A Case Study of Cerebrovascular Accident

I. INTRODUCTION
BRIEF DESCRIPTION OF THE DISEASE
Definition:
It is characterized by a relatively abrupt onset of persisting
neurological symptoms due to the destruction of brain tissue (infarction)
cause by ischemia (thrombus or embolism) or hemorrhage resulting from
disorders in blood vessels that supply the brain. Also called stroke
Stroke any sudden onset focal neurological deficit
Causes:
Intracerebral hemmorhage (rupture of a blood vessel in the pia
mater or brain
Emboli (blood clots)
Atherosclerosis (formation of plaque) of the cerebral arteries.

Risk Factor:
1. Hypertension leading risk factor for coronary heart disease and stroke
treatable and can be controlled.
2. Modifiable by change in lifestyle
a. smoking
b. elevated serum cholesterol
c. obesity
d. heart disease
3. Modifiable by Medical mean
a. Transient Ischemic Attack
b. Asymptomatic carotid bruit
c. Diabetes Mellitus
d. Increased blood viscosity
e. HPN
4. Non modifiable risk factors
a. age
b. sex
c. race
d. previous stroke

Types of Stroke by Etilogy:

1. Hemorrhage stroke (intracranial hemorrhage)
5% of all strokes
two division
a. Intracerebral (10%) due to rupture of weakened vessels
within brain parenchyma as result of Hypertension,
arteriovenous malformation or tumor
b. Subarachnoid (5%) result from aneurismal rupture of a
cerebral artery with blood loss into space surrounding the
brain; evolve over 1 2 hours.
2. Ischemic Strokes (remaining 85%)
Large (40%) or small (20%) vessel thrombosis
-most
commonly
occur
in
presence
of
atherosclerotic
cerebrovascular disease
-vascular changes or lipohyalinosis found in small deep penetrating
arteries as associated with chronic hypertension can lead to small
vessel thrombosis.
-rapid or prolonged interval of onset and may lead last many hours
Cerebral embolism (20%)
-usually a cardiac origin
-frequently result of chronic ischemic cardiovascular disease with
secondary ventricular wall hypokinessis or artial arrhythmia both
conditions increase risk of intracardiac thrombus formation
-quick onset and fully develop in a matter of minutes
Temporal Classification of Stroke
1. Transient ischemic attack (TIA)
- neurologic symptoms develop and disappear over several
minutes and completely resolve in 24 hours
- most frequently associated with atherosclerotic carotid artery
disease
2. Reversible Ischemic Neurologic Deficit
- etiology unknown
- likely the result from small infarctions (Lacunes) of the deep
subcortical gray and white matter resulting in only temporary
impairment
3. Stroke in Evolution
- describe an unstable ischemic event characterized by the
progressive development of more severe neurologic impairment
- often associated with active occlusive thrombosis of a major
cerebral artery.
- Once stable called Complete Stroke
OBJECTIVES:

General Objective: To be able to acquire knowledge on how to deal or

manage a patient with Cerebrovascular Accident.

Specific Objective:
1. To thoroughly assess the clinical manifestations of patient with CVA
based on the patients history.
2. To formulate comprehensive nursing diagnosis for a client with CVA.
3. To formulate a plan of care for patients with CVA.
4. To formulate appropriate nursing interventions that can be applied for
a patient with CVA.
5. To evaluate the plan of care for a patient with CVA.
NURSING HEALTH HISTORY
A.

BIOGRAPHIC DATA
Name: Mrs. Alen Santos
Address: Binalonan Pangasinan
Age: 52 yrs old
Sex: F
Race: Filipino
Marital Status: Married
Occupation: Tricycle Driver
Religious Orientation: Roman Catholic

B.

CHIEF COMPLAINT
Nanghina ang kaliwag bahagi ng akng katawan, as verbalizes
by the patient
C.

HISTORY OF PRESENT ILLNESS

One day prior to admission, the patient felt weak on the left side
of her body, she also has high blood pressure that day, so they
decided to go to the hospital for further management and
treatment

D.

