Acute Stroke Nursing

Stroke is a medical emergency. With active and efficient nursing management in the initial hours after stroke onset, effective recovery and rehabilitation is increased. Acute Stroke Nursing provides nurses with a current, evidenced based, practical text facilitating the provision of optimal stroke care during the primary prevention and acute phases. This timely and practical text is structured to follow the acute stroke pathway experienced by patients. It explores the symptoms, causes and effects of stroke and provides guidance on issues such as nutrition, continence, positioning, mobility and continence. The text also considers rehabilitation. discharge planning, palliative care and the role of the nurse within the multiprofessional team. Acute Stroke Nursing is an essential guide to the management of acute stroke for all nurses health care professional wishing to extend their knowledge of stroke nursing

Jane Williams is consultant Nurse in Stroke Care, based in Portsmouth Hospitals NHS Trust, UK. She has been involved in many national working parties, including the National Stroke Strategy, UK Forum for Stroke Training, and UK Stroke Forum. Jane is member of The Stroke Association research awards committee. A founder member of the National Stroke Nursing Forum, Jane undertook a term of office as chair. Lin Perry is Professor of Nursing Research and Practice Development, University of Technology, Sydney and the Northern Hospitals Network, South Eastern Sydney and Illawarra Area Health Service. A member of the Intercollegiate Stroke Working Party in the UK, the National Stroke Foundation Guidelines Working Party and Stroke Services New South Wales in Australia, she has extensive experience with national guideline development, benchmarking, service review and evaluation. Caroline Watkins is Professor of Stroke and Older People's Care at the University of Central Lancashire, UK. As a member of the Vascular Team at the Department of Health, she is working to implement the National Stroke Strategy, and leads the development of the new UK Forum for Stroke Training. Caroline is the president of the Society of Research in Rehabilitation and on the Steering Group of the National Stroke Nursing Forum.

Foreword	p. vii
Editors and Contributors	p. xiii
Setting the scene	p. 1
Introduction	p. 1
Stroke epidemiology	p. 2
Stroke policy	p. 3
Stroke management strategies	p. 8
Research and education	p. 11
Conclusion	p. 13
References	p. 13
Developing stroke services: a key role for nursing and nurses	p. 17
Introduction	p. 17
Service development	p. 17
The nursing contribution to stroke services	p. 19
The political agenda shaping stroke service development	p. 25
Conclusion	p. 30
References	p. 30
What is a stroke?	p. 33
Introduction	p. 33
Stroke development processes	p. 34
Risk factors for stroke	p. 37
Anatomy, physiology and related stroke clinical findings	p. 37
Standardised instruments for acute neurological assessment	p. 57
Conclusion	p. 60
References	p. 64
Acute stroke nursing management	p. 66
Introduction	p. 67
Priorities in acute stroke management	p. 67
Hyperacute stroke management	p. 68
Acute stroke management	p. 80
Conclusion	p. 85
References	p. 85
Nutritional aspects of stroke care	p. 91
Introduction	p. 92
Do stroke patients experience nutritional problems pre-stroke?	p. 92
How does stroke affect dietary intake?	p. 95
How can stroke patients be helped to maintain adequate dietary intake?	p. 104
Conclusion	p. 115
References	p. 117
Promoting continence	p. 123
Introduction	p. 124
Bladder problems and urinary incontinence	p. 127
Bowel problems and bowel care	p. 144
Conclusion	p. 148
References	p. 149
Management of physical impairments post-stroke	p. 152
Introduction	p. 153
Movement	p. 153
Moving and handling people with stroke	p. 155
Therapeutic positioning and seating in the acute phase	p. 157
Promoting early mobilization	p. 159
Falls prevention	p. 163
Restoration and re-education of movement	p. 164
Management of the upper limb	p. 168
Further rehabilitation strategies and novel developments	p. 171
Patients' perspective on mobility rehabilitation	p. 174
Conclusion	p. 175
References	p. 176
Communication	p. 184
Introduction	p. 185
Communication impairments caused by stroke	p. 186
Language minorities	p. 196
The role of the speech and language therapist in acute stroke care	p. 197
Psychosocial issues and quality of life	p. 199
Conclusion	p. 201
References	p. 201
Mood and behavioural changes	p. 205
Introduction	p. 205
Psychological reactions to the onset of stroke	p. 206
Conclusion	p. 218
References	p. 219
Minimally responsive stroke patients	p. 222
Introduction	p. 222
Definitions and identification	p. 223
Minimally responsive state	p. 224
'Locked-in' syndrome	p. 232
Conclusion	p. 237
References	p. 238
Rehabilitation and recovery processes	p. 241
Introduction	p. 241
Initiation of rehabilitation	p. 244
Outcomes of rehabilitation	p. 246
Recovery processes	p. 249
Transfer to rehabilitation	p. 250
Rehabilitation provision	p. 252
Conclusion	p. 256
References	p. 256
Stroke and palliative care: a difficult combination?	p. 263
Introduction	p. 264
Palliative care	p. 264
Relevance of palliative care to stroke	p. 266
Organisational challenges	p. 271
Conclusion	p. 271
References	p. 272
Reducing the risk of stroke	p. 275
Introduction	p. 275
Primary prevention	p. 276
Secondary prevention: identifying those at risk of stroke	p. 279
Public awareness and access to services	p. 296
Secondary prevention of stroke in less common aetiologies and patient groups	p. 297
Conclusion	p. 299
References	p. 299
Longer-term support for survivors and supporters	p. 309
Introduction	p. 309
Leaving hospital	p. 310
What is required longer term?	p. 313
What do carers want?	p. 316
Conclusion	p. 322
References	p. 323
Stroke resources for professionals, patients and carers	p. 331
National associations	p. 331
Resources for patients and carers	p. 332
Other resources and organizations	p. 333
Specialist international journals	p. 336
Non-specialist journals' stroke collections	p. 336
Clinical practice guidelines	p. 337
Finding current stroke research	p. 338
Evidence-based practice resources	p. 338
Chapter links	p. 339
Index	p. 343
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