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I. INTRODUCTION

 A Cerebrovascular Accident is the medical term for a stroke. A stroke is when

blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood

vessel. There are important signs of a stroke that you should be aware of and watch out

for. A left-side stroke happens when the blood supply to the left side of the brain is

interrupted. Without oxygen and nutrients from blood, the brain tissue uickly dies. The

cerebrum is the largest part of the brain. !t is made of a left and a right hemisphere. !n

most people, the left hemisphere is in charge of the functions on the right-side of the

body. !t is also involved in abilities such as the ability to speak, or use language. There

are two main types of stroke" ischemic and hemorrhagic.

#emorrhagic stroke accounts for about $% percent of stroke cases. !t results from

a weakened vessel that ruptures and bleeds into the surrounding brain. The blood

accumulates and compresses the surrounding brain tissue. The two types of 

hemorrhagic strokes are intracerebral &within the brain' hemorrhage or subarachnoid

hemorrhage.

Globally, measurements undertaken by the W#( revealed an up to ten-fold

difference in age-ad)usted and sex-ad)usted mortality rates and burden &measured in

disability-ad)usted life year loss rates &*A+s'' among countries. oth were

considerably higher in low-income countries &orth Asia, /astern /urope, Central Africa,

and 0outh 1acific' compared to high-income countries &Western /urope, orth

 America'. 234,555 new or recurrent strokes occur per year in the 60, accounting for 

approximately $ in $7 deaths. !n /urope, the incidence of stroke varies from $5$.$ to

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8%3.% per $55,555 in men and 9%.5 to $47.2 per $55,555 in women. Within 4 years of a

stroke, over half of patients aged : ;4 years will die" 48< of men and 49< of women.

0troke is the second leading cause of death above the age of 95 years, and the

fifth leading cause of death in people aged $4 to 43 years old. /very year, $4 million

people worldwide suffer a stroke. early six million die and another five million are left

permanently disabled. 0troke is the second leading cause of disability, after dementia.

 *isability may include loss of vision and = or speech, paralysis and confusion. 0troke is

less common in people under ;5 years, although it does happen. !n young people the

most common causes are high blood pressure or sickle cell disease. !n many developed

countries the incidence of stroke is declining even though the actual number of strokes

is increasing because of the ageing population. !n the developing world, however, the

incidence of stroke is increasing. !n China, $.% million people have a stroke each year 

and 24< live with varying degrees of disability as a result of stroke. The predictions for 

the next two decades suggest a tripling in stroke mortality in +atin America, the >iddle

/ast, and sub-0aharan Africa.

Nationally, according to the latest W#( data published in April 85$$ 0troke

*eaths in 1hilippines reached ;5,8;4 or 3.44< of total deaths. The age ad)usted *eath

?ate is 78.22 per $55,555 of population ranks 1hilippines @$59 in the world.

Locally, there are no records of incidence of stroke published online for *avao

*el orte. #owever, in *avao City, Councilor ?ene /lias +ope said stroke is now the

top cause of morbidity in the city, with $,755 people dying from the disease in 8557.

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OBJECTIVES

The study aims to present all the information we have gathered about the case of 

our patient who has an admitting diagnosis of T=C Cerebrovascular accidentB CA1->?.

>oreover, this intends to share the knowledge based on information gathered to the

patient, the significant others and to our fellow nursing students.

0pecifically, this study intends to"

• (btain sufficient and relevant information regarding our patients condition.

• 1resent personal data of our patient.

• Trace the past medical history affecting the patients present health condition.• 1resent factual information by conducting a thorough head-to-toe assessment

with our chosen sub)ect serving as our baseline data.

• 0how and discuss the anatomy and physiology of the involved organ and system

basing from our patients diagnosis.

• +ist down the actual laboratory results of our patient.

• 1resent the medical interventions done to the patient including the different drugs

ordered with their action in alleviating the underlying causes of present condition.• !dentify the needs of the patient and formulate effective nursing care plans

appropriate for the patients case.

• !mpart suitable and realistic health teachings to the patient himself and to his

significant others &watcher'.

• /valuate the outcome of the condition of the patient.

II. ASSESSMENT

A Biogra!ical Dataame" 1atient >agandang uhay

 Age" 98 years oldirthdate" Dune 54, $347

%

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irthplace" 1indasan, Compostella Ealley 1rovince0ex" Female0tatus" Widow

 Address" 0eminary *rive, >agugpo /ast, Tagum City, *avao del orteationality" Filipino

?eligion" ?oman Catholic*ate of Admission" February 5%, 85$4Time admitted" 3"48 pm

 Attending 1hysician" *r. *e)anB C!i"# Co$laint

*iinessC %i&tory o# r"&"nt illn"&&

1atient >agandang uhay was admitted on February 5%, 85$4 at ishop

Doseph ?egan >emorial #ospital. Few minutes prior to admission, she had

sudden onset of diiness associated with vomiting. 1atient claimed shes unable

to see. Gaa man gud koy igsuon nga nagpakamatay 8 years ago maam. Hrabe

iyang kaguol )ud atong mga panahona. >ao to, ginatabangan namo siya maam

para dli na to niya mahinumduman, kadugayan naka recover ra man pud siya.

1ero naabot man gud gahapon ang amigo sakong igsuon maam.

ahinumduman na pud guro ni mama tong nahitabo, kay pagkahuman ato,

ningkalit ra man siyag kalipong tapos sige siyag ingon na dli daw siya kakita,I as

verbalied by the watcher. *uring my first encounter with the patient, she was

stuporous, has decreased level of consciousness, asleep most of the time and

was only responsive to verbal stimulationB #as sluggish pupil reaction at left with

a gauge of $mm and fixed pupil reaction at right with a gauge of %mmB #as weak

handgrip but moderate leg movementB has spontaneous eye opening to speech,

oriented verbal response, and obeying motor response, which gives her an

overall HC0 score of $;. *uring the rounds of *r. *e)an, the watchers asked her 

a uestion, G*oc, nganong sige ra man siyag katulogJ 6sahay ra )ud niya ibuka

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iyang mata tapos wala daw siyay makita.I Then, *r. *e)an explained to them,

that the cause maybe of that manifestation is that stroke has affected the frontal

lobe of the brain of the patient.