PAST HISTORY
The client received 2 immunizations only (BCG and DPT) because
the family is not aware of its importance. The client commonly had
cough and fever. The childhood diseases that she acquired are mumps,
measles, and chicken pox and sore eyes .There were no known food or
medication allergy. Client has no history of accidents or injuries. She
does not smoke or drink alcohol

PHYSICAL ASSESSMENT

PSYCHOSOCIAL

PATHOPHYSIOLOGICAL
BASIS

Significant others

The patient is visited A very supportive family

by her daughters and who shows comfort and
nieces.
care that can relieve stress
that is felt by the patient

Coping Mechanism

Interacting with SO Being

happy
during
and Laughing trip.
treatment can contribute
to patients fast recovery
and interaction with in the
family can be a diversion
activity thus reducing pain
and stress.

Religion

Roman Catholic

Primary Language

Ibanag/
Tagalog

It is important to know, for

there might be beliefs of a
certain religion that has a
conflict with a health
intervention.

Ilocano/ Language can be a barrier

for an effective nursing
intervention thus it is
important for a nurse to
know what language to
use to have an effective
communication.

Financial Source of Patients older sister

Health Care
working in Dubai and
patients first cousin
working in London.
Occupation

Bakery Manager

General appearance

LOC: Conscious
GCS:
Eyes
Verbal
Motor
TOTAL

3
2
4 .
9

Brain damage
severe.

not

that

Due to decreased O2
supply and perfusion in
the brain.

Weak in appearance
Due to illness.
Orientation

The
patient
still An abnormal orientation
knows where she is, can be a symptom of brain
when
she
was damage caused by CVA

admitted and who are

the SO present.
Memory

Patient
still has a
good memory thus
she
recalls
diet
prescribed
her
physician and thus
still remembers a lot
things.

Damaged cause by the

infarct is not yet that
severe
to
affect
the
memory of the patient.

Speech

Slurred speech

Dysarthria resulting from

lacunar infarcts, right and
left basal ganglia

Non-verbal behavior

Silence

Patient
expresses
his
feeling
through
not
speaking especially when
she is feeling bad.

ELIMINATION
Stool

Abdomen:
palpation
Urine

Frequency: Once a
day
Pattern:
Every
morning
Consistency: Normal
Stool
Amount:
Approximately
9-10
inches in length, 1.5
in diameter
Color: Light Brown
Odor: Normally foul
stool odor
contour Rounded, (-) palpable
mass
Quantity: 500cc
1300cc per shift

to Due to oral and IV fluid

intake.

Pattern: On IFC
Color: Lt. Yellow
Transparency:
Turbid

Patient is on
decrease BP.

IFC

to

Sl. Due to the general liquid

diet of the patient.
Due to the general liquid
Spc. Gravity: 1.015
diet of the patient.

Still within normal range.

REST AND ACTIVITY
Current
level

activity Lie and sit on bed

Patient moment varies due

to body weakness

Sleep

8-9 hours a day

during
the
confinement period

Pain/relief measures

Patient
tries
to Patient usually positions
position himself on a himself on his back and
comfortable position. sometimes lie left laterally
or
right
laterally,
depending on patients
Patient
also choice of comfort.
verbalized that upon Patient
assumes
having a headache analgesics for pain relief
she takes Biogesic.
measure in addressing
headache.
Sudden headache is one of
the s/sx of CVA.

SAFETY
Allergic Reaction

Sea foods

Medications

Gentamicin
IV OD
Cefuroxime
IV q8h
Clonidine 1
now
Imidapril 1
NGT

Eye/vision
Glasses:
Pupils:

Hearing/hearing aid

160 mg Antibiotics
were
administered so as to
750 mg stop, or if not, lessen
infection which caused the
tab SL disease.
CV agent drugs were
tab OD/ ordered to lower the blood
pressure of the patient.
Antibacterial ointment was
Bactoban ointment to ordered
to
prevent
wound TID
infection of the wound.
With a 120 reading
glass
Right pupil is dilated
non-reactive to light.
Left Pupil constricted
with minimal reaction
to light.
Patient has
hearing

normal

Due to an infarct in the

brain, vision and normal
eye
function
can
be
affected.

Skin integrity
Lesion scars

Intact Skin
With scars
hand

Mucus membrane

Moist and intact

Temperature

Temperature,
via
axillary,
of
the
patient varies from
36.0C to 37.4C

on

left Due to an accident caused

by bakery machineries.

OXYGEN
Activity Tolerance

Can move minimally

Airway clearance
Nose
Mouth

With no secretions
Clear

Respiration rate
Depth
Rhythm

28 cycle per minute

Normal
Regular

Color
Skin
Nails
Lips

Pale
Pinkish
Somewhat dry

Patient
has
a
hemoglobin count.

