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					<h3 class="elementor-heading-title elementor-size-default">ACV ISQUÉMICO</h3>				</div>
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									<div class="para"><p>El accidente cerebrovascular <strong>ACV</strong> isquémico generalmente se produce por la obstrucción de una arteria que va al cerebro; la obstrucción es debida a la formación de un coágulo sanguíneo e/o a un depósito de grasa ateroesclerótico.</p></div><div class="para"><p>Los síntomas ocurren repentinamente y consisten en debilidad o astenia muscular, parálisis, pérdida de sensibilidad o sensibilidad anómala en un lado del cuerpo, dificultad para hablar, confusión, problemas en la vista, mareos y pérdida de equilibrio y coordinación.</p><script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-4254951495333536" 
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</script><div class="para"><p>El diagnóstico generalmente se basa en los síntomas y los resultados de la exploración física y en pruebas de diagnóstico por la imagen del cerebro.</p></div><div class="para"><p>Se realizan otras pruebas de diagnóstico por la imagen (tomografía computarizada y resonancia magnética nuclear) y análisis de sangre para identificar la causa del accidente cerebrovascular.</p><p>El tratamiento consiste en medicamentos para disolver coágulos de sangre o para reducir la probabilidad de que la sangre se coagule, y en procedimientos para eliminar físicamente los coágulos sanguíneos, seguidos de rehabilitación.</p></div><div class="para"><p>Las medidas preventivas incluyen el control de los factores de riesgo, los fármacos que hacen que la sangre sea menos propensa a coagularse, y a veces la cirugía o la angioplastia para permeabilizar las arterias bloqueadas.</p></div><div class="para"><p>Alrededor de un tercio de las personas afectadas recuperan la totalidad o la mayor parte de la funcionalidad normal después de un <strong>ACV</strong> accidente cerebrovascular isquémico.</p></div></div>								</div>
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									<h4>IDENTIFICACIÓN DEL PACIENTE</h4><p style="text-align: justify;">En enfermería el <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2021/02/23/proceso-de-atencion-de-enfermeria-pae/">PAE</a></span> contiene el nombre, rut, previsión, domicilio, hora de atención, sala, número de cama y establecimiento de salud en el cual es hospitalizada, pero en esta oportunidad no se indican por respeto a la intimidad de la paciente.</p>								</div>
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									<h4>CONTEXTO BIOPSICOSOCIAL</h4><p style="text-align: justify;">Mujer de 65 años, dueña de casa con estudios de enseñanza básica, activa hasta antes de sufrir el primer ACV. Vive junto a su familia y recibe cuidados de su hija.</p>								</div>
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									<h4>ANAMNESIS REMOTA</h4><p style="text-align: justify;">Paciente con antecedentes de <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2017/08/10/prevenga-ataque-cardiaco-y-acv/">ACV</a></span> (accidente cerebrovascular), dislipidemia e hipertensión arterial <a href="https://prevencionsaludproactiv.com/2017/08/20/hipertension-medidas-preventivas/"><span style="color: #3366ff;">(HTA</span></a>).</p><h4>HÁBITOS</h4><ul><li>Tabaquismo: no fuma.</li><li>Alcohol: no bebe.</li><li>Alergias: ninguna.</li></ul>								</div>
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									<h4>ANTECEDENTES FAMILIARES</h4><p>Madre hipertensa y padre diabético.</p><h4>MEDICAMENTOS EN USO</h4><p>Enalapril y losartan.</p><h4>ANTECEDENTES QUIRÚRGICOS</h4><p>Sin antecedentes quirúrgicos.</p>								</div>
