Moving on from Stroke Day Therapy Unit Outpatient Stroke Service - - PowerPoint PPT Presentation

Moving on from Stroke

Day Therapy Unit Outpatient Stroke Service

WELCOME BACK!

Week 2:

• Pharmacy
• Physiotherapy
• Speech Pathology
• Neurological Council of

WA

MEDICATION AND STROKE MANAGEMENT

OBJECTIVES

• Goals of medication management
• Medications involved in the treatment of stroke
• Lifestyle advice

WHAT IS A STROKE?

• Lack of blood flow (oxygen) to the brain caused by a clot
• r rupture of a blood vessel
• Sudden brain damage

Ischaemic = clot are the most common, accounts for 87%

• f strokes, embolic vs thrombotic

Haemorrhagic = bleed, bleeding around the brain or into the brain

RISK FACTORS

• TIA, age, gender, family history
• Irregular pulse – atrial fibrillation
• High blood pressure
• Smoking
• Diabetes
• High total cholesterol
• Low levels high density lipoprotein (HDL)
• Physical inactivity, obesity
• Alcohol overuse

STROKE PREVENTION

• Medication adherence and healthy lifestyle changes

are key to preventing stroke

• >50% of older patients sometimes forget to take their

medications

• Taking medications as prescribed is central to recovery

after stroke and preventing further strokes

GOALS OF MEDICATION

• To reduce ongoing brain injury
• To decrease long-term disability
• Prevent further complications
• Prevent stroke recurrence

TREATMENT

• Acute treatment of an event ideally managed in hospital
• Secondary prevention includes:
• Blood pressure lowering medications
• Cholesterol lowering medications (with statins)
• Antiplatelet therapy (except in patients in whom

anticoagulant therapy is needed)

HIGH BLOOD PRESSURE

• If you have a clinic blood pressure of 140/90 or more

and a TIA or stroke - blood pressure medication should be started or increased (Clinical guidelines for stroke

management 2017)

• High blood pressure may have no symptoms
• Reduction in blood pressure results in 25-30% less

strokes (Benavente, Coffet et al 2014)

• Target blood pressure individualised: 130/80- 140/9

CHOLESTEROL

Two different types of cholesterol:

• LDL (low-density lipoprotein)
• Increases risk of heart attack and stroke
• Takes cholesterol into the arteries
• HDL (high-density lipoprotein)
• Acts as a scavenger to promote reverse cholesterol

transport

• Takes cholesterol out of the artery and back to the

liver so the body can dispose of it

CHOLESTEROL - STATINS

• All patients with stroke or TIA are prescribed a

statin regardless of baseline lipids if there is reasonable life expectancy and possible atherosclerosis (Clinical guidelines for stroke management 2017)

• Medications lower LDL and slightly increase HDL to ↓

risk of stroke by 12% and all vascular events by 25%

• Examples: Atorvastatin, rosuvastatin, pravastatin
• Seek medical attention if you develop dark urine or have

any unusual muscle pain, weakness or tenderness

CHOLESTEROL - OTHERS

• Fibrates
• Fenofibrate (lipidil)
• Seek medical attention if you develop dark urine or have

any muscle pain, weakness or tenderness

• More common adverse effects are abdominal pain and

dyspepsia

• Ezetimibe (Ezetrol)
• Decreases absorption of cholesterol from the diet
• Tell your doctor if you are experiencing any muscle

pain, tenderness or weakness. Most common side effect is headache and diarrhoea

ANTIPLATELETS & ANTICOAGULANTS

• No previous AF
• Long term antiplatelets

generally used if not already on anticoagulants

(Clinical guidelines for stroke management 2017)

• Stroke and AF
• DOAC preferred if good

kidney function and non valvular atrial fibrillation

• Other patients use

warfarin

ANTIPLATELET VS. ANTICOAGULANT

Antiplatelet Anticoagulant Prevents platelets from sticking together as easily ‘thinning the blood’ Stops blood from clotting as easily Aspirin 100mg daily OR Other conditions determine choice Aspirin + dipyridamole (Asasantin)

• Should be taken with food
• Can cause headaches

Warfarin  Coumadin or Marevan- do not change brands  Regularly monitor INR: between 2 -3  Watch for bleeding, keep food choices similar, food and drug interactions  No more than 2 standard drinks of alcohol OR Clopidogrel (Plavix) OR Direct Anticoagulants (DOAC) Pradaxa, Xarelto, Eliquis. No more than 2 standard alcoholic drinks daily

STROKE PREVENTION GUIDELINES

1. Know your blood pressure. Have it checked at least

• annually. If it is high, work with your doctor to control

it. 2. Find out if you have atrial fibrillation (AF); a type of irregular heartbeat. If you have it, work with your doctor to manage it. 3. If you smoke, stop. See your pharmacist for help – nicotine replacement and support services.

STROKE PREVENTION GUIDELINES

4. If you drink alcohol, do so in moderation. 5. Know your cholesterol number. If it is high, work with your doctor to control it. 6. If you are diabetic, follow your doctor’s recommendations carefully to control your diabetes.

