Care of the Stroke Patient Page 1 of 1 Care of the Stroke Patient Description: Each person that has had a larger stroke or several smaller ones requires individual care. The area of the brain that was damaged by the stroke will determine the physical and mental affect on the patient and therefore the specific assistance needed. This lesson will provide general guidelines for the care of the patient that has had a stroke. Learning Objective: State 3 warning signs of a stroke Identify potential safety concerns for a patient with a stroke Name at least 3 care considerations for patients with one sided weakness or paralysis Identify methods to assist the patient with a stoke to eat Outline steps for successful communication with a patient who has had a stroke
Warning Signs of a Stroke Page 1 of 1 Warning Signs of a Stroke Strokes, also referred to as cerebral vascular accidents, occur when the blood flow to certain parts of the brain are reduced or totally cut off. This may be caused by a build up of plaque in the arteries of the brain or may be the result of a blood clot which cuts off all blood through an artery. While some strokes occur without warning, many times there are signs which indicate a stroke may occur. Such signs should be reported immediately to ensure prompt, appropriate care for the patient. These signs include: Headache Dizziness Ringing in the ears Nausea Vomiting Difficulty with speech such as slurring of words Sudden loss of memory
Symptoms of a Stroke Page 1 of 1 Symptoms of a Stroke Signs that a stroke is occurring or has occurred include: Weakness (hemiparesis) or paralysis (hemiplagia) on one side of the body Inability to speak (aphasia) or difficulty with speech (dysphasia) High blood pressure and low pulse rate Sudden loss of bladder and bowel control Loss of consciousness Seizures If the patient suddenly has any of these symptoms, immediately notify emergency personnel (call 911 or activate the emergency response system in the facility). Smaller strokes are referred to as transient ischemic attacks or TIA s. Symptoms of the smaller strokes or TIA s are the same as those of a larger stroke but may only last a few hours, days or weeks. Even though the symptoms may not last, they are usually a warning sign of a possible larger stroke or CVA and should not be ignored.
Safety Concerns Page 1 of 2 Safety Concerns The person that has had a stroke often has a dramatic, sudden change from what they once considered normal activity. For example, a person who has had a stroke may have paralysis (no movement) on one or more parts of the body (hemiplagia). Depending on the area of the brain that was affected by the stroke, the patient may have symptoms of confusion, weakness, loss of sensation (feeling) in his or her arms, legs or body. These changes may make the patient vulnerable to falls and/or burns. Because of this, it is important for you, as the caregiver, to be alert to the safety needs of your patient at all times. Some tips for providing a safe environment for the patient include: Remove hazards from the patient s room, such as extra equipment, clutter, and objects on the floor Use proper technique for transferring the patient to prevent injury to the person or you Closely check the patient for proper body alignment when turning or transferring to prevent damage to the patient s body or limbs since they may not be able to move or feel pain Closely monitor the patient s skin condition for any problems since they may not be able move around to prevent sores or feel developing sores Closely check bath water temperature because the patient may not be able to feel heat or pain Report any safety concerns to your supervisor Home Care Satety Tips!
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Assisting Patients with One-Sided Weakness Page 1 of 1 Assisting Patients with One-Sided Weakness Persons who have had a stroke often have weakness or loss of strength on one side of the body (hemiparesis) and some may even have paralysis on one side (hemiplagia). While each person is different and requires different levels of assistance, there are general guidelines to keep in mind when assisting the patient with weakness or paralysis on one side of the body. Encourage patients to do as much as possible for themselves in order to build strength and self-esteem. Be prepared to adapt procedures as necessary to meet the needs of the patient. Check with your supervisor to determine the best approach to turning or transferring. Always use good body mechanics with all transfers and change of position. Always use a transfer belt when transferring or walking with the patient. When helping the patient with a stroke to walk or transfer, always have the patient lead off with the weaker side. For example, when walking, the first step should be with the weaker side. Stand on and support the patient s weaker side when transferring or walking. When turning the patient in bed, roll the person to the strong side first. Before turning, the foot on the stronger side should be placed under the weaker ankle when crossing the legs. Position the weaker arm and/or leg correctly. The patient will often not be able to identify if the position causes pain due to loss of feeling in the limb. Use special equipment as needed to assist patients with dressing themselves. The stronger or uninvolved arm/leg should be undressed first to avoid unintended stretching and/or bending of the weaker limb. The weaker or involved arm/leg should be dressed first to avoid unintended stretching and/or bending of the limb. Never refer to weak side or limb as the bad side. For example, do not say, Move your bad arm over to this side of the bed. Use the word weak or involved instead to describe the weaker side or limb.
