Cva

Aging, Hypertension, Transient Ischemic Attacks, Atherosclerosis, Cardiac Conditions

Cerebral hemorrhage Occlusion of major vessel byother causes of ischemia embolism

Cerebral Infarction

Decreased flow of blood to brain

Hypoxia

Cerebral edema Vascular congestion

Compression of tissue

Impaired function

Anterior cerebral artery

Middle cerebral artery

Posterior cerebral artery

Confusion Impaired thought process Contralateral paralysis/paresis Urinary incontinence Sensory deficits

Arm paralysis Hemianopia Aphasia Agnosia Perception deficits

Hemiparesis Ataxia Visual problems Dysphasia Dysphonia

Return of normal perfusion

Continued inadequate blood flow

Decreased edema

Further compression of tissues

Function improved

Cerebral death

The patient was admitted last July 25, 2009- 11:46AM to the Emergency Room of Quezon Medical Center under Dr. Luduvice attending to the chief complaint of left side body weakness. The following orders were given: please admit to Medical Ward, secure consent, soft diet with strict aspiration precaution, monitor vital signs every 4 hours Plain NSS 1Lx8x3 Plain cranial CT scan CBC, urinalysis, ECG, chest X-ray, lipid profile, crea, SGPT, FBS Citicoline 1gram IV every 12 hours Nifedipine 30mg. 1 tablet OD Captopril 25mg. 1tablet PO every 6 hours, hold for BP>140/90 Ranitidine 50mg. IVF every 8 hours Turn to side to side every 1 hour

NAME OF DRUG

ACTION

INDICATION

DOSAG E

ADVERSE REACTION

RANITIDINE HYDROCHLORIDE (antiulcerative)

Relieves G.I. discomfort.

•Duodenal cancer •Gastric ulcer •GERD

50mg IVF q8°

•Malaise •Vertigo •Blurred vision •Nausea •Vomiting •Jaundice •Rash

VIIT. C (vitamin)

Raise vitamin C level in body.

•Prevention of vit. C deficiency

500mg 1 cap OD

•Dizziness •Diarrhea •Acid urine

NURSING RESPONSIBILI TY

•Assess pts G.I. before giving drug. •Don’t use aluminum- based needles because drug is incompatible with aluminum. •Take drug with or without food. •Remind pt. •When giving for taking drug once urine daily to take it at acidification, bedtime. check urine pH to ensure effectiveness. •Give PO solution directly into mouth.

NAME OF DRUG

ACTION

INDICATION

DOSAG E

ADVERSE REACTION

NICARDIPINE HYDROCHLORIDE (antianginal), ADALAT GTTS (antianginal)

It inhibits the flow of calcium through muscle cells which dilates coronary arteries and decrease systematic vascular resistance known as after load.

•Effort-induced angina. •Pringmetal angina

10g+90c c PNSS in solucet to run for 10-15 gtts/min PRN

•Bradycardia •Confusion •Constipation •Depression •Diarrhea •Dizziness •Dyspepsia •Edema •Fatigue •Flushing •Headache •Hypotension •Insomnia

PARACETAMOL (analgesic)

Relieves pain and reduces fever.

•Mild pain or fever.

500 mg 1 tab PRN

•Hemolytic anemia •Liver damage •Jaundice •Hypoglycemia •Rash •Urticaria

NURSING RESPONSIBILI TY •Monitor VS every 5-15 mins. •Monitor drug’s effectiveness . •Observe pt. for adverse reaction such as allergic reactions, rash, etc. •Caution pt. about the dangers of using nitrates. •Have pt. lie or sit down when taking the first dose of nitrate. •Asses for pt’s pain or temperature before giving the medication. •Tell pt. is for short-term use only. •Give liquid form to children. •Long-term use can cause liver

NAME OF DRUG

ACTION

INDICATION

CAPTOPRIL (antihypertensiv e)

Reduces sodium and water retension. Lowers blood pressure.

•Hypertension •Heart failure

DEXAMETHASONE (antiinflammator y)

Relieves cerebral edema.

