What are strokes?
Strokes are disorders of cerebral vessels resulted in brain damage and/or dysfunctions, which can be divided into three major classifications:
  1. Ischemic stroke: blood clot causing obstruction within a blood vessel in supplying blood to the brain.
  2. Hemorrhagic stroke: caused by the rupture of brain vessels.
  3. Transient ischemic attack (“TIA”): temporary ischemia of brain causing symptoms of stroke, usually recovered completely in 24 hours.
 
Symptoms of stroke:
Dizziness, headache; weakness over unilateral or bilateral limbs, loss of sensation; double vision; blurring or loss vision; slurred speech or inability to speak; difficulty in swallowing, facial palsy; unsteady gait; imbalance or abrupt falling; impairment in mental judgement or memory; convulsion; stool or urine incontinence.
 
If a stroke cannot be confirmed by the aforementioned symptoms, then the patient should be sent to emergence room or neurologic clinics for immediate investigation.
 
Treatments of stroke:
Examinations will be arranged according to the patient’s presentations, for examples: brain CT scan, MRI, angiography or doppler for brain vessels.
  1. Medical treatment
    1. Thrombolytic treatment can be given within three hours of acute stroke onset (physician’s assessment is required for avoiding brain bleeding); Intra-Arterial Thrombectomy (IAT) might be performed within 8-24 hours of onset (physician’s assessment is required for IAT indication).
    2. Avoid increasing intracranial pressure (“ICP”): The head side of bed should be elevated 30 degrees, reducing intra-cranial pressure, controlling blood pressure; smoothening defecation and urination, enema or forced defecation are forbidden in acute stage.
    3. Keep ventilation: Sputum suction is used to avoid the obstruction of respiratory tract, oral food intake is allowed if swallowing function evaluation is normal, close observation of eating to avoid aspiration pneumonia is needed.
    4. Avoid other complications: Such as pressure sore, pneumonia, falling down, joint contracture, stiffness… etc.
    5. Rehabilitation: The patients should be assessed by a doctor, if the condition is stable, early rehabilitation is therefore anticipated. 
  2. Surgical treatment:
    Surgical treatment may be arranged according to the severity and locus of stroke.
 
Lifestyle modifications:
  1. Keep semi-fowler position while eating, soft or semi-solid food is suggested for easy swallowing.
  2. Clothes and pants shouldn’t be over long, soft shoes with no shoe lace are suggested to avoid falling down.
  3. Hall way should be kept clear.
  4. Objects for daily use should be placed close to patient for convenience use.
  5. Armrest and anti-slip sheet should be established within bathroom, and sitting toilet is suggested for safety.
  6. The height of the bed should allow patient to touch his/her feet on the ground while getting off the bed.
  7. Patients with impaired activity can use walker or wheelchair to improve activity, helper should stand on the side of patient’s weak limb.
  8. Changing position every 2 hours is necessary for those who can’t turn over by himself/herself to avoid pressure sore.
  9. Avoid pulling patient’s weak limbs while moving, and avoid dislocation or fracture.
  10. Be aware of thermal injury because the patient’s limb sensation is impaired or completely lost, heating pad should be kept below 43 Celsius degrees.
  11. Rehabilitation is performed every day to keep ideal body weight to  avoid over-weight and over loading on muscle-skeleton system.
  12. Keep on medication to control other chronic disease.
  13. Rehabilitation and mental support including career, motion, sexual lives are crucial, encourage and care of families can improve the effect of rehabilitation.
 
References
  1. Cai, P. L., & Guo, S. K. (2012). Diagnosis and treatment of ischemic stroke. Taiwan Family Medicine, 22(1), 41-51.
  2. Dai, C.Y., & Lin, L. C. (2015). Nursing Care of Unilateral Neglect Patients. Journal of Nursing, 62(1), 92-97.
  3. Li, L. L., Shu, S. H., & Yen, Y. F. (2012). The Effects of Prevention and treatment for chronic stroke in a primary care. Taiwan Family 
  4. Medicine, 22(4), 165-176.
  5. Wang, G. Y., Liu, X. U., & Feng, R. F. (2014). Medical-Surgical Nursing. (5 th edition). Taipei: Wing Tai bookstore.
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