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l$sment of CO'11a and
, A Practical Scale,
64,
,re. In: Chestnut RM,
• ai, authors, Early
evere Traumatic Brain
ang M, Ratanalert S:
!diction in acute sub­
IJ!'Oi 40:22-25, 1993,
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Nursing Care for Stroke with rlypertension and Diabetes melitus I A Case Study
Objective: The purpose 0: teis study was to develop guidelrne for
providirg healthcare, physical rehabilitation and promoting family
participation
Abstract' The resull of clineal study was rrorr 2 patients with stroke,
hypertension and diabetes "I1ellill,s, The first patient was suffered fro'll
hemorrhagic slroke, while the second one was an ischemic stroke.
The most important modifiable risk factors of both patients were
hypertensron (hgh brood pressure), diabetes meliitus, The other
modifiable ~ac:ors of the first one were alcohol drink:ng and Cigarette
smoking, the second ons witn high choiesterol and obesity
For the clinical diagnosis, botll of them were hospitallzed
vitI) improper self-care, :nabllity ':0 move li:nb on right side of the bOdy
and mability to un(:1erstand formulates speech. O!her compLcations
were respiratory infections and breathing discomfort caused by
secretion. Ottlsr factors were Emotional disturbances and clinical
depression such as a sense of grief fo~ their physical and mental
:osses ana a sense of hopelessness that disrupts an ind/ldua!'s
ability to function. Family member and caregiver '.vere 8:S0 concerned
'hat tney were not able 10 prOVide proper healthc9re to pa'ients, The
f:nal factor was a cost of medical treatment and managmg caregiver
untll te,,,y CQuid be discharged from hospital,
A rehabilitation or mu!Udiscipfnary team can implement this
study as to help the patients, such as preventing cO'l1phcaUon or
infectior, redUCing physica' handicap, mobility and experses, Moral
supporting and working on abHity are crucia: for patients to relearr:
ano adapt the hemipiegic limb during functional act;vlt'es to create
lasting permanent changes. Educating family members and soc:al
imeraction playa supporfng role to preventing stroke relapse and
deteriorate as we!!.
Key word: Patients with Stroke, "ypertension and Diabetes Mellitus, N~.vs:ng Care
SunlJn Sangr:.J~gsee, B N.S.
Department of nursmg
Sar:1utprakan nospita:
Samutprakan prtMnCe 10280
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Reg 0 MedJ2011: 513-518

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(1J1I'1l.;
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iJ"~m~~~~~~n1nnIll11~ '1l1n1~""~tnn1nl~~~ 011
~il9'1lU 1ll1fm1111"~1ll1fi!J'11J'J~
<II< "'<Io!I" _F.CI
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j.o " '" ..-. 'If
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:l,t ~lJm~;mr;hlt!~'lVl 'YI~iiin1~JJ'1~m'" 5J11l'l
... .:- ,,,,, .,,, l'_ ""' .......
;'f"im3n9U1:1:::ti-1Pll11J!j';;u.JtJ.tU1'"l'W~1J!ltl WlUf11Tl!mJ'1::"JWi
, " ~ 1"" ,...,.
tt~~"'1~"'11~1ll!J W~mt"'~19m'1.1!l'u!llJ"'1ll~ tt~Un1r
fnt"~~~ ttl'lYlU ""difllJ ~nl1i(J II" ~t'h tJ~!l~j1.11'l1~1
~~l~'rj
.oi y .... ~ "
3. M111l ~l.fl"'llfl"~"I1n!ll1nt~i~b';]nj17
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1'll1n11'Y1lmn~'E~nlJrl~~"llml1C m'1lI'll,u:J~'!llJl' ct!
