Right Hemispheric Stroke

WHAT YOU SHOULD KNOW:

Right Hemispheric Stroke (Aftercare Instructions) Care Guide

  • A right hemispheric stroke is a condition where the right side of your brain does not have enough oxygen. A stroke occurs when a blood clot blocks a blood vessel in your brain, and blood cannot flow through. It may also occur when a blood vessel in your brain tears and bleeds inside your brain. A lack of oxygen may damage or cause cell death in the right side of your brain. When the cells of your brain are damaged or die, you may lose control of certain body functions. The right side of your brain controls the left side of your body.
    Brain


  • A right hemispheric stroke may cause you to have problems speaking, understanding, reading, writing, and remembering. You may also have problems moving, seeing, or feeling the left side of your body. You may feel depressed (deep sadness). You may need blood tests and brain imaging tests to check if you had a stroke. Tests to look at your brain include a computed tomography (CT) scan or magnetic resonance imaging (MRI). Treatment includes medicines and rehabilitation therapy. Having a stroke is an emergency that may lead to death if not treated right away. Treatment may improve your weakness, movement, and speech. Treatment may help you return to your normal daily activities.

INSTRUCTIONS:

Medicines:

  • Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.

  • Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
  • Blood thinners: Blood thinners prevent clots from forming in your blood.

  • Anticholinesterase medicine: Anticholinesterase is medicine that increases the amount of acetylcholine in your muscles. Acetylcholine is a special body chemical that helps your muscles and nerves communicate (talk to each other) better. It helps you get stronger. You may also take this medicine with steroids. Do not stop taking these medicines without your caregivers OK.

  • Anti-depressants: Anti-depressants are given to decrease or stop the symptoms of depression (deep sadness).

  • Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.

  • Cholesterol medicine: This type of medicine is given to help decrease (lower) the amount of cholesterol (fat) in your blood.

  • Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.

  • Pain medicine: You may be given medicine to take at home to take away or decrease pain. Your caregiver will tell you how much to take and how often to take it. Take the medicine exactly as directed by your caregiver. Do not wait until the pain is too bad before taking your medicine. The medicine may not work as well at controlling your pain if you wait too long to take it. Tell caregivers if the pain medicine does not help, or if your pain comes back too soon.

  • Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.

  • Warfarin: Warfarin is a type of medicine that helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Using warfarin may cause you to bleed or bruise more easily. If you are taking warfarin:

    • Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.

    • Many medicines cannot be used when taking warfarin. Talk to your caregiver about all of the other medicines that you use. Tell your dentist and other caregivers that you take warfarin. Wear a bracelet or necklace that says you are taking this medicine.

    • You will need to have regular blood tests while taking warfarin. Your caregiver uses these tests to decide how much medicine is right for you to take. Take warfarin exactly how your caregiver tells you to. Tell your caregiver right away if you forget to take the medicine, or if you take too much.

    • Talk to your caregiver about your diet. Warfarin works best when you eat about the same amount of Vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods.

Ask your caregiver when to return for a follow-up visit.

Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Rehabilitation:

Rehabilitation (rehab) is different therapies to help you relearn skills and return to your usual activities.

  • Physical therapy: Your caregiver may want you to go to physical therapy. A physical therapist will help you with special exercises. These exercises help make your bones and muscles stronger.

  • Occupational therapy: Occupational therapy (OT) uses work, self-care, and play activities to help you in your daily life. OT teaches special skills for bathing, dressing, cooking, eating, or driving. An occupational therapist may help you choose tools to use, and suggest ways to keep your home or workplace safe. You and your therapist will plan a therapy program that is right for you.

  • Recreation therapy: Certain activities for people who have had a stroke may be offered in your community. Recreational therapists help you find these activities if you would like to participate in them.

  • Speech therapy:

    • A speech therapist may work with you to help you talk and communicate with others. If you have trouble swallowing, a speech therapist may also help you learn safer ways to swallow. The therapist will also help you learn which foods and liquids are safe to eat and drink. You may be given thickened liquids to drink because they are easier for you to swallow. A special powder is used to thicken liquids. You may also be able to eat softer foods. You may be able to eat what you usually eat when your swallowing gets better.

    • If you are not able to swallow, you may have a feeding tube. This is called a gastrostomy tube and goes from the outside of your body into your stomach. Ask your caregiver for more information about a feeding tube or how to care for it.

  • Vocational rehab therapy: This kind of therapy teaches you skills for certain activities as you prepare to go back to work. Caregivers may also help you find a job that is good for you when you are ready to work. You may be given job skill training, and emotional and mental health support while you are working.

