Transcript After Your Stroke - American Heart Association

PALOMAR
POMERADO
HEALTH
SPECIALIZING IN YOU
After your
stroke
1
HMJ1 12.07
Table of Contents
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Welcome
Contact Information
What is a Stroke
Types of Stroke
Warning Signs of a Stroke
Stroke Diagnosis
Treatment of Acute Stroke
Who is at Risk
Personal Risk Factors
Smoking
High Blood Pressure
High Cholesterol
Physical Inactivity and Obesity
Atrial Fibrillation
Diabetes
Dietary Tips
Medications
Life after a Stroke
Aphasia
Dysarthria
Swallowing Difficulties
Life after Stroke
Rehabilitation
Being a Caregiver
Anxiety and Depression
Prevention of a Stroke
Energy Conservation
“Dial, Don’t Drive
Notes
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Welcome to Palomar Pomerado Health (PPH).
The mission of PPH is to heal, comfort, and promote health in the communities
we serve. Our vision is that PPH will be the health system of choice for patients,
physicians, and employees and be recognized nationally for the highest quality of
clinical care and access to comprehensive services. Our goal is to provide you
with excellent healthcare.
Our visiting policy is individualized and flexible based on the needs of our
patients and family members.
The packet you are receiving has general information you may find helpful in
dealing with your condition, or your loved one’s condition. Additional handouts
will be given to you for any other risk factors that may be present. Handouts are
available for medications you may be taking or will take at home. These
handouts will be given to you when you are admitted and others may be added
before you are discharged.
Your nurse or your primary healthcare provider can answer any questions you
may have. We encourage you to write down your questions or comments on the
“Notes” pages provided at the back of this booklet. Please use these pages to
speak to your nurse or primary healthcare provider about anything regarding
your hospital stay with PPH.
We want your experience to be as pleasant as possible. If we can help you with
anything, please do not hesitate to ask. For any questions, comments, or
concerns, please call the nurses’ station directly for immediate assistance.
Palomar Medical Center
All prefixes are: 1-760-739
Surgical, 8th Floor: 3840
Medical/Oncology, 7th Floor: 3740
Intermediate Care, 7th Floor: 3790
Telemetry, 6th Floor: 3640
Critical Care, 6th Floor: 3655
Orthopedic/Stroke, 5th Floor: 3540
Pomerado Hospital
All prefixes are: 1-858-613
Medical/Surgical/Telemetry,
4th floor: 4340
Medical/Surgical/Telemetry,
3rd floor: 4442
Critical Care/Intermediate Care, 3
2nd Floor: 4339
Contact Information
Please write down important contact
information in the spaces below. You may
want to share this information with family
members and friends.
• Doctor Treating Me for Stroke Issues
Name: ________________________________
Address: ______________________________
City: _______________
State: _____
Zip code: _________
Phone number: _________________________
• Other Important Phone Numbers
– Ambulance, fire department, or
emergency services: 911
Pharmacy: _____________________________
Other doctors or nurses:
____________________________________
____________________________________
____________________________________4
What is a Stroke?
A stroke is a disease that affects the arteries of the
brain. A stroke occurs when a blood vessel
bringing blood to the brain gets blocked or
ruptures so brain cells don’t get the flow of blood
that they need. Deprived of oxygen, nerve cells
cannot function and die within minutes. When
these nerve cells die, the parts of the body they
control cannot function either. These devastating
effects are often permanent because brain cells
cannot be replaced.
Other names for a stroke include:
– Cerebral Vascular Accident (CVA)
– Ischemic Stroke
– Transient Ischemic Attack (TIA)
– Intracranial Hemorrhage (ICH)
– Cerebral Thrombosis
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Types of Stroke
There are three types of strokes:
 An Ischemic Stroke is a stroke caused by a blocked
artery. This is the most common type of stroke and
can sometimes be treated with clot busting drugs.
 A Hemorrhagic Stroke is a stroke caused by
bleeding into the brain tissue. This stroke is caused
by a ruptured blood vessel.
 A TIA, or a Transient Ischemic Attack, is also
called a “mini stroke” and occurs when a blood
clot blocks an artery for a short time. The
symptoms of a TIA are like the warning signs of a
stroke but they usually last only a few minutes.
About 10 % of strokes are preceded by TIAs and
are a very strong predictor of stroke risk. TIAs are
a medical emergency and should be treated
immediately.
Ask your doctor ► The type of stroke I have had is:
_______________________________________________
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Warning Signs of a Stroke
Warning signs of a stroke can include:
– Sudden weakness or numbness of the face arm, or
leg, especially on one side of the body.
