Asian College of Technology International Education Foundation

College of Nursing and Allied Programs

Cor. Leon Kilat and P. Del Rosario Street, Cebu City, Philippines

A Case Study on
“A 70-year-old female with ischemic stroke”

Bachelor of Science
In Nursing
S.Y. 2024 - 2025

Submitted by:
Group 9

Baquiller, Leo Bern Macayan, Claire Jane

Cabrera, Hannah Mae Pareja, Jan Keenan Seth
Daguisonan, Princess Carmie Salonoy, Margie
Fedillaga, John Richer Tabares, Enelyn
Labrador, AJ Marycris

Submitted to:

Ms. Marice Romero

 TABLE OF CONTENTS

I. Nursing Assessment
a. Patient’s Profile
b. History of Present and Past illnesses
c. Genogram/Family History
d. Physical Examination
e. Review of the System

II. Introduction of the Case

III. Diagnostic and Laboratory Procedure
a. Short definition of the procedure
b. Results, normal values, and impression
c. Nursing responsibilities of each procedure

IV. Anatomy and Physiology

V. Pathophysiology
VI. Drug Study
VII. Nursing Care Plan
VIII. Conclusion
IX. References
TITLE: Schizophrenia
SHORT DESCRIPTION: Ischemic stroke is a medical condition characterized by an interruption of blood
flow to a specific part of the brain due to a blocked artery, often caused by a blood clot. This blockage
deprives brain cells of oxygen and nutrients, leading to cell death and potential loss of function in affected
areas. Symptoms can include sudden weakness, numbness, speech difficulties, and vision problems.
Prompt treatment is crucial to restore blood flow and limit brain damage.
Nursing Assessment
a. Patient’s Profile

Last Name: Matugas

First Name: Mercedes
Middle Name: Mangega
Nickname: N/A
Date of Birth: February 14, 1954
Gender: Female
Marital Status: Widow
Language: Cebuano
Race: Asian-Filipino
Home Address: Lower Subangdaku, Mandaue
City: Cebu_
State: Visayas, Philippines
Zip Code: 6014

Responsible Party

Relation to Client: Sister

Last Name: Mangega
First Name: Rhea
Middle Name: N/A
Date of Birth: No data presented
Gender: Female
Home Address: Lower Subangdaku, Mandaue
City: Cebu
State: Visayas, Philippines
Zip Code: 6014
 b. History of Present Illness and Past Illnesses
Morning prior to admission, onset of chills associated with occasional cough. No dyspnea or
fever: condition treated. Hour prior to admission, patient noted to be aphasic with facial asymmetry
thus prompted consult at ER and subsequently admitted.

Past Illness: None

Medical: No history of significant medical procedure
Surgical: No history of any surgeries perform
Traumatic Injuries: No reported trauma.
Orthopedic: No anomalies found.
Other (Psychiatric, etc.): No further assistance needed.

c. Genogram/Family History

Father Mother Father Mother

Sister Father Mother

Hypertension

Brother
Mercedes Sister

79 70 60
Hypertension Ischemic Stroke Hypertension
DM Hypertension
CAP-C

d. Physical Examination
Respiratory: (+) cough
Nervous: (+) aphasia
Breast: (-) masses
Chest lungs: (+) crackles
 e. Review of the system

➢ Nervous System:

The patient denies chest pain, palpitations, or shortness of breath. No swelling in the legs is reported.
No known history of cardiovascular disease. Blood pressure and heart rate within normal limits during
the last visit.

➢ Respiratory System:

Aphasia is observed, indicating that the stroke has impacted her language abilities. Aphasia is
commonly associated with strokes in the left hemisphere, which often controls language functions..

➢ Cardiovascular System:

The patient’s hypertension is a significant risk factor for stroke and may have contributed to the recent
ischemic event. Ongoing monitoring and management of blood pressure are essential to reduce
further stroke risk.

