A case study of Right Middle Cerebral Artery Infarction

This for study purposes

1. A Case Study Presentation of Right Middle C erebral Artery Infarction Presentation By: Bamba, Mary Karen T.

2. Course title of description This presentation provides a comprehensive understanding of right middle artery infarction, a critical condition that can lead to significant morbidity and mortality. The student nurses will learn about the pathophysiology, clinical manifestations, diagnostic approaches, and treatment options for managing this complex medical condition. Right middle artery infarction occurs when the blood supply to the right middle cerebral artery is interrupted, leading to brain damage. This can cause various symptoms such as weakness, numbness, vision problems, cognitive difficulties, and behavioral changes. Early diagnosis and treatment are crucial to minimize brain damage and improve recovery.

3. INTRODUCTION

4. INTRODUCTION The right middle cerebral artery (MCA) is a major artery that supplies blood to a significant portion of the right hemisphere of the brain. It is one of the three main branches of the internal carotid artery. When the right MCA is blocked, it can lead to a right MCA infarction, which is a type of stroke. This occurs when the blood supply to the right side of the brain is interrupted, often due to a blood clot.

5. Signs and Symptoms of a Right MCA Infarction The specific symptoms of a right MCA infarction can vary depending on the exact location of the blockage. However, common signs and symptoms include: •Weakness or paralysis on the left side of the body: This is often the most noticeable symptom, as the right side of the brain controls the left side of the body. •Numbness or tingling on the left side of the body •Difficulty speaking or understanding speech •Problems with vision, including double vision or blurred vision •Sudden severe headache •Confusion or altered mental status

6. PATIENT’S PROFILE

7. PATIENT’S PROFILE & PATIENT’S HISTORY The patient was admitted at Butuan Doctors Hospital, Floor 2D on August 31, 2024 AT 1:50 pm, with a chief complaint of Stroke seen by attending physician Dr.D. Student nurse interview was conducted on August 4, 2024, 4 days after the patient was admitted at Butuan Doctors Hospital, Floor 2D. At 7pm, Received patient lying on bed; awake with IVF #6 PNSS IL with @ 80cc per hour, administered at the left arm. The patient is referred to as Patient E. a 87-year-old Female, born on August 29, 1937, residing in San Vicente, Jabonga, Agusan Del Norte Philippines. She stands 167.64 (5’6) cm tall, weighs 65 kg. Initial VS taken: T- 36.1 PR: 70 bpm RR- 20 bpm BP- 130/80, O2sat-98 Her residence is situated in a rural area and is constructed using concrete materials, providing adequate space for living. Patient E is a mother of 14 children. Patient E prefers seafood over vegetables and has no known food or medication allergies. having received full immunizations during childhood.

8. PHYSICAL ASSESSMENT

9. ANATOMY & PHYSIOLOGY

10. ANATOMY & PHYSIOLOGY Anatomy The middle cerebral artery (MCA) is one of the three major branches of the internal carotid artery. It supplies blood to a significant portion of the cerebral cortex, including the frontal, parietal, and temporal lobes. The right MCA specifically supplies blood to the right hemisphere of the brain. Physiology Normal blood flow to the brain is essential for proper brain function. When the MCA is blocked, blood flow to the areas it supplies is interrupted. This can lead to tissue damage or necrosis due to lack of oxygen and nutrients.

11. ANATOMY & PHYSIOLOGY The areas of the brain typically affected by a right MCA infarction include: Frontal lobe: Involved in higher cognitive functions such as planning, decision-making, and personality. Parietal lobe: Processes sensory information, including touch, temperature, and pain. Temporal lobe: Involved in hearing, language comprehension, and memory formation.

