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HEMIPLEGIA

HEMIPLEGIA. Address : Riyadh / AL-Rawda area . Telephone Number : 01-4936381 . Date

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HEMIPLEGIA

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    1. HEMIPLEGIA PATIENT DATA : Name : SHAUKAT ABDULHAG . Age : 46 years old . Sex : Male . Nationality : Bangladeshi . Marital Status : Married . Education : Elementary School . Occupation : Driver . Religion : Muslim .

    2. HEMIPLEGIA Address : Riyadh / AL-Rawda area . Telephone Number : 01-4936381 . Date & Time of Admission : 15/4/1428 H At 9:30 PM . DIAGNOSIS ON ADMISSION : LF Hemiplegia and Hypertension .

    3. HEMIPLEGIA HEALTH HISTORY : Chief Complaint : 46 years old Bangladeshi male patient admitted to ER Complaining of weakness in left side since 2 hours . Present History : The patient has weakness & numbness in the LF side ( LF hand & LF leg ) since 2 hours associated with drowness & headache aggravated with movement . Past History : The patient had Hypertension since 2 years , Unknown history of allergy , No history of DM & cardiac disease .

    4. HEMIPLEGIA Surgical History : No surgical history . Family History : Heart disease : No family history of heart disease . Diabetic :His father has DM disease & HTN . Anemia : No family history of anemia . Respiratory Problem : His mother has COPD . T.B : No family history of T.B . Others : His older brother has HTN .

    5. HEMIPLEGIA PHYSICAL EXAMINATION : HEAD : Hair distribution , Texture within normal . FACE : Normal . Eye : Erythema , Weakness Eye movement . Teeth : Dental caries , Tartar . Ear : No discharge . Nose : Normal . Mouth : No facial palsy , Gingivitis , Redness . NECK : No Neck vein distended .

    6. HEMIPLEGIA RESPIRATORY : Dyspnea : Shortness of Breathing , Effort with breathing Wheezing : No Wheezing . Cough : No Cough . Sputum hemoptysis : No Sputum hemoptysis . HEART : Tachycardia . Bradycardia . Palpitation . Pain .

    7. HEMIPLEGIA ABDOMEN : Distended . Ascitis . Soft . Hard . LEGS : Varicose Vein . RT LF Swelling . Others : Weakness in left leg . GENITOURINARY : Dysuria . Polydipsia . Pain . Polyuria . Hematuria . Others :

    8. HEMIPLEGIA NEUROLOGIC : Memory . Numbness Paresthesia .( in LF side). Cognition . Others : Weakness .( in LF side ). PERSONAL & SOCIAL HISTORY : Alcoholic Caffeine : Not abuse Alcohol . Education Level : Elementary School . Sleep Pattern : He has Sleep Pattern Distribution .

    9. HEMIPLEGIA MEDICAL MANAGEMENT : Brain CT scan ( Abnormal ) . Blood test ( CBC,CHEM,PT,PTT,BS ) . ABGs test . Check vital signs . ASPIRIN, HEPARIN , ATENOLOL . INVESTIGATION : Blood CBC, U/E, BS, Bld. C/S

    10. HEMIPLEGIA

    11. HEMIPLEGIA

    12. HEMIPLEGIA

    13. NURSING CARE PLAN

    14. NURSING CARE PLAN

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