Treatment and Nursing Care of Stroke
When Stroke Attacks
Stroke is sudden. A person who used to have nothing physically unusual suddenly loses consciousness, falls to the ground unsupported, or is in a state where his or her arms and legs don't obey commands, shaking and slurring his or her speech.
Those around the patient are often at a loss for words and try to shake him, shout, try to bring him back to consciousness, or carry him elsewhere to rest. These are some of the worst emergency measures for a stroke.
In recent years, stroke has been the second leading cause of death. However, this does not mean that people who have a stroke will die. If they are given the right first aid, they will not be in danger of dying, and sometimes they can recover to a certain extent, and many of them will be able to continue to work.
So, the first aid during the attack is really important, if the attack is not handled properly, or delayed too late, it will cause serious adverse consequences.
The patient should be kept quiet
When a stroke occurs, the patient should, in principle, be kept absolutely quiet. If you panic and shake the patient or shout loudly, it may worsen the condition.
Because a stroke is sudden, there is no way to know when or where it will happen, and many people have them in inconvenient places, such as the bathroom, on the road, in a meeting place, or in the living room of a friend or relative.
If this is the case, people around the patient should never move him. If you are close to a hospital, you can stay put and find a doctor quickly. If it is not possible to find a doctor quickly, the patient must be moved to an appropriate place and wait for a doctor to come to diagnose the problem, or be sent to the hospital by ambulance. In short, the people around must have the ability to respond to the situation.
Handling the patient
As mentioned above, if the hemorrhage occurs in a toilet or courtyard, the patient must be moved into a room first.
At this time, attention must be paid to the position of the patient's head. If the patient's neck is bent and the head is drooping in an unnatural state, the patient's body must be moved gently to keep the head in a natural state, and the most appropriate position is with the head a little bit higher and tilted to one side.
When moving the patient, it is better to keep the patient's jaw upward, so the mover must support the patient's jaw with his hand, which serves to make the patient stop snoring and breathe smoothly.
If the distance to be carried is very long, or if it is a long way to the hospital, the patient must be taken to the hospital according to the doctor's instructions or accompanied by the doctor.
Loosening the patient's clothes
Stroke victims wear a variety of clothes, including work clothes, work clothes, and uniforms, not all of which are made of flimsy material.
So it's a good idea to loosen their tight clothing, sometimes with scissors as appropriate, or gently remove them and put on soft pajamas.
Additionally, the patient's resting place should be kept quiet, and no one should be allowed in or out. The light in the room should not be too bright.
Pay attention to the patient's face
The forms of stroke are categorized as cerebral hemorrhage and cerebral softening, but the methods of first aid are slightly different.
So, when a stroke occurs, it is important to find out whether it is caused by cerebral hemorrhage or cerebral softening. The easiest way to distinguish between these two symptoms is to pay attention to the patient's face. If the face is flushed, it is a cerebral hemorrhage, and if the face is pale, it is a cerebral softening, and epileptic seizures can cause a loss of consciousness, but it can be recovered in a short period of time, so it is not included in the discussion.
Softening of the brain is a disease specific to the elderly, so age is also a factor in identifying what kind of stroke is occurring. If a stroke occurs in a person in his forties to fifties, it is unlikely to be softening of the brain, but rather a cerebral hemorrhage, and emergency care must be sought.
After determining that you are having a cerebral hemorrhage, use a wet towel to cool your head on the opposite side of your paralyzed hand or foot. In other words, if the right foot is paralyzed, it is a brain hemorrhage on the left side of the body, so the head on the left side of the body should be cooled.
The head does not need to be cooled or elevated in the case of cerebral softening.
First aid for spasms
Patients who have collapsed due to a stroke will have spasms or tremors. At this time, people around him must restrain him from shaking too much, because the more he moves, the more bleeding there will be in the brain.
In addition, the teeth may hurt the tongue during a spasm, so the patient's mouth must be gagged with a cloth.
Management of vomiting
In the case of stroke, many patients have vomiting, which is more serious than in patients who do not vomit.
When a patient vomits, he or she is often unable to get it all out and swallow it back in. At this point, the vomit may enter the organs, leading to asphyxiation or respiratory distress and worsening the condition. Therefore, when a patient vomits, it is best to tilt the head to the side so that he remains in a position where it is easy to vomit.
If the vomiting continues, avoid moving the patient, as movement can intensify the vomiting and increase the amount of vomit that enters the windpipe, blocking respiratory function.
In addition, if the vomit remains in the patient's mouth, use chopsticks to gently scoop it out.
Paying attention to defecation
Defecation, urination, and stopping bleeding are the most effective dispositions for stroke, so enemas can be considered if necessary. However, it is important to follow your doctor's instructions in order not to cause adverse effects.
Avoid stimulating the patient
The patient must be kept absolutely quiet and must not be stimulated.
Light, sound, and wind from the doorway of the ward may irritate the patient, so curtains may be used to prevent the entry of light, or the position of the electric light may be changed, or the wind blowing in through the doorway may be blocked.
