stroke patient handbook

Transcription

1 OREGON NEUROSCIENCES INSTITUTE Stroke Ceter stroke patiet hadbook To help you ad your family lear about strokes ad stroke care, we have carefully prepared this booklet. It gives you a overview of what strokes are ad shows how you ca successfully live with this coditio. A stroke will greatly chage your life. This is the first step i learig about stroke ad how your life will be differet after stroke. The resources listed i the back will provide you with more iformatio. If you have questios or cocers about the iformatio i this book or about your care, we strogly ecourage you to call us at Do t be afraid to ask. We will be happy to help you. Your Stroke Care Team, Sacred Heart Medical Ceter, Stroke Ceter Neurology (ONI )

2 table of cotets 2 Welcome from the Medical Director 3 Primary Stroke Ceter 5 To the Family 6 Stroke: What is it? 7 Effects of a Stroke I the Hospital 9 Your Stroke Care Team 10 Tests You May Have 12 Medicatios 13 Prevetig Complicatios 14 Cliical Care Pathway 16 Discharge Pla Physical Therapy 20 Physical Therapy Procedure Recovery at Home 22 Takig Care of Yourself After a Stroke 23 Prevetig a Secod Stroke 23 Diet Tips for Prevetig a Secod Stroke 23 A Special Note to Family Members 24 Your Emotioal Health 25 Stroke ad Your Sex Life 26 Persoal Medicatio List Rehabilitatio 17 Rehabilitatio Programs 18 Payig for Rehabilitatio Sacred Heart Medical Ceter

3 Welcome from the Medical Director Welcome to the Sacred Heart Medical Ceter Stroke Ceter. We kow you are here because of a uexpected occurrece to yourself or a loved oe. We wat you to feel as comfortable as possible uder these circumstaces ad our professioal staff will do their best to make your stay comfortable. We have several additioal goals while you are here: 1. To do everythig medically possible to miimize the impact of your stroke through a variety of state-of-the-art medical treatmets. For those of you watig more detailed readig about stroke, I recommed: Stroke ad the Family, A New Guide by Joel Stei, M.D., published by Harvard Uiversity Press. Sicerely, Raymod N. Eglader, MD, FAAN Medical Director Sacred Heart Medical Ceter, Stroke Ceter 2. To prevet complicatios of your stroke. 3. To maximize your rehabilitatio to retur as much lost fuctio as possible. 4. Fially, we will iitiate treatmets ad recommed lifestyle chages to reduce your future risk of aother stroke or other vascular evet such as heart attack. To achieve these goals, educatio is a importat elemet. This booklet has bee created for you as the first step i your educatio. Our staff will work with you ad your family to educate you further o specific areas relevat to your specific situatio. Please review the iformatio i this booklet ad work with our staff so that all of your questios are aswered ad your eeds are met. Sacred Heart Medical Ceter 2

4 Advaced Primary Stroke Ceter Sacred Heart Medical Ceter eared the Gold Seal of Approval for stroke care from the Joit Commissio. Sacred Heart eared this distictio after the Joit Commissio coducted a o-site review ad desigated ours a Advaced Primary Stroke Ceter. What does it mea whe we say that we re a Advaced Primary Stroke Ceter? It meas we follow the guidelies set forth by the Brai Attack Coalitio ad the America Stroke Associatio s statemets/guidelies for stroke care. These guidelies are: Acute Stroke Teams The Acute Stroke Team should iclude a physicia with experiece i diagosig ad treatig cerebrovascular disease, ad oe other healthcare provider as a miimum. Hospital-based stroke teams should be available aroud-the-clock, seve days a week i order to evaluate withi 15 miutes ay patiet who may have suffered a stroke. Writte Care Protocols Hospitals should have writte procedures to streamlie ad accelerate the diagosis ad treatmet of stroke patiets. The availability of such protocols is a key step i reducig time to treatmet as well as complicatios from treatmet. emergecy Medical Services Emergecy medical services (EMS) have a vital role i the rapid trasportatio ad survival of stroke patiets. Improved coordiatio betwee hospitals ad EMS is a corerstoe of a Primary Stroke Ceter. Oe elemet of a well itegrated system would be effective commuicatios betwee EMS persoel ad the stroke ceter durig rapid trasport of a patiet experiecig a stroke. Emergecy Departmet The emergecy departmet staff should have traiig i diagosig ad treatig stroke ad have good lies of commuicatios with both EMS ad the acute stroke team. Stroke Uit A Advaced Primary Stroke Ceter wishig to provide care beyod the iitial life-threateig period should have access to a Stroke Uit where patiets ca receive specialized moitorig ad care. eurosurgical Services Advaced Primary Stroke Ceters should be able to provide eurosurgical services to stroke patiets withi two hours of whe the services are deemed ecessary. 3 Sacred Heart Medical Ceter