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									<h4>ANAMNESIS PRÓXIMA</h4><p style="text-align: justify;">Paciente sexo femenino presenta en su domicilio un ACV, es trasladada por su hija al servicio de urgencia del hospital. A su llegada es atendida en el box por personal paramédico, controlando sus<span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2017/07/02/signos-vitales/"> signos vitales</a></span>, <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2020/06/29/control-presion-arterial-2/">presión arterial</a></span>: 160/ 110 mm/Hg, frecuencia cardíaca: 80 lpm, frecuencia respiratoria: 16 rpm, temperatura: 36.5°C, saturación SpO2: 88% ambiental y valoración neurológica, Glasgow 9, con hipoxia, hemiplejia en extremidades y paresia izquierda. Luego de ser evaluada por el médico, el cual indica <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2021/02/04/administracion-de-oxigeno/">administración de oxígeno</a></span> y realización de exámenes, es hospitalizada en el servicio de neurología.</p>								</div>
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									<h4>DIAGNÓSTICO MÉDICO</h4><p>ACCIDENTE CEREBROVASCULAR ISQUÉMICO (ACV).</p><h4>DIAGNÓSTICO CON DESCRIPCIÓN DE GENERALIDADES</h4><p style="text-align: justify;">Durante la tarde paciente sufre ACV llegando a urgencia acompañada de su hija. Consulta en box de urgencia, por cuadro de alrededor de 4 horas de evolución.</p><p style="text-align: justify;">Presenta cefalea sin pérdida del campo visual, disartria leve, paresia parcial y hemiplejia en extremidades superior e inferior izquierda.</p><p style="text-align: justify;">Por orden médica se realiza TAC encefálico, donde se obtienen resultados de lesión isquémica cerebral izquierda, quedando hospitalizada en el servicio de neurología del hospital.</p>								</div>
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									<h4>EXÁMENES</h4><p>Hemograma y TAC.</p><h4>INDICACIONES MÉDICAS</h4><h4>TRATAMIENTO</h4><p>
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	<td class="column-1">Atenolol</td><td class="column-2">Vía SNG x bolo</td><td class="column-3">Antihipertensivo</td>
</tr>
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	<td class="column-1">Losartan </td><td class="column-2">Vía SNG x bolo</td><td class="column-3">Antihipertensivo</td>
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	<td class="column-1">Fragmin</td><td class="column-2">Vía S/C x rotación</td><td class="column-3">Anticoagulante</td>
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	<td class="column-1">Berodual</td><td class="column-2">Vía inhalatoria x NBZ<br />
Vía respiratoria alta</td><td class="column-3">Antiasmático y broncodilatador</td>
</tr>
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	<td class="column-1">Glucanato de calcio</td><td class="column-2">Vía E.V inyectable</td><td class="column-3">Calcioterapia</td>
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<!-- #tablepress-17 from cache --></p><h4>OTRAS INDICACIONES</h4><ul><li style="text-align: justify;">Control signos vitales cada 6 horas con énfasis en SPO2.</li><li style="text-align: justify;">Administración de oxígeno.</li><li style="text-align: justify;">Sesiones de kinesoterapia.</li><li style="text-align: justify;">Nebulizaciones y administración de tratamiento medicamentoso.</li><li style="text-align: justify;">Alimento y H2O, vía SNG por BIC.</li><li style="text-align: justify;">Posicionar en posición Fowler y Semi Fowler a paciente para favorecer una adecuada oxigenación.</li><li style="text-align: justify;">Aseo nasal y orofaríngeo con SF.</li><li style="text-align: justify;">Cambios posturales y de posición.</li><li style="text-align: justify;">Lubricación de piel y acojinamiento en puntos de apoyo para prevenir UPP.</li><li style="text-align: justify;">Realizar contenciones y cambios posturales.</li><li style="text-align: justify;">Aseo genital y baño en cama.</li><li>Control de diurésis.</li><li><span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2021/04/03/perdidas-insensibles-y-balance-hidrico/">Balance hídrico</a></span>.</li><li style="text-align: justify;">Barandas en alto para prevenir caídas.</li></ul>								</div>
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									<h4>VALORACIÓN DESDE EL PUNTO DE VISTA DE ENFERMERÍA</h4><h4>EXAMEN FÍSICO GENERAL</h4><h4>Examen clínico:</h4><ul><li>Presión arterial: 160/ 110 mm/Hg, <a href="https://prevencionsaludproactiv.com/2017/08/20/hipertension-medidas-preventivas/"><span style="color: #3366ff;">hipertensa</span></a>.</li><li>Frecuencia cardíaca: 80 lpm, taquicárdica.</li><li>Frecuencia respiratoria: 16 rpm, eupneica.</li><li>Temperatura: 36.5°C, afebril.</li><li>Saturación SpO2: 88% desaturada.</li></ul>								</div>
