Home Care for Stroke Patient

Recovery is the process of healing after a disease or major life-changing event. Stroke recovery happens as soon as the disease process is under control. The brain starts to slowly respond to the damage done to it and will alter or change its way of functioning to accommodate for the loss or death of parts. It is though this time that the patient's outcomes are questioned.

The brain and how it repairs itself is still a mystery. This is what makes each stroke survivor's prognosis different. Doctors, nurses, and therapists can only guess on how a patient will respond according to the location and severity of stroke. It is the support of the survivor's family, friends, and self that can make all the difference in recovery.

Recovery from stroke happens in a "two steps forward, one step back" process. There may be days of remarkable recovery for the stroke patient, and then there may be days of great loss. It is during this time that caregiver, friends, and family must find joy in the smallest of gains in your loved one.

The family gives us a sense of belonging, completeness, and use in life. When a family member suffers from a stroke the worse thing that can be done is to disconnect them from the family. The stroke survivor may not be able to immediately resume the roles they had previously, but to completely leave them out of the family interactions is disastrous. In our attempts not to do this there are times when we swing too far the other way. We give too much family control to the stroke survivor, not thinking of their limitations. This is painfully true when the stroke survivor is the leader or elder of the family.

How to Prevent Complications

Chances of developing complications after stroke are increasing due to muscle weakness, inability to move properly and activity to control posture. Therefore, preventive measures are of importance in determining patient's best care.

Pressure Sore

To prevent bed sore or pressure sore is crucial to all aspects. Decreased blood flow to the affected skin area anticipates this harmful complication.

Skin Care

• thorough examination of the whole skin, especially the pressure area
• move and turn over the body to one side regularly every 2 hours
• light message with cream
• avoid wet or dry dressings
• use of weight-bearing support
• clean salivary leakage
• adequate nutrition and water balance, protein and vitamin C for tissue repair
• soft bed is not recommended

Urinary Tract Infection

Stroke patients have urinary incontinence or decreased bladder capacity, so catheter may be retained. Special care must then be applied in order to prevent catheter-related infection. Cleansing genital area is recommended . Urine amount, color, and odor should be observed. Adequte hydration is necessary for prevention of urinary tract infection

Defecation Complications

Constipation seems to be the most frequently encountered problem due to inability to move and less fluid intake. Patient should be encouraged to exercise abdominal muscles, practice regular toilet habit, and take more fiber diets. Principally, vegetable such as lettuce, fruits such as papaya, prune juice, orange juice and drinking water of 2,000-2,500 ml. are preferable. Laxatives or suppository preparation may be added if required.

In case of diarrhea, especially 3-4 times a day, stool color and amount must be observed. Clinical deterioration in this situation needs prompt medical consultation.

Enteral Feeding

Loss of appetite causes a major problem in every chronic illness. Energy is inadequately produced. Gradual weight loss can then be noticed after such a period. Not only the amount of food, but also the quality of which patients take is also in consideration.

Dietary requirement in stroke patients comprises all classes of nutrition. Waterv balance is individually different. Recording water intake and output is essential in monitoring fluid balance, otherwise at least 1.5 liter per day is considered. In case of gastrointestinal tract bleeding, it may be due to stress, drugs, coagulation defects, improper nutrition supply or irritation from nasogastric tube insertion. Medical consultation is recommended when black stool, anemia, fatigue and abdominal pain are observed.

Respiratory Care

Stroke patients have limited lung expansion due to mobility. Neither could they effort full inspiration and expiration. Secretions can be collected at the lower part of the respiratory tract as well. These put them at risk of lung infection . If aspiration should occur, the risk will be heightened. Lung infection is fatal and may be the cause of death in many cases.

For Elderly Patients

• Observe abnormal breathing pattern. Difficulty breathing, or tachypnea with fever should be noted. Prompt consultation is warranted
• Drink water or fruit juice at least 1.5 liter
• Keep the body warm
• Cough training

Disability

Prevention of disability is the mainstay of care. Movement of joints conserved with best positioning and as rapid as possible. To prevent joint stiffness, active and passive motion exercise must be encouraged. Leg extension and full-length standing should be exercised. In rigid type of paralysis, stiffness of shoulder, hip, ankles is commonly seen. While in flaccid type, atrophy of muscle of the wrist and ankles is very common.

Positioning is essential since management of joint stiffness is very difficult. Physical therapy may not be sufficient , and many have ended up with surgery. So prevention is worth practicing than others.

• Move every joint around especially shoulder joint.
• Use of joint support, such as foot board.
• Special care for pressure area, using pillows or clothes