D 'a&t M"(ical %i&toryG*ili ni mao ang una nga giaatake siya ug stroke maam, kadaghan na man. Ang

pinaka bago lang katong pagkamatay sakong igsuon. Hrabe man gud )ud iyang

kaguol ato, dli )ud niya madawat ang nahitabo. 1ero naka recover na pud bia na

siya maam kay gipa therapy man namo na siya tapos naa pud siya gina

maintain na tambal, mga para sa highblood, stroke ug diabetes,I as verbalied

by the patients watcher.E '"r&onal, )a$ily an( Socio*Econo$ic %i&tory

1atient >agandang uhay belongs to a middle class family. Currently, she

doesnt have a )ob and is living with his youngest daughter, since her other children

already have their own family. ut despite that fact, they still continue to support the

patient in all her needs, especially when it comes to her health. The patients father 

was hypertensive and died also because of 0troke. The patient has five siblings and

two of them were also #ypertensive. The patient doesnt have any vices according

to the watchers verbaliation.

) 'ati"nt N""( A&&"&&$"nt

*ate" February 5;, 85$4

ame of patient" 1atient >agandang uhay

 Age" 98 years old 0ex" F 0tatus" Widow

*ate= Admission Time" February 5%, 85$4 K 3"48 pm

 Arrived on 6nit by" 0tretcher From" /mergency ?oom

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 Admitting weight=E0" Weight" 25kg.Temp" %9 LC 1" $35=$55 mm#g

??" 85cpm 1?" 22 bpm (8 sat" 3;<

Clients ?eason for Admission" Gaa man gud koy igsuon nga nagpakamatay 8

years ago maam. Hrabe iyang kaguol )ud atong mga panahona. >ao to,

ginatabangan namo siya maam para dli na to niya mahinumduman, kadugayan

naka recover ra man pud siya. 1ero naabot man gud gahapon ang amigo

sakong igsuon maam. ahinumduman na pud guro ni mama tong nahitabo, kay

pagkahuman ato, ningkalit ra man siyag kalipong tapos sige siyag ingon na dli

daw siya kakita,I as verbalied by the watcher.

#ow was problem been managed by client at homeJ >aintenance drugs

&Antihypertensive and Antidiabetic'B 1atient was immediately brought to the

hospital after such manifestations mentioned above.

 Allergies" o known allergies to food and drug

>edication &at home'" >aintenance drugs &Antihypertensive and Antidiabetic'

1hysiologic eeds

I. O+yg"nation 1 M $85=75 mm#gB 1? M2;bpmB ?? M 85cpm &regular 

respiration'.+ungs &per auscultation" sound, character, chest pain'" With symmetrical

chest expansion upon inhalation and distress not noted upon assessment.

With crackles heard upon lung auscultation.Cardiac 0tatus &per auscultation" sound, character, chest pain'" With

normal cardiac sound of G+ubb dubbI heard upon auscultation and no

complains of chest pain upon assessment.Capillary ?efill" With capillary refill of 8 seconds upon blanching.

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0kin Character and Color" rownish skin complexion, warm to touch and

dry. Hood skin turgor noted.+ife 0upporting Apparatus" With (8 inhalation N %+1> via nasal cannula.

With !EF @8 100 $+ N OE( rate infusing well N cephalic vein.(ther (bservations" o other observationsII. T"$"rat-r" Maint"nanc"

Temperature" %2.2o C0kin Character" rownish, warm to touch, dry and with good skin turgor.

III. N-tritional )l-i(#eight" 44IWeight" 25 kg.

 Amount of Food Consumed" 1atient was ordered 1( temporarily during

the first 8 days of her admission. (n the third day, she can already have

soft diet as ordered by her A1, but was only able to consume half of the

meal served. ecause according to her watcher, G*ili man gud daw siya

ganahan sa lugaw maam.I1rescribed diet" 1( &$st 8 days'B 0oft *iet &%rd day onwards'/ating pattern" (n the first 8 days, since she was ordered 1(, the

patient really wasnt able to eat or drink anything. (n the % rd day, she can

already % x a day, but with minimal to half amount of food consumed./ating problems" eeds assistance and aspiration precaution should be

considered.!EF=Fluid !ntake" !EF- $55cc, Water K one on the first day of assessment,

because she was still on 1(B 45 cc on the 8nd day, because the diet has

already been changed to soft diet.IV. Eli$ination

+ast bowel movement" February %, 85$4 in the morning, while the patient

was still at home.ormal pattern" GOaisa sa isa ka adlaw, kada buntag )ud,I as verbalied by

the watcher.6rination" Able to urinate845-;45 cc amber-colored urine within the shift.(ther observations" With Foley catheter attached to urobag

V. R"&t an( Sl""

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ed time" G0ige ra man na siyag katulog maam. Oapoy daw,I as

verbalied by the watcher.Waking up" G6sahay ra na siya magmata, gawas kung pukawon )ud ug

tuyo,I as verbalied by the watcher.0leep &pattern, amount of sleep'" Able to sleep at long intervals and wakes

up only through verbal stimulation.VI. 'ain Aoi(anc"

?ate of pain &using scale 5-$5'" o complains of pain upon assessmentB

o signs that the patient is currently experiencing pain. The patient is

stuporous, asleep most of the time and has decreased level of 

consciousness.Character" =A+ocation" =AFreuency" =A*uration" =Aehavior" =A(ther (bservations" one

VII. Sti$-lation/ ActiityWork" 0he currently doesnt have a work and is already dependentB shes

living with her youngest child, since her other children already have their 

own family.?ecreation or past time" #es doing household chores.#obbies or vices" GWala )ud na siyay bisyo maam. >agtanaw ra na siyag

TE sa balay kung walay ginabuhat,I as verbalied by the watcher.Sa#"ty 0 S"c-rity n""(&euro E0" score of $; out of $4>ental status" 0he was stuporous, has decreased level of consciousness,

asleep most of the time and was only responsive to verbal stimulation. /motional 1roblems" one(ther ob)ective cues" #as sluggish pupil reaction at left with a gauge of 

$mm and fixed pupil reaction at right with a gauge of %mmB has weak

handgrip but moderate leg movementB has spontaneous eye opening to

speech, oriented verbal response, and obeying motor response

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VIII. Lo" an( b"longingI1. S"l#* "&t""$

1. S"l#*act-ali2ation

Eric3&on4& D""lo$"ntal Ta&3

/rickson envisions life as a seuence of levels of achievement. /ach stage

signals a task that must be achieved. The resolution of the task can be complete,

partial, or unsuccessful. /rickson believes that the greater the task achievement, the

healthier the personality of the person" failure to achieve a task influences the persons

ability to achieve the next task. These developmental tasks can be viewed as a series of 

crises, and successful resolution of these crises is supportive to the persons ego.

Failure to resolve the crises is damaging the ego.

