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This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available. 1 Modified March 2013 NURSING THE STROKE PATIENT: INTRODUCTION: AIM & OBJECTIVES AIM: To inform participants about some of the key areas of care carried out by nurses for patients who have experienced a stroke INTRODUCTION: AIM & OBJECTIVES OBJECTIVES: After completion of the session, the participant should be able to: 1. List what aspects should be considered when nursing a patient with a diagnosis of stroke 2. Discuss possible complications post-stroke 3. Discuss some of the intervention(s) that can be implemented by nurses to prevent complications INTRODUCTION: AREAS TO DISCUSS Preventive Care Nurse Curative Care Rehabilitative/ Promotive Care Provide Information on Stroke, Risk Factors, Lifestyle modification Accurate assessment Plan care that is person centred Physiological monitoring Risk Assessment & Prevention of Complications Carry on Role (Therapies) Safe Discharge Planning Secondary Prevention Communication with Family/carers PREVENTIVE CARE Raising Awareness: Risk factors Lifestyle modification Medical check ups CURATIVE CARE APPROACH: EARLY ASSESSMENT & DIAGNOSIS Assessment Patient’s condition & needs Patient priorities Admit to dedicated stroke beds Early swallow screen CURATIVE CARE APPROACH: EARLY ASSESSMENT & DIAGNOSIS Majority of patients respond to simple nursing interventions Continence assessment Baseline assessment is key PHYSIOLOGICAL MONITORING WHY MONITOR PATIENT’S VITAL SIGNS? Prevent or detect stroke extension Facilitate recovery Protect the ischaemic pneumbra BLOOD PRESSURE Many patients with acute stroke have elevated BP Abrupt drops in BP MUST be avoided BP usually spontaneously decreases in first week after CVA HEART RATE Atrial fibrillation RESPIRATORY RATE & OXYGEN SATURATIONS Detect and treat hypoxaemia. Identify potential causes of hypoxia Hypoxia more commonly occurs at night PYREXIA & LEVEL OF CONSCIOUSNESS Increased temperature increases infarct size . Fever is frequent over the initial 48 hour period and negatively influences clinical outcome Many patients develop infection after stroke Treat pyrexia early BLOOD GLUCOSE Increase in glucose levels is harmful in acute stroke. No difference in mortality, or reduce severe disability. lowering glucose lowered BP PREVENTION OF VARIOUS COMPLICATIONS PATIENTS WHO ARE NIL BY MOUTH PNEUMONIA SHOULDER SUBLUXATION Shoulder Subluxation . Prevention is better than cure TYPES OF SHOULDER SUPPORTS Sub-Lux Cuff (Hemi-arm sling) Neoprene double shoulder Brace COMPLICATIONS OF ENFORCED INACTIVITY Muscle Atrophy COMPLICATIONS OF ENFORCED INACTIVITY Joint Contractures COMPLICATIONS OF ENFORCED INACTIVITY Drop Foot Deformity DEEP VEIN THROMBOSIS INTERVENTION Good Posture Sitting out in an appropriate chair Early mobilisation Passive exercises whilst in bed Physiotherapy Good MDT working – Stroke Unit Care REHABILITATIVE CARE: ESSENCE OF THE NURSING ROLE The Carry-On Role “Carry -On” work refers to the work of Physiotherapists and Occupational Therapists which nurses are expected to continue in the absence of the therapists ESSENCE OF THE NURSING ROLE… The Carry-On Role helping patients to wash & dress in a particular way continue walking practice/with or without aids ESSENCE OF THE NURSING ROLE… The Carry-On Role ESSENCE OF THE NURSING ROLE The nature of patient’s needs means nurses work with a variety of other health professionals Nurses are often seen as the coordinators of the team and a central point for communication and decision making IMPORTANT FACTORS FOR SUCCESSFUL DISCHARGE Good discharge planning Good Communication Home Visit Carer adequately trained? Medication concordance WHAT IS THE RECIPE FOR GOOD CARE IN STROKE? Organisation of services Communication between the team No professional boundaries Information giving Education NURSING Any Questions
