STROKE PATIENT GUIDE. CommonwealthHealth.net

Transcription

1 STROKE PATIENT GUIDE CommonwealthHealth.net

2 This Patient Guide has been compiled to provide helpful information to stroke survivors and their caregivers. Our hospital is committed to being a Center of Excellence in Stroke Care. One of the most important aspects of that care is that you understand the cause of a stroke and how to prevent one in the future. There are five important lessons to be learned as you begin to read this Patient Guide: Risk factors for a stroke Lifestyle changes you will need to help prevent a stroke Signs and symptoms of a stroke Calling 911 if you have symptoms of a stroke Medications you will take at home Follow-up with your family doctor 2

3 What is a Stroke? A stroke is a brain attack that occurs when the blood, which carries oxygen to your brain, stops flowing and brain cells die. Most strokes are caused by either: Blood clots that break loose and block a vessel in your brain Bleeding into the brain The treatment you receive will depend on what caused your stroke. Blood Clot Bleeding into the Brain What is a Mini Stroke or a TIA? A TIA (Transient Ischemic Attack) or mini stroke has the same symptoms as a stroke but the symptoms may last only a few minutes and disappear completely without damage to your brain. It is important to seek medical care immediately and treat these symptoms as you would a stroke. It s important to note that treating a TIA immediately may keep you from having a major stroke. 3

4 What Caused Your Stroke? Preventable Risk Factors. RISK FACTORS FOR STROKE HIGH BLOOD PRESSURE Over the age of 18, good blood pressure is 120/80 or lower High blood pressure is 140/90 or above PREVENTION MEASURES You should check you blood pressure once a year or more often if you have: High blood pressure You have had a heart attack or stroke If you have diabetes or kidney disease If you have high blood cholesterol If you are overweight If you have high blood pressure your doctor may: Make changes to your diet Start you on regular exercise program And/or start you on medication HIGH CHOLESTEROL Total cholesterol should be less than 200 HDL good cholesterol should be 40 or higher for men, and 50 or higher in women Know your numbers have your blood work done to check your cholesterol once a year. If your cholesterol is high your doctor may: Make changes to your diet Start you on a regular exercise program And/or start you on medication SMOKING Cigarette smoking increases the risk of stroke approximately 50% STOP SMOKING Your doctor may advise you: About smoking cessation programs in your area And/or start you on medication to stop smoking 4

5 Potential Problems How will you handle them? RISK FACTORS FOR STROKE CARDIAC DISEASE Find out if you have atrial fibrillation, a type of irregular heart beat. HEAVY ALCOHOL DRINKING DIABETES Your blood sugar (glucose) target is mg/dl. Another blood test, HbA1c, is a blood test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabetes. LACK OF EXERCISE/OVERWEIGHT If your waist measurement is equal or greater than your hip measurement you are 3X at greater risk for stroke. HOME MODIFICATIONS Assistive devices and home safety. PREVENTION MEASURES If you have atrial fibrillation, work with your doctor to control it. If you drink alcohol, do so in moderation. If you are a diabetic: Routinely test your glucose level to keep control Diet control Your doctor may start you on medication you can take by mouth or insulin If you do not exercise and/or or overweight talk to your doctor about: Diet control DASH Diet (Dietary Approaches to Stop Hypertension) Regular exercise program minutes 5 days a week Assistive Devices: Local rehabilitation centers or home health nurses may suggest such things as: Grab bars/ramps Raised toilet seats Hand held showers and bath chairs Electric tooth brush Safety Consideration: Remove throw rugs Unneeded furniture Life alert alarms 5

6 RISK FACTORS FOR STROKE DIETARY CONCERNS PREVENTION MEASURES Preparation If you are doing your own preparation, make sure all utensils and food are within reach Consider the Meals on Wheels program in your area Ready-made meals by family Nutritional Concerns Eat largest meal in the morning and small meal at night DASH diet- Low fat, low sodium diet Talk to a dietician or ask your doctor Special Utensils Ask local rehabilitation centers or home health nurses. Swallowing If you are having problems, talk with your doctor. You may need to be seen by a speech therapist. DRESSING AND GROOMING Dressing You should always try to change from nightwear into comfortable daywear. Minimize the difficulties: Avoid tight fitting clothes Wear clothes that fasten in front Replace buttons and zippers with Velcro fasteners Substitute a cape for a coat Velcro closers for shoelaces Avoid shoes that stick to the floor to avoid falls Ask local rehabilitation centers or home health nurses for additional suggestions 6

