Stroke

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WHAT IS A STROKE?	Where the blood supply to part of the brain is cut off. There are 3 types: ischaemic, haemorrhagic and a transient ischaemic attack (mini stroke).
CAUSE OF A ISCHAEMIC STROKE	The blood and oxygen flow to the brain is stopped due to a blood clot These clots dorm in areas where the arteries have been narrowed/blocked over time by fatty deposits (plaques) in a process called atherosclerosis Around 85% of stroke cases
WHAT CAN ACCELERATE THE PROCESS OF ATHEROSCLEROSIS?	Smoking High blood pressure (hypertension) Obesity High cholesterol levels Diabetes Excessive alcohol intake
WHAT IS ANOTHER CAUSE OF ISCHAEMIC STROKES?	An irregular heartbeat (atrial fibrillation) - can cause blood clots in the heart that break up and escape from the heart, becoming lodged in the blood vessels supplying the brain.
WHAT CAN CAUSE ATRIAL FIBRILLATION?	Lung disease Heart valve disease Excessive alcohol intake Coronary heart disease An overactive thyroid gland (hyperthyroidism)
WHAT IS A HAEMORRHAGIC STROKE?	Where the blood flow is stopped due to a weakened blood vessel supplying the brain bursts and stops any messages reaching the brain
CAUSES OF A HAEMORRHAGIC STROKE	The main cause is high blood pressure which can weaken the arteries in the brain and make them prone to split or rupture A rupture of a balloon-like expansion of a blood vessel (brain aneurysm) and badly formed blood vessels in the brain.
WHAT INCREASES THE RISK OF HIGH BLOOD PRESSURE?	Being overweight or obese Excessive alcohol intake Smoking A lack of exercise Stress
CAUSE OF A TRANSIENT ISCHAEMIC ATTACK	A temporary disruption in the blood supply to part of the brain caused by a partial clot, resulting in a lack of oxygen to the brain.
HOW LONG DO THE EFFECTS OF A TIA LAST?	A few minutes or hours Fully resolve within 24 hours
SYMPTOMS OF A STROKE	Complete paralysis of one side of the body Sudden loss or blurring of vision Dizziness Confusion Difficulty understanding others Problems with balance/coordination Difficulty swallowing (dysphagia) Loss of consciousness
SYMPTOMS OF A STROKE. F.A.S.T	Face - may have dropped on one side, may not be able to smile, eye / mouth may have dropped Arms - may not be able to life both and keep them there, weakness or numbness Speech - slurred, garbled, may be unable to talk Time - dial 999 immediately
WHO IS AT RISK?	Mainly older people Heavy smokers People with blood clotting diseases People who drink excessively People with high blood pressure Having a negative lifestyle
RISK FACTORS	Age - more likely aged 65+ Family history - if a close relative has had a stroke, then your risk is likely to be higher Ethnicity - higher if south Asian, African or Caribbean due to higher rates of diabetes and high blood pressure Medical history - higher if previously had a stroke, heart attack or TIA
REDUCING THE RISK	Lifestyle changes to avoid problems such as atherosclerosis and high blood pressure Healthy diet Regular exercise Stopping smoking Cutting down on alcohol intake Seek medical advice for irregular heartbeat - anticoagulant medications
DIAGNOSING A STROKE	Blood tests - determine cholesterol and blood sugar levels Checking pulse for an irregular heartbeat Taking a blood pressure measurement Brain scans - to see if cause if a blockage (ischaemic) or burst blood vessel (haemorrhagic), part of brain affected and severity
DIAGNOSING A STROKE	CT scans - detailed, 3D image of brain to identify any problem areas MRI scans - detailed image of inside body Swallow tests Carotid ultrasound - show any narrowing / blockages in neck arteries leading to brain Echocardiogram - images of the heart, check for any problem related to stroke
PRACTITIONERS	Physiotherapists Psychologists Occupational therapists Speech therapists Specialist nurses Specialist doctors Middle grade doctors / registrars A+E doctors and nurses if taken there.
