Armenia

2012

STROKE IS A LEADING KILLER AND CAUSE OF ADULT DISABILITY

STROKE RISK INCREASES BY 1,6 TIMES EVERY 10 MMHG INCREASE IN SYSTOLIC BLOOD PRESSURE (GOFIR, 2009).

BP CONTROL IS AN IMPORTANT ROLE TO PREVENT RECURRENT STROKE.

ANTI HYPERTENSIVE THERAPY WILL DECREASE RECURRENT STROKE RISK BY 40% (LAWES, , ET AL, 2004).

Stroke is a syndrome indicated by a rapid development of focal or global neural dysfunction for more than 24 hours (except if there is a surgery intervention or ending to death), caused by vascular diseases.

(Warlow et al., 2007)

Blood supply to the brain is suddenly disrupted

Occurs in 2 main ways:

(1) Ischaemic stroke (blocked artery)

(2) Haemorrhagic stroke (bleed in brain)

Ischemic

Stroke

Clot occluding

artery

Intracerebral

Hemorrhage

Bleeding

into brain

Subarachnoid

Hemorrhage

Bleeding

around brain

Focal Brain Dysfunction

Diffuse Brain Dysfunction

85% 10% 5%

enabling a person with an impairment:

optimal physical,

optimal cognitive,

optimal emotional,

optimal communicative and/or

optimal social functional

Heart and Stroke Foundation of Ontario

Impairments: problems in body function or structure such as a significant deviation or loss (eg weakness)

Activity limitations: are difficulties an individual may have in executing activities (eg reaching for a cup, walking)

Participation restrictions: are problems an individual may experience in involvement in life situations (eg going shopping, playing sport)

Effective intervention aims to promote maximal recovery and prevent costly complications and subsequent stroke

multidisciplinary team

Safe transfer of care from hospital to community

Carer training

Community rehab and follow-up services

Long term rehabilitation

S-pecific

M-easurable

A-ttainable

R-ealistic

T-ime frame

make informed decisions about their care and treatment, in partnership with their healthcare professionals

Good communication between healthcare professionals and people with acute stroke or TIA, as well as their families and carers, is essential

dysphasia or additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read SHOULD BE ACCESSED.

Families and carers should also be given the information and support they need.

Stroke NICE clinical guideline 68

All people with suspected stroke should be admitted directly to a specialist acute stroke unit[7] following initial assessment,.

Brain imaging should be performed immediately for people with acute stroke if any of the following apply:

indications for thrombolysis or early anticoagulation treatment

on anticoagulant treatment

a known bleeding tendency

a depressed level of consciousness (Glasgow Coma Score below 13)

unexplained progressive or fluctuating symptoms

papilloedema, neck stiffness or fever severe headache at onset of stroke symptoms.

Established papilloedema (acute)

VA - usually normal Severe disc elevation and hyperaemia Very indistinct disc margins Obscuration of small vessels on disc Marked venous engorgement Reduced or absent optic cup Haemorrhages + cotton-wool spots Macular star

Structured to provide as much practice as possible within first 6 months after stroke

Minimum of one hour of active practice a day at least 5 days a week

Early mobilisation, as frequently as possible

Upper limb training should commence early

Weakness strengthening exercises

Dysphagia (swallowing difficulty) modified diet, monitor, speech pathology intervention

Loss of sensation sensory specific training

Visual field loss

showering, toileting, dressing

Task specific practice

Training in use of appropriate aids

Aphasia impairment of language affecting production or comprehension of speech and ability to read and write

Talk time group at Royal Rehab

Enhance communication by using alternative methods

thinking,

memory,

problem solving

Nutrition and hydration

Reduced cardiovascular fitness

Fatigue

Incontinence

Mood

Behavioural change

Falls

In 6 hours

24 hours

48 hours

7 days

1 months

3 months

1 year

5 year etc

After First Stroke

3% to 10% 30-Day

5% to 14% 1-Year

25% to 40% 5-Year

Knowledge

Behaviour

(can be changed)

smoking

alcohol

Blood cholesterol levels

Diabetes

No Exercise

Hight sodium diet

Hight fat diet

circulation problems (Hypertension, coagulation)

Patient complience

Cant be changed:

Being over age 55

Being a man

Being African American

Someone in your family has had a stroke

Having diabetes

Control your blood pressure

Find out if you have atrial

fibrillation (an irregular heartbeat which allows blood to pool in the heart and cause blood clots)

Patient adherence

Quit smoking

Limit alcohol

Monitor your cholesterol levels

Manage your diabetes

Exercise often

Eat foods low in sodium (salt)

and fat

Monitor circulation problems with the help of your doctor or pharmacist

Commence as early as possible

Involves a team of health professionals

Practice, practice, practice (use of allied health

assistants)

Continues after discharge from hospital

Prevent recurrent Stroke incident

Pharmacist participation in patient complence

Home care

Seorang wanita 56 thun dilarikan ke IGD karena mendadak pingsan setelah mengeluh sakit kepala yang tidak tertahankan. Pasien juga mengalami kejang . Hasil CT scan menunjukkan adanya perdarah traserebral. Di RS ia mendapatkan infus mannitol. Keesokan harinya pasien sadar, dan diberi terapi parasetamol dan nimodipin melalui nasal sonde.

Bahaslah DRP dan pelayanan anda pada kasus tersebut!

Clinical Guidelines for stroke Management 2010