Capillary refill

1-2 seconds

Normal Oxygenation
tissue cells

Pulses

Within normal range

Blood pressure

140-210/70-110
mmHg

Edema

None

Homans Sign

Negative
NUTRITION

Hospital
Diet/Restrictions

OR feeding of 1600
calories in 4 equally
divided feeding

IVFs (according to PNSS 1L x 20-21

chart)
gtt/min
D5NSS 1L x 20-21
gtt/min
Site
D5W
L
x
20
gtt/min
Left posterior forearm
Tissue turgor
Ability to:

Good skin turgor

Patient
has
weakness

general

low

of

Patient
is
having
an
elevated BP due to illness.

Chew
Swallow

Able
Able

Feed self

With SOs assistance

Due to decreased hand

movement accuracy.

Anatomy And Physiology

The Brain
BRAIN
Made up of 1000 billion neurons and is one of the largest organs of the
body, weighing about 1300 kg (3 lbs).
It is a mushroom shaped
4 Principal Parts
1. Brain Stem
Stalk of the mushroom
Consist of medulla oblongata, pons and midbrain
2. Diencephalon
Consisting primarily of the thalamus and hypothalamus
3. Cerebrum
Spreads over the diencephalons
Constitute about seven-eights of the total weight of the brain and
occupies most of the cranium.
4. Cerebellum
Inferior to the cerebrum and posterior to the brain stem
Protection and Coverings
The brain is protected by the cranial bones. Like the spinal cord. The
brain is also protected by meninges. The cranial meninges surround the
brain are continues with the spinal meaninges and have the same basic
structure and bear the same names as the spinal meninges.
1. Dura meter

pachymenix, tough fibrous tissue

- outermost covering
2. Arachnoid - together with the pia meter is called Leptomeninges
- middle, delicate thin cob-web like membrane
3. Pia meter - innermost
- soft thin membrane which closely lines brain and spinal
cord extending into all fissures and sulci.
- extends around blood vessels throughout the brain.
Main Sulci and Fissures of Cerebral Cortex
1. Lateral or Sylvian Fissure
Divided the temporal lobe from the frontal and parietal lobe
Buried under the posterior part of the SYLVIAN FISSURE is the
TRANSVERSE TEMPORAL gyri which contains the AUDITORY
RECEPTIVE AREA.

2. Rolandic or Central Sulcus

Separates the frontal lobe from the parietal lobe
It separates the precentral gyrus from the Postcentral gyrus, thus
separating the motor from the somasthetic area.
3. Longitudinal Cerebral Fssure
Divides the cerebral hemispheres into right and left halves.
4. Parietooccipital Fissure
Separates the parietal lobe from the occipital lobe.
5. Calcarine Sulcus
This sulcus is surrounded by the visual receptive area.
Lobes of Cerebral Cortex and Brodmanns Classification
The function of the cerebral cortex has been mapped out into areas by
Broadmann. These two major types of cortical areas are:
1. Primary Cortical Area regions directly related to a specific function
2. Secondary Cortical Area/ Association Area these lie adjacent to the
primary area and are concerned with a higher level of organization and
integration.
The Major Primary and Association Areas
1. Frontal Lobe
Area 4
Area 6
Area 8
area
Area 44

- primary motor area

- premotor area
- frontal eye movement and papillary change
- motor speech (Brocas Area)

2. Parietal Lobe
Area 3, 1, 2
- primary sensory areas
Area 5, 7
- sensory association areas
Area 39 40
- Wernickes area
Area 5, 7, 39 40 - Gnostic area
Area 43
- primary gustatory area
3. Occipital Lobe
Area 17
Area 18 29
4. Temporal Lobe
Area 41
Area 42 & 22

- primary visual cortex

- visual association areas
- primary auditory cortex
- auditory association areas

AREA 4: PRIMARY MOTOR AREA

Location
: precental gyrus and paracentral lobule
Function
: contralateral voluntary motor activity
Clinical findings when damaged:
Irritative lesions will present with convulsive seizures
Gross lesions will result in flaccid paralysis and areflexia
AREA 6: PREMOTOR AREA
Location
: Superior Frontal Gyrus (lateral aspect)