➢ Gastrointestinal System:

No specific findings noted; however, given her age and stroke-related aphasia, assessment of
swallowing ability is recommended to prevent aspiration, particularly with her concurrent pneumonia.

➢ Genitourinary System:

Regular monitoring of urinary output and assessment for potential signs of infection or incontinence
are advised, as prolonged immobility may increase the risk of urinary complications.

➢ Musculoskeletal System:

Limited mobility post-stroke may increase the risk of muscle atrophy, contractures, and pressure
sores. Physical therapy and regular repositioning are advised to promote mobility and prevent
complications.
I. Introduction of the Case

Ischemic stroke is a serious and often life-threatening condition characterized by the sudden
interruption of blood flow to the brain, usually due to a blocked artery. This loss of blood supply deprives
brain cells of oxygen, causing cell death and often leading to significant neurological impairments. Strokes
are classified into ischemic and hemorrhagic types, with ischemic strokes accounting for approximately
87% of all cases. The causes of ischemic stroke are complex and typically include a combination of risk
factors such as hypertension, diabetes, and atherosclerosis. Advanced age, lifestyle factors, and pre-
existing health conditions also increase the likelihood of experiencing an ischemic stroke.

The mechanisms leading to ischemic stroke vary but commonly involve the formation of blood
clots that obstruct blood vessels in the brain, restricting blood flow. High blood pressure, or hypertension,
is one of the most significant risk factors, as it damages blood vessels over time, making them more
susceptible to blockages. Conditions such as atherosclerosis, in which plaque builds up in the arteries,
further contribute to the risk of a stroke. Additionally, conditions like atrial fibrillation increase stroke risk
by promoting clot formation within the heart, which can then travel to the brain.

Ischemic strokes can produce a range of neurological symptoms depending on the area of the
brain affected. Common symptoms include sudden weakness or numbness, especially on one side of
the body, difficulty speaking or understanding speech, and vision changes. In cases where the left
hemisphere of the brain is involved, patients may experience language impairments, known as aphasia,
as well as difficulties with right-sided motor functions. Prompt medical intervention is critical, as restoring
blood flow within a few hours can significantly reduce the risk of lasting disability.

In our patient's case, a 70-year-old woman named Mercedes, the ischemic stroke has affected
the left side of her brain, resulting in aphasia and right-sided weakness. Additionally, Mercedes has
community-acquired pneumonia (CAP-C), which presents with a persistent cough and lung crackles,
complicating her condition. Her hypertension, a key risk factor for stroke, underscores the need for vigilant
blood pressure management to reduce the risk of further ischemic events.

Mercedes’ presentation highlights the challenges of managing ischemic stroke in elderly patients
with multiple comorbidities. Her aphasia impacts her ability to communicate effectively, while her
pneumonia requires close respiratory monitoring. These conditions, coupled with her hypertension,
demand a multidisciplinary approach to stabilize her condition, address immediate health concerns, and
support her recovery.
II. Diagnostic and Laboratory Procedure

Complete Blood Count

Lab Result Normal Values

Hemoglobin 12.5 12.0 – 16.0
Hematocrit 36.6 36.0 – 48.0
RBC 4.36 4.20 – 5.40
WBC 9.25 4.80 – 10.80
Platelet 190 140 – 440
Neutrophil 76.3 50 – 70
Lymphocytes 13.7 20 – 40
Monocytes 6.5 3 – 12
Eosinophil 3.1 0.5 – 5
Basophil 0.4 0.0 – 10
MCV 84.1 78 – 95
MCH 28.6 26 – 32
MCHC 34.1 32 – 36
RDW 15.2 11 – 16

➢ Nursing Responsibilities before and after the laboratory or diagnostic exam conducted

• CBC

Before CBC (Complete Blood Count) Test:

