Both can be attributed to an acute disturbance in the blood supply to the brain. Lesions in the right cerebellar hemisphere cause symptoms on the right side of the body.
Symptoms
- Paralysis of the Arm or Leg
- Facial Paralysis
- Sensory Disorders
- Neglect
- Aphasia
- Dysarthria
- Disorders in Visual Fields
- Ataxia
- Apraxia
- Dressing Apraxia
Apraxia is the inability to perform a task or set of actions while motor skills and coordination are unimpaired. Dressing apraxia, the inability to get dressed, is usually not apraxia, but the result of a disturbed body diagram and disturbed spatial insight.
Causes of Cerebral Infarction .1 Atherosclerosis
Atrial Fibrillation
Dissection
Brain Hemorrhage
Causes and Risk Factors for Brain Hemorrhage
Furthermore, high blood pressure is a major risk factor, as well as alcohol use, especially excessive drinking, and of course antithrombotic drugs, such as warfarin and direct oral anticoagulants. Note, however, that the benefits of these drugs far outweigh their risks, as long as they are prescribed for good indications, such as symptomatic atrial fibrillation.
Other, More Rare Forms of Stroke .1 Subarachnoid Hemorrhage
Venous Sinus Thrombosis
Diagnostics and Treatment .1 Specific Treatment
- Treatment for Cerebral Infarction
- Cerebral Hemorrhage
- Subarachnoid Hemorrhage (SAH)
- Venous Sinus Thrombosis
- General Treatment
In patients with an SAH (due to an aneurysm), the best treatment is to close the aneurysm as quickly as possible before it can bleed again. In patients with cerebral hemorrhage, this treatment is delayed for 3 days until it is considered safe to administer heparin.
Risk Factors
They are expensive and cumbersome to manage, and should therefore not be used at all (Dennis et al. 2009). Patients should therefore not be forced out of bed if they are still completely bedridden due to the stroke (AVERT 2015).
Prevention
High blood pressure itself and excessive alcohol consumption, especially binge drinking, can lead to brain hemorrhages. The common risk factor for both patients with a cerebral hemorrhage and a cerebral infarction is high blood pressure.
Acute Phase
- Introduction
- Hospital Admission
- Three Phases After Stroke
- The Stroke Care Nurse
- The Hospital Stroke Care Unit
- The Glasgow Coma Scale and the National Institutes of Health Stroke Scale
- Start-Up of Rehabilitation Phase
- Prevention
- Medication
- Risk Factors
- Lifestyle
- Coping with the Consequences
- Outpatient Aftercare
The neurologist treats the patient in the hospital during the acute phase and is chairman of the MDC. The nurses in the rehabilitation centers discuss this again with the patient and his informal caregivers.
Recovery After a Stroke
Ribbers and T. Bushnik
- Introduction
- Recovery
- Recovery and Neuroplasticity
- Principles of Rehabilitation
Therefore, rehabilitation is resource-intensive, and the therapy time per patient is limited due to the need to cover many patients. They are the eyes and ears of the team, monitoring how patients actually function in daily life.
Therapeutic Climate
- Introduction
- Higher Therapy Intensity: Medical Specialist Rehabilitation for the Elderly
- Combination GRC and MSR in a Nursing Home
- Thinking in Possibilities
- Therapeutic Rehabilitation Climate
- Consequences of Stroke for Rehabilitation
- Nurses in Rehabilitation
- Practicing with Patients
- Developments That Play a Role in Rehabilitation
- Implementing a Therapeutic Climate
The therapy intensity depends on the ability of the patient and the financing options of an organization. Awareness of the patient and their environment, that the patient is in the skilled nursing facility for rehabilitation;.
Multidisciplinary Collaboration
- Introduction
- Multidisciplinary Collaboration
- Multidisciplinary Team
- Rehabilitation Offered by the Multidisciplinary Team Professionals in the multidisciplinary team need to have knowledge about health and
- Rehabilitation Relevance in Daily Functioning
- Example
- Factors That May Influence Rehabilitation
Different professionals must work in groups in the interest of the patient. It is important that the patient and his relatives know how to deal with the changed situation.
