Left-Side Stroke (Aphasia) – Stroke Nursing Care in Med-Surg

00:01 Now, again, I told you, this would be the worst for me and it broke my heart to see my dad deal with this.

00:08 But remember, the left hemisphere is usually dominant for language skills if you're right handed, and even in most left-handed people, so don't rush over that.

00:18 Usually, the left hemisphere is dominant for language skills in right-handed people, and in most of the left-handed people that you work with.

00:27 So, if they have a stroke on the left side, they're probably going to have some language problems.

00:33 So we've got aphasia. Now, aphasia occurs when a stroke damages the dominant hemisphere of the brain.

00:39 For most people, when it comes to language, that's going to be the left side, but there'll always be people that are a little different, but you've got just kind of a general rule for the general population.

00:49 Now we talk about language disorders, they're going to have difficulty with expression and understanding written and spoken words, so they may give me some pretty bizarre looks and faces.

01:00 My dad always had these super bushy eyebrows, we had to cut them.

01:04 So we would always get that weird face from him when we would say something and it wasn't processing in his brain.

01:10 So aphasia, dysphasia, and dysarthria are terms that you'll hear when we talk about problems with communication.

01:19 Now, let's first take a look at aphasia.

01:22 There's different types of aphasia.

01:24 Receptive aphasia means the patient will have difficulty in understanding written and spoken language.

01:31 Yeah, this one's a lot of fun.

01:33 Sometimes, it will feel like speaking to someone who doesn't speak the same language as you, and you have zero in common.

01:41 Again, you know what we need to do. Remain professional, remain therapeutic, and just be patient, and keep reassuring the patient in a calm and professional tone, "We'll get this. I know this is frustrating for you.

01:54 I'm sorry that I'm not understanding right now, but I'm going to stick with you until we do." So, receptive aphasia means when they receive things, they have a hard time understanding it, whether it's written or spoken.

02:08 Now, expressive aphasia.

02:10 They may know exactly what they want to say in their mind, but they can't get it out.

02:15 That's why my dad would say -- when he couldn't find the word.

02:21 So, they've lost the ability to produce spoken or written language, even.

02:25 It's very difficult.

02:27 So, global aphasia, this is horrific.

02:31 I hate it when a patient has this for them, because it's a severe form of both receptive and expressive language skills.

02:40 So they cannot receive what you're saying to them very well, and they can't communicate back to you.

02:46 To me, this would be a horrible fate to have to deal with that.

02:51 So think about stroke patients, communication is a huge factor.

02:56 You want to be aware, is it receptive aphasia, is it expressive aphasia, or is it global aphasia? And think about how you would interact with each one of these patients a little differently.

03:09 Okay. So, let's talk about some strategies. You want to make sure you have the patient's attention before you start.

03:15 So we're talking about these different types of aphasias.

03:18 Never start a conversation with a patient with your back to them.

03:23 If you're not making eye contact, don't start the conversation, okay? That is good for hearing problems, vision problems, stroke patients, and it's just professional.

03:32 So you want to make sure that you have eye contact with your patient, and you start an unhurried conversation.

03:40 You want to make sure there's not a lot of background noise. A lot of times, patients and families have TV and radio and lots of people, but if I'm going to go talk to a patient, I would just walk in, I'd make eye contact and I'd say, "Good morning, Mr. Johnson.

03:52 My name is Rhonda. I'm going to be taking care of you today.

03:54 Hey, I'm having a little bit hard time hearing in here.

03:57 Would you mind if I turn down the television?" Always ask permission, okay? I always say, "I'm having a hard time.

04:05 Would you mind if I turn the television down?" Because you need to think of the patient's room as their home.

04:11 So I don't just open the door and come in. If the door is closed, I'll gently knock on the door and wait for someone to respond.

04:18 If he's globally aphasic, like the patient's not going to be able to respond, I get it.

04:22 But it's still etiquette to let them know that you're respecting that physical boundary before you come in a room.

