Case Study: Brian Fuller - Ischemic CVA, Nursing Assessment and Care

This nursing report presents a detailed case study of Brian Fuller, a 78-year-old man diagnosed with Ischemic CVA. The report begins with an introduction to the case, outlining the patient's history, presenting symptoms such as facial drooping and speech difficulties, and initial vital signs. It then delves into the causes of Brian's CVA, highlighting hypertension, hypercholesterolemia, T2DM, and other pre-existing conditions as significant risk factors. The report explores the pathophysiology of Ischemic CVA, including the mechanisms of arterial blockage and the impact of atherosclerosis. Furthermore, it discusses the signs and symptoms Brian experienced, including dysphasia and left-sided hemiplegia. The report also covers the medications prescribed, such as diuretics, Alteplase, and anticoagulants like Heparin and Warfarin, along with their administration and potential side effects. Finally, it addresses Brian's discharge medications and the first-pass effects, providing a comprehensive overview of his care and treatment plan.

Nursing

Table of Contents
INTRODUCTION...........................................................................................................................1
Cause of Brian’s CVA.....................................................................................................................1
Overview of the case..............................................................................................................1
Factors and sign symptoms..............................................................................................................3
The risk factor which lead to CVA.........................................................................................3
Signs and symptoms which has result of CVA to Brian........................................................3
Medication for the disease from which the patient is suffering.............................................3
Administration of Brian’s discharge medication as first pass effects....................................5
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................8

INTRODUCTION
Nursing have been considered which lies as fundamental respect in term of the human
dignity along with institution of the patients’ needs which is tends to be followed to the rigorous
core learning. This have the continuous level of responsibility for encouraging the health of in
medical and community settings Ahmed, N. (2010). Ischaemic CVA is the haemorrhagic stroke
have the occurrence as the situation when the bleeding in the brains happens die to break in
blood vessels. In this report, the case of the Brian will be discussed regarding the reason, risk
factor which have increase the risk of the CVA.
Cause of Brian’s CVA
Overview of the case
Over view of the case study as the Brian fuller is the 78-year-old man living with his wife
have noticed that’s the left side of face is drooping along with weakening of the left side body.
He has failed to speaks properly and feel on the floor. As per the arrival in the hospital it has
been diagnosed as Brian have a BP of 190/91, HR 115, RR 24, SaO2 95% on room air and a
temperature of 37.2. where he has later on diagnosed with ischaemic CVA.
Ischaemic CVA is the haemorrhagic stroke have the occurrence as the situation when the
bleeding in the brains happens die to break in blood vessels. As the risk factor for the stroke is
the about the uncontrolled level of hypertensions, history if brans aneurysm, old ages as the
aging of blood vessels.
Rationale for the selection of the reason for the Brian issues
As per the per past medical history, it has been stated that’s the brain was suffering the varied
level of Hypertension, Hyper cholesterolaemia, T2DM, AF, GORD and Cholecystectomy 5
years ago. The circulatory cognition is the major level of risk for the ischemic stroke which can
be such as the high blood issue, atherosclerosis. high cholesterols and more prior to attacks
Martín‐Merino and et.al., (2011). As per in the case their ischemic stroke and hypertensions is
the considered to be the major cause of this type of the strokes. As per the past medical history
brain was suffering from the hypertensions as during this situation where the transit blood
pressure tends to have risen about their 50 % of the ischemic strokes and also increases the risk
of haemorrhagic stroke. As this reason have been selected as their major cause of the Brian
Ischaemic CVA have been to the due to the strain hypertensions which have placed all the blood
vessels of brain to the weaken situations and the predisposes them to the respective damage.
1

