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KNOW STROKE. Community Outreach & Education Community Outreach & Education Martha Power FNP-C Martha Power FNP-C Tanya Smith FNP-BC Tanya Smith FNP-BC.

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Presentation on theme: "KNOW STROKE. Community Outreach & Education Community Outreach & Education Martha Power FNP-C Martha Power FNP-C Tanya Smith FNP-BC Tanya Smith FNP-BC."— Presentation transcript:

1 KNOW STROKE

2 Community Outreach & Education Community Outreach & Education Martha Power FNP-C Martha Power FNP-C Tanya Smith FNP-BC Tanya Smith FNP-BC Angela J. Schaffer RN Angela J. Schaffer RN

3 Reduce: stroke risk Recognize: stroke symptoms Respond : at the first sign of stroke, Call 911 immediately! Be Stroke Smart

4 Why people dont respond to stroke symptoms Dont recognize symptoms Dont recognize symptoms Denial Denial Think nothing can be done Think nothing can be done Worry about cost Worry about cost Think symptoms will go away Think symptoms will go away Fear or dont trust hospitals Fear or dont trust hospitals

5 Perceptions of Stroke Myths Stroke is not preventable Stroke is not preventable Stroke cannot be treated Stroke cannot be treated Stroke only strikes the elderly Stroke only strikes the elderly Stroke happens in the heart Stroke happens in the heart Stroke recovery ends after 6 months Stroke recovery ends after 6 monthsReality Up to 80% percent of strokes are preventable Up to 80% percent of strokes are preventable Stroke requires emergency treatment Stroke requires emergency treatment Anyone can have a stroke Anyone can have a stroke Stroke is a Brain Attack Stroke is a Brain Attack Stroke recovery can last a lifetime Stroke recovery can last a lifetime

6 Stroke Facts A leading cause of death in the United States A leading cause of death in the United States 795,000 Americans suffer strokes each year 795,000 Americans suffer strokes each year 134,000 deaths each year 134,000 deaths each year -From 1996 to 2006 stroke deaths fell by 18.4% -From 1996 to 2006 stroke deaths fell by 18.4% 6,400,000 stroke survivors 6,400,000 stroke survivors

7 Stroke Facts A leading cause of adult disability A leading cause of adult disability Up to 80% of all strokes are preventable through risk factor management Up to 80% of all strokes are preventable through risk factor management On average, someone suffers a stroke every 40 seconds in America On average, someone suffers a stroke every 40 seconds in America

8 The Cost of Stroke The estimated direct and indirect cost of stroke was 73.7 billion in 2010 The estimated direct and indirect cost of stroke was 73.7 billion in 2010 The mean lifetime cost of ischemic stroke per person is about $140,048 in America The mean lifetime cost of ischemic stroke per person is about $140,048 in America

9 Types of Stroke T.I.A. T.I.A. Ischemic Ischemic Hemorrhagic Hemorrhagic

10 Transient Ischemic Attacks Warning Strokes or mini strokes Warning Strokes or mini strokes Blood clot, vasospasm, etc. Blood clot, vasospasm, etc. Occurs for a short time Occurs for a short time Symptoms resolve in 1-24 hours Symptoms resolve in 1-24 hours Indicates possible major stroke in the future Indicates possible major stroke in the future 1 in 9 will have stroke within 3 months 1 in 9 will have stroke within 3 months

11 Ischemic Stroke Caused by a blocked blood vessel in the brain 8 out of 10 Strokes are ischemic

12 Risk Factors for Ischemic Stroke Hypertension Hypertension Diabetes Diabetes Heart Disease Heart Disease Smoking Smoking High Cholesterol High Cholesterol Atrial Fibrilation Atrial Fibrilation History of previous stroke History of previous stroke Age Age Obesity Obesity Poor Diet Poor Diet Lack of exercise Lack of exercise

13 Ischemic Stroke Symptoms Facial Droop Facial Droop Slurred Speech, dysarthria Slurred Speech, dysarthria Difficulty swallowing, dysphagia Difficulty swallowing, dysphagia Expressive or receptive aphasia Expressive or receptive aphasia Gaze preference Gaze preference Weakness, numbness, loss of sensation Weakness, numbness, loss of sensation Symptoms on one side of the face or body Symptoms on one side of the face or body Visual changes or loss of part or all of vision Visual changes or loss of part or all of vision Confusion Confusion Reduced or loss of consciousness Reduced or loss of consciousness Vertigo, dizziness, ataxia Vertigo, dizziness, ataxia Nystagmus (wiggling eyes) Nystagmus (wiggling eyes) CALL 911!

