The document outlines objectives and an agenda for a session on acute inpatient stroke care, which includes presentations and activities to enhance learning about best nursing practices across the acute stroke continuum. The focus is on collaborating with colleagues to identify optimal ways of applying assessment tools and clinical recommendations in different care settings. Participants are encouraged to actively engage in discussions and exercises to facilitate knowledge sharing.
Have you ever tried to sleep in a brightly lit room with tubes and wires attached to you and people periodically talking to you ! moving you ! and touching you !
This document discusses various topics related to end of life care, including palliative care, hospice care, end of life in the ICU, common symptoms at end of life, and their management. It addresses pain management, including assessment of pain and the WHO pain ladder. It also discusses management of other common symptoms like nausea/vomiting, dyspnea, fatigue, anorexia/cachexia, depression, delirium, and euthanasia. Important court cases related to passive euthanasia in India and other countries are also summarized.
Falls are a major issue and collecting information about falls in the IIMS system allows for targeted prevention strategies. It is important to identify patient risk factors for falls through screening and put appropriate prevention measures in place, such as mobility aids, supplements for osteoporosis, and reviewing medications that could increase fall risk. Staff should communicate fall risks and prevention plans to ensure consistent care that keeps patients safe from falls.
Nurses play a pivotal role in all phases of stroke care, from the emergency phase to acute care. In the emergency phase, nurses focus on rapid assessment, treatment, and minimizing time to thrombolytic therapy. In acute care, nurses monitor for bleeding complications, manage blood pressure and fever, and provide mobility exercises to prevent complications. Throughout stroke care, nurses work to improve patient outcomes by preventing issues like contractures, deep vein thrombosis, and caregiver burden.
Ischaemic Stroke in the Very Elderly PatientsAde Wijaya
Stroke is common in the very elderly population and presents unique challenges. Risk factors like atrial fibrillation and hypertension are more prevalent. Outcomes are generally poorer with higher mortality rates over 80 and 90 years of age. While intravenous thrombolysis can improve outcomes in those 81-90, it does not for those over 90. Endovascular therapy can allow over a quarter of those over 80 to regain independence, though outcomes are inferior to younger patients. Guidelines support oral anticoagulation for atrial fibrillation in the very elderly, and direct oral anticoagulants are recommended over warfarin with a better safety profile. Treatment is otherwise similar but requires more careful assessment.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
The document provides information on patient and family education. It defines patient teaching as preparing patients and families to care for themselves during hospitalization and after discharge. The purposes of education are to identify learning needs, facilitate understanding of health status and care options, and promote healthy lifestyles. Education occurs through interactions with providers and is coordinated. Barriers and readiness to learn are assessed. Education should be ongoing, interactive, and include family members.
Early warning scores (EWS) are used to detect deterioration in patients' condition by categorizing illness severity and prompting medical review at trigger points. EWS systems measure six physiological parameters and assign points for deviations from normal values. The total score determines the monitoring frequency and level of care required, with higher scores indicating greater risk. EWS can help prioritize patient care, streamline communication, and reduce human error by facilitating timely response directly at the point of care. However, EWS only work effectively when staff are properly trained and response systems are in place to deliver the necessary escalated clinical care.
Have you ever tried to sleep in a brightly lit room with tubes and wires attached to you and people periodically talking to you ! moving you ! and touching you !
This document discusses various topics related to end of life care, including palliative care, hospice care, end of life in the ICU, common symptoms at end of life, and their management. It addresses pain management, including assessment of pain and the WHO pain ladder. It also discusses management of other common symptoms like nausea/vomiting, dyspnea, fatigue, anorexia/cachexia, depression, delirium, and euthanasia. Important court cases related to passive euthanasia in India and other countries are also summarized.
Falls are a major issue and collecting information about falls in the IIMS system allows for targeted prevention strategies. It is important to identify patient risk factors for falls through screening and put appropriate prevention measures in place, such as mobility aids, supplements for osteoporosis, and reviewing medications that could increase fall risk. Staff should communicate fall risks and prevention plans to ensure consistent care that keeps patients safe from falls.
Nurses play a pivotal role in all phases of stroke care, from the emergency phase to acute care. In the emergency phase, nurses focus on rapid assessment, treatment, and minimizing time to thrombolytic therapy. In acute care, nurses monitor for bleeding complications, manage blood pressure and fever, and provide mobility exercises to prevent complications. Throughout stroke care, nurses work to improve patient outcomes by preventing issues like contractures, deep vein thrombosis, and caregiver burden.
Ischaemic Stroke in the Very Elderly PatientsAde Wijaya
Stroke is common in the very elderly population and presents unique challenges. Risk factors like atrial fibrillation and hypertension are more prevalent. Outcomes are generally poorer with higher mortality rates over 80 and 90 years of age. While intravenous thrombolysis can improve outcomes in those 81-90, it does not for those over 90. Endovascular therapy can allow over a quarter of those over 80 to regain independence, though outcomes are inferior to younger patients. Guidelines support oral anticoagulation for atrial fibrillation in the very elderly, and direct oral anticoagulants are recommended over warfarin with a better safety profile. Treatment is otherwise similar but requires more careful assessment.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
The document provides information on patient and family education. It defines patient teaching as preparing patients and families to care for themselves during hospitalization and after discharge. The purposes of education are to identify learning needs, facilitate understanding of health status and care options, and promote healthy lifestyles. Education occurs through interactions with providers and is coordinated. Barriers and readiness to learn are assessed. Education should be ongoing, interactive, and include family members.
Early warning scores (EWS) are used to detect deterioration in patients' condition by categorizing illness severity and prompting medical review at trigger points. EWS systems measure six physiological parameters and assign points for deviations from normal values. The total score determines the monitoring frequency and level of care required, with higher scores indicating greater risk. EWS can help prioritize patient care, streamline communication, and reduce human error by facilitating timely response directly at the point of care. However, EWS only work effectively when staff are properly trained and response systems are in place to deliver the necessary escalated clinical care.
Palliative care aims to improve quality of life for patients with life-limiting illnesses through early identification and treatment of pain and other symptoms. Palliative care takes a holistic approach addressing physical, psychosocial and spiritual needs. Dyspnea, or breathlessness, is a common and distressing symptom experienced by over 50% of hospice patients. A thorough history and assessment of dyspnea is important to identify potential causes and guide treatment options. Both non-pharmacological and pharmacological interventions can provide relief, including opioids, benzodiazepines, oxygen, bronchodilators, and corticosteroids. Active management of dyspnea is important during the last hours of life to minimize suffering.
Emergency treatment of stroke involves several steps:
1. Rapid diagnosis through imaging such as CT or MRI to determine if the stroke is ischemic or hemorrhagic.
2. For ischemic strokes within 3 hours, treatment with rTPA (recombinant tissue plasminogen activator) can dissolve clots and reduce long-term disability if eligibility criteria are met.
3. Intensive monitoring is required after rTPA to control blood pressure and watch for bleeding complications.
4. Surgery may be considered for large hemorrhagic strokes or subarachnoid hemorrhage from aneurysms to relieve pressure on the brain.
CPCR Basic Life Support by Midland HealthcareAbhishek Singh
1. James Elam -first to experimentally demonstrate CPR
2. Dr. Peter Safar- brought to light effective procedures putting them together into what he called “the ABCs”
3. Claude Beck- Internal defibrillator
4. Paul Zoll- AC External defibrillator
5. Bernard Lown- DC external defibrillator
6. Foundation of successful ACLS is good BLS
For Help Visit: https://midlandhealthcare.org/
The document discusses end-of-life care and palliative care. It defines acute care as short-term medical treatment, usually in a hospital, while palliative care aims to relieve suffering for those without curative treatments. The document also outlines a dying person's bill of rights, including their right to die with dignity and participate in decisions. It discusses principles of palliative care, including addressing physical, psychological and spiritual needs, and providing comfort to the terminally ill through symptom control and a peaceful environment.
The document discusses various aspects of critical care nursing. It begins by defining a critical care unit as a facility equipped to provide life support treatment to critically ill patients. It describes the role of critical care nurses in monitoring patients on life support equipment. Key aspects of patient care discussed include feeding/fluids, analgesia, sedation, thromboembolism prophylaxis, head elevation, ulcer prophylaxis, glycemic control, spontaneous breathing trials, bowel care, indwelling catheter removal, and drug de-escalation. The document emphasizes the importance of these aspects of care and outlines the roles and responsibilities of nurses in ensuring patients receive appropriate treatment and monitoring.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
Early warning scores (EWS) are used to facilitate early detection of patient deterioration. The EWS system assigns points to physiological parameters like respiration, oxygen saturation, blood pressure, and temperature to determine a total score. This score dictates the frequency of monitoring and urgency of clinical review. Higher scores indicate more frequent monitoring and quicker medical review are needed. The system aims to standardize recognition of worsening conditions and ensure prompt treatment. Case studies are presented to demonstrate how EWS would be applied in clinical practice.
