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NEUROSCIENCE

Recovering From a Stroke

RECOVERING FROM A STROKE | JOHNSON CITY MEDICAL CENTER | 1

TABLE OF CONTENTS

Symptoms of a stroke............................................................................................................................................. 2Types of stroke ......................................................................................................................................................... 3Conditions of hemorrhagic stroke ..................................................................................................................... 4Diagnosing a stroke with medical imaging ...................................................................................................... 5Carotid stenosis ........................................................................................................................................................ 6Review your risk factors ......................................................................................................................................... 7Managing your risk factors .................................................................................................................................. 8Your healthcare team .......................................................................................................................................... 13Recovery and rehabilitation ................................................................................................................................ 14Communication complications ......................................................................................................................... 15Swallowing changes................................................................................................................................................16Safely moving .......................................................................................................................................................... 17Walking again ......................................................................................................................................................... 18Your stroke discharge checklist ........................................................................................................................ 20Your medicine list ................................................................................................................................................... 22Important information about you .................................................................................................................... 23What to expect on the stroke unit ................................................................................................................... 26Stroke care at Mountain States ........................................................................................................................ 29Resources ............................................................................................................................................................... 30Notes ..........................................................................................................................................................................31

2 | JOHNSON CITY MEDICAL CENTER | RECOVERING FROM A STROKE

WHEN YOU’RE HAVING A STROKE, EVERY MINUTE COUNTS.

SYMPTOMS OF A STROKE

During a stroke, normal blood flow to the brain has stopped. This can cause damage to the brain. Knowing the symptoms of a stroke is one of the most important things you can do for yourself, family, friends and your community. Get help right away if you have or notice any of the following symptoms, even if the symptoms do not last.

• Sudden weakness - you may feel weakness, tingling or a loss of feeling on one side of your face or body.

• Sudden speech problems - you may have sudden trouble talking, slurred speech or problems understanding others.

• Sudden vision problems - you may have sudden double vision or trouble seeing in one or both eyes.

• Sudden headache - you may have a sudden, severe headache.

• Sudden movement problems - you may experience dizziness, spinning, a loss of balance or blackouts.

IF YOU HAVE ANY OF THESE SYMPTOMS, CALL 911 AS SOON AS POSSIBLE.Spot signs of a stroke or aneurysm fast.

F: Face – Can the person smile?

A: Arm – Can the person lift his or her arms above the head?

S: Speech – Can the person say a sentence?

T: Time – Look at the clock to note when symptoms occur.


TYPES OF STROKE

1. ISCHEMIC STROKEThe brain needs a constant supply of blood, oxygen and nutrients to work. During a stroke, blood stops flowing to part of the brain. The affected area is damaged, and it may result in functions being harmed or lost. Most strokes are caused by a blockage in a blood vessel that supplies the brain. Other strokes may occur if a blood vessel in the brain ruptures or breaks open.

From the Heart to the HeadThe heart pumps oxygen-rich blood through the body in blood vessels called arteries. If an artery between the heart and head is blocked, the brain does not get enough oxygen. Some blockages are caused by plaque (fatty deposits). Others are caused by blood clots. Clots can form on the plaque and also in the heart. People with atrial fibrillation (irregular heart rhythm) are especially prone to clots formed in the heart. If a piece of plaque or blood clot breaks off, it can flow into the brain and cause a stroke.

How Does a Stroke Happen?Ischemic stroke occurs when an artery that provides blood to the brain is greatly narrowed or blocked. This can be caused by a buildup of plaque. It can also happen when small pieces of plaque or blood clots break off into the bloodstream. The plaque (emboli) flow in the blood until they get stuck in a small blood vessel in the brain. When you have healthy arteries, the lining of the artery is smooth and blood flows freely. When you have high blood pressure, it can roughen the artery walls, which allows plaque to build up in the walls. Blood clots can also form on these plaque formations. This can narrow the arteries and limit blood flow.

Treatment for Ischemic StrokeClot Buster or Thrombolytic Treatment – tPA or Tissue Plasminogen Activator – is a thrombolytic agent. It has been approved by the FDA for use in certain patients with heart attack and stroke. The purpose of the drug is to dissolve blood clots. It is the only drug approved by the FDA for the treatment of acute ischemic stroke. If given, tPA can reduce permanent disability of stroke.

2. TRANSIENT ISCHEMIC ATTACK (TIA)A Transient Ischemic Attack (TIA) is an early warning that a stroke may be coming. A TIA is a stroke that does not last and does not cause any lasting damage. Because the symptoms of a stroke and TIA can be the same, you should seek medical attention immediately.

