1. Nursing Instruction
  2. Overview
  3. Neurology
[Major points]
  1. Stroke is defined as brain tissue damage caused by changes in the brain's blood vessels.
  2. Common symptoms of stroke include headaches, unclear speech, or weakness over the limbs.
  3. If the condition is stable upon medical assessment, early and active rehabilitation is recommended.
  4. Follow the doctor's instructions for taking antiplatelet or anticoagulant medications, and do not discontinue them arbitrarily. 
 
I. What is a stroke?
Stroke broadly refers to brain tissue damage caused by changes in cerebral blood vessels. It can be classified into three types:
  1. Ischemic Stroke: Occurs when a blood clot blocks a brain artery, leading to insufficient blood flow to the brain.
  2. Hemorrhagic Stroke: Caused by the rupture of blood vessels in the brain.
  3. Transient Ischemic Attack (TIA): Characterized by temporary cerebral ischemia causing stroke-like symptoms, but generally, full recovery occurs within 24 hours.
 
II. What are the common symptoms of strokes?
  1. Headache, dizziness, or vomiting.
  2. Unusual sensations: weakness or numbness in one or both sides of the body, facial drooping, or misalignment of the eyes.
  3. Difficulty speaking clearly or inability to speak.
  4. Sudden loss of vision, seeing double images, or experiencing blurry vision.
  5. Loss of balance.
  6. Changes in personality, irritability, emotional instability, and some patients may even experience memory loss.
 
The presence of these symptoms does not necessarily indicate a stroke. If you experience any of the above symptoms, please visit the emergency room or a neurology clinic for an assessment by a physician. 
    
III. What are the common treatment strategies?
Relevant examinations are arranged based on the patient's condition, such as a brain CT scan, brain MRI, cerebral angiography, and cerebral vascular ultrasound. 
  1. Medical Treatment:
    1. In acute ischemic stroke patients, intravenous thrombolytic therapy can be administered within 3 hours after onset, as assessed by a doctor. Intra-arterial thrombectomy can be considered within 6-24 hours of onset.
    2. Patients with ischemic stroke should use antiplatelet or anticoagulant agents to prevent recurrent strokes and should not discontinue these medications without a doctor's instruction.
    3. Control risk factors, such as chronic diseases like hypertension, diabetes, hyperlipidemia, and arrhythmias. Medications must be taken regularly and timely as directed by a doctor, and patients should not adjust or discontinue medication on their own.
  2. Surgical Treatment: Depending on the severity and location of the stroke, surgical treatment may be necessary following a thorough assessment.
 
IV. Principles of Care:
  1. Avoid high brain pressure: Elevate the head of the bed by 30 degrees, use medication to reduce brain pressure, avoid high blood pressure, maintain regular bowel and bladder movements, and avoid enemas and straining during bowel movements in the acute phase.
  2. Maintain a clear airway: As necessary, suction phlegm to prevent airway blockage. If the swallowing screening is passed, the patient can eat, but monitor the eating process to prevent choking and pneumonia.
  3. Prevent complications from prolonged bed rest: Such as pressure injuries, aspiration pneumonia, urinary tract infections, contractures, rigidity, etc. Assist with turning and repositioning every two hours, oral care, perineal care, and joint exercises as needed.
  4. Rehabilitation: Should be assessed by a doctor and started as early as possible if the patient's condition is stable. 
  5. Home healthcare:
    1. Diet:
      1. When there is eating difficulty, sit while eating. Food should be soft or semi-solid for easy swallowing. Avoid talking while eating and maintain oral hygiene after meals.
      2. Eat a balanced diet at regular times and in controlled portions.
      3. Consume dietary fiber such as whole grains, beans, increase vegetables and fruits to reduce fat absorption, thereby preventing cerebral vascular thrombosis.
      4. Limit sweets, too salty or oily foods, reduce red meat (beef, pork, lamb) intake, and caffeinated or alcoholic beverages.
      5. Quit smoking and excessive drinking, maintain a healthy lifestyle and sufficient sleep.
    2. Clothing:Wear clothes and shoes that are easy to put on, lightweight, stable, and non-slip.
    3. Environment:
      1. Ensure both indoor and outdoor pathways are clear and well-lit.
      2. For patients with impaired vision, keep items within their field of vision.
      3. Install handrails and anti-slip mats in the bathroom; using a sit-down toilet is safer.
      4. The ideal bed height allows the feet to touch the floor when sitting on the edge.
      5. For those with mobility issues, use walkers or wheelchairs, and helpers should stand on the patient's weaker side.
      6. When getting up from bed, sit on the edge for 3-5 minutes before standing beside the bed for another 3 minutes to prevent dizziness and falls. 
      7. Stroke patients often have reduced or lost sensitivity to temperature, touch, and pain. When applying heat, keep the temperature below 45˚C to prevent burns.
    4. Rehabilitation: 
      1. Engage in daily rehabilitation activities, control weight to prevent muscle and skeletal strain.
      2. Moderate aerobic exercises (like brisk walking,swimming, cycling) enhance cardiopulmonary function, improve hypertension, and effectively prevent stroke recurrence.
      3. Adjusting mindset post-stroke to increase adaptability is crucial. This includes career, emotional, sexual life, and special attention to the coordination and support of various needs. Family care and encouragement can speed up rehabilitation outcomes.
         
References
  1. Chien. C., Chung, C. P. (2018). Classification of ischemic stroke. Clinical Medicine, 81(2), 72-76. https://doi.org/10.6666/ClinMed.201802_81(2).0014
  2. Chien. C., Hus, L. C. (2018). Development and prospect of treatment of acute Ischemic Stroke.Clinical Medicine, 81(5), 296-301. https://doi.org/10.6666/ClinMed.201805_81(5).0054
  3. Jeng, J. S. (2019). Impact of Cigarette Smoking and Smoking Cessation on Stroke. Formosan Stroke Journal, 1(2), 127-137. https://doi.org/10.6318/FJS.201909_1(2).0006
  4. Lin, R. C., Lin, C. H., Weng, S. M., Lin, C. F., Wang, W. Y., Tzeng, W. C. (2021). Applying Multiple Strategies to Increase the Rate of Early Rehabilitation Exercise Adoption in Patients with Acute Stroke. The Journal of Nursing, 68(1), 64-73. https://doi.org/10.6224/JN.202102_68(1).09
  5. Zyriax, B. C., & Windler, E. (2023). Lifestyle changes to prevent cardio-and cerebrovascular disease at midlife: A systematic review. Maturitas, 167, 60-65. https://doi.org/10.1016/j.maturitas.2022.09.003
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    Taipei Veterans General Hospital 
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    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
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