Function
: Sensorially guided movements this refers to voluntary
motor activity dependent on sensory, inputs; these movements
are activated in response to visual, auditory and somatosensory
stimuli.
SUPPLEMENTARY MOTOR AREA
Location
: Medial aspect of Area 6
Function
: Programming and planning of motor activities and
perhaps their imitation.
Has presentation for both right and left sides as well as
proximally and distally.
AREA 8: FRONTAL EYE FIELD AREA
Location
: Frontal lobe
Function
: Center of voluntary movements of the eye INDEPENDENT
of visual stimuli such as the conjugate eye movements.
All three areas with motor function (4, 6 & 8) receive inputs
from the thalamus, cerebellum, other cortical regions and other
peripheral receptors.
AREA 17: PRIMARY VISUAL AREA
Location
:
OCCIPITAL LOBE specifically along the lips of the
calcarine sulcus; this is called the visual or striate area.
Function
: vision
Clinical findings when damanged:
an irritative lesion will present with visual hallucinations
a destructive lesion will cause contralateral homonymous defects
of visual fields and visual disorganization.
Area 18 & 19 secondary visual areas
AREA 41: PRIMARY AUDITORY AREA
Location
: TEMPORAL LOBE specifically at the transverse gyri
Function
: hearing
Clinical findings when damaged:
irritative lesion will cause buzzing and roaring sensation
unilateral destructive lesion will lead to a mild hearing loss
bilateral destructive lesion will lead to a complete hearing loss
SECONDARY AUDITORY AREA: AREA 42 & 22, HESCHIL AREA
The auditory association area is involved in the comprehension of
language and lesions in this area results in auditory agnosia or the inability
to recognize what he hears but patient has intact hearing).
FRONTAL LOBE: additional notes
lie interior to the central sulcus and lateral fissure
main function: motor, cognition, speech, affective behavior
PREFRONTAL CORTEX (Area 9, 10, 11, 12) is essential for abstract
thinking, foresight and judgement
A lesion in the prefrontal cortex results in behavior at changes and
changes in cognitive function.
Functions of Principal Parts of the Brain
PARTS

FUNCTION

BRAIN STEM
Medulla

Pons

MIDBRAIN

DIENCEPHALON
Thalamus

Hypothalamus

1. Relays motor & sensory impulses

between other parts of the brain and the
spinal cord.
2. Reticular formation (also in pons,
midbrain and diencephalons) functions
in consciousness and arousal)
3. Vital reflex centers regulate heartbeat,
breathing (together with pons) and
blood vessel diameter.
4. Nonvital reflex centers coordinate
swallowing, coughing, sneezing and
hiccupping.
5. Contains nuclei of origin for CN 8, 9, 10,
11 and 12.
6. Vestibular nuclear complex helps
maintain equilibrium.
1. Relay impulses with in the brain and
between parts of the brain and spinal
cord.
2. Contains nuclei of origin of CN 5, 6, 7 &
8
3. Pneumotoxic area and apneustic area,
together with the medulla, help control
breathing.
1. Relay motor impulses from the cerebral
cortex to the pons and spinal cord and
relays sensory impulses from the spinal
cord to the thalamus.
2. Superior colliculi coordinates
movements of the eyeballs in response
to visual and other stimuli and the
inferior colliculi coordinate movements
of the head and trunk in response to
auditory stimuli.
3. Contains nuclei of origin for cranial
nerves III & IV.
1. Several nuclei serve as relay stations for
all sensory impulses, except small, to
the cerebral cortex.
2. Relays motor impulses from the cerebral
cortex to the spinal cord.
3. Interprets pain, temperature, light
touch, and pressure sensations.
4. Anterior nucleus functions in emotions
and sensory.
1. Controls and integrates the autonomic
nervous system.
2. Receives impulses from viscera
3. Regulates and controls the pituitary
gland

4.
5.
6.
7.
8.
9.
Cerebrum

1.
2.
3.

CEREBELLUM

Center for mind-over-body phenomena

Secrets regulating hormones
Functions in rage and aggression
Controls normal body temperature,
food intake and thirst
Helps maintain the walking state and
sleep
Functions as a self-sustained oscillator
that drives many biological rhythms.
Sensory areas interprets sensory
impulses, motor areas function in
emotional and intellectual processes.
Basal ganglia control gross muscle
movements and regulate muscle tone.
Limbic system functions in emotional
aspects of behavior related to survival.

1. Controls subconscious skeletal muscle

contractions required for coordination,
posture and balance.
2. Assume a role in emotional
development, modulating sensations of
anger and pleasure.

