Common Neurological Deficits – Care Plan for Stroke Patients
Right or Left Sided Body Weakness (Hemiparesis)/Paralysis These patients will have mobility restr
ictions that may require total care. Total care is when the patient is unable to assist with any of the care required.
The side of the body that has weak or absent strength is called the dependent extremity. Ensure that the dependent extremity is always propped up on pillows when the patient is in bed.
These patients will require repositioning every 1 to 2 hours to prevent the development of
pressure ulcers (bed sores) and swelling in the extremity (edema). See the picture below to learn how to properly position your stroke patient when they are in bed with pillows.
1. Clothing:
Gently put dressing attire such as a blouse or pants first thru the dependent extremity as this will facilitate easier application of the clothing. With removal of the clothing, take clothing off the non-dependent extremity first and then the dependent extremity.
2. Difficulty swallowing (Dysphagia)
Most stroke patients will have a swallowing assessment conducted by a professional, as difficulty swallowing is a common deficit that can occur after a stroke.
These patients will have a modified diet so that they are able to eat safely with minimal risk of choking. A modified diet is everything but a regular diet. For example: dental soft, thin and thickened fluids, pre-mashed, fork mashed are all examples of modified diets. (see below)
You must strictly follow the patients modified diet at all times. Do not give your patient anything to eat or drink that is not apart of their modified diet plan. Most food items can be thickened or pureed so that your patient can enjoy their favorite foods.
Medications will also have to be given in according to their modified diet plan. This may mean that their medication is crushed or thickened prior to administration.
As with all patients, ensure your patient is sitting upright at 90-degrees prior to all medications and meals to prevent choking.
3. Communication (Aphasia)
Your patient may have difficulty speaking, this is called Aphasia. There are different types of Aphasia that can alter the way your patient is able to communicate with you after a stroke. Some patients may not be comprehensible when speaking, words may be mixed up when speaking, while others may not be able to say anything at all.
It can be distressing for both family and the patient when Aphasia is present after a stroke. It is important to find communication strategies that are effective to help overcome the communication barrier.
*Never assume your patient does not understand you, so do not say anything you do not wish for them to hear.
Have them try writing what they are thinking
Use gestures as needed to convey what you want
Have them draw a picture or you draw a picture
Point to pictures, charts
Use other words to describe what you want
If they get frustrated ask him or her to take a short break. Have him or her try again in a few minutes.
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