1. Preparation and Education: Explain the purpose and importance of the CBC test to the patient
and address any concerns she may have. Although fasting is generally not required for a CBC,
clarify any specific instructions given by the healthcare provider.
2. Verify Patient Identification: Confirm the patient’s identity using two identifiers, such as name
and date of birth, to ensure that the correct patient is being tested and to prevent any risk of
specimen misidentification.
3. Assess Patient’s Health Condition and History: Review the patient’s medical history, including
ischemic stroke, pneumonia, and hypertension, and current medications. Identify any
medications or recent interventions (such as blood transfusions) that could influence CBC
results.
4. Assess Vascular Access and Comfort: Evaluate the best site for venipuncture, especially if
the patient has fragile veins or limited mobility due to stroke. Ensure the patient is positioned
comfortably to reduce anxiety and prevent dizziness during the procedure.
After CBC Test:

1. Monitor for Complications: Observe the puncture site for any bleeding, hematoma formation,
or bruising, as elderly patients with hypertension may have an increased risk of bruising or slow
clotting.

2. Monitor Vital Signs and Neurological Status: Assess the patient’s vital signs, including blood
pressure, pulse, respiratory rate, and temperature. Evaluate her neurological status, as any
sudden changes may indicate issues requiring immediate attention.

3. Provide Comfort and Education: Reassure the patient, explaining that minor discomfort at the
puncture site is normal. Inform her of when she can expect results and that a follow-up will be
scheduled to review findings with her healthcare provider.

4. Document and Report Findings: Document the procedure, including the time and site of
venipuncture and any patient responses or reactions. Once results are available, report any
abnormalities promptly to the healthcare provider for further evaluation and potential adjustments
in treatment based on the findings.

III. Anatomy and Physiology of the Brain

Introduction:

The nervous system is responsible for controlling and coordinating bodily functions and
facilitating communication between different body parts. An ischemic stroke occurs when a blood clot or
plaque obstructs a blood vessel in the brain, cutting off the oxygen and nutrients required for neuronal
function. Without a constant supply of blood, brain cells begin to die within minutes. In our patient, the
ischemic stroke affected the left side of her brain, which is typically responsible for language and motor
control of the right side of the body. This blockage has led to aphasia (a language impairment) and right-
sided weakness, commonly observed in left-hemisphere strokes. The loss of these functions affects her
communication abilities, quality of life, and overall independence.
Physiology of the Brain:

The brain is the command center of the human nervous system, responsible for coordinating and
regulating all bodily functions and behaviors. It is a highly complex organ composed of billions of nerve
cells called neurons, along with supporting cells known as glial cells. The brain can be divided into several
major regions, each with specific functions:

1. Cerebrum: The largest part of the brain, divided into two hemispheres (left and right). The cerebrum
is responsible for higher cognitive functions, including perception, thinking, reasoning, and voluntary
movement. It is further divided into four lobes:

- Frontal lobe: Controls voluntary movement, decision-making, problem-solving, and emotional

regulation.

- Parietal lobe: Processes sensory information such as touch, temperature, and pain, as well as spatial
awareness and perception.

- Temporal lobe: Involved in auditory processing, language comprehension, memory formation, and
emotion regulation.

- Occipital lobe: Primarily responsible for visual processing and interpretation.

2. Cerebellum: Located at the back of the brain beneath the cerebrum, the cerebellum coordinates
voluntary movements, balance, posture, and motor learning. It also plays a role in cognitive functions
such as attention and language.

3. Brainstem: Situated at the base of the brain, the brainstem connects the brain to the spinal cord and
regulates basic physiological functions essential for survival, including heart rate, breathing, digestion,
and arousal. It consists of three main parts:

- Medulla oblongata: Controls involuntary functions such as heartbeat, breathing, and blood pressure.

- Pons: Acts as a relay center for communication between different parts of the brain, as well as
regulating breathing and sleep.

- Midbrain: Coordinates sensory and motor functions and plays a role in visual and auditory processing.

4. Diencephalon: Located between the cerebrum and brainstem, the diencephalon includes several
structures, notably:

- Thalamus: Acts as a relay station for sensory information, directing signals to the appropriate areas
of the cerebral cortex for processing.