nlj'flUllJ1j~t11tl J'lilflli1~1.InlMn111U"'YluqfnWl""~
VjtJ1lJ11'l1'l11'iil'lViil"'lJJilUl'l!mnn~'1
4. UD~II1~'11l'ltJ1lJ1itJilunln.hn1~mlJnl~
1'" "" ,., , '" J ~
l'lt llJ~j).jl 'lI ,nllll~I.lI1n'1nIJ11:W~·~lJ~ nl1' 1~t).jt<
n11~IR1,:"iJrJ'" fl11111bl~';1':;m:'l~mlJ1il lVlu,UlJ
~";hui'~fll~ ~J1J1~ '1l1j').jru ii~~).jt~~Jil.;t~1':1:Jn~
b~ff~'L.'h ~ n"lnJ£liMn'1 T'V'ltl11Jl flt] Ul..J~ ~1MJ~1'W iJ01 T
... I ' " .... """ "
J1J J1Jlil1).jlJ ~:IJJlJ~"n 17fiU'11J'J~ "~~m1IJUYln'llfll;J ~ 01~
fn",lfiU11J1~11'l'Iru/1~"~~1~~'1l ,il'1l~
5. ~t:Jt~ ~'J'Mn ~iiJ!Y'''nlj',! 1b1'l~t1,~h
t1?'~l~'W~2J~ilJi"I:Jf!'LJ jIiJ~p-J h~1)litr}..I1,n ~{'.,!.fIirmll''!l btfl
~ulu.Mu
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l'l!J~1~, ,"IIlnlj',~!J~~fi1~'iI~q,:1!Jl1l'11,j,,~J1J '~'1lJ1Ji).j'1l~
' ? I " ~1 U'elJu 2551 !J 2552 "il~l 2553, ;J91IJ1lJ 148 11U
124 1I1l~135 ntJ 1I11).j~,Ji11J ~~~U1!Jh~1.1i!lIll'~"J'l~3J~~
~,~ • ' 0 "' 1 '~I ~ 0
'V1~"lI1njrY'l'l"Jn~, L'W b:f4'Y1tll1J'1fl',,,'1'W v:ry ~1J5'~'lV1nlJ~9U
ulU,/i~U111'11'1ll~i>l.;t~ii ,j~ ~~~,,~ IIJC!'1,;JJJCri'lI"b
"
,.., "" "~",I' ~"~
" 2551 " 2552 ,'~"U 2553 JJ~u~~'1M11:W~'~~~1,j~
!~ ";,,,11.1 ;.197nu 1,25511U lbj1~1,1381'1~ 'i,,~
q1!1tJcmmllJ "'lJ1lJ 6A57 nu 6,61911tm,,~ 6,343
nU~lJJ~ci>l1J m1~mn1:1f1>1~'1lIllI1i~Vl1).j!l~~1l.1fr1Jl~~
~ ~
• <, ~ Y , . ~ ~ ."
fYll:JJIJIU,~7l~fj~~L~fl::: t:lPl bl11W"J1U I.Ufl1~'U ~ k"'''1Iil'dftni'l
~r'~l ~'flat5fw~ur::::nI1~~ilIH~"ll'fl~r:rl1'Jui-.'l~'!J-J11!j~.J... "l;I 'U'iI ..
