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Falls and Syncope Service

Stroke Care (Acute Stroke Unit)

Contact: (0191) 213 7014 - Sister or Nurse in Charge of Acute Stroke Unit


IntroductionShow [+]Hide [-]

What is a stroke?

A stroke happens when there is some disruption or a blockage to the flow of blood to the brain, or leakage of blood into the brain. This means that blood cannot reach a particular part of the brain, which then becomes damaged.

There are two main types of stroke:

  • Cerebral infarction – blockage of a blood vessel in the brain, this could be caused by a blood clot or fatty clot
  • Cerebral haemorrhage – rupture of a blood vessel in the brain

What are the causes of stroke?

There are many causes and risk factors for stroke that include:

  • High Blood Pressure (hypertension)
  • Smoking
  • Eating a diet high in saturated fat
  • Using too much salt in food
  • Being overweight and not taking enough exercise
  • Alcohol
  • Diabetes
  • Heart disease
  • Family history

There are some factors which we cannot do much about, however there are steps we can take which will reduce the risk of having a stroke or a further stroke. These include:

  • taking regular exercise,
  • lowering blood pressure and cholesterol levels
  • stopping smoking
  • reducing alcohol intake
  • eating a healthy and balanced diet
  • keeping our weight at a reasonable level.

Effects of stroke

Stroke affects everybody in different ways. The effect of a stroke on a person depends on which part of the brain has been affected and how much damage has been caused. Some of the effects of stroke can include:

  • Weakness down one side of the body. This can create difficulties walking, getting in and out of bed, getting washed and dressed etc.
  • Difficulties with speech and swallowing
  • Inability to think things through clearly, and memory problems
  • Problems with sight and awareness of objects around you
  • Changes with bladder and bowel function
  • Emotional changes
  • Sudden tiredness

Stroke patients may experience one or all of the above.

About the Brain

The brain has two hemispheres (sides). The nerve signals (messages) cross over at the base of the brain, so a stroke occurring on the right side of the brain will affect the left side of the body and vice versa.

Image of the Brain

 

The Left Hemisphere (side)

The main functions of the left hemisphere are:

  • Speech
  • Writing
  • Movement of the right side of the body

A stroke occurring in the left hemisphere could affect someone’s ability to speak, write and move the right side of the body.

The Right Hemisphere (side)

The main functions of the right hemisphere are:

  • Recognition of objects
  • Finding your way around places
  • Recognition of people
  • Awareness of your own body
  • Putting on clothes
  • Sensation on the left side of the body
  • Movement on the left side of the body

This information is intended only as a brief guide to understanding stroke. Hopefully you will find it helpful. However, the brain is an extremely complex structure, and stroke and its effects can be far reaching and complicated. Your stroke will be examined and assessed in detail by all members of the hospital team. Don’t be afraid to ask them to discuss it with you.

Deep Vein Thrombosis (DVT)

This is a blood clot usually in the lower calf which occurs due to poor circulation and reduced mobility following a stroke. The signs of a DVT are pain, redness, tightness and swelling in the leg. The lower leg often feels hot to touch. If you notice any of these signs seek medical advice immediately. You will be required to wear special elasticated stockings in the early stages of your stroke to help prevent clots forming in your leg.

If you are given elasticated stockings (commonly known as TEDS) when you have left hospital, it is important that you wear them during long periods of inactivity. If you are not mobile at night please wear your stockings in bed.

The Different Types of Stroke

TACS (Total anterior circulation stroke)

  • Marked weakness (dense hemiparesis)
  • Some loss of sight (Visual Field Loss)
  • Severe speech difficulties, sometimes no speech
  • If affected area of the brain is on right then neglect will occur on the left

PACS (Partial anterior circulation stroke)

  • One or two of the above symptoms, but not all

LACS (Lacunar Stroke)

  • Physical weakness (Pure motor hemiparesis)
  • Impaired sensory function (Pure sensory hemiparesis)
  • Physical weakness and impaired sensory function (Sensory-motor hemiparesis
  • Co-ordination problems (Ataxic hemiparesis)
  • BUT speech normal, vision normal, and no neglect POCS (Posterior Circulation Stroke)
  • Loss of consciousness
  • Unsteady gait
  • Facial Problems
  • Visual Disturbance
  • Difficulty Speaking
  • BUT good comprehension (dysarthria)

Admission to the Acute Stroke UnitShow [+]Hide [-]

The Acute Stroke Unit provides dedicated and specialist stroke care. We aim to provide rapid, early expert intervention and rehabilitation for the acute stroke patient through a comprehensive pathway of care.

