Ideal Management and Nursing care

Medical

management is directed at early diagnosis and early identification Maintain cerebral oxygenation and cerebral blood flow Maintain patent airway and turn patient to side if unconscious Elevate head and neck should not be flexed Hypertension may be reduced with vasodilators and calcium channel blockers Thrombolytic agents are given to dissolve the clot Intracerebral hemorrhage should be ruled out first Must be given within 3 hours of onset of manifestations E.g. streptokinase, urokinase and tissue plasminogen activator (alteplase) Antiplatelet and anticoagulants are given to prevent clot formation Heparin and warfarin Aspirin, clopidogrel (Plavix), ticlodipine (Ticlid) or dipyridamole (Persantine) Corticosteroids to treat cerebral edema, diuretics to reduce increased intracranial pressure and anticonvulsants to prevent seizures Hyperthermia is treated immediately Temperature elevations lead to increased cerebral metabolic needs which in turn cause cerebral edema which can lead to further ischemia Antipyretics are used Causing the client to shiver should be avoided Aspiration precaution is done Oral food and fluids are generally withheld for 24-48 hours Tube feeding is done Prevent valsalva maneuver Maneuver increases ICP Straining stool, excessive coughing, vomiting, lifting and use of the arms to change position should be avoided Mild laxatives and stool softeners are often prescribed Compensate for perceptual difficulties For clients with visual deficits Approach the client from the unaffected side Place articles on the unaffected side Teach client to turn the head from side to side to see entire visual field Eye patch over one eye in clients with diplopia is helpful Assist and support client Prevent injury and falls Promote self-care and prevent skin breakdown Prevent complications

25

Physical therapy to prevent contractures and to improve muscle strength and coordination Encourage bed exercise Facilitate ROM and isometric exercises o Do not force extremities beyond the point of initiating pain and spasm o Always support the joint and move the extremity smoothly Allow client to work on balance and proprioception skills Occupational therapy Help client relearn ADLs and to use assistive devices that promote independence Teach client how to use the wheelchair and promote walking with assitance Speech therapy for clients with impaired verbal communication Most aphasic clients regain some speech through spontaneous recovery or speech therapy Speech therapy should be started early For aphasic clients o Speak at a slower rate o Give client time to respond o Do not shout and always put client at ease o Repeat simple directions until they are understood o Give client practice in repeating words after you o The family should not do all the talking for the client Provide emotional support and health education to the client and family

25