Case study on cerebro vascular accident (CVA) or stroke. It include History, Physical Examination, nursing care plan and Orem's nursing theory applied. Cerebrovascular disorder or CVA is damage to part of the brain when its blood supply is suddenly reduced or stopped. The part of the brain deprived of blood dies and can no longer function. Blood is prevented from reaching brain tissue when a blood vessel leading to the brain becomes blocked (ischemic) or bursts (hemorrhagic). Symptoms following a stroke come on suddenly and may include: weakness, numbness, or tingling in the face, arm, or leg, especially on one side of the body trouble walking, dizziness, loss of balance, or coordination inability to speak or difficulty speaking or understanding, trouble seeing with one or both eyes, or double vision, confusion or personality changes, difficulty with muscle movements, such as swallowing, moving arms and legs, loss of bowel and bladder control, severe headache with no known cause, and loss of consciousness.

1. CASE STUDY ON
CEREBRO VASCULAR ACCIDENT

2. INTRODUCTION
I Jaice Mary Joy, MSc Nursing Previous (Batch 2020) student, as a part
of my Advanced Nursing Practice clinical duties, I was posted in Trauma
ICU and I took care of a patient Mrs. XYZ, from 8/4/2021 to 12/4/2021
for my case study.
PATIENT PROFILE
Name – Mrs. XYZ
Age – 62 yrs
Gender – Female
Religion – Hindu
Marital Status – Married
Occupation – Housewife
Reg. No. – A/MDM/JDH/21/23272
Date of admission – 07-04-2021
Ward – Trauma ICU
Department – Neurology
Provisional Diagnosis – CVA, Rt. Side Hemiplegia
Informant – Family Members
PRESENTINGCOMPLAINTS
 Unconsciousness
 Vomiting – 2-3 episodes at the time of injury, half an hour later after fall
 Hemiparesis leading to hemiplegia
HISTORY OF PRESENT ILLNESS
Mrs. XYZ was apparently alright before 07-04-2021, when she had a fall from the
stairs at her house due to which she lost consciousness. After gaining mild
consciousness she had 2-3 episodes of vomiting and was unable to move her right
hand & right leg. She was taken to a nearby Community Health Centre from where
she was referred to District Hospital, Jodhpur, where she was immediately admitted in
Trauma ICU and was planned CT scan + investigations (CBC, RFT, LFT). She was
diagnosed as a case of CVA.

3. HISTORY OF PAST ILLNESS
Medical – Patient suffers from hypertension from last 3 years and is taking
medications for the same. She also had episode of syncope 2 times
Surgeries – No previous history of Surgery
Allergies – No history of allergies
FAMILY HISTORY
No. of members – 1
Types – Pt. lives alone
History of Illness – not present
Congenital problems – no
Pedigree –
- Patient/ Female
- Normal Female
- Deceased male
SOCIO ECONOMIC STATUS
Monthly Income – Rs. 10,000-15,000 / month
Housing – lives in pucca house
Sanitation – attached toilets in house
Ventilation – poorly ventilated

4. PSYCHOLOGICAL STATUS
Ethnic background – Pt follows Hindu religion and culture
Support System – Pt. has good support system of family and friends
HABITS
Substance Use – Chews tobacco
Diet – Vegetarian diet
Sleep– sleeps for 6-7 hours a day
Exercise – No habit of doing exercise
Elimination – has good
PHYSICAL EXAMINATION
GENERAL APPEARANCE
Age – 62 years
Gender – Female
Nourishment – Malnourished
Body build – Thin body built
Gait – pt. is unconscious
Hygiene & Grooming – not properly groomed
Body Odor – No bad odor
Activity – No activity
MENTAL STATUS
Consciousness – Unconscious
Look – appears irritable
Mood – Pt. is unconscious
POSTURE
Body Curves – Lordosis and Kyphosis absent
Movement – No movement
HEIGHT – 5’5
WEIGHT – 50 kg

