CARE1112 Week 12

CARING FOR CLIENT

WITH NEUROLOGICAL
CONDITION
Week 7
 Stroke (Cerebral vascular accident)
• Stroke occurs when ischemia or hemorrhage into the
brain results in death of brain cells.
• Also known as a brain attack
• Functions are lost or impaired.
• Such as movement, sensation, or emotions that were
controlled by the affected area of the brain
• Severity of the loss of function varies according to the
location and extent of the brain involved.
• Third most common cause of death in Canada
• Leading cause of serious, long-term disability
• Approximately 35% of individuals who have an initial
stroke die within 1 year. 2
 Types of Stroke
• Strokes are classified on the basis of underlying pathophysiological
findings.
Ischemic: Ischemic strokes result from
• Inadequate blood flow to the brain from partial or complete occlusion of an artery

* 87% of all strokes are ischemic strokes.

• Can be : Thrombotic
Embolic
• A TIA is usually a precursor to ischemic stroke.

Hemorrhagic: Account for approximately 15% of all strokes

• Result from bleeding into the brain tissue itself or into the subarachnoid
space or ventricles
• Intracerebral hemorrhage
• Bleeding within the brain caused by rupture of a vessel
• Hypertension is the most important cause.
3
• Hemorrhage commonly occurs during periods of activity.
RISK FACTORS
Nonmodifiable:

• Age (older than 55), gender, race, hereditary

Modifiable:

• Hypertension
• Cardiovascular disease
• Metabolic syndrome
• Obesity
• Diabetes
• Oral contraceptive use
4
• Smoking,drug and alcohol abuse
• Physical inactivity
Major Types of Stroke

Figure 60-3 Major types of stroke.

5
Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
Ischemic Stroke
Transient ischemic attack (TIA)
• Transient episode of neurological dysfunction caused by focal
brain, spinal cord, or retinal ischemia, without acute infarction
of the brain. Symptoms last <1 hour.
• Symptoms
Thrombotic last <1 hour
stroke
• Thrombosis occurs in relation to injury to a blood vessel wall
and formation of a blood clot.
• Result of thrombosis or narrowing of the blood vessel
• Most common
Embolic stroke cause of stroke
• Occurs when an embolus lodges in and occludes a cerebral
artery
• Results in infarction and edema of the area supplied by the
involved vessel
• Second most common cause of stroke
• Patient with an embolic stroke commonly has a rapid
occurrence of severe clinical symptoms.
6
 CARE1112 Week 12

Warning Signs of a Stroke

• Stroke can occur suddenly
• The person may have warning signs:
• Sudden weakness, numbness, or tingling of the
face, arm, or leg, especially on one side of the
body
• Sudden loss of speech or trouble understanding
speech
• Sudden vision problems, especially in one eye
• Sudden severe headache with no known cause
• Sudden dizziness and loss of balance
• FAST- facial drooping, arm weakness, slurred speech,
time you respond
Clinical Manifestations
Affects
many body
functions Motor
Sensation
activity

Personality Communications

Elimination Affect

Spatial- Intellectual
perceptual function
8
 CARE1112 Week 12

Effects of Stroke
• Hemiplegia paralysis (plegia) of one side (hemi) of the body.
• The area of the brain damage determines the symptoms the
client experiences.
• Weakness on one side of the body
• Loss of facial muscle control
• Difficulty swallowing (dysphagia)
• Dimmed or loss of vision
• Loss of the ability to speak or understand
• Impaired memory
• Aphasia – loss of speech
• Damage on the right side of the brain results in symptoms on
the left side of the body.
• Emotional changes may also occur
 Clinical Manifestations
Motor Function
• Most obvious effect of stroke include impairment of
• Mobility
• Respiratory function
• Swallowing and speech
• Gag reflex
• Self-care abilities
• Characteristic motor deficits
• Loss of skilled voluntary movement
• Impairment of integration of movements
• Alterations in muscle tone
• Alterations in reflexes
10
Impaired mobility (severe):
• Place objects within reach on non-affected side
• Instruct to exercise to strengthen non-affected side
• Encourage passive ROM (4-5x/day)to affected side
• Provide immobilization to affected side if needed (i.e..
arm sling during transfers; trochanter roll, lap boards,
splints, hand cones)
• Assist with transfers
• Maintain good body alignment
• Assistive devices Safety measures
• Promote participation in self care
11
• Regular skin assessments and care
• Turn Q2H if unable to move self
 12

PSW INTERVENTIONS
Altered Sensory Perception:
• Avoid using extremity due to risk of injury
• ROM to affected limb and assistive devices if needed
• Teach client to monitor limb during transfers and
when positioning self
• Be aware of temperature of bath water, food etc.
• Inspect limb for injury and skin integrity
• Blindness in same half of each visual field is a
common problem after stroke.
 PSW INTERVENTIONS
Impaired Verbal Communication:
• Listen attentively to convey the importance of client’s thoughts.
Allow sufficient time to respond
• Use alternate communication aids (i.e.. alphabet/picture board)
• Encourage practice of exercises to strengthen facial muscles
• Encourage to repeat sounds of alphabet
• Provide support in dealing with frustration related to speech
difficulty
• Speak slowly, calmly and clearly to assist client in forming
sounds
• Do not interrupt or finish their sentences for them
• Short instructions supported with visual cues
• Gestures may be used to support verbal cues 13