G"n"ratiity &. Stagnation

1atient >agandang uhay, 98 years old, falls under the >id Adulthood from %4-

94 years old which has the central task of Henerativity versus 0tagnation. This stages

ma)or task is creativity, productivity and concern for others. 0elf-indulgence, self-

concern, lack of interests and commitments are the indicators of negative resolution. !n

the case of our patient, 1atient >agandang uhay, he attained the Henerativity for he

was able to achieve and realie the ma)or task successfully by showing concern to his

family especially to his children despite of the condition she has. 0he always thinks of 

whats best for his family, willing to give the excellent care and love that she can.

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'%5SICAL ASSESSMENT

Heneral 0urvey

1atient >agandang uhay, 98 years old, male, stands 4 feet and 4 inches tall

and weighs 25kg. With the following E0 as monitored and recorded upon admission

Temp M %9o CB 1M $35=$55 mm#gB 1? M 22 bpmB ?? M 85cpm. With !EF bottle @ $

100 $+ N OE( rate infusing well. 0he was stuporous, has decreased level of 

consciousness, asleep most of the time and was only responsive to verbal stimulation.

Vital Sign& Monitoring S!""t

ame" 1atient >agandang uhay 0ex" F Age" 98 .(

Ward" 0t. Doseph ?oom=ed" %53

Date/Shift Time

 Temperatur

e

Blood

Pressure

Respirator

y Rate

Card3iac

Rate12/07/201

4

311

!2" P# 3"$7 20/130 22 %%

!30 P# 1%0/100%!00 P# 3&$3 1%0/1&0 21 %7

12/0%/201

4

117

12!00 '# 3$% 200/140 22 &

1!00 '# 200/110 2" &%2!00 '# 3$7 1%0/100 2% &2!30 '# 1"0/%0 2" &73!00 '# 3 1"0/100 2" &%4!00 '# 37 1"0/%0 24 %

12/0%/201 %!00 '# 37 1"0/100 20 &0

$5

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4

7310!00 '# 140/&012!00 (( 37$1 1"0/100 1& %&1!00 P# 170/100

12/0%/201

4

311

4!00 P# 37$3 140/&0 21 %

!00 P# 37$4 1"0/&0 21 %7%!00 P# 3$" 1"0/&0 22 %3

12/0&/201

4

117

12!00 #( 3$7 1"0/&0 22 %%

4!00 '# 37$1 10/100 22 %0!00 '# 1%0/&0 22 %&12/0&/201

4

73

%!00 '# 3$% 1"0/%0 20 %

10!00 '# 3$ 1%0/100 21 %412!00 (( 37$1 140/100 20 %"2!00 P# 37$3 1&0/&0 20 %1

12/0&/201

4

311

4!00 P# 37 10/&0 22 7

%!00 P# 37$4 10/%0 20 7"12/10/201

4

117

12!00 #( 37 1%0/100 20 7

4!00 '# 37 10/&0 20 7%12/10/201

4

73

%!00 '# 3$& 10/100 21 &0

10!00 '# 3$% 170/100 20 &112!00 (( 37$2 130/100 20 %%2!00 P# 37$1 10/&0 21 %&

$$

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• 0hort and mobile. Able to perform the different neck ?(> exercises or 

maneuvers. o tracheal deviations felt upon placing a finger along one side of 

the trachea, noting the space and comparing with the opposite side. o swollen

lymph nodes upon palpation.

T#?(AT

• Hums are in good condition. Tongue midline and mobile with visible papillae.

Tonsils are not inflamed. 1inkish hard and soft palate. Hag reflex is present.

'-l$onary Sy&t"$

• With crackles heard upon auscultationB regular breathing pattern and symmetrical

chest expansion. Theres an eual rise and fall of the chest with normal depth of 

respiration.

Car(ioa&c-lar Sy&t"$

• ormal GlubbdubbI heard upon auscultation and apical pulse heard per 

auscultation. o heaves and thrills heard. o murmurs, regular cardiac rate and

rhythm heard upon auscultation.

Ga&troint"&tinal Sy&t"$

•  Abdomen is distended, and has the same color as the rest of the body. 4-$4 clicks

per minute heard upon auscultation.

M-&c-lo&3"l"tal Sy&t"$

$%

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URINAL5SIS

)"br-ary 7, 89:;

LABORATORY 

EXAMINATION

S/

DETERMINATI

ON

RESULT NORMAL VALUE UNIT IMPLICATION

Color Stra) *i+ht yello) to a

dar, am-er color

. (ormal

Su+ar (e+atie 0 to trace

amouts$

. (ormal

'l-umi (e+atie (e+atie . (ormalReactio "$0 4$" . 7$2 . (ormal

Sp +raity 1$010 1$00" to 1$02" . (ormalCrystlas . . . .

Casts . . . .

pithellial cells . e) . (ormal#ucous threads . . . .

Pus cells 0.2 0.2 hpf (ormalRBC .% 0.2 hpf '-oe ormal$

 The presece of 

a-ormal

um-ers of red

cells is urie due

to +lomerular

dama+e tumors

)hich erode the

uriary tract

$4

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ay)here alo+

its le+th ,idey

trauma uriary

tract stoes

real ifarcts

acute tu-ular

ecrosis upper

ad lo)er uri

uriary tract

ifectios

ephrotois

ad physical

stress$Bacteria . . . .Pus i clumps . . hpf .

ELECTROL5TES

Paramet

erResult Limit Unit Interpretatin

Sodium 13& 13.14" mmol/* (ormal$

Potassium 4$4% 3$"0."$00 mmol/* (ormal$Calcium

5ioi6ed

1$10 1$12.1$32 mmol/* (ormal$

$9

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)"br-ary

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Chroic ,idey failure;

Cushi+ sydrome; cessie

food ita,e; 9yperthyroidism;

Pacreatic cacer; ad

Pacreatitis$Creatiie 121$30 4".%4 umol/* !ncreased.Generally, a high serum

creatinine level means that your

kidneys aren't working well. Your

creatinine level may temporarily

increase if you're dehydrated, have

a low blood volume, eat a large

amount of meat or take certain

medications. The dietary

supplement creatine can have the

same effect.

S

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The result of this test tells your doctor 

whether your cholesterol is too high. !f 

your total cholesterol levels are high,

your doctor will want to know your 

+*+ cholesterol and #*+ cholesterol

levels before deciding whether you

need treatment. #*+ stands for high-

density lipoprotein. !tPs also

sometimes called QgoodQ cholesterol.

ou want your #*+ cholesterol to be

high. 0tudies of both men and women

have shown that the higher your #*+,

the lower your risk of coronary artery

disease. This is why #*+ is

sometimes referred to as QgoodQ

cholesterol. +*+ stands for low-

density lipoprotein. !tPs also

sometimes called QbadQ cholesterol.

our +*+ level is what doctors watch

most closely. ou want your +*+ to be

low. Too much +*+ is linked to

cardiovascular disease. !f it gets too

high, you will need treatment.

