Case Study: Cerebrovascular Accident (CVA) - Nursing and Medical

This case study analyzes a Cerebrovascular Accident (CVA), also known as a stroke, focusing on a 62-year-old male patient with a history of hypertension and hyperlipidemia. The study details the patient's clinical presentation, including right-sided weakness, aphasia, and facial droop. It explores both general and specific clinical manifestations of CVA, differentiating between right and left-sided strokes. The pathophysiology is explained, detailing the process of clot formation and its impact on blood flow to the brain, leading to hypoxia and necrosis. The medical management section covers pharmacological interventions like platelet-inhibiting medications, thrombolytic therapy, and anticoagulation therapy, along with the management of increased intracranial pressure and neurological assessments. Nursing management, including assessment, diagnosis, planning, interventions, and evaluation, is thoroughly addressed. The nursing interventions focus on emotional care, medication management, physiological monitoring, patient positioning, and exercise programs, while the evaluation section outlines expected patient outcomes, such as improved mobility, safe swallowing, and standard sensory perceptions.

CASE STUDY ON- CEREBROVASCULAR ACCIDENT (CVA)

Cerebrovascular accident (CVA)
 Cerebrovascular accident (CVA) is a health term for stroke.
 It occurs due to clot formation in the brain hence not allowing blood flow to the
brain (Khan et al., 2019). This poor blood flow in the brain results in cell death.
 In this case study, the patient was suffering from mild expressive aphasia and right
facial droop indicating that the patient was suffering from right sided
cerebrovascular accident.

Clinical manifestation of CVA
 General clinical manifestation include (Dumanskyi et al,. 2018):
1. Visual disturbance
2. Loss of balance
3. Difficulty in walking
4. Headache
5. Confusion in medical state

Specific manifestation based on case study
In the case study, the patient was suffering from Right sided Cerebrovascular
Accident. The Specific clinical manifestation for right CVA include (Dumanskyi et
al,. 2018):
1. Left sided inclined weakness
2. Left visual deficit
3. Difficulty with spatial-perceptual relationship.
4. Left neglect
5. Right facial droop

Pathophysiology of CVA
The thrombus
might travel in
the left atrial
attachment
initiating no
real worry or,
The clot is
travelled by the
blood flow
through the
arteries
This clot will
possibly block
the cerebral
artery carrying
blood to the
brain
Diminution of
the blood flow
in the brain
causing
hypoxia
Eventually
leading to
necrosis
(demise of the
tissue)

Medical management
 Medical management of Cerebrovascular accidents include (Abiodun, 2018):
1. Platelet-inhibiting medications- It includes aspirin, dipyridamole, clopidogrel
and ticlopidine.
2. Thrombolytic therapy- Recombinant t-PA is used.
3. Anti-coagulation therapy- Coumadin is used.
4. Increased intracranial pressure (ICP) management
5. Neurological assessment.

Nursing management
 Assessment (Silas & Sanchez, 2018)
i. Assessment of conscious level based on movement, stimulation and position
ii. Assessing the presence or absence of both voluntary and involuntary
movement.
iii. Document any change of vision
iv. Assess function such as speech, pupil size, and stool
 Diagnosis
I. Distressed sensory perception
II. Acute pain
III. Reduced physical mobility related to brain injury and loss of balance

Planning and goals
The nursing planning and goals compromises of following strategy (Silas & Sanchez,
2018):
 Maintaining steady body functions
 Minimizing difficulties of stroke
 Increasing communication abilities
 Adequate nutrition maintenance
 Achieve maximum physical working
 Educate patients

Nursing interventions
 Nursing care interventions will include (Buijck & Ribbers, 2018):
I. Emotional care
II. Medication management
III. Observing physiological functions
IV. Proper assessment of thrombolytic therapy
V. Proper positioning of the patient in bed
VI. Monitoring self care actions
VII. Starting an exercise program routine

Evaluation
The expected patient outcomes are (Khan et al., 2019):
 Self-care achievement with hygiene care
 Improved mobility achieved
 Safe swallowing of food
 Attains standard bowel and bladder exclusion
 No pain complaint
 Displays vibrant thought process
 Validate standard sensory perceptions

References
 Abiodun, A. (2018). Stroke (Cerebrovascular Accident (CVA) or Brain Attack)
and Its Management-Literature Review.
 Acasio Silas, S., & Avila Sánchez, M. (2018). Nursing home intervention strategy
to improve the quality of life for patients with cerebral vascular
accident, and their caregivers. Revista Cubana de Tecnología de la
Salud, 9(1), 15-24.
 Buijck, B., & Ribbers, G. (Eds.). (2018). The Challenges of Nursing Stroke
Management in Rehabilitation Centres. Springer.
 Dumanskyi, Y. V., Stoliarova, O. Y., Syniachenko, O. V., Yehudina, Y. D., &
Stepko, F. A. (2018). Brain metastasis as a primary
manifestation of underlying disease.
INTERNATIONAL NEUROLOGICAL JOURNAL,
(4.98), 96-100.
 Khan, S. A., Khan, N. J., Langrial, I. F., Ashraf, S., & Imtiaz, I. (2019).
ISCHEMIC STROKE. The Professional