Okay. In case that felt
overwhelming, don't worry,
because we're going to dive
deeper into each section.
See, we do want you to learn about a stroke
patient. But we also want you to know,
how do you manage patient care as a nurse?
And that can be so overwhelming.
Time management is the biggest challenge
when you first start as a nurse,
and pretty much the rest of
your career. So, ready?
Let's dive deeper. We're going
to start with neurologic.
Okay. So, let's look at some specific
These are the types of things
you're going to be doing
as a nurse taking care of someone
who's had a stroke.
So, we're looking for early identification.
How do we do that?
Well, remember the NIHSS assessment tool?
We're going to keep repeating that.
They did it at baseline in ER.
They did it 24 hours after
treatment was received.
And then we've got set periods of time
where you repeat that assessment.
Now, it's a very simple assessment
when it appears,
and it takes you less than 10
minutes to do it, remember,
but I just wanted to remind you, you have
to be certified to do this correctly.
Now, most nurses who take care of stroke
patients who already have this certification,
but know that you need to have
certification to do it correctly.
Now we're going to be watching
for that stroke to be extending.
Now that might seem kind of bizarre like,
"Well, I know he had the stroke,
but we've given him the medication."
Anytime you've had a stroke, you're at an
increased risk for having another stroke.
So it might be in the same spot, might be
in a different spot, but we're on high alert
to watch and see if he's had any changes.
So we're going to watch his
level of consciousness.
That's going to tell us that
intracranial pressure is
elevating and that's not a good
sign for a neuro patient.
So we're going to closely and regularly
assess his mental status,
how his pupils respond, and his
extremity movement in strength,
making sure they're not asymmetrical
and that they're equal.
Remember, if Mr. Johnson, he didn't come
to us equal because of the stroke.
So we're going to watch for any changes
that we see from side to side.
So, every interaction you
have with Mr. Johnson
is an opportunity for informal
You'll get better information if you
don't make him feel weird, right?
If he feels really -- very self-conscious
to be the patient
and have people looking at you,
so the more you can just
make it casual conversation,
make good eye contact with him,
sit down and just talk to him,
you'll get better information.
Now, I just want to show about that NIH
Stroke Scale. Here's something really fun.
I'd like for you to pause the video and
just Google "Stroke Scale Calculator."
Now, you'll find lots of calculators out
there available on the internet.
Practice scoring Mr. Johnson
from what you know.
Don't obsess over it, if you
don't know the answer.
I just want you to click through
anyway. Make it up,
so you can just kind of see how
a nurse who was certified
would perform that Stroke Scale.
Okay. Welcome back.
Now, a certified nurse, remember,
we've already decided,
takes less than 10 minutes for them
to do it a certified nurse or a physician.
And we're going to do this repeatedly
throughout Mr. Johnson's stay,
and even in outpatient just
to monitor his progress
and document it in a consistent
and standardized way.
So we want to improve his cognitive
and functional abilities.
I haven't had a stroke, and I would like that,
but you're going to carefully
assess his ability to speak
and to understand conversation.
I think this is one of the worst
effects of a stroke,
to have a thought and not
be able to articulate,
to have a question, not be
able to ask it effectively.
This is really frustrating.
And I watched my father go through this.
He was a very bright and articulate man.
But after his stroke initially, this
was a big struggle for him.
He had those communication difficulties
that stroke patients can have,
and it made him
very anxious and it can be very
overwhelming for a stroke patient,
particularly in this acute phase.
They're not used to it.
They're very overwhelmed with
the thought that this might be
the best they can ever communicate,
so be patient with them.
Use calm, slow, and natural speech.
Think about talking to someone who
didn't speak the same language as you.
They need extra time to process
just as you would
if you're hearing something in
a language that wasn't your own.
So just act unhurried. You want to have
frequent, shorter conversations.
Those are usually the most beneficial
because if you could understand
the amount of work
that patient has to do to keep up with you,
and to follow the conversation, it is
exhausting for them after a stroke.
So you always want to appear unhurried.
Maintain eye contact, smile.
Never ever look impatient with
him trying to find the words.
So, sit down, calm down, make
eye conversation, and smile.
You'll be amazed at the relationship
you can build with your patient.
Do not appear rushed or impatient.
