A DAY IN THE LIFE OF A STROKE PATIENT

NURSING PERSPECTIVE

Noorin Darvesh BScN, RN, CNN (C)Clinical Nurse Educator, Unit 58South Health Campus Department of Clinical Neurosciences

Source: (2017). https://www.clinicasabedotti.com.br/posts/82

DISCLOSURES

None

HALIFAX INFIRMARY

Who am I?

FOOTHILLS MEDICAL CENTRE SOUTH HEALTH CAMPUS

Source: Halifax Infirmary (2018) Nova Scotia Health Authority. Photograph Foothills Medical Centre & South Health Campus (2018) Alberta Health Services

Objectives

Provide insight into what we see as inpatient stroke nurses and how we respond

Describe what we consider successes and failures as stroke nurses

Discuss how we can grow within this specialty area

Source: Corliss, J. (2016). Harvard Health Blog. Retrieved from URL: https://www.health.harvard.edu/blog/big-arm-arm-difference-blood-pressure-linked-higher-heart-attack-risk-201403057064

NATIONAL INSTITUTE OF HEALTH STROKE SCALE (NIHSS)

Source: Stroke (2005 – 2018). Healthline Media. Retrieved from URL: https://www.healthline.com/health/stroke/massive-stroke

TORONTO BEDSIDE SWALLOWING SCREEN TEST (TORBSST)

Source: (2013). Medline Plus. Retrieved from URL: https://medlineplus.gov/magazine/issues/spring13/articles/spring13pg6-7.html

TIA

ECHO

Edema

MRI

CT Scan

Homonymous Hemianopsia

Goals of Care

Modifiable Risk Factors

Source: (2014). Retrieved from URL: https://www.mirror.co.uk/news/uk-news/dementia-patients-deprived-legal-rights-3026326

“You both need your rest”

Source: Retrieved from URL:https://www.arrajol.com/content/78476/%D9%85%D9%86%D9%88%D8%B9%D8%A7%D8%AA/%D8%B3%D9%8A%D8%AC%D8%A7%D8%B1%D8%A9-%D9%88%D9%83%D9%88%D8%A8-%D9%86%D8%A8%D9%8A%D8%B0-%D9%85%D8%B3%D8%AA%D8%B4%D9%81%D9%89-%D9%8A%D9%88%D8%A7%D9%81%D9%82-%D8%B9%D9%84%D9%89-%D8%AA%D9%84%D8%A8%D9%8A%D8%A9-%D9%87%D8%B0%D9%87-%D8%A7%D9%84%D8%A3%D9%85%D9%86%D9%8A%D8%A9-%D8%A7%D9%84%D8%A3%D8%AE%D9%8A%D8%B1%D8%A9 %D9%84%D9%85%D8%B1%D9%8A%D8%B6

Source: (2016). Retrieved from URL:https://aseancruising.com/15-minutes-mariner-seas-cruise-director-dan-whitney/

THE 5 W’S

Who

What

When

Where

Why

Source: Retrieved from URL: https://electricliterature.com/a-nice-place-for-george-to-live-class-imperialism-and-the-man-in-the-yellow-hat-b748b099d140

• Who gives the tPa in emerg?

• What happens if you give tPa after 4.5 hours?

• When do I want their blood pressure high? How long do I want it high for? When do I start panicking and when do I start paging?

• Where do they actually go for a clot retrieval?

• Why doesn’t every patient who received tPa go for endovascular therapy?

• How long do we expect the cerebral edema to last for? When will that subside?

“Why do you need to know that as a nurse?”

Patient’s Wife: “Why is my husband going for a repeat CT and an ECHO when they already did a bunch of tests. What are they looking for?”

Me: “Hmm I think it’s to get a clearer picture of the heart and the brain” .

Wife: “Well why do they need to test the heart when something is wrong with his head?”

Me: “I’m not sure actually . They must just want to make sure all systems are working okay”.

Wife: “Well, how long are the tests? I didn’t really sleep well last night and I want to grab a coffee but I want to be back in time for when my husband gets back”.

Me: “Oh, the tests shouldn’t be too, too long, maybe an hour”.

Wife: “Well, I’m just worried that he’s going to need me. He has trouble getting his words out and just gets so frustrated. Is that something that normally gets better? Do you think he can understand me?”

Me: “Hmm… you’re going to have to speak to the neurologist on that one”.

Source: Retrieved from URL: https://i.pinimg.com/originals/06/b6/02/06b6022c53d22b516f6bc2bac2e41803.jpg

#1: Helped my ability to have well-informed and meaningful conversations with patients and families

#2: Has helped my ability to provide better and safer stroke care to our patients.