~ 1 tI" '1 (' .... ,d ... "" .til
U"~~~IJ~% ~i ~IJ "~'A"~~ '~fll>l1"'il~'""nI>l9"nJJI~EIlI
~~nlUllJ~"(Hemorrhagic stroi<e) 1 n~ "Il~~tl1tJl1~
1.1~~~ '~!lIll~ll·fl~~ilJ'l!).j·lI~~lma'1l~ (Ischemic stroke)
111U
'" 'I ...: _o;(j <;' "" .,. .J
~1J1!J111'l'l11 lu;J "f11.1R~l>l IRlI ~~JJ!l~'lIU"',"
.r~~11i:t~'tl(?lfitnluiUJ'fl~ (Hemorrhagic stroke)
iJ",{u ,~u~l11!lmnii~hl'l~~lf'l!"''' t1M11JJf.;l~ill'l~~

5. :
'11"''ln'ltJn1'1UWftUUfl1 6.7
11;; 25 tI!lLY. <1 ;lJ I'L . :.f! 2554516
bbllZh~ bU1~11.l ClUl!JiIJihJ1~<Wi rn1M11~fn~11J1 ri~.l
•V"" ..., "'~ Jt v <V
n11Jn11b~ UU1!Jbll rI .l~!J 9Z~ ~!J 1"1n11.l~ 1!J!J'11J11U
iJ:r:::i'i:t.!L1H Ul~fJf>l;i1 :r'JJtjfnl"J:l~tN~tJl1Jlfl~.Jvm1:w
~~r1I'lL1~~1t'hU!l [h4'm1i!J~1E~INIJ1~tn119>Umi::, ., ,
4. ,..... ~ '" ~ ~ ,
~1~~tl"~"J'l.l "~Z11~~1J~11 23 ~.lA1~1~:f1N~1~UIJ
b~ ~~ B'ood Cholesterol 182 rng/dl b,~~~~ Blood
Triglycerides 178 mgldl innri1U"Z'1l1rnmMl~"mfu
~ ? ' ? '" >.1 ,.J}i
1 '1111:;Nnil.llJ1lNYm1U1IH1iil.l1iU~U1!J.l'il.!tll'l1i.l
~t!'1tJiitnnlnllm~tyl ~Vlt~iV1 t~"ll't.itjj1~1-:J"ll'11'tl'iltUl'l..j
n~1Mrl~:h~rn!J~mfu bb'll.l'll'.'ih"'ll11~t.l~N lP.lb'il~11l
11'1 Motor Power ih'l'll11 grade 4 i1~~1!J grade 5
v..!!/ .... .,.
il'lnM~", Glasgow Coma Scale E4 V5 M6, pupil3 mm
React:on To lig'lt both Eye ~111J".llai1111 196;63
•
il,,/iblJlllnh'ill'l ~1'l"1 92 ~1'~/.l1Yi IlM11n1l"ln!Jh 24
.flf~/.llVi ,mnwiJ 37 !l"~1b'l!!H;!J1 Pi1~~1mo]jl<li.i, .
~~;j~~Il~l"1l1Ill~~~ 96% ~~rn~~j"l~~~1l1~~111~'l9
W,'i~tJ ~ nl :i'(OJd';l~ ~'fm";'il:nJtlil~tl fl ~ f.J f1 n'):r~ ~Vl'"'1til n"1l L'i'6
l'ifllJfi~l~tJf~"fl"(CT scan Bran) "lI Basa: ganglia
Hemo~rhage size 1,5 x 2 ems Occioul Id~action
~L'"lt:ih1r~;..i1b~~:;i'i11il9>[tl"ll·}.m'r'{W'1J1~3 ~fl
d J''''; .J
1. n1~1J'lI1l1'll'1l~I.l~'U~l'IlJ~~1'l1llIm'!fl"91n
I'IlJTl~1Mulii1'l.m!<~Tltln'ilb~1l:;J'W!J.JYl'1l
2 ~u1m~mvi'ilm1iil"'m1~11!JI~;lJllM~1
"" ......s ...: oJ
l'il!JJJ1ii'i.l lll'1l0~CnlJlnmnV.l:lI'JWtlU
3 01:V1!Jh11li:hb:iI'lfr11i.i11l~"1nYm
LWitrVlt!",''1 jn-qIYlrtui:1 ,~:wv:;,V~tYll.t,fi:1:j.W~~~l.fI
.'1 ~ "' 1 ~4. ~~ 'lEIJIl1'l~n"'IJ.l111l"~ .l1~~"'IJ;j (;,y­
perglycemia)
5. mj'~Mvi1'l~fl~1nmyd:l;jbilt'l~1nWlll:l.i'l1~•
6. ll1JiJbl~.in11ii1.;(hE~9911~LtJ~U.llbll~'l
,;. _.Ii, _,
7. It'itFl~'ilnl1~HYll'n''d ~'Wr~':J1J'Yl'l~bLf!UjJ~;:;ql'J::
8. 1iiTl,,111n'r11''hn,;.-j'.~tJ1~''1';;.l ,d1'l~'''n
, "';.>4 _ .J
U'll!.!-~1'll11fl'1l'!L'N "1nn'mllJWUcfi~l1cYm~IJ"H
9. 1'l'l1IJl~nil"lru~11.lif1'£HIlVlI'l~ lti£N~1n
'li1utviitlMlll'1l'l1IlV;
1O. ~U'l!Ji1i'l~11<~Mnn"1IlL~!J1n1Jm1!.Jb~lJ
lh!J'llI:l~lll.llt'"
"" v " "I
11 .CYl L'l°Jll'l ~ 11;. ~ ll~ ~ ~ ~1" W'!l1J ,t.;n1'
1JBtTM~ltd!ln~uhJtl~~trl'!
