PATTERN FOR CASE PRESENTATION

I. Introduction

A cerebrovascular accident (CVA), commonly known as a stroke, occurs

when there is a loss of blood flow to part of the brain. This happens when a blood
vessel in the brain is blocked or bursts, leading to a lack of oxygen and nutrients to
the brain cells. Without proper blood flow, brain cells start to die within a few
minutes, causing lasting brain damage, long-term disability, or even death. It is
considered a medical emergency, and immediate medical treatment is crucial. A
stroke happens when there is a loss of blood flow to part of the brain. Brain cells
cannot get the oxygen and nutrients they need from blood, leading to their death.
Strokes can cause lasting brain damage, long-term disability, or death. It is important
to seek immediate medical treatment for a stroke. Treatment for a stroke may include
medication, medical procedures, or rehabilitation. Prevention measures for strokes
include maintaining a healthy lifestyle, managing risk factors such as high blood
pressure and diabetes, and seeking medical help for underlying conditions.

II. Objectives:

General
To be knowledgeable about the causes, risk factors, symptoms, treatment, and
prevention of cerebrovascular accidents. By the end of presentation, we want to have
a clear understanding of what a CVA is, its impact on individuals and society, and the
importance of early detection and appropriate medical intervention.

Specific Objective

a. Objective : To raise awareness about the modifiable risk factors of cerebrovascular

accidents (CVAs) and empower everyone to make lifestyle changes for stroke
prevention.

b. Objective 2: To enhance the understanding of the different types of CVAs and their
respective causes, symptoms, and treatment approaches.

c. Objective 3: To emphasize the importance of early recognition and prompt medical

intervention in improving outcomes for individuals experiencing a CVA.

III. Health Profile

a. Personal Profile
- Includes name, age, date of birth, address, and occupation
b. Admission profile
- Admitting diagnosis
- Chief complaint
- Brief health history of the complaint
- Doctor’s physical examination
- Final Diagnosis
c. Medical Health History
- History of confinement and previous ailments/disorders/diseases
- Include the month and year of confinement/ailment/disorder/disease
- Previous/Regular/Maintenance drugs/medication taken
d. Family health background
- A flow chart/family tree showing disorders/diseases of the parents and
grandparents
e. Nutrition/Diet History
- Includes a 24-48hours food recall and the usual diet of the patient before
confinement
 f. Diagnostic examinations/procedure
- All laboratory and Diagnostic findings of the patients
- Include correlation to the current disorder/disease of the patient
g. Physical Examination
- Cephalo-Caudal examination
IV. Review of the Disorder
a. Review of Anatomy and Physiology
- Anatomy and Physiology of the organ/s involved in the disorder

Cerebrovascular accidents (CVAs) affect the brain, which is a vital organ responsible for
controlling various bodily functions. The brain consists of several key regions, including
the cerebrum, cerebellum, brainstem, and basal ganglia. These regions work together to
regulate movement, speech, cognition, and other essential processes.

Blood vessels play a crucial role in the brain's functioning. Arteries supply oxygenated
blood to the brain, while veins carry deoxygenated blood away. Capillaries facilitate the
exchange of oxygen, nutrients, and waste products between the blood and brain tissue.
The blood-brain barrier acts as a protective barrier, preventing harmful substances from
entering the brain.

b. Review of Disease Entity

- A brief discussion of the Definition, Cause, Signs and Symptoms, Risk
Factors, and Complication of the disease/disorder
Definition:
A cerebrovascular accident (CVA), commonly known as a stroke, refers to a sudden
disruption of blood flow to the brain, leading to brain cell damage or death. There are two
main types of strokes: ischemic stroke and hemorrhagic stroke. Ischemic strokes occur
when a blood clot blocks a blood vessel in the brain, while hemorrhagic strokes result
from the rupture of a blood vessel, causing bleeding in the brain.
Causes:
The causes of CVAs can vary. Ischemic strokes often result from atherosclerosis, a
condition characterized by the buildup of plaque in the arteries, leading to narrowed or
blocked blood vessels. Hemorrhagic strokes can be caused by conditions such as high
blood pressure, aneurysms, arteriovenous malformations (AVMs), or head trauma.
Signs and Symptoms:
The signs and symptoms of a CVA can vary depending on the affected area of the brain.
Common signs and symptoms include sudden weakness or numbness in the face, arm, or
leg, especially on one side of the body. Other symptoms may include difficulty speaking
or understanding speech, severe headache, dizziness, loss of balance or coordination, and
vision problems.
Risk Factors:
Several risk factors increase the likelihood of experiencing a CVA. These include age
(risk increases with age), high blood pressure, smoking, diabetes, high cholesterol levels,
obesity, a family history of strokes, previous history of strokes or transient ischemic
attacks (TIAs), atrial fibrillation, sedentary lifestyle, excessive alcohol consumption, and
illicit drug use.
Complications:
CVAs can lead to various complications depending on the severity and location of the
brain damage. Physical complications may include paralysis or weakness on one side of
the body, difficulty with coordination and balance, difficulty swallowing, and changes in
vision or speech. Cognitive complications can include memory loss, difficulty with
concentration and problem-solving, and changes in behavior or mood. Emotional
complications such as depression and anxiety are also common after a CVA.
c. Pathophysiology
 - A flow chart of the Pathophysiology of the disorder/disease showing how the
signs and symptoms being exhibit by the patient arises from the actual
disorder/disease
The pathophysiology of a cerebrovascular accident (CVA) involves the disruption of
blood flow to the brain, leading to brain cell damage or death. This interruption of blood
flow can occur through two main mechanisms: ischemic stroke and hemorrhagic stroke.

