1. Slide 1 Acute Changes and Stroke Central South Regional Stroke Program September 2007 Funded by the Ministry of Health and Long Term Care

2. Slide 2 Session Overview The types of stroke. The types of stroke. The common changes that result from stroke. The common changes that result from stroke. The five warning signs of stroke. The five warning signs of stroke. The changes you might see with your residents. The changes you might see with your residents. What do you do when you see that a resident is possibly showing a sign of stroke. What do you do when you see that a resident is possibly showing a sign of stroke.

3. Slide 3 What is a Stroke An interruption of the supply of blood and oxygen to an area of the brain. An interruption of the supply of blood and oxygen to an area of the brain. This causes the brain cells in an area to die, and reduces the brain function in that area. This causes the brain cells in an area to die, and reduces the brain function in that area. The area of the body controlled by the damaged area is unable to function properly. The area of the body controlled by the damaged area is unable to function properly. There are two types of stroke. There are two types of stroke. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

4. Slide 4 What is a Stroke? A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996 A stroke can happen when a blood clot blocks a blood vessel in the brain. 80% of strokes are this type.

5. Slide 5 What is a Stroke? A Guide to Understanding Stroke, Heart and Stroke Foundation of Canada, 1996 A stroke can also happen when a blood vessel breaks and this results in bleeding in the brain. 20% of strokes are this type.

6. Slide 6 Risk factors you can do something about… High blood pressure High blood pressure High blood cholesterol High blood cholesterol Heart disease Heart disease Diabetes Diabetes Being overweight Being overweight Excessive alcohol use Excessive alcohol use Physical inactivity Physical inactivity Smoking Smoking Stress Stress Pearson et.al., (2002) AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. Circulation, 106, 388-391.

7. Slide 7 What does a resident who has had a stroke look like in LTC?

8. Slide 8 What are some of the losses due to stroke? paralysis or weakness on one side of the body; paralysis or weakness on one side of the body; vision problems (double vision); vision problems (double vision); trouble speaking or understanding language; trouble speaking or understanding language; http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

9. Slide 9 What are some of the losses due to stroke? inability to recognize or use familiar objects; inability to recognize or use familiar objects; tiredness; tiredness; depression; depression; http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

10. Slide 10 What are some of the losses due to stroke? exaggerated or inappropriate emotional responses; exaggerated or inappropriate emotional responses; difficulty learning and remembering new information; and difficulty learning and remembering new information; and changes in personality. changes in personality. http://www.hc-sc.gc.ca/iyh-vsv/diseases-maladies/stroke-vasculaire_e.html#ef

11. Slide 11 Stroke Statistics There are between 40,000 and 50,000 strokes survivors in Canada each year. There are between 40,000 and 50,000 strokes survivors in Canada each year. 10% (4-5,000) of strokes survivors each year require long-term care. 10% (4-5,000) of strokes survivors each year require long-term care. 40% (16-20,000) of strokes survivors each year are left with a moderate to severe changes in their function. 40% (16-20,000) of strokes survivors each year are left with a moderate to severe changes in their function. http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=1078&Src=news&Fr om=SubCategory

12. Slide 12 Canadian Best Practice Recommendations for Stroke Care All persons (members of the public) should be able to recognize and identify at least two signs and symptoms of stroke and know to take appropriate action (seek medical attention). Canadian Best Practice Recommendations For Stroke Care (2006), 2.

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14. Slide 14 Warning Signs of Stroke Action: Call 9-1-1 or your local emergency number immediately Heart and Stroke Foundation Canada, 2006 Warning Signs Description Weakness Sudden Sudden loss of strength or sudden numbness in the face, arm or leg, even if temporary. Trouble speaking Sudden Sudden difficulty speaking or understanding or sudden confusion, even if temporary. Vision problems Sudden Sudden trouble with vision, even if temporary. Headache Sudden Sudden severe and unusual headache. Dizziness Sudden Sudden loss of balance, especially with any of the above signs

15. Slide 15 A TIA is an important warning sign! Sometimes the symptoms of stroke come and go lasting minutes or hours. This is called a TIA and is an important warning sign that a stroke is likely to happen. If you see the warning signs of stroke what should you do??? STROKE IS A MEDICAL EMERGENCY!

16. Slide 16 STROKE IS A MEDICAL EMERGENCY What would you do if there was a medical emergency in your home?

17. Slide 17 Why respond quickly? Resident may be able to receive special medical treatment to  stroke related problems. Resident may be able to receive special medical treatment to  stroke related problems. Resident will be assessed and treated for stroke risk factors to  the risk of another stroke Resident will be assessed and treated for stroke risk factors to  the risk of another stroke Resident will be assessed to see if they would benefit from rehabilitation to  the changes from the stroke. Resident will be assessed to see if they would benefit from rehabilitation to  the changes from the stroke.