7 RISK FACTORS FOR STROKE ORAL HYGIENE PREVENTION MEASURES Regular Oral Hygiene Make sure your mouth is kept clean including the tongue, roof of mouth and dentures Clean your mouth after every meal If your mouth is dry moisten with a wet swab or a water mist atomizer Follow-up with your dentist SKIN CARE Avoid pressure areas (deep red areas) or bed sores. LOSS OF BOWEL OR BLADDER CONTROL Tips for Skin Care Keep all areas clean and dry especially if you have loss of bladder or bowel control Change position frequently in chair or bed Notify you doctor of any bed sores that may develop Urination You may need a plastic tube to help you. Some other helpful tips: Avoid fluids 2-3 hours before sleep Use a bedside commode or urinal Place walker or cane for easy access Place a bell next to you so you can call for assistance Have a light on during the night Bowel Some helpful tips: Set up a regular schedule every 2 hours and immediately after meals Raised toilet seat in the bathroom Install grab bars by the toilet to help getting on and off Stool softeners, mild laxative, suppositories, small enema should be used as needed A supply of disposable or washable bed pads and underwear 7

8 RISK FACTORS FOR STROKE PAIN MANAGEMENT There are many different reasons for pain in a stroke patient and it should be reported to your doctor. DRIVING PREVENTION MEASURES Ways to Manage Pain Weak or paralyzed arms or legs can be put in a position of comfort or have a splint applied Heat packs or simple exercise may relieve pain Pain in shoulder from paralyzed arm may be positioned on a arm rest or elevated on a pillow Evaluation A driver s evaluation may include: Assessment of functional ability Reaction time Visual testing Perceptual testing In-car testing Driver s Training may include: In-class instruction Classroom driving simulation Transfer training In-car, on-the-road training Wheelchair loading instruction BEHAVIORAL CHANGES You may experience many thinking and behavioral changes They include: Denial Depression Anger Lack of interest/concentration Memory loss Laughing or crying for no apparent reason If any of these should occur and begin to affect your daily activities notify your doctor for appropriate care. 8

9 RISK FACTORS FOR STROKE INTIMACY/SEXUALITY PREVENTION MEASURES What can help: Ask your doctor what changes you can expect when having sex, and advice on how to deal with them Be sure to discuss when it is safe to have sex again Focus on being loving, gentle and caring with each other Speak honestly with your partner about your sexual changes together you can often work them out Get more information on sexuality from the National Stroke Association Your Medications Take your pills. Take each of your medicines, every day, at the correct times Do not skip doses of your medicines, even when you feel good If you think you are having side effects from your medicines, don t stop taking them, talk to your doctor immediately If you are having trouble paying for your medicine, talk to your doctor or pharmacy. Don t run out of pills. Make sure you always have enough medicine left in your pill bottles. Don t let your medicine bottles run out. Be aware of how many refills you have on your pill bottles: Every time you pick up your medicines, check the number of refills you have left. If the label says No Refills or Refills: 0, call your doctor right away to get more refills Purchase all of your medicines, every time, from the same pharmacy 9

10 How to Take Your Medications Have a system. Have a system that helps you remember how and when to take your medicines Keep a list of your medicines with instructions for how many pills to take, and when to take them Keep your medicine bottles in a place that makes it easy to remember to take them; keeping your medicines next to your toothbrush, at your bedside, or in the kitchen are good ideas Some people use a pill box in which they put their pills for each day of the week If you are going out of the house for a long time, bring enough medicine with you Bring your pills when you go to the doctor or hospital. Bring all of your pill bottles and medicine list to each doctor visit Show your doctor how and when you take your pills this will help you and your doctor to keep you safe and make sure you don t run out of pills. If you have to go to the hospital, bring a complete list of your medication and the name of your pharmacy 10

11 Medications What they do and their side effects. MEDICATION WHAT IT DOES SIDE EFFECTS ANTICOAGULATION Heparin Lovenox Pradaxa Coumadin Reduces the risk of blood clots and prevents existing blood clots from getting bigger by thinning the blood. Black tarry stools Bleeding from the gums Blood in the urine Excessive bleeding from cuts Nosebleeds Unusual bruises Headache Blue or purplish patches on skin ANTIPLATELETS Aspirin Plavix Aggrenox Effient Prevents blood cells from sticking together to form clots. Bleeding from the gums Blood in the urine Excessive bleeding from cuts Nosebleeds Pinpoint red spots on skin Unusual bruises Headache ACE INHIBITORS Lotensin Capoten Vasotec Monopril Zestril Lisinopril Accupril Altace Blood pressure pill. Severe stomach pain Dry hacking cough Skin rash Loss of taste Change in the amount and frequency of urination Cloudy urine Dry mouth or increased thirst Muscle cramps Dizziness or fainting Swelling of hands, ankles or feet Nausea, vomiting or diarrhea 11

