Stroke Scenario- Types, Treatment, Care Flashcards

Question

Care of stroke patient- what interventions are required to maintain circulation?

Answer 1

``` Monitor BP, pulse, resps Monitor CNS using GCS Document on NEWS chart BM monitoring IV line in situ FBC and U's & E's ```

Answer 2

Pain assessment tools to establish presence and severity of pain Visual signs - grimacing, groaning when turned/touched Administer prescribed analgesic- monitor effect

Answer 3

Talk to patient Reassure patient + relatives Orientate Adhere to ethical principles

Answer 4

NBM if required Swallowing assessment Nutritional plan

Answer 5

``` Honesty with patient and family Support/reassurance Ensure access to doctors and senior nursing staff Advice on support groups Contact friends/relatives Warm drinks Privacy Single room for patient DNACPR ```

Answer 6

``` bed location appropriate mattress/cot sides 2hrly positional changes Limb positioning Monitor and protect pressure areas Physiotherapy ```

Answer 7

Dysphagia is an impaired ability to swallow. It occurs post-stroke if the cortex or brainstem has been damaged by the stroke. It increases risk of aspiration pneumonia which can be fatal if severe, difficulty with nutrition and administration of medication. This can lead to complications or increased hospital stay.

Answer 8

``` Coughing or chocking whilst eating or drinking Wet or gurgly sounding vocal quality during meals Increased congestion Slowness when eating Delay in swallowing Fatigue/sob when eating weight loss Drooling Bouts of pneumonia Facial weakness ```

Answer 9

The STOPPS swallow test is used to assess swallowing. Indicated on admission in all patients at high risk for aspiration. Inclusion criteria: (part 1) Can maintain upright sitting position, and stay alert for 15 mins while upright. part 2: determines if patient should be excluded from water swallow test and referred to SALT. part 3 (WST): A. 3x5ml spoonfuls of water without coughing/breathless/hoarse/gurgly NO= NBM, reassess in 3-12hr B. 50ml water from glass at comfortable pace without coughing/breathless/hoarse/gurgly NO= NBM, reassess in 3-12hr. If fail on 2nd attempt contact SALT. YES= normal fluids text E diet and monitor

Answer 10

Follow recommendations by SALT Provide appropriate textured diet and thickens fluids ongoing assessment of fluid and calorie intake Upright position for meals and for 30 mins after Allow time for eating and drinking Check for pocketing of food Consider stoping NG feeds 1-2 hours prior to oral feeding to stimulate appetite. Educate family to aid feeding

Answer 11

Alternative routes Check for pocketing if taking oral medication If on thickens fluids use this consistency for medication administration.

Answer 12

``` Nursing notes up to date Fluid balance Must for baseline and screening Weekly weights Food and fluid chart ```

Answer 13

Regular positioning to prevent pressure damage Assess requirement for bed rails PT assessment to determine required aids Falls Risk assessment Weight transference/balance Appropriate M&H to prevent injury to staff or patient, especially subluxation of shoulder- slings may be appropriate Posture should be observed in relation to weakness and functionality.

Answer 14

Neurogenic bladder- occurs due to neurological dysfunction, it's presentation is dependent on which nerve has been damaged. The bladder can become overactive or underactive. Secondly, the frequency of urine output can increase significantly after stroke. Functional incontinence- occurs due to the physical effects of a stroke such as reduced mobility and a difficulty unfastening and removing clothes in enough time to use the toilet. Urgency incontinence- sudden, urgent and uncomfortable need to pass urine, result of bladder spasm or contractions Urinary retention- inability to fully empty the bladder resulting in urine being retained, it can also be difficult to start urination. Stress incontinence-small amounts of urinary leakage occurs due to coughing, sneezing or laughing, result of weak or damaged muscles in the pelvic floor or urethral sphincters.

Answer 15

``` Potential for depression/low mood Altered body image Effects on self-esteem Stages of grief- loss of old self Loss of independence. Effects of Pseudobulbar affect which causes emotional responses that are unrelated to mood e.g. crying/laughing. ```

Answer 16

- Discuss with PT/family- - no written consent needed - explain what has happened - explain how drug works - risks - avoid cath for 30 min prior

Answer 17

- signs of haemorrhage - neuro obs- - widening pulse pressure - bradycardia - irregular breathing - sudden worse GCS - sudden headache/irritability/ restlessness - worsening limb movement - unequal pupils - observe vital signs - signs of: - orolingual angioedema- oedema in mouth - bleeding gums - anaphylactic reaction - rash - urticaria- hives - laryngeal oedema- resp distress due to swelling in laryngeal - ABCDE

Answer 18

-avoid NG tube insertion for 24hrs -avoid cath for 24hrs No anticogagulants/anti platelets/non steroidanal/ anti inflammatorys for 24hrs -avoid CVP or art lines for 24hrs (include injections) - commence anti coag (aspirin) if usually taken 24hrs after

Answer 19

- impairment of language- production or comprehension - damage to Broca's area and Wernick's - knowing what to say but not having the right words - social affect - affect mood Things that help - carrying pen +paper - use gestures/pictures/ descriptions - carry communication card - speech and language will carry out a full assessment - arrange s&l asap after - establish personal needs and priorities +goals