Caring for a Stroke Survivor

June 2015

Ms Ng Wai MayAdvanced Practice Nursewai_may_ng@nni.com.sg

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 ??