Labs:
T2DM:
HBA1c-8.5
HTN: 145/96
Wt. 108kg
Meds:
T2DM: Metformin
1000mg bid,
HTN: lisinoprilhydrochlorothiazid
e 20mg/25mg qd,
and
HDL: atorvastatin
40mg qhs. NKDA.
Mr. Cepeda is admitted with sudden onset of facial droop, slurred speech, and
right sided weakness
Outcomes:
1. Pt will teach back 3 exercises
to promote condition.
2. Pt will have resources
available to use appropriately
3. Pt. will perform self-care
activities within level of own
ability
Med Hx: T2DM dx 2013, HTN dx 2007, and HLD dx 2011. No recent
hospitalizations Surg Hx: None Family Hx: Father deceased at 65yo from
ischemic heart disease; 45yo brother HTN. Social Hx: Tobacco use ½ PPD for 35
years. Alcohol use 4-6 six beers every Friday night. Bus driver for DOE. No
regular physical activity for many years. Does not follow any special diet.
DX: Ischemic Cerebrovascular Accident (CVA)
Obstructed arterial blood flow and oxygen to the brain due to thrombus formation
or hypoperfusion related to decreased blood volume or heart failure.
Epidemiology:
Every year, more than 795,000 people
in the United States have a stroke.
About 610,000 of these are first or
new strokes. About 185,000 strokes—
nearly 1 in 4—are in people who have
had a previous stroke. About 87% of
all strokes are ischemic strokes, in
which blood flow to the brain is
blocked.
Risk Factors: High BP, Heart Disease,
Smoking, Diabetes, Obesity,
Overconsumption of alcohol, gender,
genetics
Prevention:
Exercise, decrease or stop smoking,
limit alcohol intake, bp maintenance
meds
Etiology: Mr.C has T2DM, HTN,
Obesity, smoking history, HLD which
will damage blood vessels and
increase the chances of stroke that
will lead to CVA.
Physical inactivity
Increased Weight
Tobacco Usage
Nursing Dx: Self-care
deficit r/t Neuromuscular
impairment as evidenced
by Extremity weakness
Nursing Mgmt: 1. Assist
but promote
independence 2. Positive
feedback. 3. Provide selfhelp devices
Activation of RAAS
Nicotine
S/S: Right sided facial
sensation is decreased to
pinprick, R sided facial droop,
Gag reflex absent, Uvula
deviation to the left Right
Upper Extremities 0/5; Right
Lower Extremities 2/5
Obesity
Vasoconstriction
Increased RBP4, Lipolysis,
IL-6, Leptin and decreased
Adiponectin
Increase
Cardiac Output
Increased BP
Clot Formation
Clot Travels
Increased Resistin
S/S:
Polyuria and
Polydipsia
Decrease Insulin Secretion
Hyperglycemia
Hypertension
Labs: Blood
Glucose - 102
Nursing Dx: Impaired verbal
Communication r/t
neuromuscular impairment and
loss of oral muscle tone as
evidenced by dysarthria
Nursing Mgmt:1. Ask the patient
to follow simple commands,
repeat simple words or
sentences. 2. Point to objects
and name them. 3. Promote
communication
Occlusion of the left
internal carotid artery
Glomerular Damage
BUN: 20
Perfusion
images showed
a large region of
hypoperfusion
of the left MCA
territory
Neurological
damage
S/S: bruit in left
carotid artery