ACKNOWLEDGEMENT:

So many sleepless nights we have experienced while doing this case

presentation. Though it’s hard we’re still ecstatic we had finished it all. Thank you is

an understatement to express our feelings to all the wonderful people who had been

part of our lives. The wind beneath the wings that made us soars.

Trust, faith and belief are what God have bestowed upon. We thank you oh

God for giving us the strength, the gift of wisdom and the capability to overcome all

the pressures and hardships we’ve undergone in making this. To you, oh God, our

creator, we surrender ourselves to you and dedicate this for your greater glory.

We are deeply indebted to a host of individuals who have made unnumbered

contributions of this text, without their help this text would be the worse. Especial

thanks to the people behind every student’s humble success of all our undertakings

– Dean Charina M. Tiongco, RN, MAN, to Mr. Jurgen Rushell G. Rapacon, RN,

MAN, our over all level coordinator, to Mrs. Fatima F. Madayag and Mr. Charles

Apolinar G. Aguinaldo and to Mrs. Mila Herrera for the knowledge they have

contributed to us, for the patience, understanding and guidance they shared

throughout in making this thing possible. Thank you for the trust and belief. To our

family, we thank you for the guidance, understanding and inspiration. In conclusion,

we would like to acknowledge each other’s efforts, forbearance, and acceptance of

the sometimes differing viewpoints about certain details. At the completion of the

task, we are jointly pleased with the result and mutually pleased to have our long

standing friendship not only unmarred but strengthen. Thank you and we love you.

GROUP C2

INTRODUCTION.
EPIDEMIOLOGY

CVA is the leading cause of adult disability in the world.Worldwide, one-quarter of all

strokes are fatal.Stroke is the third leading cause of death in the United States and

the leading cause of disability.It is estimated that four of every five families in the

United States will be affected by stroke in their lifetime,More than half a million

people in the United States experience a new or recurrent stroke each year.Stroke

kills about 150,000 Americans each year, or almost one out of three stroke

victims.Three million Americans are currently permanently disabled from stroke.In

the United States, stroke costs about $43 billion per year in direct costs and loss of

productivity.Two-thirds of strokes occur in people over the age of 65.Strokes affect

men more often than women, although women are more likely to die from a

stroke.Strokes affect African Americans more often than Caucasians, and are more

likely to be fatal among African Americans.The incidence of strokes among people

ages 30 to 60 is less than 1%. This figure triples by the age of 80.The rate of

occurrence for strokes in the United States fell by 15.52% between 1988 and 1998.

But the number of deaths from stroke actually rose by 5%.

DEFINITION OF CEREBRO VASCULAR ACCIDENT

Cerebrovascular accident (CVA) is the medical term for what is commonly termed a

stroke. It refers to the injury to the brain that occurs when flow of blood to brain

tissue is interrupted by a clogged or ruptured artery, causing brain tissue to die

because of lack of nutrients and oxygen.

SIGNS AND SYMPTOMS

The symptoms of a stroke usually appear suddenly. Initially the person may feel sick,

and look pale and very unwell. They may complain of a sudden headache. They may

have sudden numbness in their face or limbs, particularly down one side of their

body. They may appear confused and have trouble talking or understanding what is

being said to them. They may have vision problems, and trouble walking or keeping

their balance. Sometimes a seizure (fit) or loss of consciousness occurs.

Depending on what function the damaged part of the brain had, a person may lose

one or more of the following functions:

Ability to perform movements — usually affecting one side of the body;

Speech;

Part of vision;

Co-ordination;

Balance;

Memory; and

Perception

The warning signs

Sudden weakness or numbness of the face, arm and leg on one side of the body.

Loss of speech, or difficulty talking.

Dimness or loss of vision.

Unexplained dizziness, especially when associated with any of the above signs.

Unsteadiness or sudden falls.

Headache (usually severe and of sudden onset).

Confusion.

Diagnosis
 Normally, initial diagnosis will be made based upon observation by health

care professionals, and usually a complete neurological examination. Once stroke is

suspected, a computed tomography (CT) scan or magnetic resonance

imaging (MRI) scan is performed to distinguish a stroke caused by blood clot from

one caused by hemorrhage, a critical distinction that guides therapy. Blood and urine

tests are done routinely to look for possible abnormalities associated with ischemic

activity within the body. Electrocardiogram (EKG), angiography, and lumbar

puncture are all used to rule out any other possible causes of the symptom

TREATMENT

If a stroke has occurred, treatment should begin as soon as the stroke is diagnosed

to ensure that no further damage to the brain occurs. Initially, the doctor may

administer oxygen and insert an intravenous drip to provide the affected person with

adequate nutrients and fluids.

In cases of ischaemic stroke, it is common to give aspirin to reduce the risk of death

or of a second stroke.

If the cause of the stroke was a clot, it is possible that the quick administration of

certain clot-dissolving drugs, such as alteplase, may prevent some symptoms such

as paralysis. However, this is not a suitable treatment for all strokes, and can

increase the risk of haemorrhagic stroke, so there are strict guidelines determining

the circumstances in which it should be used.

Once a stroke has permanently damaged the brain, the damage can't be undone.

However, many symptoms can improve considerably in the days following a stroke,

because the areas of brain on the periphery of the stroke can recover. Also, your
doctor will suggest ways to prevent a future stroke, including modifying your lifestyle

to minimise your risks of stroke, and taking medications.

Depending on the type and cause of the stroke, anticoagulant drugs (‘blood

thinners’) may be prescribed to help prevent new blood clots from forming, in order

to prevent a future stroke. Examples include aspirin, aspirin plus dipyridamole

(Asasantin), clopidogrel (e.g. Plavix) and warfarin (Coumadin or Marevan).

Where there is a blockage in a neck artery, surgery may be performed to remove the

build-up of plaque in order to prevent a future stroke. This operation is called a

carotid endarterectomy.

PROGNOSIS

Although stroke is a disease of the brain, it can affect the entire body. Some of the

disabilities that can result from stroke include paralysis, cognitive deficits, speech

problems, emotional difficulties, pressure sores, pneumonia, continence problems,

daily living problems, and pain. If the stroke is severe enough, coma or death can

result. Depression is common but may respond to antidepressants.

PREVENTION

In many cases, a person may have a transient ischemic attack (TIA), a neurological

event with the symptoms of a stroke, but the symptoms go away within a short

period of time. This is often caused by the narrowing or ulceration of the carotid

arteries (the major arteries in the neck that supply blood to the brain). If not treated,

there is a high risk of having a major stroke in the future. If you suspect a TIA, you

should seek medical attention right away. An operation to clean out the carotid artery

and restore normal blood flow through the artery (a carotid endarterectomy)

markedly reduces the incidence of a subsequent stroke. In other cases, when a

person has a narrowed carotid artery, but no symptoms, the risk of having a stroke
can be reduced with medications such as aspirin and ticlopidine (TICLID). These

medications act by partially blocking the function of blood elements, called platelets,

which assist blood clotting.

