TRANSIENT ISCHEMIC ATTACK

A Case Study

Submitted by:

Nursing Students of
La Consolacion College-Pasig
 The Prayer
I pray you'll be our eyes, Sognamo un mondo senza più violenza
And watch us where we go Un mondo di giustizia e di speranza
And help us to be wise, Ognuno dia la mano al suo vicino
In times when we don't know Simbolo di pace e di fraternitÃ
Let this be our prayer,
When we lose our way La forza che ci dia
Lead us to the place, We ask that life be kind
Guide us with your grace È il desiderio che
To a place where we'll be safe. And watch us from above
Ognuno trovi amor
La luce che tu dai We hope each soul will find
I pray we'll find your light Intorno e dentro a sè
Nel cuore resterà Another soul to love
And hold it in our hearts Let this be our prayer
A ricordarci che Let this be our prayer
When stars go out each night Just like every child
L'eterna stella sei Just like every child
Nella mia preghiera
Let this be our prayer Need to find a place,
Quanta fede c'è Guide us with your grace
When shadows fill our day Give us faith so we'll be safe
Lead us to a place E la fede che
Guide us with your grace Hai acceso in noi
Give us faith so we'll be safe
Introduction
OBJECTIVES
General Objective

To conduct a thorough and comprehensive study about Mrs.

Purple’s disease to the data that was gathered by conducting a
series of research and interview
Specific Objective
To organize our patient’s data for the establishment of good background information

To analyze the family health history as well as the history of past and present illness for the knowledge of
what could be the predisposing factors that might contribute to the patient’s illness.

To differentiate the definitions of our patients complete diagnosis for better understanding.

To describe the current condition of our patient through the physical assessment.

To list several factors, signs and symptoms of Transient Ischemic Attack that are present or absent in our
patient.

To list the different orders of the physicians assigned to our patient together with their rationale for a general
knowledge of what consist of the medical management for transient ischemic attack.

To classify the different drug used by our patient so that we can identify its functions and purposes.

To construct a discharge plan following the method format.

To validate a prognosis according to a specific criteria.

To compose an over-all conclusion and recommendations about the case study.
THEORETICAL FRAMEWORK
 Dorothea Orem’s Self Care Theory
Self-Care activities an Individual performs independently throughout life to
promote and maintain personal well-being

Self-Care Deficit it identifies when and how much a nurse is needed in the care of the
patient. Nursing care is needed if there is a problem that prevents a
person from reaching their optimal health.

Nursing System 

Wholly Partial Supportive-

compensatory compensatory  educative 

●
nurse and client perform ●
nurse’s actions are to
care, client can perform
●
nurse provides selected self-care activities,
help the client
develop/learn their own
entire self-care but also accepts care done
self-care abilities through
by the nurse for needs the
for the client. client cannot meet knowledge, support and
independently encouragement.
Application to the Study
The application and the correlation of this study to Dorothea Orem’s
Self-Care Theory is when establishing a plan of care it is the
comprehensive assessment process which is used. Every aspect of
the patients well-being is discussed, their character traits, social
situation, environment, head to toe physical assessment using self-
care requisites, behavioral characteristics and past medical history.
Orem focuses on the patient; the need for nursing care is
established by the patients self-care deficits found during the
assessment process. Also, Orem scales down to actual nursing care
requirements for the patient, separate from other health-care
providers, creating autonomy for nursing as a profession.
PATIENT’S PROFILE
A. Personal History
B. Family Health and Illness History
C. History of Past and Present Illness
D. Physical Examination
NURSING ASSESSMENT
Anatomy & Physiology
CIRCULATORY SYSTEM
The circulatory system is a network
that carries blood throughout the
body.

•supplies the cells of the body with

the food and oxygen they need to
survive

•carries carbon dioxide and other

wastes away from the cells

•regulate the temperature of the

body and carries substances that
protect the body from disease

•transports chemical substances

called hormones, which help regulate
the activities of various parts of the
body
Heart It is a hollow, muscular organ
that pumps blood

>It consists of two pumps that lie

side by side. These pumps relax
when taking in blood and contract as
they send out blood
Arteries
>carries blood from the
heart

Veins
>returns blood to the
heart

Cappilaries
>extremely tiny vessels
that connect the
arteries and the veins
Blood >blood consists chiefly of liquid called plasma, and three
kinds of solid particles known as formed elements

3 Elements
1. Red Blood Cells
>carry oxygen and carbon dioxide throughout
the body

2. White Blood Cells

>helps protect the body from disease

3. Platelets
>release substances that enable blood to clot

>aid in preventing the loss of blood from

injured vessels
NERVOUS SYSTEM
>The nervous system is
a very complex system
in the body. It has many,
many parts.