5 Advaced Primary Stroke Ceter (Cotiued) Support of Medical Orgaizatio The facility ad its staff, icludig admiistratio, should be committed to the Advaced Primary Stroke Ceter. This comprehesive commitmet esures the delivery of high quality ad efficiet care to acute stroke patiets. Outcomes/Quality Improvemet Advaced Primary Stroke Ceters should have a database or registry for trackig the umber ad type of stroke patiets see, their treatmets, timelie for treatmets ad some measuremet of patiet outcome. Neuroimagig The ability to perform brai imagig studies o acute stroke patiets is vital for physicias to make a fast, accurate diagosis of stroke patiets. Brai imagig studies iclude CT scas. A Advaced Primary Stroke Ceter must be capable of performig a imagig study withi 25 miutes of the physicia s order. The image should be evaluated by a physicia withi 20 miutes of completio. Educatio Programs The professioal staff of a Advaced Primary Stroke Ceter should receive at least eight hours per year of cotiuig medical educatio credit. I additio to professioal educatio, the Advaced Primary Stroke Ceter should pla ad implemet at least two aual programs to educate the public about stroke prevetio, diagosis ad availability for emergecy treatmet. Laboratory Services Stadard laboratory services should be available aroud-the-clock, seve days per week at a Advaced Primary Stroke Ceter. Stadard laboratory services iclude rapidly performig ad reportig blood couts, blood chemistries ad coagulatio studies. A Advaced Primary Stroke Ceter also should be able to rapidly obtai ECG ad chest x-rays. Sacred Heart Medical Ceter 4

6 To The Family You are very importat to the successful recovery of your family member. Your family member will be lookig to you for support, ecouragemet, ad acceptace. We uderstad how overwhelmig this situatio ca be, ad we are here to help you. We strogly ecourage you to ask us your questios about stroke ad stroke care. The better iformed you are, the better you are able to help your family member ad yourself. It is importat that you care for yourself so you ca maitai your stregth. Here are some thigs you ca do to help your family member recover successfully from a stroke. Visit your family member. Just beig there is supportive. Talk with the therapists ad urses about your questios ad cocers. Write dow questios that you have for the doctor. Do t be afraid to ask the doctor ad the other members of the Stroke Care Team ay questios you have. Get ivolved with your family member s care. We will help you. Ecourage your family member to practice what has bee leared. Let us kow what your family member s special eeds ad iterests are. Fid out what your family member ca do aloe or with a little help. Avoid doig thigs that he or she ca do, eve if it is difficult. Havig your family member do as much as possible will help make him or her more idepedet. Ask for meetigs with the family ad the Stroke Care Team so everyoe ca ask questios about how your family member is doig. Take care of yourself. Eat well, get rest, ad take some time for you. 5 Sacred Heart Medical Ceter

7 Stroke: What is it? Stroke is a brai ijury that causes various problems, depedig o the area of the brai that is affected. The brai ijury may cause weakess o oe side of the body or trouble with emotios, coordiatio, talkig, ad thikig. A stroke is sometimes called a cerebral vascular accidet (CVA) or a trasiet ischemic attack (TIA). A TIA causes the same symptoms as a stroke, but lasts oly a few hours or days ad does ot cause permaet damage. This is a grave warig sig, however, that a true stroke may occur. There are differet types of strokes. A ischemic (Is-KEE-mic) stroke is caused by reduced blood flow to the brai whe vessels are blocked by a clot makig them too arrow for blood to get through. Brai cells i that area die from lack of oxyge. Aother type of stroke is hemorrhagic (hem-or- AJ-ic). The blood vessel bursts ad blood leaks ito the brai causig damage because the blood does ot reach the brai tissue through the vessels. Strokes are more commo i people over 65 years of age, but they ca occur at ay age. Treatmet for stroke focuses o helpig you overcome some of stroke s most serious effects ad to help make you as idepedet as possible. Do You Kow the Sigs of Stroke? The sigs of stroke are distict because they happe quickly: Sudde umbess or weakess of the face, arm, or leg (especially o oe side of the body) Sudde cofusio, trouble speakig or uderstadig speech Sudde trouble seeig i oe or both eyes Sudde trouble walkig, dizziess, loss of balace or coordiatio Sudde severe headache with o kow cause Sacred Heart Medical Ceter 6

