Archive for the ‘Stroke’ Category

Posted on March 14, 2011 - by Nurse Virginia

THREE VERY IMPORTANT HOURS – WHEN A PERSON HAS HAD A STROKE

“Help, help, I can’t get up,” Vera called out to her sleeping husband. Vera was used to waking up around 3 a.m. and reading for an hour before going back to bed. But that night after sitting for an hour at the kitchen table, when Vera tried to stand up to walk back to bed – she found she couldn’t walk and fell.

Vera’s husband Charles called 911 – but when the paramedics came, the elderly couple persuaded them to “Just help Vera to bed.” Two hours later when Vera wanted to get up to go to the bathroom, she found she still couldn’t walk. Charles once again called 911 and this time Vera went to the hospital.

But precious time had been lost. Vera never regained the use of her left arm or leg and she never walked again. This year marks the eleventh year she has lived in a nursing home. Those paramedics who responded have long past forgotten that night. The night someone should have asked the question, why a woman who an hour ago could walk, can’t walk now.

Today we are told that if a Neurologist can get to a stroke victim within three hours of the stroke – they can expect a full recovery. The person there, standing next to the stroke victim, is the most important person. Recognizing the symptoms and getting the stroke victim to help can mean everything.

SIGNS OF A STROKE:

• Ask the person to smile.
• Ask the person to repeat a simple sentence – “It is sunny outside today.”
• Ask the person to raise both arms.

If the person is unable to do any one of these tasks call 911 – time is of the essence.

Also ask the person to stick out their tongue – if it is crooked or off to one side – it is a sign of stroke.

Vera and Charles never complained, they never even suggested that anyone was at fault. It just was what happened that night. What Vera did with those eleven years was what was important.

 

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

Posted on October 18, 2010 - by Nurse Virginia

SIGNS OF STROKE EVERYONE SHOULD KNOW

A stroke or brain attack can happen to anyone, and at any age. There have been many reports of stroke even in children. Everyone needs to be aware of the signs of a stroke and be ready to act.

STROKE OR BRAIN ATTACK IDENTIFICATION:

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke…totally. He said the trick was getting a stroke recognized, diagnosed and then getting the patient medically cared for within 3 hours.

Unfortunately, the lack of action and a sense of emergency can prove to be disastrous. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke and bring the victim for emergency treatment.

S   T   R O    K    E

S * Ask the individual to SMILE

T *       Ask the person to TALK and SPEAK A SIMPLE SENTENCE

(It is a sunny day today)

R *      Ask him or her to RAISE BOTH ARMS

IF HE OR SHE HAS TROUBLE WITH ANY ONE OF THESE TASKS CALL 911 IMMEDIATELY and describe the symptoms to the dispatcher.

NEW SIGN OF A STROKE ——STICK OUT YOUR TONGUE

Ask the person to stick out their tongue – if the TONGUE IS CROOKED  – GOES TO ONE SIDE OR THE OTHER, THAT IS AN INDICATION OF A STROKE.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on August 31, 2010 - by Nurse Virginia

HOW TO TALK TO THE ELDERLY CONFUSED PERSON WITH DELUSIONS

“It is getting harder and harder to visit. Mom keeps saying Dad divorced her.” the visiting daughter said to the nurse. No matter how much reassurance the daughter provided that Dad never would have divorced her, and that he has passed away and is now in heaven. The elderly mom keeps coming back to the same topic of “the divorce.”

Reoccurring false ideas that are unshakable in the confused elder may be delusions.  It can become very frustrating to try to visit with a person who keeps repeating the same delusional thought.

Delusions in the elderly can be a way of explaining their life to themselves now. In this case the elderly woman’s husband had died several years ago. He had been very attentive and at her side ever since her stroke. Now mom is trying to make sense of his absence and her mind is trying to find an answer.

The daughter giving reassurances based on knowledge of her parents past, just doesn’t compete with the mother’s internal voice telling her this story that she believes is more probable. Because the mother has this fixed belief she finally tells the daughter “You always did take his side.”  And so it ends, because mom isn’t going to let go of this fixed idea, and it is best just to change the subject.

The best response the daughter can have is to remain calm and not react dramatically to what is said. It isn’t always necessary to agree or disagree; sometimes it is just important to be there. If it is an ongoing thought or worry that could be checked out – offer to do so and get back to the elder.

If the daughter would become adamant and even angry stating that the mother is wrong and “it just isn’t so.” The mother would most likely shut down and not think it safe to confide in the daughter her worries and concerns.