9i+h

Desity

*ipoprotei

59D*

3 4"." m+/d*

*o)

Desity

*ipoprotei

1&&$%0 .17% m+/d*

9B'1C $10 4. > leated$ 8dicates Dia-etes$

%EMATOLOG5

$3

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LABORATORY 

EXAMINATIONS/

DETERMINATION

RESULT NORMAL

VALUE

UNIT IMPLICATION

9emo+lo-i 133 134$00.

10$00

+/* (ormal

9ematocrit 0$40 0$3.0$4" (ormal*eu,ocytes (o$ of

Coce$

&$77 ".

1010?&

* (ormal

Se+meters 0$% 0$40.0$0 leated$ Se+meters or

eutrophils are the primary

cells that respod to a

-acterial ifectio$ 9i+h

leels of your eutrophils

usually represet ad

o+oi+ ifectio a

i@ammatio physical

stress ad mali+acy

caused -y some dru+ etc$*ymphocytes 0$12 0$2".0$40 Decreased$ *o)

lymphocytes cout

idicates that the -ody is

lo) o ifectio resistace$

 This meas the -ody is

suscepti-le to ifectios li,e

tumors ad cacer$ *o)

85

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lymphocytes cout ca also

lead to the dama+e of 

arious -ody or+as$

#oocytes 0$01 0$01.0$12 (ormalosiophils 0$01 0$01.0$0" (ormal$Basophils . 0$00"Sta-s . 0$01.0$0" Throm-ocytes 2%%$0 1"0.

44010?&

* (ormal$

Blood type .Rh type .

URINAL5SIS

LABORATORY 

EXAMINATION

S/

DETERMINATI

ON

RESULT NORMAL VALUE UNIT IMPLICATION

Color *i+ht

 Aello)

*i+ht yello) to a

dar, am-er color

. (ormal

Su+ar (e+atie 0 to trace

amouts$

. (ormal

'l-umi Trace (e+atie . ' al-umi test

chec,s urie for

the presece of a

8$

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protei called

al-umi$ 'l-umi

is ormally foud

i the -lood ad

ltered -y the

,ideys$ he

the ,ideys  are

)or,i+ properly

al-umi is ot

preset i the

urie$ But )he

the ,ideys are

dama+ed small

amouts of  

al-umi lea, ito

the urie$ This is

called

al-umiuria$

9o)eer trace

al-umi i a

urie specime is

usually ot a

si+icat

88

http://www.webmd.com/hw-popup/albuminhttp://www.webmd.com/heart/anatomy-picture-of-bloodhttp://www.webmd.com/urinary-incontinence-oab/picture-of-the-kidneyshttp://www.webmd.com/kidney-stones/kidneyshttp://www.webmd.com/a-to-z-guides/rm-quiz-kidneyshttp://www.webmd.com/hw-popup/albuminhttp://www.webmd.com/heart/anatomy-picture-of-bloodhttp://www.webmd.com/urinary-incontinence-oab/picture-of-the-kidneyshttp://www.webmd.com/kidney-stones/kidneyshttp://www.webmd.com/a-to-z-guides/rm-quiz-kidneys

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di+$ 8t meas

a ery small

amout of  

protei sho)s up

i the specime$Reactio $" 4$" . 7$2 . (ormal

Sp +raity 1$00" 1$00" to 1$02" . (ormalCrystlas . . . .

Casts . . . .

pithellial cells e) e) . (ormal#ucous threads . . . .

Pus cells %.11 0.2 hpf 8creased$

8dicates that

there is presece

of ifectio$RBC 10.1" 0.2 hpf 8creased$ The

presece of  

a-ormal

um-ers of red

cells is urie due

to +lomerular

dama+e tumors

)hich erode the

uriary tract

ay)here alo+

its le+th ,idey

8%

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trauma uriary

tract stoes

real ifarcts

acute tu-ular

ecrosis upper

ad lo)er uri

uriary tract

ifectios

ephrotois

ad physical

stress$Bacteria . . . .Pus i clumps . . hpf .

IV. REVIE6 O) ANATOM5 AND '%5SIOLOG5

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NERVOUS S5STEM

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The brain is a spongy organ made up of nerve and supportive tissues. !t is

located in the head and is protected by a bony covering called the skull. The base, or 

lower part, of the brain is connected to the spinal cord. Together, the brain and spinal

cord are known as the central nervous system &C0'. The spinal cord contains nerves

that send information to and from the brain.

 

The C0 works with the peripheral nervous system &10'. The 10 is made up

of nerves that branch out from the spinal cord to relay messages from the brain to

different parts of the body. Together, the C0 and 10 allow a person to walk, talk, and

throw a ball and so on.

The brain is the bodys control centre. !t constantly receives and interprets nerve

signals from the body and responds based on this information. *ifferent parts of the

brain control movement, speech, emotions, consciousness and internal body functions,

such as heart rate, breathing and body temperature.

The brain has % main parts" cerebrum, cerebellum and brain stem.

C"r"br-$

The cerebrum is the largest part of the brain. !t is divided into 8 parts &halves'

called the left and right cerebral hemispheres. The 8 hemispheres are connected by a

bridge of nerve fibres called the corpus callosum.

89

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The right half of the cerebrum &right hemisphere' controls the left side of the

body. The left half of the cerebrum &left hemisphere' controls the right side of the body.

 

The outer surface of the cerebrum is called the cerebral cortex or grey matter. !t

is the area of the brain where nerve cells make connections, called synapses, that

control brain activity. The inner area of the cerebrum contains the insulated &myelinated'

bodies of the nerve cells &axons' that relay information between the brain and spinal

cord. This inner area is called the white matter because the insulation around the axons

gives it a whitish appearance.

 

The cerebrum is further divided into ; sections called lobes. These include the

frontal &front', parietal &top', temporal &side' and occipital &back' lobes.

/ach lobe has different functions"

• The frontal lobe controls movement, speech, behaviour, memory, emotions and

intellectual functioning, such as thought processes, reasoning, problem solving,

decision making and planning.

• The parietal lobe controls sensations, such as touch, pressure, pain and

temperature. !t also controls spatial orientation &understanding of sie, shape anddirection'.

• The temporal lobe controls hearing, memory and emotions. The left temporal

lobe also controls speech.

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• The occipital lobe controls vision.

C"r"b"ll-$

The cerebellum is the next largest part of the brain. !t is located under the

cerebrum at the back of the brain. !t is divided into 8 parts or hemispheres and has grey

and white matter, much like the cerebrum.