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15 t-PA, the Clot Buster t-PA is recommended for treatment of ischemic stroke in selected patients t-PA is recommended for treatment of ischemic stroke in selected patients However, t-PA is only administered to less than 3% of ischemic stroke patients However, t-PA is only administered to less than 3% of ischemic stroke patients Delay in seeking medical care contributes significantly to underutilization of t-PA for stroke. Delay 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. Extending time window for t- PA administration beyond the current recommended 3 hrs might be beneficial.

16 t-PA Recommendations t-PA should be administered to eligible patients within 3.0-4.5 hours after stroke t-PA should be administered to eligible patients within 3.0-4.5 hours after stroke Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following additional exclusion criteria: Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following additional exclusion criteria: –Age > 80 years; Oral anticoagulant use with INR 1.7*; baseline NIH Stroke Scale score > 25; a history of stroke and diabetes (*For the 3.0 – 4.5 hr window all pts receiving oral anticoagulant are excluded whatever their INR). 11/13/2013© 2009, American Heart Association. All rights reserved. Information from the Expansion of the Time Window for Treatment of Acute Ischemic Stroke with IV TPA – Science Advisory

17 Merci Clot Retrieval Device Meri Clot Removal Video 1:10 http://youtu.be/MGX7deuFkhc

18 Penumbra Device and Restored Cerebral Circulation Penumbra Clot Retrival Video 1:45 http://youtu.be/lyfzNgrVOOk

19 Solitaire Revascularization Device The Latest in NeurointerventionalRadiology Solitaire Revascularization Device Video 1:43 http://youtu.be/0DQPD5TTS5Y

20 Brain Attack! Stroke is a Brain Attack. Stroke is a Brain Attack. Stroke happens in the brain not the heart Stroke happens in the brain not the heart Stroke is an emergency. Call 911 for emergency treatment. Stroke is an emergency. Call 911 for emergency treatment.

21 Carotid Artery Stent Carotidendarterectomy

22 Case Study A 59 year old male working at his desk. A 59 year old male working at his desk. He sends a coworker an email that does not make sense. He sends a coworker an email that does not make sense. He is confused, has a left facial droop, He is confused, has a left facial droop, and his left arm and leg are weak. and his left arm and leg are weak. He is on Coumadin for an irregular heart rhythm. He has no other medical history. 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 cant do anything for me. He says, I am not going to the hospital, because they cant 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 Department You call 911 and your coworker is rushed to a Primary Stroke Center Emergency Department The Stroke Team meets him at the door, and after imaging, diagnose him with an acute R MCA stroke with a large penumbra. The 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. 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. 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! 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 Stroke Caused by a ruptured blood vessel in the brain Caused by a ruptured blood vessel in the brain

26 Risk Factors for Hemorrhagic Stroke Hypertension Hypertension Bleeding disorders Bleeding disorders Aneurysm rupture Aneurysm rupture Vascular malformation Vascular malformation Excessive alcohol use Excessive alcohol use Cocaine use Cocaine use

27 Hemorrhagic Stroke Symptoms Focal neurological deficits Headache, worst headache ever Neck pain Light intolerance Nausea, vomiting Decreased level of consciousness

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 hypertension ICH: bleeding into brain tissue as a result of bleeding or rupture of a small, deep cortical artery that is damaged by chronic hypertension SAH: subarachnoid hemorrhage is the result of bleeding into the subarachnoid space, most often in relation to ruptured aneurysm or AVM SAH: 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 bone Surgical clip prevents blood from entering aneurysm