SCOPE AND LIMITATIONS

The scope and limitation of our case study is about Mr. D a 55 year old man.

He was brought to Emergency Room of Metropolitan Medical Center last September

4, 2010 with an admitting diagnosis of Cardiovascular accident. After more than 1

hour in Emergency Room he was transferred to room 668 A. We handled him from

September 6-9, 2010. Our case presentation was focused on Cerebrovascular

accident based only in the condition of our patient. We got his permission to be our

patient in our case study during our exposure to 6C ward last September 8.

Personal data, Family background and Health History including the Family

Health History, Past Health History and Present History was gathered during our

exposure to 6C but some answers are can no longer remember by the patient.

Anatomy and physiology was based on the affected system, which is the

Nervous system.

The developmental data was based on the pattern of Erik Erickson and

Robert Havighurst. Interview about his pattern of functioning and Level of

Competencies before illness, during illness and during hospitalization was obtained

during his hospitalization at room 668A since he was one of our handled patient in

6C. Physical assessment and review of system was done inside his room.
 Our ongoing appraisal starts last September 6 up to September 9, other

information was based on patient’s chart. Laboratory works and diagnostic

procedures done to our patient are Hematology, Chest X-ray, Blood Chemistry and

CT scan.

Medical Management was based on the diet, activity, intravenous therapy and

pulse oxymeter of our patient. Drug study was based on the condition of our patient

particularly the medications that has been prescribed to him including Micardis,

Omepron, Azithromycin, Aldazide, Plavix, Lactulose, Kalium Durule, Bezam,

Diamicron, Citicoline, Glucophage,Lipigem, Caumadin, Therobloc, and some of his

STAT drugs are Feldene Fluash, Celebrex and Dolcet.

Formulation of Nursing Care Plan was done right after our interview and

physical assessment during his hospitalization.

Discharge plan consists of dietary management, activity and exercise,

hygiene and follow-up check up applicable in the condition of our patient. It is our

commitment that all information that has been gathered from the patient will remain

private by changing their names in our case presentation. All data will be treated

confidential.
Anatomy and physiology

The Brain

Three cavities, called the primary brain vesicles, form during the early embryonic

development of the brain. These are the forebrain (prosencephalon), the midbrain

(mesencephalon), and the hindbrain (rhombencephalon)

During subsequent development, the three primary brain vesicles develop into five

secondary brain vesicles. The names of these vesicles and the major adult

structures that develop from the vesicles follow :

• The telencephalon generates the cerebrum (which contains the cerebral

cortex, white matter, and basal ganglia).

• The diencephalon generates the thalamus, hypothalamus, and pineal gland.

• The mesencephalon generates the midbrain portion of the brain stem.

• The metencephalon generates the pons portion of the brain stem and the

cerebellum.

• The myelencephalon generates the medulla oblongata portion of the brain

stem

TABLE 1 The Vesicles and Their Components

Important

Secondary Adult Components or

Primary Vesicles Vesicles Structure Features

prosencephalon telencephacerebrum cerebral cerebral cortex (gray

(forebrain) (cerebral matter): motor areas,

hemispheres) sensory areas,

 Important

Secondary Adult Components or

Primary Vesicles Vesicles Structure Features

association areas
prosencephalon telencephacerebrum cerebral cerebral white matter:

(forebrain) (cerebral association fibers,

hemispheres) commisural fibers,

projection fibers
prosencephalon telencephacerebrum cerebral basal ganglia (gray

(forebrain) (cerebral matter): caudate

hemispheres) nucleus & amygdala,

putamen, globus

pallidus
prosencephalon diencephalon diencephalon thalamus: relays

sensory information
prosencephalon diencephalon diencephalon hypothalamus:

(forebrain) maintains body

homeostasis
prosencephalon diencephalon diencephalon mammillary bodies:

(forebrain) relays sensations of

smells to cerebrum
prosencephalon diencephalon diencephalon optic chiasma:

(forebrain) crossover of optic

nerves
prosencephalon diencephalon diencephalon infundibulum: stalk of

(forebrain) pituitary gland

prosencephalon diencephalon diencephalon pituitary gland: source
 Important

Secondary Adult Components or

Primary Vesicles Vesicles Structure Features

(forebrain) of hormones
prosencephalon diencephalon diencephalon epithalamus: pineal

(forebrain) gland
mesencephalon mesencephalon brain stem midbrain: cerebral

(midbrain) peduncles, sup.

cerebellar peduncles,

corpora quadrigemina,

superior colliculi
rhombencephalon metencephalon brain stem pons: middle cerebellar

(hindbrain) peduncles,

pneumotaxic area,

apneustic area
rhombencephalon metencephalon cerebellum sup. cerebellar

(hindbrain) peduncles, middle

cerebellar peduncles,

inferior cerebellar

peduncles
rhombencephalon myelencephalon brain stem medulla oblongata:

(hindbrain) pyramids,

cardiovascular center,

respiratory center
A second method for classifying brain regions is by their organization in the adult

brain. The following four divisions are recognized

 Figure 1The four divisions of the adult brain.

• The cerebrum consists of two cerebral hemispheres connected by a bundle

of nerve fibers, the corpus callosum. The largest and most visible part of the

brain, the cerebrum, appears as folded ridges and grooves, called

convolutions. The following terms are used to describe the convolutions:

o A gyrus (plural, gyri) is an elevated ridge among the convolutions.

o A sulcus (plural, sulci) is a shallow groove among the convolutions.

o A fissure is a deep groove among the convolutions.

The deeper fissures divide the cerebrum into five lobes (most named after

bordering skull bones)—the frontal lobe, the parietal love, the temporal lobe,

the occipital lobe, and the insula. All but the insula are visible from the outside

surface of the brain.

A cross section of the cerebrum shows three distinct layers of nervous tissue:

o The cerebral cortex is a thin outer layer of gray matter. Such activities

as speech, evaluation of stimuli, conscious thinking, and control of

skeletal muscles occur here. These activities are grouped into motor

areas, sensory areas, and association areas.

o The cerebral white matter underlies the cerebral cortex. It contains

mostly myelinated axons that connect cerebral hemispheres

(association fibers), connect gyri within hemispheres (commissural

fibers), or connect the cerebrum to the spinal cord (projection fibers).