1. Ischemic Stroke:
In an ischemic stroke, a blockage occurs within a blood vessel in the brain, reducing or
completely cutting off blood supply to a specific area. This blockage can be caused by a blood
clot or a buildup of fatty deposits (plaque) in the blood vessels. The flow of pathophysiology in
an ischemic stroke typically follows these steps:

 Formation of a blood clot or plaque: Due to underlying conditions such as

atherosclerosis, a blood clot or plaque can form within a blood vessel in the brain.
 Reduced blood flow: The clot or plaque obstructs the blood vessel, leading to a
reduction in blood flow to the area of the brain supplied by that vessel.
 Ischemia: The reduced blood flow results in inadequate oxygen and nutrient
supply to the brain cells in the affected area.
 Energy failure and cell damage: Without sufficient oxygen and nutrients, brain
cells begin to experience energy failure, leading to cellular dysfunction and
damage.
 Inflammatory response: The lack of oxygen triggers an inflammatory response,
further damaging the surrounding brain tissue.
 Infarction: If blood flow is not restored promptly, irreversible tissue damage
(infarction) occurs, resulting in the death of brain cells.

Signs and symptoms exhibited by patients with an ischemic stroke can vary depending on the
location and extent of the brain damage. Common signs and symptoms include sudden weakness
or numbness on one side of the body, difficulty speaking or understanding speech, vision
problems, severe headache, dizziness, and loss of balance or coordination.

2. Hemorrhagic Stroke:
In a hemorrhagic stroke, bleeding occurs within the brain due to the rupture of a blood
vessel. This bleeding can be caused by conditions such as high blood pressure,
aneurysms, or arteriovenous malformations. The flow of pathophysiology in a
hemorrhagic stroke typically follows these steps:

 Rupture of blood vessel: A weakened or abnormal blood vessel in the brain

ruptures, leading to bleeding within the brain tissue.
 Increased intracranial pressure: The bleeding results in an increase in pressure
within the skull, compressing the surrounding brain tissue.
 Disruption of blood supply: The increased pressure and bleeding disrupt the
normal blood supply to the brain, leading to ischemia in the surrounding areas.
 Toxic effects of blood: The presence of blood in the brain tissue causes toxic
effects, damaging the brain cells further.
 Inflammatory response: The release of inflammatory mediators triggers an
inflammatory response, contributing to additional damage.

Signs and symptoms exhibited by patients with a hemorrhagic stroke can include a sudden and
severe headache, nausea and vomiting, seizures, decreased level of consciousness, and
neurological deficits such as weakness, numbness, or paralysis on one side of the body.

V. Nursing Care Plan

 - Problem management with the use of the Nursing Care Process in a tabulated
form
- Should include all the problems manifested by the patients minimum of 4
problems
VI. Review of Drugs(Pharmacology)
- A tabulated review of the drugs used in the treatment of the patient’s
disorder/disease

- Includes Generic Name, common Brand Name, Classification, Dosage,

Available preparation and stocks, Indication, Contraindication, Side Effects,
Pharmaco-Kinetics, Pharmaco-Dynamics, Nursing Responsibilities
VII. Discharge Plan
a. The use of M.E.T.H.O.D.
- M – Medication (Home)
 Generic name, Brand name (if applicable), Dosage, and Frequency
- E – Environment
 What environment is conducive for patient’s recovery?
- T – Treatment
 All treatments that the patient will undergo for full recovery after
hospitalization
- H – Health teaching
 A health teaching plan for the patient and relatives
- O – Out-Patient Referrals
 All the out-patient referrals for the patient
 Also includes date and time of follow-up check ups
- D – Diet
 Diet prescribed for the patient at home
 Includes all the possible foods the patient can have and the list of
foods that the patient is to avoid
VIII. Evaluation
 Narrative evaluation of the objectives
In this case presentation, our objectives were to effectively communicate and present a
comprehensive understanding of CVA, its pathophysiology, clinical manifestations, diagnostic
evaluation, and management strategies. We aimed to engage and provide with valuable insights
into this neurological condition.

