VII.

CONCEPT MAP

Admitting Diagnosis: Cerebrovascular Left Middle Cerebral Artery large territory infarct, and left frontal, temporal, parietal
area probably cardioembolic, T/C Acute Coronary Syndrome NSTEMI Killip I, Coronary Artery Disease, Hypertensive
Cardiovascular Disease, S/P CVD 2013, Cardiogenic Shock Etiology
Predispositing Factors: Precipitating Factors:

Age: 69 y.o Diet: had Humba for a week prior to admission

Sex: Male (more common in male than female) Alcoholic
Diagnosed with Cardiomegaly (2002) Sedentary Lifestyle
Smoker (age of 14 year 2002)
Past history of CVD (2013)
History of hypertension (2013)

Sudden peripheral vascular resistance

Blood Pressure

Injury to arterial wall (endothelial injury)

Desquamation of endothelial injury

Lipids (LDL) & Platelet assimilate in the area

Oxidized LDL attracts monocytes &

macrophages to site

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 Plaques begin to form
Slightly palpable and weak
pulses noted on lower Lipids are engulfed by the cells & smooth
extremities muscle cell develops
Weakness
Disruption of plaques
Lethargic
Slow pulses on Continuous aggregation of platelets
extremities
Thrombus formation

Decreased cardiac output related

to change in myocardial Rapid increase in size of thrombus in coronary
contractility as evidences by weak artery wall
and slightly palpable pulses on
Coronary Artery Disease

Vasoconstriction

Decreased blood supply to the myocardium Hypertrophy and hyperplasia of arterial smooth
muscles

Acute Myocardial Ischemia: NSTEMI, Killip I Cardiomegaly

Ineffective blood flow

Myocardial cell necrosis

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 Inflammatory response stroke volume, cardiac output Lactic acid is secreted

Release of endogenous pyrogens Impaired tissue perfusion Stimulates pain receptor

Pyrogens will stimulate the cellular oxygen supply

release of prostaglandins
Impaired cellular metabolism

Cardiogenic Shock

Moved thrombus from the vessel Ineffective cerebral tissue perfusion related
to the middle cerebral artery to reduction of blood flow as evidenced by
prolonged capillary refill 21
 Occludes middle cerebral artery

Decreased level of consciousness

Decreased blood flow to the left FTP
GCS of 7
Not oriented to place
O2 supply on left frontal,
temporal, parietal area Weakness noted
Speech abnormalities (only moans at
Cerebrovascular Infarct times when talked to)
Lethargic
Slow pulses on extremities

Chest X-ray Ineffective breathing pattern Administered oxygen 4.5 cc D5W + 250mg/5mL
Head CT Scan related to neurologic damage therapy via non- Dobutamine @10cc/hr (90
Blood Coagulation Test secondary to presence of rebreather mask at mcg/kg/min)
Blood Chemistry present condition 3mL/h uptitrate/downtitrate by 2
Complete Blood Count Impaired physical mobility related Inserted Foley Bag mcg/kg/min every 30 min to
to neuromuscular changes as Catheter maintain SBP > 110mmHg
Electrocardiogram
evidences by decreased level of Cholinerv 1 ampule IV
Cardiac Monitor
consciousness Midazolam 5mg IV
Totilac 100mL IV push

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Legends:

Predisposing Factors

Precipitating Factors

Disease Process

Diagnosis

Clinical Manifestations

Diagnostics / Laboratory Tests

Managements

Medical / Pharmacological Interventions

Nursing Diagnosis

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