1. Caring for a Stroke Survivor June 2015 Ms Ng Wai May Advanced Practice Nurse wai_may_ng@nni.com.sg

2. Learning Objectives At the end of the session, you will be able to  Identify strategies to care of patient post stroke to minimise complications  Verbalise stroke risk reduction strategies  Recognise stroke signs/ symptoms

3. Every Stroke is different Effects of stroke depends on o Region of brain affected o Size of area damaged by the stroke o Functions that the area controlled

4. Let’s talk about some common post stroke complications

5. Swallowing Difficulties

6. Pneumonia

7. What You Can Do Sit out of bed for a meal and c ontinue sitting for 30mins after a meal Place food on unaffected side of mouth Avoid straws Maintain good oral hygiene (before and after a meal)

8. What You Can Do Note tell-tale signs of swallowing problems Coughing Choking on saliva or food Pocketing of food Delay or absent swallowing reflex Drooling Wet voice Inform Dr and refer to a speech therapist

9. What You Can Do Follow speech therapist’s recommendations modified diet modified fluid consistency special swallowing maneuvers Recognise swallowing problems/ fever  seek medical attention immediately

10. Malnutrition

11. What You Can Do Note factors that can cause malnutrition Reduce consciousness Swallowing difficulties Poor oral care Depression Reduce mobility Arm / facial weakness Visual impairment

12. What You Can Do Remind survivors to visually scan their plate for leftover food Use modified utensils if needed Avoid distractions during meal times Monitor weight Refer to dietitian when necessary

13. Bowel and Bladder

14. What You Can Do Maintain privacy Ensure enough fibre and fluid intake Move it! Clear bowels every 2 days if necessary. Use of softeners, laxatives, suppositories, enemas when necessary

15. What You Can Do

16. Urinary Incontinence: What You Can Do Drink more fluids in the day, reduce fluids from evening onwards Offer toileting measures 2H in the day, 4H in the night. Caution if high fall risk Watch for foul smelling / cloudy urine/ pain on passing urine / fever  inform the doctor

17. What You Can do Monitor Note usual times of urination and bowel movement Watch behaviour that shows need to urinate/ move bowels Prompt & Redirect Prompt survivors to use toilet Encourage bladder control. Distract survivors Positive feedback When stay dry & uses toilet Manage incontinent episode without comments

18. Skin

19. Pressure Sores Common Sites

20. Stages of Pressure Sores

21. What You Can Do Pressure sores can be prevented Change position every 2 hours. Avoid excessive friction Keep skin clean and dry Special mattress may be used (air mattress) Observe areas that are high risk for skin redness

22. Bones/joints

23. What You Can Do Avoid pulling affected arm or shoulder Careful support / position of arm

24. What You Can Do

25. Stretch Orthosis Medications (oral or injection)

26. Deep Vein Thrombosis

27. What You Can Do Move it! Keep hydrated Observe for limb swelling (usually 1 side), fever, pain, breathlessness  seek medical attention

28. Communication

29. What You Can Do Note discrepancies between verbal & non-verbal cues Do NOT assume that survivor is NOT intelligent Provide ample time. Be patient Be clear and concise Maintain eye level contact Pay Attention! Be creative e.g draw, write

30. What Can You Do? Decrease distraction e.g. loud radio/ TV Try using assistive technology If loss of language, provide closed-ended questions

31. Mood / Cognition

32. Depression

33. What You Can Do Know the survivor Communicate – ask how they are feeling Note signs/symptoms of depression Support survivor + tap on resources Encourage survivors to do things Encourage survivors to express grief/sadness

34. What You Can Do Set S.M.A.R.T goals Participate in rehab. Physical recovery = improvement in mental health Involve survivors in daily activities with family & friends Seek professional help!

35. Cognitive Issues: What You Can Do Cognitive impairment (e.g. attention, orientation, memory etc) can happen after stroke Get rid of any distraction Short simple instruction or list down tasks Memory training/ aid Seek professional help if there are behavioural issues

36. Falls

37. What You Can Do Attend physiotherapist’s / occupational therapist session Do not rush survivor Note visual neglect / loss Modify home when necessary

38. Stroke Prevention and Recognition!

40. Know your Numbers and Medications Medications and its potential side effects Blood pressure Cholesterol level Glucose level and 3 months control (HbA1c)

42. Conclusion Relearning everyday tasks that survivors has been doing for years can be frustrating. Recognise and celebrate each success is the key to SELF ESTEEM

43. Questions ??