3. HEMORRHAGIC STROKEA hemorrhagic stroke occurs when a blood vessel in the brain ruptures. Blood then spills into surrounding brain tissue. Normal blood supply is lost and brain cells die. The fatality rate is higher and overall prognosis is not as good for those having hemorrhagic strokes. Symptoms may include a very severe headache, nausea and vomiting. Smoking, using oral contraceptives, excessive alcohol intake and illegal drug use increase your chance of having a hemorrhagic stroke.


CONDITIONS OF HEMORRHAGIC STROKE

1. BRAIN ANEURYSMA brain aneurysm is a balloon-like bulge in the wall of a brain artery. If it tears and bleeds, nearby cells can be damaged. An aneurysm usually occurs in an artery that has a defect or a weak wall. It is often associated with hardening of the arteries, or atherosclerosis. Other risk factors to consider are high blood pressure, heredity and head injuries.

Symptoms of a Leaking or Ruptured Aneurysm• Severe headache, nausea and vomiting

• Neck stiffness

• Blackout

• Confusion or sluggishness

• Vision and/or speech problems

• Paralysis or weakness on one side of the body

• Clumsiness

• Jerking movements

2. ARTERIOVENOUS MALFORMATION (AVM)An AVM is an abnormal tangle of blood vessels within the brain, which is most commonly genetic. Most people do not know they have an AVM until there is a problem. It can cause pressure to build up in the blood vessel and prevent normal blood flow. If the pressure is too great, it can rupture and blood can leak into the brain. Signs that an AVM may have ruptured include the following symptoms: bad headaches, blurred or double vision and/or seizures.


Computed Tomography (CT) of the brain and/or Magnetic Resonance Imaging (MRI) brain - a test that produces images of the inside of the body. The result is a detailed picture that can show problems with and/or outside the brain.

Magnetic Resonance Angiography (MRA) / Computed Tomography Angiogram (CT Angiogram) - creates images of blood vessels to look at the blood vessels in your head and neck.

Echocardiography (Echo) - an imaging test that helps your physician evaluate your heart. It utilizes ultrasound that bounces waves off the heart. Echo helps show the size of the heart, the health of the heart and its chambers and valves.

DIAGNOSING A STROKE WITH MEDICAL IMAGING

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Carotid stenosis is a progressive narrowing of the carotid arteries. This is part of a process called atherosclerosis. Before any damage, normal arteries are smooth and flexible. Hypertension and injury to the vessel walls allow plaque to build up. Plaque is a sticky substance made of calcium, fat, cholesterol, and fibrous material. As time passes, plaque deposits inside the walls can form a large mass that narrows the lumen or diameter of the artery. Atherosclerosis also causes the artery walls to be less flexible. This causes an increased risk of stroke by:

1. The plaque deposit growing so large that it completely blocks the artery.

2. Plaque can roughen and deform the artery wall, which causes blood clots to form and blocks blood flow to brain.

3. Plaque can rupture and break off, traveling to the brain and blocking blood flow.

Plaque can be detected by any of the following tests: carotid Doppler, CT angiogram, MRA, or cerebral angiogram.

Treatment may vary: antiplatelet medications, cholesterol-lowering statins, antihypertensive medications, carotid endarterectomy, carotid angioplasty, or carotid artery bypass. Your healthcare provider will review your current situation and decide what is best for you.

CAROTID STENOSIS


REVIEW YOUR RISK FACTORS

Certain health and lifestyle issues, called risk factors, increase your chances of having a stroke. The leading risk factor for stroke is high blood pressure, but there are others that also put you at risk.

What are your risk factors? Check all that apply.

HEALTH RISK FACTORS ¨ I have high blood pressure.

¨ I am overweight.

¨ I have unhealthy cholesterol levels.

¨ I have atrial fibrillation.

¨ I have had a heart attack.

¨ I have narrowed arteries.

¨ I have diabetes.

¨ I have had a stroke or TIA in the past.

LIFESTYLE RISK FACTORS ¨ I rarely exercise.

¨ I often eat salty, fried or greasy foods.

¨ I smoke.

¨ I have more than 2 alcoholic drinks per day.

¨ I use illegal drugs.

AGE AND FAMILY HISTORY ¨ I am over the age of 60.

¨ I have a family member who has had a stroke.


