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Stroke week > Lecture 3- Interprofessional team working > Flashcards

Lecture 3- Interprofessional team working Flashcards

1
Q

The members of the interprofessional Stroke team include

A

· Stroke physicians

· Stroke nurses

· Healthcare assistants

· Therapists: Physiotherapists, occupational therapists, speech and language therapists, therapy assistants

· Clinical psychologists

· Social workers

· Dietitians

· Stroke co-ordinators

· Pharmacists

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2
Q

role of OT

A

OT is concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. OT’s help people maximize their independence with an emphasis on useful or functional activities.

  • OT’s class an occupation as any activity that person wishes or needs to complete.
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3
Q

OT in stroke

*

A
  • Stroke affects patients’ memory and thinking, physical ability, vision, mood, sensation, personality, energy levels, and continence which all impact on patient’s ability to perform their usual roles.
  • Occupational therapy in stroke survivors therefore involves assessment and intervention in a number of areas including
    • Cognition
    • Vision
    • upper limb function
    • transfers
    • activities of daily living (ADL’s),
    • and seating
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4
Q

OT assessments in stroke

A
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5
Q

OT treatment/interventions

A
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6
Q

role of physiotherapists

A
  • Physiotherapists restore movement and function when someone is affected by injury, illness, or disability.
  • They help to manage pain, and to prevent disease, and disability.
  • They encourage development and facilitation of recovery, enabling people to remain independent for as long as possible
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7
Q

physiotherapists and stroke

A

Physiotherapy after stroke aims to help people relearn lost abilities, regain independence, reduce the risk of post stroke complications, and help prevent further strokes. There is a strong evidence base for its effectiveness.

Physiotherapy uses a number of techniques including:

  • movement and exercise
  • manual therapy
  • education
  • advice
  • specialist equipment
  • hydrotherapy.
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8
Q
A
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9
Q

RCP guidelines for stroke care

A
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10
Q

stroke physio assessment/treatment involves

A
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11
Q

re-habilitation may involve

A
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12
Q

basis of stroke rehab

A

neuroplasticity

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13
Q

how do we encourage neuroplasticity

A
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14
Q

stroke nurses

A

Nurses that work in acute stroke care have a wide ranging role, and are responsible for the provision of specialist services all aimed at assisting the recovery and rehabilitation of stroke survivors.

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15
Q

how do stroke nurses contribute

A

Nurses conduct assessments, identification and monitoring, as well as co-ordinating the all-round holistic care that is required for all patients during a hospital stay. They also liaise with multi-disciplinary team members regarding rehabilitation, psychological support, speech and language therapy and end of life care. Nurses can play a key role to inpatient stroke recovery, by being present 24/7 with the patients they have opportunities to ensure all aspects of the patients’ needs are met, helping them towards a successful recovery.

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16
Q

nurse monitoring

A
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17
Q

nurses and thrombolysis

A
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18
Q

nurse swallow screening

A
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19
Q

ward rounds

A
20
Q

nursing assessment

A
21
Q

nurse transfer

A
22
Q

patient flow on the ward- nurse

A
23
Q

RAP nurses

A
24
Q

specialist skills of RAP nurses

A
25
Q

Speech and language therapist

A

SLT’s provide specialist assessment of swallowing and communication difficulties after stroke and are involved at all stages of the stroke pathway. SLTs work directly with patients and also provide support and training for other professionals in facilitating communication and supporting implementation of dysphagia management plans such as modification of diet and fluids. They also carry out specialist assessments of swallowing such as videoflouroscopy.