Pre hospital care of acutely injured patient by mohd taofiq et al.taofiq yinka
This document summarizes a presentation on pre-hospital management of acutely injured patients. It provides historical background on the development of emergency medical services. It also discusses epidemiology of trauma, the organization of trauma systems, concepts of pre-hospital care, the Nigerian experience, and recommendations. A study in Nigeria found that pre-hospital care was inadequate, with few patients receiving care and many experiencing delays in transport. It recommends establishing trauma centers and developing national pre-hospital care guidelines to improve trauma outcomes in Nigeria.
Nursing Case Study of a Patient with Severe Traumatic Brain Injuryrubielis
This details the critical care nurse's role in caring for a patient with severe traumatic brain injury, managing ICP and brain oxygenation. Ties in closely with Orem's self-care deficit theory for nursing.
1. The document discusses pre-hospital and emergency department management of acute stroke. It emphasizes the importance of rapid detection, transport, and treatment to maximize outcomes for stroke patients.
2. Treatment guidelines recommend administering intravenous tissue plasminogen activator (tPA) for ischemic stroke within 3 hours of symptom onset to reduce disability and mortality.
3. In the emergency department, the focus is on quick assessment, diagnosis of hemorrhagic vs ischemic stroke using CT scan, and treatment or referral for definitive care such as thrombolysis within the treatment window.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
1) PCI (percutaneous coronary intervention) is a minimally invasive procedure used as an alternative to coronary artery bypass surgery to treat blockages in the coronary arteries.
2) It involves inserting a catheter into the femoral or radial artery and guiding it to the blocked coronary artery where a balloon is inflated to open the artery. Stents are often placed to help keep the artery open.
3) Potential complications during and after the procedure include arrhythmias, vascular reactions, bleeding, and damage to the coronary artery. Post-procedure care involves monitoring the puncture site, keeping the patient flat, and removing the arterial sheath over time.
Daily awakening trials and discontinuation of sedation in mechanically ventilated intensive care unit patients may help reduce the length of their ICU stay. Assessing a patient's readiness to wake up and breathe on their own is an important part of the weaning process from mechanical ventilation support in the ICU. Shortening the duration of mechanical ventilation can benefit patients by decreasing the risks of complications and allowing for earlier mobilization.
This document discusses brain death and the criteria used to diagnose it. It begins by describing different states of consciousness including coma, persistent vegetative state, and locked-in syndrome. It then defines brain death as the total and irreversible loss of brain and brain stem functions. The key criteria for determining brain death are the absence of cortical function, absence of brainstem reflexes, and apnea during a specific oxygen challenge. Confirmatory tests like angiography, EEG, Doppler ultrasound, and scintigraphy can also be used when clinical criteria cannot be reliably assessed.
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
Nearly 20% of seniors suffer from some form of mental illness, with the most common being dementia, schizophrenia, and Alzheimer's. The rate of suicide among seniors is the highest of all age groups at twice the national average for those over 85. Common mental disorders seen in seniors include dementia, often mistaken as just a part of aging but is actually a form of mental illness; Alzheimer's, a form of dementia that causes progressive memory loss and cognitive decline; anxiety disorders characterized by high anxiety, panic attacks, and phobias; and schizophrenia, affecting thoughts and behavior through delusions and hallucinations. As a caregiver, providing humor, reassurance, distraction, understanding, and ensuring medication compliance and doctor visits can help
This document discusses critical care nursing. It outlines the roles and responsibilities of critical care nurses, which include closely monitoring patients, administering medications and treatments as directed by doctors, documenting important medical information, and collaborating with the healthcare team. Critical care nurses play a vital role in caring for critically ill patients by performing tasks like taking blood tests, suctioning fluids, and ensuring medical equipment functions properly. The document also describes the criteria for admitting patients to intensive care units and classifies critical care patients based on the level of observation and intervention they require.
Stroke is a medical condition where blood supply to part of the brain is decreased, causing loss of brain function. It is a leading cause of death and disability. There are two main types - ischemic (caused by clots) and hemorrhagic (caused by bleeding). Risk factors include hypertension, heart disease, smoking, diabetes and obesity. Prevention involves controlling risk factors through lifestyle changes and medications. Anyone experiencing symptoms like weakness or numbness on one side of the body should seek immediate medical attention.
Palliative care aims to improve quality of life for patients with life-limiting illnesses through early identification and treatment of pain and other symptoms. Palliative care takes a holistic approach addressing physical, psychosocial and spiritual needs. Dyspnea, or breathlessness, is a common and distressing symptom experienced by over 50% of hospice patients. A thorough history and assessment of dyspnea is important to identify potential causes and guide treatment options. Both non-pharmacological and pharmacological interventions can provide relief, including opioids, benzodiazepines, oxygen, bronchodilators, and corticosteroids. Active management of dyspnea is important during the last hours of life to minimize suffering.
Emergency treatment of stroke involves several steps:
1. Rapid diagnosis through imaging such as CT or MRI to determine if the stroke is ischemic or hemorrhagic.
2. For ischemic strokes within 3 hours, treatment with rTPA (recombinant tissue plasminogen activator) can dissolve clots and reduce long-term disability if eligibility criteria are met.
3. Intensive monitoring is required after rTPA to control blood pressure and watch for bleeding complications.
4. Surgery may be considered for large hemorrhagic strokes or subarachnoid hemorrhage from aneurysms to relieve pressure on the brain.
CPCR Basic Life Support by Midland HealthcareAbhishek Singh
1. James Elam -first to experimentally demonstrate CPR
2. Dr. Peter Safar- brought to light effective procedures putting them together into what he called “the ABCs”
3. Claude Beck- Internal defibrillator
4. Paul Zoll- AC External defibrillator
5. Bernard Lown- DC external defibrillator
6. Foundation of successful ACLS is good BLS
For Help Visit: https://midlandhealthcare.org/
The document discusses end-of-life care and palliative care. It defines acute care as short-term medical treatment, usually in a hospital, while palliative care aims to relieve suffering for those without curative treatments. The document also outlines a dying person's bill of rights, including their right to die with dignity and participate in decisions. It discusses principles of palliative care, including addressing physical, psychological and spiritual needs, and providing comfort to the terminally ill through symptom control and a peaceful environment.
The document discusses various aspects of critical care nursing. It begins by defining a critical care unit as a facility equipped to provide life support treatment to critically ill patients. It describes the role of critical care nurses in monitoring patients on life support equipment. Key aspects of patient care discussed include feeding/fluids, analgesia, sedation, thromboembolism prophylaxis, head elevation, ulcer prophylaxis, glycemic control, spontaneous breathing trials, bowel care, indwelling catheter removal, and drug de-escalation. The document emphasizes the importance of these aspects of care and outlines the roles and responsibilities of nurses in ensuring patients receive appropriate treatment and monitoring.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
Early warning scores (EWS) are used to facilitate early detection of patient deterioration. The EWS system assigns points to physiological parameters like respiration, oxygen saturation, blood pressure, and temperature to determine a total score. This score dictates the frequency of monitoring and urgency of clinical review. Higher scores indicate more frequent monitoring and quicker medical review are needed. The system aims to standardize recognition of worsening conditions and ensure prompt treatment. Case studies are presented to demonstrate how EWS would be applied in clinical practice.
Pre hospital care of acutely injured patient by mohd taofiq et al.taofiq yinka
This document summarizes a presentation on pre-hospital management of acutely injured patients. It provides historical background on the development of emergency medical services. It also discusses epidemiology of trauma, the organization of trauma systems, concepts of pre-hospital care, the Nigerian experience, and recommendations. A study in Nigeria found that pre-hospital care was inadequate, with few patients receiving care and many experiencing delays in transport. It recommends establishing trauma centers and developing national pre-hospital care guidelines to improve trauma outcomes in Nigeria.
Nursing Case Study of a Patient with Severe Traumatic Brain Injuryrubielis
This details the critical care nurse's role in caring for a patient with severe traumatic brain injury, managing ICP and brain oxygenation. Ties in closely with Orem's self-care deficit theory for nursing.
1. The document discusses pre-hospital and emergency department management of acute stroke. It emphasizes the importance of rapid detection, transport, and treatment to maximize outcomes for stroke patients.
2. Treatment guidelines recommend administering intravenous tissue plasminogen activator (tPA) for ischemic stroke within 3 hours of symptom onset to reduce disability and mortality.
3. In the emergency department, the focus is on quick assessment, diagnosis of hemorrhagic vs ischemic stroke using CT scan, and treatment or referral for definitive care such as thrombolysis within the treatment window.
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
1) PCI (percutaneous coronary intervention) is a minimally invasive procedure used as an alternative to coronary artery bypass surgery to treat blockages in the coronary arteries.
2) It involves inserting a catheter into the femoral or radial artery and guiding it to the blocked coronary artery where a balloon is inflated to open the artery. Stents are often placed to help keep the artery open.
3) Potential complications during and after the procedure include arrhythmias, vascular reactions, bleeding, and damage to the coronary artery. Post-procedure care involves monitoring the puncture site, keeping the patient flat, and removing the arterial sheath over time.