– Sudden confusion, trouble speaking or
understanding
– Sudden trouble seeing in one or both eyes
– Sudden trouble walking, dizziness, loss of balance
or coordination
– Sudden, severe headache with no known cause
If you recognize any of these symptoms, act FAST.
– "F" stands for Face. Ask the person to smile. If
the face is droopy on one side, that is a sign of a
stroke. Call 9-1-1 immediately.
– "A" stands for Arm. Ask the person to raise both
arms. If one arm drifts down or has no resistance to
it, that is a sign of a stroke. Call 9-1-1 immediately.
– "S" stands for Speech. Ask the person to say a
simple phrase. If the person's speech is slurred or
not able to be understood. Call 9-1-1 immediately.
– "T" stands for Time. Diagnosis and treatment of
an ischemic stroke must be within 3 hours of the
time of onset of symptoms. Call 9-1-1 immediately.
If your recognize any of these symptoms in
yourself, or someone around you, a stroke could
be happening…CALL 911 IMMEDIATELTY.
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Stroke Diagnosis
It is critical to diagnose a stroke in progress because the
treatment of stroke depends on the type, source, and
even the location of the injury in the brain.
The type of stroke also must be determined because
treatment is different for an ischemic versus a
hemorrhagic stroke.
Timing is extremely important when it comes to
diagnosing a stroke.
Different types of diagnostic tests that your physician may
order to diagnose a stroke includea:
• CT Scan (Computerized Tomography)
• An imaging test that uses radiation to create a
picture of the brain. It is usually the first test ordered
for a patient with stroke symptoms. This test will
give the stroke team valuable information about the
cause and location of the stroke and the extent of the
injury to the brain.
• MRI scan (Magnetic Resonance Imaging)
• MRI scans use a large magnetic field to produce an
image of the brain that also show the location and
extent of the stroke. The image that is created is
sharper and more detailed than a CT scan so it is
often used to diagnose small, deep injuries of the
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brain.
Treatment of Acute Stroke
Once the diagnosis of stroke is suspected or confirmed,
treatments to try to restore blood flow to the brain are
started. Timing is everything and will affect what
treatments are used. Treatment options can include
medications and medical procedures.
Thrombolytic Medications
These medicines (also called clot busters) are used to
dissolve blood clots that are blocking the arteries in the
brain. To be most effective, these medicines must be
given within 3 hours after the start of stroke symptoms.
Many new procedures are being developed for treating
acute stroke but all these therapies are time dependent.
Therefore, the need for determining the exact onset of
the stroke symptoms is extremely important.
Since timing is everything, it is important to call 911 if
you or someone around is experiencing the signs of a
stroke.
Do not drive yourself, or let someone else drive
him/herself to the hospital.
Emergency Medical Services (EMS) will notify the
Emergency Department of your symptoms and the
stroke team will be activated before you arrive.
Remember to
Dial, Don’t Drive….
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Who is at Risk?
Certain risk factors make it more likely that you will
develop artery disease and have a stroke. Some risk
factors for stroke can be controlled, while others can't.
Major risk factors for a stroke that you can control
include:
• Smoking
• High blood pressure
• High blood cholesterol
• Overweight and obesity
• Physical inactivity
• Diabetes (high blood sugar)
• Atrial Fibrillation
Risk factors that you cannot change include:
• Age: Stroke affects all ages but the older you are, the
greater your risk of stroke
• Heredity: The risk of a stroke is greater in people
whose close blood relatives have had a stroke.
• Race: African Americans have a higher risk of death
and disability from a stroke because they have a greater
incidence of high blood pressure. Hispanic Americans
are also at an increased risk for stroke due to
complications of diabetes.
• Prior Stroke: Someone who has had a stroke is at
higher risk of having another one.
• Gender: While more men have strokes each year, 10
over half of the stroke deaths occur in women.
My Personal Risk Factors
Risk Factors are different for each person.
Check the risk factors below that apply to you.
– Remember that some of your risk factors cannot be
changed but others can be managed successfully
working with your health care team.
High blood pressure
Obesity
High Cholesterol
Atrial fibrillation
Diabetes
Smoking
Sedentary lifestyle
Previous heart attack or stroke
Your nurse or primary care provider will give you
information to help you modify your risk factors.
More helpful information can also be found in this
book.
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Smoking
Tobacco use is the number one preventable
cause of serious illnesses such as heart
disease, stroke, lung cancer, and emphysema.
An estimated 25.1 million men and 20.9 million
women smoke cigarettes.
The nicotine and carbon monoxide in cigarette
smoke damage the cardiovascular system in
many ways.
Some helpful tips to quit smoking include:
• Making an agreement with yourself to
quit.
