1. N URSING THE S TROKE P ATIENT : Modified March 2013 1 This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available.

2. I NTRODUCTION : A IM & O BJECTIVES AIM: To inform participants about some of the key areas of care carried out by nurses for patients who have experienced a stroke

3. I NTRODUCTION : A IM & O BJECTIVES OBJECTIVES: After completion of the session, the participant should be able to: 1. List what aspects should be considered when nursing a patient with a diagnosis of stroke 2. Discuss possible complications post-stroke 3. Discuss some of the intervention(s) that can be implemented by nurses to prevent complications

4. I NTRODUCTION : A REAS TO DISCUSS Nurse Preventive Care Curative Care Rehabilitative/ Promotive Care Provide Information on Stroke, Risk Factors, Lifestyle modification Accurate assessment Plan care that is person centred Physiological monitoring Risk Assessment & Prevention of Complications Carry on Role (Therapies) Safe Discharge Planning Secondary Prevention Communication with Family/carers

5. P REVENTIVE C ARE Raising Awareness: Risk factors Lifestyle modification Medical check ups

6. C URATIVE C ARE A PPROACH : E ARLY A SSESSMENT & D IAGNOSIS Assessment Patient’s condition & needs Patient priorities Admit to dedicated stroke beds Early swallow screen

7. C URATIVE C ARE A PPROACH : E ARLY A SSESSMENT & D IAGNOSIS Majority of patients respond to simple nursing interventions Continence assessment Baseline assessment is key

8. P HYSIOLOGICAL M ONITORING

9. W HY MONITOR PATIENT ’ S VITAL SIGNS ? Prevent or detect stroke extension Facilitate recovery Protect the ischaemic pneumbra

10. B LOOD P RESSURE Many patients with acute stroke have elevated BP Abrupt drops in BP MUST be avoided BP usually spontaneously decreases in first week after CVA

11. H EART R ATE Atrial fibrillation

12. R ESPIRATORY R ATE & O XYGEN S ATURATIONS Detect and treat hypoxaemia. Identify potential causes of hypoxia Hypoxia more commonly occurs at night

13. P YREXIA & L EVEL OF C ONSCIOUSNESS Increased temperature increases infarct size. Fever is frequent over the initial 48 hour period and negatively influences clinical outcome Many patients develop infection after stroke Treat pyrexia early

14. B LOOD G LUCOSE Increase in glucose levels is harmful in acute stroke. No difference in mortality, or reduce severe disability. lowering glucose lowered BP

15. P REVENTION OF V ARIOUS C OMPLICATIONS

16. P ATIENTS WHO ARE NIL BY MOUTH

17. P NEUMONIA

18. S HOULDER S UBLUXATION

19. . Prevention is better than cure Shoulder Subluxation

20. Sub-Lux Cuff (Hemi-arm sling) Neoprene double shoulder Brace T YPES OF SHOULDER SUPPORTS

21. C OMPLICATIONS OF E NFORCED I NACTIVITY Muscle Atrophy

22. C OMPLICATIONS OF E NFORCED I NACTIVITY Joint Contractures

23. C OMPLICATIONS OF E NFORCED I NACTIVITY Drop Foot Deformity

24. D EEP V EIN T HROMBOSIS

26. I NTERVENTION Good Posture Sitting out in an appropriate chair Early mobilisation Passive exercises whilst in bed Physiotherapy Good MDT working – Stroke Unit Care

27. R EHABILITATIVE C ARE : E SSENCE OF THE N URSING R OLE The Carry-On Role “Carry -On” work refers to the work of Physiotherapists and Occupational Therapists which nurses are expected to continue in the absence of the therapists

28. E SSENCE OF THE N URSING R OLE … The Carry-On Role helping patients to wash & dress in a particular way continue walking practice/with or without aids

29. E SSENCE OF THE N URSING R OLE … The Carry-On Role

30. E SSENCE OF THE N URSING R OLE The nature of patient’s needs means nurses work with a variety of other health professionals Nurses are often seen as the coordinators of the team and a central point for communication and decision making

31. I MPORTANT F ACTORS FOR SUCCESSFUL DISCHARGE Good discharge planning Good Communication Home Visit Carer adequately trained? Medication concordance

32. W HAT IS THE RECIPE FOR GOOD NURSING CARE IN STROKE ? Organisation of services Communication between the team No professional boundaries Information giving Education

33. Any Questions