 

The cerebellum is responsible for"

• movement

• posture

• balance

•

reflexes

• complex actions &walking, talking'

• collecting sensory information from the body

Brain &t"$

The brain stem is a bundle of nerve tissue at the base of the brain. !t connects

the cerebrum to the spinal cord and sends messages between different parts of the

body and the brain.

 

The brain stem has % areas"

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• midbrain

• pons

•

medulla oblongata

The brain stem controls"

• breathing

• body temperature

• blood pressure

• heart rate

• hunger and thirst

Cranial nerves emerge from the brainstem. These nerves control facial

sensation, eye movement, hearing, swallowing, taste and speech.

Ot!"r i$ortant art& o# t!" brain

C"r"bro&inal #l-i( =CS)>

The cerebrospinal fluid &C0F' is a clear, watery liuid that surrounds, cushions

and protects the brain and spinal cord. The C0F also carries nutrients from the blood to,

and removes waste products from, the brain. !t circulates through chambers called

83

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The corpus callosum is a bundle of nerve fibres between the 8 cerebral

hemispheres. !t connects and allows communication between both hemispheres.

T!ala$-&

The thalamus is a structure in the middle of the brain that has 8 lobes or 

sections. !t acts as a relay station for almost all information that comes and goes

between the brain and the rest of the nervous system in the body.

%yot!ala$-&

The hypothalamus is a small structure in the middle of the brain below the

thalamus. !t plays a part in controlling body temperature, hormone secretion, blood

pressure, emotions, appetite, and sleep patterns.

'it-itary glan(

The pituitary gland is a small, pea-sied organ in the centre of the brain. !t is

attached to the hypothalamus and makes a number of different hormones that affect

other glands of the bodys endocrine system. !t receives messages from the

hypothalamus and releases hormones that control the thyroid and adrenal gland, as

well as growth and physical and sexual development.

V"ntricl"&

The ventricles are fluid-filled spaces &cavities' within the brain. There are ;

ventricles"

• The first and second ventricles are in the cerebral hemispheres. They are called

lateral ventricles.

%$

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• The third ventricle is in the centre of the brain, surrounded by the thalamus and

hypothalamus.

• The fourth ventricle is at the back of the brain between the brain stem and the

cerebellum.

The ventricles are connected to each other by a series of tubes. The fluid in the

ventricles is cerebrospinal fluid &C0F'. The C0F flows through the ventricles, around the

brain in the space between the layers of the meninges &subarachnoid space' and down

the spinal cord.

'in"al glan(

The pineal gland is a very small gland in the third ventricle of the brain. !t

produces the hormone melatonin, which influences sleeping and waking patterns and

sexual development.

C!oroi( l"+-&

The choroid plexus is a small organ in the ventricles that makes C0F.

Cranial n"r"&

There are $8 pairs of cranial nerves that perform specific functions in the head

and neck area. The first pair starts in the cerebrum, while the other $$ pairs start in the

brain stem. Cranial nerves are indicated by number &?oman numeral' or name.

Ty"& o# c"ll& in t!" brain

The brain is made up of neurons and glial cells"

• neurons

• These cells carry the signals that make the nervous system work.

• They cannot be replaced or repaired if they are damaged.

• glial cells &neuroglial cells'

• These cells support, feed and protect the neurons.

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right side of the bodyB 0peech=language problemsB 0low, cautious behavioral style and

>emory loss.

#emorrhagic stroke accounts for 

about $% percent of stroke cases. !t results

from a weakened vessel that ruptures and

bleeds into the surrounding brain. The blood

accumulates and compresses the

surrounding brain tissue.

V. ETIOLOG5 O) T%E DISEASE

Etil!" A#tual Ratinale

9i+h -lood

pressure

cotrolled icrease of -lood pressure ca

cause a essel to eplode or -urst$ Thus

causes hemorrha+ic stro,e$

5http!//)))$stro,eassociatio$or+/STREFER

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.Stro,e.

Ris,GC#G30%"3&GSu-9omePa+e$HspI

9i+h

cholesterol9ai+ hi+h Cholesterol cotri-utes to -lood

essel disease )hich ofte leads to stro,e.

(https://www.google.com.ph/?

gfe_rd=cr&ei=qKiOVM-

EB!K"#fw$o%Bw&gws_rd=ssl'q=highcho

lesteroli)*V+,

Smo,i+

Smo,i+ also early dou-les the ris, of 

ischemic stro,e$ Smo,i+ acts syer+istically

)ith other ris, factors su-statially icreasi+

the ris, of C9D$ Smo,ers are also at icreased

ris, for peripheral ascular disease cacer

chroic lu+ disease ad may other chroic

diseases$

5http!//circ$ahaHourals$or+/cotet/&/&/3243$f 

ull

cessie alcohol

ita,e The role of alcohol cosumptio as a

idepedet ris, factor for ischemic -rai

ifarctio has remaied uclear$ Both mortality

ad mor-idity from ischemic -rai ifarctio

seem to -e icreased amo+ heay alcohol

dri,ers$

%9

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5http!//stro,e$ahaHourals$or+/cotet/30/11/23

07$full

Race 'frica.'mericas 5opes i e)

)ido) hae a much hi+her ris, of death from

a stro,e tha Caucasias do$ This is partly

-ecause -lac,s hae hi+her ris,s of hi+h -lood

pressure dia-etes ad o-esity$

5http!//)))$stro,eassociatio$or+/STREFER

8/9/2019 INP CS

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a gene mutation that leads to damage of blood vessel

walls in the brain, blocking blood flow. >ost individuals

with CA*A0!+ have a family history of the disorder R

each child of a CA*A0!+ parent has a 45< chance of 

inheriting the disease.