30 Coiling Procedure for Aneurysm Performed by Neurointerventional Radiologist Performed by Neurointerventional Radiologist Catheter guided to aneurysm site Catheter guided to aneurysm site Coil is packed into aneurysm Coil is packed into aneurysm Blood no longer enters site Blood no longer enters site Associated with improved outcomes Associated with improved outcomes

31 Stroke Recovery 10% of stroke survivors recover almost completely 10% of stroke survivors recover almost completely 25% recover with minor impairments 25% recover with minor impairments 40% experience moderate to severe impairments requiring special care 40% experience moderate to severe impairments requiring special care 10% require care within either a skilled-care or other long-term care facility 10% require care within either a skilled-care or other long-term care facility 15% die shortly after the stroke 15% die shortly after the stroke

32 Lifestyle Changes for Survivors and Caregivers Daily living skills Daily living skills Dressing and grooming Dressing and grooming Diet, nutrition and eating difficulties Diet, nutrition and eating difficulties Skin care problems Skin care problems Pain Pain Sexuality/Intimacy Sexuality/Intimacy Behavior Behavior Depression & Anger Depression & Anger Emotional Liability Emotional Liability One-sided Neglect One-sided Neglect Memory Loss Memory Loss Communication Problems Communication Problems

33 An Example of Left- sided Neglect

34 Types of Stroke Rehabilitation Physical Therapy (PT) Physical Therapy (PT) –Walking, range of movement Occupational Therapy (OT) Occupational Therapy (OT) –Taking care of ones self Speech Language Therapy Speech Language Therapy –Communication skills, swallowing, cognition Recreational Therapy Recreational Therapy –Cooking, gardening

35 Well Known Stroke Survivors President Gerald Ford President Gerald Ford Teddy Bruschi Teddy Bruschi Sharon Stone Sharon Stone Della Reese Della Reese Kirk Douglas Kirk Douglas Roy Horn Roy Horn of Siegfried & Roy of Siegfried & Roy Mary Kay Ash Mary Kay Ash Charles Schultz Charles Schultz Harry Caray Harry Caray Charles Dickens Charles Dickens Ed Koch Ed Koch Ted Williams Ted Williams

36 How to Lower Your Risk for Stroke Stop smoking Stop smoking Maintain blood pressure below 140/80 Maintain blood pressure below 140/80 Keep cholesterol in acceptable range Keep cholesterol in acceptable range Manage blood sugar if diabetic Manage blood sugar if diabetic Regular Exercise Regular Exercise Low fat, low salt diet Low fat, low salt diet Moderate alcohol use Moderate alcohol use Everything in moderation

37 Primary Stroke Care A Dedicated Stroke Team Coordinates Stroke Care A Dedicated Stroke Team Coordinates Stroke Care Neurology and Neurosurgery Services 24/7 Neurology and Neurosurgery Services 24/7 Cutting Edge Imaging (CT,MRI, etc.) 24/7 Cutting Edge Imaging (CT,MRI, etc.) 24/7 Advanced Vascular Procedures performed by Neurointerventional Radiologists on call 24/7 Advanced Vascular Procedures performed by Neurointerventional Radiologists on call 24/7 Specialty Stroke Trained Nursing Care Specialty Stroke Trained Nursing Care Physical Therapy, Occupational Therapy, and Speech Therapy Physical Therapy, Occupational Therapy, and Speech Therapy Follow Up Care managed by Neurology Service Follow Up Care managed by Neurology Service Support Group, Education, Research, and Community Outreach Support Group, Education, Research, and Community Outreach Healthcare Team

38 Current Research Trials SHINE SHINE POINT POINT CLEAR-ER CLEAR-ER STROKE BIOMARKERS STROKE BIOMARKERS PEDIATRIC STROKE PEDIATRIC STROKE

39 Stroke Support Groups Meeting for Education, Community, and Healing. Meeting 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 Cooperative of Healthcare Providers coming together to improve Stroke Care Throughout Appalachia

42 ACT FAST Call 911

43 KNOW STROKE


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