MANAGING YOUR RISK FACTORS

HEALTHY WEIGHT AND GOOD NUTRITION

• Eat less fat and the right kind. A gram of fat has twice as many calories as a gram of protein. Try to balance your diet with no more than 20 to 30 percent of your calories from fat. On average, this is 2.5 to 3.5 grams of fat per 100 calories eaten. When choosing fats for your diet, choose the good fats from nuts, avocados, salmon, mackerel and sardines. Choose healthy oils such as olive and coconut for eating and cooking.

• Eat more fiber. Foods high in fiber take longer to digest and keep you fuller longer. Aim for 31 grams of fiber daily. You will find fiber in fruits, vegetables, whole grains, legumes and peas. Remember to drink plenty of water to help with digestion of fiber.

• Eat plenty of fresh fruits and vegetables. Be careful with canned foods, as their sodium and sugar content may be high.

• Drink plenty of water. Add lemon, watermelon, strawberries and cucumbers if you need flavor.

• Avoid sodas and extra sugar.

• Do not skip meals.

• Eat slowly and do not eat while you are distracted, such as when you are watching TV, reading or talking. This may cause you to overeat.

• Exercise at least 30 minutes daily.

Studies show that people who exercise are more likely to lose weight and keep it off. Exercise burns calories. It helps build muscle, which makes you stronger. Exercise gives you energy and curbs your appetite. Discuss starting an exercise program with your healthcare provider before you begin. It is recommended that you exercise at least 30 minutes daily, by engaging in the following activities:

• Walk the dog

• Ride a bike

• Take a dance class

• Do water aerobics

• Take the stairs

• Park far away at the store

My weight is: __________________________________

My activity level is: _____________________________

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What exercise appeals to me: ___________________

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Other notes: __________________________________

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KNOW YOUR CHOLESTEROLCholesterol that is too high puts you at an increased risk of heart attack and stroke. If your cholesterol is too high, you can take steps to reduce your levels. Eating the right foods and exercising are important factors for reducing your cholesterol. Some people may also need medication to control their cholesterol. Your healthcare provider can get you started on a plan to reduce your cholesterol.

Your cholesterol is checked with a blood test. This test will give you the total amount of cholesterol in your blood. The higher the number, the more likely that cholesterol will build up in your blood vessels. It is suggested that your total cholesterol be lower than 200.

My total cholesterol is: ____________________

TYPESCholesterol is made of different kinds of lipids or fats. The two most important lipids to know are High Density Lipid (HDL) and Low Density Lipid (LDL).

HIGH DENSITY LIPIDHDL is called the ‘good’ cholesterol. It has a relatively high concentration of protein and low lipid concentration that incorporates cholesterol and transports it to the liver. High levels of HDL are associated with a decreased risk of atherosclerosis and coronary artery disease. HDL moves out of the bloodstream and does not block your blood vessels. HDL levels are affected by how much you exercise and what you eat. For most people, HDL levels should be 40 or higher for males and 50 or higher for females.

My HDL cholesterol is: ____________________

LOW DENSITY LIPIDLDL is called the ‘bad’ cholesterol because it can stick to your artery walls and block blood flow. LDL levels are mostly affected by what you eat. For most people, LDL levels should be lower than 100.

My LDL cholesterol is: ____________________

TRIGLYCERIDETriglyceride is a type of fat that the body uses to store energy. Too much triglyceride can increase your risk for heart disease. Triglyceride levels should be under 150.

My triglyceride is: _________________________



CONTROLLING YOUR CHOLESTEROLHere are some tips for controlling your cholesterol:

• Eat very little saturated fat and trans fat. These types of fat can raise the LDL cholesterol in your body. Saturated fat is found in foods from animals, such as fatty meats, whole milk, butter, cream and other dairy foods made with whole milk. It is also in tropical oils (palm, palm kernel and coconut).

• Trans fat is found in all foods with hydrogenated oils. It may be in fried foods, crackers, chips and foods made with shortening or sticks of margarine.

• When cooking with oils, choose ones with unsaturated fats, such as soybean, canola, olive or sunflower oil.

• Keep the total amount of fat that you get from food to 200mg of cholesterol per day. Foods high in cholesterol include egg yolks, fatty meats, shrimp and dairy foods.

• Get 20 to 30 grams of fiber per day. High-fiber foods include fruits, vegetables and whole grains. Aim for 2 cups of fruit, 3 cups of vegetables and 3 ounces of whole grains per day.

• Soluble fiber is especially good for you. You can get it from oatmeal, dried beans and peas.

• As you add fiber to your eating plan, you should also drink more water or other fluids.