12. PATHOPHYSIOLOGY

13. DRUG STUDY

14. DRUG STUDY Name of Drug Route/Dosage/Frequency Mechanism of Action Indications & Contraindications Adverse Effects Nursing Responsibilities Name: Omeprazole Classification: Omeprazole is in a class of medications called proton-pump inhibitors. Patient’s Dose: 40 mg Frequency: OD Route: IV Treat certain conditions where there is too much acid in the stomach. To treat certain conditions Where there is two much and in the stomach) Ata It is Used to treat gastric and •Stomach cramps •Bloated •Fever •Nausea and vomiting •Advised patient to avoid alcohol and foods that may cause irritation

15. Name of Drug Route/Dosage/Frequency Mechanism of Action Indications & Contraindications Adverse Effects Nursing Responsibilities Generic Name: Apixaban Brand Name: rivaroxaban Classification: Oral anticoagulant Patient’s Dose: 5 mg Frequency : BID : Route: PO Inhibits factor Xa, a key enzyme in the blood clotting pathway Indications: Prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation Contraindications : •Active bleeding •Recent major surgery or trauma •Uncontrolled hypertension •Certain liver or kidney diseases •Bleeding •Bruishing • Anemia • Allergic reaction •increased risk of intra- cranial hem- orrhage. •Monitor for signs of bleeding •Assess platelet count and renal function as needed •Educate patient about signs of bleeding and avoiding injury •Advise patient to inform healthcare provider of new medications or supplements •Monitor for adherence to medication regimen

16. Name of Drug Route/Dosage/Frequency Mechanism of Action Indications & Contraindications Adverse Effects Nursing Responsibilities Name: NeuroAid Classification: Herbal supplement Patient’s Dose: 400mg Frequency: TID Route: PO Improves brain blood flow, reduces inflammation, promotes nerve growth. Indications: •Stroke •Traumatic brain injury •Traumatic Spinal Cord Injury •Alzheimer's, •cognitive decline. •Memmory loss Contraindications: •Pregnancy •breastfeeding •allergies •medical conditions. •Digestive issues, •headache •dizziness • Monitor for adverse reaction •Assess pt. medical history •Advice on proper usage

17. Name of Drug Route/Dosage/Frequency Mechanism of Action Indications & Contraindications Adverse Effects Nursing Responsibilities Name: Salbutamol Brand Name: Proventil Classification: Beta-2 adrenergic agonist Patient’s Dose: 1 Neb Frequency: Q 8 hrs Route: Inhalation Relaxes bronchial muscles, opens airways Indications: •Asthma •COPD •bronchospasm Contraindications : •Hypersensitivity •uncontrolled hyperthyroidism •Tremor •tachycardia •nervousness • Monitor for adverse reaction •Assess pt. medical history •Advice on proper usage

18. DIAGNOSTIC TEST

19. LABORATORY TESTS Laboratory Test Normal Values Patient’s Values Significance Complete Blood Count Hemoglobin Hematocrit RBC count WBC count Platelet count Segmenters Lymphocytes Eosinophils Monocytes Basophils Indices • MCV • MCH • MCHC Hgb: 12.0-16.0 Hct: 37-47 RBC: 4.2-5.4 WBC: 4.5-11 PLT: 150-45 Seg: 3 6-66 Lympho: 24-44 Eosino: 1-3 Mono: 4-6 Baso: 0-1 82-92 27-31 32-36 12.0 35.5 3.84 8.7 126 94 03 00 03 00 92.1 32.3 33.8 Normal Normal Low Normal Low High Low Low Low Normal Normal High Normal

20. LABORATORY TESTS Laboratory Test Normal Values Patient’s Values Significance ELECTROLYTES •Sodium • Potassium •Chloride mmol/L 134-145 nmol/ml 3.48- 5-5 mmol /L 96.0 -160 142.3 3.08 112.6 Normal Low Normal

21. RADIOLOGIC FINDINGS Exam Date: 2024-08-31 INTERPRETATION: Minimal haziness is seen in the right upper lobe. Vascular markings appear engorged. •Heart is enlarged. •Aorta is tortuous and calcified. •Trachea at midline. •Diaphragm and sulci are unremarkable. •Spurs are seen along the articular margins of the thoracic spine. •Bony thoracic cage is intact. IMPRESSION: •Consider PTB versus pneumonia right upper lobe. For clinical and bacteriologic correlation. •Cardiomegaly. •Atherosclerotic aorta. •Thoracic spondylosis.

22. NURSING CARE PLAN

23. DISCHARGE PLAN

24. Thank You