From StudyingMed

< AEB
Jump to: navigation, search
  • wikipedia:International classification of function
  • This patient's frontal and parietal primary motor/sensory and speech areas (Lt side) due to atrial fibrillation with heart thrombi that embolise to the MCA to occlude the artery
    • Needs warfarin with AF for the rest of her life unless contraindicated

Doctor

  • 2 roles
    • ensure medical care of stroke patient and any underlying issues
    • leading and coordinating of the multi-disciplinary team
      • takes ultimate responsibility
  • "When can he go home?" - the doctor needs to combine all the information from the therapists and from knowledge of their ADLs and home living situation in order to be able to answer this question.

Nurse

  • Use a wellness model – focus on abilities rather than disabilities
    • Centre around patient’s goals
  • Roles:
    • Administering/monitoring interventions
    • Bowel and bladder
    • Skinprotection
    • 7days/week, 24hours/day
    • emotional health

Physiotherapist

Try to come up with a method of independent mobility (even though people don't get 100% better completely after a big stroke, we're trying to get people independent quickly. So although we're trying to get them better, we also want to get them independent).

  • Movement
    • See what people can do
    • Teach them to do it again
  • Focus on:
    • Strength
    • Balance
    • Coordination
  • Equipment – tilt table, hoist?

4 levels:

  1. Underlying pathology
  2. Restore structure/function
  3. Restore independence even with the level of impairment
  4. Restore ability to return to ADLs with disability

Occupational therapist

  • Maximise independence
    • Self, domestic, community
  • Activities of daily living
    • Showering, changing etc
    • Support at home
  • Rehabilitation
    • Evaluation of self-care status
    • Fine-motor skills + upper limb skills
    • Assessment of homes
    • Prescription of equipment
  • Hand splints, devices to assist with toileting, dressing etc, ramps for wheelchairs
  • Very practical: all about solving the problem of getting the person as they operate now to achieve their functions (in their specific house!)

Diversion therapist

  • Leisure options – in-patient + later rehab
    • Engage them to try by leisure - show them that they can do the things that they like
  • Need leisure education for people who don't know what leisure is (work too hard etc)
    • Need leisure activities when you've had a major health crisis - stroke patients are at an increased risk of depression/suicide
    • Good way to motivate patients
  • A lot of people define themselves not by their work but instead through things like playing music etc. These leisure activities are their purpose for living
    • Aids for leisure activities e.g. needle threaders
  • Practicality of achieving many of your goals seems to drop off
    • You need major adjustments to try to achieve these things

Speech pathologist

  • Swallowing
    • Posture
    • Cognition
    • Dentition
    • Chest status – aspiration risk (in the past, a great cause of death)
    • Assess cranial nerves
  • Speech
    • Impairment – which part of the brain
    • Disability – needs to be able to properly express in order to function
    • Participation – roles in life, can they return to ‘normal’ life?
  • Practice normal conversations, hearing and understanding
  • Tailored to specific needs
  • Speech pathologist = dysphagia + dysphasia
  • Circumlocution is a skill that's taught to allow people who can't find the right word to say, and they instead describe what the thing so the other person can understand
    • For CALD - you need interpreters for speech pathologist (this is harder for assessing how good the person's speech/understanding is). Sometimes grammar doesn't translate over to the other language
    • With interpreters - don't want the
  • Phonemic cues e.g. say "ch- ch-" to hint them to chair.
  • People who have a stroke will often lose the language that they learned most recently.

Dietician

  • Nutrition
  • Weight reduction
    • Education, weight loss diet, follow-up
    • Inpatient dietary control is easy - but it's hard to make sure they change their diet long term
  • Malnourishment – renourishment

Social worker

  • Lessening impact of illness/disability
    • Maximising social functioning etc
  • Assessment of:
    • caring responsibilities o financial matters
    • discharge needs
      • support at home/nursing home

Clinical psychologist

  • Emotional support
  • Grief and loss
  • Issues:
    • Altered levels of functioning/independence
    • Dealing with identity/self-efficacy loss