Stroke care and follow-up

RN : Our patient has had a cerebrovascular accident (CVA). We’ll have to proceed to nursing care and patient education plans in order implement them here, and when the patient is discharged. Ok ?

TN : Sure. I guess the CVA was ischemic, wasn’t it ?

RN : I don’t know. We have to check his medical file first. (Grabbing the file) So, the patient is a 55-yearold male suffering from hypertension, hyperlipidemia and diabetes. He’s a heavy smoker and an occasional drinker. He does not take any maintenance medications. He was diagnosed with hemorrhagic stroke, with classical symptoms of loss of movement, memory, speech, and sensation deficits. At home, he showed a confused mental status, had trouble speaking and understanding speech, felt numbness on his face, and had visual disturbances, felt dizzy and lost balance. The day that he was brought to emergency, he couldn’t move his right arm and leg.

TN : His CT scan shows intercerebral hemorrhage. What nursing management plan will we implement ?

RN : We’ll focus on rehabilitating the patient’s deficits, hoping they’d only be temporary.

TN : Which means ?

RN : We’ll work on improving his motor and cognitive functions so that he’d regain maximum independence. So we’d be caring for the pain, usually acute, related to his hemiplegia ; impaired miction because of the bladder going flaccid ; skin integrity and selfcare ; and maybe the sexual dysfunction due to neurological deficits or fear of failure. We’ll also educate the family on how to accompany their beloved one.

TN : Can you be more specific on that ?

RN : Actually, as in almost all cases of stroke, the family relationship is interrupted due to this catastrophic illness and family caregivers’ burden. That’s why we can ask help from occupational therapists.

TN : Ok. But then again, what will the goals of our nursing and occupational interventions be ?

RN : This would aim at preventing shoulder pain by using painkillers ; improving mobility and maintaining good body posture to prevent contracture and pressure sores if the patient stays long in bed ; establishing a goal-oriented rehabilitation and physical exercise program to prepare for good ambulation by using assistive devices ; but also range of motion exercises and splints at night ; selecting suitable personal hygiene and dressing measures as soon as the patient can sit up ; and keeping the environment organized. We can also work on visual stimuli ; assist with nutrition ; and set up a cognitive and communication training program and speech therapy.

TN : And if the patient is discharged home ?

RN : We encourage the patient and the family to consult an occupational therapist who may be helpful in assessing and recommending environmental modifications for the patient to become more independent ; a physical therapist who would carry out a beneficial physical therapy program either at home or in an outpatient setting ; and an antidepressant therapy, as depression is a common and serious problem in the patient who has had a stroke, but also support groups for patients and family caregivers.