5. VITAL SIGNS
Vital Signs Patient Value Normal Range
Temperature 97.8°F 98.6°F
Pulse 98 beats/min 60-100 beats min
Respiration 24 breath/ min 16-24 breath/min
Blood Pressure 138/90 mm Hg 120/80 mm Hg
SKIN CONDITION
Color – Fair
Texture – Normal
Temperature – 97.8°F
Lesions – No skin Lesions
Turgor – Normal Skin Turgor
Condition of Nail – Clubbing of fingers absent
HEAD & FACE
Scalp – Dandruff present
Face – Bruising around the temporal region
EYES
Eyebrows – Symmetrical
Eyelashes – Normal
Eyelids – Normal
Eyeballs – Normal
Conjunctiva – Slightly Red
Sclera – White in color
Vision – No Eye opening to verbal stimuli
Pupil - Mild dilated
EAR
External Ear – No Discharge
Hearing – Does not respond properly to verbal stimuli
MOUTH & PHARYNX
Lips – Normal, no cheliosis

6. Odor of Mouth –No halitosis
Teeth – No dental carries
Mucous membrane & gums – Normal , no any bleeding present
Tongue – No coated tongue
Throat & Pharynx – No tonsilitis
NECK
Lymph Nodes – No significant lymph node enarlagrement
Thyroid Gland – No any goiter
Range of Motions – Pt. unconscious
CHEST
Thorax – Proper shape
Breath sounds – Wheezing present, abnoramal breathing pattern
Heart – No any abnormal sound like murmur
EXTREMITIES
Movement of Joints – Immobilized
Clubbing of fingers – Absent
BACK
Curves – Absence of lordosis and khyposis
GENITAL & RECTUM
Inguinal lymph nodes – No any abnormal enlargement in lymph node
Enlargement of Prostates – No possible sign of BPH
NEUROLOGICAL TEST
Reflexes – Plantar reflex – Abnormal (extension)
Test for sensations – Normal sensation are present

7. DISEASE CONDITION
I. DESCRIPTION OF THE DISEASE
Cerebrovascular disorder or CVA is damage to part of the brain when its blood supply
is suddenly reduced or stopped. A CVA may also be called stroke. The part of the
brain deprived of blood dies and can no longer function. Blood is prevented from
reaching brain tissue when a blood vessel leading to the brain becomes blocked
(ischemic) or bursts (hemorrhagic). The symptoms of a stroke differ, depending on
the part of the brain affected and the extent of the damage. Symptoms following a
stroke come on suddenly and may include: weakness, numbness, or tingling in the
face, arm, or leg, especially on one side of the body trouble walking, dizziness, loss of
balance, or coordination inability to speak or difficulty speaking or understanding,
trouble seeing with one or both eyes, or double vision, confusion or personality
changes, difficulty with muscle movements, such as swallowing, moving arms and
legs, loss of bowel and bladder control, severe headache with no known cause, and
loss of consciousness.
Ischemic stroke, cerebrovascular accident (CVA), or “brain attack” is a sudden loss of
the blood supply to a part of the brain. Ischemic strokes are subdivided into five
different types based on the cause: large artery thrombosis strokes (20%), small
penetrating artery thrombotic strokes (25%), cardiogenic embolic strokes (20%),
cryptogenic strokes (30%) and other (5%). Hemorrhagic strokes account for 15% to
20% of cerebrovascular disorders and are primarily caused by intracranial or
subarachnoid hemorrhage.
Hemorrhagic strokes are caused by bleeding in the brain tissue, the ventricles, or the
subarachnoid space. Primary intracerebral hemorrhage from a spontaneous rupture of
small vessels accounts for approximately 80% of hemorrhagic strokes and is caused
chiefly by uncontrolled hypertension. Subarachnoid hemorrhage results from ruptured
intracranial aneurysm in about half the cases.
Many studies were conducted regarding cerebrovascular accidents tackling different
aspects of cerebrovascular accident such as; the cause, precipitating factors,
predisposing factor, and its prevalence throughout the world as one of the top ten
leading causes of morbidity.
The severity associated with cerebrovascular accident can best be demonstrated by the
following facts: CVA is the leading cause of adult disability in the world.

