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Care after a stroke

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After a tragic event such as a stroke, a series of special cares are necessary during the recovery process. Here are some of them.

Hygiene in the bathroom

If the person can move around, it is advisable to do so in the bathroom, conditioned to prevent falls and provide greater safety.

The bathtub should have non-slip rubber on its surface and handrails or handrails should be installed on both sides of the toilet and bathtub.

Place a plastic chair or stool inside the bathtub or shower to allow you to sit down. A telephone shower is very useful.

If the patient suffers from sensory disorders, the family member should check the water temperature to avoid burns.

To get into the bathtub, the affected leg should be supported first, and to get out, the unaffected leg should be supported first.

Only to get out of the bathtub, place a bath mat or thick towel to avoid slipping.

Dry well and avoid wet skin, especially in the folds (armpits, groin).

Protect and care for the skin with moisturizing creams, taking extreme care of areas with bony prominences.

For shaving, it is safer to use an electric razor, except if you have a pacemaker.

For oral hygiene, long-handled toothbrushes are practical.

You may need help with hair hygiene and nail care.

It is preferable, if possible, to perform personal hygiene alone, even with difficulty, and to work on the affected part of the body.

It is not advisable to stay alone in the bathroom until complete recovery.

Bed hygiene

It should be performed daily and asking the patient’s cooperation. Prepare the material before starting and avoid drafts.

You will need:

2 basins: one with soapy water and the other with clean water.

1 sponge or mitten

1 large towel

Protective cream for the skin

Protector to avoid getting the mattress wet

First the face and body should be washed with the patient on his/her back. Then move the patient to one side to wash the back.

Dry very well avoiding the skin moisture, especially in the folds (armpits, groin, etc.).

Protect the skin with moisturizing cream, taking extreme care in the areas of bony prominences.

Avoid lying in bed during the day. For this purpose, a comfortable chair should be provided next to the bed to sit in.

If mobility is very reduced, avoid skin ulceration by having soft pillows on the chair.

It is safer to use an electric razor for shaving.

It is important to clean the mouth and teeth after every meal, as well as hair hygiene and nail care as often as necessary.

Gradually, their independence should be strengthened.

Tips for dressing

It is advisable to arrange all clothing in an orderly fashion and placed according to the order of use.

It is preferable to start dressing the affected limb first and undress the other way around.

At the beginning it is better to use practical and loose-fitting clothing, such as sportswear with elastic waistband, ties with elastic band, Velcro sneakers, clothes without buttons (zippers, etc.).

Shoes should be comfortable and closed so that the foot is supported. A long-handled shoehorn will help you put on your shoes.

Dressing and undressing is best done from a sitting position. With both hands together, put the affected leg on top of the healthy leg and it will be easier to put on the sock or pants.

It is advisable to use a belt in pants and skirts in case it is necessary to hold the patient, either to prevent a fall or to help in a displacement.

Food

A healthy diet with low fat and cholesterol content and an adequate intake of vegetables and fruit will be sought.

When this disease is associated with other diseases such as diabetes, the diet will be modified according to the recommendations indicated.

Hypertensive persons should also avoid salt.

Patients with poor mobility, who sit for long hours, often suffer from constipation. A diet rich in fruits and vegetables is advisable.

It is very important that the diet takes into account the patient’s tastes, otherwise it will be easily abandoned.

Swallowing of liquids may be impaired, so it is better to thicken them.

To facilitate feeding, plates with ridges and cutlery with special handles can be of great help.

To eat, the patient should lean forward with the affected limb well supported.

When the difficulty in swallowing is important, the use of nasogastric tubes is necessary.

Urinary incontinence

Perform local hygiene whenever necessary, avoid humidity and protect the skin with moisturizing creams.

Use absorbent pads in women and collectors in men, avoiding whenever possible the use of bladder catheters.

Establish a schedule to re-educate this altered function, facilitating access to the toilet (a toilet elevator is advisable) or offering the wedge or bottle every 2 hours, for example, at least during the day.

It is also important to have an adequate fluid intake (at least 2 liters), between 8 am and 8 pm.

Always be alert to signs that indicate the need to urinate, if the patient is not able to communicate. There are signs (such as movements of the lower abdomen, angry face, nervousness, sweating…) that may indicate this need. If the patient is conscious, try to show him/her some easy signs that can indicate the need to urinate.

