After a Stroke: The First Days to Weeks
After a patient moves from the ER to the hospital, doctors will deal with any complications and help prevent future strokes. Here's what to expect during his hospital stay, and how to prepare for his care and recovery after he gets out.
After the ER: a short hospital stay
Once a patient's stroke has been evaluated and his condition has been stabilized, he'll be transferred out of the ER and into a hospital bed. How long he spends in the hospital depends on a number of factors, including the type and severity of his stroke, what medical complications arise, and the extent of his disability. But it's unlikely that he'll be in the hospital for long. According to the National Centre for Health Statistics, the average length of hospitalisation for stroke in 2005 was 5.2 days.
What to expect after a stroke
Even though the person you're caring for is out of the ER, serious complications may still arise. An estimated one out of five stroke patients dies during his hospital stay. The patient's treatment team has two main goals: To prevent another stroke from occurring and to minimize and respond to any complications.
To this end, the person you're caring for will undergo more testing to determine the cause of this stroke. Although the doctors should know what type of stroke he had, they'll still need to pinpoint the exact cause. They may perform one or more of the following tests: Carotid ultrasound to determine if either carotid artery is narrowed or blocked. This test is non-invasive and painless: A technician applies jelly to the patient's neck, then slides an ultrasound wand over the skin covering his carotid artery.
Transcranial Doppler test for blockages in the large brain arteries. This test is similar to the carotid ultrasound, although the sound waves go through the patient's skull instead of his neck.
Cerebral angiogram to look for atherosclerosis or a brain aneurysm. The patient will be sedated to minimize his anxiety and discomfort during this procedure. A long, thin catheter, or tube, is inserted into a large artery in his groin, then manoeuvred all the way through blood vessels into his chest. Once the tube reaches his carotid artery, dye is injected, which travels through the artery into the brain. Then a series of X-rays is taken to spot any abnormalities in the blood vessels of the brain. Because this procedure carries a slight risk of causing another stroke, it will be performed only if other tests are inconclusive.
- Treatment to prevent future strokes and monitoring for complications - Depending on the patient's test results, his doctors will treat him to reduce his risk of having another stroke: - For an ischemic stroke, he may be given anticlotting drugs, have a procedure known as a carotid endarectomy, or both. - For a hemorrhagic stroke, he may need to have a torn brain artery or aneurysm repaired, both of which require major surgery. - No matter what type of stroke he had, risk factors such as high blood pressure, high cholesterol, and diabetes will be evaluated and treated. - Complications could include brain swelling, seizures, clots in his legs, aspiration due to difficulty swallowing, arrhythmias, bleeding stomach ulcers, and pressure sores. The patient's doctors will be on the lookout for these serious and potentially fatal complications.
How to help a stroke patient
The patient's hospital stay may be even more stressful for you than his stroke and time in the ER. Now that you're no longer in crisis mode, you have more time to think - and worry - about the future. But try to use that time to prepare for life after his discharge instead:
Figure out how much care he will need. The extent of his stroke-related disability may not be immediately obvious, but it will become clearer as his recovery progresses. Talk to his rehabilitation team about how much care he'll need immediately after discharge, then discuss options for his care with his family or friends. Will he be able to return to his own home or to a family member's home? Or will he need more short-term or long-term attention and care? For more information about this decision-making process, see How Much Care Will Your Parent Need After a Stroke?
Make necessary changes to your or the patient's home. If it looks like he might be able to return to his or another family member's home, this is the time to start making that home more comfortable and accessible. To get started, see Making Your Parent's Home Safer After a Stroke.
Gather your resources. You're going to need all the help and support you can get during the patient's stroke recovery period. The Family Caregiver Alliance is one resource to investigate, and family and friends will probably be willing to help. Don't hesitate to gratefully accept their assistance.
Learn as much as you can from the hospital staff. Believe it or not, the patient's hospital stay is likely to be over before you know it. While he's there, ask questions and make the most of the resources available. Nurses can help train you with such things as performing wheelchair transfers, dealing with bowel or bladder incontinence, and avoiding pressure sores. A nutritionist can help you plan for any special dietary needs, especially if the person you're caring for has difficulty swallowing.
Try to be patient. It can be very upsetting to see the person you're caring for in the throes of post stroke complications, and he may actually get worse before he gets better. His brain may need time to recover from circulation problems or swelling before the extent of his disability - or his lack thereof - will become clear. In other words, you may not be able to see any improvement at this point, but that doesn't mean things aren't going to get better. Stay positive.
Focus on recovery. The patient's stroke recovery begins in the hospital. Most spontaneous recovery actually occurs during the first days to weeks after a stroke. The person you're caring for should begin working with the hospital rehabilitation team as soon as he's stable. Your encouragement and support will be especially important as he begins the difficult work of recovery.
First Days after Stroke
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