Daily awakening trials and discontinuation of sedation in mechanically ventilated intensive care unit patients may help reduce the length of their ICU stay. Assessing a patient's readiness to wake up and breathe on their own is an important part of the weaning process from mechanical ventilation support in the ICU. Shortening the duration of mechanical ventilation can benefit patients by decreasing the risks of complications and allowing for earlier mobilization.
This document discusses brain death and the criteria used to diagnose it. It begins by describing different states of consciousness including coma, persistent vegetative state, and locked-in syndrome. It then defines brain death as the total and irreversible loss of brain and brain stem functions. The key criteria for determining brain death are the absence of cortical function, absence of brainstem reflexes, and apnea during a specific oxygen challenge. Confirmatory tests like angiography, EEG, Doppler ultrasound, and scintigraphy can also be used when clinical criteria cannot be reliably assessed.
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
Nearly 20% of seniors suffer from some form of mental illness, with the most common being dementia, schizophrenia, and Alzheimer's. The rate of suicide among seniors is the highest of all age groups at twice the national average for those over 85. Common mental disorders seen in seniors include dementia, often mistaken as just a part of aging but is actually a form of mental illness; Alzheimer's, a form of dementia that causes progressive memory loss and cognitive decline; anxiety disorders characterized by high anxiety, panic attacks, and phobias; and schizophrenia, affecting thoughts and behavior through delusions and hallucinations. As a caregiver, providing humor, reassurance, distraction, understanding, and ensuring medication compliance and doctor visits can help
This document discusses critical care nursing. It outlines the roles and responsibilities of critical care nurses, which include closely monitoring patients, administering medications and treatments as directed by doctors, documenting important medical information, and collaborating with the healthcare team. Critical care nurses play a vital role in caring for critically ill patients by performing tasks like taking blood tests, suctioning fluids, and ensuring medical equipment functions properly. The document also describes the criteria for admitting patients to intensive care units and classifies critical care patients based on the level of observation and intervention they require.
Stroke is a medical condition where blood supply to part of the brain is decreased, causing loss of brain function. It is a leading cause of death and disability. There are two main types - ischemic (caused by clots) and hemorrhagic (caused by bleeding). Risk factors include hypertension, heart disease, smoking, diabetes and obesity. Prevention involves controlling risk factors through lifestyle changes and medications. Anyone experiencing symptoms like weakness or numbness on one side of the body should seek immediate medical attention.
The document discusses stroke, including risk factors, signs and symptoms, and the importance of rapid treatment. It outlines the "Stroke Chain of Survival and Recovery" which includes early detection, emergency dispatch, pre-hospital transport and management, emergency department triage, evaluation and specific therapies, and fibrinolytic drug therapy. Rapid recognition of stroke, emergency medical response, and treatment are critical to limiting neurological damage and improving patient outcomes.
This document provides an overview of strokes, including:
- Strokes are caused by a blockage or rupture of an artery to the brain, cutting off oxygen flow.
- Symptoms include weakness, paralysis, difficulty speaking or swallowing.
- Diagnosis involves medical imaging, blood tests, and physical exams to determine the type and location of blockage or rupture.
- Treatment depends on the type of stroke but may include clot-busting drugs, surgery, medication, and lifestyle changes to prevent future strokes.
Agm10 screening for depression in stroke (v4medium)Alex J Mitchell
This is a talk from a symposium on screening for depression in neurological disease. Topic is what screener works best in stroke given the communication and cognitive difficulties that may be present.
This document summarizes evidence from 27 trials involving over 10,000 participants on the safety and efficacy of clot-dissolving drugs (thrombolytics) such as alteplase for treating acute ischemic stroke. The trials compared thrombolytics administered intravenously or intra-arterially within 4.5 hours of stroke onset to placebo or no treatment. Thrombolytics were found to improve outcomes after stroke but also increase the risk of serious bleeding in the brain. While thrombolytics can restore blood flow and reduce brain damage if given promptly, the risks and benefits were shown to depend on the time since stroke onset.
Acute management of Stroke By Dr Sanjay jaiswal Neurologist sept2012Sanjay Jaiswal
The document discusses early management of ischemic stroke. It defines stroke as a sudden neurological deficit of vascular origin lasting more than 24 hours. It emphasizes that "time is brain" and every minute of untreated stroke causes the loss of 1.9 million neurons. It outlines risk factors, signs and symptoms of different types of stroke, and the definition of transient ischemic attack. Current acute treatments for ischemic stroke including thrombolysis within 3-4.5 hours and aspirin within 48 hours are discussed.
This document provides information on cerebrovascular accidents (strokes). It defines a stroke as occurring when blood supply to the brain is interrupted, usually due to a blood clot or burst blood vessel. Strokes can be ischemic, caused by a clot cutting off blood flow, or hemorrhagic, caused by a ruptured blood vessel. Warning signs include sudden weakness, numbness, trouble speaking, and loss of vision. Acting FAST (Facial drooping, Arm weakness, Speech difficulties, Time to call for help) can help identify a stroke and get immediate medical attention, as rapid treatment improves outcomes. Risk factors include age, race, family history, high blood pressure, diabetes, smoking and more.
This document provides information about cerebrovascular accidents (strokes), including:
1. Strokes occur when blood supply to the brain is disrupted, causing brain cells to die from lack of oxygen and nutrients.
2. There are two main types of strokes - ischemic (lack of blood flow) and hemorrhagic (bleeding in the brain).
3. Signs and symptoms of strokes vary depending on the area of the brain affected but may include weakness, confusion, vision problems, and headaches.
This document discusses the challenges in nursing care for patients experiencing a cerebrovascular accident (CVA) or stroke. It begins by defining a CVA as a sudden loss of brain function caused by disrupted blood flow to the brain. The document then covers the types, risk factors, clinical manifestations, investigations, and management of strokes. It emphasizes the nursing priorities of initial treatment to prevent further deterioration, ongoing risk assessment, and interventions to address impaired mobility, vital signs, nutrition, and more. The overall goal of nursing management is to control symptoms, prevent complications, and optimize recovery through a coordinated, multidisciplinary approach.
The document discusses rehabilitation and stroke rehabilitation. It describes rehabilitation as a process of recovery through adaptation to regain maximal function after disabling conditions. The Isolda Stroke Rehabilitation Unit is described, which opened in 2006 with 6 beds and was extended to 10 beds, catering to all adults over 18. Treatment is based on a multidisciplinary team with weekly meetings to develop unified goals and plans. The expected length of stay is 90 days.
ISHCA - Implementing and Supporting Holistic Continence Awareness anne spencer
The document introduces a nursing showcase on implementing and supporting holistic continence awareness. It notes that incontinence affects 45-70% of residents in extended care settings and can have a devastating impact if not properly supported. It also notes that the population of people over 65 is increasing, and nurses are the largest group of healthcare workers. The content of the showcase will include an introduction using a story, anatomy and physiology, types of incontinence, continence assessment, management of incontinence, and selecting incontinence wear. The showcase will launch in February 2014.
Bindumol Thomas Overview of Specialist Gerontology Clinical Nurse Specialistanne spencer
Bindumol Thomas is the Clinical Nurse Specialist for older persons at St. Mary's Hospital and Phoenix Park Community Nursing Units. She provides comprehensive nursing assessments for older adults attending St. Mary's Day Hospital, with a specialist focus on patients with diabetes or incontinence. Her role also includes coordinating services, providing education to staff, patients, and families, and conducting audits and research to improve specialist care for older adults.
Angela Ukaga - Delivering Person Centred Careanne spencer
This document outlines a study that aimed to describe how nurses and healthcare assistants deliver person-centered care to older dependent adults. The researcher conducted qualitative interviews with nurses and assistants to understand their perspectives on person-centered care. Key themes that emerged included the importance of getting to know residents on a personal level, having a collaborative healthcare team, and providing a home-like and supportive environmental setting. The findings highlight how person-centered care can be effectively implemented and encourage integrating these practices.
Josna Celi Jose Urinary Incontinence in Elderly Nursing Home Residentsanne spencer
This document summarizes an analysis of urinary incontinence among elderly nursing home residents. It examines the prevalence of incontinence, staff knowledge levels, common adverse events, and current management practices. The study found an 82.6% prevalence of incontinence, with staff knowledge scores varying from 4-15 out of 15. Common adverse events included redness, rashes, pressure ulcers, falls, and UTIs. Current practices around documentation, assessment, treatment, and multi-disciplinary support are analyzed. The study concludes that staff education, improved documentation, patient education, and enhanced multi-disciplinary involvement are needed to better manage incontinence.
Clare Aspell Services and Developments St Mary's Day Hospitalanne spencer
This document summarizes services and developments at St. Mary's Day Hospital. It provides statistics on patient referrals and attendees from 2008-2013. It describes the multidisciplinary team and diagnostic resources available. Referrals come from GPs, hospitals, and community services. Patients receive a comprehensive geriatric assessment and screening. A medical assessment is conducted and a care plan is developed involving various therapies and specialists. The goal is to provide a "one stop shop" and strengthen links between hospital and community supports. Future plans include expanding falls, syncope, and dementia services.