• Asking your nurse or physician about quit
smoking aids (Chantix, Zyban, Nicoderm).
• Attending a smoking cessation class.
• Avoiding people who smoke.
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Stop Smoking Now
Smoking can make cardiovascular disease
worse, so if you smoke, you should stop
immediately.
Quitting takes hard work and a lot of effort,
but you CAN quit smoking.
For counseling or to register for PPH Kick
the Habit Program, please call the Cancer
Resource Center at (760) 739-3943 or
(858) 613-4044.
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Relapse Prevention for
New Non-smokers
Think of yourself as a non-smoker.
•
Decide that cigarettes, or any tobacco products, are not an option!
•
Refer to yourself as a non-smoker, not as an ex-smoker
Watch out for the top 3 triggers.
•
Being around smokers
•
Alcohol
•
Highly emotional situations
– (Remember to watch yourself for your personal triggers as well.)
You can manage your weight when you quit.
•
Stay active
•
Drink water and eat healthy meals
•
Keep low-fat, low-calorie snacks on hand
– (Remember to follow the specific dietary or fluid guidelines and/or restrictions
that your primary healthcare provider has discussed with you.)
You can manage stress when you quit.
•
Incorporate stress reducing activities in your new lifestyle
•
Use stress management techniques
If you “slip” (smoke or use tobacco products), do not let it turn into a relapse.
•
Ask yourself what went wrong
•
Fine tune your strategies and recommit to quitting
•
One cigarette does not mean that you are a smoker again!
If you have a relapse, you can get back on track.
•
Ask yourself if you still want to quit
•
Find a NEW reason to quit
•
Revise your strategies, commit to quit, and set a new date
•
Join, or rejoin, a support group to help you stay a non-smoker
For more information, or to register for PPH Kick the Habit Program, 14
contact the PPH Cancer Resource Center
at 760.739.3943 or 858.613.4044.
High Blood Pressure
High blood pressure (BP), or hypertension (HTN) is the
single most important risk factor for stroke. Many
people believe control of high blood pressure is a key
reason for the decrease in death rates for stroke.
It is estimated that the prevalence of high blood pressure
in adults over the age of 20 is approximately 72 million
in the United States alone.
Up to 95 % of high blood pressure are from unknown
causes, but the condition is easily detectable and
treatable.
In addition to medications, diet, exercise, and weight loss
can assist in controlling your blood pressure.
– Please ask to see a dietitian to assist you with
healthy meal planning to lower both your blood
pressure and your cholesterol.
• Normal blood pressure is 120/80.
• High blood pressure is 140/90 or higher.
• If you are diabetic, you are considered to have high
blood pressure if your blood pressure is 130/85.
My blood pressure is: _____________________
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High Cholesterol
About 36 million American adults have total cholesterol
levels above 240 mg/dL.
– Your total cholesterol should be below 200
mg/dL.
– Your triglyceride level should be below
150mg/dL.
– Your HDL, or good cholesterol, should be 40
mg/dL or higher.
– Your LDL, or bad cholesterol, should be less than
100 mg/dL
In addition to medications, diet, exercise, and weight loss
can help control you cholesterol levels.
– Please ask to see a dietitian for healthy meal
planning to assist you in lowering both your high
blood pressure and cholesterol.
My cholesterol levels in the hospital are:
Total Cholesterol: ________
Triglyceride: ________
HDL: _______
LDL: __________
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Physical Inactivity
and Obesity
About 65 % of Americans age 20 and older are overweight
or obese. Data from the Centers for Disease Control and
Prevention show that only 30.1% of American adults
engage in light-moderate physical activity for at least 30
minutes on five or more days a week.
– If you are overweight, losing even 5 to 10 pounds
will help lower your blood pressure and cholesterol
and improve your overall health.
Physical activity will build endurance, control blood
pressure, reduce cholesterol levels, help with weight
loss, and reduce your risk for developing diabetes. The
key is finding activities that fit your lifestyle and
abilities.
The American Heart Association/American Stroke
Association recommend 30 minutes a day 5 to 7 days
per week. This can be broken up in to three 10 minute
brisk walks during the day!
Ideal body weight is determined calculating your Body
Mass Index (BMI).
– Your nurse or dietitian can assist you in calculating
your BMI during your stay.
The ideal BMI is 20 – 25.
My BMI is: __________
Before beginning any exercise program, consult your
physician to discuss what is right for you and your
health.
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Atrial Fibrillation
Atrial fibrillation is a condition that causes the upper chambers
of the heart, the atria, to quiver instead of beating effectively
to move blood into the ventricle. This causes blood flow to
slow and pool and can increase the risk of clotting.