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									<h4>Estado de conciencia:</h4><ul><li>Desorientada en tiempo y espacio.</li><li>Inquieta y confusa.</li><li>Glasgow: 9</li></ul><h4>Medidas antropométricas:</h4><ul><li>Peso: 65 kg.</li><li>Estatura: 1.58 cm.</li><li>IMC: 26.1</li></ul>								</div>
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									<h4>Estado nutricional: normal.</h4><p>IMC adaptado a la población adulta mayor (MINSAL).</p><p>Estado de nutrición normal: 23,1 a 27,9 (IMC).</p><h4>Alimentación:</h4><p>Vía SNG.</p><h4 style="text-align: justify;">Movilidad:</h4><p style="text-align: justify;">Dismovilizada, en reposo absoluto sin contenciones en extremidades superiores e inferiores, barandas en alto.</p><h4>Eliminación:</h4><p>Diuresis positiva.</p><h4>Deposición:</h4><p>Normal positiva.</p>								</div>
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									<h3>EXAMEN FÍSICO SEGMENTARIO</h3><ul><li style="text-align: justify;">Cabeza: normocráneo, sin lesiones.</li><li style="text-align: justify;">Cara: piel sana con paresia izquierda.</li><li style="text-align: justify;">Ojos: conjuntivas sanas, <span style="color: #3366ff;"><a style="color: #3366ff;" href="https://prevencionsaludproactiv.com/2021/04/08/respuesta-pupilar-en-valoracion-neurologica/">pupilas isocóricas</a></span>.</li><li style="text-align: justify;">Oídos: sin lesión aparente.</li><li style="text-align: justify;">Nariz: secreciones escasas, no presenta lesiones.</li><li style="text-align: justify;">Boca: cianosis peribucal, lengua saburral, mucosas húmedas, dentadura completa con disfagia y disartria.</li><li style="text-align: justify;">Cuello: móvil, sin adenopatías.</li><li style="text-align: justify;">Extremidades superiores: hemiplejía en extremidad superior izquierda.</li><li style="text-align: justify;">Fleboclisis: no presenta.</li><li style="text-align: justify;">Contención: sin contenciones.</li><li style="text-align: justify;">Tórax: buena expansión de caja torácica y pulmones, sin tos ni expectoración.</li><li style="text-align: justify;">Pulmones: ausencia de ruido bronquial y condensación.</li><li style="text-align: justify;">Abdomen: blando e indoloro.</li><li style="text-align: justify;">Zona genital: sin lesiones y limpia.</li><li style="text-align: justify;">Zona ilíaca: sin escaras.</li><li style="text-align: justify;">Columna y pelvis: sin lesiones.</li><li style="text-align: justify;">Extremidades inferiores: hemiplejia en extremidad izquierda.</li><li style="text-align: justify;">Piel: sana e hidratada.</li></ul>								</div>
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									<h3>GRADO DE DEPENDENCIA</h3><ul><li style="text-align: justify;">Desorientada en tiempo y espacio.</li><li style="text-align: justify;">Agitada, confusa, soporosa.</li><li style="text-align: justify;">Estado sensorial, audición y visión alterado.</li><li style="text-align: justify;">Dificultad para caminar e incorporarse, debilidad.</li><li style="text-align: justify;">Tiene historial de caídas.</li><li style="text-align: justify;">No está medicada con fármacos de acción a nivel del sistema nervioso central.</li><li style="text-align: justify;">Es mayor o igual a 70 años.</li><li style="text-align: justify;">Resultado: 5 puntos, dependencia total, escala de Barthel.</li></ul>								</div>
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									<h3>RIESGO DE ÚLCERA POR PRESIÓN</h3><ul><li style="text-align: justify;">Estado general: débil.</li><li style="text-align: justify;">Estado mental: confuso.</li><li style="text-align: justify;">Actividad: reposo absoluto.</li><li style="text-align: justify;">Movilidad: disminuida.</li><li style="text-align: justify;">Contenciones: sin contenciones en extremidades superiores e inferiores.</li><li style="text-align: justify;">Resultado: 8 puntos, alto riesgo de úlceras por presión, escala de Braden.</li></ul>								</div>