• Eat cold-water fatty fish, such as salmon, tuna, mackerel and sardines.

• Add flaxseed or walnuts to your diet. They are high in omega-3 fats. These are good for your heart.

MANAGING ATRIAL FLUTTER/ATRIAL FIBRILLATIONElectrical system problems of the heart may cause the top chambers of the heart to beat faster than normal. If your heart is beating too fast but is beating regularly, it is called atrial flutter. If it is beating too fast and irregularly, it is called atrial fibrillation. These arrhythmias may be caused by heart attacks, high blood pressure, thyroid problems or unknown causes.

With atrial fibrillation, the top chambers beat so fast and unevenly that they may quiver instead of contract. If they do not contract, the lower chambers do not get enough blood, which may cause dizziness and weakness. Symptoms of atrial fibrillation may include palpitations, weakness, tiredness, shortness of breath, chest pain or tightness, dizziness or fainting.

Unless otherwise indicated by your physician, the management of atrial flutter/atrial fibrillation includes blood thinners prescribed by your physician. Please note, this is different from the aspirin or Plavix you may be already taking.

MANAGING DIABETESPeople with diabetes can develop complications over time. These problems usually occur if blood sugars are out of range. High blood sugars can lead to damaged blood vessels. Manage diabetes by monitoring blood sugar, eating healthy, exercising and taking medications if prescribed, and as directed.

Other complications that can occur if diabetes is left unmanaged include the following:

• Eye problems including retinopathy, glaucoma and cataracts

• Tooth and gum problems• Blood vessel diseases that lead to circulation

problems, heart attack or stroke• Problems with sexual function• Kidney disease• Nerve problems (neuropathy)• High blood pressure• Infections



MANAGING YOUR BLOOD PRESSUREEach day that your blood pressure is too high, your chances of having a stroke are increased. When blood presses against a vessel wall with too much force, muscles in the wall lose their stretch. This causes the wall to thicken, which narrows the vessel passage and reduces blood flow.

When blood pressure is too high, it can damage blood vessel walls. Fat and cholesterol (plaque) collect in the damaged spots. Blood cells stick to the plaque, forming a mass called a clot. Clots can block blood flow in the vessel.

Sometimes, blood flows with enough force to weaken a vessel wall. If the vessel is small or damaged, the wall can break. If this happens, blood can leak into nearby tissue and kill cells. Other cells may die because blood cannot reach them.

According to the American Heart Association, you should take your blood pressure daily, at the same time each day (morning or evening) or as your healthcare professional recommends. Recommended BPA target blood pressure of <140/90 mm Hg for most stroke patients and <130/80 mm Hg for patients with diabetes mellitus or chronic kidney disease.

Take the following steps when taking your own blood pressure:

• Sit with your back straight and supported and your feet flat on the floor.

• Support your arm on a flat surface with the upper arm at heart level.

• Make sure the middle of the cuff is placed directly over your brachial artery.

• Check the monitor’s instructions or have your healthcare provider demonstrate this for you.

• Each time you measure, take two or three readings at one minute intervals, and record all the results.

Date of last blood pressure test: ________________

My blood pressure target goal is:

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My last blood pressure readings:

Reading 1: ____________________________________

Reading 2: ___________________________________

Reading 3: ___________________________________

My blood pressure medication(s) is/are:

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IMPORTANT BLOOD PRESSURE TIPS:1. Take medications as prescribed. Do not stop

taking your medications unless directed by your primary care physician.

2. If considering surgery of any kind, consult your primary physician first.

3. Exercise and eat healthy, nutritious food.

4. Reduce stress as much as possible.

5. Limit the sodium that you get from food and drinks.

6. Foods with more than 300mg of sodium per serving may not fit into your meal plan.

7. Do not salt food at the table. Use very little salt, if any, when cooking.

8. Choose carefully when you eat in restaurants. Restaurant foods may be high in sodium.

9. Eat plenty of fruits and vegetables that are high in potassium.

10. Eat fat-free and low-fat dairy products.

11. If you drink alcohol, limit the amount. Women should drink no more than one drink per day. Men should not drink more than two drinks per day. One drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.

QUIT SMOKINGSmoking reduces oxygen flow to your heart, speeds up the buildup of plaque and increases your risk of heart attack and stroke. Quitting helps reduce smoking’s harmful effects. Here are some tips to help you:

• Ask for the support of your family and friends.

• Join a quit-smoking class.

• Ask your doctor about nicotine replacement products and prescription medications that can help you quit.

