2 Community Outreach & Education Martha Power FNP-CTanya Smith FNP-BCAngela J. Schaffer RN
3 Be Stroke Smart Reduce: stroke risk Recognize: stroke symptoms Respond: at the first sign of stroke,Call 911 immediately!
4 Why people don’t respond to stroke symptoms Don’t recognize symptomsDenialThink nothing can be doneWorry about costThink symptoms will go awayFear or don’t trust hospitals
5 Perceptions of Stroke Myths Reality Stroke is not preventable Stroke cannot be treatedStroke only strikes the elderlyStroke happens in the heartStroke recovery ends after 6 monthsRealityUp to 80% percent of strokes are preventableStroke requires emergency treatmentAnyone can have a strokeStroke is a “Brain Attack”Stroke recovery can last a lifetime
6 Stroke Facts A leading cause of death in the United States 795,000 Americans suffer strokes each year134,000 deaths each year-From 1996 to 2006 stroke deaths fell by 18.4%6,400,000 stroke survivors
7 Stroke Facts A leading cause of adult disability Up to 80% of all strokes are preventable through risk factor managementOn average, someone suffers a stroke every 40 seconds in America
8 The Cost of StrokeThe estimated direct and indirect cost of stroke was 73.7 billion in 2010The mean lifetime cost of ischemic stroke per person is about $140,048 in America
10 Transient Ischemic Attacks Warning Strokes or “mini strokes”Blood clot, vasospasm, etc.Occurs for a short timeSymptoms resolve in 1-24 hoursIndicates possible major stroke in the future1 in 9 will have stroke within 3 months
11 Ischemic Stroke Caused by a blocked blood vessel in the brain 8 out of 10Strokes are ischemic
12 Risk Factors for Ischemic Stroke HypertensionDiabetesHeart DiseaseSmokingHigh CholesterolAtrial FibrilationHistory of previous strokeAgeObesityPoor DietLack of exercise
13 Ischemic Stroke Symptoms Facial DroopSlurred Speech, dysarthriaDifficulty swallowing, dysphagiaExpressive or receptive aphasiaGaze preferenceWeakness, numbness, loss of sensationSymptoms on one side of the face or bodyVisual changes or loss of part or all of visionConfusionReduced or loss of consciousnessVertigo, dizziness, ataxiaNystagmus (wiggling eyes)CALL 911!
15 t-PA, the “Clot Buster”t-PA is recommended for treatment of ischemic stroke in selected patientsHowever, t-PA is only administered to less than 3% of ischemic stroke patientsDelay in seeking medical care contributes significantly to underutilization of t-PA for stroke.Extending time window for t-PA administration beyond the current recommended 3 hrs might be beneficial.
20 Brain Attack! Stroke is a “Brain Attack.” Stroke happens in the brain not the heartStroke is an emergency. Call 911 for emergency treatment.The term “Brain Attack” is the most descriptive and realistic description of a stroke. It also provides a powerful call to action.A brain attack should warrant the same degree of emergency care as a heart attack. After all, your brain is your mind and your body’s most vital and delicate organ.Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. The best thing to do is to call 911 for immediate assistance.Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms.Your chances of walking out of the hospital with little to no disability are greatly improved if you receive appropriate treatments early.Unfortunately, it takes the average American 12 to 24 hours to get to the hospital after experiencing the first stroke symptom. This is why it’s important that everyone learns how to RECOGNIZE stroke symptoms and how to RESPOND.References:National Stroke Association. The Complete Guide to Stroke At:Lichtman JH, Watanbe E, et al. Hospital Arrival Time and Intravenous t-PA Use in USAcademic Medical Centers, 2001–2004. Stroke. 2009;40:00-00.20
22 Case Study What do you do? A 59 year old male working at his desk. He sends a coworker an that does not make sense.He is confused, has a left facial droop,and his left arm and leg are weak.He is on Coumadin for an irregular heart rhythm. He has no other medical history.He says, “I am not going to the hospital, because they can’t do anything for me.”What do you do?