8 Effects of a Stroke Here are some of the commo effects of a stroke. Weakess, kow as hemiparesis (hem-eepa-re-sis) or paralysis, kow as hemiplegia (hem-ee-pla-ja) may affect oe whole side of the body or just a arm or leg. If the stroke was o the right side of the brai, the weakess will be o the left. If the stroke was o the left side of the brai, the weakess will be o the right. Balace may be affected. It may be hard to sit, stad, or walk, eve though your muscles are strog. Laguage skills may be affected. You may have trouble uderstadig speech or writig, or you may have trouble speakig or readig. This coditio is kow as aphasia (a-fay-zha). Or you may have trouble fidig the correct words ad sayig them clearly, eve though you kow the right words. Your memory ad ability to thik, pay attetio, ad lear ew thigs may be affected. You may get cofused easily or ot be able to keep track of the date ad time. Judgmet ca also be affected. You may be more impulsive ad ot be able to reaso as well as you did before. Sometimes swallowig ca be weakeed, makig it difficult for a perso to eat food. Sometimes chokig ad breathig i food (kow as aspiratio) occurs while tryig to swallow. Trouble swallowig is called dysphagia (dis-fay-ja). You may lose some bowel or bladder cotrol. Your visio may get blurry. You may eve lose your sight. Your persoality, emotios, ad respose to evets may chage. For istace, you may fid yourself feelig sad more ofte ad cryig easily. Neglect ca occur. This meas that you will be uaware or igore thigs o the affected side of the body. You may ot look to the weaker side, or you may bump ito thigs o that side. Odd sesatios such as pai or umbess ca occur, which ca make it hard to relax ad be comfortable. Stroke affects your body, mid, ad feeligs. The effects may produce limitatios that rage from mild to severe. Care is aimed to limit the effects as much as possible ad help you lear to adapt to them. 7 Sacred Heart Medical Ceter

9 i the hospital Our first priority is to determie the type, locatio, ad seriousess of your stroke. I the hospital, we provide emergecy departmet diagosis ad treatmet to lesse the size ad impact of the stroke. Our ext priorities are to prevet aother stroke, miimize the effects of the stroke, ad reduce the risk of ay complicatios. If your coditio is serious, you go to the Itesive Care Uit after you are admitted. You are later trasferred to the Stroke Ceter. You stay i the hospital for just a few days. Ad while you are i the hospital, your health care providers, alog with you ad your family, develop a pla for your recovery. You may be trasferred to the rehabilitatio uit. Sacred Heart Medical Ceter 8

10 IN THE HOSPITAL Your Stroke Care Team PT: Physical therapist teaches you how to regai mobility ad use devices such as a walker ad crutches to put you o the path to recovery. OT: Occupatioal therapist teaches you how to perform activities ad use equipmet so you ca perform more daily tasks o your ow. RN: Registered urses provide your direct care (such as medicatio admiistratio ad woud maagemet), teach you ad your family about your care, help pla your care, set goals, ad supervise the CNAs. CNA: Certified ursig assistat helps you with activities such as bathig ad gettig i ad out of bed. SLP: Speech laguage pathologist helps you recover laguage skills, lear other ways to commuicate, ad work with swallowig problems. RRT: Registered respiratory therapist assesses ad treats ay specialized lug care you may eed. MD: Doctors who direct your care i the hospital ad i the rehabilitatio uit. CM: Case maager, a urse or a medical social worker who assists i the coordiatio of your care i the hospital ad helps you prepare for discharge. CN: Charge urse i the hospital coordiates ad supervises the ursig care delivered to you. The charge urse ca address ay specialized problems or cocers you may have. Lab Tech: Draws blood eeded for lab tests. SC: Stroke Coordiator, a RN who coordiates programs for the Stroke Program ad provides educatio to you ad your family as well as the Stroke Care Team. Nurse Maager: Maages the Stroke Ceter ad esures the uit rus smoothly. Evirometal Services: People who maitai the clealiess of the uit ad your room. May staff members are ivolved with your care. Staff members are here to help. We strogly ecourage you to ask questios ad talk about your cocers with all members of your stroke care team. 9 Sacred Heart Medical Ceter

