in association with Welcome to Ward 6 STROKE UNIT Your Personal Care Booklet Name:.... Date Issued:. 1
About our booklet This booklet aims to provide you and your family/carer with as much information as possible following your diagnosis of stroke. It has been produced after consultation with patients, relatives and carers, who told us that it was important to know:- The type of stroke you ve had Risk factors associated with stroke Preventative measures that can be taken Easy to understand details of medical treatments Useful contacts We hope that this will prove useful and would welcome your feedback by completion of the questionnaire at the back of this booklet. Your feedback is important to us as it will help us to continually improve. We encourage you to share your booklet with your family/carer and any other professionals who may be involved in your care. It would also be helpful if you or your family/carer provides us with any information which may help us to help you! If you are having difficulty following this information, there are pictures to support/help to explain. The staff can go through these with you. 2
Welcome to the Ward Ward 6 is a 28 bedded unit. There are 20 rehabilitation beds and 8 acute beds in the Acute Stroke Unit (ASU). About your stay For the first 72 hours of your stay you will be in ASU, where you will be placed on a monitor. Do not be alarmed, this is routine for all patients. This helps us to record your vital signs by monitoring your blood pressure and heart rhythm. This is nothing to be concerned about, as it is all part of your stroke care. You will be admitted by a nurse and will be seen by a Stroke Consultant every day whilst in your acute phase. You will also be assessed by our therapy team to begin your treatment. During this time you will also have a series of tests which are explained later in the booklet. Depending on the severity of your stroke, you may be discharged home from ASU and come back as an outpatient for the remainder of your tests. If you are not discharged from ASU and you need more treatment/therapy, you will be moved onto the main part of the ward to continue your rehabilitation programme. 3
Items you will need during your stay: - Nightwear - Toiletries - Shoes/trainers/slippers - Day clothes - Glasses if worn - Hearing aids if worn - Any dentures Day clothes play an important part of your stroke treatment, as we like to get you out of bed as soon as your physical condition allows. We would also like to invite you to use the dayroom to have your meals and to socialise with other patients. 4
Family Meetings Family meetings are essential to discuss your progress, future plans for your care and discussion of possible referral to Social Services. It is important to remember that all strokes are different and can leave some people with more severe disabilities, which may require support at home or long term placement. We aim to be truthful in these meetings and not give false hope. However, whilst a patient still has goals and is making progress they will continue to receive therapy within a reasonable timescale. The initial meeting usually takes place in the first weeks after admission; subsequent meetings take place at relevant times according to your progress. People usually involved in meetings with you and your family are your therapists, a member of the nursing staff and Social Services. If you or your family/carer wishes to arrange a meeting with a member of the medical team, the nursing staff will be happy to arrange this. 5
Personal details Name:. Address:. Tel:... Mobile:..... Email: Next of kin(1) Name: Address:... Tel:... Mobile:.... Email: Relationship to you. Next of kin(2) Name: Address:... Tel:... Mobile:.... Email: Relationship to you. 6
People involved in caring for you prior to admission Name Profession Contact Number 1 2 3 4 5 6 7
Yourself and Family/Carer Please feel free to write on the following pages including any questions you may have for us: Details of any new treatments (e.g recent changes to tablets): Special Care/ Care Requirements: Special diets: 8
Daily routines: Hobbies: Other information: 9
What is a stroke? Stroke happens when the blood supply to the brain is suddenly reduced. The two types of stroke are; - Ischaemic occurs when a blockage of a blood vessel reduces the blood supply to the brain. - Haemorrhagic bleeding caused by leaks from a burst blood vessel What type of stroke did I have? Ischaemic (blockage) Haemorrhagic (leaks) Other If other, please specify... Other - there are some other less common causes. If your stroke has been caused by one of these, your Consultant will explain this you to. What are my symptoms? Why did I have a stroke? 10
Where in my brain did the stroke occur? We will discuss with you where your stroke is and what this will mean to you. 11
Patient/Carer notes Please write any questions you may have here 12
My investigations Date of CT scan: Results: Treatment: We will tick which tests you have had or due to have. Blood Biochemistry (blood test) Fasting Lipids and Glucose BM (finger prick test for glucose) Electrocardiogram Carotid Doppler Videofluoroscopy Thyroid Function Tests (blood test) Magnetic Resonance Angiogram (MRA) CT Angiogram 13