 The corpus callosum is a major assemblage of association fibers that

forms a nerve tract that connects the two cerebral hemispheres.

o Basal ganglia (basal nuclei) are several pockets of gray matter located

deep inside the cerebral white matter. The major regions in the basal

ganglia—the caudate nuclei, the putamen, and the globus pallidus—

are involved in relaying and modifying nerve impulses passing from the

cerebral cortex to the spinal cord. Arm swinging while walking, for

example, is controlled here.

• The diencephalon connects the cerebrum to the brain stem. It consists of the

following major regions:

o The thalamus is a relay station for sensory nerve impulses traveling

from the spinal cord to the cerebrum. Some nerve impulses are sorted

and grouped here before being transmitted to the cerebrum. Certain

sensations, such as pain, pressure, and temperature, are evaluated

here also.

o The epithalamus contains the pineal gland. The pineal gland secretes

melatonin, a hormone that helps regulate the biological clock (sleep-

wake cycles).

o The hypothalamus regulates numerous important body activities. It

controls the autonomic nervous system and regulates emotion,

behavior, hunger, thirst, body temperature, and the biological clock. It

also produces two hormones (ADH and oxytocin) and various releasing

hormones that control hormone production in the anterior pituitary

gland.
 The following structures are either included or associated with the

hypothalamus.

o The mammillary bodies relay sensations of smell.

o The infundibulum connects the pituitary gland to the hypothalamus.

o The optic chiasma passes between the hypothalamus and the pituitary

gland. Here, portions of the optic nerve from each eye cross over to the

cerebral hemisphere on the opposite side of the brain.

• The brain stem connects the diencephalon to the spinal cord. The brain

stem resembles the spinal cord in that both consist of white matter fiber

tracts surrounding a core of gray matter. The brain stem consists of the

following four regions, all of which provide connections between various

parts of the brain and between the brain and the spinal cord.
 Figure 2Prominent structures of the brain stem.

o The midbrain is the uppermost part of the brain stem.

o The pons is the bulging region in the middle of the brain stem.

o The medulla oblongata (medulla) is the lower portion of the brain stem

that merges with the spinal cord at the foramen magnum.

o The reticular formation consists of small clusters of gray matter

interspersed within the white matter of the brain stem and certain

regions of the spinal cord, diencephalon, and cerebellum. The reticular

activation system (RAS), one component of the reticular formation, is

responsible for maintaining wakefulness and alertness and for filtering

out unimportant sensory information. Other components of the reticular

formation are responsible for maintaining muscle tone and regulating

visceral motor muscles.

• The cerebellum consists of a central region, the vermis, and two winglike

lobes, the cerebellar hemispheres. Like that of the cerebrum, the surface of

the cerebellum is convoluted, but the gyri, called folia, are parallel and give a

pleated appearance. The cerebellum evaluates and coordinates motor

movements by comparing actual skeletal movements to the movement that

was intended.

The limbic system is a network of neurons that extends over a wide range of areas

of the brain. The limbic system imposes an emotional aspect to behaviors,

experiences, and memories. Emotions such as pleasure, fear, anger, sorrow, and

affection are imparted to events and experiences. The limbic system accomplishes

this by a system of fiber tracts (white matter) and gray matter that pervades the
diencephalon and encircles the inside border of the cerebrum. The following

components are included:

• The hippocampus (located in the cerebral hemisphere)

• The denate gyrus (located in cerebral hemisphere)

• The amygdala (amygdaloid body) (an almond-shaped body associated with

the caudate nucleus of the basal ganglia)

• The mammillary bodies (in the hypothalamus)

• The anterior thalamic nuclei (in the thalamus)

• The fornix (a bundle of fiber tracts that links components of the limbic system)

The Heart

The heart is located in the mediastinum, the cavity between the lungs. The heart is

tilted so that its pointed end, the apex, points downward toward the left hip, while the

broad end, the base, faces upward toward the right shoulder. The heart is

surrounded by the pericardium, a sac characterized by the following two layers:

• The outer fibrous pericardium anchors the heart to the surrounding structures.
 • The inner serous pericardium consists of an outer parietal layer and an inner

visceral layer. A thick layer of serous fluid, the pericardial fluid, lies between

these two layers to provide a slippery surface for the movements of the heart.

The wall of the heart consists of three layers:

• The epicardium is the visceral layer of the serous pericardium.

• The myocardium is the muscular part of the heart that consists of contracting

cardiac muscle and noncontracting Purkinje fibers that conduct nerve

impulses.

• The endocardium is the thin, smooth, endothelial, inner lining of the heart,

which is continuous with the inner lining of the blood vessels.

As blood travels through the heart, it enters a total of four chambers and passes

through four valves. The two upper chambers, the right and left atria, are separated

longitudinally by the interatrial septum. The two lower chambers, the right and left

ventricles, are the pumping machines of the heart and are separated longitudinally

by the interventricular septum. A valve follows each chamber and prevents the

blood from flowing backward into the chamber from which the blood originated. Two

prominent grooves are visible on the surface of the heart:

• The coronary sulcus (artioventricular groove) marks the junction of the atria

and ventricles.

• The anterior interventricular sulcus and posterior interventricular sulcus mark

the junction of the ventricles on the front and back of the heart, respectively.
The pathway of blood through the chambers and valves of the heart is described as

follows:

• The right atrium, located in the upper right side of the heart, and a small

appendage, the right auricle, act as a temporary storage chamber so that

blood will be readily available for the right ventricle. Deoxygenated blood from

the systemic circulation enters the right atrium through three veins, the

superior vena cava, the inferior vena cava, and the coronary sinus. During the

interval when the ventricles are not contracting, blood passes down through

the right atrioventricular (AV) valve into the next chamber, the right ventricle.

The AV valve is also called the tricuspid valve because it consists of three

flexible cusps (flaps).

• The right ventricle is the pumping chamber for the pulmonary circulation.

The ventricle, with walls thicker and more muscular than those of the atrium,

contracts and pumps deoxygenated blood through the three-cusped

pulmonary semilunar valve and into a large artery, the pulmonary trunk. The

pulmonary trunk immediately divides into two pulmonary arteries, which lead

to the left and right lungs, respectively. The following events occur in the right

ventricle.

o When the right ventricle contracts, the right AV valve closes and

prevents blood from moving back into the right atrium. Small tendonlike

cords, the chordae tendineae, are attached to papillary muscles at the

opposite, bottom side of the ventricle. These cords limit the extent to

which the AV valve can be forced closed, preventing it from being

pushed through and into the atrium.

 o When the right ventricle relaxes, the initial backflow of blood in the

pulmonary artery closes the pulmonary semilunar valve and prevents

the return of blood to the right ventricle.