11 IN THE HOSPITAL Tests You May Have You may have a umber of tests to help the Stroke Care Team uderstad the type ad seriousess of your stroke ad to see whether complicatios are developig. Here are the tests doctors use most ofte i stroke diagosis. Computed Axial Tomography (CT sca) CT sca uses X-rays to produce a 3-dimesioal image of your head. The scaer is a large machie shaped like a dout. You lie o a stretcher that moves through the hole of the dout to give a picture. A CT sca is used to diagose ischemic stroke, hemorrhagic stroke, ad other problems of the brai ad brai stem. Sometimes a dye is ijected ito your arm to help the CT scaer see the blood vessels i your brai ad to help locate the area of the stroke. Magetic Resoace Imagig (MRI sca) Carotid Doppler I this test, ultrasoud waves are used to take a picture of the carotid (ka-rot-id) arteries i your eck, which carry blood to your brai. The test is oivasive. A plastic probe shaped like your thumb is rubbed over your eck after a cool, clear gel is applied. This test ca show if your carotid arteries are arrowed by fatty deposits, a coditio kow as arteriosclerosis (ar-tir-e-o-skla-ro-sis). Trascraial Doppler This test uses ultrasoud waves to measure blood flow i some of the arteries i your brai. Cerebral Arteriogram I this test, a thi, flexible tube called a catheter is iserted i a artery i your arm or leg, ad a special dye is ijected ito the blood vessels leadig to your brai. X-ray images show ay problems i the blood vessels. MRI uses magetic fields to produce a 3-dimesioal image of your head. The scaer is similar to the CT scaer. The MRI sca shows the brai ad spial cord i more detail tha the CT sca does. MRI is used whe the CT sca is difficult to iterpret because of the size or locatio of the stroke. Sacred Heart Medical Ceter 10

12 IN THE HOSPITAL Tests You May Have (Cotiued) Electrocardiogram (EKG, ECG) This is a stadard test to show the patter of electrical activity i your heart or heart rhythm. Metal leads that have a ooily cream o them are attached to your chest, arms, ad legs with soft rubber straps. It is commo for strokes to occur because of a arrhythmia (a-rith-mi-a), which is a abormal rhythm of your heartbeat. Holter Moitor This is a cotiuous EKG moitor where you wear a small, light recordig device (like a tape recorder) attached to your chest. This device records your heart rhythm cotiuously for hours or days if arrhythmia is suspected. Telemetry Heart Moitorig Vital Sigs Nurses check your pulse, blood pressure, temperature, ad breathig rate to help assess your overall coditio. NIH Stroke Scale This test is doe to assess the extet of ijury ad to make sure that the stroke has stabilized. Neurological Checks Sometimes called euro checks, these tests assess your ervous system. Nurses ask you questios such as what is the date, time, place, ad situatio. They also test the stregth of your arms ad legs. This is aother way of moitorig damage caused by stroke ad see if it is chagig. This is cotiuous EKG moitorig while you are i the hospital. Sticky patches are placed o your chest ad attach to a box the size of a small radio. Your heart rhythm is set by radio waves from the small box to a cetral moitorig statio. Echocardiogram (ECHO) I this oivasive test, ultrasoud waves are captured by a small probe with cool gel o it to take a picture of your heart ad the circulatig blood. A ultrasoud probe may be placed o your chest or o your throat. 11 Sacred Heart Medical Ceter

13 IN THE HOSPITAL Medicatios Commo types of medicatios that may be prescribed by your doctor iclude: Atithrombotic medicies Atithrombotic medicies is a geeral term for drugs that help prevet blood clots from formig or to help existig clots from growig. Aspiri Aspiri is the most commo medicatio give to people who are havig a stroke. Aspiri belogs to a class of drugs kow as atiplatelet agets. These drugs keep harmful blood clots from formig. It is usually give withi 48 hours of the start of the stroke. It is also good for prevetig stroke. If you caot take aspiri or you are havig a trasiet ischemic attack (TIA) or a stroke while takig aspiri, you will be give other atiplatelet medicatios. Aticoagulatios Aticoagulats are give to prevet harmful blood clots from formig or to prevet existig clots from growig. They are ot give as emergecy treatmet for stroke but usually started the secod day after your stroke. Commo ames for aticoagulats are warfari (Coumadi) ad hepari. Statis Statis are a group of drugs that help lower cholesterol, which may reduce a perso s chace of havig a stroke or TIA by slowig the developmet of atherosclerosis. Statis are also kow as lipid-lowerig medicatios. Sacred Heart Medical Ceter 12

