Stroke

Question 1

what is palliative care

Answer 1

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Question 2

what is a stroke

Answer 2

A clinical syndrome: acute loss of focal cerebral function lasting more than 24h or leading to death. Either spontaneous haemorrhage into brain or inadequate blood supply to part of brain (ischaemic stroke) as a result of low blood flow, thrombosis or embolism

Question 3

what are all the reasons stroke mortality has reduced in the UK and in Scotland

Answer 3

¥ Organised stroke unit care
¥ Thrombolysis (ischaemic stroke)
¥ Time is brain (Thrombolysis - TIME IS BRAIN. Means stroke is now treated as a medical emergency.)
¥ Public awareness FAST campaign: FAST is sensitive and specific enough for A&E staff to use
¥ Secondary prevention
¥ Scottish Stroke Care Audit
¥ Scottish Stroke Research Network
¥ Hemicraniectomy for decompression – shown (DESTINY trial, 2007) to improve outcome in malignant MCA infarction
¥ Better, faster management of TIA
¥ Rehabilitation & early supported discharge
¥ Secondary prevention (management of AF, hypertension, hyperlipidaemia) is contributing to improved mortality figures.
¥ Thriving programmes of research and audit

Question 4

what are the Three possible patient groups after a stroke

Answer 4

¥ Degree of recovery expected, likely benefit from full rehabilitation
¥ Uncertainty re survival. Extent of stroke damage moderate or unclear. Possible may not survive acute phase.
¥ Extensive stroke, profound irreversible damage and/or co‐morbidities - death in days is likely

Question 5

What guidance is available for advanced care planning

Answer 5

¥ “Advance care planning should take place for those people who may survive the acute stroke with limited life expectancy, to facilitate timely referral to specialist palliative care services.”(p30) (National Clinical Guideline for Stroke, 2016)
¥ Stroke survivors living in care homes should be able to access rehabilitation to improve their quality of life (National Clinical Guideline for Stroke, 2016)

Question 6

what are the challenges of strokes

Answer 6

¥ Speed of onset
¥ Communication - aphasia
¥ Cognitive problems or impaired conscious level
¥ Dysphagia & feeding issues
¥ Comorbidity e.g. dementia
¥ Uncertainty of outcome
¥ Difficulty in identifying dying: Unconscious, bed-bound, unable to swallow tablets, fluids – effect of stroke or signs of dying??

Question 7

what are best practice points for stroke care

Answer 7

provided by healthcare professional teams experienced in stroke care
stroke units should have a protocol for making DNACPR decisions that includes timing
Staff should be trained in the use of local protocols for DNACPR decisions and capacity assessments
Oral feeding and hydration should never be withdrawn if patient is able. Time-limited trial of feeding/hydration
Anticipatory care planning is recommended as best practice
established systems of referral to palliative care
Team working and MDT
use of end of life care pathways