Stroke Education - Causes and Effects

hello my name is Laura I am the clinical nurse specialist for the district Stroke Center here at McKenzie health this presentation is one in a series of eight being delivered by our interprofessional team this pursuit started to improve the access to patients and their families particularly family members who cannot come in during the day and we offer this weekly series once a week on Wednesday mornings and for those that could not get in the team has put together this presentation online for you so we're just going to a quick overview here we're going to look at what a stroke is what the signs and symptoms of stroke are what are the risk factors and what are the effects of stroke the other two topics we'll look at is preventing complications and the recovery so what is a stroke a stroke is interruption of blood to the brain and this can be caused by two mechanisms one it could be due to some blood clot that's lodged in an artery preventing the blood from going through and getting to the brain and those are what we call ischemic strokes the second type is when one of your blood vessels ruptures in the brain and that is what we call a hemorrhagic stroke so as a slide shows here the ischemic stroke you can see that there is a blood clot on the right hand side of the picture and that is showing where the blood can no longer get to all that bluish area and pink area is area that has been affected by lack of oxygen to the brain the clot can form in that artery or it can come from other parts of the body such as the heart so it could be that a clot has formed right in in that artery shown there or a blood clot developed elsewhere and has traveled up to the brain so what is at EIA at EIA is what a lot of people call a mini stroke and a mini stroke is simply a onset of symptoms exact same symptoms as a stroke only they usually go away within an hour two or three hours and what happens as the picture shows the top vessel there is a normal vessel there's no plaque on the walls of it and you can see that blood flow can get through all the different branches of that artery on the left hand side in the bottom picture is blocked and you can see this white foamy looking stuff that is the plaque that's developed on the wall of the artery that often fissures open so you get a little opening in the plaque and the blood products stick to it and as you can see there's no blood getting to that one branch of that artery but the body has an amazing way of when it detects that there's a problem and it's not getting enough brain and oxygen to the brain it sends substances out and those substances try to break down the clot if it's successful as it is in the picture here on the right you can see that blood has been reestablished flow is going back to the brain and therefore the symptoms go away and this happens over such a short period of time that there's no lasting symptom so a true TI a or a transient ischemic attack will leave no symptoms and it is however really important that you go see your doctor these t IAS or mini-strokes can be a warning sign of a much larger stroke later so it's important to get it looked at and find out what caused it another kind of stroke as we mentioned is a hemorrhagic stroke and that's where you get a rupture of the blood vessel and then the blood can't get past that point so you can see in the picture here where there's the normal blood vessel in the little box at the bottom and it starts to bulge and this bulging can be caused by smoking hypertension and other risk factors but you see that the vessel is suddenly getting wider and eventually with high blood pressure and continued smoking and other things like diabetes you could end up with that rupturing opened and often it's these little small vessels that come off the big one and you can see these little vessels on the right-hand side of the picture of the brain here so the signs and symptoms of stroke really important to note that their sudden onset these signs and symptoms don't happen over days they appear suddenly and that's how people will normally describe it and that's how they normally are made aware that there's a problem so they're listed here in order of most common presentations so most commonly what people will find when they have a stroke is they'll get a sudden numbness or weakness on one side of the face the arm or the leg and it's usually on one side and it can be all three to be the face arm and leg or it could be one it could be just the face just the leg or any combination of so again suddenly it just happens as the second one is sudden confusion or total speaking or understanding and often it's not that the person's confused it's just that they're not understanding what people are saying to them so if you were to ask the person if they're okay they may smile and nod at you but they really aren't understanding what you're saying to them and people will take that as confusion they may also have trouble getting the words out so what they're saying either doesn't make sense or they just can't say the words so that is the second most common presentation then you can have problems with seeing in either one eye or both eyes so it could be that one eye has no vision or a very common one with stroke is if you have both sides the same side on both eyes not working so both the left side of both eyes does not see or conversely the right side of both eyes does not see the third one sudden headache and people will describe the sudden headache as the worst headache of their life it's very painful even people who suffer from migraines