8. II. ANATOMY AND PHYSIOLOGY
The nervous system has two major anatomical subdivisions;
 The central nervous system (CNS)
 The peripheral nervous system (PNS)
Cells of The Nervous System
 There are two cells of the nervous system. These are;
 Neuron and Neuroglia
 The functional unit of the nervous system is the nerve cell, or neuron
 Neuroglia or glial are supportive cells in the nervous system that aid the
function of neurons
NEURONS (Nerve Cells)
 Neurons have three fundamental physiological properties:
1. Excitability
2. Conductivity
3. Secretion
 A typical neuron is divided into three parts; Soma or cell body (perikaryon),
Dendrites, Axon
SYNAPTIC TRANSMISSION
 The meeting point between a neuron and any other cell is called a synapse
 The synapses b/t neurons and skeletal muscle cells are referred to as
myoneural or neuromuscular junction
 Synapse can be; Chemical synapse and Electrical synapse

9. Central Nervous System
 The CNS consists of the brain and spinal cord
 CNS protected by a cranium surrounding the brain
 vertebral column surrounding the spinal cord
 The CNS is bathed in cerebrospinal fluid
 The CNS is composed of gray and white matter
The Brain
 The brain is semi-spherical but soft delicate complex organ.
 It is the center for control and integration
 An adult brain weighs near 1.5 kg (3-3.5lbs)
 Averages about 1,600 g (3.5 lb) in men
 1,450 g in women
 Composed of an estimated 100 billion (1011) neurons
 Anatomically, the brain is divided into 3 regions;
1. Forebrain
2. Midbrain
3. Hindbrain
DIVISIONS OF THE BRAIN
 The brain is lined by membrane called meninges.
 The brain is conspicuously marked by surface gyri (folds) and sulci (grooves).
 The human brain is composed of neurons, glial cells and blood vessels.
 It also consists of four internal, interconnected chambers called ventricles.
Surface Anatomy Of The Brain

10. MENINGES OF THE CENTRAL NERVOUS SYSTEM
 The CNS is protected by three connective tissue membranes coverings called
meninges
 From superficial to deep, they are;
1. Dura mater,
2. Arachnoid mater,
3. Pia mater
CEREBROSPINAL FLUID & VENTRICLES OF THE BRAIN
The brain has four internal chamber called ventricles
 Two lateral ventricles
 A third and fourth ventricles
The fourth ventricle is located in the brain stem. The cerebral aqueduct (aqueduct of
Sylvius) passes through the midbrain to link the third and fourth ventricles.
CSF is a clear fluid that forms a protective cushion around and within the CNS
VENTRICLES OF THE BRAIN
SPINAL CORD
 It is an elongated cylindrical structure that is a ropelike bundle of nervous
tissue
 In adults, it averages about 1.8 cm thick and 45 cm long
 It begins as a continuation of the medulla oblongata at the level of the foramen
magnum
 The spinal cord serves three principal functions: Conduction, Locomotion and
Reflexes
 The cord gives rise to 31 pairs of spinal nerves. the part supplied by each pair
of spinal nerves is called a segment.
 The spinal cord is divided into cervical, thoracic, lumbar, and sacral regions.

11. STRUCTURE OF THE SPINAL CORD (Surface Anatomy))
BLOOD SUPPLY OF BRAIN
The brain derives its arterial supply from the paired carotid and vertebral arteries.
Every minute, about 600-700 ml of blood flow through the carotid arteries and their
branches while about 100-200 ml flow through the vertebral-basilar system.
The carotid and vertebral arteries begin extracranially, and course through the neck
and base of the skull to reach the cranial cavity. The internal carotid arteries and their
branches supply the anterior 2/3 of the cerebral hemispheres, including its deep white
matter and the basal ganglia. The vertebral arteries and basilar artery, with their
branches, supply the remaining posterior and medial regions of the hemispheres, most
of the diencephalon, the brainstem, cerebellum, and cervical spinal cord.

12. III. ETIOLOGY
BOOK PICTURE PATIENT PICTURE
 Occlusive Thrombus
 Occlusive Embolus
 Head Injury
 Brain injury
 Hypertensive Hemorrhage
 Congenital
 Brain injury
 Hypertensive Hemorrhage
IV. PATHOPHYSIOLOGY
Obstruction of blood vessel (thrombus, emboli etc)
Decreased cerebral blood flow
Initiate ischemic cascade (complex series of cellular metabolism events)
Neuron not able to maintain aerobic respiration
Mitochondria switch anaerobic respiration
Generate large amount of lactic acid, cause change in PH
Neuron incapable of producing sufficient ATP to fuel depolarization
Electrolyte imbalance will occurs, cell cease to function
Pneumbra area develop on brain
Membrane depolarization in cell leads to increase intracellular calcium and
release of glutamate
Vasoconstriction and generation of free radicles
Enlarge the area of infraction
Cell injury and death