Successfully demonstrated a strong understanding of the pathophysiology of CVA by

explaining the mechanisms of cerebral infarction due to embolism. We discussed the formation
and travel of emboli, the subsequent blockage of blood flow, and the resulting damage to brain
tissue. We supported my explanations with relevant clinical examples.

We effectively described the clinical manifestations of CVA, including common

symptoms such as sudden weakness, speech difficulties, and visual disturbances. Furthermore,
we discussed the diagnostic evaluation methods used to confirm a CVA diagnosis, such as
imaging techniques (CT scan, MRI) and laboratory tests. We provided a clear and concise
overview of these aspects, ensuring the understood the importance of early detection and prompt
medical intervention.

We presented a comprehensive overview of management strategies for CVA, including

both acute and long-term approaches. We discussed the importance of time-sensitive
interventions, such as thrombolytic therapy or mechanical clot retrieval, in the acute phase.
Additionally, We highlighted the significance of secondary prevention measures, such as
lifestyle modifications, anticoagulant therapy, and rehabilitation programs, to reduce the risk of
recurrent strokes and improve patient outcomes.
 Throughout the presentation, we effectively engaged by incorporating visual aids, case
studies, and interactive elements. We received positive feedback on my ability to simplify
complex concepts, making them accessible to a diverse audience. Additionally, we successfully
answered questions and facilitated discussions, creating an interactive learning environment.

Overall, we successfully achieved our objectives in this case presentation about CVA. We
effectively communicated the pathophysiology, clinical manifestations, diagnostic evaluation,
and management strategies associated with CVA. We received positive feedback on my
presentation style and content. Moving forward, We will continue to refine my presentation
skills and stay updated on advancements in CVA management to deliver even more impactful
presentations.

IX. Recommendation
Student:

 Keep up with the latest research and advancements in the field of stroke
management. Stay updated on new treatment modalities, guidelines, and
research studies.
 Actively seek opportunities to observe and participate in clinical cases related
to stroke care. This can include rotations in stroke units or neurology
departments.
 Work on improving presentation skills, including voice modulation, body
language, and engaging the audience. Seek feedback from peers and mentors
to further refine communication abilities.
 Understand the importance of teamwork in stroke management. Collaborate
with healthcare professionals from different disciplines to gain a holistic
perspective on patient care.

Clinical Instructor:

 Offer specific feedback on the student's presentation, highlighting strengths

and areas for improvement. Focus on enhancing communication skills,
knowledge of CVA pathophysiology, clinical manifestations, and
management strategies.
 Support the student's efforts to stay updated with the latest research and
advancements in stroke care. Provide resources, recommend relevant
literature, and suggest continuing education opportunities.
 Offer guidance on career development in the field of stroke management.
Provide opportunities for the student to engage in research, quality
improvement projects, or specialized training related to stroke care.

School:

 Ensure that stroke education is incorporated into the curriculum, covering

topics such as pathophysiology, clinical manifestations, diagnostic evaluation,
and management strategies. Provide opportunities for hands-on training and
case-based learning.
 Encourage collaboration between different healthcare disciplines to promote a
team-based approach to stroke care. Offer interprofessional education
opportunities to enhance teamwork skills.
 Regularly review and update stroke management guidelines to ensure that the
curriculum reflects the most current evidence-based practices.
Hospital:

 Offer regular training sessions and workshops on stroke management for

healthcare staff, including nurses, doctors, and therapists. Emphasize the
importance of early recognition, diagnosis, and prompt treatment of CVA.
 Consider establishing dedicated stroke units or teams to ensure specialized
care for stroke patients. This can improve outcomes and enhance
interprofessional collaboration.
 Encourage participation in quality improvement projects related to stroke care.
Foster a culture of continuous improvement and evidence-based practice.

References/Bibliography

American Heart Association - Stroke Guidelines

Primary Care of Adult Patients After Stroke: A Scientific Statement - AHA Journals
AHA/ASA Stroke Secondary Prevention Guideline