Stroke - LPNI
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Stroke
LPNI Health Topic-July 2020
Stroke
Stroke is the fifth leading killer in the United States. The incidence of stroke increases greatly after age 55. The other risk factor is hypertension. Where there is a history of Transient Ischemic Attack (TIA), or previous stroke, atherosclerosis and atrial fibrillation, the risk for stroke increases. Lifestyle risk factors are smoking and high alcohol intake.
Strokes can be thrombolytic, embolytic or hemorrhagic. In an older person, it is most commonly thrombolytic, associated with atherosclerosis. One third of all stroke patients die within the first three weeks. That leaves two thirds of stroke victims as survivors, people who often need support but also encouragement and enablement. Recovery may take days or months, depending on the amount of damage to the brain or cerebral oedema. Usually three to six months after the event a plateau is reached.
The nursing needs of a person who has suffered a stroke are complex and varied. It is important for nurses to respond to the differences of right-sided and left-sided brain damage. Right hemiplegia results in problems with speech and language, because the speech centre is in the left side of the brain in most people. These people often tend to be cautious and anxious, and disorganised when attempting a new task.
Hints for caring for a person with right hemiplegia
● Do not underestimate the person’s ability to learn and communicate – even if they can’t use speech.
● Try other forms of communication- pantomime or demonstration are useful – give the person time to respond.
● Do not overload the person with “static” in your communication – keep tasks in simple steps.
● Do not shout
● Use your normal voice (not one that is condescending)
● Give feedback and indication of progress – use words of encouragement and affirmation.
People with left sided hemiplegia often have spatial perception deficits which can impair their ability to judge distance, size, position, rate of movement, form and the relation of parts to the whole. These deficits can be overlooked as the person with left hemiplegia can often speak better than they can perform. This can have a huge impact on their ability to care for themselves. These people often do not recognise a potentially dangerous situation and may overestimate their capability. They often do not see the “left” side of the body.
Hints on caring for a person with left hemiplegia
● Do not overestimate their abilities.
● Use verbal cues if there is difficulty with demonstration.
● Break tasks into smaller sections, and give feedback.
● Observe to see what they can do safely, rather than taking their word for it.
● Minimise clutter around them.
● Avoid rapid movement.
● Highlight visual reference points.
Much of the literature about patient care following a stroke is about physical care, but psychological and spiritual support is important for their wellbeing too. Their world has changed drastically. It is worth doing a spiritual needs assessment. Create an environment where hopes, fears, questions, and expectations can be expressed. Give the person an opportunity to express how and why hope is significant in life. Be mindful that the person may feel trapped in their body and their circumstance. Make referrals for psychiatric support, especially where suicidal ideation or threatening behaviour exits. Documentation of their care and care needs is valuable in the multidisciplinary care of the person affected by a stroke.
One of the latest ways to detect and treat stroke is to remember and implement FAST: Face (facial drooping), Arms (arm weakness), Speech(speech difficulty), and Time ( to call emergency services!)
When I care for people I often say (occasionally in silence): I pray that all may go well with you and that you may be in good health, as it goes well with your soul. (3 John 2 ESV)
Some of the material is from Linton, A.D., Lash, H., Matteson, W. in McConnell’s Gerontological Nursing Concepts and Practice 3rd ed, 2007, Saunders Elsevier.
Angela Uhrhane, Pastoral Care Nurse, Albury, Australia
Pastoral Care Nursing Coordinator, Lutheran Church of Australia
angela.uhrhane@lca.org.au