CVA questions

[lakec4me]

I am an OB nurse, so I don't know much about anything but OB. Anyway, my 90 yo grandma who had been totally independent, had a cva on 12/24. She is in a small town hospital about an hour away from me and her doc doesn't see pts in the hospital, so she is assigned to the hospitalist. She has right sided paralysis, asphasia, and dysphagia. She seems to know us and responds to commands, but is confused. I know it's the holiday season, but no one can explain the plan of care to us. She has had no physical therapy, speech therapy, etc. Shouldn't this begin asap? Can anyone tell me what to expect? She is basically just lying in the bed. She is tired and worn out. She has a living will - DNR. They did put a nasal feeding tube in yesterday; she is NPO. What about the hospitalist? Should he/she be seeing her daily and explain the plan of care to us? Should I call her regular doc and get a referral for a neurologist? What can we expect regarding rehab? Thanks, I appreciate any advice; this is so different from ob.

[Blee O'Myacin, BSN, RN]

Discharge planning should begin on admission. Check with the nurse on Monday if there is a social worker or case manager that can answer your questions regarding rehab and her plan of care.

I hope you find answers soon.

Blee

[naughtynurse2c]

Unfortunately, if a stroke is admitted over the weekend or holiday season, most allied health will not be working.Also the resources vary depending on if you are admitted to a stroke centre facility or community hospital.I have worked in a variety of setings as a stroke nurse and still can not figure out why therapies are not available at these times.The assigned nurse is your best advocate. Push for appropriate treatment, but be realistic.Speech Language Pathology, OT and PT are best at determining cognition, swallow ability, mobility.They can assist you in understanding the most beneficial course of treatment for your grandmother.Every stroke patient is different. Best of luck to her.

[glasgow3]

Every CVA case is different and as you may know, giving medical advice is not permitted under the TOS for this site. That said, I believe I can give you some general information and direction.

The care of a patient who has had a CVA is very much a team effort---or should be. All things being equal by this time your grandmother should have been evaluated by a physical therapist, occupational therapist and speech therapist; proposed therapy and short and long term goals should be documented by each. If there are medical reasons why this has not yet occurred, the hospitalist should be able to explain in a clear manner exactly why not.

At this stage of recovery, however, a primary focus should be the evaluating the current CVA extent and preventing another from occurring. The evaluation typically includes an EKG, echo, carotid US, an initial CT, a later comparison CT, perhaps a brain MRI etc.; A consulting neurologist should be able to tell you the location and extent of the damage, to explain which vessels are involved and to propose recommendations and alternatives for her particular case.

For non-hemorrhagic strokes appropriate anticoagulation is very important. Appropriate blood pressure and heart rate control are often issues to be addressed as well. The hospitalist (or consulting cardiologist) should be able to tell you the goals for these issues and they should all be evidenced based.

After proper evaluation and stabilization have occurred, you will need to determine the appropriate setting to continue with the rehabilitation which should have been initiated in acute care. Although she is 90 years old, she was entirely independent prior to her stroke; One oft cited criteria for inpatient rehabilitation is the the ability to perform at least 3 hours of OT/PT daily. Be prepared to strongly advocate for a brief trial period if she is unable to meet that threshhold.

On the other hand, receiving rehabilitation services in a skilled nursing facility may well be the appropriate intensity. Such facilities vary greatly in quality so take this opportunity NOW to ask your friends, colleagues, fellow church members etc their opinions/experiences, request tours and ask questions.

Although necessarily brief and general, I hope this information helps you in some small way.

[NurseyPoo7]

Neuro nurse here. I work on a JCAHO stroke certified floor. We are not in a big city or anything.

We have PT, OT and at least one ST there on the weekend. All patients with dysphagia/aphasia or other speech problems are seen by ST.

If her CT/MRI was + for CVA, neuro is ALWAYS consulted.

[zacarias, ASN, RN]

I believe all people with CT evidence of a stroke should have a neurologist consulted, but I haven't seen this in all hospitals.