred speech,
numbness right arm,
giddiness, dysphagia,
nausea and vomiting X 1/7.

8. Doctor = Dr AA
Diagnosis
1.Stroke
2.High Cholesterol

9. PATIENT’S PROFILE
 MEDICAL HISTORY
 Nil
 SURGICAL HISTORY
 Left eye removal of cataract (2 years ago)
 Right eye removal of cataract (1 year ago)
 FAMILY MED HISTORY
 HPT (mother)

10. CURRENT MEDICATION
 Nil

12. VITAL SIGN
 TEMPERATURE
 BLOOD PRESSURE
 PULSE
 RESPIRATION
 PAIN SCORE
 Dextrosmeter
 Weight
:
:
:
:
:
:
36.8˚C
170/100mmHg
88 bpm
18 bpm
1
8.2 mmol/L
: Unfit

13. ACTIVITY DAILY LIVING
 Having difficulty in swallowing
 Loss of appetite, nauseated and vomiting
 Anxious and asking many questions.
 Need assistance in ADL and personal hygeine
 On pampers

14. PHYSICAL EXAMINATION

16. S/B Dr AA in A&E
 17K
 CT BRAIN
 IV Drip D5% slow
 Low fat diet
 KIV anti HPT
 Dietician advice
 ROM exercise

28. ISCHEMIC STROKE
• Occurs when blood clot or thrombus
formed and blocked blood flow to
part of the brain.

29. HAEMORRHAGIC STROKE
• Occurs when blood vessel ruptured
and blood fills space between brain
and skull (subarachnoid
haemorrhage) or when a defective
artery burst and blood fills the
surrounding tissue (cerebral
haemorrhage).

32. WHAT pressure
High blood CAUSES IT?
 High cholesterol
 Aging
 Stress
 Cardiovascular disease
 Smoking and alcohol
 Diabetes


41. RISK FACTORS
• Family history
• Age over 40
• High BP
• High cholesterol
• Smoking

42. RISK FACTORS
• African American or Asian
• Male
• Diabetes
• Obesity
• Cardiovascular disease
• Stress

43. RISK FACTORS
• Previous stroke or TIA
• High level of homocysteine
(amino acid) in blood
• Birth control or hormonal therapy
• Cocaine usage
• Alcohol

45. COMPLICATION
• Paralysis
• Vision loss
• Difficulty speaking or
swallowing
• Memory loss
• Death

47. 17K
• ESR
- 56 (0 – 20 mm/hr)
• Neutropil
- 79.9% (40 – 75%)
• Lymphocyte
- 16.0% (20-45%)
• Glucose
- 6.9 (3.9 – 6.1mmol/L)

48. 17K
• Total cholesterol
- 8.0mmol/L (<5.2)
• LDL cholesterol
- 5.7mmol/L (<2.6)
• Chol/HDL Chol
- 4.4 (up to 4.0)

49. CT BRAIN
• Multifocal small cerebral white
matter ischemia

52. DRUGS
IN WARD
DATE
ORDERED
DATE
OFF
IV Nootropil 3gm TDS
9/4/13
12/4/13
Tab Cardiprin 1/1 OD
9/4/13
12/4/13
Tab Vascor 20mg ON
9/4/13
12/4/13
Tab Plavix 75mg Daily
9/4/13
12/4/13

53. DRUGS
ON DISCHARGE
DATE
ORDERED
Tab Vascor 20mg ON
12/4/13
Tab Cardiprin 1/1 ON
12/4/13

54. Physiotherapy
•
•
•
•
•
•
•
To normalise muscle tone
To restore muscle function
To control compensation strategies
To maintain muscle length
To re-educate balance
To retrain walking and restore mobility
To maximise functional ability while allowing ongoing neuromuscular recovery

56. NURSING DIAGNOSIS
 Knowledge deficit
related to management of
blood pressure control.

57. SUPPORTING DATA
 Patient will verbalize understand
regarding the management of blood
pressure.
 Patient will maintain optimal
normal blood pressure.

58. NURSING INTERVENTION
 Reinforce about doctor’s
explanation.
 Monitor blood pressure 4 hourly.

59. NURSING INTERVENTION
 Explain the sign and symptom of
high blood pressure :
 Headache
 Blurring vision
 Numbness

60. NURSING INTERVENTION
 Advise patient on dietary plan and
provide :
 Low salt diet
 Low fat diet

61. NURSING INTERVENTION
 Advise patient to do regular follow
up.

62. NURSING INTERVENTION
 Advise patient to maintain healthy
lifestyle :
 Avoid stress
 Consume healthy diet and avoid
salty and high fat food

63. NURSING INTERVENTION
 Advise patient to do regular
exercise.
 Encourage family members
support.

64. NURSING INTERVENTION
 Explain the complication of high
blood pressure :
 Influences of cardiovascular
 Cerebral
 Renal system

65. NURSING DIAGNOSIS
 Alteration in emotional
status anxiety related to
symptoms of stroke and
treatment.

66. NURSING DIAGNOSIS
 Alteration in ADL related
to right sided weakness
and numbness of right
hand.

67. NURSING DIAGNOSIS
 Knowledge deficit
related to management of
blood glucose control.

68. NURSING DIAGNOSIS
 Potential fall related to
right sided body
weakness.

69. NURSING DIAGNOSIS
 Alteration in nutritional
status less than body
requirement related to
nausea, vomiting and
dysphagia.

70. NURSING DIAGNOSIS
 Potential infection
related to intravenous
cannulation.

71. NURSING DIAGNOSIS
 Knowledge deficit related
to post stroke attack
management.

72. NURSING DIAGNOSIS
 Potential alteration in skin
integrity related to
immobility.

74. •
•
•
•
•
•
•
•
Reduce your blood pressure
Improve your diet
Stop smoking
Consider how much alcohol you drink
Exercise more
Watch your weight
Relaxation and stress management
Diabetes management