Assisting with Eating Page 1 of 2 Assisting with Eating The patient who has had a stroke may have several symptoms that lead to difficulty eating. These include weakness on one side of the body, visual field loss and/or difficulty swallowing. Weakness in the arm or hand may make it difficult for the patient to use standard silverware, plates or drinking cups. While some patients may need to be fed, many can maintain their independence with the use of adapted eating utensils. These may include silverware with special built up hand grips, plate guards that assist the person in scooping up food, and drinking cups with special handles. Stroke patients may experience a loss of vision referred to as visual field loss. The person with left sided visual field loss will only see things that are directly ahead and to the right. Left Sided Visual Field Loss Right Sided Visual Field Loss While the person with right sided visual field loss will see only things that are directly ahead and to the left. Patients may not be aware of this vision loss until care providers note that the individual never eats food on a certain side of the plate. If you notice this, immediately suspect visual loss and notify your supervisor. Setting food or drinks on the visual loss side will result in the patient not seeing the food or drinks and therefore not eating or drinking it. When placing food or other items in front of the person, put things on the non-affected side. Another method that may be helpful is to have persons turn their head from side to side so that they can see everything on both sides of the plate. Persons that have had a stroke may also be at risk for choking if they have difficulty swallowing. If it has been determined that the person has difficulty swallowing, it is important to offer soft foods that are easy to chew and swallow. It is also important to closely watch for any signs of choking while the patient is eating.
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Communicating with the Person who has had a Stroke Page 1 of 3 Communicating with the Person who has had a Stroke The person who has had a stroke usually understands what is said but may have a hard time speaking (dysphasia) or may not be able to speak at all (aphasia). The following steps will help when communicating with a person who has had a stroke: Communicate in a quiet place, free of competing noises. Get the person s attention before giving instructions. Keep instructions short, simple, and direct. Give the patient choices. For example, say, Do you want coffee or tea? Use facial expressions to help communicate your message. Do not overreact or be surprised to hear swearing. He or she may not have used profanity prior to the illness, but sometimes will after a stroke. Be sure all written material can be easily seen. For example, use print that is large enough to see and don t use colors that are hard to see, such as black print on red paper. Do not talk down to the person or talk about the person in his or her presence. This leads to feelings of embarrassment, shame, or feeling less valued as a human person. Don t be afraid to admit that you simply do not understand. Take some of the responsibility for the lack of communication. For example, you may say, Maybe I can help you better next time. Do not correct errors such as when the patient uses the wrong word. Use a communication board if that helps the patient better communicate. Communication Board Example Job Aid: Communication Board Word document Adobe PDF
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Question 1 (1 point) Warning signs of a stroke may include any of the following except: Question 1 options: Headache Sudden loss of memory Joint pain Slurring of words Question 2 (1 point) A seizure may be a sign that a person is having a stroke. Question 2 options: True False Question 3 (1 point) Following a stroke, it is important to closely monitor the patient's skin condition for any problems. Question 3 options: True False Question 4 (1 point) It is not necessary to check for proper body alignment when turning a patient following a stroke since they do not feel pain. Question 4 options: True False Question 5 (1 point) You are assigned to care for Gertie today. Gertie had a stroke a month ago which caused left sided hemipharesis (weakness on one side of the body). You are assigned to help her with her cares today. When you get Gertie up to walk, which foot should you have her lead off with? Question 5 options: Left Foot Right Foot Question 6 (1 point)
You are assigned to care for Gertie today. Gertie had a stroke a month ago which caused left sided hemipharesis (weakness on one side of the body). You are assigned to help her with her cares today. When assisting Gertie with walking, which side should you stand on? Question 6 options: Left Side Right Side Question 7 (1 point) Following a stroke, weakness in the arm or hand may make it difficult for the patient to use standard silverware, plates or drinking cups. Question 7 options: True False Question 8 (1 point) A person that has dysphasia is not able to speak at all. Question 8 options: True False