• The left atrium and its auricle appendage receive oxygenated blood from the

lungs though four pulmonary veins (two from each lung). The left atrium, like

the right atrium, is a holding chamber for blood in readiness for its flow into

the left ventricle. When the ventricles relax, blood leaves the left atrium and

passes through the left AV valve into the left ventricle. The left AV valve is

also called the mitral or bicuspid valve, the only heart valve with two cusps.

• The left ventricle is the pumping chamber for the systemic circulation.

Because a greater blood pressure is required to pump blood through the

much more extensive systemic circulation than through the pulmonary

circulation, the left ventricle is larger and its walls are thicker than those of the

right ventricle. When the left ventricle contracts, it pumps oxygenated blood

through the aortic semilunar valve, into a large artery, the aorta, and

throughout the body. The following events occur in the left ventricle,

simultaneously and analogously with those of the right ventricle.

o When the left ventricle contracts, the left AV valve closes and prevents

blood from moving back into the right atrium. As in the right AV valve,

the chordae tendineae prevent overextension of the left AV valve.

o When the left ventricle relaxes, the initial backflow of blood in the aorta

closes the aortic semilunar valve and prevents the return of blood to

the left ventricle.

 Figure 1The pathway of blood through the chambers and valves of the

heart.

Two additional passageways are present in the fetal heart:

 • The foramen ovale is an opening across the interatrial septum. It allows blood

to bypass the right ventricle and the pulmonary circuit, while the nonfunctional

fetal lungs are still developing. The opening, which closes at birth, leaves a

shallow depression called the fossa ovalis in the adult heart.

• The ductus arteriosus is a connection between the pulmonary trunk and the

aorta. Blood that enters the right ventricle is pumped out through the

pulmonary trunk. Although some blood enters the pulmonary arteries (to

provide oxygen and nutrients to the fetal lungs), most of the blood moves

directly into the aorta through the ductus arteriosus.

The coronary circulation consists of blood vessels that supply oxygen and

nutrients to the tissues of the heart. Blood entering the chambers of the heart cannot

provide this service because the endocardium is too thick for effective diffusion (and

only the left side of the heart contains oxygenated blood). Instead, the following two

arteries that arise from the aorta and encircle the heart in the atrioventricular groove

provide this function:

• The left coronary artery has the following two branches: The anterior

interventricular artery (left anterior descending, or LAD, artery) and the

circumflex artery.

• The right coronary artery has the following two branches: The posterior

interventricular artery and the marginal artery.

Blood from the coronary circulation returns to the right atrium by way of an enlarged

blood vessel, the coronary sinus. Three veins, the great cardiac vein, the middle

cardiac vein, and the small cardiac vein, feed the coronary sinus.
III. ASSESSMENT

1. PERSONAL DATA

NAME: Mr. D

AGE: 55 years old

GENDER: Male

MARITAL STATUS: Married

ADDRESS: 469 Tomas Pin-pin St. Sta. Cruz, Manila

DATE OF BIRTH: February 9, 1955

PLACE OF BIRTH: Manila

EDUCATIONAL ATTAINMENT: College Undergraduate

NATIONALITY: Filipino

RELIGION: Catholic

ATTENDING PHYSICIAN: Dr. Ernesto A. Tee

ADMISSION DATE: September 4, 2010/1325H

ADMISSION #: 108491

WARD/ROOM: 6C Rm 668A

FINAL DIAGNOSIS: Cardiovascular Accident

CHIEF COMPLAINT:

"Medyo nanghihina kasi iyong kaliwang bahagi ng katawan ko"

● SOURCE OF RELIABILITY:

PRIMARY: the patient

SECONDARY: laboratory results, patient’s chart, the patient's family

● PERCENTAGE OF RELIABILITY OF THE INFORMATION: 90% from patient and

family

2. FAMILY BACKGROUND

Mr. D is a 55 y/o man, who has been a widower for almost 15 years and he has a 1

daughter name Camille 16 years old. Since his wife died, he focused more on his

work as a designer. He owns a 3 storey house which happened to be his working

place and house of his other employee as well as his cousin Dennis. He is the one

who helps Mr. D in managing his business and assist him in his daily living. Their

religion is Roman Catholic.

Mr. D is a Fine Arts graduate in University of Sto. Tomas. After graduation he

manage his own business and as he verbalized “Pagka-graduate ko nag practice

agad ako ng pagdedesign ko kaya hanggang nagyon ito pa din ang ginagawa ko”

Their family is classified as extended family because aside from his daughter,

his cousin and co-workers lives with him. Extended family is composed of the

relatives of nuclear family such as grandparents, uncles, aunts, and grandchildren

(Kozier, 430).

3. HEALTH HISTORY

a. FAMILY HISTORY

In the case of our patient, both of his parents are already deceased.

According to him, his mother died at the age of 69y/o because of diabetes while his

father died at the age 86 y/o because of natural death. They are 4 siblings in their

family. The eldest was Charito and she has a diabetes mellitus for almost 10 yrs

while his 2 brothers are both in America who are alive and well. Our patient is the
youngest among them. As verbalized by Mr. D “Pinipetition na nga ako ng mga

kapatid ko kaso ayaw ko lang umalis ng bansa masaya na ako dito”. Camille, the

daughter of Mr. D is a 4th year student of Philippine Cultural High School and as he

verbalized “Sa awa naman ng Diyos malusog naman ang anak ko”.

GENOGRAM

86 y/o HPN &

DM II
69y/o

A&W A&W
DM II

CVA, HPN,
and DM II
55y/o

A&W

LEGEND:

- Living Male DM – Diabetes Mellitus

- Living Female HPN – Hypertension

- Deceased Male CVA – Cardiovascular Accident

- Deceased Female

- Patient
 b. PAST HEALTH HISTORY

The patient has experienced having medical problems such as post

Cardiovacular Accident 8 years ago (2002), Hypertension, and Diabetes Mellitus for

almost 16 years (1994). He takes Micardis 1 tab/day, Lanoxin 25mg 1 tab/day,

Coumadin 5mg 1 tab/day, Amlodipine 5mg 1 tab/day as his maintenance for his

Hypertension he also takes Metformin 500 mg 1 tab/day and Diamicron 80 mg 1

tab/day.

During the past years, he had common illnesses such as cold, cough,

headache, tonsillitis and fever. When common illnesses arise, he only takes over the

counter drug such as paracetamol (500mg, Alvedon, Biogesic, Ponstan, Decolgen)

to alleviate the pain or illness.

Communicable disease such as chicken pox, measles and mumps were

experienced by the patient during his childhood, as he verbalized

“Nagkaroon ako ng tigdas, bulutoong pati kulani noong bata pa ako”. The patient has

no allergies to any food, drugs and latex. He did not encounter having any injuries

and accidents such as falls, car accidents, burn etc. he did not experience blood

transfusion.