Shalini John Dementia - Transformation of Bebhin Unitanne spencer
The document discusses the transformation of the Bebhin Unit to provide person-centered care for patients with dementia. Key changes include staff training on dementia care, environmental modifications to make the unit feel more like home, and implementation of personalized activities and amenities. The goals are to reduce stress and improve quality of life for patients through a relaxed, stimulating environment and individualized approach. International statistics illustrate the growing impact of dementia worldwide and in Ireland.
MR Imaging Helps Predict Time from Symptom Onset in Patients with Acute Strok...Agung Nugroho
MR imaging can help predict the time from symptom onset in patients with acute stroke, which has implications for those with an unknown onset time who may be eligible for thrombolysis. The study evaluated 130 patients with known stroke onset who underwent MR imaging within 12 hours. It analyzed the predictive value of FLAIR and diffusion-weighted (DW) imaging parameters and apparent diffusion coefficient measurements as surrogate markers of stroke duration. Results could help identify patients within the time window for thrombolysis when onset is unknown by determining if imaging findings are consistent with an acute stroke.
This document provides guidelines from the European Resuscitation Council (ERC) for adult advanced life support. It addresses the prevention and treatment of both in-hospital and out-of-hospital cardiac arrests. The guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The key changes in these 2020 guidelines include a greater focus on preventing cardiac arrests by recognizing premonitory signs, emphasizing high-quality chest compressions and early defibrillation, and expanding the role of point-of-care ultrasound and extracorporeal cardiopulmonary resuscitation. The guidelines provide concise recommendations for cardiac arrest prevention, treatment algorithms, airway management, drug
1) The document summarizes the main changes to resuscitation guidelines published in 2015 by the European Resuscitation Council compared to 2010.
2) Key changes include an increased emphasis on the importance of early bystander CPR, use of public access defibrillators, and minimizing interruptions to chest compressions.
3) The guidelines also provide new recommendations for special circumstances like cardiac arrest during surgery or from electrolyte abnormalities.
The document discusses principles of first aid and emergency care for trauma patients, including assessing and managing the ABCs (airway, breathing, circulation). It covers common emergencies like asphyxia, wounds, shock, and their signs, causes, and first aid treatments. The Heimlich maneuver and other airway management techniques like endotracheal intubation are described for establishing an open airway in emergency situations.
This document provides guidelines for resuscitation of adult cardiac arrest victims. It summarizes changes from 2010 guidelines, emphasizing the importance of coordination between emergency dispatchers, bystander CPR, and automated external defibrillators (AEDs) to improve survival. Key changes include endorsing chest compressions-only CPR; maintaining a compression depth of 5-6 cm and rate of 100-120 per minute; and encouraging public access AED programs in locations where cardiac arrests are frequently witnessed. The guidelines apply basic life support techniques like CPR and use of AEDs to increase chances of survival when sudden cardiac arrest occurs.
This document discusses strokes, including statistics on strokes in the US, risk factors, types of strokes, signs and symptoms, diagnosis, treatment, and dental management of patients who have had a stroke. Over 700,000 strokes occur in the US each year, making it a leading cause of disability. There are two main types of strokes - ischemic (caused by clots) and hemorrhagic (caused by bleeding). Common risk factors include hypertension, smoking, diabetes, atrial fibrillation, and high cholesterol. Signs of a stroke include sudden numbness, confusion, vision problems, or trouble walking. Prompt treatment is crucial. Dental treatment for stroke patients aims to control risk factors and minimize stress.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment decisions.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries, from minor illnesses to trauma, for patients of all ages.
1. Emergency nursing is a specialty that cares for patients during the critical phase of illness or injury when the cause is unknown. Emergency nurses treat a wide range of issues from minor to life-threatening for all ages.
2. The primary goals in emergency nursing are to assess patients, establish airways, control bleeding, and determine ability to follow commands in order to guide initial treatment and monitoring.
3. Emergency nurses must be prepared to assess and treat many different medical conditions and injuries ranging from minor illnesses to trauma emergencies in patients of all ages.
Knowledge & Attitudes and Practices of Interns in the Post Fall Management of...anne spencer
The study explored the knowledge, attitudes, and practices of intern doctors in managing patients in the immediate post-fall period. Interns appear confident in identifying injuries but report variable practices in preventing further falls and improving bone health. While interns believe their role in injury identification is important, some believe their role in preventing further falls is less so. Interns routinely assess history and examination but report rarely reviewing medication records or considering bone health options post-fall. The study concludes an education program for interns is needed on preventing falls and improving bone health in the post-fall period.
The document outlines several parameters for assessing quality of care in the intensive care unit (ICU). It discusses objective criteria for ICU admission including vital signs, laboratory values, imaging results, ECG findings, and physical exam findings. It also describes the roles and responsibilities of nurses in the ICU in monitoring patients, administering treatments, and advocating for patients. Key indicators of quality that are mentioned include mortality rates, complication rates, length of stay, adherence to best practices, rates of errors and infections, staff satisfaction, and patient satisfaction.
Comparison chart of key changes 2015 aha guidelines for cpr and eccElena Plaza Moreno
This document provides a summary of key changes between the 2015 and 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. Some notable changes include establishing universal elements for an integrated resuscitation system, emphasizing the role of emergency dispatchers in identifying abnormal breathing to indicate cardiac arrest, and simplifying treatment recommendations by removing vasopressin and emphasizing epinephrine alone for cardiac arrest. The target temperature management range was also expanded based on new evidence finding similar outcomes between 36°C and 33°C.
The document summarizes key changes and recommendations from the 2015 American Heart Association (AHA) Resuscitation Guidelines. Some of the major updates include: emphasizing high-quality chest compressions; allowing higher maximum compression rates of 100-120/min; delaying ventilation for initial continuous compressions; and cautioning on prognostication after resuscitation given new therapies. The guidelines are based on an extensive evidence review process involving hundreds of international participants. While manual CPR remains standard, mechanical devices may be considered in specific settings. Areas for further research are identified around physiologic monitoring during CPR and post-resuscitation care.
Guidelines of diagnosis, prevension and treatment of Infective endocarditisMohamed Abass
The guidelines provide recommendations for the diagnosis, prevention, and treatment of infective endocarditis (IE). They propose limiting antibiotic prophylaxis to high-risk patients undergoing high-risk dental procedures. Non-specific prevention measures like oral hygiene should be applied to all patients. For diagnosis, echocardiography and blood cultures are indicated. A multidisciplinary endocarditis team approach is recommended for managing complicated IE cases. Treatment involves prolonged antibiotic therapy and early consideration of surgery for high-risk patients.
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will outline the care provided to trauma patients from point of injury through completion of care. The trauma team includes surgeons, nurses, and liaisons from emergency medicine, orthopedics, neurosurgery, anesthesia, and radiology, with the shared goal of improving trauma patient care in a consistent and caring manner and preventing injuries in the local region. Participants are asked to review provided materials and complete an evaluation.
The internal educational program (IEP) of Vanderbilt University's Division of Trauma, Emergency Surgery and Surgical Critical Care aims to provide educational opportunities on topics related to trauma care from pre-hospital care to post-discharge requirements. The IEP will explore various areas of interest throughout the year and outline the full continuum of care provided to trauma patients. The IEP involves the trauma team, which consists of physicians, nurses, and other specialists from various departments. The overall goal is to continuously improve trauma patient care and reduce injuries in the local region.
The document discusses stroke management and treatment. It states that ideally patients are admitted to a dedicated stroke unit staffed by nurses and therapists experienced in stroke care, where patients have a higher chance of survival than elsewhere in the hospital. Stroke treatment is highly variable depending on factors like the location and severity of the blockage or bleeding in the brain. Treatment aims to prevent further damage, reduce risk factors, and help the patient regain independence through rehabilitation.
This document is a hospital training report submitted by Harish Sharma, a student completing their B.Pharm degree. The report provides an overview of Harish's training at District Hospital in Chandauli, including acknowledging the individuals who supported their training. It then describes the various departments observed, such as the dispensary, surgical ward, pathology laboratory, and blood bank. The report also covers topics like routes of drug administration, first aid, and waste management. The objective was to study the hospital structure and functions of different departments to gain experience as a healthcare professional.
Importance of taking medical history prior to implant placement/ dental crown...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Acute care involves providing emergency and short-term medical services for acute issues rather than long-term or chronic conditions. About 8.6% of physical therapist assistants work in acute care hospital settings, where the median annual salary is $49,000. Common diagnoses seen in acute care include joint replacements of the knee and hip as well as cardiac disorders and stroke. Stroke rehabilitation in acute care begins after stabilization and focuses initially on promoting independent movement before progressing to activities like standing, walking, and transfers.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
Similar to Nursing care across the acute stroke (20)
An outbreak of chikungunya virus has spread like an epidemic in the capital city this year, with doctors seeing many young patients suffering from acute joint pain wheelchair bound. While only a few labs can test for the virus, it is estimated that 80% of patients presenting with viral fever and joint pain symptoms at some hospitals have tested positive for chikungunya. The outbreak has been attributed to increased mosquito breeding due to heavy monsoon rains. Treatment involves painkillers, though paracetamol often provides little relief from the debilitating joint pain associated with the illness.