>The nervous system is

divided into two main
systems, the central
nervous system (CNS)
and the peripheral
nervous system
PATHOPHYSIOLOGY
 Pathophysiology
Predisposing factors -age Precipitating factors
- cigarette smoking
-sex - Diabetes Mellitus
-history of TIA/stroke & HTN on the - thromboembolism
family - stress
- personal HTN -sedentary lifestyle

Thrombus

Decrease blood supply on the brain leads to hypoxia, thus

Ischemia occurs on the brain.

Short-term ischemia leads to temporary neurologic deficits or a TIA

 If blood flow is restored,

brain tissue will
reverse the damage
within minutes

if blood flow is not restored, brain tissue sustains irreversible damage

of infarction w/in minutes

the extend of infarction depends on the location and size of the occluded artery
and the adequacy of collateral circulation to the area it supplies

Ischemia quickly alters cerebral metabolism thus decrease cerebral perfusion

leading to further damage to the brain

Lead to damaging both hemispheres of the brain thus leading to paralysis of the body,
speech, and ECG changes of the heart

A cascades of biochemical processes occurs within minutes of cerebral ischemia,

thus membrane depolarization occurs

Results to influx of calcium and sodium

Leads to cytotoxic edema and cell death area The area of edema after ischemia may lead to
results; temporary neurologic deficits

Leads to secondary neuronal injury If edema subsides, client may regain some function
Internal Caroti d Artery
DIAGNOSTIC AND LABORATORY PROCEDURE
Hematology
Procedure Date Results Normal Values Analysis and
Ordered (Units in the Interpretation
Date Results hospital)
RBC 08/15/10 5.0 (Female) NORMAL
=4-4.5x10 g/l
(Male)
=4.5-6x10 g/l

WBC 08/15/10 7.9 5-10x10g/l NORMAL

Platelets 08/15/10 180,000 150,000-140,000 NORMAL

/mm3

Lymphocyte 08/15/10 0.18 0.25-0.35 NORMAL

Neutrophils 08/15/10 0.82 0.55-0.65 NORMAL

Hematology
Procedure Date Results Normal Values Analysis and
Ordered (Units in the Interpretation
Date Results hospital)

Hemoglobin 08/15/10 150 (Female) NORMAL

=120-140 g/l
(Male)
=140-170 g/l

Hematocrit 08/15/10 0.45 (Female) NORMAL

=0.37-0.46
(Male)
=0.4-0.48
Blood Chemistry
Procedure Date Results Normal Values Analysis and Interpretation
Ordered (Units in the
Date hospital)
Results

Creatinine 08/15/10 114 44-106 mmol/l HIGH

Increase creatinine may

indicate: Chronic
Glumerulonephritis, Congestive
Heart Failure, or Muscle
disease

Sodium 08/15/10 102 135-145mmol/l LOW

low level of blood sodium

means you have hyponatremia,
which is usually due to too
much sodium loss, too much
water intake or retention, or to
fluid accumulation in the body
(edema).
Blood Chemistry
Procedure Date Results Normal Values Analysis and Interpretation
Ordered (Units in the
Date hospital)
Results

Potassium 08/15/10 3.2 3.5-5.5 mmol/l LOW

Decreased levels of potassium
indicate hypokalemia
Glucose 08/15/10 5.43 3.89-5.83 NORMAL
mmol/l
Triglycerides 08/15/10 0.9 0.33-2.65 NORMAL
mmol/l
Cholesterol 08/15/10 5.05 3.63-5.28 NORMAL
mmol/l
HDL 08/15/10 1.32 Up to 1.56 NORMAL
mmol/l
LDL 08/15/10 3.30 Up to 3.36 NORMAL
mmol/l
BUN 08/15/10 35.3 15-50mg/dl NORMAL
Urinalysis