If a clot breaks lose from the atria and enters the bloodstream, it
can lodge in an artery leading to the brain and can cause a
stroke.
About 15 to 20 percent of people who have had a stroke have
this heart arrhythmia.
People with atrial fibrillation have an increased stroke risk of
about five percent per year.
Treatment for atrial fibrillation includes medications such as
coumadin or warfarin, aspirin, plavix.
Your physician may chose to perform a cardioversion. During a
cardioversion, the atria are electrically converted back into a
regular rhythm.
My doctor has prescribed the following medication(s) for
my atrial fibrillation:
_________________________________________________
_________________________________________________
_________________________________________________
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Diabetes
Diabetes is an independent risk factor for stroke.
Many people with diabetes also have high blood pressure,
high cholesterol, and are overweight.
Diabetes is manageable with medications such as insulin,
glipizide, and/or glyburide. Diet and exercise can also
help manage diabetes.
Your physician may perform a lab test called a
hemoglobin A1c which will let them know how well
your diabetes has been controlled in the last 90 days.
The goal is to have a number less than 7.0%.
My hemoglobin A1c (HgbA1c) is: __________
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Know Your Diabetes Risk
Type Two Diabetes Mellitus (Type 2 Diabetes) is a metabolic disorder characterized by the
body’s inability to produce enough insulin and/or the body cells being resistant to insulin.
This results in an abnormal elevation of blood sugar.
Why should I be concerned to know if I have Type 2 Diabetes?
Type 2 Diabetes rarely occurs alone. People that are newly diagnosed with Type 2 Diabetes
usually already have a disease such as High Blood Pressure and/or Abnormal Cholesterol
levels. High blood sugar is not just high blood sugar. If left untreated, high blood sugar will
harm large and small blood vessels – every cell of your body is affected.
What are the risk factors of Type 2 Diabetes?
•Diabetes is more common in African Americans, Latinos, Native Americans, Asian
Americans, and Pacific Islanders (however, Type 2 Diabetes is seen across all race / ethnic
groups).
•Age over 45 (the older one gets the higher the risk – however children as young as 8 years of
age are being diagnosed with Type 2 Diabetes).
•First-degree relative (sibling or parent) with Type 2 Diabetes.
•Overweight, especially being overweight around the ‘belly’ (apple shape).
•Sedentary (inactive) lifestyle.
•Women who had gestational diabetes or gave birth to at least one baby weighing more than 9
pounds (if your mother had gestational diabetes while pregnant with YOU, you are at risk).
•Having other health problems such as: High Blood Pressure, Abnormal Cholesterol, and
other Cardiovascular Diseases.
•Other co-existing factors that could increase your risk – smoking, continual high stress
levels, and depression.
•The more risk factors you have, the more at risk you are of developing or having Type 2
Diabetes.
Don’t Ask – Don’t Tell – Absolutely NOT!
•Uncontrolled diabetes is the leading cause of blindness, renal failure, and limb amputations
(not associated with injuries).
•The leading cause of death in the United States is heart disease (68% of these people had
diabetes).
•Two out of three people with diabetes die from heart disease and stroke.
•It is estimated that once a person is diagnosed with Type 2 Diabetes, he or she likely had
diabetes for at least 5 to 7 years before being diagnosed.
Ask Your Primary Healthcare Provider for Further Evaluation to See If You Have
Diabetes or Are at Risk. Prevention and Early Diagnosis and Treatment To help Prevent
the Complications of Uncontrolled Diabetes is Crucial!
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For more information, contact PPH Diabetes Health
at 760.739.2865 or 858.613.4164.
DASH Diet
(Dietary Approaches to Stop Hypertension)
The DASH diet is simply what the name implies, a diet to
stop hypertension or high blood pressure. It is based
on research that has shown that eating a low fat, low
sodium diet rich in whole grains, low fat dairy foods,
fruits and vegetables lowers blood pressure
significantly. While it may seem difficult or
overwhelming to change a lifetime of eating habits,
making a few changes over a couple of days or weeks
is often easier than changing your entire diet overnight.
 Add a serving of vegetables at lunch one day and
dinner the next, and add a fruit at one meal or
snack.
 Increase your use of fat free and low fat milk
products to three servings a day
 Limit lean meats to 6 ounces a day –three ounces a
meal which is about the size of a deck of cards.
 Include two or more vegetarian-style, or meatless
meals each week.