Record of any other tests Test Date Result 14
Personal Treatment Plan Date. Nursing Physiotherapy Occupational Therapy Speech Therapy Progress notes 15
Management of my risk factors Hypertension (High blood pressure) High Cholesterol/ Diabetes Smoking/ Alcohol Atrial Fibrillation (Irregular heartbeat) Diet/Weight/ Exercise 16
The Stroke Team Your Consultant is: Your Stroke Specialists Nurses are: Your Physiotherapist is: Your Occupational Therapist is: Your Speech Therapist is: Your Therapy Assistant is: Your Social Worker is: Your Named Nurse is: Your Dietician is: 17
Role of the Ward Staff Consultant - is a doctor who specialises in stroke care. They will order your tests and plan your treatments. They have other medical staff who work alongside them to ensure that all your medical needs are met. Stroke Specialist Nurse The Stroke Specialist Nurse (SSN) will have been one of the first nurses to see you in the Emergency Department, working alongside the Doctors to assist in your diagnosis of stroke. During your stay the SSN will act as a support for you and your family should you have any questions about your stroke and recovery. Nursing Staff - ranging from ward manager who runs the ward to healthcare assistants who are all here to meet your nursing needs whatever they may be. Physiotherapists (Physio) - will assess you to establish problems your stroke has caused. This may be muscle weakness, sensory loss and balance problems. This may affect your ability to sit, stand up or walk. Your physio will tailor treatments to your specific needs. They will continually assess changes in your recovery and manage secondary problems such as pain and muscle tightness. They will also help to educate you and your family regarding your stroke and rehabilitation. 18
Occupational Therapist (OT) will assess the impact of any physical or cognitive symptoms your stroke has had on your ability to do your usual day to day activities. They provide advice on equipment/adaptations for your home and may identify areas where you may need help from carers. They may need to visit your home to assess your requirements for discharge. Speech and Language Therapist (SALT) will be involved in the identification, assessment and management of communication and/or swallowing difficulties. Swallowing The nursing staff will complete a swallow screen shortly after you are admitted into hospital. The SALT team will then complete a full assessment if any difficulty has been identified. Where required, they will provide exercises or compensatory strategies which aim to improve any muscle weakness or sensory loss that you may have. They may recommend nil by mouth if there is a significant risk of aspiration (food and drink going down the wrong way onto your lungs rather than into your stomach). The SALT team may also recommend modified diet and fluids, for example, a pureed diet or thickened drinks. 19
Communication The SALT team will assess your communication and where appropriate will tailor a therapy plan to your specific needs. Stroke can impact on your communication in many ways; including reduced clarity of your speech, in finding the right words, difficulty in understanding the spoken word and difficulty in reading and writing. The SALT team aim to involve family and carers in your rehabilitation goals, where possible. Orthoptist your vision may have been affected by your stroke. If this service is required your Consultant will refer you. Pharmacist will ensure that your medicines are managed safely and that they are appropriate for your age and clinical condition. Social Workers we will refer you to Social Services if necessary; we will consult you before doing so. They provide advice on housing, benefits, family issues and securing care packages for your return home. If this is not possible, they will help and advise regarding nursing home/residential placement. 20
Rehabilitation Assistants they will assist and support the implementation of your rehab programme. They will work with your OT and Physio. Neurologist a doctor who specialises in the diagnosis and treatment of nervous system disorders, including the brain, spinal cord, nerves and muscles. Your consultant may want you to see a neurologist if your symptoms are not caused by a stroke. Dietician will provide advice on diet, weight and healthy eating. Based on the nutritional assessments the nurses carry out, we may refer you if we are concerned about your weight. They are also responsible for calculating your feed requirements if you need to be fed via a tube, should your swallowing not be safe. Smoking Cessation we have an advisor in the hospital who will visit you if you want help to stop smoking. Contact number: 01270 612351. 21
