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Case presentation on Cerebrovascular accident (Stroke)
- 1. CASE PRESENTATION ON HAMMADKC IV TH PHARM . D CEREBROVASCULAR ACCIDENT 1
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- 3. PATIENT DETAILS Name: XYZ IPID : IPID0062194 Age/Sex : 76/ Male Admission Date : 18.06.19 Department : Neurology (GW 5th floor) Weight : 70 Kg Discharge Date : 24.06.19 3
- 4. SUBJECTIVE EVIDENCES CHIEFCOMPLAINTS ON ADMISSION c/o forgetting incidence , left hand weakness , deviation of angle of mouth since 1 day c/o slurred speech since 2days H/O fall from the bed , Incontinence of urine PAST MEDICAL HISTORY k/c/o HTN since 20 yrs k/c/o CVA × 5 yrs back 4
- 5. PAST MEDICATIONHISTORY T.AMLONG 10 mg (amlodipine) T.LOSAR 25 mg (Losartan) T.DEPLATT 75 mg (clopidogrel) ALLERGY No allergy known 5
- 6. SOCIAL HISTORY Diet : Mixed Sleep : Irregular Exercise : nil FAMILY HISTORY father : k/c/o HTN, DM2, Angina Mother : k/c/o HTN , DM 2 6
- 7. PHYSICAL EXAMINATION 76 years old male patient was admitted in general ward (5th floor) was semi-conscious and disoriented to time , place and surrounding. SYSTEMIC EXAMINATIONS : CVS : S1 S2 heard R S : B/L Air entry (+) Per Abdomen : Soft CNS : Disoriented , semiconscious , Drowsy Local examination: Right UL/LL: 5/5 left UL/LL: 3/5 7
- 8. VITAL SIGNS B.P : 160/100 mmHg R.R : 20 cpm P.R : 128 bpm Temperature : Afebrile 8 OBJECTIVE EVIDENCES
- 9. LABORATORYDATA 9 PARAMETER VALUENORMAL VALUE Hb (g/dL) 13.2 13 – 18 g/dl pH 7.38 7.35 - 7.45 TLC 8500 4000 – 10000 cells/cu.mm Platelet 3.6 1.5 – 4.5 lakhs/cu.mm 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
- 10. RADIOGRAPHIC DATA X-RAY : lung field are clear , cardiac size is normal , osteoporosis seen in chest bone MRI SCAN : Mild to moderate acute infract in right superior cerebral peduncle , infract in bilateral middle and inferior cerebral peduncle. ANGIOGRAM : bilateral internal carotid artery show intimal thickening. 10
- 11. PATIENT ASSESMENT SUBJECTIVE EVIDENCE C/O forgetting incidence ,Deviation of angle of mouth, H/O fall from bed , H/O left hand weakness , H/O incontinent of urine , c/o slurred speech. Past medical and medication history evidences Systemic examination evidences like CNS Local examination of arms 11 OBJECTIVE EVIDENCE LAB investigation like BP, PR, Total cholesterol , PT, INR, LDL MRI SCAN : mild to moderate acute infract in cerebral peduncle ANGIOGRAM ; Bilateral internal carotid artery internal thickening
- 12. PATIENT ASSESMENT Based onthe subjective and objective evidence the patient was diagnosed with CEREBROVASCULAR ACCIDENT (CVA) 12
- 13. GOALS OFTREATMENT To minimize the signs and symptoms of stroke reduce ongoing neurologic injury and decrease 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 & avoid fresh complaints. To provide non-expensive & effective treatment. 13
- 14. PLANNING DRUG CHART 14 BRANDNAME GENERIC NAME DOSE FREQUENCY INJ.HEPARIN Heparin 5000U 1-1-1 Inj.STROCIT Citicoline 250mg/ml 1-0-1 T.COLIHENZ Citicoline 500mg 1-0-1 INJ.LEVIPIL levetiracetam 500mg 1-0-1 T.ATORVA Atorvastatin 20mg 0-0-1 T.BETALOC Metoprolol 25mg 1/2-0-1/2 T.PAN Pantoprazole 40mg IV 1-0-1 T.ECOSPRIN Aspirin 150mg 0-1-0 DAY Day 1 – 3 Day 1 – 3 Day 4 – 5 Day 1 - 4 Day 1 - 5 Day 1 - 3 Day 3 - 5 Day 3 - 4
- 15. DRUG CHART 15 BRANDNAME GENERIC NAME DOSE FREQUENCY Syp.POTKLOR Potassium chloride 15ml 1-1-1 Syp.CREMAFIN Mg(OH)² , Liquid paraffin 30ml 1-0-1 DAY Day 2 - 5 Day 3 - 5
- 16. PROGRESS CHART 16 DAY1 Pt. was admitted with given complaints and kept under observation in ICU for 48 hrs and patient have c/o hematuria DAY 2 All vitals checked and reported. No fresh complaints. DAY 3 Patient became completely conscious, vitals checked and reported Complaints of constipation DAY 4 Comprehension of speech Mild dysarthria No c/o blood in urine , headache , vomiting Requested for discharge
- 17. GOALS ACHIEVED Disease progression is stopped and symptoms are improved All vitals came to normal Quality of life improved. 17
- 18. PLANNING SUGGESTION TOPHYSICIAN Drug interactions 1. Heparin + Aspirin : result in potentiated risk of bleeding complication close monitoring with dose adjustment according to the INR reading. Relevant investigation like ECG and CT scan reports are not included. Frequency of the past medications is not provided. 18
- 19. PATIENT COUNSELLING Disease related : Cerebrovascular accident also called stroke which is a condition in which the damage to the brain from interruption of the blood supply. Pharmacotherapy related : Citicoline is used for stroke , it’s 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 (HMG CoA reductase 19
- 20. Life styleand diet modifications : advised to take low fat , slow salted food Avoid whole milk , try skim or non fat Reduce fatty meat , egg yolk , liver Increase intake of nuts , seeds , dry beans Increase and promote intake of vegetables and fruits like banana , carrot , beetroot, apple etc… Learn new ways of cooking like baking or broiling instead of frying 20
- 21. SUMMERY Pt. gotadmitted on emergency basis with chief complaints relevant investigation is done like chest X Ray , ECG , MRI scan , MRI Angiogram to confirm stroke. Hence treatment is started on basis of subjective and objective evidence with drugs like inj.LEVIPIL , INJ.STROCIT , T.ATORVA , T.DEPLATT etc.. Later patient improved symptomatically and discharged on following advise T.DEPLATT 75mg 0-0-1 3 days T.ATORVA 20mg 0-0-1 6 days T.PAN 40mg 1-0-1 6 days Review the doctor after 1 week in OPD 21
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