Regarding to his vaccination, he doesn’t have any immunization and as he

verbalized “Wala akong bakuna, hindi pa iyon uso sa amin dati”

c. HISTORY OF PRESENT ILLNESS

 One week before he was admitted to the hospital, the patient doesn’t

experience any discomfort but 2 hours prior to hospitalization, while going to the

comfort room, his cousin noticed that he looks dizzy while walking going to their C.R

and as he verbalized “Noong nag C.R siya napansin kong parang pasuray-suray

siyang maglakad kaya sinamahan ko siya. Tapos noong umupo siya sa sala parang

dumadaosdos na siya sa pagsandal, pero nanonood pa din siya ng t.v, tinanong ko

siya kung anung nararamdaman niya, sabi niya wala naman daw, pero hindi ako

nakampante kaya dinala ko na siya dito sa ospital, kasi alam kong hindi na maganda

ang pakiramdam niya”

The patient was admitted to the Metropolitan Medical Center last September

4, 2010 at around 2030. Mr. D was complaining for left side body weakness and as

he verbalized "Medyo nanghihina kasi iyong kaliwang bahagi ng katawan ko"”

DEVELOPMENTAL DATA

A. ERIK ERICKSON

Before During After Analysis

Hospitalization Hospitalization Hospitalization
PHYSICAL Mr. D weighs 81 Mr. D. looks Mr. D’s body It indicates that
DEVELOPMENT kg or 180 lbs. weak. He’s on weight had loss because of his
and stands 5’8 ft. bed in lying from 81 kg or health
He works as a position, has 180 lbs to 78 kg condition, his
designer. He was difficulty in or 173 lbs. body weight
able to wash his breathing while had decreased
own face and lying on bed, on at 3 kg or 7 lbs,
hands, brush complete bed he is now trying
teeth and attend rest without to gain his
to his own toilet bathroom strength to go
needs, privileges back into work
specifically his For now, his
hygiene daily activities
 activities. are watching t.v
and talk to his
friends.
PSYCHOSOCIAL He is a very On the first two He makes time Mr. D has a god
DEVELOPMENT friendly person days of our to bond with is social life with
and has a lot of interaction to co-workers and his friends,
customers whom him, he doesn’t daughter family and
he loves so much talk too much because he customers,
because of his because of missed them so even in the
kindness. weakness. But much hospital he
According to his after 3 days he always tries to
cousin Dennis, become more cooperate with
Mr. D is very active and jokes us even he
helpful to other to with us doesn’t feel
the extent that he sometimes good
will try to give
everything just to
help them

COGNITIVE He is a graduate He has a good Mr. D can still Mr. D is

DEVELOPMENT of Fine arts in memory remember us hospitable and
UST and has knowing our when we re- has enough
achieved good names and visited him after knowledge to
grades. responding to his discharge in know the
our questions. the hospital. possible risk
He also has a outcomes of his
knowledge disease.
about the drugs
that we gave
him.
MORAL Mr. D. is a Mr. D is a single Mr. D was Mr. D. moral
DEVELOPMENT matured man. In father and loves assisted and development is
his case, he is a his daughter so supported by his morally
widower for much. His cousin, daughter accepted
almost 15 yrs cousin Dennis and other because he
and has a took care of him employee in loves his family
daughter named all the time their house very much.
Camille whom he
loves so much
SPIRITUAL Mr. D is a Roman He believes that He never The patient
DEVELOPMENT Catholic, a his health will be blames God proves that God
 religious and back into a about his health is his source of
God-fearing normal condition condition hope in
person. as long as he because he anyway.
has faith in God. knew that on
what he
experiences is
on God’s will.
EMOTIONAL Mr. D doesn’t Mr. D felt Mr. D felt relief Mr. D is in good
DEVELOPMENT view his depression that his illness emotional state
condition as a felt because he was minimized of health and
need problem. worried about and felt secured willing to
his condition. that he had take express his
home meds. He feelings to
felt more others.
comfortable
being at home.

AREA OF RESOLUTION: Generativity vs. Stagnation (30-65 years old)

This is the last stage of the psychosocial theory. According to Erickson, at this

stage people usually have a strong sense of creativity, success, and having "made a

mark" and are concerned with the next generation. The virtue is called care, and

represents connection to the future generations, and love is given without

expectations of a specific return. But if an adults do not feel this development, a

sense of stagnation are self-absorbed, feel little connection to others, and generally

offer little to society, too much stagnation can lead to rejectivity and a failure to feel

any sense of meaning (the unresolved mid-life crises), and too much generativity

leads to overextension (someone who has no time for themselves because they are

so busy)

Mr.D iunder the stage of “Generativity” because he is satisfied on what he

had now. He accomplished many of his goals in his life, like managing his own

business. Regarding to family relationship, Mr. D as a father, he is happy living with

 family. As of his age with the condition he had now, he’s aware of what has to be

done and for the health management to maintain good health.

B. ROBERT HAVIGHURST

Robert Havighurst believed that learning is basic to life and that people

continue to learn throughout life. He described growth and development as

occurring during six stages, each associated with six to ten to be learned.

Tasks Patient Analysis

1. Adjusting to decreaseHis cousin said that he is copingTask is achieved. He
physical health. up very well. His verbalizedachieved the task because
“Willing naman siyang gumalinghe is able to adjust in
palagi kasi responsible yan pagdecreasing physical health
dating sa mga gamot niya.” by being responsible in
taking all his medicine.

2.Adjusting to retirementEven though Mr. D experiencedTask is not achieved.

and reduced income. stroke as he verbalized “PagBecause he still don’t want
naka-recover na ako magto give up his work after
dedesign uli ako ng mga gownhospitalization because he
para makabawi sa mga gastos” needs to earn money for
the future of his daughter

3. Adjusting to death ofMr. D is a widower for almost 15Task is achieved. Because

spouse. years and after that he focusedhe survive to adjust himself
himself to his work and face histo the death of his wife
life with his daughter

4.Establishing an explicitMr. D is always talking and bondTask is achieved because

affiliation with one agewith other people. patient is very friendly to
group. others

5. Meeting social andPeople in their place areTask is achieved. He

civil obligations. respecting him because asideachieved because he is
from being a designer he alsorespected by other people.
helps many people in their place
especially with his co-workers
and as verbalized by his cousin
“Naku napakabait nyan,kung
anuman ang maitutulong niya
ibibigay niya”
6.Establishing Mr. D owns a three story house.Task is achieved. He
satisfactory physicalHe lives with his daughter,cousinachieved the task because
living arrangements. and co-workers. After thehe satisfied of what living
hospitalization Mr. D will bearrangement they have.
assisted by Dennis every time
he will go upstairs.