Assistive devices:

  • You may be given special devices to help you do things after your stroke. Special utensils with built-in handles and plate guards may help you eat easier. Grab bars placed inside your bathroom may help you move better and safer. Having toilet seats that are raised up may also help you reach the toilet seat better. You may also need a long-handled bath sponge and hand-held shower to make bathing easier.

  • If you cannot walk, using a wheelchair may help you move around. If you are able to walk, you may need a cane or a walker to help you balance. A walker or cane may help you move around, and decrease your chance of falling or being hurt. If your ankle or knee is weak, you may need to wear a brace for support. Ask your caregiver for more information about devices that may help you.

Bladder and bowel movement training:

  • Having a stroke may make it hard for you to control your urine and BMs. Caregivers can work with you to train your body to urinate at certain times each day. This prevents urine from building up inside your bladder. A bladder training program may include this and other methods to empty your bladder.

  • Bowel programs help you learn how to control your bowel function. Bowel programs may help you have a BM at a planned time each day. Regular BMs help prevent constipation (hard dry stools). Schedule your planned BM times the same as your past bowel habits. This may make your bowel training program more successful.

Counseling:

  • Your caregiver may set up meetings with you or with your family. In these meetings, you will talk about your condition and how you are coping with it. Your family may learn ways they can help you cope with your stroke and do certain activities. These include activities of daily living, such as feeding or moving from place to place.

  • You may also have sexual counseling. During sexual counseling, your caregiver will talk to you about sexual problems you may have after your stroke. Your caregiver may also help you better understand sexual function and family planning.

Driving:

You may be able to take special driving classes if you become strong enough. Different devices can be made to help you drive safely. Ask your caregiver for more information about driving classes when you are ready.

Preventing another stroke:

  • Alcohol and smoking: Do not smoke or drink too much alcohol. Smoking may harden your blood vessels and cause conditions that may lead to a stroke. Drinking more alcohol than suggested, too often can also increase your risk of having a stroke. Alcohol is found in beer, wine, vodka, whiskey, and other adult drinks. Talk to your caregiver if you smoke or drink alcohol.

  • Diet: Eating the right foods may help you lower your cholesterol level. It may also help keep your blood sugar or blood pressure levels normal. Healthy foods are fruits, vegetables, low-fat dairy products, lean meat, and fish. Eating foods high in fiber may make it easier for you to have a BM. High fiber foods include some cereals, whole-grain breads, and beans. Drinking water and prune juice may help make your BM softer. If you have trouble swallowing, you may need liquid feedings through a tube. Ask your caregiver about tube feedings or special diet instructions.

  • Exercise: Aerobic and strengthening exercises help your muscles become stronger and move better. They may also help decrease movement problems after your stroke. Aerobic exercises include physical activities done for long periods of time. Talk to your caregiver about what exercise program is best for you.

  • Medicines: Take all of your medicines given to control other health conditions as directed by your caregiver. These conditions may include diabetes, high blood pressure, and high blood cholesterol.

Preventing blood clots and deep venous thrombosis:

Deep vein thrombosis (DVT) is a condition where blood clots form inside your veins. You are at an increased risk for DVT after having a stroke. Ask your caregiver for more information about deep vein thrombosis. The following can help prevent clots from forming inside your veins:

  • Compression stockings: Your caregiver may have you wear compression stockings after your stroke. These are tight elastic stockings that put pressure on your legs. The pressure is strongest in the toe and decreases as it goes toward your thigh. Wearing compression stockings helps push blood back up to your heart, and prevents clots from forming. Ask your caregiver for more information about compression stockings.

  • Walking: Walking helps prevent blood from pooling and clotting in your legs. Walking at least 50 feet per day may help decrease your risk for blood clots. Your caregiver may give you a walking aid if you have trouble walking.

Skin care:

To prevent pressure ulcers (skin sores) from forming, a special mattress may be put on your bed. You will also need to be turned often if you cannot move by yourself. Barrier sprays or lubricants may also be applied to your skin to help prevent sores.

CONTACT A CAREGIVER IF:

  • You are having trouble with any of your therapies or exercises.

  • You are unable to have a bowel movement.

  • You have a fever (high body temperature).

  • You have a pressure sore or breaks in your skin.

  • Your blood pressure is higher or lower than your caregiver suggests.

  • You have questions or concerns about your condition, medicine, or care.

SEEK CARE IMMEDIATELY IF:

  • You have signs and symptoms of a stroke: The following signs and symptoms may happen suddenly:

    • A very bad headache. This may feel like the worst headache of your life.

    • Too dizzy to stand.

    • Weakness or numbness in your arm, leg, or face. This may happen on only one side of your body.

    • Confusion and problems speaking or understanding.

    • Not able to see out of one or both of your eyes.

    • This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital. Do not drive yourself!

Copyright © 2011. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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