13. V. CLINICAL MANIFESTATION
BOOK PICTURE PATIENT PICTURE
 Visual field deficit-
 Homonymous hemianopia(loss
of half of the visual field)
 Loss of peripheral vision
 Diplopia
 Agnosia
 Motor deficit-
 Hemiparesis
 Hemiplegia
 Ataxia
 Dysarthria
 Dysphagia
 Sensory deficit –
 Paresthesia
 Hemi sensory loss-
 Verbal deficit-
 Expressive aphasia(broca)
 Receptive aphasia(wernicke)
 Global aphasia
 Cognitive deficits-
 Short and long term memory loss
 Decreased attention span
 Impaired ability to concentrate
 Poor abstract reasoning
 Altered judgement
 Loss of self-control
 Emotional deficit
 Decreased tolerance to stressful
situation
 Depression
 Withdrawal
 Fear, hostility and anger
 Feeling of isolation
 Incontinenece-
 Bowel and bladder dysfunction
 Frequency, urgency,
incontinenece
 Motor deficit-
 Hemiparesis
 Hemiplegia
 Dysphagia
 Sensory deficit
 Paresthesia
 Verbal deficit-
 Global aphasia
 Cognitive deficits-
 Decreased attention span
 Impaired ability to concentrate
 Headache
 Self-care deficit

14. VI. DIAGNOSTIC EVALUATION
VII. COMPLICATIONS
BOOK PICTURE PATIENT PICTURE
 Aspiration pneumonia
 Dysphagia in 25% to 50% of
patients after stroke
 Spasticity, contractures
 Deep vein thrombosis, pulmonary
embolism
 Brain stem herniation
 Post stroke depression
 Aspiration pneumonia
 Dysphagia
VIII. MANAGEMENT
Medical management
BOOK PICTURE PATIENT PICTURE
 Acute Treatment
o Support Vital Functions
(A,B,C)
o Reperfusion & hemodilation
with colloids and volume
expands
o Thrombolytic therapy
o Antiplatelet agents
o Vasodilator
 Management of increased ICP
 Antihypertensive Drugs
 Diuretic Therapy
 Calcium channel blockers
 Anticoagulant Therapy
 Acute Treatment
o Support Vital Functions
(A,B,C)
o Thrombolytic therapy
o Antiplatelet agents
o Vasodilator
 Antihypertensive Drugs
 Diuretic Therapy
 Calcium channel blockers
 Anticoagulant Therapy
BOOK PICTURE PATIENT PICTURE
 Carotid ultrasound- to detect carotid
stenosis.
 CT scan- to determine cause and
location of stroke.
 MRA or CT angiogram
 Cerebral angiography
 PET, MRI with diffusion
 Hematological Investigation
 CBC
 LFT
 RFT
 CT Scan shows hypodense lesion in
left cerebral hemisphere, chronic
infarct seen on right cerebral
hemisphere, hematoma area on left
hemisphere.
 MRI shows brain injury.
 Hematological investigation shows
increased WBC (12 x 103) µ/L,
decreased lymphocytes, neutrophilia.
Blood urea (62 mg/dl) and serum
creatinine (1.97 mg/dl)levels are also
increased

15. Surgical Management
BOOK PICTURE PATIENT PICTURE
 CEA( carotid end
arthrectomy
 Clot retrieval
 Balloon angioplasty to
treat acute spasm
 None
NURSING MANAGEMENT
Nursing Assessment
 Maintain neurologic flow sheet (the Modified Rankin scale or NIH Stroke
Scale may be used).
 Assess for voluntary or involuntary movements, tone of muscles, presence of
deep tendon reflexes (reflex return signals end of flaccid period and return of
muscle tone).
 Also assess mental status, cranial nerve function, sensation/proprioception.
 Monitor bowel and bladder function/control.
 Monitor effectiveness of anticoagulation therapy.
 Frequently assess level of function and psychosocial response to condition.
 Assess for skin breakdown, contractures, and other complications of
immobility.

16. Nursing Diagnoses
 Ineffective tissue perfusion : cerebral related to thrombus, embolus, hemorrhage,
edema or spasm
 Risk for Injury related to neurologic deficits
 Impaired Physical Mobility related to motor deficits
 Disturbed Thought Processes related to brain injury
 Impaired Verbal Communication related to brain injury
 Self-Care Deficit: Bathing, Dressing, Toileting related to hemiparesis/paralysis
 Imbalanced Nutrition: Less Than Body Requirements related to impaired self-
feeding, chewing, swallowing
 Impaired Urinary Elimination related to motor/sensory deficits
 Disabled Family Coping related to catastrophic illness, cognitive and behavioral
sequelae of stroke, and caregiving burden.