14 IN THE HOSPITAL Prevetig Complicatios Blood Clots To help prevet blood clots, you wear TED hose or a sequetial compressio device. TED hose are a type of stockig used to keep the blood from poolig ad clottig i the lower parts of your legs. Sequetial compressio devices are iflatable leg sleeves that are ofte used with TED hose to help blood move back toward the heart. Peumoia You may be tured every 2 hours if you are uable to do so yourself ad asked to deep breathe ad cough. This helps prevet fluids from poolig i the lugs ad causig peumoia. Movig also helps the tiy air sacs i your lugs operate better. While you are i the hospital, we watch for ad work to prevet ay complicatios. Most of these are a result of the effects of the stroke. Beig less able to move, havig difficulty swallowig, ad havig difficulty commuicatig are frequet effects of a stroke. These ca cause additioal complicatios such as blood clots i your legs, peumoia, ad ski problems. Ski Problems You may hear your urses speak of ski itegrity, which meas healthy ski, or of ski breakdow, which meas sores or tears i the ski. We moitor your ski for bedsores ad tears every day. Frequet turig ad chagig positio while i bed help keep your ski healthy. 13 Sacred Heart Medical Ceter

15 IN THE HOSPITAL Cliical Care Pathway Day Oe 1. You are admitted to the hospital. 2. If ecessary, you receive emergecy treatmet. 3. You receive medicatios to prevet blood clots from formig. 4. To diagose a stroke, the Stroke Care Team gives you tests such as a MRI sca, CT sca. You may also have a Carotid Doppler. 5. You also have tests to measure your blood sugar, risk of heart attack, ad the level of oxyge i your blood. 6. You are tested to see how well you swallow. You will ot be able to eat or drik aythig util you pass this test. 7. Every 4 hours urses check your vital sigs ad perform the NIH Stroke Scale ad eurological checks. 8. Telemetry heart moitorig begis. 9. If you are uable to uriate, a Foley catheter (a thi sterile tube) is iserted ito your bladder to drai urie. 10. Itraveous therapy, or IV therapy, begis. IV therapy uses a eedle (IV) to place medicatios, fluids, or other liquids directly ito a vei. 11. You receive oxyge if the level i your blood is too low. 12. The Stroke Care Team assesses the possibility of your bleedig, the risk of your fallig, ad the coditio of your ski. 14. Speech therapist, physical therapist, ad occupatioal therapist visit you ad start their pla of care with you. 15. The stroke coordiator meets with you to begi your pla of care ad checks with your family to be sure they are comfortable. 16. You, your family, ad the Stroke Care Team pla your discharge. Here is the usual course of evets that happes while you sped a few days i the hospital. You will be discharged from the hospital whe: The doctors kow the severity of your stroke The brai ijury is ot chagig i size Your respose to the stroke has stabilized There is a prevetio pla for complicatios You have adequate resources or a appropriate place to help you after the hospital 13. If you use tobacco, quit NOW. Sacred Heart Medical Ceter 14

16 IN THE HOSPITAL Cliical Care Pathway (Cotiued) day two 1. Costat moitorig of your coditio cotiues to be sure your stroke has stabilized ad to prevet complicatios. 2. You begi treatmet to prevet a secod stroke. 3. If you are uable to swallow, the speech laguage pathologist ad a dieticia work with you. 4. If you are eatig eough, your IV is discotiued. 5. We test to see if the Foley catheter ca be removed. 6. If you are costipated, you receive special bowel care. 7. You get out of bed to sit up i a chair or to walk, with your physical therapist s approval ad help from the urses. 8. You cotiue to work o your discharge pla as you ad your family lear more about your ogoig recovery ad care. day three 1. Costat moitorig of your coditio cotiues to be sure your stroke has stabilized ad to prevet complicatios. 2. If you are still uable to swallow, you will be fed through a feedig tube. 3. You cotiue with most of the activities of Day If your coditio is stable, you begi to put your discharge pla ito actio. day three 1. Costat moitorig of your coditio cotiues to be sure your stroke has stabilized ad to prevet complicatios. 2. You receive iformatio about prevetig a secod stroke, which may iclude diet advice. 3. You cotiue to carry out your discharge pla. 9. You cotiue to work with your therapists to set ad reach daily goals for your recovery. 15 Sacred Heart Medical Ceter