Skills
Kooijmans and P. Gao
- Introduction
- Preparatory Actions .1 Shoulder Monitoring
- Safety Handle Hand and Arm Figures 6.3 and 6.4
- Transfers in Recumbency
- Moving Hips in Supine Position Figures 6.5, 6.6 and 6.7
- Moving Shoulders in Supine Position with Lifting of the Head
- Turning over from Supine Position to Lateral Position Figures 6.9, 6.10 and 6.11
- Moving Hips in Lateral Position and Shoulders in Lateral Position
- Bed Position
- Lying Down on the Affected Side Figure 6.13
- Lying Down on the Healthy Side and Lying Down on the Back
- Transfer from Lying Down to Sitting/Sitting to Lying Down
- Transfer from Lying Down to Seated Position Figures 6.15, 6.16, 6.17 and 6.18
- Transfer from Seated Position to Lying Down Figure 6.19
- Sitting
- Seating Positions Figure 6.20
- Moving the Buttocks into Sitting Position Figure 6.21
- Transfer from Bed to Chair
- Moving from Bed to Chair with Reduced Torso Function Figure 6.22
- Moving from Bed to Chair with Reasonable Torso Function Figure 6.23
- Moving from Bed to Chair with Good Torso Function
- Correction Sitting Position in the (Wheel) Chair
- Getting Up from the Floor
Carrying out a transfer is potentially dangerous, as the patient may fall or traumatize, for example, an ankle or shoulder. In this chapter, we describe different ways in which the transfer can be adapted to the patient's functional level. Due to loss of motor control, the patient is less able to assume a comfortable position in bed, which can lead to complications such as excessive muscle tension or shoulder problems.
Not only the posture itself, but also the way the patient moves and the way the patient receives help are of great importance. The transfer from bed to chair or to a chair requires movement insight and a lot of practice. The steps can also be performed with two people and the patient helps if possible.
Swallowing Disorders
- Introduction
- The Swallowing Process
- Preparatory Oral Phase
- Oral Transport Phase
- Pharyngeal Phase
- Esophageal Phase
- How Are Swallowing Problems Caused?
- Neurological Disorders
- Drugs
- Recognizing Swallowing Disorders
- Responsibilities of the Nurse
- Dealing with Choking
- Management of Swallowing Disorders in Stroke Patients
By contracting the muscles in the pharynx, food is moved into the esophagus. The muscles in the throat area relax again, the trachea and the nasal cavity open and it is possible to breathe again. In the elderly, swallowing is often delayed, which makes it easier for liquid to enter the trachea.
This means that a disorder occurs in the interaction of the muscle groups involved in swallowing. Decreased sensation (sensitivity) in the oral cavity may lead to reduced bolus control and consequently may cause choking. Grasp the fist with the other hand, place it just above the navel in the middle of the abdomen.
Communication Disorders
- Introduction
- Communication Process .1 What Is Communication?
- Conversation Rules
- Communication Disorders After a Stroke
- Aphasia
- Communication Advice in Case of Aphasia
- Cognitive Communication Disorder
- Functions of the Right Hemisphere
- Consequences of Stroke in Right Hemisphere with Regard to Communication
- Dysarthria
- Causes and Characteristics of Dysarthria
- Communicating with a Person with Dysarthria
Considering the other party: for a smooth transfer of information it is important to be aware of the background and situation of the interlocutor. Accompany your questions with some possible options for the person with aphasia to choose from, e.g. The person with cognitive communication disorder does not understand that the message was intended cynically.
Without recognizing prosody and intonation, people with a cognitive communication disorder may have difficulty perceiving the true meaning of a sentence as a question or command. When a person with a cognitive communication disorder speaks in a monotone, without prosody or intonation, they may appear indifferent or disinterested. The patient's solution and the nurse/therapist's solution can then be compared.