~Ul!J"E~ 2 Lil.lh~~~!lI'l'~~VlIIJ~~1i'l~~1~
'~!l~ (lsche'Tlic stroke) u~4'!Jl~!J~~!lrr1Hn",l~~~
i1f1ru~fl L:Jllhi'1m1IJi1I.l:~;;biI ~~ ll,d~fll!J1'.l11'! ~111!l
~L1;;~J'f·111~n~1<~d.iMtlL~fl~"lJI~tjl 3 t~"€l~ i1,,~tI:~tJ~
~'1l~i1~m~m111~b3J.!1.i,i1~",~~ ~i'l Blood CtlOlestero
196 mg/d' h~~~j Blood Triglycerrdes 164'Tlgld:
iiw niiim~IJt'llm1iIIlD n.;rTl~ ClU1!J1;J~~u ~1IJn"!'u"I ~ ' I l " ;
1l1~'l111'tnV1' i1J111:ii1.!1l!1~~1 ~ n1~1:l!llllh,r~n1!J
~1n1~lb"~Tl~01n~~~ 1l~nfm'iul!J~~nlii'1 wiIlllli~i.- , 'Il 'Il '«
,I -"I '1 <4 .. •-"1 <d "'" ,
u1r,Ut'l ,£lJ1n b111!l!lV'illi IIJlJm1~,'!lm CY"'llj!ln11
fL1l1~'l'.lfl'V11.lfdj!lAn11i1~n ~'I.l'iJ1-!h~'iJ·~11i~!.!
"N Grade:l liiilllllll''l UJil!l11l1rlmnf~ ill'lil'l l);iJ
!l1011U11J Glasgow Coma Sca:e E=4 V=5 M=4, pupil
3 mm Reaction To Light both ~~1IJi'i''!l"i11'l 1851
105 jj"~I!Jmlh~1'l 'il1i~j' 64 ~f~!!.!1Yi !I11111n1nn!J19
28 ~f~1Il1Yi mll~J1il 36.2 !l~~1l~jjl~!l1'1 ~1m1lJlo]jlJ, .
{.l'll!l"'f]'1ln;h~.!blii1'l~ 94 % ~l'lm1bi1119i'1~.l1~Yb
v1'."lJJniii ~~nl1~1~'uj'jn~mC:J'f]1ll1illlnfiltrat:on At left
lowe, lobe l"IJ'!l~nb~~~ Crepitation At left lower lobe
tJ~nli~j'';l'''ilfln"1ll1tJ¥lrllJ~'JL;f:fjf~~~~ (CT scan Brai;))
Y'tlJ Right Frontal Basal ganglionic infraction no
Hemorrhage ~U1tliJil(jJV 11la~-iifl~U"'llU'll~n11
'YUJI'U'":fj 4 fi'El
1. 1!.Ji'l~1"1'1Jt~n::,j,'".IIl,wmw'iild'H"1ni1
I'nllJ~",1lniii'll!i<n11lv~ ,1tl".,~t'lUl;IJ!i~
, ,
2. tJ~~ ~1~~lil!1~'l'l nn11,WIJ~·~1!.J;1l1.l
Vlft'El'" ~~'f] ~:(i~'fFl
"'.'1'" II) tv' ... .., d
3. ~1J1UlJml~mU ''l~IJ'~~1b'il!JU1i~1l lll!i~
~ ..'11r1lJm1l1ru!lUlv.!!m
4. 111~~1!J"~1aJi11l1~~1'l1iJ11Wcri!i~'llnm"
•
L~'W~lt l~I:Jn'Q v;n'klJbti~·..,:; l'~~£j'JU,i'j:;1:iJ~UNL'Cl
".' ~ ~.Ii 1 - ,5. ~u')tl~tll,):::lPl@lt'ti 'W1::;1J'UVll~L"'kO.nLl Lr.;
~'1'W~1-1 dlfl~"nnnl~'lin
i,o".oj <v ~ 4
6. ~m!J!.JJ'11~1~tlllI.l1111~1l1.llii~Vl~~ (Hy­
perglycemia)
I I " " , ..l d ...