04:29 You want to keep your voice at a normal level, unless the patient tells you, "I have a severe hearing problem." Now, my dad was almost deaf in both ears, so even if he had hearing aides, you had to speak very clearly and directly.

04:44 Once health caregivers knew that, they would always make sure they made eye contact, he lip-read a lot, and they would speak in short, but pretty loud sentences for him.

04:57 And he always told me the people that were careful and took the time to do that, how much it meant to him that they did that.

05:05 So keep the communication simple, but adult.

05:08 You should not sound like a Sesame Street episode, right? You want to be simple, short, but adult.

05:15 So use your senses that are simplified. Use a simplified structure, reduce your rate of speech, and emphasize key words.

05:23 Do not talk down to the patient with aphasia.

05:27 You want to assume, "Yes, they're understanding what I'm saying." That's the kind of speed and rhythm you want to your speech, but you want it slow, and you want to articulate and you always want to be looking at them.

05:42 Don't be at the computer --typing things in and asking them questions.

05:47 That will communicate value to your patient, plus, it's going to be less frustrating for both you and the patient when you recognize that communication with the patient is your priority in the moment, and you do that with your full attention.

06:02 No multitasking when you're trying to communicate.

06:06 So give them plenty of time to speak.

06:08 Resist the urge to finish their sentences, okay? Resist the urge to finish their sentences.

06:15 Resist the urge to finish their sentences or offer words, okay? That is really difficult for a patient.

06:24 Once you have a strong, established relationship and you maybe know some key sounds with them, that's a little different.

06:30 But it can come across as condescending to a patient when you try and fill in the blank.

06:34 Plus, you frustrate them because the more words you offer, then they have to process that word and see if it is and try to explain it.

06:40 Don't do it. Just wait. Be patient.

06:44 Communicate with drawings and gestures and writing and facial expressions is okay.

06:48 That's fine.

06:49 If you want to use a facial expression, that's appropriate.

06:52 If you want to write something down or draw a picture or point to a part of their body, that's also helpful to them.

06:59 So, make sure that you're communicating successfully with "yes" and "no" answers.

07:06 We always teach you to use therapeutic communication, which is open-ended questions.

07:10 Not with a patient with aphasia.

07:12 You want to ask them straightforward questions.

07:15 After they've communicated to you, ask them, "Is this what you were asking? Would you like a glass of water?" They can say "yes" or "no." "Would you like me to rub some lotion on your feet?" "Yes" or "no." Not the open-ended therapeutic one when it comes to figuring out what they're trying to say and communicating with someone who has aphasia.

07:38 So encourage them.

07:40 Everyone likes to be validated. We all like to act like we don't need it, but everyone likes to be validated. They're very frustrated.

07:47 Most of them are worried about taking up your time and being slow and feeling stupid.

07:53 You should just praise them. Encourage them, "You're doing really good." If they make an error, you down play it, "No big deal." Always use those words or your own way of saying that, but let them know, "Ah, it's no big deal. We'll fix it. We'll move forward, we've got it, not a problem." And don't ask them to make sure every word is produced perfectly.

08:17 If you can glean the meaning, keep moving.

08:20 Okay. So, help them with normal activities whenever possible. Remember, we want them to be as independent as possible, so don't speak for them.

08:30 Don't shield them from family or ignore them in a conversation. Include them.

08:35 Remember, you're the role model.

08:37 So, we want them to be involved in decision making as much as possible.

08:41 We want them to know about events, but we want to avoid burdening them with day-to-day stuff they don't need to know, but don't make them feel like they don't belong anymore, or they're not included.

08:50 You can also role model that for the family so they know that, "Yeah, it's okay to talk to him about things," like you normally would.

08:57 Encourage them to be independent and don't be a smother mother.

09:00 Like, you know, a helicopter -- helicopter moms, you know they are? They can't let their kids go for anything.

09:07 Don't treat them as if they're fragile. Encourage them to be independent, to do as much as they can, and to try things. They're not going to grow, they're not going to get stronger unless we encourage them to be more independent.