Figur
e2

Prominent structures of the brain

stem.

The limbic system is a network of neurons that extends over a wide

range of areas of the brain. The limbic system imposes an emotional
aspect to behaviors, experiences, and memories. Emotions such as
pleasure, fear, anger, sorrow, and affection are imparted to events and
experiences. The limbic system accomplishes this by a system of fiber
tracts (white matter) and gray matter that pervades the diencephalon and
encircles the inside border of the cerebrum. The following components are
included:

The hippocampus (located in the cerebral hemisphere)

The denate gyrus (located in cerebral hemisphere)

The amygdala (amygdaloid body) (an almond-shaped body

associated with the caudate nucleus of the basal ganglia)

The mammillary bodies (in the hypothalamus)

The anterior thalamic nuclei (in the thalamus)

The fornix (a bundle of fiber tracts that links components of the

limbic system)

Vascular Anatomy
Blood
Transport oxygen, nutrients and other substances for brain functioning
Carries away metabolites
Approximately 18% of total blood volume in brain.

Brain uses 20% of oxygen absorbed in the lungs

Two major arteries supplying blood to the brain are the INTERNAL
CAROTID ARTERY & VERTEBRAL ARTERY.
Branches of ICA: ophthalmic, middle cerebral and anterior cerebral
artery.
Vertebral artery unites to form the basilar artery in the pons.
Branches of vertebrobasilar artery: posterior cerebral, posterior and
anterior inferior cerebellar, pontine and internal auditory arteries.
The circle of Willis is formed by the PCA, ACA, anterior communicating
and posterior communicating arteries.
The MIDDLE CEREBRAL ARTERY does not form part of the circle of Willis
The venous drainage of the cerebrum includes the veins of the brain
itself, dural venous sinuses, meningeal veins (dura) and diploic veins.

CEREBRAL ARTERIES
1. MIDDLE CEREBRAL ARTERY (MCA)
From internal carotid artery
Blood supply to deep structures
Enters lateral fissure sends cortical branches to lateral aspect of
FRONTAL, TEMPORAL, PARIETAL, & OCCIPITAL LOBES.
Basal MCA sends small penetrating lenticulo striate arteries to supply
internal capsule and adjacent structures.
2. ANTERIOR CEREBRAL ARTERY (ACA)
Also branch of the internal carotid artery
Internal carotid artery to longitudinal fissure to genes of corpus
callosum - sends branches to medial frontal and parietal lobes and
adjacent cortex, extending posteriorly.
3. POSTERIOR CEREBRAL ARTERY (PCA)
Basilar artery sends branch to medial and inferior surface of the
temporal lobe and medial occipital lobe.
Blood supply to choroids plexuses of III & IV ventricles
With calcarine artery and perforating branches to posterior thalamus
and subthalamus.

PATHOPHYSIOLOGY
VII. PATHOPHYSIOLOGY
ETIOLOGY
Subacute Infarct, righ basal
ganglia and right perventricular
white matter region
Lacunar Infarct, left basal
ganglia
Sclerotic Mastiod, right

RISK

FACTOR
Age
Hypertension
Diet (LDL)
DIC

Deposition of atherosclerotic
Plaque in intima of arteries
Elastic lamina become thin and frayed
Platelet adhere to rough surface
Release of adenosine diphosphate enzyme
Thrombus form
Enlargement of
thrombus

Narrowed lumen

Break off
Emboli

Occlusion of affected
blood vessels

Vertebral arteries

Vertebrobasilar arteries

Internalcarotid arteries

Vertigo

Paralysis

Dysphagia
Numbness
Weakness
Dysarthria
Gait problem

Ataxia
Hemiparesis
Headache

Lower facial
Sensory loss
weakness
Numbness

Syncope

Labaoratory Result
URINALYSIS
Date: August 10, 20015
COLOR

Lt. Yellow

PROTEIN

TRANSPARENCY

Sl. Turbid

SUGAR

PH/REACTION

6.5 (4.5-8.0)

ACETONE

SPECIFIC GRAVITY

1.015 (1.005-1.030)

BILE PIGMENTS

CAST/LFP

CRYSTALS

Hayline Cast

Amorp.