26
Q

TYPES OF COMMUNICATION DISORDERS

A
  • Dysphasia / Aphasia Dysarthria
  • Dyspraxia / Apraxia of Speech
  • Dysphonia
  • Dysfluency
27
Q

Aphasia

A

(usually caused by stroke damaging the left side of the brain- Broca’s and Wernicke’s)Difficulty with

  • Speaking
  • Understanding
  • Reading
  • Writing
  • Numbers
  • Gesture
28
Q

Dysarthria –

A

speech disorder

Weakness and/or abnormal muscle tone of the muscles that move the articulators

such as the lips and tongue

Results in

  • Poor articulation ”slurred speech”
  • Poor respiration
  • Poor phonation (producing voice)
  • Poor resonance
  • Poor prosody
29
Q

peoples speech may sound if they have dysarthria

A
  • Slurred, slow, effortful
  • Quiet
  • Hoarse
  • Prosodically abnormal
30
Q

IMPACT OF COMMUNICATION DIFFICULTIES

A
  • Increased length of stay
  • Low mood
  • Functional outcomes- degree of independence and need for assistance in activities of daily living
  • Barriers to rehabilitation and effective clinical care e.g. accessing information
  • Psychosocial – relationships, isolation
31
Q

MENTAL CAPACITY ASSESSMENTS

A
  • People with aphasia may have difficulty in communicating whether they do or do not have capacity to make a decision. e.g. regarding healthcare, discharge plans.
  • Patients with aphasia have reported frustration about not being involved in decision making.
  • Speech and language therapists can provide accessible information that’s aphasia-friendly e.g. written information with graphics/photos (Rose et al., 2012), and help facilitate this communication.
  • As with other patients, patients with aphasia may not have the mental capacity to make decisions resulting in healthcare professionals acting in their best interests
  • Consult family when deciding what is in a person’s best interests
  • It must not be assumed that a person who struggles to communicate verbally does not have capacity.
32
Q

how to help communicate with patients with aphasia and dysrathria

A
33
Q

how to help patients understand

A
34
Q

SLT ROLE

A

SLT’s provide specialist assessment of swallowing and communication difficulties after stroke and are involved at all stages of the stroke pathway. SLTs work directly with patients and also provide support and training for other professionals in facilitating communication and supporting implementation of dysphagia management plans such as modification of diet and fluids. They also carry out specialist assessments of swallowing such as videoflouroscopy.

35
Q

Normal swallow

A
36
Q

swallow revovery in stroke

A
  • Swallowing is bilaterally but asymmetrically represented in the human motor cortex.
  • Recovery of swallowing after stroke appears to relate to compensation of function in the undamaged hemisphere.
  • There is great variability in the site and size of lesions that can cause swallowing problems.
  • In addition to primary motor areas and brainstem, other areas that have been associated with swallowing problems are the
    • Thalamus
    • Cerebellum
    • basal ganglia
    • pyramidal tracts
    • frontal operculum and insula.
  • The larger the lesion, the more likely a patient is to develop swallowing problems
37
Q

define aspiration and silent aspiration

A
38
Q

Signs of aspiration

A
  • Coughing and choking
  • Throat clearing
  • Change of facial colour
  • Eye watering
  • Excess oral secretions (not swallowing saliva)
  • Gurgly voice or change to voice quality
  • Sounds of respiratory difficulty / increased respiratory rate
  • Gasping
  • Desaturation
39
Q

Symptoms

A
  • Dehydration
  • Malnutrition
  • Loss of weight Hunger
  • Respiratory problems (chest infection, pneumonia)
  • Refusal to eat
  • Avoiding certain foods
40
Q

impact of dysphagia

A
41
Q

relevant co-morbidities to dysphagia

A
42
Q

dysphagia assessment

A
43
Q

Medication in dysphagia

A
44
Q

Risk Feeding

A
  • Decision reached with the Medical Team
  • Family and patient expectations
  • Best Interests and Patient wishes
  • Risk Feeding recommendations incorporate patient response to consistencies. The aim is for the least restrictive modification and balancing distress.
  • Management is tailored to the individual and the direction of their care. For some, this is active management and rehabilitation where nutrition remains key. For others, this may be a palliative approach which focuses on keeping the individual comfortable.
  • Response to aspiration can vary
45
Q

Dietician

A

Dieticians have many roles but in the context of stroke, their main role is in the nutritional assessment and management of patients with dysphagia. This can range from modified consistency diets (in conjunction with SLT) and oral nutritional supplements to enteral (tube) feeding. Stroke patients are at high risk of malnutrition owing to dysphagia, poor nutritional intake, and fatigue.

Stroke week (6 decks)

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