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DASH Diet
US Department of Health and Human Services, National Institute of Health.
www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
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Following the
DASH Eating Plan
US Department of Health and Human Services, National Institute of Health.
www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
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US Department of Health and Human Services, National Institute of Health.
www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
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DASH Eating Plan: Number
of Daily Servings for Other
Calorie Levels
US Department of Health and Human Services, National Institute of Health.
www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
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Dietary Tips to
Reduce Cholesterol
Eat less saturated fat and cholesterol
Eat less total fat, even “good” fats such as olive oil.
Avoid fried foods, fatty meats and whole milk
products, including cheese and ice cream.
Select foods low in cholesterol. Cholesterol is found
only in foods from animals. Foods from plants contain
no cholesterol.
Choose foods low in saturated fat. Saturated fats are
usually found in animal fats. But you should not eat
the three plant oils (coconut, palm and palm kernel)
that are high in saturated fat. These oils are often
added to packaged foods.
Use as little hydrogenated and partially
hydrogenated fats as possible. Select tub or liquid
margarine rather than stick margarine.
Special “spreads”
Special spreads, such as Benecol and Take Control are
made from plants and have been shown to lower
cholesterol. Talk with your dietitian about adding these
foods to your diet.
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Medications
Anticoagulants and Antiplatelet Medications
Medicines such as aspirin and clopidogrel, and aggrenox
stop platelets (a blood cell related to clotting) from
clumping together and forming unwanted clots.
Aspirin is recommended for preventing a first stroke in
some patients. Along with other antiplatelet agents it
also has an important role in preventing recurrent
strokes.
These medications should not be stopped without first
talking to your physicians. It is also important to tell all
physicians treating you that you take these medicines.
Medications such as coumadin (or warfarin) thin the blood
and prevent clots from forming in your arteries. They are
different from antiplatelet agents and are recommended
primarily for patients with a high risk of stroke and
people with atrial fibrillation. While these drugs are
more effective preventing clots in people with atrial
fibrillation, they may have side effects including
bruising and bleeding. Careful follow up with one’s
primary care physician, including blood tests to measure
warfarin effect, is essential for people taking these drugs.
Again, please be sure to tell any physician treating you
that you take these drugs.
Beta Blockers
These medicines decrease the workload on your heart. Beta
blockers also are used to relieve chest pain or discomfort
and to help prevent additional heart attacks. Beta
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blockers also are used to correct arrhythmias (irregular
heartbeats).
Medications
Angiotensin-Converting Enzyme Inhibitors (ACE-I)
These medicines (such as captopril, benazapril, and lisinopril)
lower blood pressure and reduce the strain on your heart.
They also help slow down further weakening of the heart
muscle. Studies have also shown that in certain patients, use
of ACE-I’s may reduce subsequent stroke incidence even if
blood pressure is normal. In diabetics, these drugs may
preserve renal function. In patients with kidney disease, these
drugs slow decline in renal function and prolong time till
dialysis is required.
Angiotensin Receptor Blockers (ARB)
These drugs are very similar to the ACE-I’s in terms of function,
but instead of blocking formation of angiotensin as ACE-I’s
do, they block the effect of angiotensin on the arteries
themselves. Most of the positive effects of ACE-I’s as listed
above are also noted with ARB’s.
Statins
These medicines, (such as lovastatin or simvastatin and others)
help lower cholesterol in the body. Statins also need to be
monitored by your primary care physician and the dose
adjusted to provide maximum benefit. Side effects can
include muscle soreness and weakness which should be
brought to the attention of your physician immediately.
Other Medicines
Medicines may also be given to relieve pain, anxiety, and
depression which often occur during and after a stroke
If you need help paying for any of your medications,
please talk to your nurse, case manager,
or pharmacist for assistance.
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Taking Medications
Here are a few tips for taking your medications. Most
medicines need to be taken every day even if you feel fine.
Ask your doctor or nurse about any special issues you
should be aware of concerning your medications.
 Have a routine: Take your medications at the same time
each day and use reminders to help you stay on track
 Take all your medicines: Some work better when used
together with others. Don’t take one and skip another.
 Plan ahead: Refill your prescriptions before you run
out.
 Be sure you have them when you travel.
 Never change your dosage or stop taking a medicine
without talking to your primary care physician, and if
you miss a pill, don’t take two when it is time for the
next dose.
 Tell your primary care physician if you think you are
having a side effect to a medication: Your physician
may change the dose or give you a new prescription
 Carry an up to date list of your medicines and bring the
list with you each time you visit your primary care
provider. The pharmacy where you fill your
prescriptions should also know about all the medications
you take even if you do not have the prescriptions filled
at the same pharmacy. This will help to prevent any
potential medication reactions.
 Use a pill box to be sure you take all your medications
properly every day. If you have difficulty filling the box
correctly, ask a friend or relative to help.