• Choose a date to stop within the next two to four weeks. My date to stop is: _______________________________________

• After picking a day, mark it in bold letters on a calendar.

MEDICATIONSYour doctor has prescribed medications to reduce the risk factors of stroke. It is extremely important to take them as directed. Your nurse can provide printed information on each of your medications. Any side effects will be explained. Here are some medication reminders:

• Fill your prescriptions as soon as you leave the hospital.

• Take medications as directed.

• Never change or stop taking medications unless directed by healthcare provider.

• Consult your physician before you start any over-the-counter medications.

• Always carry a list of medications to your doctor’s appointments and to hospital visits.

• Call your doctor if you experience side effects that do not improve.


YOUR HEALTHCARE TEAM

The members of your healthcare team guide you through your treatment, support you and answer your questions. Your team may include the following specialists:

• Neuro-Endovascular Surgeon A specialist who performs minimally invasive surgery through a tiny incision in the groin to treat vessel problems in the brain.

• Neurosurgeon A specialist who performs surgical interventions through the skull.

• Neurologist A doctor who specializes in evaluating and treating a variety of brain and nervous system disorders/diseases.

• Hospitalist Manages your medical care while in the hospital.

• Nurses Provide patient care and also provide patient education on your current situation, risk reduction and recovery.

• Physical and Occupational Therapists Help with walking, dressing and the activities of daily living, and also help teach you how to perform these activities when you go home.

• Speech Therapists Focus on swallowing and speech problems.

• Registered Dietitians Help to guide you with dietary recommendations.

• Case Manager or Social Worker Helps to guide you through the healthcare system and also helps prepare you for discharge and home.


RECOVERY AND REHABILITATION

Recovery and rehabilitation after a stroke can be a lengthy process, but your healthcare team is here to assist you in any way. It is important to be aware of what to expect after a stroke.

Each part of the brain has a role in controlling the body:

• The front of the brain is the center for emotions and reasoning. This is where personality resides.

• The right side of the brain controls the left side of the body. The right side also directs problem-solving and spatial skills, such as judging distance.

• The left side of the brain controls the right side of the body. It also handles verbal or language skills in right hand dominant people.

• The brain stem handles basic body functions, such as breathing, blood flow and swallowing.

• The back of the brain controls vision.

COMPLICATIONS AFTER STROKEThere are potential complications that may occur as a direct result of injury to the brain or because of a change in your abilities:

• Edema - brain swelling after stroke

• Seizures - abnormal electrical activity in the brain, which causes convulsions

• Depression - causes unwanted emotional and physical reactions to changes or losses

• Bedsores - pressure ulcers that result from decreased ability to move

• Pneumonia/aspiration pneumonia

• Urinary tract infection and decreased bladder control

• Limb contractures - shortened muscles in arm or leg from reduced range of motion or lack of exercise

MY THOUGHTS OR QUESTIONS:

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COMMUNICATION COMPLICATIONS

1. APHASIAAphasia is the loss of language skill that may occur if the brain is damaged. People with aphasia may not be able to express thoughts (expressive aphasia) or understand others (receptive aphasia).

Signs of aphasia:• Unable to understand words when others

speak-receptive

• Unable to speak in complete sentences-expressive

• Unable to read or write

• Unable to understand that numbers have meaning

• Mix-up order of words in sentences

• Uses the wrong words with numbers

Tips for communicating with someone who suffers from aphasia:

• Ask yes or no questions

• Speak slowly and clearly

• Use simple words

• Be patient

• Do not ignore them

2. DYSARTHRIADysarthria is a speech problem caused by a lack of control over muscles in the face and mouth. A person who has dysarthria knows which words to use, but may not make the right sounds.

Signs of dysarthria:• Unable to make sounds

• Unable to speak whole sentences clearly

• Unable to control tone or volume of voice or breaks between words

• Unable to realize speech is hard to understand

• Speaks certain sounds louder than others

• Sounds harsh or raspy

• Pauses for breaths in the wrong places

• Drops or slurs parts of words

• Speaks with hesitancy

• Speaks without moving mouth


SWALLOWING CHANGES

Dysphagia causes difficulty swallowing. It takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. Your speech therapist will put you on a special diet to help you make swallowing safer and easier. Your diet may change if your swallowing improves. Your speech therapist will give you guidelines and techniques on how to safely swallow and eat.

QUESTIONS

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SAFELY MOVING

TRANSFER: WHEELCHAIR TO CHAIRPatients who cannot walk are taught to use wheelchairs. For safety, the therapist will instruct you on the correct way to sit in or get out of the wheelchair.