• Speech Language Pathologist

 PSW INTERVENTIONS
Unilateral Neglect:
• Monitor abnormal responses to three primary types of stimuli:
sensory, visual, and auditory
• Instruct client to scan from left to right to visualize the entire
environment
• Rearrange the environment to use the right or left visual field
• Touch unaffected shoulder when initiating conversation to
attract client’s attention
• Gradually move personal items and activity to affected side, as
client demonstrates an ability to compensate for neglect
• Include caregivers in rehabilitation process to support the
client’s efforts and assist with care to promote reintegration with
the whole body 14
 15

PSW INTERVENTIONS
Impaired swallowing :
• Test pharyngenal reflexes before offering food or fluids
• Minimize distractions
• High Fowler’s position for meals
• Remind pt to hold head upright and make a conscious effort to
swallow saliva and chew thoroughly
• Place food on unaffected side of mouth and watch for pocketing
• Cut food into small pieces to prevent choking
• Provide assistance with food, supervise if needed
• Food texture and thicken fluids
• No straws
• Allow ample time to eat
• Have suction available
 16
PSW INTERVENTIONS
Inadequate Nutrition:
• Keep mealtimes simple and calm…supervise
• Provide assistance with food, supervise if needed
• Special utensils (plate stabilizer or non-spill cup)
• Thickened fluids may be needed for swallowing
• Offer one dish at a time (select high nutrient foods first) and foods
that are easy to eat or pick-up
• Snacks and supplements
• Monitor weight
• Track intake if loosing weight
• Use mealtimes to practice functional skills and provide socialization
• Dietician
 Assistive Devices for Eating

Fig. 60-13. Assistive devices for eating. A, The curved fork fits over the hand. The rounded plate helps keep
food
on the plate. Special grips and swivel handles are helpful for some persons. B, Knives with rounded blades are
rocked back and forth to cut food. The person does not need a fork in one hand and a knife in the other. C,
Plate 17
 CARE1112 Week 12

Caring for your Client

• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Assistance with ADLs
• Emotional Support
 RECOVERING FROM STROKE
• Recovery is influenced by initial degree of
impairment and continues for at least 3-6
months. After this point residual (little)
progress occurs.

• Rehab and proactive multidisciplinary care

should begin on day one

19
 CARE1112 Week 12

Acquired Brain Injury

• Also referred to as Traumatic Brain Injury
• A traumatic brain injury, often referred to as a
TBI or ABI, is a type of acquired brain injury
resulting from a sudden trauma that causes
damage to the brain.
• The area of damage within the brain will
determine the behaviours/symptoms that are
displayed
 CARE1112 Week 12

Problems associated with ABI

• Attention and concentration
• Memory
• Orientation x 3
• Decision-making
• Problem-solving
• Learning anything new
 CARE1112 Week 12

Physical Symptoms
• Headache
• Fatigue
• Dizziness
• Uneven gait
• Nausea
• Visual disturbances
• Seizures
• Changes in eating or sleeping’
• Loss of one or more senses (depending on area
of damage in the brain)
 CARE1112 Week 12

Behavioural Changes
• Depression
• Anxiety
• Irritability
• Emotional or impulse control difficulties
• Decreased initiative or motivation
 CARE1112 Week 12

Care of a person with ABI

• Follow care plan: reassure them that the
symptoms are related to the injury to their brain
• Maintain routine and structure in daily tasks
• Encourage the client to set short and long-term
goals.
• Adaptive devices should always be accessible
for the person
• Focus on what they can do not what they can’t
do
 CARE1112 Week 12

Seizure Disorders
• “A brief disturbance in the brain’s normal electrical
function, which affects awareness, movement, and
sensation” (Sorrentino & Remmert, 2013, pg 893)
• When only part of the brain is affected it is
considered a ‘partial seizure’
• When the entire brain is involved it is considered a
‘generalized seizure’
• Symptoms seen are dependent on what area of the
brain is affected
 CARE1112 Week 12

Epilepsy
• Recurrent episodes of convulsive seizures, sensory
disturbances, abnormal behaviours, and loss of
consciousness
• A seizure involves violent and sudden contractions or
tremors of muscle groups and causes uncontrolled
movements and loss of consciousness
• A single seizure does not mean a person has epilepsy, but
it can develop any time
• Affects children and young adults
 CARE1112 Week 12

Examples of Seizures and Care to Provide

• Care of a person having a seizure.
Children Hospital of Colorado (2013, October 8).
What to do if someone is having a seizure [Video file].
Retrieved from
https://www.youtube.com/watch?v=fvlzKoP10iQ
 CARE1112 Week 12

Do’s and Don'ts when caring for someone having

a seizure
• Do – Safety is paramount!
• Protect the head
• Remove everything around them that they may hurt
themselves on
• Put them in recovery position
• Reassure them when they awake or let them sleep as
needed.
• Don’t
• Put anything in their mouth
• Try and hold them still
 CARE1112 Week 12

Safety
• Safety is paramount when caring for any
person but more so in someone who may be
unpredictable. Stress, fatigue and physical
illness can increase symptoms or trigger
episodes of the persons mental disorder.
• Always provide a calm, stress-free and safe
environment.
• Watch for any changes in the person either
physical or mental.
• Report these changes to the supervisor
 CARE1112 Week 12

Group Work
• Break into groups of 3 – 4 max
• Work on assigned Case Study and then present to class