General Care After Stroke, Including Stroke Units and Prevention and Treatment of Complications of S - PowerPoint PPT Presentation


PPT – General Care After Stroke, Including Stroke Units and Prevention and Treatment of Complications of S PowerPoint presentation | free to view - id: 100822-ODMyN


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

General Care After Stroke, Including Stroke Units and Prevention and Treatment of Complications of S


Concentrate admissions to a specialized facility with ... If necessary, consider enteral feedings. Initial Management of Acute Stroke. Early mobilization ... – PowerPoint PPT presentation

Number of Views:253
Avg rating:3.0/5.0
Slides: 31
Provided by: heathe110


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: General Care After Stroke, Including Stroke Units and Prevention and Treatment of Complications of S

General Care After Stroke, Including Stroke
Units and Prevention and Treatment of
Complications of Stroke
Reasons for Admission
  • Serious illness
  • Potentially life-threatening disease
  • Risk for medical or neurological complications
  • Neurological deterioration
  • Observation, evaluation and treatment

Organization of Stroke Care
  • Acute Stroke Units
  • Concentrate admissions to a specialized facility
    with skilled care and monitoring.
  • Shorten hospitalizations and reduce death and
  • Reduce complications and promote rehabilitation.

Organization of Stroke Care
  • Stroke Teams
  • Coordinated teams of health care professionals to
    coordinate efficient and effective care for
    stroke patients.
  • Stroke Teams play a part in the hyperacute, the
    acute and the rehabilitation phases of stroke
  • Involve the multidisciplinary team.

Stroke Centers
  • Primary Stroke Centers
  • Use the cardiac/trauma model of delivering care.
  • Major elements patient care and support
  • Define institutions where appropriate care can be

Goals of Treatment After Admission
  • Continue care started in emergency department.
  • Observe for and prevent or control neurological
    and medical complications.
  • Start rehabilitation and discharge planning.
  • Evaluate for cause of stroke and start therapies
    to prevent recurrent stroke.

Neurological Complications
  • Progression of thrombosis
  • Recurrent embolism
  • Brain edema
  • Hydrocephalus
  • Increased intracranial pressure
  • Hemorrhagic transformation
  • Seizures

Medical Complications
  • Myocardial infarction Pneumonia
  • Congestive heart failure Airway obstruction
  • Cardiac arrhythmias Hypertension
  • Deep vein thrombosis Bladder infections
  • Pulmonary embolus Depression
  • Gastrointestinal bleeding Electrolyte

After Admission
  • Initially treated with bed rest mobilization
    begins as soon as the patients condition is
  • Pulse oximetry first 24-48 hours
  • Cardiac monitoring first 24 hours

After Admission
  • Frequent assessments of vital signs and
    neurological status by nursing staff.
  • Protection of airway, especially if depressed
    consciousness or signs of brain stem dysfunction.
  • Supplemental oxygen if patient is hypoxic.
  • Assessment for cause of hypoxia.

Heart Disease and Stroke
  • Heart disease often is the cause of stroke.
  • Most patients with stroke have heart disease.
  • Stroke, especially intracranial hemorrhage, can
    cause myocardial ischemia or cardiac arrhythmias.
  • Many persons will have cardiac arrhythmias or
    electrocardiographic abnormalities after stroke.

Heart Disease and Stroke
  • Sinus bradycardia Sinoatrial arrhythmia
  • Ventricular tachycardia Atrial fibrillation
  • Ventricular fibrillation PVC
  • Idioventricular rhythms PSVT
  • Torsades de pointes AV block

ECG Changes and Stroke
  • ST-T segment elevation/depression
  • Pathological Q waves
  • Negative T waves
  • Abnormal U waves
  • QT prolongation

Hypertension in Stroke
  • Arterial hypertension is common among persons
    with stroke
  • risk factor for stroke
  • consequence of stroke
  • Usually declines spontaneously
  • Secondary to pain, vomiting, stress, anxiety
  • Secondary to increased intracranial pressure