17 IN THE HOSPITAL Discharge Pla It s ever too early to start thikig about discharge ad recovery. The optios ad decisios ca be overwhelmig. You, your family, ad your Stroke Care Team work together o the discharge pla. Some questios you eed to aswer before you leave the hospital are: Where will you live? Will it be safe for you to be there? Before discharge, you ad your family eed to kow your medicatios, diet, exercise program, trasfer skills, edurace issues, ad other health eeds importat to a successful discharge pla. Do you eed care, assistace, or special equipmet? Do you eed rehabilitatio or home health services? Sacred Heart Medical Ceter 16

18 rehabilitatio Rehabilitatio Programs Hospital Rehabilitatio Programs Orego Rehabilitatio Ceter provides itese therapy that icludes occupatioal, physical, speech, recreatioal, ad europsychology (brai behavior) therapies. You must be able to tolerate a vigorous therapy program. A physiatrist (fiz-eye-uh-trist;), a doctor who specializes i physical medicie ad rehabilitatio, oversees your program. Nursig Facility Programs If you eed less itese therapy, you may qualify for rehabilitatio at a skilled ursig facility. Each facility provides differet services, so it is importat to ask what therapies are provided ad if a physiatrist or rehab physicia visits to check o your progress. Outpatiet Programs A outpatiet program i a cliic or a hospital provides occupatioal, speech, or physical therapy if you are able to leave your home. Home-health or Home-based Programs Sometimes gettig i ad out of your house is difficult, so you may qualify for a home-based rehabilitatio program. A urse or therapist will oversee your care ad will come to your home to provide treatmet. You have a uique opportuity to practice skills i the same place you actually use them. 17 Sacred Heart Medical Ceter

19 REHABILITATION Rehabilitatio (Cotiued) Payig for Rehabilitatio Most health isurace policies ad Medicare will pay for some or most of your rehab program. You ca ask your social worker to check or call your isurace carrier directly. If you are beig referred to a ipatiet rehab program or ursig home facility, the Admissio Departmet helps you determie your coverage beefits. It is importat to kow your coverage for outpatiet ad home-health programs. Be sure to check o your isurace coverage before you begi your rehabilitatio so that you will be aware of what will be a out-of-pocket expese. Differet levels of care are available to you followig a stroke. Rehabilitatio after a stroke starts immediately followig the evet or as soo as your doctor feels you are medically stable or ready for occupatioal therapy, speech therapy, or physical therapy. After a few days or perhaps a week or two you may be recovered eough to go home safely. Or you may be ready for a ipatiet rehabilitatio program. Or you may be ready to go home ad receive home-health therapies or go to a outpatiet program for ogoig therapy. Sacred Heart Medical Ceter 18

20 physical therapy At the Orego Rehabilitatio Ceter (ORC), our patiets are the measure of our success. More tha half of our patiets come to recover from stroke. Therapy programs are idividualized to meet each perso s uique eeds ad goals. Patiets sped a average of three hours i therapy each day. The primary goal of may of our patiets is to retur to a home i the commuity their ow home, a foster home or a assisted livig settig. A vast majority of our patiets achieve this goal. The ORC emphasizes a team approach, icludig the patiets ad family members i every step of the rehabilitatio process. Patiets ad their families have respoded positively to this approach. Whe asked about their care i a survey, 95 percet said the care they received was excellet ad 93 percet said they would ot hesitate to recommed the program to family ad frieds. While we are proud of these ratigs, we cotiue to ivite feedback o how we ca improve our services to meet your eeds. 19 Sacred Heart Medical Ceter

21 PHYSICAL THERAPY Physical Therapy Procedure Day Oe 1. Evaluatio withi 24 hours of receivig order ad begi pla of care Day Two 1. Progress fuctioal status/mobility as appropriate 2. Pla of care coordiated with Stroke Care Team 3. Physical activity couselig provided for the prevetio of a secodary stroke, which icludes the followig: Beefits of physical activity that would help prevet a secodary stroke iclude: a. Decreased blood pressure b. Decreased weight c. Ehaced vasodilatio (vay-zo-die-layshu) (wideig of blood vessels) d. Improved glucose tolerace e. Improved cardiovascular health 4. Family/caregiver traiig as appropriate 5. Determie home equipmet eeds For patiets with ischemic stroke or TIA who are capable of egagig i physical activity, at least 30 miutes of moderateitesity physical exercise most days may be cosidered to reduce the risk factors ad co-morbid coditios that icrease the likelihood of recurrece of stroke For patiets with disability after ischemic stroke, a supervised therapeutic exercise regime is recommeded Sacred Heart Medical Ceter 20

