Client Care Study On Mrs. O. A., With The Diagnosis Of Cerebrovascular Accident In Holy Rosary Hospital Emekuku, Owerri, Imo State.

ABSTRACT

This is a client care study on Mrs. O. A., with the diagnosis of cerebrovascular Accident in Holy Rosary Hospital Emekuku, Owerri, Imo State. Mrs. O. A. was admitted on the 16^th of April 2018. Some investigations were carried out like: urinalysis, fasting blood sugar, HIV test. Objective of this us to educate and enlighten the client on the disease process, the causes, clinical manifestation, prevention and management of disease as well as to render holistic care to the client. The significance of this study is that re-occurring cardiovascular diseases can be prevented by addressing behavioral risk factors, such as unhealthy diet, physical inactivity, harmful use of hard substance, using population wide strategies. Data collected on cerebrovascular accident in Holy Rosary hospital shows that about 25% of females admitted are death prone cases and cerebro-vascular accident. The client care study helped me to acquire god knowledge of the process and management of the disease and has helped me educate Mrs. O. A; family on the complications that may arise is not properly treated.

CHAPTER ONE

INTRODUCTION

Cerebrovascular Accident (stroke) is the primary cerebrovascular disorder in the world. It is the third leading cause of mortality, besides heart disease and cancer. Approximately 800,000 people experiences stroke each year in the United States (U.S).

Cerebrovascular disorder, according to Waugh and Grant A. (2015) is a vascular disease that occurs when blood flow to the brain is suddenly disrupted or interrupted causing hypoxia.

Cerebovascular accident can also be defined and sudden death of some brain cells, due to lack of oxygen when the blood flow to the brain is impaired by blockage or rupture of an artery to the brain.

According to W.H.O (2009) cerebrovascular accidents were the second most frequent causes of death worldwide, accounting for 6.8 million death. Approximately 17.5 million people have previously has a stroke and are still alive; today, stroke is the leading cause of serious long-term disability in most developed countries of the world (Smeltzer, Bare et al., 2009). The financial impact of stroke is profound.

Smeltzer, Bare et al, (2009) opined that it can be divided into two categories. Ischemic (85%) in which vascular and significant hypertension occurs and hemorrhagic (15%) in which there is extravasations of blood into the brain or Arachnid space. Although the broad types of stroke have some.

Background of Study

A stroke or “brain attack” occurs when a blood clot blocks the blood flow in a vessel or artery or when a blood vessel breaks.

There are two types if brain attack- they are chemic and hemorrhagic. When brain cells die during a stroke, abilities controlled by that area of the brain are loss.

These abilities include speech, movement and memory. How a stroke patient is affected depends on where the stroke occurred in the brain and how much the brain was damaged.

According to medical records in Holy Rosary Hospital, Emekuku, Owerri, Imo State, cerebrovascular accident has been a common illness in adults, most especially in female. They recorded vascular accident between September 2017 to April 2018 as stated below:

September 2017            –                   2

October 2017                 –                   1

November 2017            –                   2

December 2017            –                   3

January 2018                –                   Nil

February 2018               –                   2

March 2018                    –                   1

April, 2018                      –                   1

Objectives of the Study

• To give the client a better and clear understanding of cerebrovascular accident and its disease processes.
• To enlighten the client on some of the life modifications for people living with stroke like- assistive devices, to enhance self care after stroke.
• To create awareness to the public that cerebrovascular accident is preventable and educate them on ways of preventing it.
• To educate the public living with cerebrovascular disorder e.g hypertension on the need for adequate management and adherence to treatment regime, to avoid complications that may result to loss of function (neurologic function) and death.
• To enlighten the readers of this work especially students on the nursing and medical management of clients, suffering from cerebrovascular accident and ways of preventing it.

Significance of Study

• CUA are the number 1 cause of death globally: more people die annually, from C.U.A, than from and other cause
• An estimated 17.5 million people died from C.U.A. in (2012), resenting 31% of an global deaths in Nigeria.
• Most cardiovascular disease can be prevented by addressing behavior risk factors, such as tobaccos use, unhealthy diet, and obesity, physical inactively and harmful use of alcohol, using population wide – strategies.
• People with cardiovascular disease or who are at high cardiovascular risk (due to the pressure of one hyperlipidemia, or already established disease), need early detection and management using counseling and medicines as appropriate

Definition Of Terms

• Aneurysm: A weakening or bug in an arsenal wall
• Apraxra: inability, to perform previously learned purposeful motor act: on a voluntary basis
• Ataxra: impairment of coordinated movement often seen as a staggering gait or postural imbalance.
• Atherona: an abnormal mass of fatly material with a fibrous covering, existing in a disease raised plaque within the infima of artery.
• Dysarrthria: defect of articulation due to neurologic causes.
• Expressive aphasis: inability, to express oneself often associated with damage to the left frontal lobe area.
• Hemiphegia/hemiparesis: weakness or paralysis of one side of the body, or part of it, due to an injury to the motor area of the brain.
• Infarction: a zone of tissue deprived of blood supply.
• Korsa koff’s syndrome: personality disorder, characterized by
• Penumbra region: area of low cerebral blood flow.
• Receptive aphasia: inability to understand word some one else is saying; often associated with damage to the temporal lobe area.