Narrative Rationalization:
.

Mr. D achieved four out of six learning in this stage. He achieved the task of

adjusting to decrease physical health although he is sick, he is still responsible to

take his medicine regularly to make him feel better. Next he is adjusting to retirement

and reduces income even by saving some of his money in his bank account for the

future of his daughter. He also achieved the task of meeting social and civil

obligation and establishing satisfactory physical living he is very friendly and helpful

to others. He is satisfied regarding to his living arrangement now.

One of the task are not achieved because he still not ready to retire with his

work because he has a child that needs his support financialy.

PATTERNS OF FUNCTIONING

Patterns of Before illness During illness During Analysis

functioning hospitalization

1. Eating Patient eats 3x Patient lessen his Patient instructed to There is a

Pattern a day food intake on low salt, low fat decrease of
Breakfast: 2 and soft diet patient food
Breakfast: 4 pandesal with intake due to
pandesal with mayonnaise or becoming
mayonnaise or cheese conscious
cheese with his health
Lunch: ½ cup of status
Lunch: 1 cup of rice moderate fish
rice, pork and
fresh fruit Dinner: ½ cup of
rice and moderate
Dinner:1 cup of fish and vegetable
rice, fish and
vegetable “Kailanagn ko ng
mag limit sa
pagkain ko
mahirap na baka
lumala iyong sakit
ko”

2. Drinking Patient drink 8 Patient drinks Patient

Pattern glasses of decrease from 8 Patient still try to drinking
minimize his fluid
water daily glasses to 5 pattern is still
intake up to 5 glasses
glasses the same but
per day (1050ml/day)
during period
“ayaw kong of
uminum masyado confinement
ng tubig kasi baka fluid was also
pumasok sa baka sustained
ko iyong tubig” through IV
fluid
3. Sleeping The patient Patient sleep Patient can’t sleep Patient
Pattern usually sleeps comfortable on his well because he is sleeping
between 10-11 bed. As he not comfortable with pattern is
pm until 7 am. verbalized “kapag the bed and pillow altered due to
inside the hospital discomfort
He also takes a natutulog ako sa
because of his
nap in the kama para akong “Medyo hindi kasi
bed and pillow
afternoon for 2- nakaupo,nilalagay ako sanay matulog
3 hours. ko sa likod ko sa ibang kama, pati
iyong mga unan gumamait ng
ko” malalambot na
unan, ang lambot
kasi ng unan dito.”

4. Elimination BOWEL: Frequency: 5- Frequency: 2- Patient

Pattern 6x/week 3x/week elimination
Frequency: 5- pattern during
6x/week color: yellowish color: yellowish hospitalization
color: brown Consistency: Consistency: is decrease
formed formed because of
Consistency: decreased
formed Amount: moderateAmount: moderate mobility and
food intake.
Amount: frequency:3-4/day “hindi
moderate namaneffective
color:yellowish iyong gamot na
URINARY pinapainum sa akin
consistency:
frequency: 5- transparent,moder tuwing gabi para
7/day ate in amount, makadumi, tapos
aromatic in odor hindi ko din gusto
color:yellowish iyong mga pagkain
output: dito, iba pa din kami
consistency: approximately mismo ang
transparent,mo 210cc per voiding
nagluluto”
derate in
amount, ave: 630- frequency:3-4/day
aromatic in 840ml/day
odor color:yellowish

output: consistency:
approximately transparent,modera
210cc per te in amount,
voiding aromatic in odor

ave: 1050- output:

1470ml/day approximately
 “sa pag ihi ok 210cc per voiding
lang din nakaka
ihi ako ng ave: 630-840ml/day
maayos, wala
naman akong
nararamdaman
na masakit
kapag umiihi”

5. Bathing He usually take He still takes a He can’t able to His bathing

Pattern a bath every bath everyday take a bath in the pattern was
day hospital because altered due to
the doctor advice body
“tuwing umaga him to have a weakness
pati bago complete bed rest
matulog ako without bathroom
naliligo” privileges due to his
body weakness

Narrative:

Patient patterns of functioning decreased during hospitalization. Eating

pattern decreased due to being conscious to health and loss of appetite, drinking

pattern decreased but also sustained through IV fluid. Sleeping pattern decreased

due to discomfort in his bed. Bathing pattern decreased also due to body weakness.

LEVEL OF COMPETENCIES

BEFORE DURING ILLNESS ANALYSIS

ILLNESS
BEFORE DURING
PHYSICAL

Mr. D’s Mr. D’s illness didn’t During his confinement There were
musculoskeletal affect his physical at the hospital, he was changes or
system is well competencies; he is totally not able to do decreased in Mr.
developed and able to do the things he activities of daily living D’s activities of
well coordinated. used to do. He can because of his daily living, during
He can performed perform his activities of condition. He feels illness which may
his activities of daily living such as somewhat weak and result from his felt
daily living such dressing, bathing, restless therefore he justbody weakness
as bathing, toileting, etc. He doesn’t stays at bed. The doctor due to his
toileting, eating, needs an assistance of also ordered him to condition, it is
walking, etc. his daughter and cousin have complete bed rest because during his
There is no in doing any activities. without bathroom illness there is an
hindrance in privileges. He always abnormal in the
performing his . needs an assistance of function of an
task. He doesn’t his cousin whenever he affected area of
mind his condition was doing anything suchhim. It also
because he as sitting on the chair. affected his
doesn’t feel any appetite and even
dilemma in his his sleep pattern is
health. disturbed
MENTAL

Mr. D was Mr. D was coherent and He is still coherent, There is a slightly
coherent but his still oriented to time and oriented to time, place decreasing
memory is still place but he doesn’t and person but is changed in his
active and have difficulty in somewhat lethargic mental
working. He recalling and during the first and competencies
doesn’t have hard remembering names second day of our mainly because of
time in recalling and events. According nursing care. He wasn’t his health condition
names and to his wife, “Syempre able to get his sleep secondary to the
events. He used kahit tumatanda na ako during his confinement, environmental
to read kailangan na maging as he verbalized factor in the
newspaper and alerto pa rin sa mga “Medyo hindi kasi ako hospital.
especially bagay-bagay. “ sanay matulog sa ibang
magazines to get kama, pati gumamait ng
new ideas and malalambot na unan,
new trends in ang lambot kasi ng
fashion. He is also unan dito.”
fond of watching
television
especially in the
morning to
improve his
mental
alertness.

