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Discussion

Help!! Mom had a stroke!

I hope you rehab nurses can give me some direction. Mom went to her PCP for her regular 3 mo. check for hypertension (medicated). He found her in A-Fib. EKG verification and off to the Cardiolgist. He recommends a TEE and electrocardioversion. Doesn't work so he goes the chemical route and she is in sinus until the next morning then converts back to A-Fib. BTW - she got a challenging dose of Coumadin before the procedure but did not recieve any Coumadin the night of, nor the next day following the procedure. They told us to be prepared "in case" she had to spend the night after the procedure so we had packed her "home meds." The Cardio had a "ckeck list" of meds in the chart, including Coumadin that were to be given that night. I reviewed the checklist with the RN (being one myself I am the medical "spokesperson" for the group). She said the they were not "written" orders but assured me that she would contact said doc for them. I left the floor thinking that I had all bases covered. The next morning I call my dear sister that had stayed with Mom to see how things were progressing. She tells me that Mom had no meds the night before and that none were ordered for her this morning - the nurse actually said - I'm not REALLY telling you this - but take your meds that you brought from home." I was very cranky to say the least but showed up during discharge - just wanted to get her out of there. We took her home that night and the next morning she fell to the ground with a stroke. She can no longer move her right side. No arm or leg. Was it the lack of Coumadin after the procedure? Her carotids were fine. I am just very angry at this point. I'm a peds nurse so not used to this adult thing. Especially not having to transfer my Mom (who two weeks ago could make a family dinnner) to the potty. I am hoping for progress but I am totally out of my element and still angry that if maybe she would have had the meds LIKE THE DOCTOR WROTE we could have avoided this outcome/ Plus - I am clueless to rehab.....how can I make my Mom better?

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The onset of Coumadin is 36-72 hours. I'm not sure what a "challenging" dose is, but if you meant "loading" dose, know that it is possible for a person to have a thromboembolic event during that window of time. I'm so sorry this happened to your Mom! Hopefully some rehab nurses can chime in with some thoughts on assisting with your Mom's recovery. My thoughts are with you.

  • Author

Thanks for the reply. I think the loading dose...again showing my practice limits :) was 7.5 mg. I think we are all thinking "Should we have done this?" "What caused this?", etc. One sister who ironically has no medical training -stated it pretty well today by saying "I guess someone has to make up the 1-5% bad outcome for any procedure - it stinks that it had to be Mom."

That definitely made me think.....I think it's hard to be an RN when your loved one is the patient - a little knowledge can drive you crazy. I promise that we are not being "those family members" though. I have been very impressed with the care that Mom has gotten from the rehab staff and the incredible team approach that you have in this area with the different therapies and medical staff (and we let them know).

Now what are your suggestions on helping Mom on this journey?

If she has right sided hemiplegia, that means it was a left sided stroke, affecting the left side of her brain. There are differences between left hemisphere and right hemisphere strokes that you may want to familiarize yourself with. She may have homonymous hemianopsia- a visual field cut, meaning that she cannot see out of her right eye, and she may not know that she needs to turn her head to see to her right, or she may forget that she has a right arm and leg and thus neglect them.

You might try calling the Stroke Family Warmline and talk to a live person who can answer questions and provide support.

http://www.strokeassociation.org/presenter.jhtml?identifier=2550

Hi Scooby, I'm so sorry about your mom. How is she doing! I am in LTC/Rehab and we get post cva pts. often. They receive intensive PT, OT and speech therapy/swallowing if necessary. Usually are discharged home in 3 to 6 weeks. Please let us know how she is doing ! Sending best wishes! :flwrhrts:

  • Author

Thanks for the reply - positive thoughts are the greatest!

Mom "graduated" from speech yesterday. She talks with a slight slur and

and has a little trouble with word recall at times. She thought the "games"

they were playing with her were silly so she really wasn't putting forth her

best effort. We just try to keep her talking - making her answer more than

yes/no and she is coming along well. Swallowing was fine thank goodness.

They have her up walking a few steps in PT w/brace. She has minimal

movement in the right hip/shoulder which the therapists think is promising.

The staff is great! One of my sisters is an LPN who worked LTC before she

opted to stay home with her kids and I worked as a CNA in LTC/DD before

I got my RN so the nurses/aides/therapists are giving us a refresher

course on gait belts, transfers, etc. The skills are coming back - just

wish it wasn't Mom that we have to use them on.

A rep came in a couple of days ago and used Mom as a guinea pig - her

words - not mine, to try out a relatively new prothesis. It's called a

Bioness L300 Foot Drop System. It's a device that uses electrical stim

to help ambulation. I wasn't there to see it - darn - but Mom gave it

rave reviews.

Have you or anyone else on the board seen it in use? From what I have

been told it is pretty pricey - around $6000.00. Mom is on Medicare and I

did some research and found that they will cover it only for spinal cord injuries

at this point. BUT - if it is what would help her gain function than that is what

she needs. My credit card company would love me!

Scooby

Scooby, Sorry to hear about your Mom. It sounds like she is doing relatively well under the circumstances. The thing I love about rehab nursing is that people leave better off than when they cam in. Keep that in mind as you go through this emotional roller coaster that is the rehab process. I have never heard of this brace you mentioned, it sounds like a high tech AFO.

Good Luck Keep us posted on how Mom is doing.

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