Stroke Nursing

Stroke Nursing is the leading guide for optimal stroke care, facilitating the provision of evidence-based practice across the stroke journey, and covering the sixteen elements of care outlined in the UK's Stroke-Specific Education Framework (SSEF).

Drawing from years of clinical and research experience, the authors provide practical guidance on the essential areas of stroke nursing, including stroke classification, stabilisation, thrombolysis and thrombectomy, rehabilitation and recovery, nutrition and oral care, palliative and long-term care, physical impairment management, and more.

Now in its second edition, this indispensable guide helps practitioners expand their knowledge, skills and competence in all areas of stroke nursing services.

• Adopts a practical and evidence-based approach to stroke management, exploring UK and international perspectives
• Authored by expert clinicians and leaders in the field of nursing practice, research and education
• Includes updated case studies and practice examples, expanded coverage of clinical application in practice, and new discussions of the knowledge and skills required by nurses

Stroke Nursing is essential reading for students of nursing and neuroscience, and is the definitive reference for practicing nurses and healthcare professionals caring for stroke patients.

Jane Williams is Divisional Director for Transformation, based in Southern Health Foundation Trust, Southampton, UK.

Lin Perry is Professor of Nursing Research & Practice Development, South Eastern Sydney Local Health District and University of Technology Sydney, Sydney, Australia.

Dame Caroline Watkins is Professor of Stroke and Older Peoples' Care, University of Central Lancashire, Preston, UK.

Editors and Contributors ix

Foreword: Stroke Nursing xiii

Foreword: Stroke Services In Australia xv

Foreword: Stroke Care In Hong Kong xix

Acknowledgements xxiii

1 Setting the Scene 1
Caroline Watkins and Dominique Cadilhac

1.1 Introduction 1

1.2 Stroke Epidemiology 2

1.3 Cost Burden 3

1.4 Stroke Policy 4

1.5 Stroke Management Strategies 8

1.6 Research and Education 11

1.7 Conclusion 13

References 13

2 What Is a Stroke? 19
Anne W. Alexandrov

2.1 Introduction 19

2.2 Stroke Classification 20

2.3 Risk Factors for Stroke 22

2.4 Anatomy, Physiology, and Related Stroke Clinical Findings 23

2.5 Standardised Instruments for Acute Neurological Assessment 41

2.6 Conclusion 44

References 50

3 Reducing the Risk of Stroke 53
Josephine Gibson and Stephanie Jones

3.1 Introduction 54

3.2 Primary Prevention 55

3.3 Primary Prevention – Medical Considerations 56

3.4 Secondary Medical Prevention After TIA or Stroke 59

3.5 Interventions for Secondary Prevention After TIA or Recovered Stroke 63

3.6 Conclusion 68

References 68

4 Acute Stroke Nursing Management 75
Anne W. Alexandrov

4.1 Introduction 76

4.2 Priorities in Acute Stroke Management 76

4.3 Hyper-acute Stroke Management 77

4.4 Hyper-acute Treatment of Haemorrhagic Stroke 90

4.5 Acute Stroke Management 93

4.6 Conclusion 96

References 96

5 Nutritional Aspects of Stroke Care 103
Lin Perry and Elizabeth Boaden

5.1 Introduction 104

5.2 Do Stroke Patients Experience Nutritional Problems Pre-Stroke? 106

5.3 How Does Stroke Affect Dietary Intake? 107

5.4 How Can Stroke Patients Be Helped to Maintain Adequate Dietary Intake? 119

5.5 Conclusion 132

References 133

6 Oral Care After Stroke 143
Mary Lyons

6.1 Introduction 144

6.2 Oral Assessment 145

6.3 Management and Care 146

6.4 Patient and Carer Perspective 147

6.5 Conclusion 148

References 148

7 Communication 153
Jane Marshall, Katerina Hilari, Madeline Cruice, and Kirsty Harrison

7.1 Introduction 154

7.2 Aphasia 155

7.3 Dysarthria and Apraxia of Speech 160

7.4 Right-Hemisphere Damage (RHD) Communication Deficit 163

7.5 Language Minorities 165

7.6 What Can SLTs Contribute in Acute Stroke Care? 166

7.7 Psychological Issues and Quality of Life 169

7.8 Conclusion 171

References 171

8 Management of Physical Impairments Post-Stroke 177
Cherry Kilbride, Rosie Kneafsey, and Vicky Kean

8.1 Introduction 178

8.2 Movement 179

8.3 Promoting Physical Activity and Movement After Stroke 180

8.4 Promoting Early Rehabilitation 184

8.5 Re-education of Movement 188

8.6 Management of the Upper Limb 192

8.7 Patients’ Perspectives on Early Physical Rehabilitation 195

8.8 Conclusion 195

References 196

9 Rehabilitation and Recovery Processes 203
Jane Williams and Julie Pryor

9.1 Introduction 204

9.2 Understanding Rehabilitation 204

9.3 Initiation of Rehabilitation 207

9.4 Nursing’s Rehabilitation Role 208

9.5 Outcomes of Rehabilitation 210

9.6 Goal–Directed Rehabilitation 210

9.7 Recovery Processes 212

9.8 Transfer to Rehabilitation 214

9.9 Rehabilitation Provision 216

9.10 Length of Rehabilitation 219

9.11 Adjustment to Life After Stroke 220

9.12 Conclusion 221

References 222

10 Promoting Continence 229
Kathryn Getliffe and Lois Thomas

10.1 Introduction 230

10.2 Prevalence and Causes of Continence Problems Post-Stroke 230

10.3 Importance of Continence Care 231

10.4 Bladder Function and Dysfunction 233

10.5 Main Types of UI 234

10.6 Transient Causes of UI 236

10.7 Assessment of UI and Bladder Dysfunction 236

10.8 Treatment Strategies and Care Planning for UI 242

10.9 Management and Containment of Incontinence 247

10.10 Bowel Problems and Care 249

10.11 Conclusion 254

References 255

11 Emotional and Cognitive Changes Following a Stroke 259
Peter Knapp and Elizabeth Lightbody

11.1 Introduction 260

11.2 Psychological Reactions to the Onset of Stroke 260

11.3 Coping with Stroke 261

11.4 Depression 261

11.5 Conclusion 274

References 274

12 Stroke and Palliative Care 281
Clare Thetford, Munirah Bangee, Elizabeth Lightbody, and Caroline Watkins

12.1 Introduction 282

12.2 Specific Challenges in Stroke 283

12.3 Tools to Support Palliative Care 286

12.4 Case Studies 291

12.5 Discussion 294

12.6 Conclusion 296

References 296

13 Minimally Responsive Stroke Patients 301
Elaine Pierce

13.1 Introduction 302

13.2 Definitions 302

13.3 Assessment and Diagnosis 303

13.4 Management and Care 308

13.5 Locked-In Syndrome 314

13.6 Conclusion 318

References 319

14 Longer-Term Support for Survivors of Stroke and Their Carers 323
Judith Redfern, Clare Gordon, and Dominique Cadilhac

14.1 Introduction 324

14.2 Longer-Term Consequences of Stroke, Informal Care and Costs 325

14.3 The Need for Support 325

14.4 Responsibilities of Health and Social Care Professionals 330

14.5 Identifying Those at Risk 331

14.6 Interventions to Support Stroke Survivors and Carers 334

14.7 Supporting Working-Age Survivors of Stroke 338

14.8 Conclusion 339

References 340

Appendix A: The stroke-specific education framework (ssef) 347

Index 349

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