7. ~U~U~'!lln1mJII'J.lu'LIl~l'!!)~~1mn~
m~~UJ?lIJ~"~'!l~ Eiectrolyle
Reg8.7MedJ
Va'. 25 No 4
8. il~muiil
~ .. '.!"~Y'UJ,!'W'€lt'W~,,:j~1n~'iJ'1t1 ~
9. bllJlJll~lln
,
10. b~m~~w
~~U mii~ i'i'~bj'j~11l1ii
~ -:. t~tI~;l'fH'i1
,ii~~~"nn1~1,,1rn~ltJ~'
12. Yl1ij'·'.ln1
~~t.;n'IJ~1~tlIlU~'"'lnr
13. nIJ~Iilv1'f)i
'1 ~14.~t 1tllJ~1
:11U~!l'~.l"N UJl1'llh'
~ ~
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~thuh~1~!i~~~j'j~~IJj'j
i1m~~1nq~Yi~n~llJ~ij:
IiU~t~tl~1"f1..n1n!i!.!yjl.v •
bi'1~~!i ~ ,ii",,,,j~,,,~~ilt
~ ~.t~~:::m~.r:·YJ::~l."l1f1"'11!lU'Yll
l"wun11:J1~tjj.l'i11n11b
, ... ,... ...
tW"'l".m~mln'l1lJ~lI[
t~[ln11;ilnltJJ1I'Y1thu~
W~ij1!.!mn!iuyj~mi'i'l1•
~1:'1~n.~UUr"~!J1~b'
~n"~ ~1~1~~';11'1l1!Jnr
fu n1ru~~1'1~-i1 2 i''il~
1~'o~!IJ~,,~Ui>l~1~l~!)~
lJ1lN!1!JllJ1~ 3.J1l Lb~~
"', ~.,. .,d
fJl~11 ~'1fJ£J~tl1nl1~~U'
'rmU1~~·1'hl1l'chhmnl
" .b~!l Wil~liii>lm1:ololC~1~1
~1tJhltl.!b~1l1 6 .J.l~'LI'
fll:lnttl!~i11!J1'1!Jfulm!J!.J
'i"~~11l'm1~".~~mn't~
n1miuihw:;t11!J!T~~~'
•

6. • •
.,m1M~n1fU"1Jtftl1lf 6.7 Reg 6.7 MedJ
~ 25 fJliii114 ~.fj. ~ ii.A. 2554 fl '; 1~fJ11] i'l ~Ihtlhr/.tf.tHOl ~ftTI ~ea,'il-lt')unl.fI1f' P1'l1:J(ih,jli'l.:.::iVl'~~~n::bM!.1J 1~I)'I 'U : fl'j'{u~n1:r:n
Vol 25 No.·1 517
.~~~'11U'i~m.j1,;n1;'
~ ~
~~~,~'~~~~'il~'IlU!Il~'I'"
;8l~mliiflfl1j',n'"hA~
~UIl~tj'~,U1V111J ~),btJ
1m 3 t~'ill.! lj~{m~m
~ ~~ Blood Clolesterol
l'ycerides 164 mg/dl
~l.htJhil'11u~~nlj'fu
~~1~nl1t'!lnfi111~nl ~
~l.htf~n,r~ ~o;l.1fo;
Wl1')::-;6~tn r~1~U't!n11
l~n U~U1l1i1~'llr;,'fi'f)U
ln1:ri'nln~~ l.1;n", l.1i:l
lie E=4 V=5 M=4, pupil
::ye ~~ilJ~.JT~~Vl 185/
f~1W1~ !l~l1mnn~19
11~~1'll!J~ ";lmllJ,o!ilJ
~~G11fi1119~~u1vHh
Ifl~Y<U Infiltration At left
lalion At left lower lobe
fiI~fl~ (CT scan Brain)
19lior.ic Infraction no
bU~~{if.l1iJ""t1Y1'I-.'l nl d
It ' ... .... ...