Reassure them without patronizing,
particularly elderly patients, that
is degrading when you call them,
That might mean a term of
endearment to you,
but it's not perceived by all
patients to be that way.
So, reassure them like, "Oh, yes, thank you.
I understand what you were
trying to tell me."
Use feedback. "Is this what you were saying?"
So simplify your sentences
without patronizing them.
Give them plenty of time to
process and respond.
Don't look away while they're responding or
start charting or doing something else.
Just make calm and casual eye contact.
Now, you can work or collaborate,
is what we call it,
collaborate with the speech therapist.
You can create a plan that'll help
and some possible communication aides.
Some patients, if they have very severe
we can use things like
picture boards and key words.
But if it's just a matter of them taking a
difficult time finding the right word,
or processing things, then that's
all on us to be patient.
Also, we can role model
that for their family.
Hey, it has been extremely stressful
for Mr. Johnson's family
to walk through this,
so you can role model for them,
"Listen, if you can just stay calm
and wait for him, he'll be able to tell
you what he's trying to tell you."
And remember, gets real complicated
in family relationships and marriage,
so we don't have all that emotional
baggage with a patient.
So we're the best person to
teach the family members
how you can do it and get the
most effective communication.
So let's practice a little bit
with Mr. Johnson.
I want you to work through
just some simple conversational phrases.
Let me give you some ideas and you
pause the video and add those in.
Okay. So, I want you to practice,
all along wherever you're studying,
as you walk into the room,
what are the things you would do and
say when you first met Mr. Johnson?
Okay. I know that feels a little weird,
but promise you, practicing it now will
make it much easier with a patient.
Now you're trying to communicate with Mr.
Johnson and he's stu-, stu-, stu-, stu-, stu-.
He can't tell you what he wants.
He starts making a noise like
Okay. You have a patient that's
waiting for you in the next room.
You got a full day's list and he can't come
up with a word. What do you do?
You tell yourself to take a deep breath
before you ever walk in the room
of a patient that you know
has communication problems.
So you take one breath for you
one breath for your patient.
Then you walk into the room when you know
that this is a challenge for Mr. Johnson,
because you reset your brain
and your mindset,
so he has no idea how rushed
and how hurried you are.
When he's having trouble finding that word --
which is what patients have done, it's
what my father did after his stroke,
you just say, "Hey, it's okay. It'll come
to you. We will figure this out together."
So, pause the video, picture in your mind
a patient being extremely frustrated
using weird mouth sounds to try
and communicate to you.
Practice some responses that you would
say to that patient like Mr. Johnson.
Okay. I know you feel pretty
ridiculous, but I can tell you,
this is the kind of stuff, as a nurse,
if you will practice it, it
will come naturally.
And you will make an impact on people
that they will never forget
for the rest of your life.
They may not remember you exactly,
but they're going to remember
how they were treated with respect,
how they were valued, and what
it meant to them at the time.
That's the kind of nurse you want to be.
That's why we go into nursing.
Okay. So, remember,
we've talked about speech problems.
They also have these sensory
perceptual alterations as part of their
cognitive and their functional abilities.
Vision is a big one.
It could range everything from diplopia,
which is double vision,
that would be so bizarre,
or it could be like even a loss
of the corneal reflex,
and I have a drooping eyelid
or they might have --
wait for it --
homonymous hemianopsia. I love that word.
That's fun to say to friends
that aren't medical
because they're just like,
"You're weird." It's true.
Okay, so, homonymous hemianopsia.
That's a big one.
I would hate to have to spell that
one myself. We'll talk about that
in a little more.
We'll give you kind of a feel for what
it might feel like for your patients.
But vision problems are
a huge factor in safety
and the patient's ability to be independent.
Can you imagine if you're trying to feed
yourself and you saw two bites of food,
and you're trying to find your
mouth? That's kind of weird.
If somebody has diplopia or double vision,
they usually put an eye patch on it,
which you might as well just take
that with a grain of salt, right?
If you get to be in an eye patch, you're
going to get a lot of pirate jokes,
but there you go. It will help
with the double vision.
Now, if the corneal reflex is absent,
a patient's really at risk for
a corneal abrasion.
So we got to watch them closely
and protect against eye injuries,
if that's really the case.