Flashcards in stroke management Deck (42)
what age group does majority of stroke occur in?
after six months what things can still be challenging for a person who had stroke?
cannot walk indoors
need help to dress
need to be fed
need help with toileting
common symtpoms of stroke?
Right side of mouth drooping, drooling saliva
Able to raise left arm, but not right arm or active right leg
Difficulty communicating and finding words: expressive dysphasia
Right homonymous hemianopia (visual field defect)
why is scan essential before treating stroke patient?
exclude haemorrhage so thrombolysis can be given
what is given if swallowing is seen to be unsafe?
what weakness is caused by stroke?
Contralateral weakness of limbs -->Extent of stroke determines degree of arm and leg weakness
Weakness and incoordination of oropharyngeal muscles:
Dysarthria: slurred, indistinct speech
Incoordination of swallowing
what are the language problems involved in speach? In right handed patients
If Broca's areas damage then --> Flow of speech: stilted, difficult + Expressive dysphasia.
Reading, writing and comprehension relatively intact
If Wernicke's area damaged then --> speech is fluent but Neologisms (“made up” words)
Comprehension, reading and writing impaired
Antihypertensive treatment is not recommended after acute stroke, unless?
Intracerebral haemorrhage with systolic BP >200,
Hypertensive encephalopathy/ nephropathy/ cardiomyopathy
Eclampsia/ pre-eclampsia (a condition of pregnancy:
what is hypertensive nephropathy?
the high blood pressure damages the kidney
what is hypertensive cardiomyopathy?
damage to the heart due to high blood pressure
when is oxygenation recommended?
Supplemental oxygen is recommended if saturations fall below 95% on air
what is system used to help set goals for rehabilitation after a stroke?
SMART: Specific, Measurable, Achievable, Relevant, Time-limited
Set within 5 days of admission, review regularly
what is the assessment for swallowing?
Position patient correctly, ensure they are alert
1) Give a single teaspoon of water
2) Give 2 further teaspoons of water
3) 50ml water
Allow normal diet and fluids
what actions will make the patient fail the swallowing assessment and what will be the outcome?
Drooling from mouth?
Coughing or choking?
Wet voice or cough?
UNSAFE SWALLOW -->Keep Nil By Mouth +Feed by NG tube
why is DVT caused in hospital, how can it be prevented and treatment?
Risk factors include immobility and sepsis ( Stasis of blood in leg veins leads to thrombosis)
Prevention: Consider injections of low molecular weight heparin
Treatment: warfarin for 6 months
what is the risk factors of pressure ulcers and how is it caused?
Immobility, malnutrition, diabetes, smoking, terminal illness, sensory impairment
Sustained pressure, often over bony prominence
Friction and shear forces when moving patient
Moisture: incontinence, sweating
why might shoulder subluxation occur after a stroke? How is it managed?
Weakness of rotator cuff muscles on stroke side
Neglect of affected limb (in right hemisphere stroke only)
Management: optimise positioning, support shoulder
what pre-conditions can be exacerbate due to overuse of one side of the body?
Chronic back pain
what occurs in post stroke pain?
Damage to sensory cortex leads to contralateral sensory disturbance
Decreased sensation in one or more modalities
Paraesthesia, burning, shooting pains
Dysaesthesia: altered perception (e.g. soft touch felt as prickly pain
what type of drugs don't work on post stroke pain
what drugs will patients reply to when having post stroke pain?
Pregabalin or Gabapentin: anti-epileptic agents
Amitriptyline: a type of antidepressant
after a stroke what might be the causes of incontinence?
Immobility: can’t reach toilet in time
Constipation with overflow
Medication: on laxatives, diuretics
Other medical problems: diabetes mellitus (polyuria), urinary tract infection, prostatic hypertrophy
what is the management of incontinence?
Communication strategies to allow him to summon help when needed
Managed bowel regimen: use suppositories to open bowels at predictable intervals
Is he able to manipulate bottles?
Convene: sheath as opposed to indwelling catheter
Long term catheter
what factors might make a person depressed aftera stroke? How common is it
adjustment to disability
relationship with family/partner
Up to 50% of people
assessment and mangement of depression post stroke patient?
Observation of behaviour: crying, withdrawal
Standardised assessments: some suitable for use in dysphasic patients
DON’T FORGET SUICIDE RISK ASSESSMENT!
Counselling: supported conversation approach
Drugs: (selective serotonin reuptake inhibitors) second line
what recoverys occurs in the first few days after stroke? physiologically
Resolution of oedema
Reperfusion of ischemic penumbra
what recoverys occurs in the weeks and months after stroke? physiologically
Neuronal plasticity, cortical remodelling
Dendrite sprouting, synaptic remodelling
in what type of stroke does neglect take place in?
Neglect is a feature of RIGHT hemisphere stroke
what occurs in neglect post stroke?
May be visual or somatosensory
Problem of attention: failure to attend to/ monitor left side