 Consult your physician if you are having difficulty 29
swallowing pills, for example, coughing or ”getting
stuck”.
Life After a Stroke
When brain cells injured by a stroke cannot work, the part
of the brain they control cannot work either. This is
why a stroke can be so devastating.
Brain injury from a stroke can affect the senses, motor
activity, speech and the ability to understand speech.
Brain injury can also affect a person’s behavior and
thought patterns, memory and emotions.
Paralysis or weakness on one side of the body is common.
These effects may be temporary or lasting depending
on the area of the brain affected and the extent of the
brain injury.
Injured and dead brain cells cannot heal or replace
themselves.
Recovery from a severe stroke usually takes months or
years of medical treatment, rehabilitation therapy and
determined effort by the stroke survivor.
Many survivors never regain all their lost functions but
despite these losses, many go on to lead full,
productive lives.
Almost everyone feels tired after a stroke and while
feeling fatigued is normal at first, you will probably
start to feel less tired in a few months. It is important to
plan your activities to conserve your energy.
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Aphasia
Aphasia is a language disorder that affects the ability to
communicate. Aphasia is most often caused by a stroke
that affects the left side of the brain which controls
language.
Aphasia does not affect intelligence. Many stroke
survivors remain mentally intact even though their
speech may be jumbled, fragmented or impossible to
understand.
Aphasia may manifest itself as trouble speaking, trouble
finding words, understanding what others say,
difficulty with reading , writing, or math, and/or the
inability to process long words and infrequently used
words.
People with aphasia are often frustrated and confused
because they cannot speak or understand things the
way they did before the stroke. They may act
differently because of these changes in their brain.
They report feeling isolated and alone. While these
feelings are normal, they should be reported to your
physician so they can determine if short term
medications will help the situation.
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Types of Aphasia
Receptive Aphasia: A patient with receptive aphasia is not
able to follow directions or has difficulty understanding
questions.
Some tips to make communicating with your loved one easier
include:
 Using visual cues
 Using simple gestures
 Simplifying instructions even to one word
 Speaking slowly
 Asking to perform tasks one step at a time
 Checking for comprehension frequently (don’t
assume that he or she understands)
Expressive Aphasia: Patients with expressive aphasia have
limited ability to use words. The patient may say words
that they do not mean, for example, “no” for “yes.”
Some tips to make communicating easier include:
 Using a communication board.
 Giving extra time for the patient to answer
 Giving auditory/visual/ written choices
 Using yes/no questions
 Asking the patient to point or gesture
 Using writing if appropriate
 Having the patient fill in the blank (e.g. Would you
like a cup of ----------?”
 Sometimes their words and sentences may not
make sense.
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My communication strategies include: ______________________
Dysarthria
Dysarthria is another communication and speech problem
that can occur with stroke. Dysarthria is characterized
by slow, “slurred,” or unintelligible speech. In other
words dysarthria affects how words are spoken. While
this often occurs with aphasia, a language problem, it is
not the same and can occur alone. Patients may
experience weakness of the lips and tongue affecting
speech clarity.
Some tips for improving communication with the patient
with dysarthria include:
 Sitting the patient up, if possible, for better breath
support
 Asking the patient to slow down and speak up.
 Asking the patient to over-articulate or pretend they
are speaking for a lip reader.
My Speech strategies are:__________________
If you have any questions regarding communication
between you and your loved ones, please talk to
your speech therapist of nurse for more helpful
tips.
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Swallowing Difficulties
Immediately following a stroke, patients sometimes have
difficulty swallowing or may not be able to swallow at
all. This disorder is called dysphagia. People with this
problem often cough or choke when or immediately
after they eat or drink. Food particles or liquid can then
go into the lungs and cause aspiration pneumonia. Safe
eating or drinking guidelines may be recommended by
a speech therapist. Please follow the provided
directions when feeding yourself or your loved one.
While in the hospital, do not feed your loved one
unless the staff has given you permission to.
The speech therapist working with your physician will
develop a treatment program to help you with any
swallowing difficulties. The therapist may recommend
special consistencies for food and liquids to decrease
the risks of aspiration and pneumonia. Please ask your
speech therapist, nurse or a dietitian for specific details
on the special food consistency that you may need.
My swallowing guidelines are:
___________________________________________________
___________________________________________________
____________________________________________________
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My diet is: ___________________________________________
Life After a Stroke
Treatment After You Leave the Hospital
Most people spend several days in the hospital after a
stroke. When you leave the hospital, treatment does
not stop. At home, your treatment may include daily
medicines and rehabilitation (rehab). Your doctor may
recommend lifestyle changes including quitting
smoking, losing weight, changing your diet, and
increasing your physical activity, to lower your
chances of having another stroke.