•Cerebral edema •Shock •Supression

DOSAG E

ADVERSE REACTION

NURSING RESPONSIBILI TY

25mg 1 tab PO q6° hold for BP 140/90 mmHg

•Dizziness •Fainting •Fever •Angina pectoris •Anorexia •Tachycardia •Hyperkalemia •Cough •Renal impairment

4mg/tab 1 tab PO q6°

•Seizure •Headache •Vertigo •Edema •Hypertension •Cataracts •Hypokalemia •Muscle weakness

•If pt. has dry, productive cough, watch out for renal impairment. •Take drug 1hr. before meal because it decreases absorption. •Monitor BP and PR often. •Monitor renal function and potassium level. •Inform pt. that •Give with food light-headedness when possible. may occur. •Always adjust to lowest effective dose. •Warn pt. about easy bruising. •Tell pt. not to abruptly stop taking the drug because this may be fatal. •Give pt. low

NAME OF DRUG

ACTION

INDICATION

DOSAG E

ADVERSE REACTION

NURSING RESPONSIBILI TY

MANNITOL (diuretic)

Decreases intracranial pressure.

•To reduce intraocular/intra cranial pressure.

20% 125cc IV q4°

• confusion •Seizures •Headache •Heart failure •Circulatory overload •Blurred vision •Thirst •Nausea •Diarrhea •Water intoxication

•Monitor VS hourly. •Administration: slow push to prevent crystallization. •If pt’s oliguria increases, notify prescriber. •Increase fluid intake, it may cause dryness of mouth.

CEFUROXIME (antibiotic)

Hinders or kills susceptible bacteria.

•LRTI •UTI •Acute bronchitis

750mg IV

•Headache •Malaise •Nausea •Vomiting •Pruritis •Dyspnea •Anaphylaxis

•Assess pt’s infection before giving the medication. •If G.I. reaction occur, monitor hydration. •Ask pt. about previous reaction to penicillin. •Tell pt. to report adverse reaction.

NAME OF DRUG

ACTION

INDICATION

DOSAG E

ADVERSE REACTION

NIFEDIPINE (antianginal)

Reduces BP and prevents angina.

•Vasopastic angina •Hypertension

30 mg 1 tab OD

•Dizziness •Headache •Heart failure •Nasal congestion •Nausea •Hypokalemia •Muscle cramps

PHENYTOIN (anticonvulsant)

Prevents and stops seizure activity

•To prevent and treat seizures during neurosurgery.

125mg/5 ml 4 ml q8°

•Dizziness •Confusion •Hypotension •Blurred vision •Nausea •Vomiting •Hyperglycemia •Osteomalacia

NURSING RESPONSIBILI TY •Monitor potassium level regularly. •Monitor BP regularly. •Don’t use nifedipine sublingually to rapidly reduce severely high blood pressure. •Don’t give drug with a high-fat meal or grape products. •fruit Check BP during •Instruct pt. to administration. •swallow drug If rash appears, whole, do not stop giving the crush or chew. drug. •Inform pts that drug may color urine pink, red or brown. •Do not abruptly stop giving the drug. •Advise pt. not to

NAME OF DRUG

ACTION

INDICATION

DOSAG E

ADVERSE REACTION

NURSING RESPONSIBILI TY •Assess pts G.I. before giving drug. •Don’t use aluminum- based needles because drug is incompatible with aluminum. •Take drug with or without food. •Remind pt. taking drug once daily to take it at •bedtime. When giving for urine acidification, check urine pH to ensure effectiveness. •Give PO solution directly into mouth.

RANITIDINE HYDROCHLORIDE (antiulcerative)

Relieves G.I. discomfort.

•Duodenal cancer •Gastric ulcer •GERD

50mg IVF q8°

•Malaise •Vertigo •Blurred vision •Nausea •Vomiting •Jaundice •Rash

VIIT. C (vitamin)

Raise vitamin C level in body.

•Prevention of vit. C deficiency

500mg 1 cap OD

•Dizziness •Diarrhea •Acid urine