STROKE : Elderly care

Published On - April 14, 2020

admin disease, doctor on call, Elderly bedridden, Homedoc, homedoctor, patient care, Pneumonia

Stroke

Stroke is a very common medical problem in elderly people. Stroke disease is a brain disease and is also called cerebral vascular disease(CVA) or brain attack.

In this we will discuss the following topics on stroke:

  1. Definition
  2. Classification
  3. Causes
  4. Diagnosis
  5. Treatments
  6. Complications
  7. Post-stroke care

 

Definition: stroke occurs when part of the brain loses its blood supply and stop working. Because of this injured brain, the part of the body controlled by that brain part stops working for more than 24 hours.

If the control of the part of the body is stopped less than 24 hours it is called TIA i.e Transient ischemic attack.

It is a medical emergency where the affected person needs to rush to the emergency care.

Classifications: Stroke is of 2 types

  1. Ischemic stroke where part of the brain loses blood flow.
  2. Hemorrhagic stroke where bleeding occurs within the brain.

 

Causes:

  1. High BP
  2. High cholesterol
  3. Diabetes
  4. Smoking
  5. Heart rhythm disturbances like AF

 

Clinical symptoms:

  1. Acute change is level of consciousness.
  2. Partial vision loss.
  3. Double vision.
  4. Difficult speech or slurring of speech.
  5. Difficult in balance or vertigo
  6. Acute Weakness or paralyze of half or part of the body.

 

FAST :

F–facial drooping

A-arm weakness

S-speech difficulty

T-time to call hospital/ ambulance

Diagnosis:

  1. The most important is clinical history from the patient or patient’s family.
  2. Radiological CT/ MRI scans to confirm the diagnosis of Stroke and rule out other causes.
  3. With the help of CT/MRI we can also differentiate the type of stroke.

Treatments:

  1. Maintain CAB where C stands for circulation i.e to maintain blood pressure to normal range. A stands for airways to see that can patient maintain his or her airway or needs ventilator support. B stands for breathing to see that patient breathing is fine or need an external support.
  2. Treatment of stroke depends on the type of stroke.
  3. For ischemic stroke we use antiplatelets and anti-thrombotic agents.
  4. If a patient reaches the hospital within 3 to 4.5 hours of the start of symptoms we can give tPA like alteplase, streptokinase injection to dilute the clot and improve the symptoms of the patient, but this injection can only be given if the patients reach hospitals before 3 to 4.5 hours of the start of symptoms and chances of bleeding in first 24 hours.
  5. Ischemic stroke needs surgery if the effected brain is of big size and because of which brain pressure is increasing.
  6. Hemorrhagic strokes need both medical and surgical management.
  7. Hemorrhagic stroke need neurosurgery review and if needed needs to be get operated.

 

Complications:

  1. Pneumonia
  2. Bedsores
  3. Infections
  4. Seizure

Post-stroke care :

  1. Physiotheraphist
  2. Occupational therapist
  3. Speech therapist