Few

Urate/Phospates
CELLS/HPF

EPITHELIAL CELLS

WBC/Pus Cell

3-6 (0-4)

Squamous

RBC/Red Blood Cell

>50 (<2)

Renal

Rare

Yeast Cells

MUCUS THREADS

Rare

Pregnancy Test

Bacteria

Occasional

Interpretation:
The urinalysis of the above patient shows that there is an increase in
RBC. This suggest that RBC cast indicates hemorrhage in the nephron thus
suggesting acute glomerolonephritis. This might be due to the prolonged
catheterization, increasing the ascending infection causing damage to the
nephron. With regards to this, it indicates that there is an acute bacterial
infection within the urinary tract, supported by the U/A laboratory result with
an increase WBC.
Nursing consideration before Urinalysis:
1. Instruct patient to collect urine early in the morning (Clean catch
technique).
2. Collect midstream urine.

3. Bring obtained specimen to the laboratory no more than 30

minutes.
HEMATOLOGY
Date: August 10, 20015
EXAMINATIONS
HEMOGLOBIN

REFERENCE VALUES
132

120-160 g/L

39

34-47 vol %

13.1

5.0-10.0

Nuetrophils

84

50-70 %

Lymphocytes

15

20-40 %

1-3 %

HEMATOCRTI (HCT)
LEUKOCYTE COUNT (WBC)
DIFFERENTIAL COUNT:

Eosinophils
Toxic Granules

Negative

Clotting Time

2-6 minutes

Bleeding Time

1-4 minutes

Malarial Smear

No Malarial Parasite Seen (NMPS)

Intrepretation:
Leukocytosis is a raised white blood cell count (the leukocyte count)
above the normal range. This increase in leukocytes (primarily neutrophils) is
usually accompanied by a "left shift" in the ratio of immature to mature
neutrophils. The increase in immature leukocytes increases due to
proliferation and release of granulocyte and monocyte precursors in the bone
marrow which is stimulated by several products of inflammation including
C3a and G-CSF. Although it may be a sign of illness, leukocytosis in-and-of
itself is not a disorder, nor is it a disease. It is simply a laboratory finding. A
leukocyte count above 25 to 30 x 109/L is termed a leukemoid reaction,
which is the reaction of a healthy bone marrow to extreme stress, trauma, or
infection. (It is different from leukemia and from leukoerythroblastosis, in
which immature blood cells are present in peripheral blood.) Leukocytosis is
very common in acutely ill patients. It occurs in response to a wide variety of
conditions, including viral, bacterial, fungal, or parasitic infection, cancer,
hemorrhage, tissue necrosis (for this case, brain tissue death or infarct)
and exposure to certain medications or chemicals including steroids.
Leukocytosis can also be the first indication of neoplastic growth of
leukocytes.
Nursing consideration:
1. Explain the procedure and the purpose of the test.
2. Assess the clients knowledge of the test.
3. Adhere standard precaution.
4. Apply pressure to the venipuncture site.
5. Explain that some bruising, discomfort, and swelling may appear
at
the site and that moist compress can alleviate this.

6. Monitor signs of infections.

BLOOD CHEMISTRY
Date: August 10, 2015
EXAMINATIONS

RESULT

S.I. UNITS

NORMAL VALUES

Glucose (Fasting)

3.26

mmol/L

3.85-6.05

Total Cholesterol

7.52

mmol/L

3.9-5.1

9.0

mmol/L

1.7-9.3

167.4

mol/L

53-106

Blood Urea Nitrogen

Serum Creatinine

Interpretation:
Too much cholesterol in the blood, however, can cause deposits of
cholesterol inside arteries. These plaques can narrow the artery enough to
block blood flow. This process known as atherosclerosis commonly occurs in
the coronary arteries which nourish the heart. For this case, an increase in
the Total Cholesterol is just a proof supporting the atherosclerosis and the CT
scan result having an impression of a sclerotic right mastoid.
Measuring serum creatinine is a simple test and it is the most
commonly used indicator of renal function. A rise in blood creatinine levels is
observed only with marked damage to functioning nephrons. Therefore, this
test is not suitable for detecting early stage kidney disease. The increase
serum createnine is only indicative that due to the ischemic stroke there is a
renal failure and the damaged nephrones are caused by bacterial infections.
Nursing Considerations:
1. Explain the procedure and the purpose of the test.
2. Assess the clients knowledge of the test.
3. Adhere standard precaution.
4. Apply pressure to the venipuncture site.
5. Explain that some bruising, discomfort, and swelling may appear
at
the site and that moist compress can alleviate this.
6. Monitor signs of infections.