17. NURSING CARE PLAN
ASSESSMENT
NURSING
DIAGNOSIS
PLANNING INTERVENTION IMPLEMENTATION
EXPECTED
OUTCOME
Subjective Data
(None)
Pt. is hemiplegic
and unconscious
Objective Data
 hemiplegia
 altered mental
status
 restlessness
 changes in
pupillary
 Reactions
 difficulty in
swallowing
Ineffective
cerebral tissue
perfusion r/t
interruption of
blood flow
secondary to
CVA
Short term goals
Patient will be
able to display
decrease signs of
ineffective tissue
perfusion as
evidence by
gradual
improvement of
vital signs
Long term goals
Patient will be
able to gradually
improve tissue
perfusion as
evidenced by
good capillary
refill and pink
conjunctiva
 Monitor vital signs
 Check capillary refill
and conjunctiva for
paleness
 Elevate head of bed as
ordered
 Avoid neck flexion
and extreme hip/knee
extension
 Provide and maintain
oxygen as ordered
 Perform GCS
monitoring as ordered
 Administer
medications as
ordered
 Vital signs
monitored
 capillary refill
delayed and
conjunctiva for is
slightly pale
 head of bed
elevated to 30
degrees
 neck flexion and
extreme hip/knee
extension avoided
 Patient is intubated
endotracheally
 GCS monitoring
done (E2 V1 M1)
 Medications
administered as
ordered
Patient shall have
gradually improved
tissue perfusion as
evidenced by
gradual
improvement of
vital signs, good
capillary refill and
pink conjunctiva

18. ASSESSMENT
NURSING
DIAGNOSIS
PLANNING INTERVENTION IMPLEMENTATION
EXPECTED
OUTCOME
Subjective Data
(None)
Pt. is hemiplegic
and unconscious
Objective Data
 right
hemiplegia
 limited ROM
 difficulty
turning
 slowed
movement
 gait changes
 Postural
Instability
during
performance
of routine
ADL’s
Impaired
Physical
Mobility R/t
neuromuscular
involvement
secondary to
CVA infarct
Short term goals
Pt. is willing to
participate in
activities
necessary for the
patient
Long term goals
Pt. will be able to
improve and
increase strength
and function of
affected body
part..
 monitor vital signs
 note
emotional/behavioral
responses to problems
of immobility
 determine readiness to
engage in
activities/exercises
 provide for safety
measures including
fall prevention
 identify energy
conserving techniques
for ADL’s
 involve patient and
family in care assisting
them to learn ways of
managing problems of
immobility
 assist patient to do
passive range of
motion
 provide restful
environment for
patient after periods of
exercise
 Vital Signs
monitored
 Fear, hostility and
anger expressed by
the pt.
 Pt. is afraid to
engage in activities
 Safety measures
including fall
prevention taken
 Energy conserving
techniques for
ADL’s
 Involved pt. and
family to learn
management of
immobility
problems
 assisted patient to
do passive range of
motion
 provide calm and
peaceful
environment for the
patient to rest
Patient shall have
participated in
activities necessary
for the patient and
shall have improved
and increased
strength and
function of affected
body part.

19. ASSESSMENT
NURSING
DIAGNOSIS
PLANNING INTERVENTION IMPLEMENTATION
EXPECTED
OUTCOME
Subjective Data
(None)
Pt. is hemiplegic
and unconscious
Objective Data
 with soiled
clothes
 with
unsatisfying
appearance
 with minimal
sweating
 uncombed
hair
Self-Care Deficit
R/t
musculoskeletal
impairment
secondary to
CVA
Short term goals
Pt will be able to
identify personal
resources that can
provide assistance
and be able to
verbalize
knowledge of
health care
practices.
Long term goals
Pt. will
demonstrate
techniques/
lifestyle changes
to meet self-care
needs
 establish rapport
 monitor vital signs
 Assess for type and
severity of immobility
impairment, muscle
flaccidity, spasticity
and coordination,
ability to walk, sit.
 Perform passive ROM
to all limbs and
progress to assistive
and then active ROM
in all joints four times
a day
 use assistive devices
as appropriate for
ambulation, clothing
with zipper closures,
personal hygiene
articles for brushing
teeth, combing hair,
clothing that is easily
managed to dress and
undress
 Adjust the
environment
according to Pt. needs
and protection
 rapport established
 Vital signs
monitored
 Severity of
immobility
assessed – Pt.
cannot move right
hand and right leg.
 Performed passive
and active ROM
 Taught the family
and the Pt. how to
use assistive
devices like walker
 Environment
modification done
according to the pt.
Pt shall have
identified personal
resources that can
provide assistance
and be able to
verbalized
knowledge of health
care practices and
also shall have
demonstrated
techniques/ lifestyle
changes to meet
self-care needs

