Clinical Management Protocols for Stroke, Pressure Sores, and Syncope
Stroke: Causes, Symptoms, and Nursing Care
Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two main kinds of stroke:
- Ischemic Stroke: The more common kind, caused by a blood clot that blocks or plugs a blood vessel in the brain.
- Hemorrhagic Stroke: Caused by a blood vessel that breaks and bleeds into the brain.
Transient Ischemic Attacks (TIAs), often called “mini-strokes,” occur when the blood supply to the brain is briefly interrupted.
Parts of the Body Affected
The brain.
Signs and Symptoms of Stroke
- Speech difficulties, including dysphasia (impaired ability to talk, read, and write).
- Facial paralysis on the affected side.
- Visual deficits.
- Impaired movement of the limbs on one side of the body (hemiplegia).
- Loss of bladder/bowel control (incontinence).
Stroke Care Plan and Nursing Responsibilities
- The nurse should regularly check the patient’s vital signs: blood pressure, pulse, and respiration.
- Nurses must monitor the patient’s level of response.
- If the patient experiences swallowing difficulties, these should be assessed by a dietitian or nurse before giving oral feeding. Oral intake may be given via a nasogastric tube.
- When the patient has speech impairment, the nurse should write a referral to the speech and language therapist.
- For patients experiencing urinary incontinence, it is recommended to use a bedpan or absorbent pads (nappies) instead of inserting a urinary catheter.
- Since the patient experiences a lack of mobility on one side of the body, a physiotherapist can assist in restoring mobility.
- The patient might need assistance dressing and washing. Health care assistants will be able to provide help in this aspect of care.
- Doctors will prescribe medications to treat the patient’s condition.
- Key nursing responsibilities include preventing pressure sores and ensuring adequate oral intake.
Important Considerations for Stroke Management
- A CT scan may be performed to determine the location and type of Cerebrovascular Accident (CVA).
- There are three main causes of strokes, and the treatment plan may change depending on the underlying cause.
Pressure Sores (Bedsores)
Pressure sores, also known as bedsores, occur when the skin breaks down due to prolonged pressure. They can start with redness of the skin and progress to an open wound or necrosis of subcutaneous tissue.
Parts of the Body Affected
Common areas include the heels, buttocks, sacrum, elbows, spine, and hips.
Prevention of Pressure Sores
- Position should be changed frequently.
- Keep risk regions clean and dry.
- Observe pressure areas regularly.
- Use pressure-relieving aids, such as special mattresses and pillows, to relieve pressure on risk regions.
Fainting (Syncope)
Parts of the Body Affected
- Nervous System: Brain and nerves.
- Cardiovascular System: Heart, blood vessels, arteries, and veins.
Signs and Symptoms
- Loss of consciousness.
- Preceding signs (prodrome) often include: sweating, blurred vision, paleness, nausea, and dizziness.
Fainting Care Plan (First Aid)
- Assess the level of consciousness and check vital signs (pulse and respiration).
- Lie the casualty down looking upwards, and elevate their legs above heart level.
- Turn their head to one side to avoid airway obstruction or in case of vomiting.
- Loosen the casualty’s clothes around the waist and neck to allow easy breathing.
- Open the window if indoors, or remove them from the sun if outdoors.
- Ensure people stand clear of the casualty.
- Do not administer anything by mouth until the casualty has fully recovered consciousness.
- Once the casualty has fully recovered, avoid sudden movements to prevent a new episode.
When Further Investigation is Required
Further investigations are required if the casualty has any of the following conditions:
- Elderly people.
- Repetitive episodes.
- Severe trauma.
- Suspected cardiovascular or neurological disorder.
Preventing New Fainting Episodes
The casualty can help prevent new episodes by avoiding trigger causes, such as:
- Stress.
- Excessive heat.
- Excessive physical exercise.
- Changing posture abruptly.
Medical and General Vocabulary
This section provides key English terms and their Spanish translations:
- Owners (PROPIETARIOS)
- Reassure (TRANQUILIZAR)
- Concerned (PREOCUPADO)
- Frail
- Immobile
- Confused
- Independent
- Forgetful
- Incontinent
- Short Sighted
- Healthy
- Develop (DESARROLLAR)
- Rewire (RENOVAR)
- Motor Skills (HABILIDADES MOTORAS)
- Degenerative Brain Diseases
- Mental Decline (DETERIORO MENTAL)
- Damages (DAÑOS)
- Wandering (VAGABUNDEAR)
- Shuffling Gait (ARRASTRAR PIES)
- Shellfish (MARISCO)
- Harmful (DAÑINO)
- Adverse Reaction
- Immune System
- Antibodies
- Allergic Reaction
- Peanuts
- Wheat (TRIGO)
- Nuts
- Soy
- Tingling (HORMIGUEO)
- Abdominal Cramps
- Mild (LEVE)
- Cravings (ANTOJOS)
- Fatigue
- Clog Up (OBSTRUIR)
- Nourishing (NUTRITIVO)
- Endurance (RESISTENCIA)
- Tooth Decay
- Spoonfuls
- Drowsiness
- Discharged (DADO DE ALTA)
- Bottle of Tablets
- Capsules
- Cough Syrup
- Eye Drops and Dropper
- Nasal Spray
- Fulfilled (SATISFECHO)
- Wisdom (SABIDURÍA)
- Impaired (DAÑADO)
- Physiotherapist
- Redness
- Blood Vessels
- Loss of Consciousness
- Blurred Vision
- Paleness
- Casualty
- Limbs (EXTREMIDADES)
- Bedsores/Pressure Sores
General Health and Lifestyle Advice
- Please don’t strain your eyes by reading or learning in poor light.
- You should try to eat more fresh fruit and vegetables.
- You could try nicotine patches (if applicable).
- You must keep all medicine out of reach of children.
- What about writing a letter to your sister?
- You’ll recover more quickly if you try to get some exercise.
- Don’t hesitate to call us if her condition changes.
- It would be a good idea to stop smoking.
- Have you tried swimming?
- We’d like you to do these exercises every day.
- I strongly suggest that you reduce the amount of beer you drink.
- Do you think you could lose a bit of weight?
- You may find it helpful to raise the head of your bed.
- It would be good for you to drink more water.
Example Questions (Who, What, How, Why)
- Who came last night?
- What did the doctor and the midwife want to speak about?
- What were they doing?
- What kind of fruit do you like?
- How is the patient?
- Who gave you the pill?
- Why is the nurse so scared?
- When are you coming back?
- Who are you talking with?
- How much did you pay?
- Who did you phone?
- What are you doing?
- What do you want?
- What did you buy?
- What did you use?
- Who has got your pillow?
- Who has cleaned the bathroom?
- Who saw the…?
- What is there for dessert?
Medication Instructions (Oral Use)
- For oral use only. Swallow capsules with water; do not chew.
- Take 2 capsules every 4 hours. Do not exceed 8 capsules in 24 hours.
- To be taken every 3 to 5 hours as required, according to the severity of the symptoms.
- Do not use more than the stated dose.
- This medicine is not recommended for children under 5 years.
- May cause drowsiness. Avoid driving or operating machinery when taking this medicine.
- You need to take 4 capsules, 3 times a day at meal-times.