Your plastic water bottle could be as dirty as your toiletNursing Hi Nursing
Researchers tested four types of reusable water bottles and found that bottles that were used for a week without washing had more bacteria than a toilet seat. Specifically, the slide-top bottle had more bacteria than an average toilet seat, pet bowl, or kitchen sink. Over 60% of the bacteria found on the bottles could make people sick. The cleanest bottle type tested was the straw-top bottle, and researchers also found that stainless steel bottles were healthier options than plastic bottles.
This document provides information and strategies for sun safety at resorts. It discusses establishing a sun safety program called "Go Sun Smart" that would provide education materials to guests and training to employees. The program is based on over a decade of sun safety research focusing on outdoor workers and recreationists. The document then covers the skin cancer problem, the effects of UV radiation, assessing personal risk factors, and practicing sun safety strategies like using shade, covering up with protective clothing and sunglasses, and applying sunscreen. It emphasizes the importance of monitoring UV levels and reapplying sunscreen regularly.
The document discusses various topics related to transport operations and ambulance services including emergency vehicle design, checking ambulances, ambulance equipment, driving techniques, incident response, transporting patients, and air medical transports. It provides information on setting up landing zones and transferring patients safely. National EMS education standard competencies are also listed that cover operations, transport safety, medicine, infectious diseases and more.
This document provides information and strategies for sun safety at resorts. It discusses establishing a sun safety program called "Go Sun Smart" that would provide education materials to guests and training to employees. The program is based on over a decade of sun safety research focusing on outdoor workers and recreationists. The document then covers topics like the skin cancer problem, how UV radiation affects skin, assessing personal risk factors, and practicing sun safety strategies like using shade, covering up with protective clothing, and applying sunscreen properly. It emphasizes the importance of early skin cancer detection.
Pizza shops and steakhouses that use charcoal or wood burners produce significant emissions and damage the environment in major cities like Sao Paulo, Brazil. A study found emissions from thousands of pizza shops and domestic waste burning contribute to Sao Paulo's air pollution problems despite its green vehicle policies. While vehicles use cleaner biofuels, emissions from over 800 pizza shops using wood burning stoves daily and over 1,000 pizzas produced for home delivery weekly on wood burning stoves negate some of the environmental benefits.
The document discusses the effects of marijuana use and abuse. It defines marijuana and how it is consumed. It outlines short-term effects like rapid heart rate and long-term effects on the brain, lungs and other organs. Signs of addiction and dependency are provided. Treatment typically involves detoxification and support to reintegrate into society. Myths about marijuana are debunked, such as it being safe because it is a plant. The summary emphasizes that marijuana is harmful and can isolate users from society, and that treatment requires holistic social support.
Bill Gates says that genetically modified mosquitoes may be used to fight malaria within the next five years. Researchers are using a gene editing technique called a "gene drive" to alter mosquitoes so they are resistant to diseases like malaria and dengue. Gates believes this technology could dramatically reduce malaria deaths by suppressing mosquito populations. However, some scientists have raised concerns that unintended mutations in released mosquitoes could have unknown consequences.
A study from the University of Manchester found that frequent childhood moves, especially during early adolescence, are linked to higher risks of negative outcomes in adulthood such as suicide attempts, criminal violence, mental illness, substance abuse, and premature death. The researchers collected data on all people born in Denmark from 1971 to 1997, documenting every residential move from birth to age 14, and correlated subsequent adverse events in adulthood.
An international team of scientists reviewed 19 previous studies involving 68,000 elderly people and found no link between high cholesterol levels and heart disease in those over 60 years old. The study suggests that 92% of elderly people with high cholesterol lived as long or longer than those with low cholesterol. The authors call for a reevaluation of statin prescriptions for the elderly, but their findings have been criticized by other academics who question the research methods. Some experts say that as people age, many other factors impact health, making the effects of high cholesterol less clear.
India has seen a decline in childhood stunting but now faces rising issues with diabetes and being overweight. The number of diabetics in India is projected to increase to over 100 million in the next 15 years. While India has made progress against undernutrition, public health policies now need to also address the growing problems of overnutrition and diabetes. Non-communicable diseases like heart disease also place a large economic burden on Indian families.
Scientists have developed the world's first vaccine for Toxic Shock Syndrome (TSS), a severe circulatory and organ failure caused by bacterial toxins from Staphylococcus bacteria. The vaccine was successfully tested in a Phase I trial. TSS, also known as "tampon disease", often affects young women using super absorbent tampons and was first described in the 1980s. This led to regulations on the absorbency of tampons.
Saxbee Consultants holds the number 1 position across major social media platforms when searched, including Google, Yahoo, Bing, Facebook, LinkedIn, SlideShare, Twitter, and India Mart. The document lists Saxbee Consultants as having the top result on each of these search and social media sites.
According to research studies, employee health risks are directly related to increased costs for companies, as healthy employees can contribute up to 12.5% more to a company. The document also lists various health and wellness magazines and journals the trainer has experience with, and states that the goal is to help individuals tap their highest potential through healthier lifestyle choices involving exercise and mental stimulation.
Nurses and attendants are available to provide care for a healthy recovery. This email is regarding nurse staffing and bookings can be made by contacting nursingnursing@yahoo.in. Happy Nurse Day.
Saxbee Consultants is collecting ideas from the public to present to the Prime Minister of India on January 31, 2016. The public is encouraged to submit their ideas for building a stronger India by emailing them to saxbeeconsultantspm@gmail.com. Saxbee Consultants previously faced a technical issue that prevented emails from being received but their technicians have now fixed the problem, so the public is asked to resend any ideas they had submitted.
Saxbee Consultants is collecting ideas from the public to present to the Prime Minister of India on January 31, 2016. The public is encouraged to submit their ideas for building a stronger India by emailing them to saxbeeconsultantspm@gmail.com. Saxbee Consultants previously faced a technical issue that prevented emails from being received but their technicians have now fixed the problem, so the public is requested to resend any ideas.
Saxbee Consultants is collecting ideas from the public to present to the Prime Minister of India on January 31, 2016. The public is encouraged to submit their ideas for building a stronger India by emailing them to saxbeeconsultantspm@gmail.com. Saxbee Consultants previously faced a technical issue that prevented emails from being received but their technicians have now fixed the problem, so the public is asked to resend any ideas they had submitted.
Air India has introduced yoga sessions for newly-recruited cabin crew and pilots undergoing training, as well as a two-day yoga workshop for senior management, to help staff cope with stress and bring discipline. Trainees are required to attend early morning yoga sessions, while the workshop for managers will be held later in June. The initiatives were proposed by Air India's personnel department and coincide with Prime Minister Modi's push to celebrate International Yoga Day.
The author discusses the health risks of raising children in Delhi, India due to the city's extremely high air pollution levels. He describes how his young son was hospitalized twice for respiratory issues caused by Delhi's air. Experts advise that the pollution will likely cause permanent lung damage in children and reduce their life expectancy. While some expats choose to remain in Delhi for work, the author is reconsidering staying due to the threats to his family's health from the polluted air and contaminated water.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
1. 1
Acute Inpatient Stroke Care
Best PracticeBest Practice
Nursing CareNursing Care
Across theAcross the
Acute StrokeAcute Stroke
ContinuumContinuum
N S
N C
2. Acute Inpatient Stroke CareAcute Inpatient Stroke Care
This session includes presentations andThis session includes presentations and
activities to enhance your learningactivities to enhance your learning
The focus is on working with colleagues toThe focus is on working with colleagues to
discover best ways of using the tools in yourdiscover best ways of using the tools in your
clinical settingsclinical settings
So, sit back (or stand up) and have fun!!!So, sit back (or stand up) and have fun!!!
Welcome!
07/08/14 2
3. So, what do you want to get out of this module?
07/08/14 3
Expectations?
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
4. Identify the goal of acute inpatient stroke care within the stroke
care continuum
Review the components and Best Practice Recommendations
related to acute inpatient stroke care
Identify how you can help to implement these
recommendations at your institution
Identify the benefits of early assessment and stroke
rehabilitation
Identify your role in patient and caregiver education
Create a stroke care action plan for acute inpatient stroke care
Objectives
07/08/14 4
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
5. Introduction 15 min
Stroke 101(optional) 15 min
Acute Inpatient Stroke Care BPRs 45 min
Break 15 min
Components of Acute Inpatient Care BPRs 60 min
Early Assessment & Stroke Rehab 15 min
Patient and Family Education 15 min
Putting It All Together 30 min
Agenda
07/08/14 5
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
6. Prevention of stroke
Public awareness & patient education
Prevention of stroke
Public awareness & patient education
Hyperacute stroke
management
Hyperacute stroke
management
Acute inpatient stroke careAcute inpatient stroke care
Stroke rehabilitation
& community reintegration
Stroke rehabilitation
& community reintegration
Continuum of Stroke Care
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
7. Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Synthesis of best practice recommendations
for stroke care across the continuum
Address critical topic areas
Commitment to keep current and update
every two years
First edition released in 2006
Current update released in 2008
With four new recommendations
Elaboration of existing ones
www.cmaj.ca December 2, 2008
Canadian Best Practice Recommendations for
Stroke Care
8. 07/08/14 8
Intended only
for audiences
with no previous
knowledge of
stroke.
