Adult Neurologic:STroke Flashcards
Recovery
Most rapid in 1st month. Constantly re-evaluating.
Prior medical history and complications greatly influence patient recovery.
Why is it important to re-evaluate
Constant re-evaluation necessary to make an accurate prognosis.
Can patients improve long-term
Yes, have been known to improve years post-onset.
Patients may also stop improving and function can level out before reach full oral level.
What happens in acute phase?
Patient rapidly changing, so alertness comes and goes.
High risk for complications due to comorbid conditions
High risk for malnutrition and de-hydration, so must tailor plan to that.
What are goals for assessment/treatment during acute phase?
Determine best way to minimize or avoid complications from comorbid conds.
Assess need and readiness for therapy.
Maintain and improve nutrition and hyradtion.
Freq reeval to see if plan working
How long is acute
0-1 months
How long is Improving phase
1-6months
What happens during Improving phase
patient more stable and has better enduracnce.
Comorbid conds often under medical control
Already established feeding plan
What are treatment and assessment goals during improvement phase?
Need and readiness for therapy.
The type of therapy we’ll provide
What’s the chronic stage
after 6 mos
What happens after chronic stage
feeding plan more established
May have impaired swallow still even though they eat orally
May have developed maladaptive behaviors that interfere with swallowing (taught self how to improve swallow)
The impat of prior therapy
What are the complications of head trauma?
Impulsive: too much food in mouth when eating
Tend to have cognitive difficulties which make therapy hard, especially swallow maneuvares
Reduced sensation: reduced awareness of swallowing problems
What are some compliance issues We might face?
Difficult to convince patient and family to comply with dietary changes.
What are reasons it’s hard to convince family?
This can be hard if swallow not assessed during acute period, so it seems the changes are our of the blue.
Patient is unaware and seems not to struggle.
Younger adult patients can tolerate aspiration for short period of time, so consequences of long term aspiration not readily obvious