20. APPLICATION OF NURSING THEORY: OREM’S SELF-CARE
DEFICIT THEORY
INTRODUCTION
The Self-Care Deficit Theory developed as a result of DOROTHEA E.
OREM working toward her goal of improving the quality of nursing in general
hospitals in her state.
Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting
others in the provision and management of self-care to maintain or improve human
functioning at the home level of effectiveness.” It focuses on each individual’s ability
to perform self-care, defined as “the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-being.”
“The condition that validates the existence of a requirement for nursing in an adult is
the absence of the ability to maintain continuously that amount and quality of self-
care which is therapeutic in sustaining life and health, in recovering from disease or
injury, or in coping with their effects. With children, the condition is the parent’s
inability (or guardian) to maintain continuity for the child the amount and quality of
care that is therapeutic.” (Orem, 1991)
MAJOR ASSUMPTIONS
 People should be self-reliant and responsible for their own care and others in
their family needing care
 People are distinct individuals
 Nursing is a form of action – interaction between two or more persons
 Successfully meeting universal and development self-care requisites is an
important component of primary care prevention and ill health
 A person’s knowledge of potential health problems is necessary for promoting
self-care behaviors
 Self-care and dependent care are behaviors learned within a socio-cultural
context

21. OREM’S THEORY AND NURSING PROCESS
 Nursing process presents a method to determine the self-care deficits and then
to define the roles of person or nurse to meet the self-care demands.
 The steps within the approach are considered to be the technical component of
the nursing process.
 Orem emphasizes that the technological component "must be coordinated with
interpersonal and social processes within nursing situations.
As a nurse, considering the scenario, assessing the client condition, taking care and
providing holistic care by utilizing the elements or components of Orem's self-care
deficit theory accordingly was intended. The whole nursing care plan of care
embedded in the Orem's instruction to nurses to meet self-care needs of instead,
different approaches can be used to meet similar needs. Self-care abilities requires
deliberate, calculated action which is influenced by an individual's knowledge and
skills repertoire, and which is based upon the premise that individuals know when
they are in need of assistance and are aware of the specific actions they therefore need
to take. Individuals will inquire the ways to develop and meet known self-care
demands. When they overcome with realities, their self-care.
Universal self-care
requisites
Self-care
agency/actions
Nursing agency/actions
Maintenance of
sufficient intake of air
Cough and deep-breath
expectorate
Encourage coughing, deep
breathing, active and passive
exercise
Thorough respiratory system
assessment for the risk of infections
Maintenance of
sufficient intake of
water
Use of right arm/hand in
drinking when he is able
to drink and swallow
without N/G tube
Proper N/G feeding techniques and
assessment for the regaining of the
ability of spontaneous swallowing
Assist in daily fluid intake with
proper documentation
Observe for signs of dehydration or
fluid overload

22. Maintenance of
sufficient intake of
food
Use of right hand in
food intake when
swallowing ability
resumes
Proper food management and
nasogastric administration with
consultation of nutritionist/
dietician
Encourage and help to regain the
swallowing ability with the help of
swallowing therapist Food
consumption timing, requirement
and assessment
Modification of diet to prevent
constipation
The provision of care
associated with
elimination processes
and excrement
Bladder and bowel care with urine
output and bowel movement record
Maintain hygiene of the perineal
area
Maintenance of a
balance between
activity and rest
Assist with mobility and
exercises
Assist with ambulation
Provide environment suitable for
rest, nap and quiet times
Encourage to express anger
positively, reduce fatigue
Prevent deformities by ensuring
exercises Engage and motivate to
cooperate with other health care
team members like
physiotherapists, swallowing and
speech therapists
Maintenance of a
balance between
being alone and in
social gathering
Maintain ways and
patterns of
communication
Allow visits from
relatives and friends
Provide conducive environment for
social interaction
Provide aids for communication and
means for orientation
Ensure flexible routine and
consistent nursing care
Tactics to explain events carefully,
encourage motivate and appreciate
for the drive of positive outcomes.
Encourage to face situations and
meet challenges
The prevention of
hazards to life, human
functioning, and
human well-being
Make him understand
and
provide assistance
before
movements
Check vital signs frequently and
assessment of physical and
psychological condition Provide
environmental safety and
conduciveness