TRANSFER: BED TO WHEELCHAIRYour caregivers should follow these steps for safety:

• Lock the wheelchair.

• Turn over onto back or side facing the wheelchair.

• Keep one arm positioned under neck with one hand under the shoulder and the other behind the knees.

• Swing legs over the edge of the bed, lifting to a sitting position.

• Scoot to the edge of the bed.

• Keep both arms around the chest, and clasp hands behind the back.

• Stand and lift at the same time.

• Pivot the chair toward the strongest side.

• Lower into the wheelchair.

TRANSFER: WHEELCHAIR TO TOILETYour caregivers should follow these steps for safety:

• Lock the wheelchair.

• Place feet directly under body.

• Grasp the back of a belt or pants and lift.

• Keep weaker knee between legs.

• Pivot toward the strongest leg.

• Adjust clothing and gently sit down using the grab bar for additional support.

• Never pull on weak arm or by the armpit.


WALKING AGAIN

Many patients walk after a stroke. You might start on a set of parallel bars. Most patients will graduate to an assistive device, such as a walker or cane. Your therapist will help you learn to use these devices correctly. Some patients use a special treadmill to regain walking skills.

TIPS FOR USING A CANE• Hold the cane on your stronger side.

• Get your balance.

• Move the cane and your weaker leg forward.

• If using a quad cane, make sure all four tips touch the ground.

• Support your weight on both the cane and your weaker side.

• Step with the stronger leg.

STAIRS AND CURBS• If there is a railing, hold onto it with your

free hand.

• Step up with your strongest leg first.

• Move the cane and weakest leg together cane first.

• Then follow with your stronger leg.

TIPS FOR USING A WALKER• Lift or roll the walker forward about

12 inches.

• Step forward with your weaker side first.

• Use the walker to help keep your balance.

• Bring your other foot forward to the center of the walker.

SIX TIPS TO REDUCE YOUR CHANCES OF FALLING

• Stand up and sit down. Practice standing and sitting at each meal with the dinner chair. Having the chair behind you and the table in front makes it safer for you to practice.

• Practice getting out of bed using your weaker side. This will help to strengthen your weaker side.

• Focus on your core. Do modified sit-ups in a chair.

• Try to stand on one leg.

• Turn your head.

• Be more active.


WALKING AGAIN

IMPROVED POSITIONINGCorrect body posture helps reduce slumping and stiff joints. Weak arms and legs need to be supported and positioned properly. The therapist will start gently moving your legs and arms. These stretches help relax muscles that tighten up without use.

BATHING AND DRESSINGPerforming your routine tasks may be difficult after a stroke. Many patients can learn ways to manage their daily activities. Doing so strengthens muscles and helps you regain your functioning.

Tips:

• Test water temperature with a hand or foot that was not affected by the stroke.

• Use grab bars, a shower seat, a hand-held shower and long-handled brush.

• Dress while sitting, starting with the affected side.

• Put on shirts that pull over the head and pants with elastic waistbands.

INCONTINENCEProblems with bladder function are common after a stroke. In the case of stroke, incontinence may occur when there is nerve damage in the part of the brain that controls waste removal or signals for it. Keep your caffeine intake to 100mg per day or less to help with incontinence symptoms. Seek help from your healthcare provider. It can most often be treated.


YOUR STROKE DISCHARGE CHECKLIST

1. What was the diagnosis?

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2. What caused the stroke?

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3. Am I at risk for another stroke? What can I do to reduce that risk?

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4. What can I expect in terms of my recovery and rehabilitation?

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5. What physical, emotional, behavioral and communication changes can I expect?

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6. What do you suggest with regard to diet and exercise?

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YOUR STROKE DISCHARGE CHECKLIST

7. Are there any follow-up appointments? Fill them into the chart below.

Appointments Date/Time Physician Name Phone Number

8. What safety precautions should we take to prepare our home?

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9. What tasks will I need help with?

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10. What kind of equipment and supplies will I need?

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11. How can I determine what my insurance will cover and how much I will have to pay?

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12. Is a caregiver or stroke support group available in my community? What resources are available?

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YOUR MEDICINE LIST

Name of Medicine What is it? How often

and what? Instructions Prescribing Doctor

Pharmacy Phone Number


IMPORTANT INFORMATION ABOUT YOU

In case of an accident or emergency, we recommend filling out these sections and keeping them in a place that is easy for your family and emergency medical services (EMS) providers to find.