Treatment of Arterial Hypertension
  • Oral agents preferred
  • Continue or re-institute antihypertensive
  • Goal of lowering pressure by 15 during first 24
  • If parenteral medications are used, prefer
    short-acting drugs

Initial Management of Acute Stroke
  • Treat fever and search for the cause of fever
    suspect pulmonary or urinary tract infections
  • Maintain hydration with intravenous fluids
  • Treat hyperglycemia and hypoglycemia
  • Assess swallowing before starting oral feedings
  • If necessary, consider enteral feedings

Mobilization After Stroke
  • Early mobilization
  • positive for morale
  • expedites rehabilitation
  • lessens risk of pulmonary, skin, musculoskeletal
  • Watch for hypotension or neurological worsening
  • Protect against falls

Prevention of DVT and Pulmonary Embolism
  • Mobilization
  • Heparin
  • LMW heparins/heparinoids
  • Oral anticoagulants
  • Aspirin
  • Alternating pressure stockings

Brain Edema and Increased Intracranial Pressure
  • Peaks within one week of stroke
  • Earlier with hemorrhagic stroke
  • A leading cause of death
  • Seen with large multi-lobar strokes
  • Can be secondary to hydrocephalus or mass effect
    of a hematoma

Brain Edema and Increased Intracranial Pressure
  • Common cause of neurological worsening
  • progression of stroke
  • secondary brain ischemia
  • herniation syndromes
  • Hallmark is depression of consciousness
  • Vital signs unstable and arterial hypertension

Management of Brain Edema and Increased
Intracranial Pressure
  • Restrict fluids moderately
  • Avoid hypo-osmolar fluids
  • Control fever, hypoxia, hypercarbia
  • Elevate head of bed by 30
  • Monitor intracranial pressure

Trial of Dexamethasone for Supratentorial
Intracerebral Hemorrhage
  • Dexamethasone Placebo
  • n46 n47
  • Good Recovery 8 5
  • Poor Survivor 17 21
  • Dead 21 21
  • Infectious Complications 13 6
  • Pougvarin, et al. New England Journal of
    Medicine 19873161229-1233..

Intracranial Pressure
  • Hyperventilation to a pCO2 of approximately 28-30
    mm Hg
  • Corticosteroids are not recommended
  • Mannitol, 0.25-1 g/kg intravenously given every 6
    h maximum osmolarity 310
  • Furosemide 40 mg intravenously

Surgical Management of Brain Edema and ICP
  • Drainage of CSF fluid
  • Evacuation of hematoma
  • Resection of infarcted tissue
  • Hemicraniectomy

Evaluation for Cause of Stroke
  • Magnetic resonance imaging of brain
  • Magnetic resonance angiography
  • Spiral CT imaging
  • Carotid duplex
  • Transcranial Doppler
  • Transthoracic echocardiography
  • Transesophageal echocardiography

Prevention of Recurrent Stroke Cardioembolic
  • Oral anticoagulants
  • prosthetic valves INR 2.5-3.5
  • other causes INR 2.0-3.0
  • Stroke despite adequate anticoagulation
  • add aspirin
  • add dipyridamole
  • Contraindication for anticoagulation
  • Aspirin

Prevention of Recurrent Stroke
  • Carotid endarterectomy if ipsilateral high-grade
    stenosis, acceptable risk, and skilled surgeon
  • Antiplatelet aggregating drugs
  • Aspirin
  • Ticlopidine
  • Aspirin and dipyridamole

  • Critical part of care after stroke
  • Begin as soon as patient is stable and while the
    patient is still in an acute care bed
  • Tailor to individual patients needs
  • Progress in a step-wise progression
  • Maximize patients independence

Decisions About Rehabilitation Influence
Discharge Planning
  • In-patient rehabilitation unit
  • attached to acute hospital
  • free-standing hospital
  • Outpatient care
  • Home care
  • Skilled nursing facility

Discharge Planning Considerations
  • Cognitive and functional status
  • Family and caregivers support
  • Financial resources
  • Patient and family education
  • Follow-up medical care, rehabilitation
  • Identify safe place of residence
  • Community support or resources