Hospital Care for the Stroke Patient

LEE P. DRESSER, M.D. NEUROLOGIST.

WILMINGTON NEUROLOGY CONSULTANTS

 

Stroke patients are often admitted to specialized sections of the hospital where they can be monitored closely. If the patient has received T.P.A., the clot dissolving medicine, they will spend the first day in the intensive care unit (I.C.U.). Often they wear leads on their chests to monitor the electrical activity of their hearts. To make sure the injured part of the brain receives a rich supply of oxygen, it is frequently supplied to stroke patients by nasal tubes or a mask. Most patients are given fluids through tubes in their veins to help prevent dehydration. Nurses will check their neurological status frequently to make sure the symptoms of stroke are not worsening. The stroke patient may not be given anything to eat or drink until they are seen by a speech therapist. This is to make sure they can safely swallow and do not choke or have food or drink go into their lungs and cause an infection. Patients may be instructed not to get out of bed and to lie flat for the first 24 hours after they suffer a stroke. After that they may be told to only get out of bed with help since balance problems are common with stroke and can lead to falls. One of the problems that can occur after a stroke is the development of blood clots in the legs. This happens because of lying in bed and being unable to move one side of the body. To prevent this, some patients will be given injections of low doses of a blood thinner or fitted with air powered compression stockings. A catheter tube may be temporarily used to help drain the bladder of stroke patients immediately after admission to the hospital.

 

The first day in the hospital for stroke patients in often filled with testing. They may have a computerized tomography (C.T.) picture of their brain made if it was not done in the emergency room. A magnetic resonance imaging (M.R.I.) scan of their brain may be performed. At the same a M.R angiogram (M.RA.) picture of the blood vessels supplying the brain may be made. The blood vessels in the neck can be investigated with a carotid ultrasound. Because a blood clot coming from the heart is a common cause of stroke, sound wave pictures of the heart may be ordered. Sound waves can be bounced off the heart from the chest (transthoracic echocardiogram) or from a probe placed in the swallowing tube (transesophageal echocardiogram or T.E.E.). Blood tests are often taken during the first few days in the hospital. If a blood thinner is used to prevent stroke, it may be necessary to do blood tests more than once a day. Most tests are done to find out what caused the stroke and help doctors prevent any more strokes.

 

Usually within 48 hours of entering the hospital the stroke patient is evaluated by a number of therapists. These include speech therapists who help evaluate and treat problems with talking and swallowing. Physical therapists help patients recover the strength in their arms and legs and improve their ability to balance and walk. Occupational therapy helps patients with skills needed to take care of themselves, such as feeding, cleaning, dressing and bathing. Patients may be evaluated by a physiatrist, which is a doctor who specializes in rehabilitation. The physiatrist will help determine where the stroke patient should go to continue rehabilitation after leaving the hospital. If the patient has minor problems, they may go home. If they have more severe problems, they may go to a rehabilitation hospital or a nursing home (also called an extended care facility). Most extended care facilities offer speech, physical and occupational therapy. Stroke patients are usually evaluated by social workers and discharge planning nurses, who work with the doctors to help decide what is the best place for the patient to go when they leave the hospital. Most stroke patients leave the hospital 3-7 days after they had their stroke.