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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Physical Examination on Hydrocephalus

Definition

Hydrocephalusis a condition caused by an unbalanced production and absorption of cerebrospinal fluid within the ventricular system. When production is greater than absorption, cerebrospinal fluid accumulates in the ventricular system.

Causes
Causes of hydrocephalus include:

• Congenital abnormalities
  
• Infection
• Neoplasms
• Bleeding.

Physical examination on Hydrocephalus

Usually a myelomeningocele, head circumference measurements (Occipitofrontal)

On hydrocephalus obtained:

Early signs:

• Cockeye
• Headache
• Irritable
• Weary
• Cry if picked up, and silent when lying
• Nausea and vomiting is projectile
• See twins
• Ataxia
• Development was slow
• Pupillary edema
• Pupillary response to light is slow and not equal
• Usually followed: altered levels of consciousness, opistotonus and spastic in the lower extremities
• Difficulty in feeding and swallowing
• Cardio pulmonary disorders

Following Signs :

• Headache followed by vomiting
• Pupillary edema
• Strabismus
• Increased blood pressure
• The pulse is slow
• Respiratory disorders
• Convulsions
• Lethargy
• Nausea, Vomiting
• Extrapyramidal signs / ataxia
• Irritable
• Tired, weary
• Apathetic
• Confusion
• Often times incoherent
• Blindness

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