Stroke Part 1: What Should I Do?

You hear your loved one just had a stroke and now can't walk, can talk, can't eat, can't lift their hand and is in the hospital. A sense of disbelief, then shock comes over you. Where do you even start?! Here are 8 steps you can take to help you adjust as a family, as your loved one is in the hospital for one to two weeks depending on the severity of the stroke.

1) Adjusting to the situation: The first couple of days it will be a shock, and you will have to allow yourself time to adjust and take it all in. Understand, that your loved ones symptoms will fluctuates the first 5 days as the body's immune system reacts to the injury causing some inflammation to the brain.

2) Educate and ensure Rest: Find a short educational video about what stroke is, the causes, symptoms, and treatment so your loved one can have a better idea of what has occurred with them. This is especially helpful if your loved one is older and is non-english speaking. Ensure your loved one rests well in order that they have enough strength to do exercises during the day.

3) Create a schedule: Make a list of people who can come support/translate for your loved one while they are in the hospital. Then, create a schedule of who can come what shift (Morning shift 8-4, Evening 4-12, and Night 12-8). The schedule will help ensure that relief is provided for all involved during this critical stage.

4) Exercise regimen: During the day, help your loved one start exercising. The sooner your loved one starts exercising the better. You can do these exercises every hour for 10 minutes as tolerated.

• Exercises to do in bed: https://www.youtube.com/watch?v=5VqSrFGyOF0
• Exercises of upper arm: https://www.youtube.com/watch?v=3GbpbuwcWDk
• Exercises of lower arm: https://www.youtube.com/watch?v=BM0P-iLSlbs
• Have people stand on your loved ones weak side as much as possible.
• Other: Have them practice squeezing their hands, raising their hands and feet. You can also massage their weak side to stimulate the senses. 

5) Nutrition: It might take 2-3 days to start giving your loved one something by mouth in order that they make sure your loved one can swallow well after the stroke. A speech therapist is the one who will have to evaluate your loved one. If they cannot swallow well they might need a feeding tube, either through the nose (NG) or the stomach (PEG).

• NG tube insertion: https://www.youtube.com/watch?v=1OakmxZDa5c
• PEG tube insertion: If after a week your loved ones swallowing doesn't improve, they might consider inserting a PEG tube. Understand, that a PEG tube can be temporary and that with time, it can be removed if things improve. Showing a before an after picture of the incision might help your loved one feel less anxious about getting one. 

6) Preventing skin breakdown: Its important to turn your loved one every 2 hours to avoid pressure ulcers or red wounds to form on your loved ones bottom from lack of movement.  Use the white board in the room to keep track of when your loved one was last turned.

• Since your loved one can't shift their weight, try to limit their stay in a a chair for 1:30-2 hours. 

7) Collaborate with the medical team: Doctors, nurses, therapist, and case managers all take part of the medical team and provide invaluable insight of how to help take care of your loved one once they discharge from the hospital. Take notes, and take the opportunity to ask all of your questions.

8) Transitional options to consider after hospital discharge:  

• Home health: You can have a nurse, physical therapist, occupational therapist, and/or speech therapist come to your home and continue rehabilitation. Less intense compared to SNF. 
• Skilled Nursing Facility (SNF): A temporary nursing home that can assist with nursing, physical/occupational/speech therapy needs. Less intense compared inpatient rehabilitation. 
• Inpatient Rehabilitation: They do 3 hours of intense therapy every day. In order to qualify, your loved one needs to be able to follow commands, and keep up with the exercise. Its important that your loved one sleeps well at night, since they can get tired during the day from all the exercising. 

What helped you cope with your loved ones recent stroke?

Photo source: Kob.com

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