case study on cerebrovascular accident.pptx

Cerebrovascular accident is also know as stroke

1. CASE STUDY. Prasad 19CK1T00 09 Pharm D Intern Prathista institute of pharmaceutical sciences

2. SUBJECTIVE EVIDENCE. A male patient of age 62 years is admitted in the department of neurology. Chief complaints: C/o forgetting incidence, left hand weakness, deviation of angle of mouth since 1 day. C/o slurred speech since 2 days. C/o incontinence of urine, fall from the bed. H/O present illness: C/o left hand weakness, slurred speech. C/o incontinence of urine.

3. Past medical history : Hypertension since 10 years, CVA 5 years back. Past medication history:Labetolol 100mg, Losartan 25 mg, Clopidogrel 75 mg. Family history: Father _Hypertension, Type 2 diabetes mellitus, Angina. Mother_Hypertension , Type 2 diabetes mellitus.

4. Allergies : Nill . Social history: Diet _ Mixed. Sleep_Irregular . Exercise _ Nill . Personal history:Nill .

5. OBJECTIVE EVIDENCE. Physical examination: A 62 years old male patient was admitted in general ward was semi_conscious and disoriented to time, place and surrounding. Systemic examination: CVS _ s1 s2 (+) RS _Bilateral air entry (+) Per abdomen _Soft CNS_Disoriented , semiconscious, Drowsy.

6. Vital signs: B.p_160/100 mmhg R. R_20 Cpm . P. R_128 Bpm. Temperature_Afebrile . PICCLE_ Negative. Provisional diagnosis- cerebrovascular accident (stroke).

7. LABORATORY INVESTIGATIONS. PARAMETERS VALUE NORMAL VALUE Hb (g/dl) 13.2 13-18 g/dl. TLC 8500 4000-11000 cells / cumm . PLATELETS 3.6 1.5-4.5 lakhs / cumm . TOTAL CHOLESTEROL 225 Less than 200 mg/dl. LDL 147 Less than 100 mg/dl. PT 10.5 11-15.8 sec. INR 0.6 0.8-1.2. GRBS 145 79-160 mg/dl.

8. RADIOGRAPHIC DATA. X-RAY-lung field is clear,cardiac size is normal. MRI SCAN-Mild to moderate acute infarct in right superior cerebral peduncle,infarct in bilateral middle and inferior cerebral peduncle. ANGIOGRAM-Bilateral internal carotid artery show intimal thickening.

9. ASSESSMENT. Confirmatory diagnosis: Based on the – Subjective evidence:Forgetting incidence ,left hand weakness. Objective evidence: Slurred speech,incontinence of urine. Laboratory evidence:Increased cholesterol,increased LDL,increased prothrombin time,increased INR, abnormality in MRI and abnormality in angiogram. The patient condition was confirmed as cerebrovascular accident(stroke).

10. ABOUT THE DISEASE. Stroke is defined as sudden onset of focal neurological deficit. Ischemic stroke occurs when blood supply to the part of the brain is interrupted (or)reduced , preventing brain tissue from getting oxygen and nutrients. The main cause of ischemic stroke is atherosclerosis (or) fatty deposits (Plaque) that line the bloodvessel .

11. GOALS OF TREATMENT. To minimize the signs and symptoms of stroke. Reduce ongoing neurologic injuryand decreased mortality and long-term disability. Prevent complications secondary to immobility and neurologic dysfunction. Prevent stroke recurrence. To maintain normal vitals. To improve quality of life and avoid fresh complaints. To provide non-expensive and effective treatment.

12. PLAN. PROGRESS CHART. Day-1: Patient was admitted with given complaints and kept under observation in ICU for 48 hrs and patient have c/o hematuria . DAY-2: All vitals are checked and no fresh complaints. Day -3: Patient became completely conscious ,vitals checked and reported complaints of constipation. Day-4: Slurred speech,mild dysarthria,N /O of blood in urine,headache,vomiting . Day-5: Requested for discharge.

13. BRAND NAME GENERIC NAME DOSE FREQUENCY DAY INJ.HEPARIN Heparin 5000U 1-1-1 Day 1-3 INJ.STROCIT Citicoline 250mg/ml 1-0-1 Day 1-3 TAB.COLIHENZ Citicoline 500mg 1-0-1 Day 4-5 INJ.LEVIPIL Levitriacetum 500mg 1-0-1 Day 1-4 TAB.ATORVA Atorvastatin 20mg 0-0-1 Day 1-5 TAB.BETALOC Metaprolol 25mg 1/2-0-1/2 Day 1-3 TAB.PANTOP Pantoprazole 40mg IV 1-0-1 Day 3-5 TAB.ECOSPRIN Aspirin 150mg 0-1-0 Day 3-4 SYP.POTKLOR Potassium chloride 15ml 1-1-1 Day 2-5 SYP.CREMAFIN Magnesium hydroxide,liquid paraffin. 30ml 1-0-1 Day 3-5

14. ABOUT DRUGS. INJ Heparin-To treat blood clots. ADR-Swelling of the face,breathing difficulty. INJ.Citicoline -Used to treat stroke,head injury,alzheimers disease,dementia . ADR-GI disturbances,hypotension,tachycardia . INJ.Levitriacetam -Used to treat seizures. ADR-Nasal congestion ,decreased appetite,irritability . TAB.Atorvastatin -Used to lower cholesterol and triglyceride levels in blood. ADR-Liver damage,kidney damage,muscle damage. TAB.Metoprolol -To treat high blood pressure. ADR-Shortness of breath,wheezing,tightening of chest.

15. TAB.Pantoprazole –Used to treat heartburn,acid reflux,GERD . ADR-Blurred vision,dry mouth,increased urination. TAB.Aspirin -Used to treat blood clots,muscle aches,fever . ADR- Nausea,vomiting,stomach pain. Syp.potassium chloride –Prevents and treats low levels of potassium in our body. ADR- Nausea,vomiting,diarrhoea,stomach pain.

16. Goals achieved: Disease progression is stopped and symotoms are improved. All vitals came to normal. Quality of life improved. Discharge medication: TAB. Clopidogrel-75 mg, 0-0-1, 3days. TAB.Atorvastatin-20 mg,0-0-1,6 days. TAB.Pantaprozole-40 mg ,1-0-1,6 days.

17. PATIENT COUNSELLING. Disease related- Cerebrovascular accident also called as stroke which is a condition in which the damage to the brain from interruption of the blood supply. Drugs related- Citicoline is used for stroke ,its a nerve protecting medicine,nourish and protect nerve cell. Heparin and aspirin is used to prevent blood clots. Atorvastatin is used to control the blood cholesterol.

18. LIFE STYLE MODIFICATIONS. Advised to take low fat ,low salted food. Reduce fatty meat,egg yolk,liver . Increase intake of nuts ,seeds and dry beans. Increase and promote intake of vegetables and fruits like banana, carrot ,beetroot and apple etc... Follow up: Reviewed after 10 days. Consult the doctor if any problem persist.

19. THANK TOU