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Cerebral Hemorrhage and Hypertension PDF

   

Added on  2021-05-31

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Running header: CEREBRAL HEMORRHAGE AND HYPERTENSION 1Cerebral hemorrhage and hypertensionStudent’s nameInstitutionalA.Background

Running header: CEREBRAL HEMORRHAGE AND HYPERTENSION 2Case presentationMr. X a 60 year old male driver from Australia, married and having six children the youngest being twenty years old, retired driver (was a driver) and cigarette smoker was admitted to the nursing unit from his physician’s office. He was diagnosed with cerebral hemorrhage and hypertension. He complained of a severe headache, nausea and vomiting, weakness on the arm and the leg, trouble with vision and swallowing. Three months ago he was treated with hypertension, with a blood pressure of 170/100 and a reduced urine creatinine removal. He complained of headache and blurred vision. He was recommended three months therapy which included diet restriction such as avoidance of food with high cholesterol did not show a response to the blood pressure elevation. His medical history showed that he had not been complying withreduced sodium, cholesterol diet and medication that were prescribed to him. His social history showed that he has been an alcohol addict and smoked five cigarette per day. An emergent non-contrast head computed tomography showed a left frontal cerebral hemorrhage.Signs and symptomsMr. X was admitted to the hospital complaining of the following sign and symptoms-Severe headache-Nausea and vomiting -Weakness on the arm and leg-Trouble with vision and swallowingPhysical exam

Running header: CEREBRAL HEMORRHAGE AND HYPERTENSION 3The client was examined and his vital signs were as follows. Temperature of 36.9, blood pressureof 155/133 mmHg, pulse 69, respiratory rate of 20 and oxygen saturation of 94 %. Both lungs were clear during bilateral auscultation. The client had a normal heart rate with a regular S1 and S2. There was no murmurs and the abdomen was soft with normal bowel sounds. In the peripheral areas there was no sign of edema. Glasgow coma scale was done and the result was a fifteen. He had a best eye response (E4), he was oriented to date and place (V5). He had a fluent speech, his eye were reactive to light bilaterally.Medical historyMr. X was diagnosed with hypertension three months ago and he was given the following drugs. Diuretics example hydrochlorothiazide so as to reduce the blood volume and cardiac output. Adrenergic agents’ example clonidine hydrochloride which affects the central nervous system leading to a reduction in blood pressure. Vasodilator example hydralazine hydrochloride which reduces resistance in the periphery.Diagnostic test resultsPatient Control White blood cell9.74-11Hemoglobin 10.411.5-15.5Platelets 231150-450Creatinine2.340.5-1.2mg/dlBlood urea nitrogen546-20 mg/dlPotassium 4.43.5-5.5 mmol/lAlbumin 3.4/7.2

Running header: CEREBRAL HEMORRHAGE AND HYPERTENSION 4Alanine aminotransferase/ Asparate aminotransferase19/34Up to 33U/LBilirubin 0.39Up to 1.1 mg/dlblood glucose199pH 7.46partial pressure of carbon dioxide30-4Bicarbonate 19.5 Medication -Albumin, IV dose: 100u-Hydrocortisone, IV dose: 50mg-Cloxascillin, IV dose: 19m-Phenytoin, IV dose: 100mg- Levophed IV dose PathophysiologyBrain hemorrhage is defined as bleeding around the brain, it is either caused by raptured aneurysm also known as hemorrhagic stroke or head trauma. Brain hemorrhage is divided into two types, extra-axial hemorrhage meaning outside the brain tissue and intra-axial hemorrhage which is within the brain tissue. Extra-axial bleeding is also known as intracranial bleeding, this is the bleeding within the skull. Examples of the extra-axial bleeding include the epidural,

Running header: CEREBRAL HEMORRHAGE AND HYPERTENSION 5subdural and subarachnoid. Intra-axial hemorrhage include the intracerebral hemorrhage and intraventricular hemorrhage. Extra-axial hemorrhage is bleeding that occurs within the skull but outside the brain tissue. An epidural hemorrhage is a hemorrhage that occurs between the skull and the dura membrane. It’s often as a result of trauma to the head. The bleeding that occurs between the dura and the skull isoften from the middle meningeal artery. Clinical manifestation include altered consciousness, headache, vomiting, confusion and aphagia. Subdural hemorrhage is the hemorrhage that occurs below the dura matter. The hemorrhage occurs between the dura matter and the sub-arachnoid membrane. The source of blood is often from the bridging veins. Clinical manifestation of subdural hemorrhage are the same are those occurring in epidural hemorrhage. The final type of extra-axial hemorrhage is the subarachnoid. The bleeding occurs mostly in the subarachnoid space. It is often as a result of the cerebral artery specifically an aneurism within the artery. The most common cause, is a rapture of a saculam type of an aneurism which leads to subarachnoid hemorrhage. The clinical manifestation are the same as those mentioned above except that in subarachnoid hemorrhage there is a sudden severe headache, loss of consciousness and meningismus. Causes of epidural hematoma include head trauma such motor vehicle accident, falls and assault. Intracerebral hemorrhage is divided into two, lobam hemorrhage which is the hemorrhage that occurs on specific lobes in the brain, thalamic hemorrhage which is the hemorrhage that occurs in the thalamus pontine hemorrhage which is the hemorrhage that occurs in the pons and lastly cerebellar hemorrhage which occurs in the cerebellar. Intracerebral hemorrhage is the most common cause of stroke.

Running header: CEREBRAL HEMORRHAGE AND HYPERTENSION 6Cerebral atherosclerosis leads to a condition known as hypertension which is defined as a systolic blood pressure of more than 140mmHg and a diastolic pressure of more than 90mmHg over a long period of time. Cerebral atherosclerosis is caused by several factors. First, high levelsof triglycerides and cholesterol in the blood which destroys the endothelium. Second, high blood pressure which is caused by two forces the first is the pressure created by the heart as it pumps blood and the other is resistance in the arteries during blood flow. The harder it is for the blood to flow, the higher the blood pressure. This rapid increase of blood pressure damages the arteries.The third and the last is cigarette smoking. Tobacco particles exacerbate atherosclerosis in the following ways, the tobacco smoke contains toxins which reduce high density lipoprotein while increasing the levels of low density lipoproteins. Carbon monoxide and nicotine found in cigarette smoke destroys the endothelium increasing the risk of plaque formation. Lastly is high blood pressure, smoking by a hypertensive person may increase the risk for malignant hypertension which is a life threatening form of high blood pressure. Atherosclerosis is characterized by fat deposit known as atheroma that infringe on the lumen of the large arteries in the brain. Macrophages which develop from T lymphocytes and monocytes infiltrate the area andeat away the lipids and then die. This causes the proliferation of the smooth muscle cell forming a dead fatty core. This plaque causes an obstruction in the blood flow due to narrowing.Tiny arteries take blood to deep areas in the brain. High blood pressure causes the rapture of the thin walled arteries releasing blood into the tissues. The clotted blood which is enclosed in the rigid skull causes the buildup of fluid which leads to an increase in pressure(Demchuk and Buchan, 2014). The created pressure can compress the brain against the bone or cause a herniation. The distributed blood in the tissue causes a decrease in blood supply in the arteries

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