Source: Retrieved from URL: https://www.canstockphoto.ca/stroke-wordcloud-1877806.html

NURSES

Source: (2016). American Traveler. Retrieved from URL: https://www.americantraveler.com/travel-nursing-blog/how-survive-night-shift-nursing

Source: (2017). Medscape. Retrieved from URL:https://www.medscape.com/answers/1916662-53885/what-is-the-role-of-hemorrhagic-transformation-in-the-etiology-of-stroke

PHYSIOTHERAPISTS

Source: Retrieved from URL: https://www.pinterest.ca/pin/326511041712203110/?lp=true

Source: Retrieved from URL: https://medium.com/@robertwall/marathon-runners-do-not-have-tattoos-8056ccaad4fd

OCCUPATIONAL THERAPISTS

Source: (2014). Synapse Together. Retrieved from URL: http://recoverfromstroke.blogspot.com/2014/12/hemianopsia-neuroplastic-model.html

DYSPHAGIA TEAM

Dysphagia can occur in over 50% of people with a new onset of stroke.

Source: (2018). Daily Caring. Retrieved from URL: https://dailycaring.com/why-do-seniors-have-trouble-swallowing/

PHARMACISTS

Source: (2018). Vet on the hil ltd. Retrieved from URL: https://www.vetonthehill.co.uk/repeat-medications/

SOCIAL WORKER

Source: (2018). Mitchell, J. Retrieved from URL: https://www.west-legal.ca/calgary-wills/what-is-a-personal-directive/attachment/west-legal-calgary-personal-directive/

• PD

• Agent

• Substitute Decision-Maker

NURSE PRACTITIONERS

Source: (2018). Mitchell, J. Retrieved from URL: http://www.epilepsynorcal.org/what-is-epilepsy/:

5-15% of patients will experience a seizure post-stroke

PHYSICIANS

Source: (2018). Knowing Neurons. Retrieved from URL: https://knowingneurons.com/language_cover_1/

Source: (2017). HBOT.com & Paul Harch M.D. Retrieved from URL: http://www.hbot.com/hbot-and-stroke

PATIENTS AND FAMILIES

Source: Retrieved from URL:https://www.england.nhs.uk/what-matters-to-you/

MORAL DISTRESS IN NURSING

Source: (2016). Hinz, C. Retrieved from URL:https://dailynurse.com/making-moral-dilemma/

CRUISE DIRECTOR OF THE SHIP

Source: (2018). Bioscape Digital. Retrieved from URL: http://www.bioscapedigital.com/?p=649

CASE

On November 29th, 2013, Mr. King was feeling dizzy while he was walking up the stairs inhis home. His wife was running errands during the day, so he called his neighbor. Hisneighbor then called 911, and Mr. King was brought to the emergency department byEMS within 1.5 hrs of his symptom onset.

He waited in the emergency department, where his dizziness was first attributed to thefact that he did not eat breakfast that morning.

He underwent further neurological testing, and his brain CT scan did not show blood. Hedid not receive tPa in the emergency department, and he was diagnosed with a TIA.

His signs and symptoms included homonymous hemianopsia, ataxia, and numbness onhis left side, which unfortunately did not resolve.

After further testing in the emergency department, he was diagnosed with a PosteriorCommunicating Artery stroke, and he was later transferred to an inpatient unit.

Throughout the course of his one week stay in hospital, he remained alert and fullyoriented, but he did have short-term memory deficits.

In the case of this patient, it is important to consider that although he was alert andoriented x 3, he actually couldn’t remember very much about that time period followinghis stroke.

One week after he was discharged from the hospital, he developed flu-like symptoms and a few days later was diagnosed with a hemorrhagic transformation.

Objectives

Provide insight into what we see as inpatient stroke nurses and how we respond

Describe what we consider successes and failures as stroke nurses

Discuss how we can grow within this specialty area

QUESTIONS?

Source: Retrieved from URL: https://languageexchange.com/questions-and-answers/

REFERENCES

J Conrad, M. P. (2013). Seizures after cerebrovascular events: Risk factors and clinical features. European Journal of Epilepsy, 275-282.

JM Boulanger, e. a. (2018). Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, EmergencyDepartment, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. International Journal of Stroke, 1-36.

Russell, A. C. (2012). Moral Distress in Neuroscience Nursing: An Evolutionary Concept Analysis. Journal of Neuroscience Nursing, 1-20.

S. Krieg, N. S. (2013). Functional Language Shift to the Right Hemisphere in Patients with Language-Eloquent Brain Tumors. PLoS ONE , 1-9.

Thompson, G. (2010). (APSS) Preventing Complications of Stroke. Alberta, Canada: ALBERTA PROVINCIAL STROKE STRATEGY .