Question

List Complication that may occur related to a stroke, L side Hemiplegia, procedure, and comorbidities.

What nursing or medical interventions may prevent the above alert or complications?

Answer 1

Stroke is a condition in which either decreased blood supply to the brain or cessation of blood supply to the brain. It is generally classified in to ischemic stroke and hemorrhagic stroke.

Complications related to stroke

Acute complications are

Brain edema leads to ischemia and cell death

Seizures due to abnormal electrical or impulse transmission.

Dysphagia is difficulty in swallowing due to weakness of neck muscles

Speech difficulties and aphasia either expressive or receptive

Loss of consciousness

Ventilatory failure if lesions extended to brainstem

Late complications

Pneumonia due to aspiration of food particles or from accumulated secretions

Urinary tract infection due to urinary stasis or incontinence

Bed sores immobility leads to skin break down on the pressure points.

Limb contracture and spasticity- lack of movement and muscle stimulation causes stiffening of joints and contracture.

Deep vein thrombosis blood clot formed in side of deep veins due to immobilization of leg.

Shoulder pain due to immobilization

Fall and acccidents due to unsteady gait and limb weakness and poor coordination.

Respiratory complications- Ventilatory failure due spasticity of respiratory muscles resulting decreased vital capacity, respiratory volume. Pneumonia and lung abscess.

Clinical depression and social isolation.

2. Left side hemiplegia .

Left side brain stroke results right side paralysis. Right side weakness or paralysis, sensory impairment, receptive aphasia( understanding language difficulty), slurred speech, unable to see objects in the right visual field of both eyes.

3. Diagnostic procedure

Detailed history about present conditions and comorbidities

Previous history of stroke, family history, dietary and lifestyle pattern

Physical examination and vital signs, neuro check

CT/ MRI to diagnose type of stroke, area involved.

Cerebral angiography to diagnose arterial block, calcification.

Surgical procedures

Craniotomy- making a hole and remove blood clots

Craniectomy- a bone flap is removed and evacuation done. This procedure preferred when there is extended hemorrhage or subsequent bleeding expected. The brain is allowing to expand. Once the acute condition is resolved, preserved bone flap repaced .

Burhole procedure- small hole will be made and the clot is removed.

Endarterectomy- removal of blood clot from the affected artery.

Surgical management of aneurysm- if aneurysm compress brain tissue aneurysm coiling or ligation performed.if it is bleeding,graft procedure done .

5. Comorbidities

Hypertension, cardiac failure, respiratory failure

Seizures

Contracture and Spasticity

Deep vein thrombosis

Pneumonia , lung abscess

Bed sore , nutritional problems

Speech difficulties

Depression

Constipation and urinary incontinence

Fall and fracture

Prevention of complications

1. Brain edema

If it is ischemic stroke

Admister osmotic diuretics ( manitol) or hypertonic saline solution .thses medicine will shift fluid from interstitial space to intravascular space .thus by edema will reduce.

Elevate head end 30 degree to promote venous return

Reduce external stimuli

Monitor vital signs and maintain BP in normal level.

If hemorrhagic stroke is present :

Don't admister diuretics which will further Increase bleeding.

Prevention of seizures

Reduce external stimuli by providing calm and quite environment, dim light, reducing noise, avoiding painful procedures.

Antiseizure drugs

Maintain intracranial pressure in normal range.

Dysphagea and related complications

In acute phase

NGtube feeding Is ideal to prevent aspiration. After returning gag reflex initiate oral intake. First provide semisolid food. If the client can swallow and doesn't not showing aspiration initiate fluid and solid foods.

Swallowing excercise to regain muscle tension and swallowing ability.

Small and frequent feeding is appreciated. At 2 hrly interval

Prevention of pneumonia

NG tube feeding to prevent aspiration and chemical pneumonia.

Decompress stomach if abdominal distention present

Airway suctioning to maintain airway patency and prevent accumulation of secretions.

Prevention of DVT

apply antiemboli stokings, calf muscle massage, turn patient every two hourly

Administer low molecular weight heparin, prophylacticaly if patient is risk or low dose aspirine

ROM exercise

Prevention of UTI

In acute phase. Catheterize with Foley's catheter

Later, intermittent catheterization if urinary retention is present.

Bladder training. Ask the client to void at 2 hrly interval in day time and 4th hrly interval in night time.

Use crede method to empty the bladder completely

Prevention constipation

Drink warm water.

Have fibre containing food.

Laxatives, suppository or enema to manage chronic complications.

Bed sore, contracture, muscles spasticity

Turn patient's at every 2 hours interval

Provide back massage, sponge bath

ROM exercises

Massaging limb with electrical massagers.

Use comfortable devices. Foot board to prevent foot drop. Air bed to prevent formation of bedsore.

Physiotherapy, walking exercises can be started as early as possible.

Managing clinical depression and social isolation.

Counselling and teach client using coping mechanism.

Occupational rehablitation

Managing communication

Use sign board.

Stand in front of the client and talk with wide open mouth.

Speech therapy.

Reorient the client every day and before doing Angeles procedures.

Managing nutrition

Provide high protein, moderate fat and carbohydrate diet. It is depend onclient physical condition and co morbidities.

Prevention of fall and fracture

Floor and contact place must be a nonslippery

Use non slippery well fitting shoes

Use can or walkers to maintain balance

Orient the client about surroundings

Gait excercise, balance exercises, muscles strengthening excercise are helpful

Tell the client do not change the position abruptly. Take a minute then change fro sitting to standing then walk.

If you feel giddiness, sit on the floor .

Prevention of respiratory complications

Chest physiotherapy, turning position, use of incentive spirometry. Breathing excercise helps to increase lung capacity and inspiratory volume.