Case presentation on hemiplegia

Hemiplegia is paralysis of one side of the body caused by damage to spinal chord or to the brain, mostly seen in cva patients

1. CASE PRESENTATION ON HEMIPLEGIA PRESENTED BY: P. Vigneswari Y17PHD0821. IV/VI PHARMD NIRMALA COLLEGE OF PHARMACY 1

2. Hemiplegia is a condition  caused by brain damage or spinal cord injury  that leads to paralysis on one side of the body. HEMIPLEGIA 2

3. SUBJECTIVE DATA A 52 yrs old female patient was admitted in hospital with chief C/o left sided weakness and drowsiness. She had past history of HTN+DM on medication. She had undergone CABG 3 grafts a month ago. Her bowel and bladder habits are normal with normal appetite. She had no social and familial histories . 3

4. . Physical examination-. Systemic- Conscious. CVS - S1S2 +
Temperature- 98 c RS - B/L VBS + BP - 140/90 mm of hg. P/A - Soft
PR - 86 beats/min
SPO2- 100% Provisional diagnosis- Left hemiplegia 4

5. OBJECTIVE DATA Lab investigations- S.NO PARAMETER OBSERVED VALUE NORMAL RANGE 1. Serum sodium 120 mEq /L 135-145 mEq /L 2. Serum potassium 4.2 mEq /L 3.6-5.2 mEq /L 5

6. Radiographical investigations CT brain- Left infracts in right fronto , parietal and occipital bone. Chronic infarcts in left thalamo capsulo ganglionic regions and corona radiata . Large chronic infarct in left cerebellum 6

7. ASSESSMENT Based on the subjective and objective data, the final diagnosis was found to be HEMIPLEGIA. Definition : It is the severe/ complete loss of motor function on one side of the body. ETIOLOGY : CVA 7

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9. PATHOPHYSIOLOGY Brain is deprived of O2 Results in death of neurons Corticospinal tract is damaged and thus injury develops on the other side of the body (Depending on the site of lesion , severity of the condition varies) 9

10. CLINICAL PRESENTATIONS 10

11. STANDARD TREATMENT Physiotherapy Occupational therapy Psychotherapy 11

12. PLAN GOALS- To get symptomatic relief To avoid further complications To suppress the disease progression 12

13. DRUG CHART S.NO BRAND GENERIC DOSE ROA FRE CATEGORY INDICATION 1. T.ARKAMIN Clonidine 0.1 mg p/o TID Alpha agonist To treat HTN 2. T.PANTOCID Pantoprazole 40 mg p/o OD PPI To treat GERD 3. T.TOLVAPTAN Tolvaptan 15 mg p/o OD V2 antagonist To treat hyponatremia 4. T.Met -XL Metaprolol 50 mg p/o BD B-blocker To treat HTN 5. T.ECOSPRIN GOLD Aspirin Clopidogrel Atorvastatin 75 mg 75 mg 20 mg p/o OD Anti-platelet Statin Prophylactic 13

14. PHARMACIST INTERVENTIONS DRUG INTERACTIONS : MAJOR - Clonidine x Metaprolol - Lowers BP & leads to slower HR Management: Monitor BP MINOR - Aspirin x Pantoprazole - Co-administration decreases the bioavailability of aspirin Management: Avoid combination 14

15. PATIENT COUNSELLING About disease- Plegia - weakness, hemi- one side Complete paralysis of one half of the body, including one arm and leg It is caused due to stroke, embolus, hemorrhage, head injury, infections, migraine syndrome 15

16. About drugs: Pantop - Administer 15-20 min before breakfast Tolvaptan - Avoid co-administration with grape juice Metaprolol - Avoid food ingestion 30 min before/ after administration 16

17. LIFESTYLE MODIFICATIONS Start an exercise plan Follow regular medications and checkups Reduce saturated fat and cholesterol Maintain sugar & BP levels Avoid stress 17