Question

A 60-year-old female has been recently diagnosed with a right-sided stroke. She is being seen in the stroke clinic for a follow-up appointment.

a.    What teaching components would be important to alert this patient to, related to her medical diagnosis?

b.    What areas of health promotion should be emphasized with this patient?

Answer 1

Patient's with right-sided stroke

• Patients who had right-sided stroke usually have difficulty in judging position,distance and rate of movement
• These patients are usually impatient and impulsive and tend to deny problems related to stroke
• They may fail to corelate spatial-perceptal problems with the inability to perform activities such as guiding a wheel-chair through the door way
• The patients with right brain stroke (left hemiplegia) are at high risk of injury because of mobility difficulties
• Directions for activities are best given for comprehension
• Break the task down into simple steps for the ease of undrstanding
• Environmental controls, such as removing clutter and obstacles and using good lighting aids in concentration and good mobility
• Provide non-slip socks at all times
• One-sided neglect is common for people with right-sided stroke, so the care giver may assisst or remind the patient to dress the weak or paralyzed side

In addition, the patient with stroke may experience many loses including sensory, intellectulal, communicative, functional, role behaviour, emotional, social and vocational losses

Health promotion

Together with patient ,care-giver and family establish the goals of care:

Typical goals are :

1. the patient will maintain stable and improved level of consciusness
2. attain maximum physical functioning
3. attain maximum self-care abilities and skills
4. Maintain stable body functions ( eg: bowel and bladder control)
5. maximise communication abilities
6. maintain adequate nutrition
7. avoid complications of stroke
8. maintain effective personal and family coping

Follow-up care is carefully planned to permit continuing nursing care; physical, occupational, speech therapy, and medical care

Identify community resources to provide recreational activities, group support, recreational activities, respite care,adult day care and home assisstance, based on patient needs

The patient , cargiver and family need help in coping with the losses associated with the stroke

Provide assisstance by

• Supporting communication between patient and family
• Discusing life-style changes resulting from stroke deficit
• Discussing changing roles and responsibilities within the family
• Being an active listner to allow expression of fear, frustation and anxiety
• include patient and family in short-term and long-term goal planning
• Supporting family conferences

Rehabilitation require a team approach: Physical therapy focus on mobility, progressive ambulation, transfer technique and equipment needed for assisstance. Occupational therapy emphazises retraining skills of daily living involving dressing, hygiene, cooking and eating. Speech therapy focuses on improving communication skills, eating skills and cognition