Your care team may feel you are not strong enough to go
directly home after your hospital stay and may
suggest that you go to a skilled nursing facility for
more rehab and strengthening. Your case manager
will assist you and your family with these
arrangements.
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Rehabilitation After
a Stroke
Rehabilitation is a critical part of the recovery of a stroke
survivor. The effects of stroke may mean that you must
relearn, change or redefine how you live. While rehab
does not reverse the effects of the stroke, it can help
you return to your optimum level of function.
Rehabilitation begins when your physicians determine you
are medically stable, you have the stamina to tolerate
the therapy, and that you will benefit from it.
Rehabilitation services are started in the hospital, but
can be continued in various settings such as an acute
rehab unit, skilled nursing facility, at home with home
health, or in out-patient facilities.
What you will do in rehab depends on what you need to
become independent. The rehab team will assess your
needs and determine a plan which may include:
 Self-care skills such as feeding, grooming, bathing
and dressing
 Mobility skills such as transferring, walking or use
of a wheelchair
 Speech and language skills to improve
communication
 Memory and problem-solving skills
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 Social skills for interacting with others
Rehabilitation After
a Stroke
The Rehabilitation Team consists of several specialists.
They include:
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Rehab physician
Rehab nurses
Physical, occupational, and speech therapists
Dietitians
Social workers
Support group members
Chaplains
The services you may require from each will be
determined by your physician and the team members
working together with you to develop an individual
rehab plan.
Palomar Pomerado Health has an Acute Rehabilitation
Unit (ARU) located within Palomar Medical Center
(PMC). Your physician may ask the staff to come and
evaluate you to determine if you are strong enough for
this intense program. If you are not a candidate
immediately after your stroke, you may be later after a
short stay at a skilled nursing facility (SNF) for
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strengthening.
PMC: Acute
Rehabilitation Program
The ARU at PMC is a hospital-based, comprehensive
physical and cognitive rehabilitation program
dedicated exclusively to treating those individuals who
have experienced a disabling injury or illness.
Services are provided for patients who have suffered
functional loss due to a stroke as well as other
rehabilitation diagnoses.
Our goal is to ensure an optimum level of recovery from a
CVA while providing cost-effective outcomes for each
patient. To reach our goal, the Medical Director works
with and coordinates the efforts of a team of
professionals focusing on improving the function of
each patient, in an effort to restore the patient to his/her
fullest potential.
The ARU at PMC accepts referrals from physicians, social
workers, rehabilitation nurses, case managers, patients,
and their families. Candidates for admission will
receive an assessment at no cost to determine their
appropriateness for the program. You can discuss
whether or not your diagnosis meets criteria for
admission to the ARU with your physician.
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Being a Caregiver
When a loved one is disabled, it changes the family
system by changing how each of the members relate to
each other. Being a caregiver can be a satisfying
experience but can also be stressful. Family roles
become confused. Some members may not feel
comfortable in their new roles or the caregivers new
role. Some may not want to “interfere” with what has
already been planned or decided.
Family meetings can be uncomfortable and awkward
especially for people who have not talked openly about
family matters before. Talking about feelings or asking
for help is difficult for many people.
Case managers, social workers, physicians, and nursing
staff at Palomar Pomerado Health are available it assist
you, your family and caregivers through this difficult
time. Chaplaincy services are also available. Please
notify your nurse or physician if you would like to
speak to anyone about this new role in your life.
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Caregivers Bill of Rights
I have the right to:
 Take care of myself.
 This is not an act of selfishness, it will enable me to
take better care of my loved one.
 Seek help from others even though my loved one may
object.
 I recognize the limits of my own endurance and
strength.
 Maintain facets of my own life that do not include the
person I care for, just as I would if he or she were healthy.
 Get angry, be depressed, and express other difficult
emotions.
 Reject any attempt by my loved one to manipulate me
through guilt, anger, or depression.
 Receive consideration, affection, forgiveness, and
acceptance from my loved one as long as I offer these
qualities in return.
 Take pride in what I am accomplishing and to applaud the
courage it sometimes takes to meet the needs of my loved
one.
 Protect my individuality and my right to make a life for
myself that will sustain me when my loved one no longer
needs my full-time help.
 Expect and demand that as new strides are made in
finding resources to aid physically and mentally impaired
persons in our country, similar strides will be made
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towards aiding and supporting caregivers.