- Hypothalamus: Regulates homeostasis by controlling hunger, thirst, body temperature, and hormone
production. It also plays a role in emotions and the sleep-wake cycle.

- Pituitary gland: Often referred to as the "master gland," the pituitary gland secretes hormones that
regulate various bodily functions and controls other endocrine glands.

5. Cerebral Circulation and Blood Supply

The brain’s high metabolic demand requires a constant supply of oxygen-rich blood, provided through a
network of arteries:

1. Carotid Arteries: Supply the anterior part of the brain, including the frontal, parietal, and
temporal lobes.
2. Vertebral and Basilar Arteries: Supply the posterior brain structures, including the
cerebellum, brainstem, and occipital lobes.
3. Circle of Willis: An interconnected system of arteries at the brain's base that provides
a collateral blood supply, allowing for some compensation in case of an arterial blockage.

Each cerebral artery has specific areas of responsibility:

4. Middle Cerebral Artery (MCA): Supplies blood to portions of the frontal, parietal, and
temporal lobes, including areas critical for language and motor control.
5. Anterior Cerebral Artery (ACA): Primarily supplies the medial portions of the frontal
lobes.
 6. Posterior Cerebral Artery (PCA): Supplies blood to the occipital lobe and portions of
the temporal lobe.

The brain's anatomy facilitates its intricate functions through the intricate network of neurons,
which communicate with one another through electrical and chemical signals. This complex interplay of
structures and processes underlies all aspects of human behavior, cognition, and physiology.

IV. Pathophysiology
PATHOPHYSIOLOGY OF ISCHEMIC STROKE

Etiology

Ischemic stroke leading to aspiration pneumonia has multiple underlying causes that significantly
contribute to the patient's condition. The primary etiology of ischemic stroke is the obstruction of blood
flow to the brain, typically caused by a thrombus (blood clot) that forms due to atherosclerosis in the
cerebral arteries. In the case of a 70-year-old female patient, hypertension is a critical risk factor, as
elevated blood pressure can damage blood vessels and promote the formation of clots. Other contributing
factors may include a history of cardiovascular disease, diabetes, and atrial fibrillation, all of which
increase the risk of thrombus formation. The left hemisphere of the brain is particularly affected in this
case, leading to neurological deficits such as right-sided weakness, expressive aphasia, and dysphagia.
These deficits can significantly impair the patient's ability to swallow safely, increasing the risk of
aspiration.

Pathophysiologic Process

The pathophysiological process of ischemic stroke resulting in aspiration pneumonia involves a

cascade of events that impact both the neurological and respiratory systems. When the left hemisphere
of the brain is compromised due to ischemia, vital functions such as motor control and language are
disrupted. The patient may experience right-sided hemiparesis, leading to weakened muscles involved
in swallowing and decreased oral control of food and liquids. This impairment, combined with expressive
aphasia, increases the likelihood of dysphagia, where the patient cannot swallow effectively, making
aspiration more probable.

With the neurological deficits in place, the protective cough reflex, which normally helps clear
aspirated material from the airway, may be diminished. As a result, aspirated contents, often containing
bacteria from the oropharynx, can enter the trachea and subsequently the lungs. This invasion of bacteria
leads to aspiration pneumonia, characterized by symptoms such as cough, fever, and difficulty breathing.
Physical examination may reveal crackles in the lungs upon auscultation, indicating the presence of fluid
or inflammation.
 Furthermore, aspiration pneumonia can lead to additional complications, including systemic
inflammation and respiratory failure. The combination of immobility due to weakness can also predispose
the patient to deep vein thrombosis (DVT) and pressure ulcers. Overall, the pathophysiological
consequences of ischemic stroke extend beyond the initial brain injury, significantly impacting respiratory
health and leading to serious complications that require prompt medical intervention.
 V. DRUG STUDY