Intended only
for audiences
with no previous
knowledge of
stroke.
Stroke 101Stroke 101
Acute Inpatient Stroke Care
10. 4.1: Stroke unit care
Patients admitted to hospital because of an acute stroke or
transient ischemic attack should be treated in an
interdisciplinary stroke unit
Core interdisciplinary team should consist of people with appropriate
levels of expertise in medicine, nursing, occupational therapy,
physiotherapy, speech– language pathology, social work and clinical
nutrition
Interdisciplinary team should assess patients within 48 hours of
admission and formulate a management plan
Clinicians should use standardized, valid assessment tools to
evaluate the patient's stroke-related impairments and functional
status
Best Practices Recommendations
OVERVIEWOVERVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
11. Acute Inpatient Stroke CareAcute Inpatient Stroke Care
07/08/14 11
TABLE DISCUSSIONTABLE DISCUSSION
1. At your tables, discuss:
What are the benefits of a dedicated stroke unit vs. a
medical floor?
What are some challenges you experience in getting
patients out of the ER?
Identify what’s happening in your institution now and
brainstorm strategies to explore
12. 1.1. Compared with alternative care,Compared with alternative care,
stroke unit care showed a reductionstroke unit care showed a reduction
in the odds of:in the odds of:
Death at final follow upDeath at final follow up
Death or institutionalized careDeath or institutionalized care
Death or dependencyDeath or dependency
Benefits of Stroke Care Unit
Data demonstrated
improved patient
outcomes when
treated in an
organized stroke
unit with
dedicated stroke
staff!
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
13. Stroke unit care can reduceStroke unit care can reduce
the likelihood of death andthe likelihood of death and
disability by as much as 30%disability by as much as 30%
Evidence suggests patientsEvidence suggests patients
treated in stroke units havetreated in stroke units have
fewer complications, earlierfewer complications, earlier
recognition of pneumonia andrecognition of pneumonia and
earlier mobilizationearlier mobilization
Why Is This Important?
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Characterized by
a coordinated
interdisciplinary
team approach
for preventing
stroke
complications
and recurrence,
and accelerating
mobilization and
early rehab.
15. Components of Acute Inpatient CareComponents of Acute Inpatient Care
Best Practice RecommendationsBest Practice Recommendations
07/08/14 15
Acute Inpatient Stroke Care
60 min
16. 1. Referring to the case study in your PW, each table will
prepare a set of Case Notes to bring to an interdisciplinary
meeting to begin establishing rehabilitation goals
2. Base your notes on Best Practice Recommendation 4.2
Components of acute inpatient care
3. Venous thromboembolism, temperature, mobilization,
continence, nutrition and oral care
4. When done, we’ll conduct our meeting with
each table getting a turn to present
Interdisciplinary Meeting
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
TABLE ACTIVITYTABLE ACTIVITY
17. Mrs. C is a 76 year old right handed woman who was
admitted to the Stroke Unit post thrombolysis. She lives with
her 80 year old husband who requires some assistance with
ADL’s due to his Parkinsons’ disease.
They live in a 2 bedroom condominium and have the support
of 2 adult children nearby.
On admission Mrs. C is found to have expressive aphasia,
right sided weakness (arm weaker than leg) and right visual
neglect.
Past medical history: hypertension, hypercholesteremia,
osteoporosis, gastroesophageal reflux
No known allergies and does not drink or smoke
Case Study
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
18. Mrs. C’s vital signs are:
BP 158/70
P-100 and irregular
R-22
Temperature: 37.4’C
Mrs. C appears anxious and frustrated, especially
when trying to communicate. She is restless and
makes attempts to get out of bed
Case Study
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
19. 4.2: Components of acute inpatient care
Risk for venous thromboembolism, temperature, mobilization,
continence, nutrition and oral care should be addressed in all
hospitalized stroke patients
Appropriate management strategies should be implemented for
areas of concern identified during screening
Discharge planning should be included as part of the initial
assessment and ongoing care of acute stroke patients
Best Practices Recommendations
REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
21. 4.2a Venous thromboembolism prophylaxis
All stroke patients should be assessed for their risk of
developing venous thromboembolism
High risk patients include patients with inability to move one or both
lower limbs and those patients unable to mobilize independently
Patients who are identified as high risk for venous
thromboembolism should be considered for prophylaxis
provided there are no contraindications
Early mobilization and adequate hydration should be encouraged
with all acute stroke patients to help prevent venous
thromboembolism
Best Practices Recommendations
REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
22. 4.2a Venous thromboembolism prophylaxis
In addition to secondary stroke prevention, antiplatelet therapy
should be used for people with ischemic stroke to prevent VTE;
The following interventions may be used with caution for
selected people with acute ischemic stroke at high risk of VTE:
Heparin in prophylactic doses (5000 units BID) or low molecular
weight heparin (with appropriate prophylactic doses per agent)
External compression stockings
Best Practices Recommendations
REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
23. Hot Off the Press!Hot Off the Press!
Lancet May 27, 2009Lancet May 27, 2009
24. 24
Clots in Legs Or sTockings after StrokeClots in Legs Or sTockings after Stroke
Trial 1:Trial 1:
Do graduated compressionDo graduated compression
stockings reduce the risk ofstockings reduce the risk of
DVT in stroke patients?DVT in stroke patients?
Trial 2:Trial 2:
Are full length graduatedAre full length graduated
compression stockingscompression stockings
more effective than belowmore effective than below
knee stockings in reducingknee stockings in reducing
the risk of DVT? (QEII )the risk of DVT? (QEII )
07/08/14
25. 25
ConclusionsConclusions
DVT occurred equally in patients with andDVT occurred equally in patients with and
without stockings.without stockings.
Alteration in skin integrity was seen more oftenAlteration in skin integrity was seen more often
in the stocking group.in the stocking group.
Data does not support use of (thigh length)Data does not support use of (thigh length)
stockings in patients admitted to hospital withstockings in patients admitted to hospital with
acute stroke.acute stroke.
Guidelines will be revised!Guidelines will be revised!
07/08/14
27. 4.2b Temperature Management
Should be monitored as part of routine vital sign assessments
(every 4 hours for first 48 hours and then as per ward routine or
based on clinical judgment)
For temperature more than 37.5°C, increase frequency of
monitoring and initiate temperature reducing measures
For temperature more than 38°C, iidentify and treat source (site and
etiology) of fever in order to start tailored antibiotic treatment and
antipyretics
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
30. 4.2c: Mobilization
Acute stroke patients should be mobilized as early
and as frequently as possible preferably within 24
hours of stroke
symptom onset, unless contraindicated
Assessment of patients’ ability in activities of daily
living should be completed and reassessed regularly
Within the first 3 days after stroke, blood pressure,
oxygen saturation and heart rate should be monitored
before each mobilization
Acute stroke patients should be assessed by
rehabilitation professionals as soon as possible after
admission preferably within the first 24 to 48 hours
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
Mobilization
is defined as
the act of
getting a
patient to
move in the
bed, sit up,
stand, and
eventually
walk.
31. 31
AVERT TrialAVERT Trial
Within the first 3 days after stroke, blood pressure, oxygen saturation,Within the first 3 days after stroke, blood pressure, oxygen saturation,
and heart rate should be monitored before each mobilizationand heart rate should be monitored before each mobilization
If during mobilization, there is a drop in blood pressure of greater thanIf during mobilization, there is a drop in blood pressure of greater than
30 mmHg this mobilization attempt should cease. If a drop of greater30 mmHg this mobilization attempt should cease. If a drop of greater
than 30 mmHg occurs on 3 consecutive attempts, further medicalthan 30 mmHg occurs on 3 consecutive attempts, further medical
assessment is required.assessment is required.
Julie Bernhardt PhD*; Helen Dewey PhD; Amanda Thrift PhD; Janice Collier PhD; and Geoffrey Donnan MD. (2008). AJulie Bernhardt PhD*; Helen Dewey PhD; Amanda Thrift PhD; Janice Collier PhD; and Geoffrey Donnan MD. (2008). A
Very Early Rehabilitation Trial for Stroke (AVERT) Phase II Safety and Feasibility. Stroke. Published online beforeVery Early Rehabilitation Trial for Stroke (AVERT) Phase II Safety and Feasibility. Stroke. Published online before
print January 3, 2008, doi: 10.1161/STROKEAHA.107.492363print January 3, 2008, doi: 10.1161/STROKEAHA.107.492363
Mobilization: Physiological Monitoring
07/08/14
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
32. 32
Deterioration in the person’s condition in the firstDeterioration in the person’s condition in the first
hour of admission that:hour of admission that:
resulting in direct admission to ICU,resulting in direct admission to ICU,
a documented clinical decision for palliativea documented clinical decision for palliative
treatment (e.g. those with devastating stroke)treatment (e.g. those with devastating stroke)
immediate surgery.immediate surgery.