will point out that it is not their usual migraine headache so it is something that is not common even if you've had a migraines or headaches in the past this will be different and the last one is sudden dizziness or just being unsteady not coordinated maybe having trouble balancing these normally are accompanied by one of the other four that that we've already mentioned by itself dizziness can be a lot of things and it's not necessary a stroke but if it's accompanied by one of the others there's a good chance it could be so if this happens you need to call 911 right away if you get these symptoms just pick up the phone and dial 911 you need to get to the hospital right away if it turns out you get here and you are better by the time you get here so your symptoms have gone away and it's just been a mini-stroke well then that's great they're still going to work you up they're still going to try to find out why it happened and they're going to start you on some treatment we want to prevent it from going to this mini stroke or transient ischemic attack to a full-blown stroke and if it is a stroke then you're in the right place and you'll get seen quickly and they we have time limited treatments you need to be here within three and a half hours of the onset of the symptoms so just pick up that phone so I'm not going to go into big depth on the risk factors there are two other presentations that also talk about some of the risk factors and how to manage them but there are some that you cannot change so you're probably wondering why are we talking about risk factors if I can't change them and the important thing to know is if you do have these risk factors then you need to be particularly careful and monitoring the other aspects of healthy living as you don't want to increase your risk by adding other risk factors on top of the ones that you can't change so just really quickly age obviously we can't change that stroke occurs at any age children can have strokes teenagers can have stroke but as you get older especially over the age of 55 your risk will double every 10 years gender males tend to have a higher risk particularly women are lower risk premenopause but women tend to have a higher death rate from stroke than men ethnicities so that we know that there's an increased risk for people of Aboriginal African or South Asian descent and that's often because they tend to have higher blood pressure problems and diabetes and that so if we keep that in mind and keep those things in check that will help with that risk factor as well family history so a very close relative idea parent or sibling and if you've had a prior stroke or TIAA that increase your risk some other risk factors include lifestyle so high stress levels or excessive alcohol intake smoking high-fat diet sedentary lifestyle illegal drugs all those type of things will all increase your risk for having a stroke and there's some medical conditions as well that will do that and the thing to remember again with medical conditions is if you are able to keep your condition in check it will help bring your wrist back down so for example high blood pressure if you have high blood pressure but you managed to lower it through exercise losing weight taking medications then you get your blood pressure where the physician wants it then you are going to help improve your your chances of not having a stroke similarly if you have high cholesterol walking is a good thing for high cholesterol many people however do need medication that will help bring your wrist back down blood glucose levels you don't want the sugars too high high sugars damage the inner lining of the vessels and that can cause problems so again keeping your sugars controlled will help bringing your wrist down again so because you have these medical conditions does not mean that you are going to have a stroke it just means you have to be very diligent in taking care of yourself so how do they diagnose stroke well once you get to the hospital one of the first things they're going to want to know is what happened the history of the event is really he did it was it a sudden onset of weakness was it a sudden onset of speech problems what exactly happened the other thing is the physician will do and nursing will do a physical exam so they're going to be testing your arms looking at your eyes asking you a lot of questions and these are all just to determine possibly where the stroke may be located once that's done you'll go to the cat scanner and the cat scans just used to take pictures of your brain and it will help to tell if there's some early changes in your brain saying oh there's a stroke here it will also tell you if there's a clot sitting there they'll be able to see the plot and it'll also let them know if it's a hemorrhagic stroke the MRI is very seldom used in acute stroke in the hyper acute so we in the emergency department is very seldom they would do an MRI the CT scan does tell whether it's a bleed or whether it's a clot and that's what the big interest is at that particular time so some of the tests that they will do once you're admitted to find out why did the stroke occur really important to know why it happened so that we can prevent another one from happening so one of the first things they'll do when you come into emergency is they put get an ECG a cardiogram that tells them what's happening with the Electrical part of your heart it will tell them if you are having an abnormal rhythm and there's a lot of people probably 15 to 25% of people running around with atrial fibrillation which causes the upper chambers of the