22 recovery at home It is difficult to predict exactly what eeds you will have whe you go home. Your eeds deped o the physical effects of your stroke, how you ad your family respod to these effects, whether you go through a rehabilitatio program, ad what support is available to you ad your family whe you get home. We will trai your home caregivers before you are discharged. Takig otes ad askig questios about issues ot clear to you is importat. Adjustig to a stroke is ot oly difficult for you; it is also a big chage for your family. Whe you retur home or go to a ew home, the skills leared at the hospital may be difficult to apply. You may attempt to do old activities that may ot be safe or appropriate to do immediately. Equipmet you use may chage over time. There may be equipmet or chages eeded immediately such as a ramp or wideig doorways to make rooms accessible. Modifyig your home for adaptive equipmet, learig the use of ew equipmet, hirig health care professioals, ad usig ew skills are all ew resposibilities. All of this may be stressful for you ad your family. Remember that we are here to assist you through this. We ecourage you to ask questios of ay member of your stroke care team. 21 Sacred Heart Medical Ceter

23 RECOVERY AT HOME Takig Care of Yourself After a Stroke Here are some thigs you ca do be active i your care: Let others kow that you wat to be ivolved i decisios about your care. Ask questios, state your opiios with your health care providers. If you have speech difficulties, have someoe assist you with makig your issues kow. Do t let others talk dow or speak about you as if you were t there. Express yourself. Kow your recovery pla, be it at home or i a facility. Recovery is hard work ad a slow process. May thigs may seem more difficult for you tha they were before your stroke. Be aware that feelig tired ad discouraged is ormal. Notice your progress, ad take pride i your accomplishmets. Whe you are at home, you may experiece problems that ca be serious ad require medical attetio. Be aware of these potetial problems: Falls from problems with balace, visio, speech, ad harmful behaviors Bladder ifectios or problems with uriatio High blood pressure Seizures Sores or tears i the ski (ski breakdow) Blood clots i the legs that may travel to the lug causig shortess of breath Pulmoary embolism (a clot that travels to the lugs) Peumoia from ot breathig deeply or other causes Muscles wastig away from ot beig used As a stroke survivor, you are the most importat player o the Stroke Care Team. The effort you make will help you i the log ru. You eed to take a active role i your care. This may be overwhelmig to you at times, ad you may feel like lettig others make importat decisios for you. It is importat to always commuicate your feeligs regardig those decisios. Irregular pulse Major ifectios Sacred Heart Medical Ceter 22

24 RECOVERY AT HOME Prevetig a Secod Stroke Ufortuately, the likelihood of havig a secod stroke icreases after havig a stroke or TIA. You ca help prevet a secod stroke by: Cotrollig high blood pressure with diet ad medicatios Stoppig smokig Lowerig cholesterol, which may iclude chagig your diet ad takig medicatios Takig aticoagulats if you have irregular heartbeat Maitaiig a healthy weight Cotrollig diabetes You start therapies while you are i the hospital to begi your program of prevetig stroke. Maitaiig them after you are discharged is a importat decisio for you. Diet Tips for Prevetig a Secod Stroke Reducig sodium i your diet will help cotrol high blood pressure. Sodium makes the body retai extra fluid. This extra fluid is the i your blood vessels. With additioal fluid i your blood vessels, the pressure withi the vessels icreases ad ca cotribute to high blood pressure. Reducig the amout of sodium (ot just salt) i your diet will help you miimize this effect. A Special Note to Family Members Whe cosiderig beig a caregiver, thik carefully about this before your loved oe leaves the hospital. Aswer carefully the followig questios: Are you traied i the care eeds? Do you work outside the home? Will you be able to cover that time that you are goe with other care providers cosistetly so your job is ot at risk ad you will ot worry while at work? Ca you hire someoe to be at home with your loved oe if there are o other family or frieds available to relieve you? Discuss these issues with the social worker, urses, or your doctor to help you make the best decisio for yourself as well as for the perso affected by the stroke. 23 Sacred Heart Medical Ceter