CLASSIFICATION INDICATION CONTRAINDICATION MECHANISM OF

ACTION

Generic Name: Piperacillin- • Known hypersensitivity Piperacillin is a broad-

PiperacillinTazobactam tazobactam is to piperacillin, spectrum penicillin
indicated for the tazobactam, or any antibiotic that works by
Brand name: treatment of moderate component of the inhibiting bacterial cell
Zosyn to severe infections formulation. wall synthesis. It binds to
caused by susceptible • History of allergic penicillin-binding proteins
Classification: microorganisms, reactions to penicillins (PBPs) located inside the
including: or beta-lactam bacterial cell wall,
Therapeutic Class: Anti- • Intra- antibiotics. disrupting the integrity of
infectives, specifically abdominal • Caution is advised in the cell wall and leading
broad-spectrum antibiotics infections patients with a history of to cell lysis and death.
• Skin and soft asthma, allergy, or Tazobactam is a beta-
Pharmacologic Class: tissue significant renal lactamase inhibitor that
Penicillin and beta- infections impairment. protects piperacillin from
lactamase inhibitor • Respiratory hydrolysis by beta-
combination tract lactamase enzymes
infections, produced by resistant
including bacteria, thereby
pneumonia enhancing its antibacterial
• Urinary tract efficacy.
infections
• Gynecological
infections
• Bone and joint
infections
• Sepsis
ADVERSE REACTIONS ROUTE / DOSAGE NURSING
& SIDE EFFECT INTERVENTION

• Route: Intravenous Monitor vital signs, including

CNS: Agitation, confusion, (IV) infusion temperature, heart rate,
delirium, depression, dizziness, • Dosage: The typical respiratory rate, and blood
drowsiness, seizures adult dosage for pressure, for signs of
moderate to severe infection or adverse
CV: Atrial or ventricular reactions.
infections is 3.375 g
fibrillation, bradycardia, chest
(piperacillin 3 g and
pain, hypotension
tazobactam 0.375 g) Confirm the patient’s allergy
EENT: Blurred vision, dry mouth, every 6 hours, or 4.5 g history, particularly to
increased nasal congestion, (piperacillin 4 g and penicillin or other beta-
tinnitus tazobactam 0.5 g) lactam antibiotics, prior to
every 8 hours, administration.
ENDO: Hyperglycemia, depending on the
hypoglycemia severity and type of Assess renal function tests
infection. Adjustments (creatinine, BUN) regularly,
GI: Diarrhea, nausea, vomiting, may be necessary for especially in patients with a
pseudomembranous colitis patients with renal history of renal impairment
impairment. or those receiving concurrent
Hematologic: Anemia, nephrotoxic medications.
leukopenia, thrombocytopenia
Administer the medication as
MS: Muscle pain, myalgia an IV infusion over 30
minutes to reduce the risk of
Skin: Rash, pruritus, urticaria
adverse effects and monitor
for signs of infusion reactions.
Other: Angioedema,
hypersensitivity reactions, fever,
electrolyte imbalances. Educate patients about the
purpose of the medication,
potential side effects, and the
importance of completing the
full course of therapy even if
symptoms improve.

Monitor laboratory tests,

including complete blood
count (CBC) and electrolyte
levels, to identify any
hematologic changes or
imbalances.

Watch for signs of

superinfection (e.g.,
persistent fever, new
infection symptoms) due to
the alteration of normal flora.
 VI. Nursing Care Plan

