Slide 1 Acute Changes and Stroke Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long Term Care

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Acute Changes and Acute Changes and Stroke Stroke

Central South Regional Stroke Central South Regional Stroke ProgramProgram

September 2007September 2007

Funded by the Ministry of Health and Funded by the Ministry of Health and Long Term CareLong Term Care

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Session OverviewSession Overview

The types of stroke. The types of stroke. The common changes that result from The common changes that result from

stroke.stroke.The five warning signs of stroke.The five warning signs of stroke.The changes you might see with your The changes you might see with your

residents.residents.What do you do when you see that a resident What do you do when you see that a resident

is possibly showing a sign of stroke.is possibly showing a sign of stroke.

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What is a StrokeWhat is a Stroke

An An interruption of the supply of blood and interruption of the supply of blood and oxygen to an area of the brain.oxygen to an area of the brain.

This causes the brain cells in an area to die, This causes the brain cells in an area to die, and reduces the brain function in that area.and reduces the brain function in that area.

The area of the body controlled by the The area of the body controlled by the damaged area is unable to function properly.damaged area is unable to function properly.

There are two types of stroke.There are two types of stroke.

http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#efhttp://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

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What is a Stroke?What is a Stroke?

A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

A stroke can A stroke can happen when a happen when a blood clotblood clot blocks blocks a blood vessel in a blood vessel in the brain.the brain.

80% of strokes are 80% of strokes are this type.this type.

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What is a Stroke?What is a Stroke?

A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996

A stroke can also A stroke can also happen when a happen when a blood vessel blood vessel breaksbreaks and this and this results in results in bleedingbleeding in the brain.in the brain.

20% of strokes are 20% of strokes are this type.this type.

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Risk factors you can do Risk factors you can do something about…something about…

High blood pressureHigh blood pressureHigh blood High blood

cholesterolcholesterolHeart diseaseHeart diseaseDiabetesDiabetes

Being overweightBeing overweightExcessive alcohol Excessive alcohol

useusePhysical inactivityPhysical inactivitySmokingSmokingStressStress

Pearson et.al., (2002) AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. Circulation, 106, 388-391.

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What does a What does a resident who has resident who has had a stroke look had a stroke look

like in LTC?like in LTC?

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What are some of the losses What are some of the losses due to stroke?due to stroke?

paralysis or weakness on one side of paralysis or weakness on one side of the body; the body;

vision problems (double vision); vision problems (double vision); trouble speaking or understanding trouble speaking or understanding

language; language;


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inability to recognize or use familiar inability to recognize or use familiar objects;objects;

tiredness; tiredness; depression; depression;


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exaggerated or inappropriate emotional exaggerated or inappropriate emotional responses; responses;

difficulty learning and remembering new difficulty learning and remembering new information; and information; and

changes in personality. changes in personality.


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Stroke StatisticsStroke Statistics

There are between 40,000 and 50,000 There are between 40,000 and 50,000 strokes survivors in Canada each year.strokes survivors in Canada each year.

10% (4-5,000) of strokes survivors each year 10% (4-5,000) of strokes survivors each year require long-term care. require long-term care.

40% (16-20,000) of strokes survivors each 40% (16-20,000) of strokes survivors each year are left with a moderate to severe year are left with a moderate to severe changes in their function.changes in their function.

http://ww2.heartandstroke.ca/Page.asp?http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=1078&Src=news&From=SubCategoryPageID=33&ArticleID=1078&Src=news&From=SubCategory

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Canadian Best Practice Canadian Best Practice Recommendations for Stroke Recommendations for Stroke

CareCare

All persons (members of the public) All persons (members of the public) should be able to recognize and should be able to recognize and identify at least two signs and identify at least two signs and

symptoms of stroke and know to symptoms of stroke and know to take appropriate action (seek take appropriate action (seek

medical attention).medical attention).Canadian Best Practice Recommendations For Stroke Care (2006), 2.

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Warning Signs of StrokeWarning Signs of Stroke

ActionAction: Call 9-1-1 or your local emergency number : Call 9-1-1 or your local emergency number immediatelyimmediately

Heart and Stroke Foundation Canada, 2006

Warning SignsWarning Signs DescriptionDescription

WeaknessWeakness SuddenSudden loss of strength or sudden numbness in the face, arm or leg, even if temporary.

Trouble speaking SuddenSudden difficulty speaking or understanding or sudden confusion, even if temporary.

Vision problems SuddenSudden trouble with vision, even if temporary.

Headache SuddenSudden severe and unusual headache.

Dizziness SuddenSudden loss of balance, especially with any of the above signs

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A TIA is an important A TIA is an important warning sign!warning sign!

Sometimes the symptoms of stroke come and go lasting minutes or hours.

This is called a TIA and is an important warning sign that a stroke is likely to happen.

If you see the warning signs of stroke what should you do???