Activities in Daily Life (ADL)
- Introduction
- ADL Training with the Stroke Patient
- Rehabilitation Is Effective Learning
- Washing
- Unaffected Arm
- Drying
- Showering
- Shaving
- Dental Care
- Dressing
- Starting Attitude
- Help/Guidance/Instruction
- Involvement of the Affected Side
- Fixed Sequence When Dressing
- Practicing Step by Step
- Care
- Attention Points for Washing and Dressing in Case of Imbalance
- Attention Points Washing and Dressing with Reasonable Balance
- Attention Points for Washing and Dressing with Sufficient Balance
- Measuring Is Knowing: Clinimetry Within the ADL
It is vital that nurses working in rehabilitation make good use of the 24-hour period for the patient. However, obstacles can stand in the way of this and can cause anxiety in the patient. The learned task must be relevant and meaningful to the patient's daily functioning.
The duration and complexity of the training should be in accordance with the patient's abilities. Place clothing on the affected side (if possible) so that the patient has to reach for the clothing on that side. Ensure that everyone who assists the patient in care does so in the same way.
Urinary Incontinence After Stroke
- Introduction
- Role of the Nurse
- Different Types of Incontinence
- Signaling Rather than Registration
- Support with Toilet Use
- Common Issues
- Practical Tips for Limiting Functional Incontinence Some practical tips for limiting functional incontinence are
- Passing Information to Team Members
In the rehabilitation phase of patients after a stroke, the focus is on increasing the patient's abilities. Problems surrounding the patient's continence are often mistakenly considered insurmountable and a normal part of aging. The nurse's role in signaling problems surrounding the patient's continence is of great importance.
With the theory of the different types of incontinence as a guideline, knowledge about offering appropriate interventions in the stroke unit is essential. In this way, we translate the theory from motor skills and cognition directly into daily practice on the stroke unit and emphasize the important role of the nurse within the team (Leandro et al. 2015). Based on the diagnosis, they assess together with the patient a choice to use one or a combination of interventions (Thomas et al. 2014).
Presentation of the Shoulder and Hand Due to Hemiplegia
- Introduction
- Shoulder Pain
- Anatomy of the Shoulder
- Causes of Shoulder Pain
- Shoulder Subluxation
- Prevention and Treatment of Shoulder Subluxation
- Shoulder Pain
- Healthy Movement
- Deviating Movement
- Prevention and Treatment of Shoulder Pain
- Edema of the Hand
- Causes
- Prevention and Treatment of the Edema
When the pain increases, the patient may have difficulty identifying the exact location of the pain. When the patient relies only on the arm during transfers and has insufficient torso control. Skin wrinkles disappear and hand tendons are no longer visible.
This results in severe deformities of the hand and fingers, which can no longer be used effectively by the patient. This condition of the wrist blocks the venous drainage of the hand. Dorsiflexion is the overextension of the wrist, whereby the hand bends towards the forearm.
Cognition, Emotion, and Behavior
- Introduction
- Cognitive Disorders
- What Are Cognitive Disorders?
- Disorders in Emotion and Behavior
- Cognitive Changes in the Elderly
- Some Figures About Disorders in Cognition, Emotion and Behavior
- Research and Treatment in Disorders in Cognition, Emotion and Behavior
In the first months after a stroke, most attention is paid to restoring movement functions. Partners, children and friends are often unaware of the invisible effects they may face after a stroke. For example, they are extremely tired because they cannot keep up with the world around them.
Changes in the patient's emotions and behavior after a stroke can seriously disrupt the relationship with the partner and children. Both the location and size of the brain injury play an important role in the degree of cognitive recovery that occurs, as does the patient's age and (previous) intelligence. If the patient cannot compensate for the impaired functions, it may be necessary to adapt the environment to the patient's current capabilities.
