Timing Is Imperative For Stroke Victims
• Outstanding emergency team – Quick response – Caring to family members
• Helicopter – negotiating the electrical lines
Rural Recovery
History • This patient prior to stroke – 100% independent – highly intelligent – walk the elliptic one mile a day – took care of her own accounts and estate – lived on the second floor of her house. • This 84 year old is diagnosed with Stagethree lung cancer metastasized in the brain. (reason for haircut)
Stage-one vs Stage-three • It was determined the patient had Stage-one lung cancer requiring a lobectomy not Stage-three involvement requiring radiation of the brain. The results and treatment of the two are quite different.
Two Week Visit
•STROKE
• DUE TO HER DR TELLING HER TO STAY OFF HER BLOOD THINNERS UNTIL SUNDAY. THIS WAS THREE DAYS. • SHE HAD THE STROKE SUNDAY
Coumadin ?
• Two week post-operative checkup from lung removal before stroke – impressive – coumadin was high (5.7)
• Thoracic surgeon recommended suspending coumadin Thursday night then follow doctors orders. • Told to resume coumadin Sunday. • Sunday she experienced a 100 % occlusion of the left carotid artery in her brain.
Emergency Room – The family was called to say their goodbyes. “The patient would not live through the night.” – This decision is based on the experience of the emergency room staff. – Patient had a 100 percent occlusion of the left internal carotid artery. Aggressive therapy is not an option for this patient due to the stroke victim’s history, although the alternative is death.
Aggressive Stoke Therapy • According to David Tong, M.D., medical director of California Pacific’s Stroke Care Center, "The good news is that nearly 50% of patients treated for stroke within a three-hour window experience little, and sometimes no, physical or speech deficit. • “Ischemic strokes are treated with thrombolytic therapy using recombinant tissue Plasminogen Activator (rTPA). rTPA is a naturally occurring clotdissolving enzyme.” • http://www.cpmc.org/about/e-health/2006/4-06stroke.html
HELP ME • A stroke victim may ‘not know’ what is happening. – Patient must rely on healthcare workers • Stroke victim may not be able to talk or move. – Patient must rely on healthcare workers • Most patients do not have someone to stay with them and be their advocate.
– Patient must rely on healthcare workers
ALERT Wristbands • A nurse placed a red alert band on this stroke victim which said:
Allergic to Anticoagulants
A DEADLY MISTAKE Nurse’s reasoning: Anticoagulant was written under the ‘alert’ heading in the patient’s chart. The nurse took this to mean no anticoagulants.
This patient can stroke or bleed without anticoagulants.
Atrial fibrillation • Also known as A-fib. This is irregular beating of the heart. • It leaves the blood in a constant state of clot, like jello, waiting for an obstacle to catch on, creating the actual ‘clot’. • For the blood to stay thin enough, not to clot blood, thinners must be used. • Anticoagulants = blood thinners.
Flaccid Arm This is the stoke effected arm
• Blood pressure readings are different on the right and left arm during the same period of time. It is important to be consistent as to which arm is used. • These marks are from the blood pressure cuff.
Elevating Paralyzed Arm • Affected arm can be elevated to relieve swelling. • It is important that the edge of this tray is covered or padded. • Pad the edge so the arm does not lay directly on the hard plastic edge.
Paralyzed • Many times the paralyzed arm is forgotten by the patient and the attendants. • When turning the patient it is important the affected limb does not gets caught underneath the weight of the patient causing addition trauma.
• Many stroke victims are prescribed anti-coagulants which increase bruising. • Bruising can be reduced by teaching attendants proper handling of patients.
Bruising
• Turn the patient with the palm of the hand not fingers this increases surface area reducing pressure that causes bruising.
It is best to move patient with the bottom sheet when moving.
• This stroke victim has an elastic binding covering a peg tube used for feeding. • This stroke victims breasts are also bound.
Why?
• This binder, which can be cut to size, belongs below the breasts this additional restriction is unnecessary.
If You Were the Patient • You are the result of all the years of your life. • Now, suddenly someone is changing your diaper because you cannot move or speak due to a stroke • Who makes sure you are cleaned properly and with respect?
Self Esteem
• Importance of dentures • Importance of glasses
• Importance of being dressed daily • Importance of a clean diaper
• I cannot speak, I am paralyzed, • I cannot use the call button
Imagine • Your linens, clothes and diaper are removed after soiling. • You are left uncovered and cold until supplies are found to clean you. • In the meantime the attendant’s assistant uses a dry pillowcase to clean you. • A diaper is replace without cleaning of the skin.
How Do I Ask? • The skilled nursing home sent me to the Emergency Room. • When released [from the hospital] the doctors orders did not include the pain medicine I had been receiving. • Now I must ask the nurse for pain medicine. I
can not talk. Page one
How Do I Ask? • I see the nurse twice a day as I am administered my medicine. • I saw the doctor (who goes to twenty-eight other facilities), on admittance, and I see a Physicians Assistant once a week. • I am paralyzed, I cannot speak, I cannot use the call button.
• How do I ask for medicine or tell them I am in pain? Page two
Postings Can Be
Inefficient Due To Overuse
Prevention of Aspiration This stroke victim is under doctor’s orders needing 100% supervision due to lost of the gag reflex. Aspiration can occur. This stroke victim is unattended. Note: Patient is feeding herself (unattended). How will she reach the food on the right of the tray with right side paralysis? Notice the comb in her plate.
Patient Hygiene
• Blood under nails from finger prick glucose testing • No standardization for hygiene, or cleaning of hands before feeding. • (rules state patients are scheduled for showers twice a week)
She did not have daily dental care
Feeding • This stroke victim (with feeding tube) is hand fed by an attendant. • The elevation of the bed is not adequate to prevent aspiration, ninety degrees is ideal. • Minimum of thirty five degrees is the suggested level for a patient with a feeding tube. • Note the location of the emergency call button. • .
Anxiety or Pain
Death: August 18, 2007 This was nine days earlier, a victim of metastasized lung cancer. The hospital
staff is not convinced this patient Is in pain as she rocks back and forth for hours.
ACTIONS: Throwing pillows off bed, pulling herself from one side of the bed to the other side of the bed for three hours. I have had a stroke, I can not speak.
• Rescue team great • Psychiatrist • Bluebells kewl
I can not speak.
• classes Patient’s ACTIONS: Removal of covers, throwing pillows off the bed, refusing help. This patient remained this way for eight hours. The patient was a stroke victim and had chronic back problems. The patient died ten days later from an intestinal blockage, stage four metastasized lung cancer.
Self Esteem
• Importance of dentures • Importance of glasses
• Importance of being dressed daily • Importance of a clean diaper
• • • •
Family and friends must grieve. This is a natural process. Humans are visual animals. BUT… When we lose a loved one it is hard to disassociate the body of our loved one from the spirit. • Our mom will always be our mom, our dad always our dad. • It is important that everyone dealing with our loved one understands.
B e in v o lv e d in th e w h o le p r o c e s s D u e t o a b u s y w e e k e n d t h i s is t h e o n l y v e h i c le a v a i l a b l e t o t r a n s p o r t t h e b o d y f r o m t h e f a m i l iye ’s h o m e t o t h e fu n e ra l h o m e .
Be involved in the whole process
Make your wishes known
My Mom