STROKE IS A MEDICAL EMERGENCY!STROKE IS A MEDICAL EMERGENCY!

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STROKE IS STROKE IS A MEDICAL A MEDICAL EMERGENCEMERGENC

YYWhat would you do if there was What would you do if there was

a medical emergency in your a medical emergency in your home?home?

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Why respond quickly?Why respond quickly?

Resident may be able to receive special Resident may be able to receive special medical treatment to medical treatment to stroke related stroke related problems.problems.

Resident will be assessed and treated for Resident will be assessed and treated for stroke risk factors to stroke risk factors to the risk of another the risk of another strokestroke

Resident will be assessed to see if they Resident will be assessed to see if they would benefit from rehabilitation to would benefit from rehabilitation to the the changes from the stroke.changes from the stroke.

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Changes in CommunicationChanges in Communication

Difficulty expressing Difficulty expressing themselvesthemselves

Difficulty understanding Difficulty understanding informationinformation

Changes in ability to read or Changes in ability to read or writewrite

Adapted from Elements of a Comprehensive Assessment for a Stroke, American Medical Directors Association, CPGNews.org

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Changes in EatingChanges in Eating

Delayed or difficult feeding Delayed or difficult feeding Chewing or swallowing Chewing or swallowing

problemsproblems ChokingChoking Pocketing of food in the Pocketing of food in the

cheekcheek


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Changes in Functional AbilityChanges in Functional Ability

Oral or Facial Oral or Facial Hygiene Hygiene

GroomingGroomingDressing Upper Dressing Upper

and Lower Bodyand Lower Body


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Loss of independence Loss of independence toileting toileting

Difficulty bathingDifficulty bathingHeavier transfersHeavier transfers


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Changes in: Changes in: Walking (falls)Walking (falls)The ability to use The ability to use

the wheelchairthe wheelchairStair climbingStair climbing


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What do you do ???What do you do ???

AlertAlert your your registered health registered health care professional care professional

so they can so they can assessassess the the resident.resident.

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CASE STUDYCASE STUDY

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Next Steps…Next Steps…

You are the eyes and ears of your facilityYou are the eyes and ears of your facilityBe aware of the diagnosis of your residentsBe aware of the diagnosis of your residentsTake this information and use it with the Take this information and use it with the

residents.residents.Share this information with other staff.Share this information with other staff.

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More InformationMore Information

Acute Changes and StrokeAcute Changes and Stroke Continence and StrokeContinence and Stroke Dementia and StrokeDementia and Stroke Falls and StrokeFalls and Stroke Pain and StrokePain and Stroke

Please contact: Please contact:

Rebecca Fleck or Kim Young Rebecca Fleck or Kim Young Community and Long Term Care Specialist Community and Long Term Care Specialist Central South Regional Stroke ProgramCentral South Regional Stroke Program905-521-2100 x 44127905-521-2100 x 44127

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AcknowledgementsAcknowledgements Best Practices Long-Term Care Advisory GroupBest Practices Long-Term Care Advisory Group Best Practices Long-Term Care Evaluation GroupBest Practices Long-Term Care Evaluation Group Frank Rubini, Heart and Stroke Foundation of OntarioFrank Rubini, Heart and Stroke Foundation of Ontario Mary-Lou van der Horst, Regional Best Practice Coordinator Long-Term Mary-Lou van der Horst, Regional Best Practice Coordinator Long-Term

Care, Central South RegionCare, Central South Region Wendy MacDougal, Regional Best Practice Coordinator Long-Term Care, Wendy MacDougal, Regional Best Practice Coordinator Long-Term Care,

Central West RegionCentral West Region Rosemary Crisp, Director, St. Joseph’s Health Care, GuelphRosemary Crisp, Director, St. Joseph’s Health Care, Guelph Marilyn Irwin, St. Joseph’s Health Care, GuelphMarilyn Irwin, St. Joseph’s Health Care, Guelph Lindsay Ogilvie, Librarian, St. Joseph’s Health Care, GuelphLindsay Ogilvie, Librarian, St. Joseph’s Health Care, Guelph Central South Regional Stroke ProgramCentral South Regional Stroke Program Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro-Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro-

ambulatory Centreambulatory Centre Melanie Fall Stratton, Regional Stroke Program, Program Manager,Melanie Fall Stratton, Regional Stroke Program, Program Manager, Kim Young, Regional Stroke Program, Community and Long-term Care Kim Young, Regional Stroke Program, Community and Long-term Care

SpecialistSpecialist Lisa Colizza, Regional Stroke Program, Regional Stroke Development Lisa Colizza, Regional Stroke Program, Regional Stroke Development

SpecialistSpecialist Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation

CoordinatorCoordinator Carol Pereira, Regional Stroke Program, LTC Project CoordinatorCarol Pereira, Regional Stroke Program, LTC Project Coordinator

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Documents

Slide 1 Acute Changes and Stroke Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long Term Care