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*Advanced Age
*Increased Na Intake
Hardening of arteries
Prolonged HPN
Elastic and muscular tissues of the arteries are replaced with fat and fibrin deposits (Arteriosclerosis) Narrowing of Arteries Thickening of blood vessels Increased Plasma Volume
Increased Vascular Resistance Amlodipine 10 mg 1 tab OD PO May be taken with other cardiovascular drugs Food helps decrease stomach upset Report symptoms of chest pain, swelling of extremities; irregular pulse, altered vision, shortness of breath, or hypotension. Decreased cardiac output related to presence of thrombus in the right middle cerebral artery Observe skin color, moisture, temperature, and capillary refill time. Note presence, quality of central and peripheral pulses. Assess for signs and symptoms of decreased cardiac output such as arrhythmias, abnormal ABG, weight gain, edema, decreased urine output, dizziness, restlessness, fatigue, clammy skin and diminished peripheral pulses, etc.
Increased Afterload
Kidneys
Aprovel 300 mg itab OD PO Monitor for edema in feet, legs daily Inform that drug may cause dizziness, fainting; lightheadedness may occur Caution patient to rise slowly to sitting or standing position to minimize orthostatic hypotension
Arteriolar Vasoconstriction Levofloxacin 500 mg IVTT OD Obtain history of seizure disorder pf other CNS before initiating therapy. Advice patient to take drug with plenty of fluids, at least 2L/day and to avoid antacids, sucralfate and products obtaining iron or zinc for at least 2 hrs before and after each dose Instruct patient to rinse mouth frequently and use sugarless candy or gum for dry mouth
Increased Aldosterone
High blood pressure causes damage to vascular arteries due to shearing force
Increased Na Reabsorption
Captopril 25 mg SL q6h PRN for BP > 160/90 mmHg Do not take salt substitutes or potassium substitutes while taking, unless doctor has ordered Report prolonged diarrhea or vomiting, may lead to fall in BP Inform patient that xanthines like coffee, teas, chocolate, cola can prevent action action of drugs
Increased Water Reabsorption Smooth stenotic area degenerates cell wall of blood vessel Increased Plasma Volume (ECF) Damaged vessels Activation of Factor XII BP = 140/90 mmHg Monitor BP Maintain activity restrictions Encourage patient to limit intake of caffeine, sodas and chocolates Restrict fat intake Instruct to follow diet restrictions Monitor heart rate and rhythm and also respiratory rate
Factor XI
Factor IX
LEGEND:
Combines with Factor VII and platelet phospholipids Pathophysiology Nursing Mgt. Platelet: 407 T/cumm
Manifestatiions
Medications
Factor X
N - Diagnosis
*- risk factors
Activation of Prothrombinase
Clot Circulates
Decreased Blood Flow Citicholine 1 gm IVTT q6h Safe if taken in short term (90 days)
Travels to brain
ISCHEMIA S/sx: dizziness, fainting Decreased supply of O2 and Glucose to brain tissue
PNSS 1L @ 10 gtts/min 02 therapy @ 2-3 L/min Piracetam 3 gms IVTT q6h Monitor test for renal, hepatitis, and hematologic function Monitor effect on other vital signs Monitor signs of sedation, tranquilization, locomotor stimulation, and psychodysleptic symptomatology
Brain CT Scan: Unenhanced brain plan CT scan shows a hypodense area on the R cerebral hemisphere from frontal, temporal, parietal lobe. There is a effacent of the sylci, gyri, grauy and white matter interface, no abnormal fluid collection nor abnormal calcification. Midline Septum and falx cerebri. No falcine shift. Remarks: Infarct R fronto-temporp-parietal areas with cerebral edema
Ineffective Tissue Perfusion related to infarction of the right fronto-temporo-parietal areas of the brain 1. Monitor and document neurological status frequently and compare with baseline (Glasgow Coma Scale) 2. Monitor vital signs 3. Evaluate pupils, noting size, shape, equity, light reactivity 4. Assess higher functions including speech, if patient is alert
Level Codes: Feeding 2 Bathing 2 Toileting 2 Dressing 2 Grooming 2 General mobility 2 Bed mobility 2 Cell Death
Disturbed sensory perception related to neurological trauma in the R frontotempero-parietal areas of the brain 1. Observe behavior response like hostility, crying, inappropriate affect, agitation, hallucination 2. Approach the client in a slow, calm, matter of fact manner. 3. Assess the clients ability to think logically and to utilize realistic judgment and problem-solving abilities.
EDEMA
Piracetam 3gms IVTT q6h Monitor test for renal, hepatitis, and hematologic function Monitor effect on other vital signs Monitor signs of sedation, tranquilization, locomotor stimulation, and psychodysleptic symptomatology
Muscle Grading Scale: LUE = 0 LLE = 0 RUE = 2 RLE = 2 Glasgow Coma Scale: Eye opening response = 3 Verbal response = 4 Motor response = 5
Impaired physical mobility related to occlusion of a thrombus in the right middle cerebral artery Do passive ROM Instruct patient to put the unaffected leg under the affected one Place the patient in a prone position for 15 30 minutes several times a day Encourage appropriate use of assistive devices in ambulation Observe for color, edema or other signs of compromised circulation Encourage doing self care activities using one hand (unaffected one) Teach patient to dress the affected side first when putting clothes on to avoid neglect syndrome
Impaired verbal communication related to decreased blood flow in the R fronto-tempero-parietal areas of the brain Provide alternative methods of communication, Provide visual cues. Anticipate to help the clients needs Talk directly to client, speaking slowly and distinctly. Use yes or no questions to begin with. Speak with normal volume and avoid talking to fast. Gibe ample of time to respond. Talk without pressing for a response.
Left Hemiplagia Left hemisensory deficits Inability to turn eyes toward left side Impulsiveness, distractability Decrease ability to express and understand verbal or written language (Aphasia) Loss of short-term memories and inability to retain new information Poor judgment, overestimation of abilites Impulsiveness, distractability
Health Teaching: Ways to prevent recurrence: - Dietary modification - Stress reduction - Smoking cessation - Exercise program - Drug compliance Residual deficits and balancing realistic expectation Special methods of feeding Ensure continuity of care and emotional support
DISCHARGE
Refer or consult with physical therapist regarding active resistive exercises and patient ambulation Rate muscle strength Examine neurological status Bed rest: keep mainly on unaffected side Use of pillows to support, to prevent flexion, deformity, thrombus formation Communication: speak or talk slowly and calmly Reorientation. Minimize environmental stimuli Emotional support