Right-Side Stroke – Stroke Nursing Care in Med-Surg

by Rhonda Lawes, PhD, RN

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    00:01 Okay. So, we just got this why does a patient with right-sided stroke have a higher risk for injury due to mobility differences? Let's see if you can recall what we've talked about when a patient has a stroke.

    00:13 Remember, a right-sided stroke, the patient has difficulty in judging position, distance, and rate of movement.

    00:21 That is a recipe for disaster when a patient's walking, right? So we know right-sided strokes, they're going to have a real problem with that.

    00:30 They're also very impulsive, they're impatient, and they deny that they have any problems. They say they're fine, they're fine, they're fine.

    00:37 So, put bullet point number 1 and 2 together and we have a real risk for falls.

    00:43 So, a right-sided stroke patient will respond best to verbal directions.

    00:49 Now, I do better seeing something written, and then I can follow it much quicker.

    00:54 Verbally, it takes my brain a little longer to process, but in a right-sided stroke, they're going to do better with clear, concise, objective directions that you give them verbally.

    01:06 Not patronizing, not using the words "Honey" or "Sweetie," and not talking to them like they're a child, but clear, concise and objective directions.

    01:18 So, you want to break tasks down into simple steps.

    01:21 Don't give them multiple steps to do at one time, break it into simple steps and a few steps.

    01:28 Make sure that you assess their environment.

    01:30 Now, I don't mean to be patronizing, but I'm saying much like we do for a toddler, when they're just kind of learning to walk, how we baby proof a home, you want to stroke proof a room and a home.

    01:42 So we want to make sure the lighting is good.

    01:44 We want to make sure there's not clutter or obstacles.

    01:47 You don't want throw rugs on the floor that they could easily catch their foot and trip on.

    01:51 The footwear they're wearing needs to be non-slip footwear.

    01:56 So this patient doesn't need to be walking on a hospital floor in regular socks, because those are -- those are slippery.

    02:02 They have those really ugly socks in the hospital, but they've got all the grip on the bottom.

    02:07 That's what they should be wearing.

    02:09 But make sure just in case Mr. Johnson has any edema in his lower extremities, make sure you have the right size on him, otherwise, we're gonna have an issue with skin breakdown.

    02:19 And if he has one-side of neglect, you're going to address it with the nursing interventions we've just talked about.

    02:27 So, with Mr. Johnson, let's apply what we've talked about.

    02:31 He's going to be slower in organization and performance of tasks.

    02:35 So we're going to have to breathe 2 deep breaths twice before we go in his room to remind ourselves of that, and then we're going to walk in and be ready to be calm and unrushed.

    02:46 So we're going to have impaired spatial discrimination.

    02:49 That's not going to be a real easy thing to see.

    02:52 Gonna be a little fearful and anxious because of the stroke which makes perfect sense to me, no matter what side your stroke is on, and going to respond well to nonverbal cues.

    03:03 So, pointing, and the more you spend time with him, you'll learn each other's languages.

    03:08 But remember, it's our job to always remain professional.

    03:12 Even if the patient is not, that's okay, because they're going through a really stressful experience.

    03:18 My job as a nurse, I always take the high road. I have to remain professional.

    03:23 Inside my head, I may be thinking unkind things, but externally, it's not appropriate.

    03:29 You can find a co-worker or a counselor to debrief with, but for the patient, no matter what happens, no matter what they say, no matter how they react, our job is to remain professional and therapeutic.

    About the Lecture

    The lecture Right-Side Stroke – Stroke Nursing Care in Med-Surg by Rhonda Lawes, PhD, RN is from the course Neurology Case Study: Nursing Care of Stroke Patient.

    Included Quiz Questions

    1. Right side of the brain
    2. Left side of the brain
    3. Brain stem
    4. Cerebellum
    1. Break tasks down into simple steps.
    2. Control the environment to limit clutter and obstacles.
    3. Be patient and allow the client time to respond.
    4. Address the client using terminology such as "honey" or "sweetie."
    5. Turn off all the lights and limit all noises.

    Author of lecture Right-Side Stroke – Stroke Nursing Care in Med-Surg

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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