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Learning Objectives:

*Stroke Definition and facts

*How a stroke can affect a person

*Areas to Observe, Record and Report when working with a client after a stroke

*The Aide’s role in working with a client after a stroke

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In-Home Aides

- February 2016 -

Partners in Quality Care

• Ischemic stroke is the most common type of stroke. An ischemic stroke happens when an artery in the brain is blocked. There are two types of ischemic stroke:

Embolic Stroke: In an embolic stroke, a blood clot or plaque fragment forms, usually in the heart or the large arteries leading to the brain, and then moves through the arteries to the brain. In the brain, the clot blocks a blood vessel and leads to a stroke.

Thrombotic Stroke: A thrombotic stroke is a blood clot that forms inside an artery that supplies blood to the brain. The clot interrupts blood flow and causes a stroke.

• A hemorrhagic stroke happens when a blood vessel in the brain bursts and spills blood into or around the brain. High blood pressure and aneurysms (a weak spot on the wall of an artery that bulges out into a thin bubble) can make blood vessels weak enough to burst. There are different types of hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage.

In-Home Aides Partners in Quality Care is a monthly newsletter published for member in-home aide agencies. © Copyright AHHC 2016 - May be reproduced for in-home aides. Kathie Smith, RN: VP State Relations, Home and Community Based Care Editor in Chief

Major symptoms of a TIA include:

• Numbness, weakness or loss of vision

• Trouble speaking

• Loss of balance or coordination

When a TIA happens, the artery either becomes unblocked after a short time or a new path opens up and blood flow goes back to normal. Because of that, the symptoms last for a short time and then disappear.

A TIA is a serious warning sign that a person might have a stroke. If someone has had a TIA, they should see their doctor immediately.

Cerebrovascular accident (CVA) also known as a Stroke

Blood vessels that carry blood to the brain from the heart are called arteries. The brain needs a constant supply of blood, which carries the oxygen and nutrients it needs to function. Each artery supplies blood to specific areas of the brain. A stroke occurs when one of these arteries to the brain is either blocked or bursts. As a result, part of the brain does not get the blood it needs, so it starts to die. A transient ischemic attack (TIA) occurs when the blood supply to the brain is blocked for a short time. When this happens, the brain temporarily malfunctions.

While all strokes happen in the brain, there are different types. Identifying the type of stroke leads to quicker treatment.

If an artery within the brain or one that goes to the brain is blocked for a short time, the blood flow to that area of the brain slows down or stops. This can cause a transient ischemic attack (TIA), sometimes called a mini-stroke.

How a stroke affects a person- the sides of the brain

The left side of the brain controls the right side of the body. You use the left side of your brain to move the right side of your body, figure out math and science problems and understand what you read and hear. You may have trouble doing these things if you have a stroke that damages parts of the left side of your brain.

The right side of the brain controls the left side of the body. You use the right side to move the left side of your body and do creative things like paint a picture, appreciate art or music, recognize the emotion in someone’s voice or find where you plan to go. You may have trouble doing these things if you have a stroke in the right side of your brain.

The human brain has different areas that control how the body moves and feels. When a stroke damages a certain part of the brain, that part may not work as well as it did before. This can cause problems with walking, speaking, seeing or feeling.

After a stroke, a person may have emotional and physical changes. Depending on the part of the brain that was affected, a person might have problems with: seeing, sleeping, having seizures, controlling bladder or bowels, moving parts of the body, pain, fatigue, thinking, memory, depression.

Some signs of stroke include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

• Sudden confusion, trouble speaking or understanding

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness or loss of balance

• Sudden severe headache with no known cause

If you have any of these symptoms or see someone else having them, call 9-1-1 immediately! Fast treatment at the hospital can have better results.

In Home Aides- Partners in Quality Care- February 2016-pg.2

Learn the many warning signs of a stroke. Act FAST

and CALL 9-1-1 IMMEDIATELY at any sign of a stroke. Use FAST to remember the warning signs.

FACE: Ask the person to smile. Does one side of

the face droop?

ARMS: Ask the person to raise both arms. Does one

arm drift downward?

Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

TIME: If you observe any of these signs, call 9-1-1 immediately.

Note the time when any symptoms first appear. If given within three hours of the first symptom, there is an FDA-approved clot-buster medication that may reduce long-term disability for the most common type of stroke.