Name: ___________________________________________________________________________________________

I prefer to be called: _______________________________________________________________________________

Date of birth: _____________________________________________________________________________________

Address: _________________________________________________________________________________________

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Phone number: ___________________________________________________________________________________

How I communicate/what language I speak: _________________________________________________________

Next of kin contact: _______________________________________________________________________________

Relationship: _____________________________________________________________________________________

Address: ________________________________________________________________________________________

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Phone number: ___________________________________________________________________________________

Who I live with: ___________________________________________________________________________________

Religion: _________________________________________________________________________________________

Religious needs: __________________________________________________________________________________

Ethnicity: ________________________________________________________________________________________

My doctor (or primary care provider): _______________________________________________________________

Doctor’s phone number: ___________________________________________________________________________

Allergies: ________________________________________________________________________________________

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Medical interventions (special ways to take my blood pressure, etc):

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Heart/breathing problems:

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Risk of choking, problem swallowing or speaking:

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My medical history:

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My current medications:

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How I take my medications (crushed, split, etc):

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Problems with hearing:

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How to communicate with me (writing, reading lips, talking loud):

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How I move around:

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Seeing/hearing problems:

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How I eat:

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How I drink:

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How I keep safe at home (bed rails, walker, etc):

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How I use the toilet:

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Sleeping problems:

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WHAT TO EXPECT ON THE STROKE UNIT

EMERGENCY DEPARTMENTYou will be quickly evaluated by trained physicians and nurses. You will need and receive diagnostic tests, such as labs, EKG, CT and X-rays. The emergency department physician will communicate directly with the specialists to determine the initial plan of care.

NEURO-INTENSIVE CARE UNITThe Intensive Care Unit (ICU) is located directly upstairs from the Johnson City Medical Center Heart Hospital main entrance.

The physicians and the nurses in the critical care areas will monitor your vital signs and your neurological status frequently. You will be on a continuous cardiac monitor. Your treatments may include intravenous medications to manage blood pressure. Advanced therapies may be required if your condition is unstable. Visitation times will be provided by the nursing staff.

NEUROSCIENCE SUITEThe Neuroscience Suite, or Stroke Unit, is located on the fourth floor of Johnson City Medical Center.

In this unit, you may need portable cardiac monitoring called telemetry. The nursing staff will work closely with other medical team members, such as our physical therapist, occupational therapist and speech therapist, to evaluate and treat your stroke symptoms. You will not be allowed to eat or drink until the team evaluates your ability to swallow. This is called NPO or ‘Nothing by Mouth’. Vital signs will be taken regularly. We encourage family members to participate in the plan of care. This helps staff to move freely in the room when completing tasks.



PREVENTING FALLS IN THE HOSPITALPeople who have suffered from a stroke are generally at high risk for falling. Your individual risk will be evaluated regularly and steps will be taken to keep you safe. Remember to always ask for help when you need it. The following are some tips to keep you safe:

KEEP THINGS WITHIN REACHKeep the things you use often within easy reach. Practice using the call button before you really need it and while the nurse is in the room. Do not be afraid to use it. Know how to turn the light on and off from the bed. Also, know how to operate the bed.

GET HELP MOVING AROUNDDo not get up on your own even to use the bathroom. Call before you fall. Do not try to move IV poles or equipment on your own. Use walking aids and handrails as advised by the nursing staff.

WHAT SPECIAL STEPS ARE TAKEN TO PROTECT ME?

• Visual cues will be used to alert all caregivers that you are at high risk for a fall.

• A yellow magnetic sign will be placed outside of your door.

• You will wear a yellow wrist band to help team members quickly recognize that you need assistance getting up.

• You will be asked to wear yellow non-skid socks which help prevent slipping.

• Your room is also equipped with a bed alarm and chair alarm that will be adjusted based on your level of activity.

• Please call for assistance any time you need to get up.

WHY SHOULD I WORRY ABOUT FALLS IN THE HOSPITAL?

• Environment changes

• Decreased muscle strength due to inactivity

• IVs, cords or tubes hooked to your body or near your bed

• Dizziness or poor balance

• Diarrhea or frequent bathroom trips

• Anesthesia from recent surgery

• Poor eyesight

• Medication side effects such as dizziness

• Need for walking aids such as a walker or cane, or the need to hold on to a wall or furniture for balance

• History of previous falls



WAYS YOU AND YOUR FAMILY CAN HELP YOU STAY SAFE:

• We want you to be safe and are concerned for your well-being.

