Group 1 Case

Hypertension with left-sided body weakness

Pathophysiology

Medical Management for HYPERTENSION: Pharmacologic Interventions Non pharmacologic Interventions

Laboratory/ Diagnostics

Medical Management

 A- Ace Inhibitor
B- Beta blocker C- Calcium channel blocker D- Diuretic, Direct-acting vasodilator S- Sedatives (optional)

Pharmacologic Interventions

 Ace Inhibitor Captopril(Capoten) Anapril Enapril(vasotec) Benazepril(lotensin) Beta blocker Propanolol(Enderal) Timolol

Calcium channel blocker Verapamil Nifedipine Diltiazem

Diuretic Spironolactone(Aldactone)

Direct-acting vasodilator Hydralazine(Apresoline)

Sedative Diazepam (Valium)

Pharmacologic Interventions

JNC 7 recommendations: Weight loss DASH Limit alcohol intake Reduce sodium intake Stop smoking and reduce intake of dietary saturated fat and cholesterol Aerobic exercise

Nonpharmacologic Interventions

 Blood pressure test done several times Diagnose by physician (Type or stage)

Laboratory/ Diagnostics

Medical management for ISCHEMIC STROKE:

1. Thrombolytic Therapy Thrombolytic agents--- to dissolve the clot t-PA U-Urokinase S-Stretokinase A-Alteplase Dose: 0.9 mg/kg (max 90 mg IV) 10% bolus, 90% infusion pump In 60 minutes

Medical Management

2. IVF Therapy: IV within 3 hours

Management after giving Thrombolytics: No other Anti-thrombolytics given in 24 hours of TPAs

Notice decrease LOC, Neurodeficit----STOP drug

Give cryoprecipitate/ Fresh frozen plasma No Catheterization for 2 hours from Administration

Medical Management

Drugs for secondary prevention during stroke: Anticoagulantpatients with atrial fibrillation Heparin Warfarin Antiplatelet (TCA)--Dec incidence of cerebral infarction Ticlopidine Clopidrogel Aspirin

Medical Management

3. Treat increase ICP Hyperosmotic Diuretic: IV mannitol Stool softener: Prevent valsalva Manuever Corticosteroid (Prednisolone): for acute inflammation

Mechanical ventilation: Adjunctive therapy

Oxygen causes constriction, thus decreasing ICP

Medical Management

4. Treat Decrease CPP

Volume Expanders: Dextran, Albumin, Hetastarch & 3L PNSS

Oxygen therapy

Medical Management

 CT scan--- detects fresh bleeding, MRI cant but can detect extent of damage Shows: hypointensity (black)

Laboratory/ Diagnostics

A. Improve Mobility and Prevent Joint Deformities 1. Position the patient correctly

2. Assist in maintaining good body alignment

3. Prevent shoulder adduction 4. Position hand and fingers

5. Change clients position every 2 hours

6. Establish an Exercise program 7. Prepare for ambulation

Nursing Management

B. Prevent shoulder pain C. Enhance self care

D. Manage sensory-perceptual difficulties

E. Assist with Nutrition F. Attain Bowel and bladder control

Nursing Management

G. Improve thought Processes H. Improve communication I. Maintain skin integrity J. Improve family coping

K. Helping the patient cope with sexual dysfunction

Nursing Management