This situation would not be considered a particularly bizarre delusion because it is not unusual for people to get divorced. A bizarre delusion would be an ongoing thought that couldn’t possibly have happened. A bizarre delusion could be that the elder, states that the President doesn’t like them, or that they are personally responsible for some large disaster. Some idea so impossible, that it enters the category of bizarre.

Any change in level of confusion or increase in confused thoughts needs to be reported to the elder’s physician. When visiting the best thing to do is offer reassurances by holding the elder’s hand, making eye contact, use a low soothing tone of voice and if able redirect the conversation to a safe topic.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on August 23, 2010 - by Nurse Virginia

ALZHEIMER’S DISEASE OR VASCULAR DEMENTIA? MAYBE IT REALLY IS BOTH – THE MIXED DEMENTIA

(PART II)

When the elder is showing signs of an increase in their confusion it is time to have a baseline cognitive assessment. There are many types of cognitive assessment as well as many different healthcare practitioners who give them. From psychologists and neuropsychologists, to speech therapists many professionals conduct this testing. The testing will include:

• History – what was normal for the elder as far as their intellectual functioning?
• How are they functioning now intellectually?
• Attention span will be tested as well as concentration.
• Short-term memory
• Long-term memory
• The ability to recognize things
• The ability to recall – maybe a list of unrelated items.

The family or caregiver will be asked the level of self-care abilities. Are there changes in hygiene, socially appropriate behaviors, dressing inappropriately for season, weather or wearing the same clothes all the time.

What is really important in the testing is the elder’s self-reporting of problems they are having. This includes how they feel about the losses they are reporting. Testing should always be done if possible when the elder is not taking any form of antipsychotic medication to mask any symptoms.

While losses due to Vascular Dementia are the same for the elderly as losses due to Alzheimer’s disease, becoming familiar with the stages of Alzheimer’s disease can be very helpful.  By the caregiver knowing the stages of Alzheimer’s disease, they can better identify whether the cognitive losses are following a pattern or are more random.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on August 17, 2010 - by Nurse Virginia

ALZHEIMER’S DISEASE OR VASCULAR DEMENTIA? MAYBE IT REALLY IS BOTH – THE MIXED DEMENTIA

(Part I)

Mixed dementia, is when the elder has vascular dementia and now is also demonstrating signs of Alzheimer’s dementia.  Researchers are now finding on autopsy of the elderly who have had a stroke, almost 45% also have the plaques and tangles associated with Alzheimer’s disease.

Alice had a stroke eight years ago, and her family was told that she has Vascular Dementia. For several years after the stroke, Alice’s level of confusion stayed constant. Alice, who could no longer walk, would “forget” she couldn’t walk. Alice would talk about how during the night in the nursing home her roommate would call out for something. Alice would then tell how she had gotten up and went to help the roommate. It was simple during those years to talk through those reoccurring false ideas. Alice would agree, that what she thought happened couldn’t have happened.

But for the most part Alice was still the Alice everyone knew. She still had a dry sense of humor, recognized everyone, and had her short term as well as long-term memories. Due to the severity of the stroke Alice could no longer take care of herself physically. But mentally she was the sharpest elder at any activity and the staff counted on her many times for trivia answers.

However for the last six months her family and her nursing home family have been concerned about her occasional lapses into an extremely confused state. Mini-strokes (also known as TIAS, transient ischemic attacks) result in partial blockage of blood flow to the brain and will appear as a decline in a step pattern. The elder will decline and then stay at that level of function for some time until another “Mini stroke” and then a further decline.

These declines can be in areas of memory loss, ability to think and reason, increased confusion, slowed thinking as well as declines in function and changes in behavior. But the declines do not follow a pattern; it remains very individualized depending on where the blockage is and how much damage has been done.

Alzheimer’s dementia follows a distinct pattern of losses or stages of decline. From; Stage 1, no cognitive impairment through to Stage 7, very severe cognitive and functional decline, or total care.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on August 6, 2009 - by Nurse Virginia

Caregiver Tips: Part III – The new stroke patient needs the caregiver with empathy.

Start with getting to know the person.

The couple down stairs from Mabel aren’t related to her, what a surprise. Knowing this was a turning point in her care. Now I spent the time that I should have before, sitting with her and hearing her story.

