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*Increased fat intake

*Hypertension Cholesterol: 249 mg/dL LDL: 192 mg/dL

*Advanced Age

*Increased Na Intake

Circulation of fat metabolites

Sustained elevation of systemic blood pressure

Hardening of arteries

Na+ = 136.6 mmol/L

Formation fatty plaques around arteries

Prolonged HPN

Increased Water Reabsorption

Damages wall of the arterioles

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

Decreased Blood flow to organs

Kidneys

Release of Renin in the Juxtaglomerular apparatus to the circulation

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

Conversion of Angiotensinogen to Angiotensin I

Conversion of the Angiotensin I to Angiotensin II in the lungs by the ACE

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

Adrenal Cortex Stimulation

Increased Peripheral Resistance

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

WBC: 13, 700 / cumm

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

Conversion of prothrobin to throbin

Thrombin converts fibrinogen to fibrin

Fibrin forms a clot

Formation of Fibrin Clots

Clot formation in the periphery

Clot formation in the artery/ies of the brain

Clot Circulates

Decreased Blood Flow Citicholine 1 gm IVTT q6h Safe if taken in short term (90 days)

Travels to brain

Decreased Brain Tissue Perfusion

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

Nuclear damage to neurons

Activation of the latent suicide proteins in the nuclei

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.

Initiation of the autolytic process of the brain cells

Massive Cell Death

Permanent Loss of function

Mannitol 20% 100cc

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

Right Middle Cerebral Artery

Right frontal Lobe

Right Temporal Lobe

Right Parietal Lobe

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

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