23. Normalcy Maintain
communication skills
with family members,
friends and health
providers Appropriate
interaction with others
Help to provide environment where
Mrs. XYZ can develop and
maintain:
 Self-esteem
 Improved body image
 Established trust
 Minimum anxiety and sense
of loss
 Insight of his condition
PREVENTION MEASURES
 Healthy Diet
Eating foods low in saturated fats, trans fat, and cholesterol and high in fiber
can help prevent high cholesterol. Limiting salt (sodium) in diet can also lower
blood pressure. High cholesterol and high blood pressure increase chances of
having a stroke.
 Healthy Weight
Being overweight or obese increases chances of having a stroke.
 Physical Activity
Physical activity can help you stay at a healthy weight and lower your
cholesterol and blood pressure levels.
 No Smoking
Cigarette smoking greatly increases chances of having a stroke.
 Limited Alcohol
Avoid drinking too much alcohol, which can raise blood pressure.

24. HEALTH TEACHING
 Teach the family members and the pt. the risk factors of CVA/Stroke
 High blood pressure
 High cholesterol
 Cigarette smoking
 Diabetes
 Carotid or other artery disease
 Heart disease
 Not being physically active
 Obesity
 Drinking too much alcohol
 Family history of stroke
 Salty, fried, or greasy foods
 Teach family and pt. when conscious to adapt home environment to safety and
ease of use.
 Assist family to obtain self-help aids for the patient.
 Encourage to do lifestyle changes such as
 Taking medicines as directed
 Controlling cholesterol level
 Learning stress management methods.
 Doing exercise – Daily stretching & strengthening exercises, ROM exercise.
 Dietary Modifications such as – Reducing fat and salt, eating more vegetables
and fruits, limiting oils, sweets and processed foods such as chips, cookies,
and baked goods.
 Keep follow-up appointments. Close follow-up is important to stroke
rehabilitation and recovery.
 Seek immediate medical help if following symptoms of stroke occur:
 Weakness, tingling, or loss of feeling on one side of your face or body
 Sudden double vision or trouble seeing in one or both eyes
 Sudden trouble talking or slurred speech
 Trouble understanding others
 Sudden, severe headache
 Dizziness, loss of balance, or a sense of falling
 Blackouts or seizures

25. CONCLUSION
Mrs. XYZ was admitted in DISTRICT HOSPITAL; Jodhpur on 7/4/2021 at 11:52
a.m, with the complaints of UNCONSCIOUSNESS, VOMITING, HEMIPARESIS,
HEAD INJURY, and INCREASED BP. Mrs. XYZ was primarily hypertensive pt.
which leads to CVA also causing hemiplegia.
The patient relatives were health educated on various aspects of her disease condition
and their role in pt.’s well-being such as, the diet or nutrition required for her disease,
the changes in home environment and assistance in doing activities of daily living,
and the need for exercise during the recovery stage. Mrs. XYZ received Five days of
nursing care from me during my days of posting. And the patient response was well.
From this case, I had gained immense knowledge regarding the disease condition -
Cerebro Vascular Accident, its sign and symptoms and its medical and surgical
intervention.

26. BIBLIOGRAPHY
1. Black MJ, Hawks HJ. Medical surgical nursing. Volume – 2. 8th Edition.
New Delhi. Elsevier publications; 2015.
2. Lippincott, Williams & Wilkins. Manual of nursing practice. 10th Edition.
New Delhi. Wolters Kluwer publications: 2014.
3. Hinkle LJ, Cheever HK. Brunner & Sudharth's textbook of medical surgical
nursing. Volume - 1. 13th Edition. New Delhi. Wolters Kluwer publications:
2014.
4. Chintamani, Mani M. Medical surgical nursing. New Delhi. Elsevier
publication: 2014.