ENSURING QUALITY CARE
STROKE September 2019 Safety, Oversight and Quality Unit 1
PURPOSE AND KEY TERMS • Aphasia The purpose is to help the learner understand the causes of strokes; • Dysphasia information that needs to be • Neglect of side gathered when screening a • Transient ischemic attack (TIA) potential resident who has had one or more strokes; and accommodations and AFH will need to provide for a resident with a diagnosis of a stroke. September 2019 Safety, Oversight and Quality Unit 2
OBJECTIVES The learner will be able to: Define what a stroke is and list common causes List key questions to ask when screening potential residents with a diagnosis of stroke Describe care guidelines for residents with a diagnosis of stroke, including common treatments Describe symptoms of a stroke and warning signs of a transient ischemic attack (TIA) Give examples of rehabilitation and communication issues for residents with a stroke diagnosis Explore your own physical and emotional limits regarding the type of care required for residents with a stroke diagnosis September 2019 Safety, Oversight and Quality Unit 3
INTRODUCTION A stroke is a loss in neurological function caused by a sudden blockage or rupture of an artery in the brain. Damage can be temporary or permanent. Causes of a stroke include: • Blood clots – this is the most common cause of stroke • Embolus –a blood clot, gas bubble or fatty droplet that develops in a distant blood vessel and travels until it blocks the blood supply to the brain • Hemorrhage (bleeding) – a weakened spot in an artery of the brain that bursts or leaks blood into the brain, damaging surrounding brain tissue September 2019 Safety, Oversight and Quality Unit 4
MAJOR SYMPTOMS • Symptoms include: Symptoms of a stroke: • Can be severe or mild; and • Paralysis • May appear suddenly or gradually • Convulsions • Headache • Vomiting • Trouble speaking • Memory slips or loss • Mental confusion • Falling September 2019 Safety, Oversight and Quality Unit 5
If you believe someone is experiencing a stroke: Call 911 immediately Quick medical attention may prevent a fatal or disabling stroke. September 2019 Safety, Oversight and Quality Unit 6
WARNING SIGNS Transient ischemic attacks (TIAs), are also referred to as “little strokes,” and may be indicators of an impending stroke: • TIA’s occur when a blood clot briefly clogs an artery, blocking normal blood flow • Most TIA symptoms occur and disappear quickly, usually in less than five minutes. • Symptoms may last several hours, but never more than 24 hours September 2019 Safety, Oversight and Quality Unit 7
WARNING SIGNS CONTINUED Symptoms of a TIA include: • Sudden temporary weakness, clumsiness or loss of feeling in the face, arm or leg on one side of the body • Sudden, temporary blindness or double vision • Dizziness • Staggering • Loss of speech, slurred speech, trouble talking – particularly with weakness on the right side • Confusion September 2019 Safety, Oversight and Quality Unit 8
MEDICAL TREATMENT The cause of the stroke determines the treatment. Aspirin, anti- depressants and heart medications are often indicated after a stroke. Rehabilitation depends on the amount of brain damage and rehabilitation efforts. Rehabilitation can help the individual to regain function, adjust to changes and prevent another stroke. September 2019 Safety, Oversight and Quality Unit 9
AFTER EFFECTS OF A STROKE Individuals recovering from a stroke typically experience problems in the following areas: • Paralysis or weakness on the affected side • Loss of voluntary motor control • Changes in muscle tone • Loss of sensation or feeling on the affected side • Vision problems • Speech disorders • Expressive or receptive aphasia and dysphasia • Loss of bladder and bowel control September 2019 Safety, Oversight and Quality Unit 10
COGNITION CHANGES After a stroke the individual may lose the ability to accurately perceive their environment. Symptoms of this include: • Neglect of the affected side is when they forget to turn their head to compensate for loss of vision • Impaired judgment, associated with right brain damage, interferes with awareness of limitations and abilities • Impaired cognitive ability can cause a mix-up in a individual’s ability to estimate the passage of time • Faulty spatial perception • A decrease in visual tracking abilities September 2019 Safety, Oversight and Quality Unit 11