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									<h3>PLAN DE ATENCIÓN DE ENFERMERÍA</h3><h4>Problema N° 1</h4><p style="text-align: justify;">Alto grado de dependencia, hemiplejia en extremidades superior e inferior izquierda.</p><h4 style="text-align: justify;">Riesgo de hipoxia por la falta de irrigación sanguínea cerebral relacionada al ACV y con la posición decúbito. Riesgo de regurgitación y broncoaspiración que puede producir neumonía.</h4><p>
<table id="tablepress-30" class="tablepress tablepress-id-30">
<thead>
<tr class="row-1">
	<th class="column-1">Necesidad alterada</th><th class="column-2">Objetivos de la atención</th><th class="column-3">Acciones de Enfermería</th><th class="column-4">Evaluación</th>
</tr>
</thead>
<tbody class="row-striping row-hover">
<tr class="row-2">
	<td class="column-1">Oxigenación</td><td class="column-2">Lograr una adecuada oxigenación tisular.</td><td class="column-3">1. Realizar lavado de manos.<br />
2. Control de SV, P/A, T°C, SpO2, FR y FC.<br />
3. Realizar aseo de cavidades.<br />
4. Ubicar al paciente en posición Fowler y Semi Fowler, para favorecer la ventilación.<br />
5. Administración de oxígeno, según indicación médica.<br />
6. Colaborar en sesiones de kinesiología respiratoria.<br />
7. Realizar NBZ (nebulización), según indicación médica, aplicando los 5 correctos y los 4 yo.<br />
8. Administrar tratamiento medicamentoso, según indicación médica.<br />
9. Valorar dificultad respiratoria, hipoxia y oxigenación tisular.<br />
10. Valorar cianosis peribucal y pliegue ungueal.</td><td class="column-4">Paciente satura 96% ambiental.</td>
</tr>
</tbody>
</table>
<!-- #tablepress-30 from cache --></p><h4>Problema N° 2</h4><h4 style="text-align: justify;">Dificultad para deglutir por disfagia, riesgo de hipoglicemia y broncoaspiración por SNG.</h4><p style="text-align: justify;">
<table id="tablepress-31" class="tablepress tablepress-id-31">
<thead>
<tr class="row-1">
	<th class="column-1">Necesidad alterada</th><th class="column-2">Objetivos de la atención </th><th class="column-3">Acciones de Enfermería</th><th class="column-4">Evaluación</th>
</tr>
</thead>
<tbody class="row-striping row-hover">
<tr class="row-2">
	<td class="column-1">Alimentación e hidratación.</td><td class="column-2">Mejorar nutrición.</td><td class="column-3">1. Lavado de manos.<br />
2. Ubicar a la paciente en posición Fowler y Semi Fowler para prevenir neumonía y asfixia por regurgitación de contenido gástrico, (OVACE).<br />
3. Alimentación por vía SNG, BIC con previa medición de contenido gástrico.<br />
4. Control de temperatura post alimentación.<br />
5. Verificación del tipo de alimento y cantidad, según hoja de enfermería e indicaciones de nutricionista.<br />
6. Realizar cuidados de la sonda, que no se ocluya ni se acode.<br />
7. Administración de medicamentos por bolo y verificar permeabilidad de SNG.<br />
8. Colaboración a enfermera en instalación de SNG.<br />
9. Registro de tratamientos y medicamentos en hoja de enfermería.</td><td class="column-4">Paciente con buena tolerancia a tratamiento y alimentación.</td>
</tr>
</tbody>
</table>
<!-- #tablepress-31 from cache --></p><h4>Problema N° 3</h4><h4>Riesgo de incontinencia urinaria por enfermedad neurológica.</h4><p>
<table id="tablepress-32" class="tablepress tablepress-id-32">
<thead>
<tr class="row-1">
	<th class="column-1">Necesidad alterada</th><th class="column-2">Objetivos de la atención</th><th class="column-3">Acciones de Enfermería</th><th class="column-4">Evaluación</th>
</tr>
</thead>
<tbody class="row-striping row-hover">
<tr class="row-2">
	<td class="column-1">Eliminación</td><td class="column-2">Control de diuresis y prevención de globo vesical.</td><td class="column-3">1. Lavado de manos.<br />
2. Realizar aseo genital, cambio de pañal y ropa.<br />
3. Lubricación de la piel y cambios posturales, <br />
4. Medición de diuresis, registrar en cartilla miccional, cantidad, color y olor.<br />
5. Realizar balance hídrico.<br />
6. Registrar en hoja de enfermería.</td><td class="column-4">Diuresis positiva en pañal.</td>
</tr>
</tbody>
</table>