23 Case Study Continued…You call 911 and your coworker is rushed to a Primary Stroke Center Emergency DepartmentThe Stroke Team meets him at the door, and after imaging, diagnose him with an acute R MCA stroke with a large penumbra.
24 Case Study Continued…He takes Coumadin for Atrial Fibrilation, but a blood test and the fact that he arrived so soon after onset of his symptoms, meets criteria for him to receive tPA, the “clot busting” medication for stroke.His stroke symptoms completely resolve with the tPA.When he returns to work without any neurological deficits, he Thanks You for calling an ambulance and getting him medical treatment so quickly!
25 Hemorrhagic StrokeCaused by a ruptured blood vessel in the brain
26 Risk Factors for Hemorrhagic Stroke HypertensionBleeding disordersAneurysm ruptureVascular malformationExcessive alcohol useCocaine use
28 Two Categories of Hemorrhagic Stroke ICH: bleeding into brain tissue as a result of bleeding or rupture of a small, deep cortical artery that is damaged by chronic hypertensionSAH: subarachnoid hemorrhage is the result of bleeding into the subarachnoid space, most often in relation to ruptured aneurysm or AVM
29 Aneurysm Clipping Performed by Neurosurgery Incision and removal of skull boneSurgical clip prevents bloodfrom entering aneurysm
30 Coiling Procedure for Aneurysm Performed by Neurointerventional RadiologistCatheter guided to aneurysm siteCoil is packed into aneurysmBlood no longer enters siteAssociated with improved outcomes
31 Stroke Recovery 10% of stroke survivors recover almost completely 25% recover with minor impairments40% experience moderate to severe impairments requiring special care10% require care within either a skilled-care or other long-term care facility15% die shortly after the stroke
32 Lifestyle Changes for Survivors and Caregivers Daily living skillsDressing and groomingDiet, nutrition and eating difficultiesSkin care problemsPainSexuality/IntimacyBehaviorDepression & AngerEmotional LiabilityOne-sided NeglectMemory LossCommunication Problems
34 Types of Stroke Rehabilitation Physical Therapy (PT)Walking, range of movementOccupational Therapy (OT)Taking care of one’s selfSpeech Language TherapyCommunication skills, swallowing, cognitionRecreational TherapyCooking, gardening
35 Well Known Stroke Survivors President Gerald FordTeddy BruschiSharon StoneDella ReeseKirk DouglasRoy Hornof Siegfried & RoyMary Kay AshCharles SchultzHarry CarayCharles DickensEd KochTed Williams
36 How to Lower Your Risk for Stroke Stop smokingMaintain blood pressure below 140/80Keep cholesterol in acceptable rangeManage blood sugar if diabeticRegular ExerciseLow fat, low salt dietModerate alcohol use“Everything in moderation”
37 Primary Stroke Care Healthcare Team A Dedicated Stroke Team Coordinates Stroke CareNeurology and Neurosurgery Services 24/7Cutting Edge Imaging (CT,MRI, etc.) 24/7Advanced Vascular Procedures performed by Neurointerventional Radiologists on call 24/7Specialty Stroke Trained Nursing CarePhysical Therapy, Occupational Therapy, and Speech TherapyFollow Up Care managed by Neurology ServiceSupport Group, Education, Research, and Community OutreachHealthcare Team
38 Current Research Trials SHINEPOINTCLEAR-ERSTROKE BIOMARKERSPEDIATRIC STROKE
39 Stroke Support GroupsMeeting for Education, Community, and Healing.
40 Women & Stroke AHA/ASA Campaign to increase awareness of cardio- and neurovascular disease in Women ~
41 Appalachian Stroke Network A Regional Cooperativeof Healthcare Providerscoming together toimprove Stroke CareThroughout Appalachia
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