heart to fibrillate they're not actually contracting and squeezing that blood through another test they'll do is an echocardiogram so that cardiogram itself was telling us about the electrical system that echocardiogram is going to tell us more about the motor part of it so is that heart beating are all the walls of the heart moving if people have had a heart attack in the past it's very possible that one wall of that heart is not going to move as well as it should and then blood can stick and clot there so it looks at the motor the cardiogram looks at that electrical they'll also do a 24-hour or 48-hour halter monitor if they don't detect electrical problems in the ECG many people have what we call proximally fit and what that means is that sometimes your hearts beating normal sometimes it goes into the irregular rhythm so the cardiogram is showing them what's happening right now and the halter monitor will show them continuous readings for 24 hours or 48 hours so it will pick up those intermittent abnormal heart rhythms the carotid dopplers r is an ultrasound of the neck they're looking at your arteries your carotid arteries the bigger artery that gets the blood up to the brain and what it will show is if you have plaque and narrowing of those arteries that's important because that can be treated as well and finally there'll be a lot of blood tests just to see if perhaps you have some clotting disorder that maybe you didn't know about or that your physician didn't know about or any other blood disorders so the the brain function then the picture here shows the left in the right hemisphere the left hemisphere controls the right side of your brain of your body so we have the left hemisphere controlling our arm our face our leg all on the right side most people are what we call left-side dominant and that simply means that your speech centers are located on the left side of your brain so in the picture here chose under left hemisphere it says your right hand your spoken language so your ability to be able to put words to your what you want to say is in that hemisphere as well your ability to do number calculations and remember groups of numbers like phone numbers on the scientific functionings and your written language they all go with that side of the brain and your ability to reason things out the right hemisphere on the right side of the picture shows a left hand that's because the right hemisphere of your brain is controlling the right the left side of your body left hand face and arm so again if you have problems in the right hemisphere chances are you're going to have some weakness on the left side of the body as well it's your artistic side so it tapes music pictures puts everything together for you and it's also your area for insight and creativity so in the event that you do have a problem on the right side sometimes people lose insight and they may not even know that they have some weakness on the left side so we just need to to keep that in mind because that can be a safety issue if the person thinks they're fine and tries to stand up but has some left leg paralysis then they could very well end up on the floor so what are some of the effects other effects of stroke physically we've already talked about you can have weakness paralysis again usually on one side affecting arm Legg face you could have difficulty with balance or coordination and all those can also add to difficulty with swallowing and I know our SLP has also talked today about swallowing difficulties some of the effects on our sensory system is we may lose the ability to detect light touch so we don't feel it if somebody's touching us or conversely if we're touching something that maybe we should not we may not sense that there's a temperature change so if you lose the ability to sense temperature you could easily get burnt getting into a bathtub that's got too hot of water in it we spoke earlier about changes in vision and that can cause people to bump into things if they have problems with not seeing out of the left side they may very well be bumping into walls doorways as they're going through and obviously we can have as we mentioned earlier changes in communication some of the cognitive effects of stroke then people with stroke often will have problems with attention so they cannot focus for a long period of time on one thing and they can become easily distracted to the point that if you're trying to show someone something new you pretty much have to eliminate all distractions around them so you don't want them to be trying to eat while the TV's going in someone's talking and phones are ringing because they're going to just be constantly and looking around and they're not going to be able to focus to help them you want as I said just get rid of any distractions and you want to make sure that any instructions are given are really simple initially and you want to focus on only one thing at a time another one is disorientation so they they may not know where they are they may not know what month it is they may not know people most commonly its place that goes first so most commonly a person would not really know where they are this can be really a problem for patients coming from other hospitals that are here by ambulance and bypass their own hospital as well but we just we just tell them so how do we get people in the hospital to be more oriented really important when we're talking to them we go oh good morning it's Monday you know how was your weekend or you know today is Saturday or today is Wednesday but it also to just make sure there's a calendar in the