ru l~ Lfjt!.:JW'f) L"..J't"l"'1 nlJ
!~l'l11.1~;;1'l~
'Innl';'l~dJfl'J l:tl ~'W1'kI
1-' ... .... ~
1~1"1-!i'l1''ilUUV<~·'! ,"!l~
:~1I11lm'l1,rl~191n'l1~
imui'lz1!Ji1"Nlfl
~bl':ul:m~I~1.ImtJl'1
~ d
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8, i'1~fl1~i1hfl1l1t;f'Ji'l'11~1t11m~~J,'~"
li;ju~'i~'1:tl191n{ll~ul~r,Jr1n~J,~~~'Clllol1~
9, UUUi,~,;rl1fUii1~~~~C1~,U~Ll."U~~
1C, l~tI..:lMfln'inn ~ lttJ'H;~Y,1J~eil.;J"1n ~~}nl
"ii1mM~fllf1'4 Lf>,~1JJ~~~
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12. y;j-r;~'14flPI'j'i1n"l~'B'1;'l;~::::«i1<1U .tit1~~,n
.J~ .... .J
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> 13, nl1ili~Iii'Cl~'il~1j",JnY<:'N'~'Cl191ml~~i!ll
1~1n~iJt!'d
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- ..1"1'1'in!
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v ~ •
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... ""..... , ...... .. "" ~I 1 ~
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t':h!lM'1l~~ncm~.,yj~mY<turn!J~~t'!l~!J]ltJ~ 1d11.l
... " , ' "
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.... " ""''' w ...... ~I '"'
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lMl.Jn1nh~,ill.!mnlnU~!ll.!I.tJl~"I~'.MiJm;um'll
mh~!1l.!vi~~ii91nii~~~m'i ~U1!JlllJl~n~lJ~111n1~
Lfi1!Jnlj'yhrnU111Y'L'nrlil"'lJfW'l~1J,,~~lMUn1j"'lh!;
lViflil'l.ln1~h.J~~.illY!~ln'bll&i~lf'l~~f?J Llfi~,,'jf..lfi"'~~ ~-L1'1U
flll-j11n ,~,;l:1i~i1tJt:J.V111l'lIJ1.1 lr ~~u'ii.lol"jY<11M r
vnll'lJ fl'lJlmiw~ltJn~UU11Jli1fml.r'1J 11 <j'l.!u,t;~1~
fUnl]tr"U"t1~~l 2 iu"n1~1l~!Jnt'Ii 2 d11.lT'I'11-!~'tl~
.~'tl!il~~fl~'CC~'1n~..~'tl~ ~illfll;,Jln~ij'!.I1·~V)'W-rl'lrl'Cl'W
J"JllNYi!.l"lU'"HN 31.6 Uft!::Ofllw11ti:ill'1Jru::fin~1~Yl'",!,W
~"1.... ~ ~ _4 ~ '1""Ile!,~ ~,:,~t1"1'llnTlm1.l~tJle!~L ~lJ~" '1Jl,",~lJl~1 N
d '1»" ~ • •.1 ~
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1-!1!l19lu.,mn ~ <j'1J~U1U9~~Il-j1j'ml1'1i'1l'i1u~l~t,9
1""1....... '" ~ «;l
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