NURSING 2MM3 Chapter Notes - Chapter 1: Long-Term Care, Stroke Recovery, Surrogate Decision-Maker

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Published on 16 Sep 2018
School
McMaster University
Department
Nursing
Course
NURSING 2MM3
Professor
Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care
Guidelines
Acute Stroke Unit Care
Stroke Unit Care Recommendations
- Patients admitted to hospital with TIA should be treated on inpatient stroke unit
ASAP (within 6h)
o Patients should be admitted to stroke unit
o Interprofessional team should consist of health care professionals with stroke
expertise including physician, nurses, OT, physiotherapists, speech language
pathologists, social workers and clinical nutritionist
§ Other members may include pharmacist, discharge planners/case
managers, psychologists, palliative care specialists, recreation and
vocational therapists, spiritual care providers, peer supporters and
stroke recovery group liaisons
o Interprofessional team should assess patients within 48h of admission to
hospital and formulate a management plan
§ Evaluate impairments and functional status
§ Assessment should include dysphagia, mood and cognition, mobility,
functional assessment, temperature, nutrition, bowel and bladder
function, skin breakdown, discharge planning, prevention therapies,
venous thromboembolism prophylaxis
§ Assessment to determine type of ongoing pot acute rehab services
required should occur as soon as patient is stabilized, and within first
72h post stroke
o Child admitted with stroke should be in a center with a pediatric stroke expert
- In-hospital stroke
o Hospital inpatients with a new diagnosis of stroke should be assessed and
receive acute inpatient stroke care in a timely manner
Inpatient Stroke Management and Prevention of Complications
- Acute stroke is responsible for prolonged lengths of stay compared to other causes of
hospitalization, and the burden on inpatient resources increases with complications
- Priorities for inpatient care are management of stroke sequelae to optimize recovery,
prevention of post stroke complications that may interfere with the recovery process and
prevention of recurrence
Inpatient Stroke Management and Prevention of Complications Recommendations
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- Appropriate investigations and management strategies should be implemented for all
hospitalized stroke and TIA patients to optimize recovery, avoid complications, prevent
recurrence, and provide palliative care when needed
o Patient should undergo appropriate investigations to determine stroke mechanism
and guide stroke prevention and management decisions
o Care plan should address nutrition, oral care, mobilization and incontinence, and
reduce risk of complications
o Discharge planning should start at initial assessment and continue throughout care
o Everyone involved should receive timely and comprehensive info, education and skill
training
o Past history of depression should be identified
o Patients should undergo an initial screening for vascular cognitive impairment when
indicated
- Cardiovascular Investigations
o Where ECG doesnʼt show fibrillation but a cardioembolic mechanism is suspected,
prolonged ECG monitoring up to 30 days is recommended
o Echocardiography should be considered for those with embolic stroke and normal
neurovascular imaging, and no contraindications for anticoagulant therapy
o Children with stroke should get cardiac evaluation including echocardiography and
detailed rhythm monitoring
- Venous Thromboembolism Prophylaxis
o All stroke patients should be assessed for their risk of developing venous
thromboembolism
§ Patients at high risk should be started on thigh high IPCdevices or
pharmacological venous thromboembolism prophylaxis immediately if there
is no contraindication
§ Use of anti-embolism stockings for post stroke venous thromboembolism
prophylaxis isnʼt recommended
§ Early mobilization and adequate hydration should prevent venous
thromboembolism
§ Antiplatelet agents and anticoagulants should be avoided for at least 48h
after onset
- Temperature Management
o Temperature should be monitored with vitals every 4h for first 48 h and then as per
routine
o For temp greater than 37.5 C increase monitoring, initiate temperature reducing
measures, investigate possible infection like pneumonia of urinary tract infection
- Mobilization
o Mobilization: the process of getting a patient to move in bed, sit up, stand, and
eventually walk
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Document Summary

Canadian stroke best practice recommendations: acute inpatient stroke care. Patients admitted to hospital with tia should be treated on inpatient stroke unit. Asap (within 6h: patients should be admitted to stroke unit. Interprofessional team should consist of health care professionals with stroke expertise including physician, nurses, ot, physiotherapists, speech language pathologists, social workers and clinical nutritionist. Other members may include pharmacist, discharge planners/case managers, psychologists, palliative care specialists, recreation and vocational therapists, spiritual care providers, peer supporters and stroke recovery group liaisons. Interprofessional team should assess patients within 48h of admission to hospital and formulate a management plan. Assessment should include dysphagia, mood and cognition, mobility, functional assessment, temperature, nutrition, bowel and bladder function, skin breakdown, discharge planning, prevention therapies, venous thromboembolism prophylaxis. Assessment to determine type of ongoing pot acute rehab services required should occur as soon as patient is stabilized, and within first.