&http"==www.strokeassociation.org=0T?(O/(?H=About0t

roke=6nderstanding?isk= '

Stress   Stress could icrease prolo+ed eposure to

hi+her -lood pressure ad therefore promote

dama+e to -lood essel )alls icrease your

ris, of heart disease ad atrial -rillatio

5irre+ular heart -eat ad it could predispose

you to atheroma 5s)elli+ i a artery )all

ad aeurisms 5a -ul+e i a -lood essel )all

ad ischemic stro,e$

5http!//)))$a-c$et$au/health/thepulse/stories/

2012/10/0&/30"%71$htm

VI. S5M'TOMATOLOG5

S"mptms A#tual Ratinaleea,ess

or um-ess of

the face arm or

le+ o oe side of

(um-ess ca occur from dysfuctio

ay)here alo+ the path)ay from the sesory

receptors up to ad icludi+ the cere-ral

corte$

%7

http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/http://www.strokeassociation.org/STROKEORG/AboutStroke/UnderstandingRisk/

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the -ody 5http!//)))$merc,mauals$com/professioal/

eurolo+icGdisorders/approachGtoGtheGeurolo+

icGpatiet/um-ess$html

*oss of speech

diculty tal,i+

or uderstadi+

)hat others are

sayi+

commuicatio decits are characteri6ed -y

diculty i uderstadi+ or produci+

speech correctly 5aphasia slurred speech

cose:uet to )ea, muscles 5dysarthria

ad/or diculty i pro+rammi+ oral muscles

for speech productio 5apraia$ These decits

ary i ature ad seerity depedi+ o the

etet ad locatio of the dama+e$ Some

idiiduals may also hae diculty i social

commuicatio such as diculty ta,i+ turs

i coersatio ad pro-lems maitaii+ a

topic of

coersatio$http!//)))$asha$or+/pu-lic/spee

ch/disorders/Stro,e/*oss of isio or

dimmi+ 5li,e a

curtai falli+ i

oe or -oth eyes

 Kisio loss ca -e -oth a symptom ad result

of a stro,e$ Temporary isio loss ca -e a

si+ of impedi+ stro,e ad re:uires

immediate medical attetio$ *ear a-out

ho) stro,e may aect isio ad )hat to do

a-out ithttp!//)))$stro,e$or+/stro,e.

%3

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resources/li-rary/stro,e.ad.isio.loss

Sudde seere

headache )ith o

,o) cause

Pai ca also accompay a stro,e$ (um-ess

ad pai ca also alterate i the same area

as the -rai is hai+ diculty

commuicati+ )ith eres i a certai

area$http!//)))$healthlie$com/health/stro,e/

complicatios

*oss of  

-alace or

usta-le )al,i+

usually com-ied

)ith aother

symptom

Pro-lems )ith -alace are commo after

stro,e$ 8f your -alace has -ee aected you

may feel di66y or usteady )hich could lead

to a fall or loss of codece )he )al,i+

ad moi+ aroud$ *oss of -alace ca -e a

result especially if certai part of the -rai is

aected$

http!//)))$stro,e$or+$u,/factsheet/-alace.

pro-lems.after.stro,e

VII. 'AT%O'%5SIOLOG5

A 6ritt"n 'at!o!y&iology

0trokes are divided into two main categories" I&c!a"$ic and %a"$orr!agic.

;5

0!H0 A* 0>1T(>0"

-

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Diagra$ o# 'at!o!y&iology

 Age

;8

1recipitating Factors"

- #ypertension

- 0tress

1redisposing Factors"

- Family #istory of 0troke

rain sends message to adrenal glands

1roduce hormones, including adrenalin and cortisol, that

put you into Pfight or flightP mode and increase your

breathing, heart rate and blood pressure.

The adrenalin you produce when you experience stress can

affect the platelets in your blood and promote clotting,

possibly causing a blockage of arteries in or near the brain.

8/9/2019 INP CS

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;%

#emorrhagic- !mpaired tissue perfusion

!nfarction of cerebral vessels known as stroke

0pace-occupying blood clots put more pressure on the brain tissues

The regulatory mechanisms of the brain attempt to maintain

euilibrium by increasing 1 and !C1

The ruptured cerebral vessels may constrict to limit blood loss. #owever,

the vasospasm will result to further ischemia and necrosis of brain tissues.

0!H0 A* 0>1T(>0"

-+oss of alance - 0udden or severe headache - +oss of vision

-+oss of 0peech -Weakness or umbness of face and extremitiesComplications

+oss of >uscle

Control=1aralysis

0peech 1roblems

0wallowing *ifficulties

Cognitive !mpairments

1ersonality and >ood

Changes

*epression

1harmacological >anagement

Furosemide

Ceftriaxone

Citicoline

(mepraole

 Amlodipine

+osartan

>annitol

ursing >anagement"

$. ?eposition client 8

8. 0upport dependent body

parts with pillows

%. 1rovide safety measures

including environmental

management

;. /ncourage 0(s

involvement in activities S

decision making

4. 1eroform passive range

of motion exercises daily

9. !ncrease functional

activities as strength

improves  H((* 1?(H(0!0 A* 1?(H(0!0

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VIII. 'LANNING

A NURSING CARE 'LAN

Date /

Time

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CA1->?

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'n"-$onia is inf 

lammation of the

terminal airways

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various agents.

Community

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8/9/2019 INP CS

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-reathi+

. )ith E2ihalatio W

2*P# ia asal

caula

.lyi+ @at o -ed

1neumonia

&CA1' is a

disease in which

individuals who

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develop an

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lungs. !t is an

acute

inflammatory

condition thats

result from

aspiration of

oropharyngealse

cretions or

stomach contents

in the lungs.

Therefore, airway

clearance is noteffective.

?eference"

http"==nursingcrib.

com=

R! 8t helps to softe

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.coura+ed to do

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cou+hi+ eercises$

R! Deep -reathi+

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lu+s ad smaller

air)ays$ Cou+hi+

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atural self.cleai+

mechaism that

assists the cilia to

maitai patet

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.Demostrated

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chest tappi+ to

)atchers$

R! 8t ca aid to

mo-ili6atio ad

epectoratio of

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.'dmiister meds as

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;4

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*ate ?etrieved"

*ecember $$,

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prescri-ed$

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R! To preet

further

complicatios ad

to preet accidets

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iHury$

Date /

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ala -aya Hud

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weakness

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care as

.sta-lished rapport$

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;9

8/9/2019 INP CS

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as er-ali6ed

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?ationale"

>otor deficit

are the most

obvious effect

of stroke.

0ymptoms are

caused by

destruction of

motor neurons

in the

pyramidal

pathways

&nerve fibers

in the brain

and passing

through the

spinal cord to

the motor

tract.' Whenthis happens,

activities of

daily living can

be impaired

and even self-

care.

eideced

-y!

.'ssured that the

cosistecy of the

diet is appropriate for

patietVs a-ility to

che) ad s)allo)$

R! #echaical

pro-lem may prohi-it

the patiet fromeati+$

.'ssisted duri+ -ed

-ath$

R! To +ie comfort$

.#aitaied priacy

duri+ -athi+$

R! The eed for

priacy is

fudametal for most

patiets$

.'ssisted i cha+i+

the clothes$

R! To +ie comfort

ad to assess for the

parts )hich caot

-e moe fre:uetly$

.Proided fre:uet

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assistace as eeded

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R! To reduce eer+y

unable to

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bedside on

his own.b. eing able

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;2

8/9/2019 INP CS

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assistace

duri+ 'D* li,e

-athi+ ad

clothi+

.

