Stroke is a medical emergency that requires immediate medical attention. With active and efficient nursing management in the initial hours after stroke onset and throughout subsequent care, effective recovery and rehabilitation is increased.Acute Stroke Nursing provides an evidence-based, practical text facilitating the provision of optimal stroke care during the primary prevention, acute and continuing care phases.

This timely and comprehensive text is structured to follow the acute stroke pathway experienced by patients. It explores the causes, symptoms and effects of stroke, and provides guidance on issues such as nutrition, continence, positioning, mobility and carer support. The text also considers rehabilitation, discharge planning, palliative care and the role of the nurse within the multi-professional team.Acute Stroke Nursing is the definitive reference on acute stroke for all nurses and healthcare professionals wishing to extend their knowledge of stroke nursing.

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 for Research in Rehabilitation and on the Steering Group of the National Stroke Nursing Forum.

Foreword vii

Editors and Contributors xiii

1 Setting the scene 1
Caroline Watkins and Michael Leathley

Introduction 1

Stroke epidemiology 2

Stroke policy 3

Stroke management strategies 8

Research and education 11

Conclusion 13

References 13

2 Developing stroke services: a key role for nursing and nurses 17
Christopher R. Burton

Introduction 17

Service development 17

The nursing contribution to stroke services 19

The political agenda shaping stroke service development 25

Conclusion 30

References 30

3 What is a stroke? 33
Anne W. Alexandrov

Introduction 33

Stroke development processes 34

Risk factors for stroke 37

Anatomy, physiology and related stroke clinical fi ndings 37

Standardised instruments for acute neurological assessment 57

Conclusion 60

References 64

4 Acute stroke nursing management 66
Anne W. Alexandrov

Introduction 67

Priorities in acute stroke management 67

Hyperacute stroke management 68

Acute stroke management 80

Conclusion 85

References 85

5 Nutritional aspects of stroke care 91
Lin Perry and Elizabeth Boaden

Introduction 92

Do stroke patients experience nutritional problems pre-stroke? 92

How does stroke affect dietary intake? 95

How can stroke patients be helped to maintain adequate dietary intake? 104

Conclusion 115

References 117

6 Promoting continence 123
Kathryn Getliffe and Wendy Brooks

Introduction 124

Bladder problems and urinary incontinence 127

Bowel problems and bowel care 144

Conclusion 148

References 149

7 Management of physical impairments post-stroke 152
Cherry Kilbride and Rosie Kneafsey

Introduction 153

Movement 153

Moving and handling people with stroke 155

Therapeutic positioning and seating in the acute phase 157

Promoting early mobilisation 159

Falls prevention 163

Restoration and re-education of movement 164

Management of the upper limb 168

Further rehabilitation strategies and novel developments 171

Patients perspective on mobility rehabilitation 174

Conclusion 175

References 176

8 Communication 184
Jane Marshall, Katerina Hilari and Madeline Cruice

Introduction 185

Communication impairments caused by stroke 186

Language minorities 196

The role of the speech and language therapist in acute stroke care 197

Psychosocial issues and quality of life 199

Conclusion 201

References 201

9 Mood and behavioural changes 205
Peter Knapp

Introduction 205

Psychological reactions to the onset of stroke 206

Conclusion 218

References 219

10 Minimally responsive stroke patients 222
Elaine Pierce and Aeron Ginnelly

Introduction 222

Definitions and identification 223

Minimally responsive state 224

Locked-in syndrome 232

Conclusion 237

References 238

11 Rehabilitation and recovery processes 241
Jane Williams and Julie Pryor

Introduction 241

Initiation of rehabilitation 244

Outcomes of rehabilitation 246

Recovery processes 249

Transfer to rehabilitation 250

Rehabilitation provision 252

Conclusion 256

References 256

12 Stroke and palliative care: a diffi cult combination? 263
Christopher R. Burton and Sheila Payne

Introduction 264

Palliative care 264

Relevance of palliative care to stroke 266

Organisational challenges 271

Conclusion 271

References 272

13 Reducing the risk of stroke 275
Peter Humphrey, Jo Gibson and Stephanie Jones

Introduction 275

Primary prevention 276

Secondary prevention: identifying those at risk of stroke 279

Public awareness and access to services 296

Secondary prevention of stroke in less common aetiologies and patient groups 297

Conclusion 299

References 299

14 Longer-term support for survivors and supporters 309
Louise Brereton and Jill Manthorpe

Introduction 309

Leaving hospital 310

What is required longer term? 313

What do carers want? 316

Conclusion 322

References 323

15 Stroke resources for professionals, patients and carers 331
Graham Williamson

National associations 331

Resources for patients and carers 332

Other resources and organisations 333

Specialist international journals 336

Non-specialist journals stroke collections 336

Clinical practice guidelines 337

Finding current stroke research 338

Evidence-based practice resources 338

Chapter links 339

Index 343