Recovering from Stroke Long Term Management Flashcards
Language problems with Broca’s area
Flow of speech stilted, difficult and cannot find words.
Expressive.
Language problems with Wernicke’s area
Fluent flow of speech
Neologisms (made up words)
Mistake closely related words
Comprehension, reading + writing impaired
What happens to blood pressure after a stroke?
Rises acutely and may settle
Only give antihypertensives if intracerebral haemorrhage with systolic BP>200
What happens to oxygenation levels after stroke?
Needs to be above 95%, if less, supplement O2
What happens to capillary blood glucose after stroke?
First confirm diabetes by checking fasting venous blood glucose
Needs to be between 4-11 mmol/l
Avoid hypoglycaemia
Example of initial goals following stroke
Explore strategies for communication
To be able to sit out of bed for two hours at a time
Explore options for swallowing normal diet and fluids
Assessment of swallowing
Check patient positioned correctly and are alert
- Give a single teaspoon of water
- Drooling from mouth? Coughing or choking? Wet voice?
- Give two further teaspoons of water
- Repeat two
- Give 50ml of water
- Repeat two
= safe swallow
What to do if unsafe swallow
Keep nil by mouth, feed by NG tube
Refer to speech and language therapist for formal assessment
Advice on thickened fluids
If still unsafe after 6 weeks consider gastrosomy tube
Pressure ulcers risk factors and pathogenesis
Immobility, malnutrition, diabetes, smoking, terminal illness, sensory impairment
Sustained pressure, mainly over bony prominence.
Friction and shear forces when moving patient
Moisture: incontinence, sweating
Shoulder subluxation contributing factors
Weakness of rotator cuff muscles of stroke side
Neglect of affected limb
Consider other causes of shoulder pain: tear of rotator cuff muscles, capsulitis, tendonitis, exclude by USS
Post stroke pain
Damage to sensory cortex leads to contralateral sensory disturbance leads to two types of phenomenon: negative and positive
Negative phenomena post-stroke pain
Decreased sensation in one or more modalities
Positive phenomena post-stroke pain
Paraesthesia, burning, shooting pains
Dysaesthesia: altered perception
Post stroke pain treatment
Does not respond to paracetamol, opiates or NSAIDs
May respond to pregabalin or gabapentin (anti-epileptic agents)
Amitriptyline (anti-depressant)
Contributing factors to incontinence
Need to communicate the problem - hard for a lot of stroke victims
Immobility
Constipation with overflow
Medication: laxatives, diuretics
Other medical problems: DM, UTI, prostatic hypertrophy
