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Left Middle Cerebral Artery infarction - Coggle Diagram

- - - - The patient's relatives said. When the patient is mildly ill, he or she will buy medicine to eat But if the symptoms are very severe, they will come to the hospital. Underlying disease hypertension Continued treatment, lack of medication for 5 years, DLP and IHD continued treatment. And knowing that he had (Atrial fibrillation) received cardiac catheterization in 2017, denied the use of drugs. Refuse to drink alcohol Smoking and decoction set.
    - - Cannot breathe on their own, put ET-tube connected to ventilator, limbs weakness, fatigue, unable to take care of their own health. Relying on help from nurses and nursing students.
    - - Patients self-care Deficit
  - - - Relatives said that the patient likes to eat salty, greasy food, but when he knows he has an underlying disease, he eats tasteless food, eats 3 meals on time, doesn't like food, pungent smell, doesn't find symptoms of chewing, difficulty swallowing, drinks 2000 ml / day.
    - - retained NG-tube for feed BDR (1:2:1) 250 ml x 4 feed feed+water 50 ml./feed , feed accept. no content No symptoms of choking
      - Received energy from BDR = 250x1.2x4 = 1,200 kcal
      - Nutrient energy ; BEE = 665.1+ (9.6x60) + (1.8x152) – (4.7x73) = 1,514.7–343.1 = 1,171.6 kcal/day
      - DTX 12.00 = 120 mg%
    - - Neutrophil 70 Cells/ul
      - Lymphocyte 19 %
      - Monocyte 7 %
      - Eosinophil 3 %
      - Basophil 1 %
      - Albumin 2.6 g/dL
      - Potassium 3.6 mmol/L
      - Magnesium 1.9 mmol/L
    - - Not getting enough nutrients to meet the needs of the body
  - - - Urine 3-4 times a day, clear yellow, no blood, no burning, scrub 1 time a day in the morning.
    - - 03/08/63 off foley cathter at 9:30 am, but the patient does not urinate. It makes the patient come back again.
        
        04/08/63 Retain foley cathter patients clear yellow urine. No sediment or blood in about 300 cc.
      - Intake / Out put
        
        03/08/63 Intake 1600 cc Out put 1275 cc
        
        04/08/63 Intake 1280 cc Out put 1000 cc
    - - BUN 12 mg/dL 6-20
      - Cr 0.90 mg/dL 0.51-0.95
      - GFR(MDRD) 61.38 MI./min
      - GFR(CKD-EP) 63.64 MI./min
    - - Does not excrete urine
  - - - The patient is unable to daily activitiesand right arm and leg is weakness,on ET-tube with O2 T-piece, Switch ventilator after off tube No dyspnea RR=18 bpm. PR= 64 bpm. O2 sat 100 %
      - ADL = score 0 (very low initial ) Braden score = score12 (risk pressure sore)
      - Assessment q 8 hr.
      - 04/08/63 : On O2 Ventilator mode CPAC PEEP=5 cmH20 , FiO2 = 30% , RR = 18 bpm
      - 05/08/63 : off ET-Tube at 9.20 o'clock On Air vo 10 bpm , Success weaning for off ET-tube (after off ET-tube the patient not dyspnea respiratory RR= 15-18 bpm.)
    - - HEENT: not pale conjunctiva , pupil 2+ mm.
      - Heart: RR 18 bpm, regular HR , Rhythm , Pulse amplitude grade 3 , No murmur, EKG show AF with Rapid VR rate 140-160 bpm
      - Lung: mild dyspnea, fine crepitation at Rt. Lower lung
      - Extremities: no pitting edema
      - Motor Power :Right Arm and Leg=grade 3,Left Arm=grade 4 ,Left Leg=grade 3
    - - Sputum AFB day 1-3= NO AFB seen
      - RBC =3.84 ul. (4.5-6)
      - Hb=11.5 g/dl. (12-16)
      - Hct=33.5% (37-47)
      - Lymphocy=19% (20-40)
    - - 1.AF.
      - The patient is unable to daily activity.
      - Unsuccessful weaning of ventilator.
      - Dyspnea respiratory.
      - Sputum is bloody.
      - Risk of pressure sores.
      - Phlebitis along the limbs.
      - Right arm and leg is weakness
      - 9.Paleness.
      - Risk of hypoxia.
  - - - conscious is Alert and sensory evaluation (Hearing, smells , touch,could ,hot) is normal,The right Eye Twitching
    - - LOC= Alert
      - GCS = E4VtM6
      - Motor Power= Right Arm and Leg=grade 3,Left Arm=grade 4 ,Left Leg=grade 3
      - NIHSS = score 15
      - Pupil = Rt.2+ , Lt. 2+
    - - -CT brain Non contrast: Hypo density lesion at Lt. fronto-parietal area with loss of sulci and gyri no herniation with Lt. MCA infarction
    - - The right arm and leg is weakness.
      - Risk of seizures.
      - The perfusion to the brain is Decrease.
      - Risk of Increased intracranial pressure (IICP)
      - Risk of a change in consciousness
- - - - Atrial Fibrillation (pulse140-150 bpm.)
        
        Heart contractions are ineffective and Decrease preload
        
        blood clot at Left Atrial Appendage
        
        acute disruption of blood flow
        
        chronic low perfusion
        
        ischemic stroke
        
        1 more item...
- - - - Cordarone 150 mg. + 5%D/W 100 ml. v in 15 min.
  - - - The mattress should be an air mattress Or a tight mattress or a thick mattress
      - Clean sheets, not damp The tension is not wrinkled or creased.
      - Take care of the patient's body posture to ensure proper posture of head, shoulder, hip joint.
      - In the supine position, place the position using the cloth roll. Insert the outside of the hip
      - Turn over or change the patient's position every 2 hours