EMOTIONAL AND BEHAVIORAL RESPONSES • Depression, fear of death, Remember, the individual may be more affected than they appear. disability and disfigurement Responses common after stroke: • Short-temperedness • Shallowness, self-centeredness • Uninhibited behavior • Euphoria or sadness • Crying for no obvious reason • Rash or impulsive behavior • Loss of desire/ poor motivation September 2019 Safety, Oversight and Quality Unit 12
GUIDELINES FOR CARE After a stroke, daily activities such as walking or eating may require careful attention and planning. This can be stressful and mentally exhausting. The challenge is to increase progress, or maintain current levels of self- care, mobility and strength in a individual who has limited energy. Aphasia can result from stroke, resulting in the resident having difficulty communicating his/her wishes. September 2019 Safety, Oversight and Quality Unit 13
REHABILITATION Your role in assisting with rehabilitation can include the need to: • Pace activities - offer rest periods; on low energy days, cancel other activities to allow for rehabilitation efforts • Reduce pressure to perform • Reduce clutter, noise and other distractions • Use adaptive devices • Give step-by-step reminders if necessary • Demonstrate the task if necessary • Provide positive encouragement • Provide cue-rich surroundings • Encourage the resident to use the affected side September 2019 Safety, Oversight and Quality Unit 14
BEHAVIORAL CHALLENGES Supporting emotional and behavioral needs after a stroke can be more stressful than caring for physical needs. To assist in helping the individual and yourself with these needs: • Avoid making an issue of mood swings; • Maintain structured and predictable routines; • Offer simple explanations - reduce confusion and anxiety by letting the individual know about new routines or people • Redirect repetitive behavior by providing distractions • Provide enough time for tasks - rushing a individual can lead to accidents, aggression and withdrawal. September 2019 Safety, Oversight and Quality Unit 15
EATING CHALLENGES After a stroke the resident may forget they just ate or fail to recognize hunger cues. Poor control of the muscles of the face, tongue and throat may cause choking. • Dysphagia diet modifications may be required to aid in swallowing • Dysphagia changes to diet may include pureed foods and liquids thickened as an aid to effective swallowing The effect of a stroke, combined with wearing dentures, reduces the ability to taste. Using the non-dominant hand to eat, combined with a decrease in vision, can cause food spillage and feelings of distress. September 2019 Safety, Oversight and Quality Unit 16
EATING CHALLENGES CONTINUED To maintain adequate dietary intake: • Serve foods such as soup in a mug, or offer finger foods • Ask a dietician about the right thickness or texture for foods • Remind resident to chew and swallow if you suspect food has been left in their mouth • If food on one side of the resident’s plate is ignored, remind the resident or give the plate a half turn • Encourage the use of the affected hand - suggest they use the weaker hand to hold a sandwich or glass • The use of special gadgets, such as a one-handed knife-fork combination, promotes independence September 2019 Safety, Oversight and Quality Unit 17
PERSONAL CARE Good grooming and cleanliness can help a individual feel better. After a stroke, the individual learns self-care routines during rehabilitation. Be sure to maintain a professional attitude. For example, the resident may put their clothes on wrong side-out which could be humorous to you but embarrassing to the resident. Respond in a manner that protects that individual’s dignity. September 2019 Safety, Oversight and Quality Unit 18
PERSONAL CARE CONTINUED To promote good habits and independence: • Assist with part of the task, when necessary - encourage the individual to complete the task if they can • Reschedule unnecessary self-care activities • Make bath time easy and safe - use soap on a rope, a long handled sponge, a shower bench or chair, hand-held shower spray, and non-skin strips • Remind the resident to groom the affected side, when needed • Reorient the individual to the bathroom, as needed • Place needed items in view • Encourage the use of adaptive clothing September 2019 Safety, Oversight and Quality Unit 19
BOWEL AND BLADDER CONTROL Assessment by a health care professional is needed to determine if a bowel or bladder concern is stroke related. In general, toileting schedules and adaptive equipment can help the resident remain continent after a stroke. September 2019 Safety, Oversight and Quality Unit 20
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