1. Nursing Instruction
  2. Overview
  3. Neurology
[Key Points for Learning]
  1. Stroke is a disease of cerebral blood vessels.
  2. The common symptoms of stroke include dizziness, headache, slurred speech, and weakness of limbs.
  3. Early rehabilitation is highly recommended the patient’s condition is stable by the doctor’s evaluation.
  4. Patients with ischemic stroke should take the antiplatelets or anticoagulants as directed and never stop taking the medication without medical consultation
 
I. What is a stroke?
    Stroke generally refers to the cell death or dysfunction of brain tissue caused by cerebrovascular event. There are three categories as follows:
  1. Ischemic stroke: The brain vessels got blocked by blood clots, resulting in insufficiency of blood flow.
  2. Hemorrhagic stroke: Rupture of cerebral blood vessels causes bleeding in the brain.
  3. Transient ischemic attack: Stroke symptoms induced by temporary insufficiency of blood flow to the brain, which recover completely within 24 hours.
 
II. What are the common symptoms of strokes?
    The common symptoms of strokes include dizziness and headache; weakness of one or both sides of the limbs and impairment of the sensation, which may recover in a few minutes; sudden loss of vision , blurred or double vision; slurred speech or inability to speak; swallowing difficulty, crooked mouth, and slanted eyes; unsteady gait, inability to balance the body or sudden falls; mental impairment, inattention, or poor memory, orientation , and judgment; convulsion; stool or urinary incontinence.
    These symptoms do not necessarily mean a stroke. However, if you have these symptoms suddenly, you should visit the emergency department or the neurology clinic.
 
III. What are the common treatment strategies?
    Examinations are arranged according to the patient’s condition. These may include brain computed tomography (CT), brain magnetic resonance imaging (MRI), angiography, and cerebrovascular ultrasonography.
  1. Medical treatment:
    1. Within 3 hours of onset, patients can be treated with intravenous thrombolytic agents. The risk and benefit should be evaluated cautiously by the doctors, since there is possibility of cerebral hemorrhage. Within 6 to 24 hours of onset, intra-arterial thrombectomy can be removal of the blood clot.
    2. The mainstay medicine for ischemic stroke is antiplatelet or anticoagulant.
    3. Risk factors, such as hypertension, diabetes, hyperlipidemia, and cardiac arrhythmia, must be controlled by strict medication adherence. Patients should follow the doctor’s instruction and are not allowed to adjust or stop the medication by themselves.
  2. Surgical treatment: Depending on the severity of the disease and the location of stroke, patients may need surgical intervention.
 
IV. Principles of Care:
  1. Avoid high intracranial pressure: Elevate the head of the bed to 30 degrees, use drugs to lower the intracranial pressure, avoid overly high  blood pressure, and maintain good bowel movements. Both enema and effortful defecation should be avoided during the acute phase.
  2. Maintain patency of the airway: If necessary, draw out the sputum to avoid airway obstruction. If the patient passes the swallowing screening test closely, the patient may have oral diet. However, the process of eating should be observed to avoid aspiration pneumonia.
  3. Prevention of various complications: Complications such as  pressure injury, aspiration pneumonia, urinary tract infection, joint contracture, and stiffness should be prevented. Depending on the patient’s need, patients should change positions every two hours, keep oral hygiene, receive urinary tract care, and do joint exercise.
  4. Rehabilitation: Patients should start rehabilitation program as soon as possible if the condition is stable based on the doctor’s assessment.
 
V. Home healthcare:
  1. Diet:
    1. If the patient has eating difficulty, a sitting position should be adopted when having meals. Soft or semi-solid food is easy to be swallowed and thus is preferred. The patient should avoid talking when eating and maintain a clean oral cavity after eating.
    2. A balanced meal should be taken regularly and of regular amount.
    3. The patient should have less sweet or salty food, and beverages that contain caffeine.
    4. The patient should maintain a healthy and regular lifestyle and quit smoking and drinking alcohol.
  2. Clothing:The patient should not wear clothes and pants that are over sized. Shoes should be easy to wear, light and not slippery.
  3. Environment:
    1. Both of the walkways inside and outside the house should be kept unblocked and brightly lit.
    2. For patients with visual defects, objects should be placed within their visual field.
    3. It is better to have handrails and anti-slip mats in the bathroom and safer to use a sitting toilet.
    4. The ideal height of the bed should allow the patient’s feet to touch the ground when they get out of the bed.
    5. It is advisable for those with reduced mobility to use a walker or wheelchair to assist the movements. Meanwhile, the caregiver must stand on the side of the patient’s weaker limb.
    6. The patient should get out of bed slowly to prevent falls.
    7. After a stroke, the patient may lose the limb sensation to cold, heat, touch, or pain, and other . Be careful to avoid burns when keeping the patient warm.
  4. Rehabilitation:
    1. Rehabilitation activities should be done every day to maintain the ideal body weight so as to prevent excessive musculoskeletal load.
    2. Rehabilitation and psychological adjustment after a stroke are crncial.It is important to establish the collaboration and maintain the support from all aspects, including career, emotional and sexual lift. Care and encouragement from the family members can enhance the efficacy of rehabilitation.
 
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. Theofanidis, D. (2016). Nursing interventions and rehabilitation activities for stroke patients. Journal of Nursing and Care, 5(3),1000e131. https://doi.org/10.4172/2167-1168.1000e131V
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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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