What is a stroke and what happens after your loved one has a stroke?
We all know its a possibility, we all know strokes happen. Until we experience it, actually go through it we really have no clue. This post gives a detailed explanation of what to expect upon arrival at the emergency department. As a caveat, no two strokes are the same and every single experience is unique. This serves as a general guideline as what to expect.
1).The Beginning: Basic info about Strokes
Signs of a Stroke
Sudden numbness or weakness: Numbness or weakness on one side of the body, particularly the face, arm, or leg.
Sudden confusion: Difficulty understanding what others are saying or trouble speaking.
Sudden vision problems: Vision loss or changes in one or both eyes.
Sudden trouble walking, dizziness, or balance issues: Difficulty walking, a sudden loss of balance, or feeling unsteady.
Sudden severe headache: A sudden, intense headache with no known cause.
Other Potential Signs
Slurred speech: Difficulty speaking clearly or understanding what is being said.
Difficulty finding words: Trouble remembering words or forming sentences.
Loss of coordination: Feeling clumsy or having difficulty with fine motor skills.
Fainting or loss of consciousness: Brief loss of consciousness or feeling like you might pass out.
Nausea or vomiting: Feeling sick to your stomach or vomiting.
General weakness or fatigue: Feeling unusually tired or weak.
Other unusual symptoms: Such as persistent hiccups, sudden drowsiness, or seizure
I did not get to witness any of this since Glenn and I had separate bedrooms and I was not with him when the stroke happened sometime overnight. Of course, a part of me is still upset that I was not there for him in his time of need.
Facts about stroke
A stroke occurs when the blood supply to the brain is blocked by a clot or tear in a blood vessel. There are two types of stroke: Ischemic & Hemorrhagic. In an ischemic stroke, a blood vessel becomes blocked by a blood clot and a portion of the brain becomes deprived of oxygen. Ischemic strokes are the most common type of stroke, representing about 87% of all strokes. In one second, 32,000 brain cells die, and in 59 seconds, an ischemic stroke will have killed 1.9 million brain cells. A hemorrhagic stroke can occur when an aneurysm, a blood-filled pouch that balloons out from an artery, ruptures, flooding the surrounding tissue with blood. The fatality rate is higher and prognosis poorer for those who experience hemorrhagic strokes.
In the United States, about 795,000 people suffer a stroke each year. Someone has a stroke every 40 seconds, and every 4 minutes someone dies from a stroke. There are more than 140,000 deaths each year from stroke. Statistics show that about 40% of stroke deaths occur in males and 60% in females.
Stroke is also the leading cause of serious long-term disability in the United States. There are over 7 million stroke survivors that live in the United States and two-thirds of them are currently disabled. Around 25% of people who recover from their first stroke will have another within 5 years.
Although stroke has fallen from the third to fourth leading cause of death within the United States, outlook after survival is still grim. Medical treatment has become much more advanced for stroke survivors immediately following a stroke and through rehabilitation, but strokes are a very serious medical condition that require a lifetime of dedication to overcome.
Stroke severity and patient age are the two most important factors in predicting one’s chances of survival after a stroke. Stroke severity is measured by analyzing neurological impairments (in language and behaviors) and by conducting a CT scan or MRI.
Medical professionals will also use the National Institutes of Health Stroke Scale (NIHSS), within 24 hours of a stroke, to measure neurological impairment and predict the chance of survival. Each point a patient scores, his or her odds of survival after three months decreases by 17 percent.”
2). Time in the hospital
Initial Assessment and Stabilization
Vitals: Upon arrival, healthcare professionals will assess the patient’s vital signs, including heart rate, blood pressure, temperature, oxygen saturation, and glucose levels.
Oxygen: If needed, supplemental oxygen will be administered.
IV Access: An intravenous (IV) line will be established for medication administration.
Glucose Check: A blood draw will be performed to check glucose levels, as hypoglycemia can mimic stroke symptoms.
Neurological Exam: A neurological exam will be conducted to assess the patient’s ability to move, speak, and feel.
NIHSS Scale: A National Institutes of Health Stroke Scale (NIHSS) may be used to determine the severity of the stroke.
Diagnosis
CT Scan: A CT scan of the brain will be performed to identify the type of stroke (ischemic or hemorrhagic) and its location.
Other Tests: Blood tests, such as a CBC, chemistry panel, and INR/PTT tests, may be ordered to assess the patient’s overall health and clotting status.
ECG: An electrocardiogram (ECG) may be performed to check for heart-related issues.
Treatment
Thrombolytics (tPA): If the CT scan shows an ischemic stroke and the patient is eligible, tPA, a clot-busting medication, may be administered.
Thrombectomy: In some cases, a thrombectomy, a surgical procedure to remove the clot, may be performed.
Surgical Intervention: For hemorrhagic stroke surgery may be needed to repair the damaged blood vessel.
Blood Pressure Management: Blood pressure will be carefully monitored and managed
Craniotomy: When conventional medical treatments like tPA are not sufficient or when brain swelling and pressure are severe, a craniectomy (a more extensive craniotomy where the bone flap is not immediately replaced), may be performed to relieve pressure and allow the brain to swell in the hopes of preventing more damage.
ICU
Why the ICU for a Stroke? Some stroke victims experience too much damage and need ICU level treatment.
Severe Stroke: Severe strokes can lead to breathing problems, decreased consciousness, and difficulties with swallowing or speech.