18. Slide 18 Changes in Communication Difficulty expressing themselves Difficulty expressing themselves Difficulty understanding information Difficulty understanding information Changes in ability to read or write Changes in ability to read or write Adapted from Elements of a Comprehensive Assessment for a Stroke, American Medical Directors Association, CPGNews.org

19. Slide 19 Changes in Eating Delayed or difficult feeding Delayed or difficult feeding Chewing or swallowing problems Chewing or swallowing problems Choking Choking Pocketing of food in the cheek Pocketing of food in the cheek Adapted from Elements of a Comprehensive Assessment for a Stroke, American Medical Directors Association, CPGNews.org

20. Slide 20 Changes in Functional Ability Oral or Facial Hygiene Oral or Facial Hygiene Grooming Grooming Dressing Upper and Lower Body Dressing Upper and Lower Body Adapted from Elements of a Comprehensive Assessment for a Stroke, American Medical Directors Association, CPGNews.org

21. Slide 21 Changes in Functional Ability Loss of independence toileting Loss of independence toileting Difficulty bathing Difficulty bathing Heavier transfers Heavier transfers Adapted from Elements of a Comprehensive Assessment for a Stroke, American Medical Directors Association, CPGNews.org

22. Slide 22 Changes in Functional Ability Changes in: Walking (falls) Walking (falls) The ability to use the wheelchair The ability to use the wheelchair Stair climbing Stair climbing Adapted from Elements of a Comprehensive Assessment for a Stroke, American Medical Directors Association, CPGNews.org

23. Slide 23 What do you do ??? Alert your registered health care professional so they can assess the resident.

24. Slide 24 CASE STUDY

25. Slide 25 Next Steps… You are the eyes and ears of your facility You are the eyes and ears of your facility Be aware of the diagnosis of your residents Be aware of the diagnosis of your residents Take this information and use it with the residents. Take this information and use it with the residents. Share this information with other staff. Share this information with other staff.

26. Slide 26 More Information Acute Changes and Stroke Acute Changes and Stroke Continence and Stroke Continence and Stroke Dementia and Stroke Dementia and Stroke Falls and Stroke Falls and Stroke Pain and Stroke Pain and Stroke Please contact: Rebecca Fleck or Kim Young Community and Long Term Care Specialist Central South Regional Stroke Program 905-521-2100 x 44127

27. Slide 27 Acknowledgements Best Practices Long-Term Care Advisory Group Best Practices Long-Term Care Advisory Group Best Practices Long-Term Care Evaluation Group Best Practices Long-Term Care Evaluation Group Frank Rubini, Heart and Stroke Foundation of Ontario Frank Rubini, Heart and Stroke Foundation of Ontario Mary-Lou van der Horst, Regional Best Practice Coordinator Long- Term Care, Central South Region Mary-Lou van der Horst, Regional Best Practice Coordinator Long- Term Care, Central South Region Wendy MacDougal, Regional Best Practice Coordinator Long-Term Care, Central West Region Wendy MacDougal, Regional Best Practice Coordinator Long-Term Care, Central West Region Rosemary Crisp, Director, St. Joseph’s Health Care, Guelph Rosemary Crisp, Director, St. Joseph’s Health Care, Guelph Marilyn Irwin, St. Joseph’s Health Care, Guelph Marilyn Irwin, St. Joseph’s Health Care, Guelph Lindsay Ogilvie, Librarian, St. Joseph’s Health Care, Guelph Lindsay Ogilvie, Librarian, St. Joseph’s Health Care, Guelph Central South Regional Stroke Program Central South Regional Stroke Program Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro- ambulatory Centre Maryann Watts, Hamilton Health Sciences, Clinical Manager Neuro- ambulatory Centre Melanie Fall Stratton, Regional Stroke Program, Program Manager, Melanie Fall Stratton, Regional Stroke Program, Program Manager, Kim Young, Regional Stroke Program, Community and Long-term Care Specialist Kim Young, Regional Stroke Program, Community and Long-term Care Specialist Lisa Colizza, Regional Stroke Program, Regional Stroke Development Specialist Lisa Colizza, Regional Stroke Program, Regional Stroke Development Specialist Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation Coordinator Nancy van Essen, Regional Stroke Program, Stroke Rehabilitation Coordinator Carol Pereira, Regional Stroke Program, LTC Project Coordinator Carol Pereira, Regional Stroke Program, LTC Project Coordinator

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