Additionally, visitors should avoid meeting the patient and be greeted by the patient's family. Idle people should be absolutely forbidden to enter or leave the hospital room.
The use of ice pillows
The use of ice pillows for stroke depends on the situation. It is necessary if there is brain hemorrhage, but not if there is softening of the brain.
No matter what the case is, it should be used according to the doctor's instructions. When using an ice pillow, it is advisable to avoid moving the patient's head, and two people can work together to immobilize the patient's head before placing the ice pillow on it.
The position of the ice pillow should be centered on the site of the brain hemorrhage. When the ice melts, the patient will have a headache and will not be able to stabilize, so when using the ice pillow, the ice must be replaced often.
Use of hot water bag
The use of hot water bag is mainly for brain softening. It can also be used to warm the feet of patients with brain hemorrhage, as in winter. However, when using a hot water bag, direct contact with the patient's feet should be avoided to avoid ironing. It is best to wrap the hot water bag in a blanket and place it in a position where it is not easily touched even if the foot is stretched out.
Use of diapers
When a stroke occurs, many people have bowel movements and urinate, and if the urine or stool is blocked and cannot be easily discharged, an enema must be given according to the doctor's instructions.
Most stroke patients are in a coma, some are conscious but paralyzed. So they can't handle their own stools and urine. At this point, the medical staff must use diapers to take care of his excretion.
If the patient is stabilized, warm water or olive oil can be used to wipe the area to keep it clean. In the summer, talcum powder can also be used to increase the patient's comfort.
Thermal insulation and air circulation
The temperature of the ward should be maintained at 18-20 degrees Celsius, and in summer, the room temperature may increase to more than 30 degrees Celsius, which means that the ventilation of the room should be taken into consideration. However, you can't open windows, doors or blow directly on the patients with electric fans, as this will have adverse consequences for the patients.
In winter, heating equipment is needed, and in this case, electric heaters are the most suitable because they do not have the risk of gas leakage, and at the same time, they do not produce large amounts of carbon dioxide.
Only when using heating equipment, remember that the temperature should not be too high, which is harmful to the patient. In addition, it is advisable to avoid drying out the air in the ward. You can increase the humidity by boiling water in the room to produce steam or by opening the windows frequently to make the air circulate.
Cleaning of the ward
The ward must be kept clean. However, since there are patients in the room, it is important to consider how to clean the room. It is better to avoid using a duster, and it is best to use a vacuum cleaner if you have one, but if not, you can use a rag to wipe the room.
When cleaning the ward, you can cover the patient's face with a handkerchief to avoid dust falling on the patient's face, and then gently clean. When cleaning, you can also tear up the newspaper and put it on the floor, because the newspaper has the effect of absorbing dust, which can avoid dust flying everywhere.
Cleaning of the patient's body
A patient who has suffered a stroke is not allowed to move around for one or two weeks. So some degree of dirtiness is inevitable.
If the situation is good and you have the doctor's permission, you can wipe the patient's body. The cleaning does not have to be done all at once, but can be divided into hands, feet, and all parts of the body, taking several days to complete, and the action must be quick. Especially in winter, you should avoid making the patient cold, so you should pick a warmer day to help the patient wipe.
Bathing should also be done with a doctor's permission, and the caregiver should not be allowed to do it without authorization, as this may worsen the condition.
Preventing bedsores
Patients who have suffered a stroke may be confined to their beds for months, even if their symptoms are mild. Because the patient is paralyzed and can't move freely, it's easy to get bedsores if you stay in the same position for too long.
Decubitus ulcers can start with redness on the skin that touches the bed and can turn into pus or sepsis in severe cases.
In order to prevent bedsores, after the patient stops bleeding, the caregiver should be two people to change the patient's posture, first the cushion to the folds, placed behind the patient so that he lies on his back, and then the left and right side to change.
The discomfort of bedding is also the cause of bedsores, so it is necessary to choose the texture of the soft and light sheet, the following can be laid under the seafoam cushion. In addition, the crease in the sheet can also cause bedsores and must be smoothed out.
The pleats on pajamas, or the hard seams and straps, can cause bedsores, so be careful.
Bedsores can also develop early if you are not clean.
If you already have bedsores, you need to treat them as soon as possible to prevent them from getting worse.
Most of the areas that are prone to bedsores are the waist, shoulders and ankles. If you see redness in these areas, you must massage the area with sterilized alcohol and then dust it with talcum powder.
If the epidermis is ruptured and the tissues are eroded, you must rub olive oil or alcohol around the affected area, then apply a liniment ointment, then wrap it with an emery cloth, and finally put an air pillow underneath it to avoid pressure on the affected area.
Patient's diet
For the first few days after a stroke, the patient does not need to be given food, because the doctor will give the patient glucose or saline injections to replenish the patient's nutrients and water. If the patient needs to eat or drink, he or she should talk to a doctor for proper dietary instructions.
The diet of a stroke patient is roughly the same as that of a weaned toddler, starting with fluids such as milk, rice soup, fruit juice, three-minute porridge, five-minute porridge, and then gradually moving on to regular food.
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