This makes the hart to work harder in order to make their heart keep circulation. This have been
the major reason for the blood vessel to have the blocking and turned out to be the important
causes ischemic stroke and hypertension is the most important cause of this type of stroke and
also transient ischemic attacks.
Pathophysiological perspective for the ischemic CVA
As per the pathophysiological perspective have the implicates there most important cases as the
implication in is implicated in haemorrhagic strokes when a blood vessel in the brain bursts and
blood leaks into the brain Karimi, M and et.al., (2010). As pathophysiology for the CVA in brain
have the affect level of artery (thrombosis) which ever is the calot which is travelled form
another part of the body have the gets lodged in the blood vessels of the brain. As the blockage in
the single artery can be manages or more often being compensates by other arteries which are
known as there call collaterals. As per the pathophysiological perspective the damage that’s is
the diene bey the hypertension have the apprising offer over large times which can be only bee
reasoned when the adage in already have the happened body blood vessels.
In the case of Brian Atherosclerosis (hardening of the arteries) along with damage of the other
arteries can have the leading to the Arteriovenous malformations (AVMs) by forming the
abnormal way of tangles in the blood vessels which flow directly into the vein and directly
have the been the another cause of the ischemic stroke.
Pathogenesis of CVA as per the past medical history.
As the pathogenesis is been discussed regarding the case of the brain can be such as there is the
relationship between the obstruction of the internal carotid arteries in the neck and
cerebrovascular disease. In order to that’s it is further suggested that thrombotic debris were
responsible for the event Jager, N. G and et.al., (2014). On the other hand, there is the vascular
level of pathology which is underlying to under the lacunar infracts. In addition to the past
medical history. it can be stated as the brain was suffering for the Hypercholesterolaemia which
is the excess level of cholesterol in human body which increases the risk of the of
cerebrovascular disease, including ischemic stroke. There was the level of suffering of brains
such as T2DM is the age life have the helped in increase the cardio vascular disease in perfect
manner as over; it effects the 36% of all predoom who race suffering form CVA.
2

Factors and sign symptoms
The risk factor which lead to CVA.
As the consideration to the brain medical past history, it can be celery stated that’s the Brian
have the several other issues other than hypertension such as the Hypercholesterolaemia and
T2DM is the age life. Bad level of blood cholesterol level which can have the lead to have the
coronary artery diseases and the noncardinal infractions which can make there damaging the
heart muscles (myocardium) which have they might increase the risk of stroke.
As the risk factor which have the elevated, the high level of types of diabetes in which the
quarter of people have the die from the stroke Festus, O and et.al., (2013). The presence of the
diabetes makes the proper level of doubling of the risk of strokes which is due to the damaging
of the vessels in the increased order of CVA. Hence the people from the CVA make the people
with diabetes are likely to have the four times higher risk in order to have the carotid artery
diseases.
Signs and symptoms which has result of CVA to Brian
From the study of Brain it is identified that while shaving he noted that his left side of face was
drooping and when he tried to speak and shout for help from his wife then that time he found that
he cannot speak properly. So, main 2 symptoms which identified was:
Dysphasia: It is the main symptom in which Brian was facing problem in speaking properly and
expressing what he wants to express and speak. It may become severe if it lasts for longer period
so, it is important to suggest appropriate medicines for solving this problem at initial stage.
Left sided hemiplegic: Other main symptoms which Brian had faced at the time of CVA was
left sided hemiplegic which means half of the body of the patient paralysed and patient face
problems in moving that side of body parts. It happens because of brain damage Delcroix & et.al.
(2016).
In this context, it can be said that these problems may occur again if it is not treated again and
after treatment also it may occur if patient does not take care and because of stress
Medication for the disease from which the patient is suffering
It is stated that Brain, who is 78 year old is facing from ischemic stroke which is known as brain
stroke. It happens when damaged cerebral arteries become blocked by the formation of blood
3

clot within the brain Sommer, (2017). There may be several causes of brain stroke. But it is
important to suggest effective medication for improving health of the patient at initial stage and
for that it is also important to identify some factors and causes by analysed his heart rate, blood
pressure and others rates. On that day, when Brian fall down, His measured BP was 190/91 and
heart rate was 115. From these rates it can clearly be said that it ischemic stroke in the patient
was because of hypertension. In this situation hypertensive urgency is suggested and bring
patient’s blood pressure down as soon as possible. Uncontrolled and high blood pressure can
cause chronic damage to arteries so, medications can be suggested as per the cause of the disease
which is hypertension Blood Pressure which Indicates Hypertensive Crisis, (2019).
Diuretics: It is one of the best and the most recommended medicine to patient with 190/91
as it can help Brian to rid the body of sodium in order to control blood pressure and damages to
organs as well.
Alteplase: It is one of the best and approved drugs in acute ischemic stroke (AIS). One of the
main reasons of suggesting this Pharmacokinetics of alteplase is functional recovery. At the time
of acute myocardial infarction (AMI), cardiac function, hepatic perfusion and clearance of
alteplase may be impaired. Recommendations of dosage to the patients are all depend upon the
size of clot and intensity of the disease Pharmacokinetics of Alteplase in the Treatment of
Ischemic Stroke, (2012).
After administering patient for 30 minutes after hospitalization and measuring all rates dosage of
TPA can be suggested. As the age of the patient is 78 so 100mg as per his age as total dosage and
15 mg IV bolus accordingly suggested.
Adverse effect or contraindications: There are some common side effects of this medicine.
Sometimes it may lead some severe side effects as well which include: significant bleeding into
the brain. Abnormal heartbeats, pulmonary embolism and allergic reactions are some severe side
effects which this medicine may cause. These all are some severe side effects but some other
common side effects of TPA include: vomiting and nausea.
Some anticoagulants drugs which include:
Heparin: It is a drug which is being suggested and given for blood thinning by needle at the
hospital. It is mainly given after stroke in order to prevent clotting and also for preventing
patients from new formation of clotting.
4