?eference"

http"==nursesla

bs.com=cerebr 

ovascular-

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*ate

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;7

8/9/2019 INP CS

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patiet i 'D* li,e

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8/9/2019 INP CS

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48

8/9/2019 INP CS

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treatmet of

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.coura+ed

)atchers to

support thepatiet -y

assisti+ i

performi+ 'D*$

R! To proide

safety ad aoid

accidets that

may cause iHury$

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B DISC%ARGE 'LAN

Areas O%&e#ti'e A#ti'ities

#edicatio 100 > compliace to home

medicies

$ /ncourage the patient to comply

with the prescribed medication. This prevents further

development of the disease

process and other possible

complication.8 /ncourage the client to take the

medicine into the right time,

right dose, right amount, and

right freuency and take note

the side effects of the medicine.

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This would enable them to

know what are the drugs and its

desired dosage. The exact

dosage and time are important

to ensure the drugs

effectiveness.% !nstruct patient to notify

physician if there is any

abnormalities after taking the

medicine.; !nstruct patient to do not buy

any drugs that does not

prescribed by the physician.

To avoid the ineffectiveness of 

the drug prescribed, and to

ensure the safety of the client.

ercise To sta-ili6e the coditio of the

$ Avoid strenuous activities.8 /ncourage patient to have

activities of daily living.% /ncourage client to have

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patiet$ coura+e to do li+ht

eercise ad uderstads itVs

importat$

adeuate rest periods

between activities.

 Treatmet derstadi+ the recommeded

treatmet or lesse uderlyi+

illess$

$. /xplain the purpose of

the medication that is

prescribed by the

physician.8. !nform the significant of

the treatment others that

they should be involved

in the treatment of the

client.%. /ncourage to take

medications religiously.

9ealth teachi+s To preet the ris, of ay

$ !nstruct to take extra care in

doing daily A*+ especially in

ambulation.8 !nstruct the client to have a

proper diet and hygiene.% /ncourage client to wash hands

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activities of daily living and

range of motion exercises.; /ncourage him to comply with

all the modifications and

instructions given to her  !n order to have a fast

recovery.

Diet Decrease ita,e of fatty ad salty

foods as )ell as those foods that

ca irritate the

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)ene

ri#

Name

Bran$

Name

Classi*#ati

n

In$i#atin A#tin Si$e

E+e#ts/

A$'erse

Rea#tin

Time ,

Dsa!e

Nursin!

Respnsi%ilit

ies

Ceftriaoe

or+ram

Cephalosporis

8dicated ipatiets )ith

eurolo+ic

complicatios

carditis ad

arthritis$ 8t is

also eectie i

ot mi

pareteral

solutio )ith

hi+hly acidic

solutios )ith

p9 -elo) 3$"$.Do ot

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ifectios$ oplasmicm

em-rae$

 These

e6ymes

are

ioled i

cell.)all

sythesisad cell

diisio$ By

-idi+ to

these

e6ymes

Ceftriaoe

results i

the

formatio

of

of defectie

cell )alls

ad cell

death$

dru+ therapy

to idetify

if correct

treatmet has

-ee iitiated$

.Report si+s

such aspetechiae

ecchymotic

areas

epistais or

other forms

of ueplaie

d -leedi+$

9$

8/9/2019 INP CS

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)eneri

#

Name

Bran

$

Nam

e

Classi*#ati

n

In$i#atin A#tin Si$e

E+e#ts/

A$'erse

Rea#tin

Time ,

Dsa!

e

Nursin!

Respnsi%iliti

es

Citicoli

e

Choli

er

C(S

stimulat

Peripheral

Kasolidlator

Cere-roasc

ular

Diseases

accelerates

the recoery

of coscious

ess ad

oercomi+

motor decit

Citicolie

actiates

the -iosythesis

of structural pho

spholipids i the

euroal

mem-rae

icreases

cere-ral

meta-olism ad

icreases the

leel of arious

eurotrasmitte

rs icludi+

acetylcholiead dopamie$

Citicolie has

sho)

europrotectie

aects i

situatios

of hypoia ad

ischemia$

citicolie

may eert

a

stimulati+

actio of

the parasy

mpathetic

as )ell as a

@eeti+

ad

iscretehypo

tesor

eect$

"00m+

1 cap

 T8D

.atch out

for hypotesie

eects$

.#ust ot -e

admiistered

alo+ )ith

medicamets

cotaii+

98

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9%

)eneri#

Name

Bran$

Name

Classi

*#ati

n

In$i#atin A#tin Si$e

E+e#ts/

A$'erse

Rea#tin

Time

an$

Dsa!

e

Nursin!

Respnsi%ilities

Emepra6

ole

Emep

ro

Proto

pump

ihi-ito

r

Short term

treatmet

of actie

duodealulcer

+astroesopha

+ealre@u

disease

5

8/9/2019 INP CS

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9;

)eneri

# Name

Bran$

Name

Classi*#ati

n

Me#-anism

( a#tin

In$i#atin Si$e

E+e#ts/

A$'erse

Rea#tin

Time

an$

Dsa!

e

Nursin!

Respnsi%ilities

#aito

l

Esmitr

ol

Esmotic

Diuretic

8creases

osmotic

pressure of

plasma i

+lomerular

ltrate

ihi-iti+

tu-ular

rea-sorptioof )ater ad

electrolytes

5icludi+

sodium ad

potassium$

 These actios

ehace

)ater @o)

from arious

tissues ad

ultimately

decreaseitracraial

ad

itraocular

pressures

 Test dose

for mar,ed

oli+uria or

suspected

iade:uate

real

fuctio

preet

acute realfailure

duri+

cardioasc

ular ad

other

sur+eries

acute real

failure to

reduce

itracraial

pressure

ad -raimass

reduce

itraocular

pressure

to promote

dieresis i

dru+

toicity

irri+atio

duri+

trasurethr

al resectioof prostate$

C0"

diiness,

headache,

seiures

CE" chest

pain,

hypotension,

hypertension,

tachycardia,thrombophlebi

tis, heart

failure,

vascular

overload

//T" blurred

vision, rhinitis

H!" nausea,

vomiting,

diarrhea, dry

mouth

H6" polyuria,

urinary

retention,

osmotic

nephrosis

>etabolic"

dehydration,

water

intoxication,

hypernatremia

, hyponatremi

a,

hypovolemia,h okalemia h

"0ml

8KTT

eery

hrs

->onitor vital signs.

->onitor intake and

output.

->onitor central

venous pressure.

->onitor pulmonaryartery pressure.

->onitor signs and

symptoms of

dehydration.

