Okay. So, let's wrap this part up.
Remember, the goals in
are to minimize possible complications
from the stroke.
We want to facilitate the optimum
functioning and sensory perception
for every patient after a stroke.
So we're going to be looking at communication,
emotional control, affect,
because we know that all of these can be
negatively impacted after a stroke.
And you're going to continue to collaborate,
which is my very favorite part
with the whole team.
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.
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.
Patients who have a stroke often
have cardiovascular disease.
So you're going to want to watch the
cardiovascular system closely also.
You're going to monitor their
and make sure it stays within the healthcare
provider's ordered parameters.
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.
So we're in the medical
We know that patients are at risk for
developing respiratory complications.
The ones I'm going to be sharp to be
on the lookout for are aspiration,
atelectasis, and pulmonary edema.
So I'm going to be monitoring that
fluid volume status very closely.
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.
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.
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.
That's going to help us open up those
lungs and avoid the risk of atelectasis.
Constipation is the most likely bowel
problem after a stroke.
Now, remember that patients after a stroke
need to stay appropriately hydrated.
We're also going to use stool softeners
and help them be as mobile as possible.
Now, hydration is important for
the cardiovascular system
to keep their blood pressure up.
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.
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.
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.
Now, we might need to do bowel retraining
to have to help the patient return to a
normal bowel elimination pattern.
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.
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.
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.
Stroke patients are at a higher
risk for skin breakdown,
or the other name, pressure ulcers.
Either way, it's the same concept.
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.
After a stroke,
patients are likely to experience some
type of motor function impairment,
and they're definitely at an
increased risk for falls.
So be on the lookout for safety.
Their specific deformities or
contractures may develop
on the weak or paralyzed side,
so reflexes might initially
and then they'll progress to hyperreflexia.
So, keep an eye out for that
and know that it's normal.
Muscle control can initially be flaccid,
and then it might progress to that
spasticity that we just talked about.
The experience of an acute
stroke has physical,
emotional, and functional impact on
your patients and their families.
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.
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.
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.
Now, lifestyle management
of modifiable risk factors
is where you really come in
and helping Mr. Johnson recognize
the benefit to him.
Don't just go in and tell him what
he should and shouldn't do.
Nobody likes to be bossed around.
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.
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.
Thank you for walking with us through
the entire case study of Mr. Johnson,
from home to discharge.