EMOTIONAL

Mr. D is a jolly andMr. D had accepted his Mr. D instilled a close Client’s emotional
socially-interactive illness and he just family ties much more competency has
person. He is a realized that the during his hospitalizationnot changed
type of person avoidance of his because whenever his despite of his
who solves his condition’s severity is to family stays with him at present condition.
problem or their put things first. Although the hospital, he feels He continued to
family problem it is hard on his part, he much cared and loved. show the stronger
together with his still manages to smile to According to him, side of his illness.
family. He is an the world. “Tanggap ko na may The client never
optimistic person. sakit ako, sana lang ceased to show his
He always thinks humaba pa buhay ko love and care for
that whatever the para makasama ko pa his family
problem it can be sila ng matagal, lalo na especially to his
solved no matter iyong anak ko. Kaya daughter.
what. And he ngayon iniiwasan ko na
always sees to it lahat ng bawal sa akin.”
that he has time to
bond with his
daughter.

SOCIAL
As time passes by, Mr. Mr. D expresses Mr. D’s social
Mr. D’s social life D’s health condition boredom. However he competence
was very active didn’t affect much of his was happy whenever hisdoesn’t change. He
way back before social life. He is still relatives visited him is socially active
he had illnesses. active and prefers to be during his confinement. even if he is n the
As a businessman busy in his work rather He also showed hospital and
in the field of than to stay in their friendliness and smiles maintaining his
fashion designing, house. with the hospital staffs good relationships
he serves his and to the student nurse with the people
customers with during his stay in the that surround him.
smiles and full of hospital. He also
energy. He is also participates in anything
has a good that can make his
relationship condition to be in good
toward his co- progress.
workers. And he
always attends
whenever he is
invited to a
gatherings and
party.
SPIRITUAL
Mr. D spiritual
Mr. D’s religion is Even before he was Though Mr. D has competency didn’t
Catholic. He hospitalized Mr. D confined in the hospital, changed, instead it
always goes to doesn’t lessens in it is not a hinder in his remained constant
the church to attending in the mass. spiritual health. He is and strong.
attend their mass. His strong faith does not still faithful and prepares
He also prays a change, he continues to himself of whatever may
lot at home before pray and entrust his life occur to him. Prayers
going to sleep at to God. “Uma-attend pa strengthen him most of
night and rin ako ng mass every the time.
whenever he Sunday sa kabila ng
wakes up in the mga nangyari sa akin.”
morning. As Mr. D verbalized.

SEXUAL
What important to him Mr. D’s sexual
Mr. D is not Mr. D’s condition of now is his health and his aspect observed to
sexually active aging, having an illness love to his wife, children decrease due to
because her wife and his wife’s death and grandchildren. his condition and
died long time ago affects his sexual the natural
and just focuses life..”Kapag matanda ka extremes of aging
him on providing na hindi mo na iniisip and the fact that
the needs of her iyongmga ganoong he’s already
daughter. bagay, ang mahalaga widowded. Also his
na lang sayo ay ang main focus now is
anak mo at ang his health and his
kondisyong ng family. And despite
panganagtawan.” of his illness, he
still showed his
love to them.

REVIEW OF SYSTEMS.

General :

“nakaramdam kasi ako ng panghihina sa kaliwang katawan ko.”

Respiratory System:

“nahihirapan ako huminga pag nakahiga ako”

CardioVascular system:

“may lahi kaming hypertension sa mother side ko.”

Gastrointestinal System:

“Nililimitahan ko na yung pagkain ko,iniingatan ko na kasi ang sarili ko.”

“Hindi naman umeepekto yung binibigay nilang gamot sa akin tuwing gabi na

pampadumi,utot lang ako ng utot doon.”

Genito Urinary System:

“sa pag-ihi okay lang naman,nakaihi ako ng maayos wala din naman ako

nararamdaman na masakit.”
Musculo Skeletal System:

“medyo nahihirapan ako kumilos”

Endocrine System:

“may lahi kaming DM.”

Integumentary System:

“Noong dinala nila ako sa ER namamaga yung dalawang paa ko.Pero ngayon

hindi na siya namamaga.”

Neurologic System:
PHYSICAL ASSESSMENT

Prior to the assessment, the client was informed of the procedure to

be done. The interaction took place in a systematic manner, although some of the

body’s part was not assessed and observed for the client’s request and privacy. The

assessment was done last September 6, 2010 at the room of the patient at around

10am.

A. GENERAL APPEARANCE

Patient is in Semi-fowler’s position with an IVF of PNSS1L + 20mEq

KCL X KVO @ right lower arm and wearing his own pajama. Patient has a left side
body weakness.

B.VITAL SIGNS

NORMAL ACTUAL REMARKS

TEMPERATURE 36.5-37.5 c 36.5 c Normal

BLOOD 90/60-140/90 140/90 mmHg Normal

PRESSURE mmhg

PULSE RATE 60-100 bpm 69 bpm Normal

CARDIAC RATE 60-100 bpm 70 bpm Normal

RESPIRATORY 12-20 bpm 20 cpm Normal

RATE

BODY PART TECHNIQUE NORMAL FINDINGS ACTUAL ANALYSI

FINDINGS S
1. Head Inspection Normocephalic, Proportion in size Normal
proportion to the size & normocephalic
of neck & body.

Palpation Absence of nodules No nodules or normal

or masses. lesions.
2.Scalp Inspection No lice and dandruff Doesn’t have any Normal
lice or dandruff.

Palpation No lumps and No lumps & Normal

lesions lesions
3.Hair Inspection Color varies mostly The client’s hair is Normal
in black smooth in evenly distributed,
texture and shiny. smooth in texture
Evenly distributed. and shiny.
Thick.

4.Face Inspection Symmetrical asymmetric face Abnormal

due to
shallow nasolabial shallow
folds nasolabial
folds

5.Eyes Inspection Round cornea w/ Has a black and Normal

black color round cornea, because it
conjunctiva thins is brought
and decreased about by
visual acuity with the aging
eyeglasses of process.
650/650

6.Eyebrows Inspection Hair evenly With evenly hair Normal

distributed w/ skin distribution,
intact symmetrically symmetrically
aligned w/ equal aligned w/ equal
movement movement.

7.Ears Inspection Bean shaped and The patient’s ear Normal

firm cartilage. is bean-shaped.
Proportion to the Non-tender, no
size of the head, edema
symmetrical and
parallel.
8.Hearing Inspection Can hear in Normal Diminished Normal
Voice tones hearing acuity due to
aging
process

9.Nose Inspection Symmetrical, no Symmetrical, Normal

lesions, midline and midline and
patent. Air can pass patent. No
through the presence of
openings discharges.

