Stroke, or cerebrovascular disease, is the most important neurologic disease in adult life. It is the sudden occurrence of focal neurologic deficit due to an infarct or hemorrhage in the brain. It is the third most common cause of death in the United States, and its effects can be debilitating to the patient and the caregivers…
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The effects of stroke can be divided into two categories: impairments and disabilities. Impairments are changes in the body structure and function. Disabilities, on the other hand, are limitations in the performance of the activities of daily living. These can be affected not just by the physical effects of the disease, but by psychological and social factors.Impairments and disabilities can worsen with time if no intervention is done. It may lead to further deterioration due to immobility or reduced activity, leading to complications such as thrombus formation, decubitus ulcers, and pulmonary embolism. Patients may also become more dependent on others and have decreased normal social interactions. All of these can have a profound effect on a person’s well-being.
Backe, Larsson, and Fridlund (1996) investigated how patients conceived their life situation during the first week after the onset of stroke. They uncovered deep psychological trauma in the patients, wherein they had feelings of unreality, awareness of a changed role in life, feelings of a changed perception of the body, and feelings of being confused. Patients were also found to have a heightened sense of loss of capability and awareness of living in a confined space. Fortunately, some patients also developed an appreciation for the importance of support and encouragement and a will to look for new opportunities after the onset of stroke.
One of the important debilitating effects of stroke is immobility.
It also discusses the role of nurses in the management of stroke patients and in rehabilitation programs. It concludes with learnings from the literature review and critical appraisal and recommendations on how to apply these to nursing practice. The Importance of Movement and Positioning Stroke as a disease process can be progressive. Even though the cerebrovascular event that leads to the neurologic deficits is acute, its sequelae can continue to build on each other, leading to progressive deterioration of the patient. One important example of this is immobility. Due to neurologic deficits, a patient may have difficulty moving. This can lead to development of contractures, muscle atrophy, and nerve palsies (Summers et al., 2009). Current practice advocates early mobility for stroke patients. Summers et al. (2009), in their statements regarding the comprehensive care of the acute stroke patient, recommends that stroke patients may be initially kept on bed rest but should be mobilized once hemodynamically stable. It has been found that early mobilization reduces the risk of atelectasis, pneumonia, DVT, and pulmonary embolism. Aside from early immobilization, a longer term rehabilitation program has also been found to be effective in stroke patients. Ernst (1990) reviewed the literature on rehabilitation and physiotherapy among stroke patients and found that it was associated with improvement in functional status and lower incidence of secondary complications such as pneumonia and ulcers. Furthermore, Gordon et al. (2004) found in their review of literature that aerobic exercise can enable activities of daily living to be performed
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