1. Stroke Management Jean Luciano, MSN, RN, CNRN, CRNP
Nurse Practitioner, Stroke Team
The Hospital of the University of Pennsylvania

2. What is a Stroke?
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die. Stroke is the third-leading cause of death in the United States and a leading cause of disability. However, research shows the public remains unaware of stroke's warning signs and the need for immediate medical attention, even if the symptoms subside. Call 9-1-1!

3. Epidemiology of Stroke in the U.S.A.
725,000 new and recurrent strokes per year
Every 45 seconds someone in the USA has a stroke
Every 3 minutes someone dies from stroke
Approximately 4,000,000 stroke survivors
The leading cause of adult disability
The leading diagnosis from the hospital to long term care

4. Stroke Epidemiology
Twice as many women die from stroke as die from breast cancer each year
African Americans have almost twice the risk of first ever strokes.
The Southern United States “Stroke Belt”.
Affects all age groups

5. Caregiver Burden
50% of stroke survivors are still disabled one year post stroke
Most require assistance with ADL’s
Many have insufficient resources
One-half of all caregivers develop emotional illnesses after one year of caring for a stroke patient

6. GIVE ME FIVE ! TALK WALK FEEL SEE
To check if someone is having a stroke, ask the person to give you five:
REACH
WALK
TALK
SEE
FEEL

7. Things to look for or ask:
WALK   IS THEIR BALANCE OFF?
Things to look for or ask:
Are they able to stand straight and tall? Or do they slump to one side?
Do they appear to have lost strength on one side of their body?
Are they leaning to one side when they try to walk?
Are they veering off to one side?
Are they dragging the foot on the side they are leaning toward? Can they tell you whether they can feel the side that they are leaning toward?

8. TALK   IS THEIR SPEECH SLURRED OR FACE DROOPY?
Things to look for or ask:
Are they having problems speaking?
Are they having problems "getting their words out?"
Do they sound like they have something in their mouth when they speak?
Are they saying the appropriate words (do their words make sense) when they speak?
Does one side of their mouth droop down?

9. REACH   IS ONE SIDE WEAK OR NUMB?
Things to look for or ask:
Ask the person to raise both their arms up together. Does one arm begin to fall down?
Ask the person to squeeze your fingers with each hand; is one hand weaker than the other?
If you ask the person to try to hold something like a pen, can they do it without any difficulty?
Can the person feel you touch them on their arm? Lightly touch them on the skin of both arms, and ask them if the feeling is the same on each.

10. SEE   IS THEIR VISION ALL OR PARTLY LOST?
Things to look for or ask:
Ask the person about their vision. Do they normally wear glasses or contact lenses, or do they normally not use either of these? Ask the person to try to describe any changes in their vision.
Is their vision clear?
Is it blurry?
Can they see everything in their field of vision? Does the person see everything or just part of the visual field?
Does the person see double?

11. FEEL   IS THEIR HEADACHE SEVERE?
Things to look for or ask?
Do they have a headache? On a scale of 1-10, 10 being the worst, ask them to rate their headache.
Do they normally have headaches? If so, is this headache any different from their usual headache?
Does this feel like the worst headache of their life?
Does light bother or hurt their eyes?
Does a sound or loud noise make the headache worse?

12. Stroke Survivors
NOT
Stroke Victims!

13. “A stroke is like a snowflake,
no two look alike”.

14. Avoiding Another Stroke
Having already experienced a stroke means that your risk of having another is higher than someone who hasn't had a stroke. By controlling all the risk factors you can can reduce your risk of recurring stroke.

16. Rehabilitation
Rehabilitation is a critical part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation helps you return to independent living.

17. Regaining Independence
The goal for many stroke survivors is to recover as much independence as possible. Examples: Taking care of their own afairs, Driving & returning to work

18. Dressing
Choosing and adapting the right clothes can make the daily task of getting dressed go smoothly.

19. GETTING DRESSED
To Survivors: The general rule is to use your unaffected
arm to dress the affected side first. To undress, take the garment
off the unaffected side, then remove it from the affected side.
To caregivers: When you are helping someone dress, always tell them what you are doing first so you don’t startle them

20. CHOOSING CLOTHING
Knit fabrics wrinkle less than woven fabrics, so they require little or no ironing.
Coats and jackets lined with slippery fabrics like satin, silk or nylon are easier to put on than unlined garments.
Use Velcro closures on shoes instead of laces. Replacing buttons with Velcro closures makes dressing and undressing faster.
Adapting clothing

21. Adaptive/Assistive Technology
Adaptive and assistive technologies can be of help for everything from chopping vegetables to reading a book.

22. Communication Technology
As computer technology has become more efficient and less costly, an increasing variety of hardware and software options are available that can help people recovering from stroke.

23. DEPRESSION after STROKE
Depression occurs in about 40 to 50 percent of all stroke survivors. It can occur soon after the stroke or several months later.
Signs of depression can include:
Felling of worthlessness
Decreased energy
Pessimism
Decreased ability to concentrate
Anger
Frustration
Survivors and Caregivers should be alert for signs of depression so they can identify it to a healthcare provider.

24. Cognitive Issues
Memory
Comprehension
Return to work issues

25. FATIGUE !!!!!!!!

26. GETTING SUPPORT
FAMILY & FRIENDS
Support Groups
Church & Community

27. www.heart.org 1-888-4-stroke INFORMATION IS POWER!
Consider becoming part of the American Heart and the American Stroke
Association’s Grass Roots Network!

28. Early Intervention is the Key to Stroke Prevention and Treatment