ANATOMY AND PHYSIOLOGY OF THE BRAIN

The Brain

The brain constitutes above one-fifteen of the body weight.

Position: it lies within the article cavity.

The brain is divided into:

Cerebrum

Thalamus                                        the diencephalons

Hypothalamus

Mid brain

Pons

Medulla oblongata                           the Brain stems.

Cerebellum

CEREBRUM:

This is the largest part of the brain and it occupies the anterior and middle cranial fosses. It is divided by a deep cleft, the longitudinal cerebral tissue into right and left cerebral hemispheres. Each hemisphere of the cerebral i.e. divided into a lobe which takes the name of the bones of the cranium under which they lied, they are as following

• Frontal
• Temporal
• Parietal
• Occipital

The boundaries of the lobes are moved by deep suler, these are central sulci, lateral sucli and paricto occipital sulci.

Functions Of Cerebrum

1. Mental activities involved in memory, intelligence sense of responsibility, thinking, reasoning, moral sense and learning.
2. Sensory perception; including the perception of pain, temperature touch, signs, hearing, taste and smell.
3. Initiation and control of skeletal muscle contracting and therefore voluntary movement.

Thalamus

This consists of two masses of grey and white matter, situate within the cerebral hemisphere just below the corps callosum, one each side of the third ventricle. Sensory receptors in the skin and viscera sends information about touch, pain and temperature and input from special sense organs, transfers to the thalamus where is it recognized. The thalamus relays and redistributes impulses from most parts of the brain to the cerebral cortex.

Hypothalamus

The hypothalamus is a small but important structure which weighs about 7gram and consists of a number of Nuclei. It is situated below and in front of thalamus, immediately above the pituary glands.

Functions of the Hypothalamus

• It controls the output of hormones from both lobes of the pituary gland
• It controls appetite and satiety
• It controls thirst and water balance, body temperature, emotional reactions e.g. pleasure, fear.
• It controls sexual behavior and child rearing, sleeping and waking cycles.

MIDBRAIN

This is the area of the brain situated around the cerebral aqueduct between the cerebrum above the pins below. It consists of nuclei and nerve fibre which connects the cerebrum with lower parts of the brain and with the spinal cord. The nucleus acts as relay stations for ascending and descending news fibres.

PONS

The Pons is situated in front of the cerebrum below the mid brain and above medulla oblongata. It consists mainly of nerve fibres which forms a bridge between the two hemispheres of the cerebrum and of fibers, passing between the higher levels of the brain and spinal cord.

Medulla Oblongata

It extends from the point above and is continuous with the spinal cord below.  It is about 2.5cm long and it lies just within the cranium above the foreman magum.

It consists of both grey and white matters. The white matters are the fibres running to and for the cerebrum and spinal cord.

Functions of Medulla Oblongata

1. Cardiac Centers: controls the rate of heart beat, sympathetic and parasympathetic nerve fibres pass from the medulla to the heart.
2. The respiratory centre controls the rate and depth of respiration.
3. The vaso motor center control the diameter of the blood vessels, especially the small arteries and arteriories.

The Cerebellum

The cerebellum is situated behind the pons and immediately below the posterior cranial fossa. It is oval in shape and has two hemisphere, separated by a neurons median strip called the dermis.

Grey matter forms the surfaces of the cerebrum and white matter lies deep.

Functions of the cerebellum

1. It is concerned with the co-ordination of voluntary muscular movement, posture and balance.
2. It controls and co-ordinates the movement of various groups of muscles, ensuring smooth even and precise actions.
3. It co-ordinates activities associated with maintenance of the balance and equillibrum of the body.

BLOOD SUPPLY AND DRAINAGE 

The supply of blood to the head arises from the left and right common carotid arteries. These supply blood to the anterior part of the brain and the vertebral arteries supply the posterior part.

The greater part of the brain is supplied with blood by the circle of Willis on unusual configuration of anatomized blood vessels, located in the base of the brain.

Venous drainage is by small veins in the brain stem and cerebellum and external and internal veins, draining the cerebrum, some of the external and internal veins, empty into one lalrge vein, called the vein of Galen (Great cerebral vein).

Unlike other parts of the body, these veins do not correspond with their arterial supply. All these vein, empty directly into a system of venous sinuses. The principal sinuses, are the superior and inferior sagittal, the straight transverse sigmoid and cavernous sinuses.

Pages:  48

Category: Project

Format:  Word & PDF               

Chapters: 1-5                                          

Source: Imsuinfo                                     

Material contains Table of Content, Abstract and References.