• Please don’t try to get up without assistance because you are feeling better, or because you “think” you can do it or you just don’t want to bother anyone. It’s not worth the risk!

• Do not be afraid to ask questions.

• We may identify certain periods of your stay or times of day as a greater safety risk and ask for a family member or a friend to stay with you in your room.

• If something happens and you fall, please tell a team member so we can make sure you are not injured.

WHY AM I CONSIDERED AT RISK FOR A FALL?

• Your nurse and doctor have used an assessment tool to rate your chance of falling during your hospital stay. Because you have been identified as a higher fall risk, additional precautions will be taken to make sure you stay safe.

• Standard fall precautions are used for all patients, but extra steps are put in place for those who might have a greater risk of falling.

HERE ARE SOME SPECIFIC WAYS YOU AND YOUR FAMILY CAN HELP:

• Make sure your room is as clutter-free as possible

• Make sure your call bell is within your reach before visitors leave

• Always wear your safety socks when you get out of bed

ALWAYS CALL A TEAM MEMBER WHEN YOU:

• Want to get out of bed or get up from a chair

• Need to use the restroom or bedside commode

• If you drop something on the floor

• If you are feeling dizzy, weak or faint


STROKE CARE AT MOUNTAIN STATES

Every year, many patients and families are impacted by the diagnosis of stroke. Stroke is one of the leading causes of disability and death in the United States. Early identification and intervention can improve outcomes and quality of life.

If you or someone with you develops stroke symptoms, do not delay! Immediately call 911. It is very important to get to the hospital quickly! If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

Mountain States Health Alliance is dedicated to providing the highest level of stroke care to individuals who experience a brain attack. Our dedicated team is armed with the most up-to-date advancements in the treatment of stroke to ensure patients receive high-quality care.

JOHNSON CITY MEDICAL CENTER CERTIFIED PRIMARY STROKE CENTERJohnson City Medical Center is a certified stroke center and now offers comprehensive stroke services including:

• 24/7 response team comprised of fellowship-trained neuroendovascular surgeons, neurosurgeons, teleneurology, emergency department physicians and nurse practitioners

• Quick evaluation and treatment initiated for acute blocked (ischemic) or ruptured (hemorrhagic) brain vessels stroke

• Neurologic and neuroendovascular surgical services

• Post-discharge recovery including: case management services, education, support groups, dietary guidance and outreach for stroke awareness to staff, community, patients and families

JOHNSTON MEMORIAL HOSPITAL CERTIFIED PRIMARY STROKE CENTERJohnston Memorial Hospital is a certified stroke center and offers the following services for stroke patients:

• 24/7 stroke response team, comprised of neurologists and emergency department physicians

• Quick evaluation and treatment initiated for acute blocked (ischemic) brain vessels

• Quickly assess, stabilize and transfer acute ruptured (hemorrhagic) brain vessel patient to a higher level of care as needed

INDIAN PATH MEDICAL CENTERIndian Path Medical Center’s 24/7 emergency department offers the following services for stroke patients:

• Trained emergency department physicians and nurse practitioners to quickly evaluate and initiate treatment for the acute stroke patient and transfer to a higher level of care as needed

• Cares for most blood vessel blockage (ischemic) stroke patients

• Teleneurology

SYCAMORE SHOALS HOSPITALSycamore Shoals Hospital’s 24/7 emergency department offers the following services for stroke patients:

• Trained emergency department physicians and nurse practitioners to quickly evaluate and initiate treatment for the acute stroke patient and transfer to a higher level of care as needed

• Cares for most blood vessel blockage (ischemic) stroke patients


RESOURCES

Your healthcare team will guide you on your way to recovering from a stroke. We also want to provide you with the following resources that may be helpful:

American Stroke Association: A Division of the American Heart Association1-800-4STROKEwww.strokeassociation.org

National Stroke Association1-800-STROKESwww.stroke.org

National Aphasia Association1-800-922-4NAAwww.aphasia.org

American Speech-Language-Hearing Association1-800-638-8255www.asha.org

National Rehabilitation Information Center1-800-346-2742www.naric.com

Johnson City Medical Center423-431-6111www.MountainStatesHealth.com/stroke

Consult-a-NurseFree 24/7 Physician Referral Hotline1-800-611-6913

The Wellness Center423-431-6668www.MountainStatesHealth.com/wc


NOTES

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400 N. State of Franklin Road | Johnson City, TN423-431-6100 | MountainStatesHealth.com/jcmc-stroke

MRG 16-0184 > 01/2017

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Recovering From a Stroke

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