room in in the hospital we usually have whiteboards at the end of the patient's beds or above the patients beds and we'll put the the date on it and people's names another problem is people can suffer memory loss so they may lose their short-term memory short-term memory is if you just met someone and they tell you their name you could lose your recent memory which would be thinking back and saying oh what did I have for breakfast that's a recent memory and then of course long-term things from when you were years ago and again they can lose any one of those the problem with the short-term memory loss is that they're unable to easily learn new things because in order to learn something it needs to go into your short-term memory then your recent memory before you can file it in the long term another problem that people sometimes run into is lack of insight now as I mentioned earlier they may not be safe because they may not realize that they have a paralysis or they may not they just think that I need this now and they jump up to do it they don't put the brakes on the wheelchair so there's a lot of different it just requires making sure that we keep an eye open and keep the patients safe another one would be a lack of judgment and again that kind of goes along with that as well as along with the insight problem and again not thinking out that this might not be a good idea sometimes particularly patients had to have some problems with the right side of their brain they will be impulsive so again I'm going to do this now and they're not waiting and they're not thinking that it might be to get help and then problems with sequencing and we can help them with that as well sequencing is when perhaps they forget that you put your underwear on first not after you put your jeans on so we make sure we lay things out appropriate in the appropriate order and help them relearn to sequence some of the perceptual problems that that patients will encounter when they've had a stroke is the ability to to interpret the information around them that's coming from either eye so if they have a visual problem they could they may have problems with seeing hearing if it's affected their hearing again we talked about touch and taste and smell but some of the things that vision and hearing and touch and taste what all those do they work together to allow you to judge things in your environment so if we have trouble with our vision we may not notice that the steps are six inches not four so we may fall on the stairs another thing you'll notice quite often is people with touch they're they're pushing when they're trying to get people up they'll push the wrong direction because they think the falling but they're not their body needs to in the brain needs to reset itself in terms of sitting straight up sometimes people will develop a neglect what we call a neglect so again more pronounced if you've had a stroke in your right hemisphere for it to appear on the left side and people that have this left side neglect typically don't recognize that side of them they don't see things on the left and some patients it's severe that you can hold their hand in front of them and say what is this and the patient will look at you and say it's a hand and you say but whose hand is it and they'll say well it must be yours and they don't recognize that's a part of their body so again working with the team with our occupational therapists and our physiotherapist they'll gradually get people and families can help with this you can rub the person's arm gently just to get them used to the touch on it you can put it where they can see it and some people if they can see it then then they know it's there so there's a few different disorders that you can have as a result of the stroke that can affect everyday functioning some other effects affect it more on a psychosocial level so it's not uncommon for patients to go through a grieving process and typically families will will go through that as well so patients are often and families are often and they're working on people work on different tum times it's not that everybody is going to go through it the exact same way it is that exact same time period it's all different for everybody so there's often initially anger then you get the grieving people are sad sometimes people get changes in their personality and again with these angry outbursts and they may just withdraw their ages are withdrawn and depressed they may lack interest in activities they may have a lack of patience and sometimes because of the damage done to the brain they lack motivation and it's not that they're not willing to do things they are but if you say do you want to they'll say no so the whole idea around that is rather than do you want to go to therapy you'll say why don't we go for a walk so the patient will go for the walk but if you say you want to go to therapy no they won't go so other things they may feel is guilt particularly if they've had a lot of risk factors and they haven't addressed their risk factors patients then feel guilty that oh dear I didn't lose weight I didn't do this I didn't do that so these are just some of the effect that we see psychosocial effects that we see so here at the hospital one of the things that we're trying to do is to prevent you from getting complications so as a team which includes you and your family we work together trying to ensure that that the complications don't occur one of the big ones that one of them is a urinary problem so patients can get urinary tract infections these can come through two different mechanisms one is incontinence