Mabel told me she had had many chances to marry over the years and had always chose her career. She spoke of the high power job she had chosen over family, all the opportunities for travel and the influential people she had met. Mabel said that she knew there would be a price to pay someday for not having that family, but the day came sooner than she expected. Taking the time to get to know her, created the relationship I needed, to have the conversations with her that we needed to have.

4- Questions the nurse will need to ask to get to know the person.

1.What was her past experience with healthcare? Mabel had always enjoyed amazingly great health. She had no previous hospitalizations, no surgeries and had expected to have an uneventful retirement.
2. Had she ever been a direct care giver for a family member or anyone else? No, Mabel’s parents had died years ago in an auto accident, she had no siblings. No one had ever needed Mabel in that capacity.
3. What did she know about stroke and the level of patient participation that would be required for recovery? Mabel said she had little knowledge of stroke, only having heard other people’s experiences with their parents. Those stories usually ended with the parents needing Nursing Home care. This was her fear that with no family to care for her, this would be her fate.
4. How would she feel about someone coming into her home for a while? If it came to going home with a caregiver or going to a Nursing Home, Mabel didn’t even consider it a choice – she would be going home. Mabel shared that she had been well compensated for her high powered job. She had intentionally bought a two flat building so that when she was traveling, someone would be on the property. Now she realized that she should have taken the lower level, and at her first opportunity she would make that switch. She also had very good insurance as well as Medicare benefits.

Having these conversations after already establishing a relationship, increases the quality of communication. Picking the right time to have these conversations was most important. A time when Mabel was well rested and open, when we would not be disturbed and when the nurse could give her full attention.

Once Mabel felt the empathy from the nurse, it was much easier to answer the hard questions. After developing the relationship the nurse was able to follow up with the questions to assess Mabel’s knowledge base regarding her current condition. After the sharing of the information the nurse was better able to reflect and imagine how Mabel’s former life was and how the healthcare team could help her get back to the life she had carved out for herself.

Posted on August 3, 2009 - by Nurse Virginia

Caregiver Tips: Part II – The new stroke patient needs the caregiver with empathy.

Feeling another’s pain – empathy.
Thinking about the Kim family and how that connection was never made with Mr. Kim that could have made all the difference. It put me in mind of a day many years ago when I had needed to “call-in” to work. Something I very rarely did, but it was the words of the Director of Nursing that have

Posted on August 1, 2009 - by Nurse Virginia

Caregivers Tips: The new stroke patient needs the caregiver with empathy, with the ability to understand another’s feelings

 

Part 1

“This can’t be happening to me!”

He was a nice looking forty-ish man of Asian decent. I had never before, but the wide eyed “Oh my goodness this can’t be happening to me, get me out of here” expression I had seen many times. Mr. Kim had just experienced a stroke the day before affecting his right side.

Mr. Kim was a successful local restaurant owner who, just the day before had been living his life, running the restaurant with his wife of 20 years. Now he had some limitations in his right leg and arm, however they were of such a moderate degree that total recovery was pretty much assured. The significant change was his speech which was totally garbled and difficult to understand.

When he found no one could understand him, it didn’t take long for the look of “Oh, my goodness” change to a look of anger and total disgust. Whenever a staff member attempted to reassure Mr. Kim that he could look forward to a remarkable recovery due to his age. His expression said it all, I don’t believe you, and I don’t trust you.

Mrs. Kim visited every day, all day long, while he kept gesturing to her to pack his clothes and let’s get out of here. After a few days, due to Mr. Kim’s lack of participation in therapy, arrangements were made for him to go home. He promised that he would participate in home therapy.

With any therapy you only get out of it what you put into it.
Shortly after Mr. Kim left us to go home, we went as a group from the therapy department, out to dinner. We decided to go to the Mr. Kim’s restaurant to ask his wife how he was doing. We found to our dismay that when Mr. Kim went home he refused all therapy and started drinking, a problem that he had overcome many years prior.

Two years and many patients later I stopped at Mr. Kim’s restaurant again, this time with my family. There was Mrs. Kim as always showing diners to their tables. She remembered me and tears came to her eyes as she thanked me for everything the staff had done for her husband. She told me that after he came home his condition never improved and that he was a very angry man and spent his days drinking. She and their son had decided that he would be better off going back to Korea to be taken care of by his parents. Mr. Kim had died there six months ago, just short of his 50th birthday.

How could this happen to a man not that old and not that debilitated?

In taking the time for reflection it occurred to me that in my role of nurse- I had certainly been sympathetic, in fact very sympathetic but empathetic, maybe not.