12 MEDICATION WHAT IT DOES SIDE EFFECTS ARB Atacand Avapro Cozaar Micardis Diovan Benicar Blood pressure pill. Dizziness, lightheadness or fainting Change in how much or how often you urinate Swelling of hands, fee and ankles Irregular heart beat BETA BLOCKERS Tenormin Lopressor Topral Corgard Inderal Betapace Blocadren CALCIUM BLOCKERS Norvasc Lotrel Vascor Cardizem Plendil Procardia Calan Isoptin Blood pressure pill. Blood pressure pill. Flair up of asthma Cold hands and feet Depression Erection problems Sleep problems Lightheadness or fainting Rapid weight gain Irregular heart beat Drowsiness, fatigue or tiredness Swelling of hands, ankles or feet Cold sweats Bluish colored skin May cover up signs of very low blood sugar Constipation Dizziness, fainting Headache Irregular or very fast heartbeat Swollen ankles Tiredness Warmth or redness of the face, neck, arms or upper chest 12

13 MEDICATION WHAT IT DOES SIDE EFFECTS DIURETICS Bumex Diuril Hygroton Lasix Esidrix Hydrodiuril Lozol Aldactone Blood pressure pills. Causes the body to rid fluid and sodium. Increased urination Blood chemistry imbalance Headache Muscle cramps or weakness Increased thirst or dry mouth Lightheadedness or fainting Loss of appetite Hearing loss or ringing in the ears VASODILATORS Isordil Apresoline Nitrates Blood pressure pill. Fluid retention Headaches Irregular or very fast heartbeat Joint aches and pains Swelling around the eyes Facial flushing Lightheadness upon standing DO NOT USE WITH VIAGRA STATINS Crestor Lipitor Zocor Pravachol Mevacor Lowers bad cholesterol (LDL) and raises good cholesterol (HDL). Muscle pain, tenderness, or weakness Headache Abdominal pain, nausea, vomiting or loss of appetite Decreases how much and how often you urinate Dark colored urine Pale stools SPECIAL NOTE: Many of these drugs cause severe dizziness when standing up from a chair or getting out of bed. RISE SLOWLY. 13

14 Exercising for your Brain Check with your family doctor before starting any exercise. Being more active is one of the best things you can do Moving more can help you have more energy and feel more upbeat If you are not exercising, start with 10 minutes a day: It can be as simple as walking 5 minutes from your door and turning around and walking back Start slowly You can exercise by: Using a stationary bicycle Walking in your neighborhood or at the mall Going to an exercise class Sweeping, vacuuming, or dusting Mowing the lawn or working in your garden Walking to the bus A lot of people say that walking is the easiest exercise for them many people walk with a friend or their pet, and it s easy, fun and free! Turn off the TV, get up and get moving! Lifestyle Changes for a Healthy You Weight modification Exercise (30 minutes per most days) Healthy food choices (portion sizes) DASH diet: fruits and vegetables, low-fat dairy products and low saturated fat/total fat Decrease sodium Stop smoking! When Should I Call My Doctor? If you having any problems with your medications If you are having problems in your activities of daily living When Should I Call 911? If you develop any symptoms of a stroke! 14

15 Signs and Symptoms of a Stroke Severe Headache Sudden Dizziness Sudden Numbness or Weakness especially on one side of the body Sudden Confusion Trouble Speaking Trouble Seeing in One or Both Eyes Alert for Signs of Stroke (FAST) Face: Arms: Speech: Time: Ask the person to smile. Does one side droop? Ask the person to raise both arms. Does one arm drift down? Ask the person to repeat a simple sentence. Are the words slurred? Can they repeat the sentence correctly? If the person is showing these symptoms, time is vitai. CALL 911 and get to a Commonwealth Health Stroke Center 15

16 Before you put down this booklet make sure you can answer the following questions: What are the risk factors for stroke? What are the important lifestyle changes you can do to prevent stroke? What are the signs and symptoms of stroke? What do you do if you have signs and symptoms of a stroke? What medication are you taking to prevent further problems with stroke? What is the importance of following up with your family doctor? If you are unable to answer any of the above questions, ask your doctor, or nurse or Stroke Coordinator. Search any of the listed websites: a portal for information, tools and resources about cardiovascular disease and stroke. a web site for stroke patients and their caregivers. Caregivers and family members play an important and prominent role throughout the post-stroke recovery process. National Stroke Association is pleased to offer Lotsa Helping Hands as part of our commitment to supporting caregivers of stroke survivors. NATIONAL STROKE ASSOCIATION: STROKES ( ) CommonwealthHealth.net Berwick Hospital Center First Hospital Moses Taylor Hospital Regional Hospital of Scranton Tyler Memorial Hospital Wilkes-Barre General Hospital CWH-B /2015