25 RECOVERY AT HOME Your Emotioal Health Your image of yourself as a whole perso may be affected by the stroke. You may see yourself differetly ow. Here are a few tips to help with this: Be sure to bathe or shower to maitai a positive, respectful self-image. Wear regular clothes, ot pajamas. Pajamas are for sick people! If you wore jewelry or makeup before your stroke, lear ways to do this agai. It will help you feel more like yourself. If you had a beard before the stroke, keep it trimmed. If you were clea-shave, shave. If you are limited to the use of oe had, use a electric razor. Feelig sad or depressed after you ve had a stroke is ormal. Copig with a stroke ad its effects ca be wearig ad may lead to you or your care provider feelig depressed. It may be hard for you to recogize that you are depressed. Your family may be a good barometer for you to keep tabs o how you are doig. If you thik that you are depressed, talk with your health professioal. If depressio is ot treated, it causes eedless sufferig ad may slow your recovery. Watch for these sigs of cliical depressio i yourself of i your caregiver: Loss or gai of weight Decreased or icreased appetite Difficulty fallig asleep or sleepig too much; feelig tired all the time Feelig worthless or very guilty Becomig more irritable or agry Uable to cocetrate, remember, or make decisios as well as before the stroke Thoughts of death or suicide If you have thoughts of death or suicide, seek medical help right away. A coditio kow as cliical depressio is differet ad more serious tha just feelig dow i the dumps. Cliical depressio iterferes with your ability to face the day ad is cotiuous over several weeks. Sacred Heart Medical Ceter 24

26 RECOVERY AT HOME Stroke ad Your Sex Life While recoverig from a stroke, you may be tired ad depressed a lot of the time. You may have pai, stiffess, or trouble sleepig. As a result, you may feel less iterested i sex, or you may ot ejoy sex as you used to. Here are some suggestios for keepig your sex life healthy after a stroke: Read about your illess. There are self-help books that discuss sex ad stroke. Pla sexual activity for the time of day whe you have the most eergy ad your health problems bother you the least. Be sure that you are rested ad relaxed. Try differet sexual positios to fid oes that are comfortable for you ad your parter, or use pillows for comfort. Try persoal lubricats to help reduce discomfort with sexual itercourse. Talk with your parter about how you feel ad why you feel that way. Ask questios. Talk to your doctor about ay cocers you have about your sex life. Ask questios. Your doctor may have some suggestios that ca help. Be sure to let your doctor kow if you are feelig depressed or if you thik that side effects from a medicie are affectig your sex life. Wait at least 2 hours after you eat to have sex. If you eed pai medicie to feel better, take the medicie 30 miutes before sexual activity. Limit the amout of alcohol you drik, ad avoid usig tobacco i ay form. Alcohol ad tobacco ca affect sexual fuctio. Hold hads, hug, ad touch your parter, eve whe you do ot pla to have sex. Use your seses to make sexual activity more ejoyable. For example, have sati sheets o the bed, light sceted cadles, or play soft romatic music. Tell your parter what you like ad do ot like. Liste to your parter s likes ad dislikes. 25 Sacred Heart Medical Ceter

27 RECOVERY AT HOME Persoal Medicatio List Your ame If you miss a dose of medicatio, take it as soo as possible. The take ay remaiig doses for that day at regularly spaced itervals. Do ot take double doses. Resume your regular schedule the ext day. Do ot stop takig ay medicatio without your health care provider s istructios. Carry a card that lists the ames of your medicatios. Lear why you are takig them ad the side effects of your medicatios. Call your health care provider if you thik you are havig a reactio to a medicatio. Prescribed Medicatios These are medicatios you are curretly takig that a health care professioal has advised you take: Brad/Geeric Name Purpose Stregth How may? Whe? Sacred Heart Medical Ceter 26

28 Persoal Notes 27 Sacred Heart Medical Ceter

29 Questios to Ask Sacred Heart Medical Ceter 28

30 OREGON NEUROSCIENCES INSTITUTE Desigated Advaced Primary Stroke Ceter The Joit Commissio Advaced Primary Stroke Ceter Sacred Heart Medical Ceter RiverBed 6th Floor South 3333 RiverBed Drive Sprigfield, Orego Y Orego Rehabilitatio Ceter Uiversity District 4th ad 5th Floor Northwest; 5th Floor Northeast 1255 Hilyard Street Eugee, Orego Y Y (ONI )