STROKE PREVENTION GUIDELINES

7. Include exercise in your daily routine. 8. Enjoy a lower sodium (salt) diet (to help control blood pressure) and lower fat diet (to help control cholesterol). 9. If you experience any stroke symptoms, call 000

• immediately. Every minute matters!

QUESTIONS?

PHYSIOTHERAPY

Which risk factors for stroke can be influenced by exercise?

BENEFITS OF EXERCISE

• Diabetes– management of raised blood sugar levels
• Reduces blood pressure
• Reduces stress
• Reduces cholesterol
• Prevents/ improves obesity
• Improves Depression

EXERCISE TIPS

• Find something you enjoy: swimming, walking, cycling,

exercise groups…

• Make exercise part of your daily routine
• Exercise with a friend, meet at set times
• Don’t overdo it / Pacing
• Ask for assistance

HAVE FUN!

EXERCISE RECOMMENDATIONS- AEROBIC EXERCISE

• E.g. walking, swimming, cycling
• IMPROVE: general fitness, heart

and lung function, circulation

• 30-60 minutes of physical activity on

>5 days per week

• E.g. resistance exercise, gentle

weight training

• IMPROVE: bone health, ability

to complete day-to-day tasks

• 2x/week 8-10 exercises of low

load (less than 2kg) and high reps (10-15 reps)

EXERCISE RECOMMENDATIONS- STRENGTHENING

EXERCISE RECOMMENDATIONS- BALANCE

• E.g. Tai Chi, Balance

classes

• IMPROVE: balance,

reduce risk of falls

• 2-3x/week (total of 2

hours), gradually increasing difficulty

FALLS RISK IDENTIFICATION AND MANAGEMENT

• 1. Move Your Body
• Build your balance
• Strengthen your body
• 2. Improve Your Health
• Check your medications
• Keep a healthy mind
• Fuel your body
• 3. Remove Hazards
• Make your home safer
• Check your eyesight
• Wear safe footwear

Stay On Your Feet

Stay On Your Feet

Case Study: 50yr old Sally suffered a stroke 2 years ago. She has reduced strength on her left side and poor sensation in her left foot and ankle. She is able to walk with the assistance of a walking stick. Sally also suffers from type two diabetes and is on regular medication to try to stabilise her blood sugar levels. Sally lives in her own home with her small Jack Russel dog. Sally has two steps to get inside the front door but once in her home is level.

What risk factors does Sally have for falling?

FALLS RISK IDENTIFICATION AND MANAGEMENT

MYCLE BRANDY - A 4X STROKE SURVIVOR’S CAMPAIGN

• Walked over 10 000km

across America

• Completed 9 full

marathons  All on a walking stick!

QUESTIONS?

SPEECH PATHOLOGY

SWALLOWING AND COMMUNICATING

• After a stroke or TIA you may experience:
• Difficulty talking
• Difficulty understanding others
• Difficulty concentrating, especially in noisy and busy

places

• Difficulty eating and drinking

QUALITY OF LIFE- COMMUNICATION

For people with aphasia, these factors can affect their quality of life.

COMMUNICATION - SPEECH

• Can be slurred or unclear, mumbly OR sounds can get

jumbled up

• A speech pathologist can give you exercises to help

recovery or give you strategies to make you clearer

Talking to others is the best way to improve

SUPPORTING YOUR SPEECH & VOICE

• Also known as deep

breathing

• Uses your abdominal

muscles to increase the amount of air inhaled and exhaled

• Helps to power your

voice and make speech clear Abdominal breathing

COMMUNICATING

Some ways we can practice speaking:

• Find activities that you enjoy doing!
• Ask a friend or family member over for a chat.
• Join community or social groups.
• Being involved in a communication group 1x a week

increases satisfaction and reduces anxiety.

COMMUNICATION - LANGUAGE

• It can be difficult to find the right word, make a sentence
• r understand what others are saying
• A speech pathologist can help you recover your

language or find other ways to help you communicate

COMMUNICATION

• There are many ways to communicate including using

gesture, body language, facial expressions and using props.

• Pictures and objects can help others understand what

you want to say and can help you understand too.

Used as an alternative to or add to existing communication skills Who can benefit from AAC?

• If you are not able to use speech to communicate

effectively in one or more situations

• If you are not understood by some people
• If you have difficulty with having long conversations
• If you have difficulty understanding others

AUGMENTATIVE & ALTERNATIVE COMMUNICATION (AAC)

COMMUNICATING IN THE COMMUNITY

• There are ways you can

engage in the community if you have difficulty speaking, reading or understanding

• Picture menus
• Ordering using a phone
• r screen

NATIONAL RELAY SERVICE

• www.relayservice.com.au/
• Phone:1800 555 660
• Internet relay calls
• Speak and listen calls
• Type and listen calls

HOW TO COMMUNICATE CLEARLY

Take your time Use strategies! Say one thing at a time Ask others to slow down Take extra time in noisy places If you don’t understand, ask again

SAFE SWALLOWING

• Eat small bites of food & chew them well
• Drink small sips
• Sit upright
• Avoid eating and drinking when fatigued

If you are having difficulties with swallowing, a speech pathologist can help

QUESTIONS?

Community Neurological Nurse - Janet Rebola

Thank you for attending, see you next week!