and so they have the inability to control their bladder and about 40 to 60 patients with a stroke will forty to sixty percent of patients with stroke will have this condition after a year about eighty five percent have regained control so they're back to ability to use the washroom when they need to go the other one is urinary retention so these patients are unable to release the bladder and let the urine out and both of these conditions can cause urinary tract infections so it's really important that we carefully monitor patients that have incontinence and or retention and there are obviously things we can do about it in terms of trying to prevent the infections one of the things we need to do is ensure that you're getting adequate fluids if you don't get enough fluids that can increase your risk and you want to avoid the total number of days that a catheter is in place sometimes people get catheters when they're first admitted and it's really important to get those out as soon as we can and to establish regular toileting routine the bowels incontinence can be a problem with bowels as well and again that's something that's usually by the time most patients go home that has already been the bowels have been retrained constipation can be a problem and that can be for my number of reasons one people aren't probably as active as they were they may not be getting enough fluids they're laying around in bed sometimes more than normal than they would at home and they may require medications just to keep them regular okay so deep vein thrombosis deep vein thrombosis is simply a blood clot that develops either in an arm or a leg in the vein and that can happen from just being on bed rest with patients who've had a stroke it's particularly a high-risk for patients who have what we call flaccid paralysis so they cannot move their arm or their leg at all and those are veins aren't getting the blood back to the heart is easily and the blood tends to clot it can affect up to 50% of patients and for the most part if they disappear without any difficulty most patients will come in if they've had a stroke due to a clot they will be put on heparin injections while they're not moving around a lot the patients who've had bleeds in the head they may have those white tight stockings on to help get the blood back to the heart so the prevention again we need to make sure you're getting adequate fluids so they'll be making sure you're drinking making sure that we get you up and even if it's just sitting on the side of the bed into the chair and then ambulating and all that will help move that blood back towards the heart dysphasia is another problem that we see in patients who have had strokes and again obviously different patients are going to have different combinations of these complications I'm not going to go into a whole lot about aspiration pneumonia because I know that are as helped you did speak to this earlier but dysphasia is simply the ability the difficulty swallowing and it will affect up to 50% of patients who come in some will be so severe that they will need tubes in their nose to help feed them for the first little while until they work on getting their swallowing back half of the patients do recover their ability to swallow within the first weeks of having a stroke the big problem with dysphasia or trouble swallowing is that you can get a pneumonia if patients on choke on water or food it goes down the wrong way it's not just the the fluid for example water going into your lungs it's the bacteria from the mouth that's being carried down into the lungs so how are we going to prevent that first of all nobody should be giving any patient anything to eat or drink until they've been screened for swallowing either by an SLP or by a trained nurse and if the patient is deemed okay to swallow then they can they can eat and drink whatever diet the SLP and dietitians put out for them if they cannot swallow certain foods they'll be put on modified diets and really important that visitors make sure that if they're bringing anything in that it does meet that criteria because we really don't want patients getting into trouble with pneumonia we never give a patient with a stroke straw and never give them anything to eat or drink unless they're sitting up laying back is a good way to to choke and ensure that the diet that they're eating has been recommended by the SLP some other problems that people may have is Falls forty percent of people fall within the first year of stroke and it's it's usually because of either weakness a visual problem they didn't see the step they fell and could be they've lost their balance so Falls and again knowing that people can be a little bit more cautious pain is a problem that some patients will have some of them patients come and they've already had arthritis at home and of course that's not going to go away when they get here so that will continue and we will be making sure that we're giving them medications to help improve their comfort level as well they may run into problems with their joints particularly if patients have a paralyzed arm have to be really careful that we don't harm the shoulder by letting that arm fall down so to avoid damage we have to make sure that we're protecting that arm every time we move or transfer the patient and spasticity so the a lot of patients that have had like a flaccid paralysis so they're not moving their arm at all it's just you know flaccid will often develop as they start getting back some tone it'll get really tight and we want to make sure that they don't develop contractures