Cues Nursing Scientific Basis Goal & Nursing Rationale Evaluation

Diagnosis Outcome Intervention

Subjective Data: Impaired Ischemic stroke is Short Term: Establish a Building rapport can Short-term:
physical a type of stroke trusting enhance patient
mobility that occurs when After nursing relationship by cooperation and The patient
• “Dili na siya
related to blood flow to a intervention, spending time with decrease anxiety, was able to
kahibalo
neuromuscula part of the brain is the patient the patient and fostering a supportive attempt
mobarog r impairment obstructed, will be able actively listening environment that standing
basta mag secondary to leading to the to to her concerns. promotes with
inusara” as ischemic death of brain demonstrate engagement in assistance
verbalized stroke as cells. This improved rehabilitation. within 48
by the evidenced by obstruction is often mobility by hours,
patient’s inability to caused by a blood attempting to Monitor the Continuous indicating
sister. stand clot that forms in a stand with patient's mobility assessment provides progress in
independently blood vessel assistance and document any critical information on mobility and
Objective Data: and supplying the brain within 48 changes in the patient's progress response to
weakness on (thrombotic stroke) hours. strength, balance, and effectiveness of nursing
-Patient exhibits the right side. or by a clot that and ambulation. interventions, allowing intervention
weakness on the right travels from Long Term: for timely adjustments s.
side (hemiparesis). another part of the to the care plan.
body (embolic After nursing Long-term:
- Patient demonstrates stroke). Risk intervention, Assist the patient Encouraging
difficulty with balance factors for the patient with activities of participation fosters The patient
when attempting to ischemic stroke will be able daily living (ADLs) independence and successfully
stand. include to stand and encourage helps the patient stood
hypertension, independentl her to participate regain confidence independent
- Patient requires diabetes, y and as much as while promoting ly and
assistance for hyperlipidemia, participate in possible. muscle use and participated
transfers and and lifestyle a daily functional mobility. in a daily
ambulation. factors such as physical physical
smoking and rehabilitation Educate the Providing education rehabilitatio
- Patient's skin obesity. The program patient and her empowers the patient n program
integrity is intact, but resultant brain within two family about the and family to take an within two
there are signs of tissue damage can weeks. importance of active role in the weeks,
potential pressure lead to significant regular physical recovery process, demonstrati
areas due to neurological therapy sessions improving adherence ng improved
immobility. deficits, including and adherence to to therapy and overall physical
weakness, speech the rehabilitation outcome. mobility and
Blood Pressure (BP): difficulties, and plan. adherence
140/80 mmHg cognitive to the care
impairments. plan.
Temperature (Temp): Prompt diagnosis
36.8°C and treatment are
crucial to restore
Pulse Rate (PR): 120 blood flow and
bpm minimize brain
damage.
Respiratory Rate (RR):
27 breaths per minute

Oxygen Saturation
(O2 Sat): 95%

.
VII. Conclusion

In the case of our 70-year-old female patient with ischemic stroke, pneumonia, and hypertension,
we encounter a complex clinical scenario that underscores the significant challenges associated with
managing multiple comorbidities. The ischemic stroke has led to neurological deficits that impair her
ability to stand independently and communicate effectively, which profoundly affects her quality of life.
Concurrently, the presence of pneumonia introduces additional respiratory complications, potentially
hindering recovery and increasing the risk of further adverse outcomes. Hypertension, as a longstanding
condition, remains a critical factor that not only contributed to the stroke but also necessitates vigilant
management to prevent future cardiovascular events.
Our approach to care must be comprehensive and multidisciplinary, focusing on both immediate
and long-term interventions. Immediate management strategies should address the acute effects of the
stroke and pneumonia, including rehabilitation efforts aimed at improving mobility and respiratory
function. Long-term, we must prioritize controlling her hypertension through medication adherence,
lifestyle modifications, and regular monitoring to reduce the risk of recurrent strokes.
Furthermore, we recognize the importance of providing supportive care that encompasses both
physical and emotional well-being. Encouraging family involvement and education can enhance the
patient's support network, fostering an environment conducive to recovery. By working collaboratively
within our healthcare team, we aim to develop and implement a personalized care plan that addresses
the patient's unique needs and goals.
Ultimately, our commitment to a holistic approach will be instrumental in improving our patient’s
overall health outcomes and enhancing her quality of life as she navigates the challenges of her
conditions. Through ongoing assessment, adjustment of care strategies, and the provision of resources,
we strive to empower our patient in her recovery journey.
VIII. Reference

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