Stroke case study histrionics Vital signs

Types of stroke

1. CASE PRESENTATION ON
Acute Ischemic Stroke With
Right Hemiparesis.
Presented by,
Md Masiuddin
H.T. no : 15ED1T0015,
Pharm-D IV year.

2. DEMOGRAPHIC DETAILS:
NAME : XXX
AGE : 36years&3months
SEX : Male
ADDRESS : Warangal
IP NO : 13927
DOCTOR : Dr.Rajeev Rajan

3. REASONS FOR ADMISSION :
Sudden onset of Reduced Vision In the Right Eye,since 1 day.
Associated with Pain in Both Temporal Regions of Head.
Weakness of Left Upper and Lower Limbs,since 1 day.

4. PAST MEDICAL HISTORY :
Nill
FAMILY HISTORY : Nothing significant
SOCIAL HISTORY : Mixed diet,
alcoholic,
Non smoker.

5. VITAL SIGNS :
TEMP : 98.6ºF
BP : 130/80 mmHg
PR : 86beats/min
RR : 18/min
O/E :Patient was conscious and coherent.
P+, Iº, Cº, Cº , Eº
Moderately built.

6. GENERAL EXAMINATION :
CVS : S1 S2 +
RS : Clear
GIT : nil
CNS : nil
GU : nil
OTHERS : nil
ALLERGIES : nil

7. PROVISIONAL DIAGNOSIS :
Cerebrovascular Attack with Occipital
infarct.

8. DAY-1
TEMP :98.6ºF BP : 140/80 mmHg
PR :84beats/min RR : 18 /min
O/E : P+, Iº, Cº, Cº , Eº
C/O : Reduced Vision in Right Eye.
ADV : CT scan Brain and Pns,Hemogram,Lipid profile.

9. MEDICATIONS :
Normal saline -1 pint –TID
Inj Mannitol 100ml/IV/TID
Inj Pantoprazole/IV/OD
Tab Ecosprin 150mg/PO/OD
Tab Clopidogrel 75mg/PO/OD
Tab Atorvastatin 20mg/PO/OD
Tab A-Z/PO/OD

10. LABORATORY DATA

11. CBP
PARAMETER NORMAL RANGE PATIENT
HAEMOGLOBIN 12-18gm% 13.9gm%
RBC 3.6-6.0m/cmm 5.5m/cmm
TOTAL WBC 4000-11000cells/cmm7400cells/cmm
NEUTROPHILS 45-75% 64%
LYMPHOCYTES 20-45% 30%
EOSINOPHILS 1-6% 03%
MONOCYTES 1-9% 03%
BASOPHILS 0-1% 00%
RBC Normocytic

12. BIOCHEMICAL INVESTIGATIONS :
GRBS : 96 mg/dl (NR : Upto160mg/dl)
BLOOD UREA : 26 mg/dl (NR : 10-50mg/dl)
SERUM CREATININE : 1mg/dl (NR : 0.5-1.5mg/dl)

13. SERUM ELECTROLYTES :
PARAMETER NORMAL
RANGE
PATIENT
SODIUM 136-145mEq/L 140mEq/L
POTASSIUM 3.5-5.0mEq/L 3.9mEq/L
CHLORIDE 97-111mEq/L 108mEq/L

14. CT Scan of Head and Brain :
Acute Infarct Noted in Left Occipito parietal Region in
Parafalcine Location

15. FINAL DIAGNOSIS :
Acute Ischaemic Stroke with Right
Hemiparesis.

16. DAY WISE FOLLOW UP

17. DAY-2
TEMP :101ºF BP : 130/90 mmHg
PR : 52 beats/min RR : 21/min
O/E : Patient conscious and coherent
ADV : CST

18. DAY-3
TEMP :99ºF BP : 110/70 mmHg
PR : 82beats/min RR : 22 /min
O/E : Patient conscious and coherent
C/O : no new complaints
ADV : CST

19. DAY-4
TEMP :99ºF BP : 120/80 mmHg
PR : 91beats/min RR : 18/min
O/E : Patient conscious and coherent
C/O : no new complains
ADV : CST

20. DAY-5
TEMP : N BP : 130/80 mmHg
PR : 82beats/min RR : 18/min
O/E : Patient conscious and coherent
C/O : No fresh complaints
ADV : CST

21. SOAP NOTES

22. SUBJECTIVEEVIDENCE
Sudden onset of Reduced Vision In the Right Eye,since 1 day.
Associated with Pain in Both Temporal Regions of Head.
Weakness of Left Upper and Lower Limbs,since 1 day.

