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syposium control and movement > stroke management > Flashcards

stroke management Flashcards

1
Q

what age group does majority of stroke occur in?

A

over 65

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2
Q

after six months what things can still be challenging for a person who had stroke?

A

cannot walk indoors
need help to dress
need to be fed
need help with toileting

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3
Q

common symtpoms of stroke?

A

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)

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4
Q

why is scan essential before treating stroke patient?

A

exclude haemorrhage so thrombolysis can be given

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5
Q

what is given if swallowing is seen to be unsafe?

A

NG tube

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6
Q

what weakness is caused by stroke?

A

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

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7
Q

what are the language problems involved in speach? In right handed patients

A

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

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8
Q

Antihypertensive treatment is not recommended after acute stroke, unless?

A

Intracerebral haemorrhage with systolic BP >200,
Hypertensive encephalopathy/ nephropathy/ cardiomyopathy
Aortic dissection
Eclampsia/ pre-eclampsia (a condition of pregnancy:

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9
Q

what is hypertensive nephropathy?

A

the high blood pressure damages the kidney

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10
Q

what is hypertensive cardiomyopathy?

A

damage to the heart due to high blood pressure

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11
Q

when is oxygenation recommended?

A

Supplemental oxygen is recommended if saturations fall below 95% on air

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12
Q

what is system used to help set goals for rehabilitation after a stroke?

A

SMART: Specific, Measurable, Achievable, Relevant, Time-limited
Set within 5 days of admission, review regularly

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13
Q

what is the assessment for swallowing?

A 
Position patient correctly, ensure they are alert
1) Give a single teaspoon of water
2) Give 2 further teaspoons of water
3) 50ml water
SAFE SWALLOW
Allow normal diet and fluids
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14
Q

what actions will make the patient fail the swallowing assessment and what will be the outcome?

A

Drooling from mouth?
Coughing or choking?
Wet voice or cough?

UNSAFE SWALLOW –>Keep Nil By Mouth +Feed by NG tube

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15
Q

why is DVT caused in hospital, how can it be prevented and treatment?

A

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

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16
Q

what is the risk factors of pressure ulcers and how is it caused?

A

Risk factors

Immobility, malnutrition, diabetes, smoking, terminal illness, sensory impairment

Pathogenesis

Sustained pressure, often over bony prominence
Friction and shear forces when moving patient
Moisture: incontinence, sweating

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17
Q

why might shoulder subluxation occur after a stroke? How is it managed?

A

Weakness of rotator cuff muscles on stroke side
Neglect of affected limb (in right hemisphere stroke only)

Management: optimise positioning, support shoulder

18
Q

what pre-conditions can be exacerbate due to overuse of one side of the body?

A

Chronic back pain
Osteoarthritis
Rheumatoid arthritis

19
Q

what occurs in post stroke pain?

A

Damage to sensory cortex leads to contralateral sensory disturbance

Negative phenomena
Decreased sensation in one or more modalities

Positive phenomena:
Paraesthesia, burning, shooting pains
Dysaesthesia: altered perception (e.g. soft touch felt as prickly pain

20
Q

what type of drugs don’t work on post stroke pain

A

analgesic drugs

21
Q

what drugs will patients reply to when having post stroke pain?

A

Pregabalin or Gabapentin: anti-epileptic agents

Amitriptyline: a type of antidepressant

22
Q

after a stroke what might be the causes of incontinence?

A 
Communication
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
23
Q

what is the management of incontinence?

A

General:
Communication strategies to allow him to summon help when needed

Bowels:
Regular toileting
Managed bowel regimen: use suppositories to open bowels at predictable intervals

Bladder:
Is he able to manipulate bottles?
Convene: sheath as opposed to indwelling catheter
Long term catheter

24
Q

what factors might make a person depressed aftera stroke? How common is it

A 
adjustment to disability
financial problems
medical condition
relationship with family/partner
communication
Up to 50% of people
25
Q

assessment and mangement of depression post stroke patient?

A

Assessment
History
Observation of behaviour: crying, withdrawal
Standardised assessments: some suitable for use in dysphasic patients
DON’T FORGET SUICIDE RISK ASSESSMENT!

Management:
Counselling: supported conversation approach
Drugs: (selective serotonin reuptake inhibitors) second line

26
Q

what recoverys occurs in the first few days after stroke? physiologically

A

natural recovery
Resolution of oedema
Reperfusion of ischemic penumbra

27
Q

what recoverys occurs in the weeks and months after stroke? physiologically

A

Neuronal plasticity, cortical remodelling

Dendrite sprouting, synaptic remodelling

28
Q

in what type of stroke does neglect take place in?

A

Neglect is a feature of RIGHT hemisphere stroke

29
Q

what occurs in neglect post stroke?

A

May be visual or somatosensory

Problem of attention: failure to attend to/ monitor left side

30
Q

what is Agnosias?

A

Modality-specific inability to access semantic knowledge of an object

31
Q

what happens in visual agnosias?

A

Unable to recognise common object by sight alone. May be able to do so when allowed to use other modalities, e.g. touch

32
Q

what is Prosopoagnosia

A

inability to recognise faces

33
Q

what is DVLA regulations for driving?

A

Absolute ban for one month post stroke

Driving absolutely barred:Seizure within past year, visual neglect, visual field defect, Cognitive impairment

Limb weakness: may be able to control adapted vehicle

34
Q

what is Dyspraxia?

A

loss of ability to conceptualise, plan, and execute complex sequence of motor actions

35
Q

what difficulties might a patient with dyspraxia have?

A

Identifying and knowing how to use objects
Copying drawings
Tasks such as walking, dressing

36
Q

what anatomical lesion can cause dyspraxia?

A

Left inferior parietal lobe

Supplementary motor area

37
Q

what is required when planning discharge?

A

Planning a care package requires information on:

The patient’s abilities: what assistance do they need?
Are any family or friends willing to provide care?
Any foreseeable and modifiable risks?
The environment they will be discharged to:Accessibility, need for adaptations, hazards

38
Q

what occurs in Spastic hemiparetic gait?

A

Stiff legged
Short, slow steps
Risk of falls

39
Q

what is the mangement of Spastic hemiparetic gait?

A

Splints to correct foot drop, physiotherapy, manage spasticity, walking aides

40
Q

what is Spasticity?

A

is a condition in which certain muscles are continuously contracted.

41
Q

consequence of spasticity?

A

Loss of function: impaired balance, manual dexterity
Unable to maintain skin hygiene in flexures
Pain

42
Q

management of spasticity?

A

Physiotherapy and splinting to maintain joint range of movement
Drugs: botulinum toxin injections (local), baclofen (systemic)

syposium control and movement (11 decks)

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