Mini-Med School: Stroke

Objectives:

After you take this class, you will be able to:

  1. Describe the signs of a stroke and how a stroke happens.
  2. Discuss stroke risk factors.
  3. Detail the care and rehabilitation of a patient who has had a stroke.



What is A Stroke?

Stroke is the third highest cause of death in America. It is also the highest cause of a disability in the United States. A stroke is also called a CVA.

Strokes stop the flow of oxygen to the brain cells. The blood flow is stopped when a blood clot enters the brain or when bleeding occurs in the brain. Brain cells die when the brain does not get the oxygen it needs to stay healthy and to work properly.

A body function done by a certain part of the brain is affected when this part of the brain dies or is hurt with a stroke.



For example, when the speech center of the brain is hurt by a stroke, the person may not be able to speak. Some people may not be able to walk when the part of the brain that controls walking is hurt with a stroke. Others may not be able to lift their arm.

Some people die as a result of a stroke. Many more live but they also have to change their life after they have had a stroke. Many people who were once able to drive a car, walk to the store, cook their own meals, dress themselves and talk to others may not be able to do any of these things after a stroke. They may also not even be able to do the most basic of life’s jobs, like walking, going to the bathroom and bathing. These problems often make a person go into a nursing home or an assisted living facility after their stroke. They can not take care of themselves in their own home. They need others to take care of them.

The Signs of a Stroke

The most common signs of a stroke are:

· A numb, weak or paralyzed face, leg or arm. This can come on very quickly. It often happens to only one side of the body. For example, the person may not be able to use their right arm and their right leg.

  • The person can not speak.
  • The person can not understand what other people are saying to them.
  • Their eyes change. The person may have blurred vision.
  • Trouble swallowing.
  • Loss of balance.
  • Dizziness.
  • A very bad headache.

These signs can get worse over a day or more, as it gets worse. Some people may not have any signs of a stroke at all.

At times, people may have some of these signs but when they last only a few minutes. These people are having a TIA or “mini stroke” and not a stroke. TIAs do not cause lasting damage to the person, but TIAs are a warning sign that a person may have a stroke soon.

The Two Types of Stroke

There are two types of stroke- ischemic stroke and hemorrhagic stroke.

Ischemic stroke. This type happens when a person has atherosclerosis, or the buildup of plaque matter on the inside of their arteries. This was once called “hardening of the arteries”.

These strokes happen when:

  • these plaque pieces close off the free flow of blood to the brain with a clot OR
  • when a piece breaks off the wall of the artery and blocks the free flow of blood to the brain, an ischemic stroke occurs.

Hemorrhagic stroke. The breaking of a brain blood vessel causes this kind of stroke. Cells get damaged when a blood vessel in the brain bursts and leaks. This kind of stroke is most often caused by the patient’s high blood pressure (hypertension).

Stroke Risk Factors

Some of the things that increase the chance of getting a stoke are:

  • Age. The older one gets, the greater the risk of stroke. Elderly people are at greatest risk of stroke.

  • History of Stroke in the Family. A person is at risk for stroke if the person has a family member that has had a stroke or a TIA.

  • Race. African Americans are more likely to have a stroke than other groups of people. The reason for this is because diseases, such as diabetes and high blood pressure, are found at a high rate in this race and these diseases lead to strokes.

  • Gender. Men are more likely to have a stroke than a woman before the age of 55. After age 55, men and women are at the same risk.

  • Things Like High Blood Pressure and Diabetes. Some of the same things that lead to high blood pressure and diabetes are the same for stroke. For example, people that weigh too much, those who do not eat a good diet and those who do not have regular exercise are at high risk for high blood pressure, diabetes and stroke.

  • Life Style. People that have poor habits are more likely to have a stroke. Cigarette smoking, drug use, alcohol abuse, a poor diet with a high intake of foods with fat, a lack of exercise and being over weight add to the risk of stroke.

  • A History of a TIA. People that have had a TIA are at risk for a stroke.

Risk factors like race, gender and family history cannot be changed by a person to lower their chances of getting a stroke. But, a person can control life style habits like diet, exercise and cigarette smoking.

Caring for the Patient After a Stroke

About 20 percent of the people who get a stroke will die in the hospital as a result of it. Many people who have had a stroke will get better and be able to enjoy a full and happy life. Still more are not able to function as well as they used to. Others may never be able to speak, walk, or eat on their own after a stroke.

A patient may have oxygen and an intravenous line (IV) right after their stroke. They may also get medicine to lower brain swelling.


Soon after the stroke, nursing care restores function and prevents complications. For example, rehabilitation, bladder and bowel function and the prevention of pressure sores become nursing care priorities shortly after a stroke.

