I have had 16 years of expertise with Stroke victims. I am blessed to have been able to work with few of the best Neurologists in the country as well as the best nurses’, Neurology Residents, Physical, Occupational and Speech Therapists. It is very amazing that the hospital I have worked for before has been one of the top hospital for Stroke and has a very high standard of practice when it comes to Stroke. I have witnessed and has been a part of the team that saved numerous patients lives and has managed their care so well in order for them to maintain their optimum level of health and functioning.
So What Is Stroke
According to Stroke.org, Stroke is a “brain attack”. It can happen to anyone at any time. It occurs when blood flow to an area of the brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.
With my years of experience, I have seen different level of disabilities due to Stoke. Strokes has different types of presenting symptoms depending on the severity of the stroke or how much brain tissue has been damaged and what part of the brain has been involved.
Some may not look like they had a Stroke as they may have had just the TIA which is short for Transient Ischemic Attack or mini stroke. Their symptoms are usually temporary like weakness of arms or legs. But they still need to be seen and get treated as there’re diagnostic procedures that needs to be done to find out what caused the TIA and for prevention of another TIA from happening again.
Stroke Warning Signs
Before I dived into caring of Stroke victims, let me just mention about the F.A.S.T. warning signs as this is the quickest way to determine if a person is suffering from a Stroke.
F is for face. Is it drooping or is it numb? Ask the person to smile. Is the smile uneven or lopsided?
A is for arm weakness. Ask the person to raise both arms. Does one drift downwards?
S is for speech. Ask the person to repeat a simple question. Is the speech slurred or hard to understand?
T is for time. If the person is presenting any of these symptoms even if it has been resolved, call 911 and have them take the person to the nearest emergency department immediately.
Knowing these may help save lives from Stroke or prevent permanent disability of a victim as there’re medications that can be given and diagnostic procedures that can be done.
I would like to mention also as this is very important that if a patient has been confirmed to have had an Ischemic Stroke, the doctor needs to restore the blood flow to the brain so within 3-4 hour window of time from the moment patient’s symptoms occurred patient can be given a clot busting drug through the vein. This should be given as soon as possible as this will increase the chances of survival and may reduce complications.
TPA (Tissue Plasminogen Activator) or Alteplase is the clot-busting drug that’s being given to the stroke victim. This is considered the gold standard treatment for Ischemic Stroke.
How To Care For A Stroke Patient
Caring for a stroke victim poses a lot of challenges as they can range from someone who has sustained paralysis on either side of the body or someone may not be able to speak or understand any instructions. Patients may be of medium built or obese and some has no family support and has no health care plan, which is another challenge as these kinds of patients needs continuous care or rehabilitation to be able to maintain their safety and to eventually regain their functioning for independence and to live a good quality of life.
- Most stoke patients end up with cognitive issues meaning they may not be able to process information well. So it is always important for their safety to be taken into consideration as their safety judgment can be poor. Some may end up not able to swallow any solid food and water so it’s best not to place anything that they may eat or drink nearby them as they can choke or aspirate.
- Some are able to still eat but needs a lot of supervision as they have certain restrictions and swallow techniques to follow to prevent aspiration. Aspiration is when food or drink goes down the wrong way which is in the airway that causes Aspiration Pneumonia. That is why it is very important that a Speech therapists and a proper swallowing test has been done prior to feeding or giving a patient their medications.
- Due to weakness or paralysis they may not able to stand up well or go to the bathroom by themselves but they will still try even though they have been forewarned as they don’t retain information and as I said their safety judgment maybe compromised. So some requires a sitter or someone to stay with them in the room 24/7 so they won’t fall.
- As early as possible Physical and Occupational therapists need to evaluate the patient and if able to they can start working with those disciplines to regain their strength and be aware of what they can and can’t do. Some may require stand by assist, minimal, moderate or maximum assist.
- Some may need assistance with basic activities of daily living like brushing their teeth, baths etc.
- Others need to be fed due to arm weakness or poor fine motor control.
- They sometimes end up incontinent so taking good care of their skin is a must as they can end up with skin breakdown.
- Due to inability of movement from side to side, they can develop a pressure sore so turning them each sides every 2 hours is very important as well.
- If patient has no family or sitter with them, nurses’ and assistant has to visit them constantly for safety and monitoring.
- As any other conditions and diseases their blood pressure, respiration, temperature, heart rate and oxygen saturation has to be monitored. Some needs blood sugar check as some of them ends up a diabetic if not already been diagnosed before.
- They also have blood draws that are specific for stroke patients.
- They are also on continuous heart monitoring so nurses’ are to monitor those too.
- Some may end up with a feeding tube so proper positioning of the patient, good mouth care and monitoring of patient for signs of intolerance or aspiration needs to be done. If patient is going home with a tube feeding it is the nurses’ responsibility that the family or caregiver is aware of the process and has been given a thorough education. Because remember, discharge planning starts at the beginning of patients hospital stay and continuously being followed through during hospitalization.
- Proper and thorough patient and family education is also a must regarding disease prevention and management. Medication education is also needed to be done thoroughly even though the patient and the family says they already are aware or familiar with them as we can never be too sure.
- Case manager and Social worker’s support should be anticipated too as most patients needs equipment or assistance for placement if needing to go for Rehabilitation, Skilled Nursing Facility or a Nursing Home due to different reasons.
- Monitoring for signs of circulation problem is essential too.
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Types Of Stroke
I would like to go over these with you as I would like for all of you to know that there’re different kinds of Stroke and that each one has different kinds of treatment and presentation which is very important for safety management.
As I have discussed above, Ischemic Stroke patients can be given clot busting drug if it’s within 3-4 hour window from the time the symptoms occurred. Ischemic Stroke accounts for 87% of all strokes.
Disclosure: The following information are based from American Stroke Association.
Ischemic Stroke–Occurs when a blood vessel supplying blood to the brain is obstructed.
Hemorrhagic Stroke–Occurs when a weakened blood vessel ruptures. The most common cause of this type of stroke is uncontrolled high blood pressure.
TIA (Transient ischemic Attack)–Called a “mini stroke”. It’s caused by a serious temporary clot. This is a warning stroke and should be taken seriously.
Cryptogenic Stroke–In most cases, a stroke is caused by a blood clot that blocks the flow of blood to the brain. In some instances, despite testing, the cause of a stroke cannot be determined. A stroke of unknown cause is called a “cryptogenic stroke”.
Brain Stem Stroke–When stroke occurs in the brain stem, it can affect both sides of the body and may leave someone in a ‘locked-in’ state. When a locked-in state occurs, the patient is generally unable to speak or move below the neck.
Preventing the recurrence of stroke is the major goal after patient has been discharged from the acute settings. It is important to follow the regimen and being aware of the symptoms and the risk factors. Living a healthy lifestyle is the key.
Have you had a stroke? Has any of your family members or love ones suffered from stroke? Are you or someone you know is a caregiver of a stroke victim? If you are, please share with us your experience. For questions and comments please leave them down below.