WHAT ARE THE 6 TREATMENT OPTIONS FOR ISCHAEMIC STROKES?	Carotid endarterectomy Statins Antihypertensives Anticoagulants Antiplatelets Thrombosis
TREATMENT OF ISCHAEMIC STROKES: CAROTID ENDARTERECTOMY	A surgical method used to unblock the clot caused by fatty deposits
TREATMENT OF ISCHAEMIC STROKES: STATINS	A drug that lowers the level of low density lipoprotein cholesterol in the blood
TREATMENT OF ISCHAEMIC STROKES: ANTIHYPERTENSIVES	A group of medicines that lower the blood pressure e.g. alpha blockers, beta blockers, calcium channel blockers
TREATMENT OF ISCHAEMIC STROKES: ANTICOAGULANTS	Medication used to prevent further blood clots by changing the chemical composition of the blood
TREATMENT OF ISCHAEMIC STROKES: ANTIPLATELETS	Most patients are given aspirin which makes the blood platelets less sticky and therefore less likely to clot Others include clopidogrel and dipyridamole
TREATMENT OF ISCHAEMIC STROKES: THROMBOSIS	A 'clot-busting' medication system where the patient is given injections of a drug (alteplase) which dissoles the blood and restores blood flow to the brain It is crucial to get a full brain scan and to diagnose as an ischaemic stroke before as it can worsen haemorrhagic strokes
WHAT ARE THE 2 TREATMENT OPTIONS FOR HAEMORRHAGIC STROKES?	Surgery Surgery for hydrocephalus
TREATMENT OF HAEMORRHAGIC STROKES: SURGERY	A craniotomy is done to remove any excess blood and to stop the bleeding before repairing the damaged/split vessel
TREATMENT OF HAEMORRHAGIC STROKES: SURGERY FOR HYDROCEPHALUS	A complication for a haemorrhagic stroke -the fluid has built up in the brain A tube is placed in the brain to allow the fluids to drain
WHAT ARE THE 4 ADDITIONAL TREATMENTS?	Feeding tube inserted into stomach through your nose - provide nutrition -difficulty swallowing. Nutritional supplements - malnourished due to inability to swallow Oxygen through nasal tube/face mask - increase oxygen amount to rest of body Fluids given intravenously - dehydration
IMPACTS: PHYSICAL	Can cause permanent paralysis Can cause speech to be permanently slurred and non-comprehendible Exhaustion due to physiotherapy
IMPACTS: INTELLECTUAL	Depression Anxiety Changes in behaviour Loss of the ability to communicate verbally can cause distress
IMPACTS: EMOTIONAL	Anger Frustration Sadness Hopelessness
IMPACTS: SOCIAL	Lack of language capabilities may become a barrier between patient and family/friends They may not be able to go out due to a lack of physical ability Family may become frustrated with caring for patient
IMPACTS: FINANCIAL	In some cases there is an inability to recover regular body uses so can no longer work Time off work whilst in hospital Usually recommended to only go back to work part time whilst receiving physiotherapy
PATIENT CENTRED APPROACH	Patient is recommended treatments for their type and severity of stroke once in stable condition Treatment is started immediately for the best chance of recovery Allowed to ask for a specific nurse/doctor and is allowed to decide who they have for physiotherapy out of those working
PATIENT CENTRED APPROACH	They are allowed to request appointments with a specific physiotherapist or specialist nurse when they are out of hospital
PATIENT CARE PATHWAY: DIAGNOSIS	Symptoms shown - F.A.S.T A+E - stroke confirmed, type, cause, severity Asking about what happened before symptoms appeared, lifestyle, any medical conditions or allergies Blood tests for cholesterol and blood sugar levels
PATIENT CARE PATHWAY: DIAGNOSIS	Brains scans- MRI / CT - to determine type and severity of stroke Swallow test Carotid ultrasound - areas around the neck and all arteries leading to and from the brain to see if there is a blockage Echocardiography - ultrasound of chest to see if it was a stroke or issue with heart
PATIENT CARE PATHWAY: IN HOSPITAL	Once diagnosed, informed of all treatments by A+E consultant and recommended the best option Stroke Ward to receive treatment Regular check ups from doctors, specialist nurses, physiotherapists, speech therapists, clinical psychologists while in hospital
PATIENT CARE PATHWAY: DISCHARGE	Once discharged, book regular appointments with physiotherapy, given contacts for social groups of stroke sufferers, specialist hotlines and specialist nurses. Visited at home for a few months by physiotherapist - given challenges and exercises to become more mobile
PATIENT CARE PATHWAY: HOW LONG DO PATIENT RECEIVE SUPPORT FOR?	Receive support for as long as they feel they need it
RECOVERY	Around 1/4 will die 50% will be dependent on some form of care for help with daily activities Local authorities should provide free 'reablement services' for anyone assessed as needing them to help the person recovering to learn/relearn the skills for independent daily living at home
CARING FOR SOMEONE WHO HAS HAD A STROKE	Create a care plan - community care assessment GP is responsible for their medical care - The medical team in hospital should write to the GP about their treatment, future care needs and medication Information about local groups and services - e.g. a day centre
CARING FOR SOMEONE WHO HAS HAD A STROKE	Community/district nurses - support people living at home, rehabilitation exercises, arrange equipment (wheelchair, hoist...), advice on arranging home to make caring easier Community rehabilitation services - speech and language therapy, physiotherapy, occupational therapy Respite care - to give carers a break
HELP AND SUPPORT FACILITIES	Community Service Volunteers (CSV) - recruits and trains volunteers to help individuals live more independently at home DIAL UK - information and advice lines on local services Relate - free online counselling service
HELP AND SUPPORT FACILITIES	Remploy - helping disabled people return to the jobs market, training and rehabilitation Shaw Trust - helping people come off benefits and get back into work, helps access government funded employment programmes

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	Erstellt von Beth Tonks vor fast 8 Jahre