->onitor signs of

electrolyte

imbalance

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1. S5NT%ESES O) CLIENT4S CONDITION/STATUS )ROM ADMISSION TO

'RESENT

A. Concl-&ion

Therefore, after we had studied the case, our client has suffered from

Cerebrovascular Accident because of some possible factors that might have contributed

on the development of the condition. Cerebrovascular Accident refers to is the medical

term for a stroke. A stroke is when blood flow to a part of your brain is stopped either by

a blockage or a rupture of a blood vessel. There are important signs of a stroke that you

should be aware of and watch out for. !f you think that you or someone around you

might be having a stroke, it is important to seek medical attention immediately. The

more uickly you get treatment, the better the prognosis. When a stroke goes untreated

for too long, there can be permanent brain damage.

The certain condition that the patient is suffering is really considered dangerous.

!t is a life-threatening condition especially if the patient will not follow the prescribed

meds and a healthy lifestyle as it would lead to many other complications that may

greatly affect his life as well as his family and eventually may lead to death. *espite of 

all that facts, there are treatments and preventive measures that people should do in

order to stop or prevent this condition from getting worst. We conclude that the need for 

medical consultations and abiding the medical orders regarding health condition and at

least preventing the worst to happen should be really observed and taken into

consideration by the patient himself and by the significant others as well. *oing right

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things and sufficient knowledge about the patients conditions can be of great help and

they should know the preventive measures for prevention is always better than cure.

B. 'ati"nt4& 'rogno&i&

Pr .air )$ usti*#atinDuratio

Patiet has -ee

admitted

-ecause of ri+ht

sided )ea,ess

ad still preset

duri+ our 4 day

eposure$Eset

 The patiet still

eperieced his

chief complait

duri+ our shift$illi+es

s

 The patiet has

the )illi+ess

to ta,e all

medicatios

after the

eplaatio of

the purpose of

the medicie$

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irom

et

 The patiet

stayed i a )ard

room ad )as

coducie for

heali+ ad

recoery$Diet

 The patietVs

diet )as more

o salty ad

fatty foods$

Computation"

1oor- $x5M5

Fair- 8x%M9

Hood- %x8M9

:8/; ? 8.< =)air 'rogno&i&>

C. RECOMMENDATIONS

Hiving importance to the health of ourselves and maintaining a healthy lifestyle

as individuals, is highly reuired to maintain a good and healthy life. !t is because

ignoring the health condition could greatly affect life especially when certain conditions

or diseases would develop.

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!t is very important that every person should give importance to his=her health. A

person should promote healthy lifestyle changes that include adeuate nutrition, clean

environment, and free from stress. For our patient, it is important to eliminate those

factors that can trigger to his condition.

With this we recommend the following"

$. >aintain proper hygiene all the timeB8. *eep breathing exercises to promote relaxationB%. Adeuate rest and sleepB;. 0trict compliance to the medical treatment and medical check-upB4. !nstructed watcher to assist patient in performing A*+B

9. !nstructed watcher not to leave the patient aloneB2. Follow-up with appointment with the physician.

1I. EVALUATION O) T%E OBJECTIVES O) T%E STUD5

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 After days of collecting relevant information and seuence of analysis on related

topics of this case study, we are now presenting our evaluation related to our ob)ectives

that have been presented. We have certified that we were able to complete the chosen

case with factual data gathered including the necessary information related to this case.

Within the span of at least of rendering care to 1atient Oowowo, we have drawn

together the important and relevant information that serve as the baseline of our study

and were able to identify potential problems. y gaining the patients trust and

cooperation and with the help of the significant others, we were able to assess properly

every single data regarding the patients condition and thoroughly assessed every

system involved. We were able to obtain his past health history that contributed to the

occurrence of the condition. Additionally, we were able to get the complete diagnosis,

able to perform the cephalocaudal physical assessment of the patient, and discussed

firmly the anatomy and physiology of the systems involved. esides, we were able to

present the pathogenesis of certain conditions included in the admitting diagnosis.

>oreover, we were able to present the factors that affect the patients condition,

comprehensively interpreted the laboratory results, discussed and enumerated the

medications prescribed including the nursing responsibilities and given the interventions

we have planned and implemented for our patient.

We were able to appreciate more the essence of utiliing the nursing process in

the care, service and management of our patient. This case study improves not only our 

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knowledge but also with our skills concerning on providing care for our patient with such

diseases and we can be able to share our learning regarding this study to the significant

people. !n addition, it enhances our analysis, research, knowledge and skills on the field

of nursing. !t was indeed a hard )ob on conducting this study yet, it gave a great impact

in our career regarding how useful it is in our chosen profession.

1I. BIBLIOGRA'%5

ooks

2$

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• runner and 0uddarthPs Textbook of >ed.-0urg. ursing $8th ed Copyright U

85$5 by +ippincott Williams S Wilkins, a Wolter Oluwer business.

•

>edical - 0urgical ursing 2

th

 ed. by lack Doyce >. and Dane #okanson #awks

• 1orths/ssentials of 1athophysiology %rd /ditionCopyright U 85$$ by +ippincott

Williams S Wilkins, a Wolter Oluwer business.

• Fundamentals of ursing, 2th ed. by Ooier, arbara

• >edical K 0urgical ursing 2 th ed. Copyright U 8557 by +ewis, et.al. urses

pocket guide, $8th ed. by *oenges, >arilynn, et.al.

• urses #andbook of #ealth Assessment 9th ed. by Weber, Danet

• *aviss *rug Huide for urses. T/T# /*!T!(.

• *aviss urses 1ocket Huide. $8th edition

!nternet

• http"==www.healthline.com=health=cerebrovascular-accident@(verview$ *ate

of ?etrieval" *ecember $%, 85$;

• http"==www.medicinenet.com=script=main=art.aspJarticlekeyM8929*ate of

?etrieval" *ecember $%, 85$;

• http"==health.cvs.com=HetContent.aspxJtokenMf24323d%-3c2c-;b$9-af49-

%e$88a%f$3e%SchunkiidM9;4534*ate of ?etrieval" *ecember $%, 85$;

• http"==www.world-heart-federation.org=cardiovascular-health=stroke=*ate of

?etrieval" *ecember $%, 85$;

• http"==www.strokeforum.com=stroke-background=epidemiology.html*ate of

?etrieval" *ecember $%, 85$;

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• http"==www.worldlifeexpectancy.com=philippines-stroke*ate of ?etrieval"

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• http"==www.livestrong.com=*ate of ?etrieval" *ecember $%, 85$;

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• http"==www.ncbi.nlm.nih.gov=*ate of ?etrieval" *ecember $%, 85$;