2. At the end of this session, you will be
able to :
 State the definition of stroke.
 List the etiology of stroke.
 Identify the pathophysiology of
stroke.
 State the sign & symptom of
stroke.

3. LEARNING OBJECTIVES cont.
 Identify the complication of stroke.
 Understand regarding treatment of
stroke.
 Identify the nursing intervention &
appreciate the nursing care for
stroke patient.

5. PATIENT’S PROFILE
 MRS. M
 FEMALE
 75 YEARS OLD
 HOUSEWIFE

6. PATIENT’S PROFILE
 TROLLEY
 ANXIOUS
 ALLERGICS - NIL
 D.O.A 9/4/12 @ 1015 Hrs

7. Mrs M was admitted to 5XX-1
with complaint of right sided
weakness, slurred speech,
numbness right arm,
giddiness, dysphagia,
nausea and vomiting X 1/7.

8. Doctor = Dr AA
Diagnosis
1.Stroke
2.High Cholesterol

9. PATIENT’S PROFILE
 MEDICAL HISTORY
 Nil
 SURGICAL HISTORY
 Left eye removal of cataract (2 years ago)
 Right eye removal of cataract (1 year ago)
 FAMILY MED HISTORY
 HPT (mother)

10. CURRENT MEDICATION
 Nil

12. VITAL SIGN
 TEMPERATURE
 BLOOD PRESSURE
 PULSE
 RESPIRATION
 PAIN SCORE
 Dextrosmeter
 Weight
:
:
:
:
:
:
36.8˚C
170/100mmHg
88 bpm
18 bpm
1
8.2 mmol/L
: Unfit

13. ACTIVITY DAILY LIVING
 Having difficulty in swallowing
 Loss of appetite, nauseated and vomiting
 Anxious and asking many questions.
 Need assistance in ADL and personal hygeine
 On pampers

14. PHYSICAL EXAMINATION

16. S/B Dr AA in A&E
 17K
 CT BRAIN
 IV Drip D5% slow
 Low fat diet
 KIV anti HPT
 Dietician advice
 ROM exercise

28. ISCHEMIC STROKE
• Occurs when blood clot or thrombus
formed and blocked blood flow to
part of the brain.

29. HAEMORRHAGIC STROKE
• Occurs when blood vessel ruptured
and blood fills space between brain
and skull (subarachnoid
haemorrhage) or when a defective
artery burst and blood fills the
surrounding tissue (cerebral
haemorrhage).

32. WHAT pressure
High blood CAUSES IT?
 High cholesterol
 Aging
 Stress
 Cardiovascular disease
 Smoking and alcohol
 Diabetes


41. RISK FACTORS
• Family history
• Age over 40
• High BP
• High cholesterol
• Smoking

42. RISK FACTORS
• African American or Asian
• Male
• Diabetes
• Obesity
• Cardiovascular disease
• Stress

43. RISK FACTORS
• Previous stroke or TIA
• High level of homocysteine
(amino acid) in blood
• Birth control or hormonal therapy
• Cocaine usage
• Alcohol

45. COMPLICATION
• Paralysis
• Vision loss
• Difficulty speaking or
swallowing
• Memory loss
• Death

47. 17K
• ESR
- 56 (0 – 20 mm/hr)
• Neutropil
- 79.9% (40 – 75%)
• Lymphocyte
- 16.0% (20-45%)
• Glucose
- 6.9 (3.9 – 6.1mmol/L)

48. 17K
• Total cholesterol
- 8.0mmol/L (<5.2)
• LDL cholesterol
- 5.7mmol/L (<2.6)
• Chol/HDL Chol
- 4.4 (up to 4.0)

49. CT BRAIN
• Multifocal small cerebral white
matter ischemia

52. DRUGS
IN WARD
DATE
ORDERED
DATE
OFF
IV Nootropil 3gm TDS
9/4/13
12/4/13
Tab Cardiprin 1/1 OD
9/4/13
12/4/13
Tab Vascor 20mg ON
9/4/13
12/4/13
Tab Plavix 75mg Daily
9/4/13
12/4/13

53. DRUGS
ON DISCHARGE
DATE
ORDERED
Tab Vascor 20mg ON
12/4/13
Tab Cardiprin 1/1 ON
12/4/13

54. Physiotherapy
•
•
•
•
•
•
•
To normalise muscle tone
To restore muscle function
To control compensation strategies
To maintain muscle length
To re-educate balance
To retrain walking and restore mobility
To maximise functional ability while allowing ongoing neuromuscular recovery

56. NURSING DIAGNOSIS
 Knowledge deficit
related to management of
blood pressure control.

57. SUPPORTING DATA
 Patient will verbalize understand
regarding the management of blood
pressure.
 Patient will maintain optimal
normal blood pressure.

58. NURSING INTERVENTION
 Reinforce about doctor’s
explanation.
 Monitor blood pressure 4 hourly.

59. NURSING INTERVENTION
 Explain the sign and symptom of
high blood pressure :
 Headache
 Blurring vision
 Numbness

60. NURSING INTERVENTION
 Advise patient on dietary plan and
provide :
 Low salt diet
 Low fat diet

61. NURSING INTERVENTION
 Advise patient to do regular follow
up.

62. NURSING INTERVENTION
 Advise patient to maintain healthy
lifestyle :
 Avoid stress
 Consume healthy diet and avoid
salty and high fat food

63. NURSING INTERVENTION
 Advise patient to do regular
exercise.
 Encourage family members
support.

64. NURSING INTERVENTION
 Explain the complication of high
blood pressure :
 Influences of cardiovascular
 Cerebral
 Renal system

65. NURSING DIAGNOSIS
 Alteration in emotional
status anxiety related to
symptoms of stroke and
treatment.

66. NURSING DIAGNOSIS
 Alteration in ADL related
to right sided weakness
and numbness of right
hand.

67. NURSING DIAGNOSIS
 Knowledge deficit
related to management of
blood glucose control.

68. NURSING DIAGNOSIS
 Potential fall related to
right sided body
weakness.

69. NURSING DIAGNOSIS
 Alteration in nutritional
status less than body
requirement related to
nausea, vomiting and
dysphagia.

70. NURSING DIAGNOSIS
 Potential infection
related to intravenous
cannulation.

71. NURSING DIAGNOSIS
 Knowledge deficit related
to post stroke attack
management.

72. NURSING DIAGNOSIS
 Potential alteration in skin
integrity related to
immobility.

74. •
•
•
•
•
•
•
•
Reduce your blood pressure
Improve your diet
Stop smoking
Consider how much alcohol you drink
Exercise more
Watch your weight
Relaxation and stress management
Diabetes management