Complications: Strokes can also cause complications like respiratory or circulatory problems that require intensive monitoring and support.
Ventilation: Some stroke patients may need a breathing tube and mechanical ventilation, which can only be provided in an ICU setting.
Neurological Monitoring: ICUs provide specialized monitoring and care for neurological conditions, which is crucial for stroke patients.
Stroke Complications: ICUs can also help manage complications like intracranial hypertension and hydrocephalus.
ICU Care for Stroke Patients
Airway Management: ICU nurses assess and manage the patient’s airway, ensuring they can breathe effectively.
Intubation and Mechanical Ventilation: Patients with severe strokes, especially those with decreased consciousness or inability to protect their airway, may need intubation and mechanical ventilation to support breathing.
Vital Signs Monitoring: Patients in the ICU have their vital signs (heart rate, blood pressure, etc.) closely monitored.
Neurological Assessments: Regular neurological assessments are performed to monitor for any changes in the patient’s condition.
Medications: ICU staff administer medications as needed to manage stroke-related complications.
Central line: In severe cases, when warranted, a central line, also known as a central venous catheter (CVC) must be placed. This is a thin, flexible tube inserted into a large vein in the neck, chest, or groin and advanced to a large vein near the heart, like the superior vena cava. It’s used for delivering medications, fluids, blood products, or nutrition, and can also be used for blood draws and dialysis.
Support for Other Systems: ICU care can also address problems with other organ systems that are affected by the stroke’s damage to different parts of the brain such as kidney, liver, lungs, digestive tract, and bladder.
3). Recovery and Rehabilitation:
Rehabilitation Begins Early: For stroke survivors who are medically stable, rehabilitation often starts within 24 hours of the stroke. For those in the ICU rehabilitation is not a priority, as saving the life is the top priority. Once the patient leaves the ICU for the step down unit rehabilitation becomes a priority.
Long-Term Care: Some stroke patients may require long-term medical care, rehabilitation and support to regain lost skills and improve their quality of life and, as such, will often be discharged to one of the following:
Long-Term Acute Care (LTAC) hospitals offer intensive, physician-led care for patients with complex and serious medical conditions, often requiring specialized treatments like respiratory support or wound care.
Skilled Nursing Facilities (SNFs) Offers skilled nursing care, therapy, and rehabilitation for patients who are no longer acutely ill but need ongoing care to improve their functional abilities and daily living skills.
Inpatient Rehabilitation Hospitals: For stroke survivors that are medically stable, inpatient Rehabilitation Hospitals (IRFs) are recommended to provide the intensive, specialized rehabilitation they require.
4).Discharge from long term care or rehab to home or nursing home
After receiving discharge from an LTAC, SNF or IRF or rehabilitation center following a stroke, patients may return home with a plan for continued care. The decision to discharge home depends on factors like the patient’s ability to care for themselves; their ability to follow medical advice, having access to caregivers, and their ability to move around and communicate. Stroke survivors may qualify to receive outpatient therapy or home health services to continue their rehabilitation in the home.
Sometimes, though, stroke survivors are not able to return home because of the high level of care they need and often need to be placed into a nursing home for longer-term residential care.
Key Steps in Discharging a Stroke Survivor to Home:
Comprehensive Assessment
Functional Abilities: Evaluate the survivor’s ability to perform daily tasks like eating, dressing, bathing, and mobility.
Cognitive Function: Assess memory, attention, and problem-solving skills.
Medical Needs: Determine the need for medications, medical equipment, and ongoing care.
Home Environment: Assess the safety of the home, including potential hazards and accessibility.
Discharge Planning
Develop a Plan: Collaborate with the survivor, family, and care team to create a plan for home care, including therapy, medication management, and support services.
Consider Support Systems: Evaluate the availability of family, friends, or community resources to provide assistance and emotional support.
Identify Needs: Determine the specific needs of the survivor, such as physical therapy, occupational therapy, speech therapy, or social work support.
Home Modifications
Safety: Address potential hazards in the home, such as slippery floors, tripping hazards, and lack of grab bars.
Accessibility: Make adjustments to the home to improve accessibility, such as widening doorways, installing ramps, and adjusting furniture.
Stroke Education and Training
Survivors and Caregivers Provide education about stroke, its effects, and how to manage the survivor’s needs.
Home Exercise Programs Teach the survivor and caregivers how to perform exercises to improve mobility, strength, and coordination.
Medication Management Explain the importance of medication adherence and how to manage medication schedules.
Follow-up Services
Outpatient Therapy: Arrange for follow-up therapy sessions to continue rehabilitation and address specific needs.
Home Health Care: If traveling out of the house is not practical then in home health care services can be provided: such as nursing care, physical therapy, and occupational therap.
Support Groups: Encourage participation in stroke support groups to connect with other survivors and share experiences.
Post-Discharge Support
Monitor Progress: Track the survivor’s progress and make adjustments to the care plan as needed.
Address Challenges: Provide support and resources to address any challenges that arise, such as difficulties with daily tasks, emotional distress, or social isolation.
Strokes suck!
There is no sugar coating strokes. They are horrible for the victim and the families, but just know that you are not alone. I encourage you to share this post with as many people as possible, even if they have not experienced this situation as it might help them in the future, should the situation arise. Personally, I think it would have been helpful to have had this type of knowledge when Glenn’s stroke happened. It was difficult learning as I go.