A loss of function or weakness to the left side of the body occurs when a person has a stroke to the right side of the brain. Likewise, when a person has a stroke on the left side of the body, losses of function will occur on the right side of the body. Paralysis and weakness to one side of the body is called hemiplegia.

About 20% of stroke patients have aphasia. Aphasia gives the stroke patient trouble with speaking, reading, writing and understanding others.

Other functions, such as bladder, bowel, swallowing, breathing, balance and vision, may be affected with both right sided and left sided brain damage as a result of a stroke.

Rehabilitation

Rehabilitation aims to restore some function by promoting the body’s ability to have a new part of the brain take over the lost function. It helps the person to increase their muscle strength, balance, gait, speech, confidence and communication abilities. It also helps to prevent pressure sores and contractions.

Rehabilitation usually begins right after a stroke. It continues for weeks or months after a stroke. It is given in a rehab center, in the patient’s own home, in a hospital and in a nursing home.

Occupational therapists, physical therapists, speech and language therapists, recreation therapists, dietitians, doctors, nurses, nursing assistants, restorative and rehabilitation aides are members of the rehab team for stroke patients.


Occupational therapists

Occupational therapists help the person to do their activities of daily living. They work with the patient so they will be able to dress themselves, and do personal grooming after a stroke.

Some people need special assistive devices after a stroke. They use special forks, plates and devices to pick items up from the floor. These things help with the activities of daily living. The occupational therapist uses these things with the patient so that they can be as independent as possible.

Nursing assistants who take care of people after a stroke should help the person with their activities of daily living as planned by the occupational therapist and other members of the rehab team. They should help them with dressing, brushing their teeth and using any assistive devices that they have.

Physical therapists

Physical therapists help stroke patients with moving about in bed, ambulation, balance, gait and muscle strength.


Physical therapists use heat and cold treatments, massage, weight training, assistive devices, orthotic devices, range of motion exercise and other kinds of exercise to improve the patient’s level of functioning.

Some of the assistive devices that a physical therapist uses to help the person walk are:

  • Canes
  • Walkers
  • Gait belts

Some of the orthotic devices that a physical therapist uses to support, align and prevent bodily deformities are:

  • Braces
  • Splints

Speech and language therapists


Speech and language therapists assist their patients with communication. They also help patients with a swallowing disorder, something that often happens after a stroke.

These therapists also use assistive devices. For example, they may use a word board so that a patient can communicate their needs to others with out the spoken word.

Recreation therapists

Recreational therapists also work on the rehab team. They plan and conduct activities that are fun and also help the person’s physical, mental and social skills.

Some of these activities include:

  • Bingo
  • Singing groups
  • Wheelchair exercise groups
  • Reading
  • Current event group


Dietitians

Dietitians provide good diets to patients. They adjust diets when a patient has a swallowing disorder. They also work with nursing staff members to prevent and treat pressure sores after a stroke.

They help to plan restorative dining groups. These groups help patients to feed themselves, with some cues or help, using assistive devices, like a food guard plate, an easy hold cup and heavily padded forks, knives and spoons.

Doctors, nurses, nursing assistants, restorative and rehabilitation aides

Doctors, nurses, nursing assistants, restorative and rehabilitation aides carry out the plan of care for the rehab team during all of their interactions with the patient after the stroke.

Nursing assistants must:

  • Prevent falls and make sure that the patient is safe. (Take our class called “ Preventing Falls” for more information about falls and falls prevention.)

  • Encourage and support the patient. It is important for all health care providers to give the stroke patient and their family members encouragement and support. This is a very difficult time for them. Rehab is also mentally and physically exhausting.

  • Encourage as much independence as possible.

  • Feed hemiplegia patients by placing the food on the good side of the mouth. (Take our class called “Feeding Residents and Patients” for more information feeding after a stroke.)

  • Provide good skin care. (Take our class called “Preventing Pressure Ulcers” for more information about skin care after a stroke)

  • Assist the patient with their assistive and supportive devices.

  • Follow the ordered bowel and bladder retraining program.

  • Help the person with their activities of daily living. Help them bathe, get dressed and eat.

  • Assist the patient with mobility and ambulation.

  • Do range of motion exercises with the person.

  • Encourage and support the patient after the stroke.

Summary

Stroke is a major health problem, especially among the elderly. Nursing assistants play a very important role in caring for patients that have had a stroke. They assist the patient with their restorative and rehabilitation treatments and they help to prevent some of the problems that stroke patients have, like falls, skin breakdown and the loss of independence.

References

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

 

Copyright © 2010 Alene Burke


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