Procedure Date Ordered Results Analysis and

Date Results Interpretation

Urinalysis 08/15/10 Color: yellow The greater the

Specific Gravity:1.000 concentration of the
Sugar: negative abnormal substance
Albumin: negative (such as greatly increased
Appearance: slightly amounts of glucose,
turbid protein, or red blood
Reaction: pH 6.0 cells), the more likely it
  will be that there is a
Microscopic: problem that needs to be
Pus cells: 1-2 addressed.
Red Cells: 0-1
Epithelial cells: few
Mucus threads: rare
DRUG STUDY
Amlodipine
Drug Name Dosage Classification Indication Contraindication Adverse Effect Nursing
Responsibilities

250mg P.O OD Antiangi Hypertension, Contraindicated to CNS: Know

Generic: nals Chronic patients hypertensive 10R’s.
Headache,
Amlodipine Angina, to drugs. Assist
Vasospastic fatigue, patient
Angina dizziness, for any
Brand : Norvasc drug
allergies.
CV:
Edema Administer drug
which are ordered.
GI: Report to
Abdominal pain Nod for any drug
Muscoskeletal: effect and notify
Muscle physician.
pain Glucose
and Blood Pressure
Respiratory: Monitoring.
Dyspnea

Skin:
Rash
Furosemide
DRUG NAME DOSAGE CLASSIFICATION INDICATION CONTRAINDICATION ADVERSE NURSING
EFFECTS CONSIDERATION

GENERIC NAME Initially 1/2-1- acute pulmonary Sodium and Anuria vertigo, dizziness, Know 10 R’s
headache, Give preparation in
2 tab/day edema, edema, Chloride re-
Furosemide Hepatic coma & precoma paresthesia,
hypertension absorption at the the morning and
orthostatic
Maintenance: proximal and hypotension, early in the
BRAND NAME 1/2-1 tab/day Severe hypokalemia &/or
distal tubules and thrombophlebitis, afternoon to
hyponatremia abdominal pain,
Lasix the ascending prevent nocturia
20-40 mg hypokalemia,
loop of Henle Hypovolemia w/ or w/o anemiamuscle
IV/IM Watch for signs of
hypotension spasm
hpokalemia
Hypersensitivity to
furosemide or
sulfonamides
Salbutamol
DRUG DOSAGE/ CLASSIFICATION INDICATION CONTRAINDICATION ADVERSE NURSING
NAME FREQUENCY/ REACTION RESPONSIBILITY
ROUTE

Used as a Contraindicated with CNS: BEFORE:

GENERIC Dosage neb Beta- 2 receptors of nervousness, restlessness, ~Assess lung sounds,
NAME 1cc + 2cc of bronchioles by bronchodilator in hypersensitivity to tremor, headache, pulse, and blood
Salbutamol PNSS increasing the management albuterol; insomnia. pressure before
Route: levels of cAMP of reversible airway tachyarrhyth-mias, administration and during
BRAND Inhalation which relaxes CV: chest pain peak of medication. Note
(nebulization) smooth muscles to obstruction caused tachycardia cause by palpitations, angina, amount, color, and
NAME
Ventolin Frequency: produce by asthma or COPD digitalis intoxication. arrhythmias, character of sputum
every 4 hours bronchodilation Hypersensitivity to hypertension. produced.
Used as a quick- Fluorocarbons GI: nausea, vomiting. ~Monitor pulmonary
relief agent for inhaler. Endo: hyperglycemia. function tests before
acute Neuro: tremor. initiating therapy and
periodically
bronchospasm and
throughout course to
for prevention of determine
exercise-induced effectiveness of
medication.
bronchospasm
DURING:
~Observe for
paradoxica
bronchospasm (wheezing). If
condition occurs, withhold
medication and notify
physician or other health
care professional
NURSING CARE PLAN
Discharge Planning
 Discharge Planning
M-Instructed the client to continue medication as ordered
1. Amlodipine 250mg P.O. 1tab/day as Maintenance (8am)
2. Furosemide 20mg P.O. 1 tab/day as Maintenance (8am)

E- Instructed the client to do Passive ROM exercises with the aid of a nurse:
Flexion-extension exercise the affected extremities to increase muscle strength.

T- Instructed the client to continue the medication as prescribed.

H-
1. Reinforce low salt, low fat diet.
2. Have ambulation with assistance and support as tolerated.
3. Compliance to medication must be observed religiously
4. Provide adequate rest period before, during, after activities

O- Instructed the client to come back for follow up check up 7days prior to discharge

D- Advised the client to a DAT Diet as tolerated but preferably low salt and low fat
PROGNOSIS