In the case of John his environment was contributing to his continence problems. This is also the case for many stroke patients in a hospital environment therefore as health professionals we need to consider the issues identified in this case study.
Main messages are:
optimise environment
signpost toilet facilities
ensure patients are able to access facilities
assess functional ability
provide appropriate equipment to support bladder and bowel rehabilitation and recovery of continence
raise staff awareness on impact on environmental/functional factors on patient’s continence
Before completing this module on hyperacute treatment including thrombolysis and thrombectomy we suggest you listen to John’s experience of having a stroke, and receiving thrombolysis.
John’s experience of having a stroke
Clip duration: 1 min 59 seconds
The consultants description of his assessment and treatment, and John’s recollection of this
Physiological monitoring is the measurement of parameters allowing for early detection of any abnormalities and potential deleterious changes so that complications can be prevented or minimized for the patient.
You will have learned:
The important physiological parameters that you can monitor
Alternative methods of monitoring each parameter
Including the common pitfalls which need to be avoided
Acceptable ranges of values for each parameter and the most important common causes of deviation from normal values
Possible effects on patient outcomes of uncorrected abnormal parameters
Appropriate responses and actions you should make to abnormal readings
The benefits that your prompt interventions have on patient outcomes
To adapt your monitoring of different physiological parameters as the patient’s condition changes
You have now covered the following physiological parameters during this module:
Although Mrs McGinty presented with a minor stroke her co-morbidities and the fact that she had been lying on the floor at home for an indeterminate period lead to a complex combination of clinical features.
The timely identification and appropriate management of the complications that she developed means that she is now making good progress towards discharge home. It is likely that Mrs McGinty’s recovery from her stroke will be compromised by her co-morbidities (COPD and previous stroke) and this will need to be addressed within her discharge plan.
The ward staff have been working with Mrs McGinty to ensure that her right arm is kept elevated and well supported. She has been shown how to do some simple passive exercises for her hand and wrist, and her daughter has brought in some emollient and massages Mrs McGinty’s hand when she comes to visit.
The same principles apply to oedema in the lower limb which may need to be elevated periodically so as to prevent the collection of fluid in the extremity. Unexplained limb swelling is investigated.
Early identification and intervention is recommended to prevent deteriorating function and development of more severe problems such as shoulder hand syndrome.
Visual inspection – obvious swelling of the affected hand/wrist/forearm in comparison with the other arm
Circumferential measurement – using a tape measure
Volumetric assessment using a volumeter (recommended mainly for research purpose)
Treatment/management
There is limited scientific evidence for the management of post stroke hand oedema and interventions should be selected based on the individual needs of the patient. Suggested interventions include:
Removing jewellery such as rings and watches which may become too tight and restrict blood flow
Positioning – arm elevated and in an extended position
Support – lap tray/pillow/table placed to side of patient with pillow for support
Education of patient, family, carers and other healthcare staff on the management of symptoms and effective positioning programme
Active movement where possible and maintaining passive range of movement
Light retrograde massage – may reduce swelling for increased range of movement and functional use
Compression garments – may control and reduce swelling
Intermittent pneumatic compression has been shown to be ineffective in reducing upper limb oedema
This module aims to provide you with a working knowledge of human cognition and perception, understand the impact of their impairment after stroke, and be aware of some techniques which you can apply to help your patients and clients.
The answers to all the test questions are contained within the module. This information may be provided in the ‘Additional Information’ boxes on some of the pages.
Mrs McGinty’s daughter is on the ward visiting her mother. You take the opportunity to discuss Mrs McGinty’s hand swelling with her and explain why this may have happened.
It is important to remember that swelling can cause pain and hypersensitivity of limb which can limit use Mrs McGinty’s ability to self manage.
Although Mrs McGinty presented with a minor stroke her co-morbidities and the fact that she had been lying on the floor at home for an indeterminate period lead to a complex combination of clinical features.
