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Thursday, September 6, 2012

Physical Examination and Investigations of Stroke

Physical Examination of Stroke
  1. The general state
    Awareness: Generally, decreased consciousness
    The voice spoke: Some disorders are difficult to understand, sometimes can not talk
    Vital signs: increased blood pressure, pulse rate varied.

  2. Examination of Integument
    Skin: If the client is less oxygen skin will look pale. If less fluid, it's ugly skin turgor. In addition, it should also be assessed signs of pressure sores, especially on areas that stand out as the client CVA Bleeding should bed rest 2-3 weeks
    Nails: Need to see a finger clubbing, cyanosis
    Hair: Generally no abnormalities

  3. Examination of the head and neck
    Head: Shape normocephalic
    Advance: Generally not symmetrical is lopsided to one side
    Neck: Stiff neck rare (Satyanegara, 1998)

  4. Examination of the chest
    In breathing audible breath sounds sometimes obtained ronchi, wheezing breath sounds or additional, irregular breathing due to decreased cough reflex and swallowing.

  5. Examination of the abdomen
    Obtained decrease intestinal peristalsis caused by bed rest periods, and sometimes there are bloated.

  6. Examination of inguinal, genital, anal
    Sometimes there incontinensia or urinary retention.

  7. Examination of the extremities
    Often obtained paralysis on one side of the body.

  8. Examination of neurology
    • Cranial Nerve
      Generally there is interference with cranial nerve VII and XII central.
    • Motor
      Almost always happens paralysis / weakness on one side of the body.
    • Sensory
      Hemihypesthesia can occur.
    • Reflex
      In the acute phase of physiological reflexes are paralyzed side will disappear. After several days of physiological reflexes will reappear didahuli with pathological reflexes.

Investigations of Stroke
  1. Radiological Examination
    • CT scan: hyperdense focal obtained, sometimes get in the ventricles, or spread to the brain surface. (Linardi Widjaja, 1993)
    • Magnetic resonance imaging (MRI) to show the area that experienced hemorrhagic. (Marilynn E. Doenges, 2000)
    • Cerebral angiography: to find the source of bleeding such as aneurysms or vascular malformations. (Satyanegara, 1998)
    • X-ray of the thorax: to show the state of the heart, whether there is an enlargement of the left ventricle, which is one sign of chronic hypertension in patients with stroke. (Jusuf Misbach, 1999)

  2. Laboratory Tests
    • Lumbar puncture: a red liquor inspection is usually found in massive bleeding, minor bleeding while liquor is usually normal color (xanthochromia) during the first days. (Satyanegara, 1998)
    • Routine blood tests
    • Chemical examination of blood: in acute stroke hyperglycemia may occur. Blood sugar can reach 250 mg in the serum and then gradually fell back. (Jusuf Misbach, 1999)
    • Complete blood count: fatherly look for abnormalities in the blood itself. (Linardi Widjaja, 1993)

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