Warfarin: It is other pill which can be taken for the long run for blood thinning and preventing
patient from blood clotting. While taking this drug it is important to take extra care and be aware
that some foods can interfere with its absorption.
Side effects: As like Alteplase, Warfarin can also become treason of severe bleeding, vomiting,
severe headache and others are some side effects.
Administration of Brian’s discharge medication as first pass effects
First pass effects is a phenomenon of drug metabolism where concentration of drug is
administered orally. It plays an important role as because of first pass effects, body of the patient
receives less of drug which they actually take. But it is stated that some drugs which patients take
orally are lost as it passes through the gastrointestinal system. In this only some proportion of
drug can reaches the circulation Kang & et.al. (2020). From Brian’s discharge some medications
as first pass effects are being identified which include:
Apixaban 5 mg PO daily: This is one of the most common dose and medicine to patients with
brain stroke and chances of this. It is also suggested to patients of age above 70.
Simvastatin 40 mg PO daily: It is other main disease which is being recommended to the
patient or Brain in order to reduce risks of heart attack, heart diseases and brain stroke. Initial or
starting dosage is 10-20mg per day. But it may range from 5-40 as per the nature and intensity of
disease.
Amlodipine 10 mg PO daily: It is other medicine which is being recommended to Brian for
preventing him from chest pain. Dose of this medicine can be adjusted as per the effects of it
after analysis.
CONCLUSION
From the above case of Brian it has been summarized that brain stroke is one of the main
problem which may cause death and other severe problems. It is important to prevent patient at
initial stage by analysing and determining all problems and history of the patient in an effective
manner. Further, it has shown importance of medications such as: Heparin, Altepalse and others.
It prevents patient against blood clotting and forming of new blood clotting. Further, this study
5

has shown some causes of CVA or ischemic stroke along with some signs and symptoms which
results of CVA.
6

REFERENCES
Books & Journal
Ahmed, N. (2010). Frequency of ischaemic heart disease and stroke in hypertension. JPMA. The
Journal of the Pakistan Medical Association, 60(4), 297.
Delcroix, F. & et.al. (2016). A predominantly left-sided skin reaction to pristinamycin in a
patient with right hemiplegia. JAAD case reports. 2(1). 84.
Festus, O and et.al., (2013). Serum Lipid Profile in Nigerian Patients with Ischaemic
Cerebrovascular Accident. Current Research Journal of Biological Sciences, 5(3). 123-125.
Jager, N. G and et.al., (2014). Cerebrovascular events during nilotinib treatment. Neth J Med,
72(2). 113-4.
Kang, D. H. & et.al. (2020). Effects of first pass recanalization on outcomes of contact aspiration
thrombectomy. Journal of NeuroInterventional Surgery. 12(5). 466-470.
Karimi, M and et.al., (2010). Magnetic resonance imaging to determine the incidence of brain
ischaemia in patients with β-thalassaemia intermedia. Thrombosis and haemostasis, 103(05),
989-993.
Martín‐Merino, E and et.al., (2011). Hospitalised ischaemic cerebrovascular accident and risk
factors in a primary care database. pharmacoepidemiology and drug safety, 20(10). 1050-1056.
Sommer, C. J. (2017). Ischemic stroke: experimental models and reality. Acta
neuropathologica. 133(2). 245-261.
Online
Blood Pressure which Indicates Hypertensive Crisis. 2019. [Online]. Available through
<https://mymedicalscore.com/blood-pressure/190-91/>
Pharmacokinetics of Alteplase in the Treatment of Ischemic Stroke. 2012. [Online]. Available
through <sshttps://pubmed.ncbi.nlm.nih.gov/22248305/>

1