Unstable coronary or other medical condition.Unstable coronary or other medical condition.
A suspected or confirmed lower limb fracture atA suspected or confirmed lower limb fracture at
the time of stroke preventing mobilizationthe time of stroke preventing mobilization
Systolic blood pressure less than 110, or greaterSystolic blood pressure less than 110, or greater
than 220mmHg.than 220mmHg.
*Contraindications to Mobilization
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
*AVERT Trial recommendations
33. 33
Oxygen saturation of less than 92% withOxygen saturation of less than 92% with
supplementation.supplementation.
Resting heart rate of less than 40 or greater thanResting heart rate of less than 40 or greater than
110 beats per minute.110 beats per minute.
Temperature of greater than 38.5°C.Temperature of greater than 38.5°C.
Persons who have received rt-PA can bePersons who have received rt-PA can be
mobilized if the attending physician permits.mobilized if the attending physician permits.
*Contraindications to Mobilization
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
*AVERT Trial recommendations
35. 4.2d Continence
All stroke patients should be screened for urinary incontinence
and retention (with or without overflow), fecal incontinence and
constipation
Stroke patients with urinary incontinence should be assessed by
trained personnel using a structured functional assessment
A bladder training program should be implemented in patients who
are incontinent of urine
A bowel management program should be implemented in stroke
patients with persistent constipation or bowel incontinence
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
36. 36
Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
40-60% of stroke patients have urinary incontinence
25% of incontinent patients will have urinary incontinence at
discharge
15% will have incontinence at 1 year post stroke
Urinary incontinence within 24 hours of a stroke is a predictor
of functional disability
37. 37
Bladder Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
All stroke patients should be screened for urinary incontinence
and retention (with or without overflow)
Urinary incontinence should be assessed by trained personnel
using a structured functional assessment
The use of indwelling catheters should be avoided. If used,
indwelling catheters should be assessed daily and removed as
soon as possible
38. 38
Bladder Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
The use of a portable ultrasound (bladder scanner) is
recommended as the preferred non-invasive painless method
for assessing post void residual and eliminates the risk of
introducing urinary infection or causing urethral trauma by
catheterization
39. Acute Inpatient Stroke CareAcute Inpatient Stroke Care
39
07/08/14
Assessment of Incontinence
Post residual volume
Urine culture
Vaginal examination
Rectal examination
Incontinence history
Fluid intake
Medical history
Medications
Functional ability
40. 40
Strategies for Urinary Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Ensure adequate fluid intake (1500-2000 mls)
Assess post void residuals (normal is 50-100 mls)
Review medications (?diuretics)
Introduce a regular toileting routine
41. 41
Strategies for Urinary Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Encourage bladder retraining (urge incontinence)
Pelvic muscle exercises – Kegal’s
Double voiding, Crede maneuver and intermittent
catheterization (overflow incontinence)
Limit use of dietary bladder irritants ( caffeine, etoh, spicy
foods)
42. 42
Bowel Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Bowel incontinence occurs in 30% of stroke patients and 97%
regain control within one year.
Incontinence may result due to the following:
Altered consciousness
Cognitive deficits
Impaired communication
Neurogenic bowel without sensation
or control
43. 43
Bowel Incontinence
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Bowel function risk factor assessment should include:
mobility, inactivity, adequate fluid and food intake, polypharmacy,
etc.
All stroke patients should be screened for fecal incontinence
A bowel management program should be implemented in
stroke patients with persistent constipation or bowel
incontinence
44. 44
Establishing a Bowel Program
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Encourage appropriate fluids, diet, and activity.
Choose an appropriate rectal stimulant.
Provide rectal stimulation initially to trigger defecation daily.
Select optimal scheduling and positioning.
Select appropriate assistive techniques.
Evaluate medications that promote or inhibit bowel function
Source: www.guideline.gov/
46. 4.2e Nutrition
The nutritional and hydration status of stroke patients should
be screened within the first 48 hours of admission using a valid
screening tool
Results from the screening process should guide appropriate
referral to a dietitian for further assessment and the need for
ongoing management of nutritional and hydration status
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
47. 47
Nursing Interventions for Dysphagia/Nutrition
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Maintain all patients with stroke NPO (including oral
medications) until a swallowing screen has been administered
and interpreted, within 24 hours of patient being awake and
alert
Screening results should guide appropriate referral to a
Dietician for further assessment and the need for ongoing
management of nutritional and hydration status
48. 48
Dysphagia/Nutrition
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Consideration of enteral nutrition support within 7 days of
admission for patients who are unable to meet their nutrient
and fluid requirements orally
This decision should be made collaboratively with the
multidisciplinary team, patient and their caregivers/family
49. 49
Nursing Interventions for Dysphagia
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Assess for signs & symptoms of dysphagia
Choking on food
Stifled, suppressed or overt coughing during meals
Nasal regurgitation
Moist, wet voice
Complaints of food sticking in the throat
Drooling or loss of food &/or fluid from the mouth
Pocketing of food in cheeks
Slow, effortful eating
Delay in initiating swallow (i.e. > 5 seconds)
50. 50
Dysphagia – Points to Remember
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
All stroke patients should have a nutritional screen within 48
hours of admission
Many dysphagic patients aspirate without any external sign that
food or liquid is entering the airway – instead ‘silent aspiration’
Although many stroke patients will recover from dysphagia
spontaneously, all stroke patients should have a SLP/RD
assessment
The presence of a gag reflex does not excludeThe presence of a gag reflex does not exclude
the possibility of dysphagiathe possibility of dysphagia
51. 4.2f Oral Care
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
52. 4.2f Oral care
All stroke patients should have an oral/dental assessment,
which includes screening for obvious signs of dental disease,
level of oral care and appliances, upon or soon after admission
For patients wearing a full or partial denture it must be determined if
they have the neuromotor skills to safely wear and use the
appliance(s)
An oral care protocol should be established and include:
Frequency
Types of oral care products
Strategies for patients with dysphagia
Consultation with dentistry
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
53. 53
Oral Care
07/08/14REVIEWREVIEW
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Consider consulting dentistry, occupational therapy, speech
language pathologists, and/or a dental hygienist to develop an
oral care protocol
A referral to dentistry for consultation and management of oral
health and/or appliances should be made as soon as possible
54. 4.2g Discharge planning
Discharge planning should be initiated as soon as possible
after patient admission to hospital (emergency department or
inpatient care)
A process should be established to ensure involvement of patients
and caregivers in the development of the care plan, management
and discharge planning
Discharge planning discussions should be ongoing throughout
hospitalization to support a smooth transition from acute care
Information about discharge issues and possible needs of patients
following discharge should be provided to patients and caregivers
soon after admission
Best Practices Recommendations
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
55. Check Up QuizCheck Up Quiz
QUIZQUIZ
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
56. Check Up
07/08/14 56
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
In one clinical study, stroke unit
care reduced the odds of what
three outcomes?
1. Death at final follow up
2. Death or institutionalized care
3. Death or dependency
57. Check Up
07/08/14 57
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Name two common
complications related to stroke.
Aspiration Pneumonia 40%
Urinary tract infection 40%
58. Check Up
07/08/14 58
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
In what type of unit shouldIn what type of unit should
patients admitted to hospitalpatients admitted to hospital
with acute stroke or TIA bewith acute stroke or TIA be
treated?treated?
In an interdisciplinary stroke unitIn an interdisciplinary stroke unit
59. Check Up
07/08/14 59
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What type of planning should be
included as part of the initial
assessment and ongoing care of acute
stroke patients?
Discharge planningDischarge planning
60. Check Up
07/08/14 60
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What type of treatment should
patients who are identified as high
risk for venous thromboembolism be
considered for?
Prophylaxis provided there are no
contraindications
61. Check Up
07/08/14 61
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
In addition to secondary stroke
prevention, what type of therapy
should be used for people with
ischemic stroke to prevent VTE?
Antiplatelet therapy
62. Check Up
07/08/14 62
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What action should be taken if a
patient’s temperature rises to more
than 38°C?
Identify and treat source (site andIdentify and treat source (site and
etiology) of fever in order to startetiology) of fever in order to start
tailored antibiotic treatment andtailored antibiotic treatment and
antipyreticsantipyretics
63. Check Up
07/08/14 63
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
How often should the temperature of
a stroke patient be monitored?
As part of routine vital sign
assessments (every 4 hours for first
48 hours and then as per ward
routine or based on clinical
judgment)
64. Check Up
07/08/14 64
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
When should acute stroke patients be
mobilized?