so really important to make sure they're positioned correctly and again working with the physios and the nurses they will help provide the best positioning for the patient and help family to recognize which way to put the patient and finally patients may complain of headaches and normally it's not a severe headache unless it's associated with a hemorrhagic stroke but headaches can be a nuisance and so we need to make sure we're looking for them and treating them as well poster depression can be a real issue it affects up to 40 or 50 percent of all patients who come in with a stroke and patients with depression tend not to do as well because they aren't interested in getting up they're not interested in participating in therapy so one of the things that we need to be sure to watch for is identifying patients we will be screening patients to see if they're having problems with depression and treating it if necessary it's just important to know that you know stroke affects a lot of people in terms of their emotions and their self-image it affects the relationship sometimes with other people and so many people are afraid they have anxiety and anger frustration so those are normal feelings but if you have prolonged feelings of just being totally down and not wanting to eat and not want not sleeping and not wanting to do normal Act Vivat ease then we need to be making sure that you're assessed by the physician to see if in fact you are having depression because that can be treated and only a doctor can really determine that and we need to be sure that you're going to be able to participate and if you're depressed you will not be able to so hopefully we can get everybody catch everybody who may be having some depression so the road to recovery then on the road to recovery it's important to know that there are no two patients who will be exactly the same you could have similar strokes you can have similar effects but no two patients will be the same each stroke is individual and recovery is going to be very individual as well it's most rapid in the first month but it can continue for years so each patient will progress at a different rate and a lot of it will depend on you know your own where your stroke was how large it was and all those types of things your recovery has only just begun here at the hospital we get you on the road to recovery but it's an ongoing process after you leave here and you may be getting out patients through CCAC or through outpatient programs in the region recoveries influenced as I said by the type of injury was at an ischemic stroke caused by a clot was it a hemorrhagic stroke caused viably was it a small stroke or a big stroke where in the brain did it affect what are some of the other chronic illnesses that may do you have high blood sugars hypertension other illnesses that may make things a little bit more difficult it also affects how we look at things on the individuals outlook their support system do they have family and friends that are helping support them and their emotional state as well the ability to participate so if someone is unable to participate because they're too sick or they're two-tire they're not awake enough then that will also influence how quickly they recover motivation and as I mentioned before motivation can be affected by strokes so we have to look at ways that we can motivate patients who've had that area of the brain affected and then one of the big big ones is support from family and friends patients who have support through family and friends do tend to do better and that's what they show in the research so our integrated stroke unit then we have a team of interprofessional zazz I mentioned earlier that includes physiotherapists we have occupational therapists speech language Social Work dietitian rec therapist nursing it's a huge team physiatrist medical doctors and our whole team is there to help you and your family progress and get back out to the community the benefit of having all this these people in stroke unit is you have a team that works mostly exclusively with stroke and therefore has a great deal of expertise the stroke unit goals are to minimize complications of stroke to start secondary prevention so that you don't have another stroke follow best practice recommendations to get early rehab and get you moving and to provide a team-based rehab that's tailored to each individual patient's own needs there's not one plan for everyone each plan will be a little different for each patient and it will depend on what they're trying goals they're trying to reach so the key messages then are that no two patients are the same you can have similar strokes but it'll be a whole different journey for each patient the team on the stroke unit are committed to helping you with your recovery and together the team you and your family we can prevent complications of stroke so just like to acknowledge the the dedication and commitment of the stroke team over on the integrated stroke unit and always available to help if people have questions thank you you

Channel: Mackenzie Health

Views: 101,926

Rating: 4.8032231 out of 5

Keywords: of Stroke, York Region, caregivers, care, Physiotherapy, therapy, stroke rehabilitation, Signs and Symptoms, Mackenzie Health, Effects of Stroke, District Stroke Centre, Stroke, Stroke Education, Occupational Therapy, physical therapy, stroke therapy, Recovery, Rehabilitation, stroke recovery, Preventing Complications, recreation therapy, Risk Factors, what is a stroke?, Stroke Videos

Id: DrPXM-LFATA

Length: 40min 18sec (2418 seconds)

Published: Fri Mar 01 2013