Stroke Nursing Care in Med-Surg: In a Nutshell

00:01 Okay. So, let's wrap this part up.

00:03 Remember, the goals in telemetry/Med-Surg units are to minimize possible complications from the stroke.

00:09 We want to facilitate the optimum functioning and sensory perception for every patient after a stroke.

00:15 So we're going to be looking at communication, emotional control, affect, intellectual function, because we know that all of these can be negatively impacted after a stroke.

00:25 And you're going to continue to collaborate, which is my very favorite part with the whole team.

00:30 So, all of us will put our best skills together in an interdisciplinary team to evaluate and plan for a safe discharge for Mr. Johnson.

00:38 It'll include physical therapy, speech therapy, occupational therapy, social work, and the registered dietician will all come together as experts to give advice to the health care provider what we think is best for Mr. Johnson.

00:52 Patients who have a stroke often have cardiovascular disease.

00:55 So you're going to want to watch the cardiovascular system closely also.

01:00 You're going to monitor their blood pressure and make sure it stays within the healthcare provider's ordered parameters.

01:05 Watch their cardiac rhythm as appropriate, and watch closely for signs of fluid volume overload, and problems with circulation in the form of a thromboembolism.

01:17 So we're in the medical surgical/telemetry unit.

01:20 We know that patients are at risk for developing respiratory complications.

01:23 The ones I'm going to be sharp to be on the lookout for are aspiration, atelectasis, and pulmonary edema.

01:31 So I'm going to be monitoring that fluid volume status very closely.

01:35 So I'm going to watch for breath sounds posteriorly and anteriorly because I know that crackles, which are a sign of fluid volume overload, are going to develop first in the back and the bases.

01:46 I'm going to keep the head of the bed elevated when eating and drinking because I want to minimize that risk of choking and aspiration pneumonia.

01:54 Now, lastly, I'm going to encourage Mr. Johnson to be as mobile as possible, and I'm going to make sure he deep breathes regularly.

02:02 That's going to help us open up those lungs and avoid the risk of atelectasis.

02:07 Constipation is the most likely bowel problem after a stroke.

02:12 Now, remember that patients after a stroke need to stay appropriately hydrated.

02:16 We're also going to use stool softeners and help them be as mobile as possible.

02:21 Now, hydration is important for the cardiovascular system to keep their blood pressure up.

02:26 But it's also important for the GI systems what we're talking about, because they need to have enough fluid so that stool isn't dried out inside their system.

02:35 So we use stool softeners that will help draw extra fluid into the waste, and we also help them stay very mobile to keep that gut moving.

02:44 So they need adequate fluids, they need stool softeners to draw extra fluid into the waste, and we want them to be as active as possible to keep that gut moving.

02:54 Now, we might need to do bowel retraining to have to help the patient return to a normal bowel elimination pattern.

03:00 That just involves regularly taking Mr. Johnson to the bathroom, knowing that about 30-40 minutes after he eats, we have that gastrocolic reflex, and that's probably a good time to do that after a meal.

03:13 Avoid the use of indwelling catheters on any patient, but including stroke patients as much as possible because you want to minimize the risk of infection.

03:23 Bedside bladder ultrasound can help you identify any residual problems or how much urine is in the bladder, and bladder retraining might be necessary to help your patient reestablish normal elimination patterns.

03:36 Stroke patients are at a higher risk for skin breakdown, or the other name, pressure ulcers.

03:42 Either way, it's the same concept.

03:44 So you want to remember the 4 Ps for minimizing risk of skin breakdown: positioning, protect the paralyzed side, pressure relief, and proper skin hygiene.

03:57 After a stroke, patients are likely to experience some type of motor function impairment, and they're definitely at an increased risk for falls.

04:05 So be on the lookout for safety.

04:07 Their specific deformities or contractures may develop on the weak or paralyzed side, so reflexes might initially be hyporeflexive, and then they'll progress to hyperreflexia.

04:18 So, keep an eye out for that and know that it's normal.

04:22 Muscle control can initially be flaccid, and then it might progress to that spasticity that we just talked about.

04:28 The experience of an acute stroke has physical, emotional, and functional impact on your patients and their families.

04:36 So you want an interdisciplinary collaboration from the initial admit, all the way through Mr. Johnson's stay. These are critically important to help them develop the most effective discharge plan to home or even another level of care after the telemetry/med-surg unit.

04:51 Now, we'd hoped that Mr. Johnson could discharge home, but he may need to go to a rehab unit or a skilled nursing unit in a lower level of care.

05:00 So, that will be determined by the family, the patients, and the interdisciplinary team as to the best, next safest place for him to go.

05:09 Now, lifestyle management of modifiable risk factors is where you really come in and helping Mr. Johnson recognize the benefit to him.

05:17 Don't just go in and tell him what he should and shouldn't do.

05:21 Nobody likes to be bossed around.

05:23 So we're going to help him connect what he thinks is most important to changing small behaviors about his life to take the next step.

05:30 Then we'll move to the next step because our goal is to improve the quality of his life for Mr. Johnson and minimize his risk of developing complications or another stroke.

05:43 Thank you for walking with us through the entire case study of Mr. Johnson, from home to discharge.