As early and as frequently as
possible preferably within 24 hours of
stroke
symptom onset, unless
contraindicated
65. Check Up
07/08/14 65
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Mobilization of stroke patients isMobilization of stroke patients is
contraindicated when systolic bloodcontraindicated when systolic blood
pressure is less than or greater thanpressure is less than or greater than
what values?what values?
Systolic blood pressure less thanSystolic blood pressure less than
110mm Hg or greater than 220mm110mm Hg or greater than 220mm
Hg.Hg.
66. Check Up
07/08/14 66
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What percentage of stroke patientsWhat percentage of stroke patients
have urinary incontinence?have urinary incontinence?
40-60% of stroke patients have40-60% of stroke patients have
urinary incontinenceurinary incontinence
67. Check Up
07/08/14 67
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What does the use of a portableWhat does the use of a portable
ultrasound (bladder scanner) toultrasound (bladder scanner) to
access bladder function eliminate?access bladder function eliminate?
Risk of introducing urinary infectionRisk of introducing urinary infection
or causing urethral trauma byor causing urethral trauma by
catheterizationcatheterization
68. Check Up
07/08/14 68
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What are three strategies for treatingWhat are three strategies for treating
overflow incontinence?overflow incontinence?
1.1. Double voidingDouble voiding
2.2. Crede maneuverCrede maneuver
3.3. Intermittent catheterizationIntermittent catheterization
69. Check Up
07/08/14 69
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Bowel incontinence occurs in whatBowel incontinence occurs in what
percentage of stroke patients andpercentage of stroke patients and
what percentage regain control withinwhat percentage regain control within
one year?one year?
Bowel incontinence occurs in 30% ofBowel incontinence occurs in 30% of
stroke patients and 97% regainstroke patients and 97% regain
control within one yearcontrol within one year
70. Check Up
07/08/14 70
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What should a bowel function riskWhat should a bowel function risk
factor assessment include?factor assessment include?
Mobility, inactivity, adequate fluid andMobility, inactivity, adequate fluid and
food intake, polypharmacyfood intake, polypharmacy
71. Check Up
07/08/14 71
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Identify four things you can do toIdentify four things you can do to
manage bowel incontinence.manage bowel incontinence.
1.1. Increase dietary fibre and fluidsIncrease dietary fibre and fluids
2.2. Increase mobilityIncrease mobility
3.3. Maintain a bowel recordMaintain a bowel record
4.4. Establish a regular toiletingEstablish a regular toileting
routineroutine
72. Check Up
07/08/14 72
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
The nutritional and hydration status of
stroke patients should be screened
within what period of time after
admission and using what tool?
WithinWithin the first 48 hours of admission
using a valid screening tool
73. Check Up
07/08/14 73
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Maintain all patients with stroke NPOMaintain all patients with stroke NPO
(including oral medications) within 24(including oral medications) within 24
hours of patient being awake andhours of patient being awake and
alertalert
What should be done with allWhat should be done with all
patients with stroke until apatients with stroke until a
swallowing screen has beenswallowing screen has been
administered and interpreted?administered and interpreted?
74. Check Up
07/08/14 74
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
The presence of a gag reflex does not
exclude the possibility of dysphagia
The presence of a gag reflex does
not exclude the possibility of
what?
76. Acute Inpatient Stroke CareAcute Inpatient Stroke Care
When should stroke rehabilitation start?
77. When Should Stroke Rehabilitation Start
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Priorities are :
Manage stroke sequelae to optimize recovery
Prevent post-stroke complications that may interfere with recovery
process
Acute stroke accounts for the longest length of stay in
Canadian hospitals and places a significant burden on inpatient
resources, which increases further when complications are
experienced.
78. When Should Stroke Rehabilitation Start
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Consider that rehabilitation is a process, not a place.
Rehabilitation and discharge planning begins
at the time of admission to acute care
79. Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What are the benefits of early
assessment and rehabilitation?
80. Benefits of Early Assessment & Rehabilitation
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Assessment should start as early as possible in the ER and
continue through the inpatient and community reintegration
phases
81. Benefits of Early Assessment & Rehabilitation
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Early consultation with rehab professionals:
Contributes to reductions in complications from immobility such as
joint contracture, falls, aspiration pneumonia and deep vein
thrombosis
Contributes to early discharge planning for transition from acute
care to specialized rehabilitation units or to the community
Should reduce the overall cost of care through improved outcomes
and reduced time to discharge (BPG 5.1)
82. Examples of Assessment Tools
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Clinicians should use standardized, valid assessment tools to
evaluate stroke-related impairments and functional status
Domain Selected Measure
Measures of stroke
severity
Orpington Prognostic Scale (OPS)
National Institute of Health Stroke Scale
Upper/lower
extremity structure
and function
Chedoke-McMaster Stroke Assessment (CMSA)
Language Screening in acute care and follow-up, with
Frenchay Aphasia Screening Test (FAST)
Boston Diagnostic Aphasia Examination (BDAE)
Cognition Montreal Cognitive Assessment (new addition
by Canadian Stroke Strategy cognitive working
group, January 2008)
Self-care activities
of daily living
Functional Independence Measure (FIM)
83. Your Role in Early Assessment &Stroke Rehabilitation
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
TABLE ACTIVITYTABLE ACTIVITY
When done,
we'll review
some of your
pearls of
wisdom!
At your tables discuss
What are the benefits of early assessment and
stroke rehabilitation at your institution?
Where can you make a difference in realizing
these benefits?
What is the role of the nurse in stroke
rehabilitation?
What barriers and enablers do you see?
85. From the Patient and Family’s Perspective:From the Patient and Family’s Perspective:
86. Where You Can Make a Difference!
Did you know that
skills training of
caregivers makes
a huge difference
in patient
outcomes in areas
of functionality
and depression!
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
1. At your tables, discuss
What would be your role in educating
and supporting patients and caregivers
about acute inpatient stroke care?
1. When done, we'll debrief the whole
group to identify some best practices
87. Patient and Family Education
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Content should be specific to;
The phase of care
Patient/caregiver readiness
Patient/caregiver needs
Education should be timely, interactive, up to date and provided in a
variety of formats, languages including aphasia friendly
Processes should be established by clinical teams for
education including designating team members for provision
and documentation of education
REVIEWREVIEW
88. Patient and Family Education
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
REVIEWREVIEW
Education content should include:
The nature of the stroke and its manifestations
Signs and symptoms of stroke
Impairments and their impact on the person
Caregiver training to manage
Risk factors
Post-stroke depression
Cognitive impairment
Discharge planning and decision making
Community resources
Home adaptations
89. Patient and Family Education
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
www.heartandstroke.ca
91. Case Study
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
1. Review the case study in your PW
2. With your team, answer the questions on the worksheet at
the end of the study
3. We’ll review when done to share some best practices and get
ready to create a Stroke Care Action Plan
TABLE ACTIVITYTABLE ACTIVITY
92. Case Study
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
Mrs. C is a 76 year old right handed woman who was admitted to the
Stroke Unit post thrombolysis. She lives with her 80 year old husband
who requires some assistance with ADL’s due to his Parkinsons’
disease.
They live in a 2 bedroom condominium and have the support of 2 adult
children nearby.
On admission Mrs. C is found to have expressive aphasia, right sided
weakness (arm weaker than leg) and right visual neglect.
Past medical history: hypertension, hypercholesteremia, osteoporosis,
gastroesophageal reflux
No known allergies and does not drink or smoke
93. Case Study Questions
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
What would be the priority areas for Mrs. C’s care plan
development?
What education would you provide for the family?
What complications would you be monitoring for with Mrs. C?
94. Case Study Questions
Acute Inpatient Stroke CareAcute Inpatient Stroke Care
1. With the case study we just reviewed in mind, create a stroke
care action plan
Identify 1-2 key learnings from today that you could take back to
help kick start your change initiatives
1. Use the Stroke Care Action Plan worksheet in your PW to
record your plan
95. Our views have increased theOur views have increased the
mark of the 10,000mark of the 10,000
Thank you viewers
Looking forward to franchise, collaboration, partners.
96. This platform has been started byThis platform has been started by
Parveen Kumar Chadha with theParveen Kumar Chadha with the
vision that nobody should suffervision that nobody should suffer
the way he has suffered becausethe way he has suffered because
of lack and improper healthcareof lack and improper healthcare
facilities in India. We need lots offacilities in India. We need lots of
funds manpower etc. to make thisfunds manpower etc. to make this
vision a reality please contact us.vision a reality please contact us.
Join us as a member for a nobleJoin us as a member for a noble
cause.cause.
98. Best Practice Nursing Care AcrossBest Practice Nursing Care Across
the Acute Stroke Continuumthe Acute Stroke Continuum
Thank you for your participation!
Editor's Notes
The Canadian Best Practice Recommendations are a result of an extensive review of both international and national stroke research and of published evidence-based best practice guidelines
The first edition was released in 2006 with a commitment to formally update the recommendations every two years to ensure currency and coordination with both national and international initiatives.
The 2008 edition includes updates to the original recommendations and the addition of 4 new recommendations.
Each edition underwent a rigorous development and review process
usually defined as symptom onset within the previous 4.5 hours