In-home aides provide support to the client and family during the long road to recovery after a stroke.

If communication is an issue after a stroke some tips to help are:

• Ask questions that can be answered with a simple “yes” or “no”

• Use nonverbal communication: gestures, pictures, chalkboards, flash cards, typewriters, and computers.

• Try to anticipate your client’s need before he or she has to ask for something

• Follow instructions given by the speech-language therapist if applicable and as directed by your supervisor

• Be sure your face is visible, this will help those who lip read

• Rephrase the sentence if it is not understood

Your client may be on certain medications after a stroke such as anticoagulants (sometimes known as “blood thinners”), they are medicines that delay the clotting of blood. Or they may be on medication for high blood pressure. Discuss with your supervisor if there are observations that need to be reported due to your clients being on certain medications after a stroke or any medication assistance you are to provide your clients.

Stroke is the number 5 cause of death and the leading cause of adult disability in the United States. About 795,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds

Resources- National Stroke Association- Explaining Stroke brochure; American Heart Association/ American Stroke Association- about Stroke; Stroke Statistics, let’s talk about Stroke. Mosby’s Textbook for the Home Care Aide, third edition, Chapter 22, Caring for Clients with Illnesses Requiring Home Care; Cerebrovascular Accident.

Symptoms depend on the extent of the brain injury and the area involved, Symptoms may include problems with:

Communication: Due to difficulty receiving, understanding, and expressing speech and language. Aphasia (absence of speech) is caused by injury to the speech center of the brain. Short attention span is also caused by brain damage. Clients may have slurred speech and problems finding the “right” word they want to say. This is very frustrating, and clients may cry or become angry because they are unable to clearly express their needs and feelings. Sometimes, they will not understand what you are asking or telling them.

Safety- Due to poor balance, hemiplegia (paralysis of one side of the body), hemianopsia (blindness or defective vision in one half of the field of vision). The client is at great risk for falls. Assist client with mobility assistive devices as directed.

Mobility- Due to hemiplegia and enforced bed rest.

Pain in affected shoulder and/or arm: Due to weight of paralyzed arm pulling on joints.

Elimination- Due to incontinence, urinary retention, and constipation

Nutrition- Due to difficulty in swallowing, self-feeding, and perception problems.

Depression- Due to effects of serious illness, problems with mobility, and prolonged rehabilitation. Clients may have low self-esteem because of the many losses they have experienced and the need to depend on others for so much care.

The In-home Aides’ role in assisting clients after a stroke:

Due to limited mobility, weakness, and perception (ability to recognize sensations through the senses), there may be severe problems with performing Activities of Daily Living (ADL’s), and clients usually require a great deal of assistance with grooming and hygiene.

Assisting with or performing ADL’s-

• Follow the plan of care for your client; encourage the client to become as independent as possible. Assist with bathing and grooming as per plan of care, know all safety precautions and what type of assistance your client needs.

• Use assistive devices (i.e. special toothbrushes, combs, soap-on-a-rope) as directed from your supervisor

• Promote client mobility through range of motion exercises and ambulation, if possible, as directed from your supervisor

• Change position every two hours, and check skin for injury; client should not lie on affected side any longer than 1 hour, as directed from your supervisor

• Do not pull on or use the affected limb when lifting or moving the client

• Apply a sling or elevate the paralyzed arm according to the plan of care and as directed from your supervisor

• Watch for swelling, discoloration, and pain in the affected limb

• Schedule rest periods between activities; due to the client tires easily

• Take the client to the bathroom for elimination, if possible. A raised seat will make it easier for the client to use the toilet; a commode at the bedside may also be used. Clothing that is easy to get off will help to prevent accidents.

• Helping the client maintain good nutrition- remind the client to follow the speech-language therapist’s instructions about proper swallowing techniques if applicable. Use assistive devices when needed. Follow plan of care instructions regarding assistance with feeding your client if required. Watch for choking and difficulty swallowing. Follow any special dietary restrictions or therapeutic diets assigned if meal preparation is part of the plan of care.

In Home Aides- Partners in Quality Care- February 2016- pg.3

Observe, Record, and Report

• Coughing and choking when eating and swallowing

• Incontinence; Constipation

• Skin changes

• Complaints of pain

• Swelling, discoloration, and pain in the affected limb

• Depression

• Signs of infection and other observations to report as assigned

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