23. OBJECTIVE EVIDENCES
Pallor :+ve Hb: 13.9gm%
RBC : 5.5 m/cmm RBC : Normocytic
CT SCAN : Acute infarct Noted in Left occipito Parietal
Region in Parafalcine location

24. ASSESSMENT
Diagnosis :Based on the subjective and objective evidences the
diagnosis was made to be Acute Ischaemic Stroke with Right
Hemiparesis.
Etiology:Mixed diet,
caused by a Blocked Blood Vessel in the Brain.
Assessment if therapy is indicated : Yes therapy for this
patient is absolutely essential to prevent further complications.

25. Standard therapy
Category Drug Max.Dose
ANTI
CONVULSANTS
PHENYTOIN
LEVETIRACETA
M
10-20 or 1-2
mcg/L
500mg iv
every 12hrs
BETA
BLOCKERS
LABETOLOL 200-400mg
PO BID
Anti platelet Aspirin 150 mg po OD
Diuretics Mannitol 1.5-2gm/Kg
for 30-60mins

26. ASSESSMENT OF CURRENT THERAPY
DRUG DOSE FREQ ROA
INJ.PANTOPRAZOLE 40mg OD IV
INJ.MANNITOL 100ml TID IV
TAB ASPIRIN 150mg OD PO
TAB CLOPIDOGREL 75mg OD PO
TAB ATORVASTATIN 20mg OD Po

27. INJ.PANTOPRAZOLE :
CATEGORY : Proton pump inhibitor
INDICATION : it is indicated todecrease acid production.
DOSE : 40mg OD
SIDE EFFECTS :Headache,Facial edema,Chest pain,
Diarrhea.

28. Tab.Aspirin
CATEGORY :NSAID,Anti Pyretic,Anti Platelet.
INDICATION :It is used to treat or Prevent Heart attacks,
Stroke and Chest pain.
DOSE : 150mgonce daily.
SIDE EFFECTS :Hepatotoxicity,Trachycardia, Hypotension,
Chest pain.

29. INJ.MANNITOL
CATEGORY :Osmotic diuretic.
INDICATION :it is used to reduce Swelling and pressure
inside the eye or around brain.
DOSE : 1.5-2gms/kg/IV/
SIDE EFFECTS : hyponatremia, hypokalemia, hypochloremia,
hypovolemia.

30. Tab.Clopidogrel
CATEGORY :Anti platelet agent.
INDICATION :It is used to lower your risk of having a stroke,
blood clot, or serious heart attack.
DOSE :75mg once daily.
SIDE EFFECTS :chest pain,Head ache, arthralgia.

31. Tab.Atorvastatin
CATEGORY :lipid lowering agents.
INDICATION: It is used to treat high cholesterol and to
lower the risk of Stroke,heart attack etc.
Dose :20mg po once daily.
Side effects : Diarrhea, Nasopharyngitis,arthralgia.

32. PLANNING
DISCHARGE MEDICATIONS :
Atorvastatin -20 mg once daily at night after food.
Clopidogrel -75mg once daily.

33. MONITORING PARAMETERS
THERAPEUTIC MONITORING:
Haemogram
CT Brain
2D Echo
TOXICITY MONITORING :
No major toxicities found.

34. GOALS OF TREATMENT
GENERAL GOALS :
To reduce morbidity and mortality,
To improve quality of life,
To prevent and treat complications
PATIENT SPECIFIC GOALS :
Todecrease signs and symptoms like reduced vision
ToAvoid Complications of delirium and seizures

35. PATIENT CONSELLING :
ABOUT THE DISEASE :
Disease is in Acute stage.
Medication adherence is very important.
Missed dose should be taken within 45 mins,If not it should
not be taken, Double dose should not be taken at a time.
ABOUT THE DRUGS :
Tab.Atorvastatin : Taken once daily after food at night time

36. LIFE STYLE MODIFICATIONS :
Avoid Alcohol Consumption and smoking.
Be physically Active.
Decrease your stress level and Maintain a healthy weight.
Avoid foods like egg yolks,fatty meals,butter,cream which are
high in Fat and cholesterol.
Eat Moderate amount of food and cut down on saturated fat,
sugar and salt.
Eat fruits, vegetables, whole grains, and fat-free or low-fat
dairy foods. Whole grains include whole-wheat breads,
cereals, pasta, and brown rice.
Do not eat right before bedtime.