Post-stroke Neuropsychiatric Symptoms
- Introduction
- Prevalence of NPS
- Causation of NPS
- Neuropsychiatric Inventory
- Recognizing Neuropsychiatric Symptoms
- Psychotherapy
In recent years, there has been increasing awareness of the NPS experienced by stroke survivors (Hackett et al. 2014). The literature indicates a high prevalence of these symptoms in stroke survivors (Angelelli et al. 2004). Recent literature identifies depression and anxiety as common for stroke survivors (Mitchell et al. 2017).
Post-stroke depression has been identified as the most common NPS, experienced by at least 33% of survivors (Hackett and Pickles 2014; Buijck et al. 2012). This time spent alone can lead to rumination resulting in anxious thoughts and negative feelings (Vermeulen et al. 2013). For example, engagement in music therapy has been shown to reduce depression and anxiety in a variety of populations, including stroke recovery (Raglio et al. 2017).
Care in the Chronic Phase: Care at Home
- Introduction
- Care in Chronic Phase
- The Consequences of Stroke for the Patient in the Home Situation
- Health Issues in ADL
- Health Issues in the Field of Psychological, Emotional and Cognitive Functioning
- Health Issues in the Field of Social Functioning and Relationships
- Guidance, Treatment and Care at Home
- Advice and Information
- Disciplines Involved
Accompanying the patient and his informal carers in the home situation is therefore of great importance. In this chapter we discuss the care in the chronic phase and the consequences of stroke for the patient in the home situation. Care in the chronic phase occurs when the patient returns to the home situation.
In addition, what the patient has learned during rehabilitation is not always directly transferable to the home situation. It causes frustration and is often misunderstood by the patient and the people around him. Depending on the disability and the needs of the patient and his network, the guidelines are aimed at:
Integrated Care Pathways After Stroke
- Introduction
- Caring for Patients with a Stroke in Phases
- Acute Phase in the Hospital
- Rehabilitation Phase in the Rehabilitation Facility
- Chronic Phase in the Community
- Pathways After Stroke
- Integrated Care
- What Is Integrated Care?
- Integrated Networks of Care
- Development Model for Integrated Care
- Experiment and Execution Phase
- Expansion and Monitoring Phase
- Consolidation and Transformation Phase
- How Can Integrated Care Improve Outcomes?
- Organization of an Integrated Care System of Care/
- An Example of an Integrated Care System: Rotterdam Stroke Service
- Dutch Stroke Knowledge Network
The Maturity Model of Integrated Care, recently developed, takes a whole system or regional perspective on the development of integrated care (population-based). This cluster is about identifying performance and outcome indicators and standards to evaluate and improve results in the integrated healthcare system. It involves a collective determination and evaluation of the goals, bottlenecks and shortcomings in the integrated healthcare system and the sharing of knowledge in an open and supportive atmosphere.
The organizational/management structures of the network were redesigned around an integrated system of care. Care Coordination and Integrated Care System Funding Agreements - This includes agreements between providers or with health insurance companies. Integrated care for stroke patients in the Netherlands: results and experiences of a national breakthrough collaborative improvement project.
An Example: Course Developed in the Rotterdam Stroke Service
- Introduction
- Competence Profile: Pyramid of Miller
- Core Competencies
- Final Assignment
- Objective Final Assignment
- Choice of Theme
- Number of Participants
- Guidance and Assessment
- Structure of the Report
- Introduction
- Summary
- References
- Attachments
- Presentation
In the context of education, Miller uses a pyramid to draw the levels at which the competencies of the participants can be described. The student not only knows how to care for the patient, but also shows that he/she can actually do it. The aim of integrated care is to provide continuity of care and to adapt the care and treatment to the constantly changing health needs of the stroke patient during the different phases (acute phase, rehabilitation phase, chronic phase).
Finally, cooperation with the families of the stroke patient is also included in this core competence. This involves writing a paper and presenting the findings to the group on the seventh and final day of the course. The first page of the report contains the title of the assignment; for example: 'Communication plan for multidisciplinary collaboration'.
