caring for a stroke survivor june 2015 ms ng wai may advanced practice nurse [email protected]
TRANSCRIPT
Learning Objectives
• At the end of the session, you will be able to
Identify strategies to care of patient post stroke to
minimise complications
Verbalise stroke risk reduction strategies
Recognise stroke signs/ symptoms
Every Stroke is different
• Effects of stroke depends on
o Region of brain affected
o Size of area damaged by the stroke
o Functions that the area controlled
Let’s talk about some common post stroke complications
Swallowing Difficulties
Pneumonia
What You Can Do
• Sit out of bed for a meal and continue sitting for
30mins after a meal
• Place food on unaffected side of mouth
• Avoid straws
• Maintain good oral hygiene (before and after a meal)
What You Can Do
• Note tell-tale signs of swallowing problems Coughing Choking on saliva or food Pocketing of food Delay or absent swallowing reflex Drooling Wet voice
• Inform Dr and refer to a speech therapist
What You Can Do
• Follow speech therapist’s recommendations • modified diet • modified fluid consistency• special swallowing maneuvers
• Recognise swallowing problems/ fever
seek medical attention immediately
Malnutrition
What You Can Do
• Note factors that can cause malnutrition
Reduce consciousness
Swallowing difficulties
Poor oral care
Depression
Reduce mobility
Arm / facial weakness
Visual impairment
What You Can Do
• Remind survivors to visually scan their plate for leftover
food
• Use modified utensils if needed
• Avoid distractions during meal times
• Monitor weight
• Refer to dietitian when necessary
Bowel and Bladder
What You Can Do
• Maintain privacy
• Ensure enough fibre and fluid intake
• Move it!
• Clear bowels every 2 days if necessary. Use of
softeners, laxatives, suppositories, enemas when
necessary
What You Can Do
Urinary Incontinence: What You Can Do
• Drink more fluids in the day, reduce fluids from evening
onwards
• Offer toileting measures 2H in the day, 4H in the night.
Caution if high fall risk
• Watch for foul smelling / cloudy urine/ pain on passing
urine / fever inform the doctor
What You Can do
• Monitor Note usual times of urination and bowel movement Watch behaviour that shows need to urinate/ move
bowels
• Prompt & Redirect Prompt survivors to use toilet Encourage bladder control. Distract survivors
• Positive feedback When stay dry & uses toilet Manage incontinent episode without comments
Skin
Pressure Sores Common Sites
Stages of Pressure Sores
What You Can Do
• Pressure sores can be prevented
• Change position every 2 hours. Avoid excessive friction
• Keep skin clean and dry
• Special mattress may be used (air mattress)
• Observe areas that are high risk for skin redness
Bones/joints
What You Can Do
• Avoid pulling affected arm or shoulder
• Careful support / position of arm
What You Can Do
What You Can Do
• Stretch
• Orthosis
• Medications (oral or injection)
Deep Vein Thrombosis
What You Can Do
• Move it!
• Keep hydrated
• Observe for limb swelling (usually 1 side), fever, pain,
breathlessness
seek medical attention
Communication
What You Can Do
• Note discrepancies between verbal & non-verbal cues
• Do NOT assume that survivor is NOT intelligent
• Provide ample time. Be patient
• Be clear and concise
• Maintain eye level contact
• Pay Attention!
• Be creative e.g draw, write
What Can You Do?
• Decrease distraction e.g. loud radio/ TV
• Try using assistive technology
• If loss of language, provide closed-ended questions
Mood / Cognition
Depression
What You Can Do
• Know the survivor
• Communicate – ask how they are feeling
• Note signs/symptoms of depression
• Support survivor + tap on resources
• Encourage survivors to do things
• Encourage survivors to express grief/sadness
What You Can Do
• Set S.M.A.R.T goals
• Participate in rehab. Physical recovery = improvement in
mental health
• Involve survivors in daily activities with family & friends
• Seek professional help!
Cognitive Issues: What You Can Do
• Cognitive impairment (e.g. attention, orientation, memory etc)
can happen after stroke
• Get rid of any distraction
• Short simple instruction or list down tasks
• Memory training/ aid
• Seek professional help if there are behavioural issues
Falls
What You Can Do
• Attend physiotherapist’s / occupational therapist session
• Do not rush survivor
• Note visual neglect / loss
• Modify home when necessary
Stroke Prevention and Recognition!
Know your Numbers and Medications
• Medications and its potential side effects
• Blood pressure
• Cholesterol level
• Glucose level and 3 months control (HbA1c)
Conclusion
Relearning everyday tasks that survivors
has been doing for years can be frustrating.
Recognise and celebrate each success is the key to
SELF ESTEEM
Questions ??