Author unknown:
http://www.americanheart.org/downloadable/heart/1196275052136CaregiversRights.pdf
Life After a Stroke
Anxiety and Depression After a Stroke
Immediately after a stroke a survivor may respond one
way and weeks later respond entirely different. These
emotional reactions may occur due to biological causes
resulting from the stroke or psychological causes.
Emotional changes such as rapid mood changes, crying
or laughing that does not match a person’s mood or
that lasts longer than seems appropriate and depression
are common. Psychological changes including
frustration, anxiety, anger or apathy are common and
often helped by talking to someone and acknowledging
these feelings. These feelings are normal and let you
cope without feeling guilty about them.
Depression is common after a stroke and can be treated
with a variety of medicines. Depression often occurs
within two weeks of the event and may seriously affect
your rehabilitation and recovery. Depression also
affects people who care for you during your recovery.
If you think you or your loved one is suffering from
depression, please talk to your physician or nurse about
possible treatments available to you.
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Prevention
Modifying your personal risk factors is a very
important step in preventing another stroke. It
is also important for your friends and loved ones
to know their risk factors to prevent their first
stroke.
Healthy Lifestyle Choices
Healthy lifestyle choices to help prevent a stroke
include:
 Following a low-fat diet rich in fruits and
vegetables. Pay careful attention to the amounts
and types of fat in your diet. Lower your salt
intake. These changes can help lower high
blood pressure and high blood cholesterol.
 Losing weight if you are overweight or obese.
 Quitting smoking.
 Doing physical activity to improve heart
fitness. Ask your doctor how much and what
kinds of physical activity are safe for you.
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Prevention
Treat Related Conditions
In addition to making lifestyle changes, you can help
prevent a first or recurrent stroke by treating your
modifiable risk factors such as:
 High blood cholesterol.
 You may need medicine to lower your cholesterol if
diet and exercise are not enough.
 High blood pressure.
 You may need medicine to keep your blood pressure
under control.
 Diabetes. If you have diabetes, control your blood
sugar levels through diet and physical activity (as
your physician recommends).
 Take your medications as prescribed by your
physician.
 Quit Smoking now!
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Suggestions for Energy
Conservation
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Plan Ahead and Organize Your Work
 change storage of items to reduce trips or reaching
 delegate when needed
 combine motions and activities and simplify details
Schedule Rest
 balance periods of rest and work
 rest before fatigue
 frequent, short rests are beneficial
Pace Yourself
 moderate pace is better than rushing through activity
 reduce sudden or prolonged strains
 alternate sitting and standing
Practice Proper Body Mechanics
 when sitting, use well-supporting chair
 adjust work heights-work without bending over
 bend at knees and hips, not at back
 carry several smaller loads or use a cart
Limit Overhead Work
 use long handled tools
 store items lower
 delegate
Limit Isometric Work
 breathe evenly, do not hold your breath
Identify Effects of Your Environment
 avoid extremes of temperature
 eliminate smoke or noxious fumes
 avoid long, hot showers or baths
Reduce Stress
 learn relaxation techniques
 physical exercise reduces stress
 anticipate fatigue and stress and plan ahead to reduce stress
Prioritize
 decide what activities are important to you, and what could be delegated 44
 use your energy on important tasks
“Dial, Don’t Drive”
Use of Emergency Services,
Dial 911
 Learn the signs, but remember that even if you are
not sure it is a stroke, have it checked out.
 Minutes matter! Fast action can save lives, maybe
your own. Do not wait more than five minutes to
call 911.
 Calling 911 is almost always the fastest way to get
lifesaving treatment. Emergency medical services
staff can begin treatment when they arrive — up to
an hour sooner than if someone gets to the hospital
by car. The staff are also trained to revive someone
whose heart has stopped. Patients with stroke
symptoms who arrive by ambulance usually
receive faster treatment at the hospital, too.
 If you cannot access the emergency medical
services (EMS)/911, have someone drive you to the
hospital right away. If you are the one having
symptoms, do not drive yourself, unless you have
absolutely no other option.
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Palomar Pomerado Health: http://dialdontdrive.org/
Make This Plan a Permanent
Part of Your Life
Living with the effects of a stroke is a chronic condition and
requires continuous follow up with a primary care physician. If you
do not have a physician you see on an ongoing basis, please ask the
physician treating you here to assist you in finding a solution. The
case manager and social worker can also assist you with this
process. If you are having trouble sticking to your treatment plan,
please do not change anything. Talk with your nurse or primary
healthcare provider for help!
The Hurdles People Often Experience Are:
 Cost of medicines
 Communication issues
 Depression
 Caregiver issues
We can help and we want to help. Talk with your
nurse or primary healthcare provider about
these barriers and we can work out solutions
together! We are here for you!
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