<!-- #tablepress-32 from cache --></p><h4>Problema N° 4</h4><h4 style="text-align: justify;">Riesgo de presentar úlceras por presión o escaras por reposo absoluto.</h4><p style="text-align: justify;">
<table id="tablepress-33" class="tablepress tablepress-id-33">
<thead>
<tr class="row-1">
	<th class="column-1">Necesidad alterada</th><th class="column-2">Objetivos de la atención </th><th class="column-3">Acciones de Enfermería </th><th class="column-4">Evaluación</th>
</tr>
</thead>
<tbody class="row-striping row-hover">
<tr class="row-2">
	<td class="column-1">Seguridad</td><td class="column-2">Conservar integridad de la piel.</td><td class="column-3">1. Lavado de manos.<br />
2. Verificar indicaciones médicas y cuidados de enfermería.<br />
3. Baño en cama y aseo genital.<br />
4. Realizar secado y lubricación de piel, especialmente en puntos de apoyo y acojinamiento de prominencias óseas para prevención de UPP.<br />
5. Realizar cambios de posición cada 5-6 horas.<br />
6. Verificar funcionamiento de colchón antiescaras.<br />
7. Realizar registro en hoja de enfermería.<br />
8. Evaluación: piel sana sin escaras.</td><td class="column-4">Piel sana, sin escaras.</td>
</tr>
</tbody>
</table>
<!-- #tablepress-33 from cache --></p><h4>Problema N° 5</h4><h4 style="text-align: justify;">Deterioro de la comunicación verbal, disartria por interrupción de la irrigación sanguínea.</h4><p>
<table id="tablepress-34" class="tablepress tablepress-id-34">
<thead>
<tr class="row-1">
	<th class="column-1">Necesidad alterada</th><th class="column-2">Objetivos de la atención</th><th class="column-3">Acciones de Enfermería</th><th class="column-4">Evaluación</th>
</tr>
</thead>
<tbody class="row-striping row-hover">
<tr class="row-2">
	<td class="column-1">Comunicación</td><td class="column-2">Lograr comunicación entre la paciente, personal médico, enfermería y familia.</td><td class="column-3">1. Lavado de manos.<br />
2. Verificar indicaciones médicas y cuidados de enfermería.<br />
3. Ayudar a comunicarse a la paciente con el personal y familia.<br />
4. Darle tiempo para que se pueda comunicar.<br />
5. Evitar que se sienta aislada.<br />
6. Realizar registro en hoja de enfermería.</td><td class="column-4">Logra comunicación.</td>
</tr>
</tbody>
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							<h4>Prevención en Salud Proactiva</h4> 
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							<p>Nuestra misión es proteger la vida y la salud de las personas, con enfoque en el entorno laboral. A través de programas especializados en primeros auxilios y maniobras críticas (RCP, DEA, SVB y Heimlich), educamos y capacitamos a personas y equipos para responder con seguridad ante emergencias. Además, garantizamos la continuidad y el bienestar organizacional mediante una gestión de riesgos alineada con la Ley 16.744 y los más altos estándares ISO.</p><div class="fa2752738c61f2593e5755f4d15b4d9c" data-index="2" style="float: none; margin:0px 0 0px 0; text-align:center;">
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2025/10/29/guias-aha-2025-para-rcp-y-ace-actualizaciones/" class="_blank" target="_blank" >Guías AHA 2025 para RCP y ACE Actualizaciones</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2022/05/12/rcp-en-tiempos-de-covid-19/" class="_blank" target="_blank" >RCP en Tiempos de COVID-19</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/02/01/fractura/" class="_blank" target="_blank" >Fracturas</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/11/27/fleboclisis/" class="_blank" target="_blank" >Fleboclisis</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/04/17/paciente-con-acv-isquemico/" class="_blank" target="_blank" >Paciente con ACV Isquémico</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/04/07/caso-clinico-pae/" class="_blank" target="_blank" >Caso Clínico PAE</a></h4>
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<h4 class="pt-cv-title"><a href="https://prevencionsaludproactiv.com/2021/04/03/importancia-de-los-electrolitos/" class="_blank" target="_blank" >Importancia de los Electrolitos</a></h4>
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Paciente con ACV Isquémico