Stroke Helpline 0303 3033 100 www.stroke.org.uk The Stroke Specialist Nurse will refer you to the Stroke Association with your consent. Your first contact will probably be with an Information, Advice and Support Co-ordinator, who will visit you on the ward to offer support to you and your family. The Information Advice and Support Co-ordinator looks at your needs and those of your family at this difficult time. They can help you prepare for the changes that happen because of a stroke. This initial visit on the ward is to give you an introductory pack and to discuss any non-medical concerns you may have. They can offer you home visits and/or telephone follow up calls to: Help you understand the effects of your stroke Help you get financial support Tell you how to get help from health services, Social Services and voluntary organisations Offer advice about prevention and a healthy lifestyle Offer carer support and refer to other carer organisations. They also have various stroke support groups that you may wish to attend such as:- Northwich Stroke Group Crewe Stroke Group Crewe Moving on Stroke Group for people of working age Communication Support Groups in Northwich and Crewe Fishing Group. The Stroke Association is registered as a charity in England and Wales (No 211015) and in Scotland (SC037789). Also registered in Northern Ireland (XT33805), Isle of Man (No 945) and Jersey (NPO 369). 22
Driving after your stroke Stroke can affect your ability to drive safely in a number of different ways due to changes in: - Physical strength - Decision making - Perceptual skills - Vision - Reactions and concentration. You must NOT drive for at least one month after a stroke. If you are advised not to drive or have remaining physical problems including weakness/visual problems then you may only start driving again with the consent of your Consultant or your GP. We would advise you to contact your insurance company. For further information, please see Driving after Stroke (Stroke Association factsheet). The DVLA can also provide advice for you if you are a lorry driver [HGV], coach, taxi or bus driver. Flying after your stroke There is no absolute medical ban on flying after stroke. Each airline has its own rules. The cabin pressure during flight is lower than at sea level, so there is a theoretical risk of stroke. Most airlines advise not to fly for two weeks after your stroke unless it is imperative. Your travel agent or flight operator should be able to assist. You should also contact your travel insurance provider to inform them of your stroke. 23
Returning to work Your ability to return to your previous employment will depend on the residual effects of your stroke and the type of job you do. Your Consultant and OT can help decide whether you are well enough to return to work. You should discuss returning to work with your employer and may want to consider some of the following options for your return. Some options to consider are: - Planned phased return - Part time - Change of role - Transport to and from work - Fatigue - Concentration Under the Disability Discrimination Act [1995] your employer is required to make reasonable adjustments to your working arrangements or conditions. The employment advisor at your local job centre can give advice regarding disability, transferrable skills and retraining. Vocational rehabilitation can be available through a specialist team. Your OT can provide further information. Please see Stroke Association factsheet Stroke in people of working age (18-65) for further information. 24
Supported discharge While you are receiving treatment from the Specialist Community Stroke Rehabilitation Team, we will work with you to set realistic weekly goals. This will focus your treatment and aid recovery from your stroke. Long term goals may not be achievable straight away, or in the way you would like, but we will, as a team, work towards this by using a step by step approach. Examples of goals could be: 1. to be able to get from my bed to my chair with some help. 2. I would like to be able to help myself get dressed. 3. I would like to improve my talking. XXXXXXXXXXXXX XXXX 25
S.M.A.R.T = Specific, Measurable, Achievable, Realistic, Timely Your Goal: S.M.A.R.T Goal: How will we achieve your Goal? Date Set: 26
Review Date: Your Goal: S.M.A.R.T Goal: How will we achieve your Goal? Date Set: 27
Review Date: Your Goal: S.M.A.R.T Goal: How will we achieve your Goal? Date Set: 28
Review Date: Your Goal: S.M.A.R.T Goal: How will we achieve your Goal? Date Set: Review Date: 29
ACT FAST Ensure this information is kept with you at all times. I had a stroke on / / F ace - has my face fallen to one side? A rms - can I raise both and keep them up? S peech - is it slurred? T ime - call 999 **PLEASE** If you see me start to suffer any of the above, please note the time it began. It can help determine the treatment I receive : AM/PM Thank you 30
Useful websites: DVLA www.gov.uk Department Work and Pensions www.gov.uk Different Strokes www.differentstrokes.co.uk 31
Summary for the Community This information is available in audio, Braille, large print and other languages on request. This booklet has been reviewed by the Readers Panel June 2015. Printed July 2015 Review July 2017 Ref: EC/ASU/0040715 32