You will be looked after by doctors and nurses and depending on your individual needs, may also have some contact with other ward staff i.e. physiotherapists, occupational therapists, speech therapists and social workers. All aspects of your treatment and care will be overseen by a specialist stroke consultant.

On admission to the ward you will be assessed and examined, and a range of medical investigations may be carried out such as CT scan, blood tests, ECG (heart tracing) etc. Following your assessment, you may be given new tablets and medicines to reduce the risk of further problems. Sometimes people who have had a stroke recover enough that they don’t need any further treatment in hospital and are able to go home. If you do need further treatment you may be transferred to a stroke rehabilitation ward or may be able to receive your rehabilitation at home.

After admission to hospital, your personal details and medical diagnosis will be entered into a computer record system. The information stored is used for hospital purposes and is subject to strict confidentiality guidelines. Please speak with a member of the ward staff for further details.

The Stroke Unit is very active in research to improve the quality of future stroke care. There is a dedicated research team including specialist research doctors and nurses. They work with the doctors and nurses from the acute stroke unit. If you wish to participate in research, you will be assessed by them and new trial treatment and monitoring options will be discussed. If you participate in any of the stroke research trials, you will be under the joint care of the acute stroke team as well as the research team.

Nursing care on the Acute Stroke UnitShow [+]Hide [-]

The nursing staff have the skills and expertise to help your recovery in the initial stages of stroke. You will be closely observed and your blood pressure and oxygen levels, heart rate and temperature monitored.

The nurses will watch for signs of stroke complications such as chest infection, deep vein thrombosis, continence problems and low mood (which is very common) and will ensure that these are treated appropriately.

The aim of the nursing staff is to help you achieve as much progress as possible. They play a key role in your rehabilitation and ensure that it is a continuing process.

We recognise that family and carer involvement is vital to recovery, and will aim to provide you and your family with as much information as possible. This will help you to understand

  • more about stroke
  • how you can reduce your own risk of stroke
  • details of support networks and organisations which might be able to provide further assistance.

RehabilitationShow [+]Hide [-]

What is rehabilitation?

For stroke patients, rehabilitation involves a programme of treatment given by a team of professionals. The team is made up of doctors, nurses and therapists who work together with you, your carers and family to help you gain as much independence as possible, and achieve a good quality of life for you and your family. Rehabilitation begins in hospital and may continue when you return home, depending on your level of recovery.

Ongoing Rehabilitation and Support

Some patients may require further therapy in a hospital setting whilst others may be able to return home and have therapy in their own home. The options available will be discussed with you and your family, taking into consideration your needs, the needs of your carers and where you live.

Occupational Therapy

Following a stroke some daily activities can become more difficult. For example, eating, getting washed and dressed, bathing, preparing meals, getting around your home or pursuing your work and leisure activities. Occupational therapists will work with you to assess how your stroke has affected your ability to carry out these activities and look at ways to help you overcome any difficulties you may be having.

Physiotherapy

Physiotherapy helps to assist the return of movement and control to the body and limbs. This can improve balance and activities with a view to maximising your recovery of function after stroke. You may encounter problems with your swallowing. If this happens, the physiotherapist will help monitor your chest and help you to clear away any secretions.

Speech and Language Therapy

Speech and language therapists are trained to identify and treat a wide range of communication disorders including problems with understanding, speaking, reading and writing. The type of problem will depend on the nature and severity of your stroke. Speech and language therapists are also trained to assess eating and swallowing disorders that involve the mouth and throat. You may be required to take a special diet or thickened fluids for a period of time. In some cases, it may be unsafe to eat and drink due to weakness of the muscles used in swallowing. When this occurs, tube feeding is considered. This is only continued until normal feeding can be resumed.

If you or your relative wears glasses, dentures or a hearing aid, please ensure that they are worn when the speech and language therapist visits. This will help us to carry out the best possible assessment.

Social Workers
 
A referral may be made to the Social Work Department at an appropriate point during your rehabilitation to make plans for your transfer or discharge from hospital. When making an assessment of your needs the social worker will work closely with you and your carers, as well as with staff on the ward. An assessment will help in deciding if you need support to enable you to return home. For example, this could include Home Carers to assist with personal care, shopping, domestic tasks, attending a day centre, respite care or a referral for meals at home. On some occasions, a referral to a Community Resource Centre could also be considered as part of a rehabilitation programme. For some people alternative care may need to be considered. This could include re-housing, residential or nursing care or continuing care. Advice and information can also be given with regard to financial issues and emotional support offered to you and your family.

If you need to speak to a social worker just ask your named nurse on the ward.

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