Hey. Welcome to our last system.
We're going to look at the
musculoskeletal and mobility
as far as our nursing priorities
for a patient after stroke.
Now, our goal here is to promote
optimum mobility and function.
Everybody wants that.
Now, the symptoms are caused from the stroke
from motor neuron destruction in
the pyramidal pathways.
Those are the nerve fibers that
come from your brain,
pass through the spinal cord,
to the motor cells.
So, after a stroke, patients are
most likely to experience
motor function impairment in mobility.
So mobility, respiratory function,
gag reflex, and self-care abilities,
they're all impacted by that.
So when we say mobility, we're
not just saying walking, right?
Want you to be aware that the destruction
of those motor neurons
can impact all of those areas.
So, early and safe mobility for
joints and muscles will help
minimize any deformities and help
improve function of the patient.
So the idea is as soon as we can
get them active, we do.
Now that might just mean range
of motion in the bed
until we can actually get them up
and move them around.
Because range of motion and positioning
in the most acute phases,
where the goal is to keep them as
mobile as early as possible,
because we don't want them to get
kind of stuck in a position.
So, in the very, very acute phases,
as soon as we can,
we'll start working with them
to move those joints.
Physical therapy will assist with this,
but we're with the patient, as nurses,
longer and more often than physical
therapy are. So, you work with them,
but you also help remind the
patient of the range
of motion activities that they
need to practice.
Then as the patient progresses,
you teach them to do those
exercises on their own,
depending on which part of their
body is most affected.
So these are kind of the motor deficits.
You have muscle tone and akinesias.
Let's look at muscle tone.
The muscles can weaken and lose mass.
So since he has right-sided weakness,
if we're not right on top of it,
Mr. Johnson can -- his leg muscles
can get very weak.
They'll even start to lose mass.
Think about if someone had been like
in a cast for a long period of time.
Once you take that cast off their leg
one leg where the cast was will
look smaller than the other leg.
Akinesias are different,
"A" means without, "kinesia" means movement,
so akinesia means the patient can't move
their voluntary muscles as they wish.
So they can't move their leg
as much as they want.
They can't move their arm
as much as they want,
depending on which side was affected.
So, initially, it'll look like hyporeflexia.
The muscles might be kind of flaccid. These
are in the first days after the stroke,
depending on the amount of nerve damage.
But as it progresses, the muscles
might become kind of spastic
because you've got interruptions in
those upper motor neurons.
So, initially, a patient after a stroke
may experience hyporeflexia,
so the muscles are kind of flaccid
maybe in the first days or weeks.
Depends on how severe the stroke was.
Then they moved from that hypo,
meaning low or less reflexes,
to hyperreflexia, where they
were kind of spastic
as the body is healing and
trying to receive itself.
So you might see some
Maybe you've seen somebody in
the community or in the hospital,
but they have some pretty
or contractures on the
weaker paralyzed side.
So you may notice the patient's hand or
arm comes up like this on their weak side.
If it was Mr. Johnson, he
experienced a contraction --
remember, he had a right side impacted,
so you might see it kind of turned.
I can't even get my wrist
into that position.
So we've got a picture for you
there to get a better idea.
But these are muscles that were not used
and they end up just kind of tightening up.
It looks very abnormal. Once you've seen it,
you won't forget what it looks like.
They can have an internal
rotation of the shoulder.
They have flexion and contractures of
the hand, the wrist, the elbow.
They've got external rotation of the hip,
and the plantar flexion of the foot.
So you can see that where people, their foot,
and their leg even looks very different
than from a normal walk or a normal leg.
So you're going to collaborate with
physical therapy. See, we don't
want this to happen to a patient.
We want to prevent this and
with the level of care,
we can help most every patient
make some progress.
Now, if there's severe damage,
we can't completely resolve it,
but we can do our very best to
help minimize the impact of this.
So, take a look at that picture.
Think through your mind if you've ever seen
anyone with these type of deformities.
You want to be set in your mind
that these deformities or contractures
are what we're trying to avoid,
or minimize for any patient after a stroke.