10.Mouth Inspection Well proportioned Asymmetrical Abnormal

and symmetric mouth due to
stoke

11.Lips Inspection Smooth, pink in color Patient’s lips is Normal

and has no lesions pinkish and slightly
dry and no noted
lesions

12.Teeth Inspection Complete without Client has a Normal

dentures, white dentures in upper
portion of his teeth

13.Tongue Inspection Pink in color, whitish The patient’s Normal

coating tongue is pinkish
and has whitish
coating.

14.Neck inspection Head-centered. The patient’s neck Normal

Muscles equal in is head-centered,
size. Coordinated, can able to move
smooth movements without discomfort.
with no discomfort

15.Chest Inspection Symmetrical, no The patient’s chest Normal

bulging. Normal has no bulging
respiration falls and symmetrical.
under 16-20 bpm. RR=20cpm

Auscultation No abnormal breath There is a Abnormal

sounds presence of due to the
crackles pulmonary
 edema

16.Heart Auscultation Normal cardiac rate Audible and clear Abnormal

sounds at the 5th due to
(60-100 bpm), has a intercostals space irregular
normal heart rhytm. left sterna mid rhythm
Radical and apical clavicular line,
pulse should be cardiac rate of the
identical. patient is within
normal range
CR=70bpm,
irregular rhythm,
no murmurs.

17.Skin Inspection Fair complexion, Color of skin is fair Normal

absence of scars and there is
and lesions. Skin absence of any
color depend on rashes or lesions.
patient’s race. Client’s skin is
warm and dry to
touch

18.Abdomen Inspection No masses, No No tenderness, no Normal

enlargement. No lesion, flat
Palpation tenderness and No rounded
distention.

Auscultation Bowel sounds 5-30 Normal

sounds per minute Bowel sounds 15
per minute

19.Upper Inspection Symmetrical, can The patient has Abnormal

Extremities move freely without difficulty in moving due to
Palpation any discomfort his left side of the body
body weakness

20.Palms Inspection Slightly visible veins Has rough palmar Normal

with rough palmar surface with
Palpation surface slightly visible
veins

21.Fingernail Inspection Thickened yellow Has thickened Normal

s brittle nails, clean yellow brittles and
Palpation nails, well trimmed the nails are
properly trimmed
 Good capillary
refill
Normal

22.Lower Inspection Symmetrical and can The patient’s lower Abnormal

Extremities move without any extremities is due to
Palpation discomfort symmetrical but body
has difficulty to weakness
move his left side
of the body

LABORATORY RESULTS

DISCHARGE PLAN:

MEDICINES:

• Discuss with the patient and watcher the need to comply with home
medications.
 This will help the family and the patient to know the importance and
advantage in complying treatment regimen.

• Explain with them the advantage and disadvantage of strict compliance of

treatment regimen.
 This will ensure and encourage the patient that taking medication will
help treat and prevent recurrence of the disease and for faster
recovery.

• Instruct the patient and watcher the right time, right medication, right dosage,
and right route as ordered by the physician.
 This will avoid confusion of the proper drugs that would be taken by the
patient.
 • Instruct the patient not to skip taking medication and complete the whole
course of medication.
 This will help for an effective action and compliance of the medication
and for faster recovery.

• Remind the patient and watcher the importance of taking consideration of the
food or other drugs that is contraindicated while taking the medication.
 This will prevent further complications and unnecessary effects to the
patient.

• Instruct and warn patient and significant other about the possible effects and
adverse reactions that may occur brought about by taking the medications.
 Side effects and adverse reactions from the medications will
sometimes lead into another occurrence of complication or disease.
This will also facilitate proper medical assistance.

• Remind them to take the drugs properly and taking note the expiration date
before taking the medications.
 This will ensure good compliance of the medications to be taken and
prevent accident poisoning.

• Encourage the patient not to take medication not prescribed by the physician.
 Non-prescribed drug may contain antagonistic or synergistic effect.

• Instruct the patient not to stop the medication abruptly or adjust the dosage
without prescription of the physician.
 Stopping the medication abruptly or adjusting the dosage would not
take the effect or action of the medication.

• Instruct the family to properly store and handle the medications so as not to
let children accidentally get hold of it.
 This will prevent accident of drug poisoning.

EXERCISE:

• Encourage the patient to perform light exercises such as walking and jogging.
 Exercise help reduce cholesterol levels in the biliary tract, which could
help prevent gallstones.
 • Avoid heavy exercise.
 To prevent body fatigue.

TREATMENT:

• Explain the purpose of the treatment and why it is continued at home.

 This will help the patient and family to be oriented about the treatment
and this will help him understand about the importance of taking the
prescribe drug for faster recovery in the disease process. To also make
them aware that the treatment is not only done in the hospital but it
should be continued at home.

• Explain to the family the condition of the patient and give them factual
information.
 To have better understanding the condition of the patient and to make
appropriate action of the disease.

• Direct and instruct the watcher to give the medication or assist the patient
according to the medication regimen.
 Giving the medication and assisting the patient accordingly will have
good compliance of the medication and will give sufficient effect to the
patient condition
• Emphasize the importance of recognizing any sign of unusuality.
 To give appropriate interventions.

HYGIENE:

• Encourage and advice the patient and family member to practice proper hand
washing before and after eating.
 Proper hand washing will prevent the spread of microorganism.

• Instruct patient to do activity of daily living.

 To promote good health and prevent infection. It also increases the
sense of wellness, which is very much needed in the therapeutic
process.

FOLLOW UP CHECK UP
 • Encourage patient and family to have a regular check up with their physician.
 To monitor health status and conditions. This will help recognize any
alterations in the body.

• Advice patient and family to follow doctor’s order comply with the doctor’s
advice and follow what is stated in the written discharge instruction.
 Follow doctor’s advice and complying will help achieve the success of
the treatment coarse and will help for the immediate recovery of the
patient.

• Encourage the patient and the family to immediately report any unusualities
regarding the patient conditions.

 Signs of unusualities will indicate the occurrence of the disease and

reporting it immediately to the health care provider will immediately
give enough attention to treat the said complaint.

DIET:

• Avoid crash diet or a very low intake of calories-less than 800 calories a day.
 Losing weight too quickly is associated with an increase risk of
gallstones.

• Choose a low-fat, high-fiber diet that emphasize fresh fruits, vegetable and
whole grains. Reduce the amount of animal flat, butter, margarine,
mayonnaise and fried food in daily meal.
 A high-fiber, low-fat diet help keep bile cholesterol in liquid form. Do not
cut out fats abruptly or eliminate them altogether, as too little fat can
also result in gall stone formation.

• Eat regular meals, 5 or 6 small meals per day.

 This helps to avoid over loading the digestive system and allows the
body more time to digest any fats.