Encourage the patient to sit down as soon as possible to urinate. Perform exercises that help to start urination: it may be useful to compress the lower abdomen, put warm water, caress the inner thigh, open a faucet… At night, leave the walker or cane if you need it to walk.

Before going to bed, it is advisable to try to urinate to empty the bladder and provide the patient with a warning system. Sometimes, it is useful to set an alarm clock to urinate in the middle of the night.

Urinary retention

Offer the wedge or bottle.

It may be necessary for the patient or a family member to learn the technique of bladder catheterization.

It should be explained to the patient that the catheter is a temporary measure. In the meantime, adequate fluid intake and good local hygiene are recommended.

Stretch

Abdominal distention (bloating), flatus, nausea and abdominal spasms may be signs that indicate the need to defecate.

Eat an adequate diet high in fiber. Include laxative foods in the diet. Astringent foods should be avoided.

Do not self-medicate. Try to avoid dependence on laxatives and enemas.

Fluid intake: minimum 2 liters per day.

Maintain as much physical activity as possible.

Relaxation is important.

It may be helpful to drink prune juice before bowel movements.

Diarrhea

If it is severe or long lasting, consult a physician.

Administer an astringent diet.

Prevent dehydration of the patient, administering large amounts of clear liquids.

Prevention of complications due to immobility

Move all joints at least 2 times each day, either with family help or by yourself to avoid joint stiffness.

Sometimes it is necessary to use certain devices to avoid deformities (sling, splints…).

Use a support or arch in bed to prevent the feet from supporting the weight of the blankets.

With the help of family members, the back and bony prominences should be massaged in a circular motion with moisturizing cream. If redness appears in these areas, rubbing should be avoided by leaving them exposed to the air.

In completely disabled patients, the position in bed should be taken into account.

Postural changes should be made.

When lying on the back, the hands should be facing upwards and open. A pillow prevents outward rotation of the affected leg. The body should be well aligned, avoiding neck flexion.

On the side over the affected extremities: The unaffected shoulder forward and the affected elbow in extension. Place a pillow between the two knees, with the unaffected leg slightly more forward. On the back place another pillow to prevent the body from turning.

To put him on one side or the other, first cross and turn the paralyzed leg, and then rotate the whole body to the healthy side.

In some cases, anti-decubitus mattresses may be useful.

For your communication you need to:

Speak to the person clearly and simply, without shouting. To place oneself in front of the person.

When comprehension is normal and there is speech impairment, it is advisable to use cards with drawings to facilitate communication or use pencil and paper or blackboard.

Stimulate the person with their progress. Do not interrupt him/her when he/she is talking and give him/her time.

Avoid making the person feel isolated. Make him/her participate in everything that happens in his/her environment and collaborate as much as possible.

Later it will be necessary the help of a speech therapist.

Social environment

Involve the person, as far as possible, in his recovery.

Provide distraction.

Encourage social interaction: radio rather than TV, newspapers, music, keeping the person up to date with family matters, etc.

Encourage professional readaptation, if possible.

Never treat him/her as a child.

Sometimes it is necessary to advise new hobbies and activities.

Encourage him/her.

Be optimistic.

General advice

Home:

In the home, minor modifications may be necessary and adjust for changes in level with ramps.

If there are stairs inside the home, attaching a chair to the handrail may be helpful.

Chair:

For sitting, it is usually best to use high chairs that have armrests and firm backs (it is easier to get up from a chair that allows you to rest your heel and force your hands on the armrests).

Wheelchairs should always have a brake with an easily accessible lever. Footrests and armrests should be easy to lift.

The patient should get dressed before transferring from the bed to the wheelchair, unless he/she is going to take a shower.

For transfer from bed to chair: surfaces should be at the same height and close together.

Bed:

The mattress should be hard. In some cases, it may be useful to place a bar at the head of the bed to make it easier to sit up.

Nowadays, there are also special beds with an electric device that allows the head or feet to be raised.

Travel and transportation

When requesting a transportation service by telephone, the disability should be noted so that the appropriate vehicle can be arranged.

Travel should be scheduled in advance (hotel reservations, transfers, etc.).

It is very important to always carry a medical report.

If, after consulting with your doctor, there is no objection to driving your car, it should be automated and prepared for easy handling.

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